Saturday, February 11, 2017

Tough Row to Hoe

At work I saw a patient who took a seemingly minor fall nearly a year ago which caused a spinal cord injury and changed him from a strong, healthy person to one who hobbles about with a cane and is treated like an invalid. He asked several times why God was angry at him: if God is in charge of everything and I have a terrible situation, God must have done this to me on purpose. I am hardly a master of theology or theodicy (sticking up for God even though he does bad stuff to nice people), but my approach to this was to find out how he would treat a friend who was dealing with difficulties. It turned out the patient doesn’t have any, but he does have children, so I asked him to imagine how he would comfort a tiny child who had fallen and skinned her knee, and tears came to his eyes.

I returned to that idea a couple of times during our long visit, and toward the end, I led him in a guided meditation starting with mindfulness of the body, followed by loving-kindness (metta) for himself, and concluding with a bit of gratitude practice: cultivating the prosocial emotions that build resilience and are protective against debilitating stress. He became teary again during the loving-kindness part, as people often do.

Just before leaving, I again mentioned the idea that perhaps God loves him very much and is in fact sending kindness and comfort, just as he would have offered to his own young child. To my surprise, the patient smiled and said gently, “Well, maybe I’m supposed to learn something from this.” And then, sounding almost jovial, “He’s certainly given me a tough row to hoe.”

The next day, I encountered a patient with terrible abdominal pain and tried my first guided meditation aimed at coping with pain. I did the same thing as described above, except that after mindfulness of the body and before loving-kindness, I asked the patient to let his attention rest on the painful area. He winced, so I said, “I see your wince. Let your attention move out to the edge of the painful area, to the border between where it’s painful and where it stops being painful.” This idea came from my own hours spent sitting with physical pain on meditation retreats. I suggested that he cultivate a sense of allowing the sensations he was noticing to be present and explained that it is natural for us to resist pain, but that pushing it away makes the whole experience more miserable.

Then I asked him to identify a part of his body that didn’t hurt—a foot or hand—and let his attention rest there. After a bit, I asked him to notice the edge of his pain again, and then the pain-free area again. I borrowed this from Somatic Experiencing, which I took a class on at the Zen Center. Then we went on with loving-kindness and gratitude.

For gratitude practice, I might say, “Thinking now of something we’re grateful for, even just a small thing. Maybe your nurse smiling at you or a pleasant conversation with your nurse, or maybe something delicious you had for breakfast. Remembering that pleasant moment and noticing how it feels in your body to remember this.”

At the end of the meditation, I thought the patient was going to say, “My abdomen still is killing me, but I feel a little more relaxed.” But he said, “That was really nice!” and when I asked how his pain was, he announced that it was gone! I’m sure it was back soon enough, but I’m glad he had some moments of relief. The whole meditation took less than ten minutes, and consisted of simple steps the patient can easily do on his own if he feels like it.

Another day, a nurse asked me to see a patient in an overflow pre-op area that I didn't even know existed. The patient was deaf and a sign language interpreter was present. The patient understood the interpreter so readily and responded verbally, in perfectly smooth English, so quickly that I could hardly believe she was deaf. I stopped by the front desk to get the patient's record number so I could chart the visit. The woman who works there, who is a character and who often makes me smile, checked to see if I could access a system that tracks surgeries and we found that I could.

Poking around there later, I noticed two patients whose records were adjacent to each other and who had the same last name: what are the odds? But then I took a closer look and saw that one was donating a kidney and the other receiving one.

I also saw a man of less than retirement age who came down with a mild case of flu and was dead less than two weeks later, his final few days spent in the ICU, with his children and wife at his side.
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