As someone who combines twin careers in teaching Asian Bodywork Therapy and authoring books of fiction and non fiction, I was thrilled to hear that Columbia University College of Physicians and Surgeons is launching the first ever interdisciplinary Masters degree program in Narrative Medicine. Aimed at graduates of integrative medicine, the arts and the humanities, the program includes free discussions titled "Narrative Medicine Rounds" on the first Wednesday of each month at Columbia's medical center faculty club. A new journal on narrative medicine – Intima – is also publishing articles like "Can Literature Make a Better Doctor?"
Storytelling
We all love stories. As Asian Bodywork therapists spend 60 – 90 minutes with each patient, we can certainly give our patients time to tell their own stories to complete our diagnostic insights and add a spark of creativity to our treatment procedures. I encourage my graduates to ask their patients, "What are the five main reasons why you are seeking Asian Medicine? And what are the five activities in your life (theater, sport, books, movies etc) that bring you joy?" Often, patients say, this is the first time in their lives a therapist has sought the source of joy – not just the source of illness in a new patient.
This always prompts storytelling. A compassionate therapist can then draw on some element of that story in imagery or metaphors to be woven into the treatment.
Enhancing Case Studies
Recently a L.Ac friend asked me to check the English translation of an article she co-wrote with colleagues in China on a case of pneumothorax . She described the patient as a chef. "We need to know more the chef, "I suggested. "Where and how does he work? Big fancy restaurant, or a greasy spoon? How old is he? And what do you know about his background and health history?" My friend contacted her colleagues and discovered, yes, the chef did indeed work long hours on his feet in a roadside cafe with a small, poorly ventilated kitchen. He sought acupuncture treatments for work-related back pain. Selected acupoints were needled on his back and paraspinal region. He was tall and thin and a smoker, all factors that contributed to upper body vulnerability. Moreover his work activity meant tossing a wok repeatedly, involving forceful movement of the muscles of his back, chest and intercostal spaces, all of which could aggravate pneumothorax.
Fortunately the chef lived and worked less than a mile from the hospital so sought immediate attention after experiencing a stabbing pain when he returned to work following his seventh acupuncture session in just over two weeks. Doctors took all his work factors into consideration, but also explored the possibility that the needles were too long and penetration too deep for such a tall, thin patient. Graphic details about the chef and his work transformed him from a dry, technical case study into a human being, that a reader could visualize perfectly. His story gave texture and depth to a checklist of facts on pneumothorax and relevant treatment procedures.
Honoring a Patient's Story
Legendary neurologist Oliver Sacks MD is a master of narrative medicine and his patients like The Man who Mistook his Wife for a Hat have a way of lingering in our thoughts like some of the greatest characters in literature. Yale Medical School internist, Lisa Sander MD presents colorfully detailed case studies in her column Diagnosis in the New York Times magazine, and in her great book "Every Patient Tells a Story" reflecting her medical observations and her background in journalism. She often describes cases where the simplest diagnostic facts – a body rash, a recent meal, a specific allergy to some plant in the patient's garden, were totally missed by attending ER physicians who relied too heavily on a battery of hospital tests instead of examining patients and actually listening to them.
Where Do You Live?
Sander's stories remind me of a case where a young teenager was on a point of death - with excessive vomiting and diarrhea. Following a battery of the usual tests, even GI specialists seemed incapable of pinpointing a cause and diagnosing an effective treatment. Finally a local chiropractor asked her a simple question – where – and how - do you live? The patient described a house boat on one of the area lakes drinking lake water - unpurified. It turned out the teenager had picked up a specific parasite peculiar to that lake. A short course of antibiotics relieved her symptoms within a short time. Her life was saved, just because a practitioner asked the simple question, where do you live?
Chronic pain afflicts over 20% of the adult population. Sadly, most MDs have essentially no education in treating pain, beyond offering a few toxic medications. Then they tend to steer people with pain away from those health practitioners who are trained. This puts the acupuncture community on the front lines for addressing this epidemic.
When the body is going through a stressful event, the sympathetic system is activated. This activation will help the body with a life-threatening situation. If this state is activated for prolonged periods of time, it starts to consume energy. These traumatic events that generate stressors in the autonomic nervous system (ANS) will eventually become internalized.
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One of the things that makes acupuncture so difficult to measure is that the medicine actually does contain some esoteric aspects. There have been numerous studies that demonstrate the neurochemical reasoning behind why acupuncture points stimulate the autonomic nervous system to enact change However, not all the benefits of TCM can easily be measured by randomized, controlled trials. But does that make them fundamentally and definitively untrue?
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