What I have striven to do as an acupuncturist is to help people with chronic problems find the end of a piece of energetic string that they can follow out of their maze. Sometimes you pick up and drop many ends of string before you find one that leads somewhere. Sometimes the string leads you in a bad direction and you have to retreat. And sometimes it's just a big ball of knots and you have no choice but to sit there, picking and picking at the knots to try to get the line to run free.
For awhile now I have used the image of an old-fashioned fishing reel to describe the process of dealing with a chronic health issue. Some people talk about an onion, and describe how you have to peel away layers to get at what's underneath, but I find that a detestable metaphor -- onions are nothing BUT layers! The implication is that there is nothing to life BUT pathology, and when you get under the layers which are currently tormenting you there will be new layers beneath for you to peel. Ugh. I'd step in front of a truck if I believed that.
I prefer the fishing reel image because when it gets a backlash (a big tangle of knotted fishing line which keeps the reel from working correctly) you have no choice but to untangle the knot on the surface, then the next knot you come to, then the next knot until the line runs free. At that point you can reel in the line and resume fishing. Yes, it also works to just cut the whole mess of tangled line out of the reel and fish from there, but you can only do that a couple times before you run out of line entirely and have to quit fishing. "Fishing" standing in for "living" in this metaphor, I plainly think it is worthwhile to try the patient knot-picking approach for some time before resorting to surgery. It's also a good idea to work on your cast ("cast" being synonymous with "lifestyle"), but when you've got a big ol' backlash staring at you it's not the time to lecture about casting technique.
When there is an auto-immune, latent or hyper-sensitive component to the chronic health issue, I add to the backlash image a layer of glue (dampness, in Chinese pathological terms). The glue is made up of painkillers, steroids, antibiotics, alcohol, sugar, fat and other substances we use to comfort ourselves, but which are all suppressive, in Chinese energetic terms. The glue holds the knots in place, allowing you to reel up whatever line you have on top of the backlash and continue fishing, but your cast is greatly limited and you're going to be in big trouble if you catch a big one and need to let out some line. Furthermore, as you fish you are constantly losing a little line here and there, tying on lures and whatnot, and it's only a matter of time before you work your way down to the level of the original problem. When you finally get down to untangling the backlash, you will find that the glue has cemented the knots in place and has spread to deeper and more superficial layers of the line, expanding the boundaries of the original backlash in a very discouraging way.
I think this is a pretty good analogy, but now that I have spent 6 months considering chronic, diffuse pain from the inside, I would add another factor to the puzzle: it can happen that you don't know which way to turn the reel's handle. This means that until you find a productive end of line to pull on and then watch to see which way the handle turns in response, you don't know, literally, which way to turn. Your choice is to either thrash about in a panic, almost certainly making the knots worse, or to wait calmly until you get a clue, which can look like denial, indecision or self-destruction from the outside and which feels like paralysis from the inside.
This is where the assistance of an experienced, sensitive and trusted practitioner comes into play. Their distance provides some context for pointing out to you the way to turn. In this situation, the practitioner is not just helping you find an end of string -- he or she is throwing you a lifeline.
One of my drawbacks as a practitioner is perhaps too much deference to my patients. Some of it has to do with maintaining clear boundaries and avoiding fostering dependence, some has to do with avoiding making a reputation for myself as someone who just wants you to come back for another treatment, and some has to do with sincere philosophical belief -- who the hell am I to tell anyone else how to live? But some of my stand-off-ishness may have to do with a kind of cowardice -- the kind of cowardice that allowed me as a young man to enter into romantic liaisons with a disclaimer that I wouldn't commit to the relationship. It took me far too long to realize the shamefulness of that trick -- I pretty much had to be on the receiving end before I understood the dishonesty, cruelty and sophistry of such words. Although I started in a decent place, not wanting to manipulate anyone, I proceeded in a cowardly and dishonest fashion, denying involvement or entanglement in spite of the evidence provided by tangled limbs and complicated schedules.
Now, having been on the receiving end of a lifeline thrown by my honest, loving and brave friend Frania, I am beginning to realize an additional layer of responsibility and commitment I owe to my patients. No, I can't help everyone, and no, I don't want to have certain types of reputation, but I am more self-serving, less brave and less generous than I care to admit when I hold myself aloof. Having caught this lifeline and felt the relief, hope and restored confidence that had been so drowned by my sea of pain, I realize now how little my concerns about professional boundaries matter. I wouldn't have minded if my butt was bared in public, would have paid all the money I have and would have endured any kind of lecture (and believe me -- Frania can lecture!) in return for that lifeline.
It is a small but terrifying step to go from standing at a patient's side, helping them look for the end of a piece of string, to going out on a limb, looking them full in the face and giving it your best shot, throwing with all your heart in hopes that they will be able to catch hold and start to pull themselves out of their torrent of pain or dysfunction. It is a step that I will be taking from now on, and it is a huge part of what I have been able to learn from my ordeal.
If I intend to keep writing I'm going to have to find another disability to blame, or maybe scrap that whole morbid need for an excuse to write and simply write because I can. And because my writing may act as a lifeline for someone who reads it and needs it.
No comments:
Post a Comment