Letters to a Young Doctor…
A continuing story… A gift from the dying…
I have been thinking of you lately, how hard, you work on the analytical, mechanical, decisive approach to medicine. How hard you work to get the diagnosis just right so you can prescribe the right cure. I remember how that felt, and I wanted to give you a little taste of how you change over the next 25 years.
To be clear, my ‘way’ of being with patients has evolved in the last 10 years. When I arrived on PEI in 2008 my process was very much the rushed American model of care delivered quickly. It was about establishing the diagnosis, arranging the treatment, and moving on. What I discovered was, that the people I was caring for wanted a relationship as much as they wanted health care, and maybe even a little more. They appreciated the quality of care I brought to my work, with just the right amount of OCD. However, what they valued more was my relationship with them, the care of them, and of their lives.
Arriving here, the pace of care was slower than the US, and for some time that maddened me. I would push against the system to move it more quickly. To get people in and out of the hospital more quickly. To get the diagnosis more quickly. However, I began to notice that all this did was create discomfort and grumpiness in my own head, doing little to change the course of the disease progression, and certainly not improving the lives of those who were manifesting the disease.
I learned to slow down, and as I did, I began to listen more. I found that I heard more of what was important to hear. My natural ‘tracking’ began to evolve. I found myself hearing the difficulties they had in making changes, the stresses they had trying to live up to the community standards, the internal struggles that would show up in the word choice during self-reflection. I found myself becoming more of a cheerleader for the possibilities, for the potential to change. However, the cheering did not accomplish much, and that is when I began to wonder into other options for helping people find a way to work with change in a sustainably. This was aided by the fact that I had been here 6 years, my panel was pretty stable, a few deaths, some births, but pretty much the same 2000 souls I had been caring for now for 6 years.
This is when I ran into hypnotic regression via Brian Weiss and Dolores Cannon. I started using this approach with some folks and had some success. I then found Hakomi, and eventually now EMDR, and have found even more success in helping people change the unconscious programming that runs their lives.
Throughout this, the tracking of the folks in a Hakomi sense, that close watching and listening, to what they were saying verbally and non-verbally, some gentle contact, some connection, allowed the opportunity to really be seen, really be heard, and in that brief moment, the possibility to consider change was opened up a crack. I began speaking to the part of the patient who was present in the room asking for change. It might be the adult who was in front of me, or the little kid inside them that had never been seen. In speaking to the one who was present but unheard, I began to see things really open, and I saw my medical perspective begin to recede just a bit from the forefront of my mind.
In thinking about your query around the effects of working with the dying, I have found that this has required my strongest work on myself. Initially it was the change of perspective from cure to comfort that I focused on. For me, it was like remembering which horse I was riding, the seasoned old mare or the green broke filly. They require different riders. It helped that in our small 18 bed hospital we decided to put in an artificial archway, decorate it, and designate the four beds beyond the archway as palliative, making sure that none only palliative patients step into that space. Being physically located in a specific hall, decorated to be different, helped me mentally shift gears when I went from my regular hospital patients to the palliative patients.
Once I had been able to successfully shift gears, remembering the purpose and point of my care (a soft landing as I put it to folks), then I began more of the work on my own soul. I had to come to terms with what it was like to swim in grief most days, to bring myself into the rooms where extended family surrounded their loved one. To speak words that they did not want to acknowledge, but represented the truth they all needed to hear. My meditation practice has paid off for this work. I began to take some time before walking down the hallway, to notice my breath, to speak in my heart a short prayer ‘may I bring the most good possible for all that are present here now’. I would step into the room, center myself and my breath before I began to speak or to listen. I started feeling for the energy of the room when I arrived, to notice how it felt to be there, to feel for the ripples of the relationships as I stepped into this stream. Could I feel the eddies of unspoken troubles, those that felt like we should keep fighting, those that felt we had done too much already, those that were simply heartbroken and could not fathom life without this soul in their world. What did the energy of the patient feel like, were they at a place of acceptance, were they worn out from the fight, ready for rest, were they afraid of this change and fighting to the very end. I would feel all of this internally before I would speak, it would inform the words that were chosen, the way they were spoken.
What I found from doing that work were all the internal snags that I could feel in my system that had nothing to do with the work, the words, or the room. These were my own internal battles, the unresolved beliefs, the un-soothed hurt, the feelings of unworthiness and unlovability that remained in my system, just below the surface, modulating and modifying my perspective. I began turning myself towards those ‘rough spots’ and diligently started sanding them smooth. In this way, I began using the difficulties of the work to help me seek and repair my own heart. To be able to do all of this, I had to allow my heart to once again become part of the work.
You see, my medical coming of age took place in Dallas Texas in 1990. At that time, crack and HIV had blown up in the city. Parkland Hospital was the epicenter of these twin disasters. At that time, UT Southwestern Medical School and Parkland Hospital did not have a palliative care team, hell I do not think they had even heard of the term. If they had, it was for Cancer patients only. For everyone else, it the full hard press of curative care to the bitter end. My time on the medicine floors was a time spent watching young men, my age, die grisly deaths. I listened to newborns wale and writhe withdrawing from crack. They were un-soothable, crying until they were physically exhausted collapsing into sleep. Listening to the older nurses who had worked the newborn nursery for years weep for these little ones. My heart hurt, I had no tools, few skills, and zero desire to work on it, so I put my heart away for safe keeping becoming the modern medical doctor, all science. It was a survival mechanism to make it through medicine. Watching families abandon young men because AIDS was God’s punishment for the sin of choosing to be gay. It was crushing, so my heart had to be safely placed in protective storage, or risk total destruction. I did not begin to pull it out of storage until I arrived on the island and was asked to feel again by the people of my practice. As I began to bring my heart back out of the shelter, I began to work on repairing the damage such a long period of solitary confinement had taken upon it. I began to think of medicine less analytically, and to think of my choices less decisively, thinking instead of the people in front of me, and what it was that they seemed to be asking for in this moment.
As I started that process, I noticed that the effect of being a machine began to diminish. I realized that I enjoyed sleep. I remembered the joy of reading for pleasure instead of knowledge. I started practicing art again, calligraphy, and writing letters to dear friends who had remained part of my life even when I had become a bit of a mechanized person. In this way, I began to nurture the part of me that had wanted to go into medicine in the first place, the part of me that wanted to help others, the part of me that truly loved the people who were sitting in the office. This process has allowed me to disassemble the side effects of medicine in my life and has allowed me to begin to repair some of the unintentional damage that has been done over the last 25 years.
I realize this is a lot to hear, and I know that so much of it seems so foreign to where you are in your life right now. Not to worry, it is a glimpse of a possible journey you could take, it is not the right choice or the only choice, but a choice. And, if you head this way, I will be here when you arrive, with a beer in my hand, a firm hug, and a deep love for who you are becoming.
If any of resonates for you, and you happen to be curious, and wish to know more, do not hesitate to drop me a line. If you would like to know more about my work, or to work with me, feel free to contact me. I post regularly to Instagram (@gilgrimes), Twitter (gilgrimes) , Medium and Facebook (gilgrimes) about whatever arises. And if you would like to stay in touch sign up for my newsletter (probably once or twice a month at most).