San Francisco – Doctors, nurses, yoga instructors, nutritionists and other healthcare professionals are expected to descend upon San Francisco from Sept. 12-14 for the Heart Based Medicine Summit 2019. The Heart Based Medicine Summit will bring together paradigm-changing speakers, thought leaders and culture shifters who are dedicated to putting the heart back into healthcare.
The Heart Based Medicine Summit is presented by Heart Based Medicine, an international resource for healthcare professionals and patients committed to creating a global field of heart-based healing driven by kindness and compassion.
World-famous Dr. Patch Adams to speak at Heart Based Medicine Summit
Made famous by the movie of the same name in which he was played by the late Robin Williams, Dr. Patch Adams will speak at the Summit. Adams was an early evangelist of the connection between laughter and health. He is a nationally known speaker on wellness, laughter, and humor as well as on health care and health care systems. At the Summit he will be presenting “Celebration of Care.”
Additional Summit speakers include HeartMath CEO Deborah Rozman; Dr. John Gray, best selling author of books including Men are from Mars, Women are from Venus, and a Qigong master. Other doctors, specialists and therapists are being added daily.
Venue and special rate
The 2019 Heart Based Medicine Summit will be held at the Embassy Suites By Hilton in Burlingame, San Francisco, CA. A special discount for Heart Based Medicine Summit attendees is available by calling 1-800-HILTONS (1-800-445-8667) or visiting the Hilton’s HBM Summit pagehere.
Fourteen-year-old Tina would teach me more about medicine and the life force than I thought I needed to learn.
The doors of the emergency room swung open as the paramedic team swept in. I was standing in line on the receiving hospital team, ready for the handover.
‘We have Tina, a 14-year-old girl with suspected bacterial meningitis,’ we were told. ‘She weighs about 40 kg and is febrile and drowsy. Her neck is stiff, she has a petechial rash and her breathing and circulation are rapid but stable. We’ve started IV fluids.’
After a few more exchanges we confirm the handover, connect Tina to our monitoring units, start IV antibiotics and, after talking with her parents, perform a lumbar puncture. Despite our efforts, Tina was getting worse and worse. She was unconscious by the time she went to the Intensive Care Unit. A team of four dedicated and caring medical professionals battled to keep her alive, inserting a breathing tube and catheters through her veins which almost reached her heart. Tina was also receiving lots of intravenous fluids, blood transfusions and drugs which regulated her heart, blood circulation, clotting, kidneys and other bodily functions. After a few hours, she seemed to be stabilising and I handed her over to the next shift.
That evening, as I settled into bed, I ran the day through my mind and recalled Tina’s case. Immediately, histological images of healthy brain tissue and meningitis flashed through my mind. I watched with interest as these mind movies showed me cartoons of immune responses, which then expanded until I could visualise the myriad of body functions taking place during such an overwhelming infection.
I could see how we as medics were doing our best to support all these bodily functions as best we could throughout this healing process.
Although I was thankful to the miraculous modern medicine that helped keep Tina alive that day, I felt even more awe for the human body and its ability to regulate itself, overcome disease and self-repair. It became clear to me how vital – but small – the medical contribution was to Tina’s ability to heal. Her body had been keeping her brain safe for 14 years. On that day, it was her body that had regulated her stability while we messed around with it. And now her body’s healing capacity would be called upon to make major repairs so that she could continue living a normal life. Modern medicine, with all its achievements, could only take on a fraction of the body’s functions, not to mention the repair of cells and tissues.
What was this life force that conducted such a vast orchestra?
‘In the end, it’s life energy that allows us to change and adapt, while healing and medicine can only sometimes create an enabling environment,’ I heard myself say out loud to my wife Jessica, lying next to me.
‘Interesting you should say that,’ Jessica was clearly not asleep either. ‘My brother just told me he’d witnessed the spontaneous remission of a tumour and my thoughts keep spinning around this woman who was given a second chance at life.’
‘Really? Wow. Isn’t it amazing how little we know about health and the true cause of disease? And how much we feel we know because of all the things we can do? Life is so much more intelligent than even today’s medicine.’
We paused in respectful silence.
‘You know, maybe we should pay more attention to the placebo group in all these studies. Rather than taking them as baseline, we should examine them and learn about the body’s self-regulatory capacities and how to support them,’ Jessica added.
I was thinking hard. What if we changed our idea that practitioners have all the answers while the patient sits by passively at the receiving end, like a consumer? What if, instead of our usual biomechanical approach where we consider all the symptoms, arrive at a diagnosis and prescribe a treatment plan, we take a different route and form a kind of therapeutic alliance?
If we could assume that the patient has all the solutions, perhaps the role of the healthcare worker would then be to help the patient access this healing potential and heal themselves at a much deeper level?
A week later, I noticed Tina’s name on the transfer list from ICU to my ID ward.
‘How are you, Tina? I am so glad to see you!’ I said.
Tina looked at me, then at her mother, and once more back at me before exclaiming ‘This is the doctor who I saw from above saying “Come on, you can do it Tina! You will make it! We are fighting for you to survive!”
She turned to me and smiled gently.
‘Because of you, Doctor, I did not give up.’
That moment will stay with me for a long time.
The story above is based on personal experiences. Places and names are fictional.
Let me tell you about Sophie. When she came to my private office with her mother for the first time, I went to meet her in the crowded waiting lounge. ‘Sophie Wildwood, please,’ I called out as my eyes scanned the room for a 14 year old girl. A tall, slim girl with short blond hair and a pale complexion lifted herself from her chair as if it was against her will.
She was wearing sporty outdoor clothes with light training shoes. Sophie shuffled towards me, eyes cast down with her upper body slightly hunched forward, her shoulders pulled halfway up to her ears. She was followed by her mother who looked directly at me with loving open eyes when she spoke.
‘Good morning Dr Bonhoeffer’. I welcomed them both to my consulting room and we gathered around a small table.‘Thank you, we are so glad to be here. We have been referred to you by Dr Roberts who was our family paediatrician where we used to live.’ Mrs Wildwood sighed, a note of exhausted urgency creeping into her voice. ‘Sophie has a lot of complaints and we really need to make progress.’‘Tell me, Sophie, what’s bothering you?’ I asked, expecting a vivid response that would explain the urgency. Instead, it took about a minute for her to answer.
She stared down at the floor between her knees, her head drooping as she uttered: ‘I don’t know, there is so much.’
I paused, with a gentle look inviting her to continue and over the next 45 minutes I learned about her many symptoms. A splitting headache every week, heartburn for six months and a stomach ache which had plagued her for almost a year. Sophie had also lost her appetite, feeling fat despite losing weight, and was experiencing pain in her lower back, right knee and left ankle. She also told me about the dry, red and itchy skin on her elbows and knees and how this never seemed to improve. All these symptoms were affecting her sleeping patterns and she was having trouble concentrating in school. Homework meant she was studying until late at night so she struggled to fall asleep easily, then woke in the morning feeling like she’d been run over by a truck.
During our conversation, I also learned that Sophie loved to wear sporty outdoor gear and spent most weekends in the mountains with a group of boys building teepees and watching birds.
‘I would really like to help you feel better again, Sophie,’ I reassured her. ‘You have a lot of symptoms, and I’m realising that we’re going to need more time than the hour I’d planned for us to get to the bottom of them.’ Sophie and her mother both nodded. ‘May I propose that we schedule an appointment soon where I can examine you thoroughly so that we can determine whether we need more lab tests or further appointments? Then we can review all your results and plan together how we will meet your needs. Would that work for you?’We all agreed and as she made her way to the reception desk to arrange her next appointment, I noticed that she walked with more energy. When Sophie returned the following week, her body posture was the same as before. ‘How are you today?’ I asked. Sophie just shrugged, indicating that nothing had changed since our last appointment. I took her through an extensive physical examination in the presence of her mother, which revealed nothing abnormal except her eczema and the absence of breast and pubic hair development. I thanked her for giving me permission to examine her and we discussed my proposed lab test. ‘I’ve looked at the list of eight medications that you are taking. There is nothing wrong with them, but I’m not sure whether you really need them and how they’re modifying what is actually going on in your body. Given how long you’ve been suffering already, I would like to propose stopping all of them and only keeping the painkillers as a reserve if you really need them. Would this be acceptable to you?’ Sophie nodded and her mother confirmed ‘Yes,’ with a sigh of relief. At the end of our 30 minute consultation, I had the hunch that the lab results would not shed the light we needed to get to the bottom of this case. I followed Sophie and her mother to the reception desk and asked our wonderful receptionist if she could find an appointment for us at the end of the day to discuss the lab results.
‘We will also need some extra time to listen more deeply,’ I added.
On our third appointment, Sophie and her mother were the last in the waiting room. They sprang up nervously from their seats. As we sat down together in my consulting room, I opened our conversation by declaring ‘All the lab tests came back normal, Sophie.’ She just shrugged as if she knew this already. But her nervousness did not settle. ‘Sophie, we’ve only known each other for about 2 hours in total, but you came to seek help.
‘I feel that you know something that I don’t know yet and that it may explain a lot of your suffering. Is this possible?’
After a long pause, she looked at her mother, who widened her eyes, encouraging her daughter to share what they both already knew. Tears started to roll down Sophie’s cheeks and she whispered: ‘Yes.’ She took a few minutes to grasp her courage before finally daring to blurt out:‘I feel like a man in a woman’s body … and nothing really fits … and it all hurts … and this is not my body … and sometimes it is … and I feel ashamed, and I don’t know what to do about all this.’I leaned forward and held her hand. For five minutes no one said anything. When her crying started to settle, I continued holding her hand and her attention. ‘Congratulations, Sophie. I am so proud of you! You just took a tremendous step!’As she started to collect herself, I passed her a tissue. She straightened up in her seat, wiped her swollen eyes and blew her nose.
‘Thank you for your trust and for sharing this with me. You have just opened a gate for yourself to walk through.’
Sophie drew a deep breath, looking straight at me and filling her chest as if to say ‘here I am, see me as a young man.’‘Sophie, how do you feel now?’ I probed. ‘Just relieved,’ she sighed. ‘Now we are on a journey together!’ I smiled. ‘We can build a team to help us learn more and to find the best route for you. But before we even take any action, Sophie, I wonder if you have a hunch as to how many of the complaints you mentioned to me in our first meeting have to do with your feeling of being a man in a female body?’For the first time her response was immediate: ‘All of them, Dr. Bonhoeffer. It’s all part of the same.’Every cell in my body agreed as I listened to her. My initial list of suspected diagnoses, which included chronic gastritis, juvenile arthritis, atopic dermatitis and anorexia, all collapsed. The extensive diagnostics I had been planning – including MRI of the head and gastroscopy – were now unnecessary and I scrapped my list of treatment options which featured antacids, anti-inflammatories, antibiotics and more.
Why fight the body when it clearly knew what was out of balance?
‘It seems to me that the best option would be to listen to your body and everything you feel. How about if we take a gentle approach and invite your body to re-align with this new perspective?’There was the trace of a smile on her face as I asked her: ‘If you had a wish, what would be best for you?’Again she didn’t hesitate: ‘Drop school for a few days … eat lightly, rest most of the day … drink tea … do nice things.’And so we agreed. I wrote a note for her school, suggesting that she rest a lot and take light walks in nature. She was also advised to lay down every morning and evening for 15 minutes with a large cup of a camomile infusion while gently massaging her tummy with a clover ointment, and to obtain an empty notebook for sketching thoughts and feelings as they arose. I also prescribed 6 soothing massages and physical therapy sessions focussing on Feldenkrais ‘awareness through movement’ exercises.
I was struck by Sophie’s body language as I proposed all of this.
She stroked her hair, rocked her body gently on the chair, held her hand over her heart for a moment and looked at me as if she’d just enjoyed a beauty session with her female friends. ‘I’m looking forward to learning a lot together in the weeks to come,’ I smiled as we closed the appointment. When Sophie left the consultation room, I took a minute to reflect and reset myself before going home to my family.
I felt that Sophie had taught me another valuable lesson in healing.
By taking time to build a sincere open-hearted relationship, to listen more deeply and be guided by the patient’s own assessment, I had been more effective than if I’d merely applied my professional knowledge to her diagnosis and prescribed a lot of drugs. By being present and attentive, together with using what I’d learned in medical school, I was able to create a conducive environment and unlock the healing potential of my patients, which is at the core of Heart Based Medicine.
The story above is based on personal experiences. Places and names are fictional.
This morning, my hospital announced that a new CT scanner can produce more pictures per second while radio-blasting children at an unprecedented low level, so that more kids can be scanned by the machine. Medical IT and biotech companies are working on ‘lab-on-skin’ solutions, allowing us to measure up to 10,000 parameters without a needle stick – just by analyzing sweat from a patient’s skin.
Enzymes are now able to edit our DNA, spawning the rapid development of a new field of genetic surgery with the intention of redesigning or repairing broken or malfunctioning pieces of our genome. And this evening, I received the news that a Cambridge-based company is announcing a new robotic surgical system which will operate on real humans with its spider-like arms while hovering over the sleeping patient!
Welcome to next generation medicine.
The scientist and academic that live within me are thrilled. My heart rate increases, my eyes open wider and I lean forward as I absorb more and more of these daily messages.
But a greater part of me sinks deeper into my chair, a cloud of sadness gathering around my eyes.
I realize that this sinking sensation is being felt most keenly by Jan the pediatrician, the human being, the person who loves to take time and be with his patients eye to eye and heart to heart.
New scientific breakthroughs and technological advances are on the rise. The future holds a vision of a home care robot helping grandma to look after herself while her automated home provides her with a sense of security and saves time for her children. A ‘no-touch’ policy within physiotherapy and nursing is intended to protect privacy and hospital hygiene. Artificial communication systems that are being introduced into hospitals are all being developed to improve patient safety – and admittedly they sometimes do.
Yet with all this progress, we are on the verge of replacing the increasingly rare postmodern species of a well-trained clinical doctor who cares personally for their patients.
Is this really where we want to go with health care?
It seems to me that there is more and more health and less and less care. We are at the tipping point where the key ingredient of health – care – gets buried under the results of advances in technology and the quality control of technicalities.
When I consider my years of education and training, considered to be my main asset as a doctor caring for children, I realise that the knowledge I’ve accumulated is dismal in the face of this future landscape. Digital stethoscopes with audio recognition software will soon deliver globally standardized listening data while artificial intelligence accesses information systems and matches it with inspiring visuals, coming to balanced conclusions within milliseconds.
I expect that my hands will also be replaced by more sensitive devices soon, a type of ‘tactile ultrasound’. Prescriptions will be standardized globally to comply with much-needed quality control efforts, while the choice of drug and dosage instructions will be calculated based on measurable and digitally recorded patient parameters.
In short, robots will soon be better at most of the things I went to medical school for and which I have tried to refine and build upon ever since.
The same will be true for nurses and therapists. As automation of health care is likely to reduce the cost in countries where human labor is expensive and add capacity in middle income countries, it is likely to become a widespread reality.
Is this really the long-term strategy for us humans on this precious planet?
Everyone knows that the essential ingredient to healing is care. Most of us remember the sacred feeling of being taken into our mother’s arms when we take a tumble or fall ill. It’s easy to spot the difference between a doctor or nurse showing up stressed or being present and caring. And many of us recognize the value of being welcomed into a relaxing environment of wellbeing compared to a cold, clinical hospital.
Yes, to continue improving health we need science. Healthcare may dramatically benefit from technological advances, but unless we invest in cultivating compassionate care with the same attention and diligence as we drive progress in the other health domains, we will gradually forget to include the essence of our nature as humans in the healing process. That would not be a caring choice or even a smart one.
Personally, I come from a very loving family environment and have acquired a lot of knowledge during my practice. The families I have cared for over the last 20 years are mostly very happy and have felt loved and seen. As I start to explore the dimensions and options of heartfelt care, I am beginning to realise that current wisdom is scarce and fragmented.
Heart-based medicine is a platform for those who wish to compile and compose the wisdom of our time, to give it structure and visibility and work towards a balanced future in caring for people’s health.
As an adolescent, I was active in church-based social work and would sometimes help out in homes for the elderly. One of the homes I visited had a quiet, oak-floored entry hall with a distinctive dusty smell. As you stood there, waiting to go inside, it felt as if nothing had changed for centuries.
‘Hi Jan!’ I was greeted by Tanja, the duty nurse.
‘Would you like to take care of Mrs. Jones today?
She’s a 78-year-old lady, pretty much wheelchair-bound and she needs help with almost everything. She would like you to take her outside for a little stroll,’ she added.
I was more than willing to help and leaned down to introduce myself before we headed out to the nearby park. As I pushed the wheelchair, I noticed Mrs Jones was hanging her head. We came to a stop and she seemed to be day-dreaming, gazing into the far distance, her head now tilted slightly to the right. Her face was still, almost mask-like as she spoke:
‘My life has no meaning. Everything is difficult when you get old.’ As a young man I couldn’t really relate to what she was saying, but her sadness hung heavy on me, stirring my compassion.
A few steps on, I reached out to pick a branch of delicate white flowers from a small bush along the path and gave it to her with a smile. She immediately straightened up in her wheelchair and looked deeply into my eyes as a heartfelt smile lit up her face. Dozens of creases of joy enlivened the corners of her eyes and lips as if there was one wrinkle for every starlike flower on the twig I had given her.
A tear rolled down her cheek and she whispered: ‘It must be more than 20 years since someone gave me flowers – just like that.’ She marvelled at the beauty of the tiny blossoms then looked up, reflecting:
‘I think I must have stopped looking at flowers.
Now I see them again,’ and her face relaxed into a gentle smile.
When we returned to the home, all the nurses were completely bewildered by the change in the radiant Mrs Jones, who was still cradling her bunch of flowers. They were curious to know what had happened. We both shrugged our shoulders and smiled. ‘The park is so beautiful today,’ was all Mrs. Jones would say.
That was one of the many moments that would guide my life’s work – to bring joy and healing just by being present.
I was touched by the effect my spontaneous gesture had brought to an elderly lady who thought the world held no more surprises for her. Just a few moments of loving attention had transformed her state of mind, visibly increasing her life force. ‘How little it takes,’ I thought.
I often look back to that day if I’m feeling stressed and thank Mrs Jones for lighting my way.
The story above is based on personal experiences. Places and names are fictional.
Early morning sunshine filters through the curtains, caressing my skin. Slowly I tune into full consciousness, holding Jessica, my love, in my arms. I feel the cosy warmth of the soft blanket covering us and a deep bubble of joy escapes from my heart. ‘Thank you,’ I whisper. And as Jessica wakes and our eyes meet, ‘What a perfect you.’
After a quenching shower and a light breakfast we leave home, heading in different directions. I stroll down the road, marvelling at the emerging colours and inhaling deeply the crisp air of an early spring morning in Basel. The River Rhein sparkles with hope, a delicate morning mist rising towards the sun, and it’s hard to tell whether this is heaven or earth.
Eighty percent of the nurses and doctors employed at the children’s hospital where I work are women and they all reflect back to me the love I am feeling as I almost skip down the corridor. The more I smile, the more they radiate back and I feel like embracing everyone.
‘Hey you look great today,’ they call out.
‘Tina, how come you’re so pretty?’ I grin.
‘I just look at you and I need to smile, you’re so happy,’ she returns.
‘Why thank you, that’s sweet. Enjoy the day!’ I breeze past.
This is the tone of the day, nothing spectacular, just pleasantries. But I start to notice that if I set the tone, people join in.
When I reach my ward, instead of saying ‘Alright, are you ready for the round?’ I try ‘Alright, let’s go play!’ At first the team look startled, as if to say ‘This is medicine, this is serious, not child’s play.’ But they respond with smiles, obviously thinking ‘This could be a good day.’
We knock on the door of our first patient’s room. A deeply exhausted mother stares back at us, dark circles under her eyes. ‘Good morning, how are you today?’
‘Ugh, it’s been such a rough night with all the machines beeping and my child coughing, struggling to breathe.’
‘I know, it’s hard sometimes, but you’re doing really, really well,’ I reassure her.
‘Oh thank you! I feel so helpless, you know?’
‘Yes I understand, it must be difficult to watch your baby suffer. Tell me, what was the most difficult part of last night? And what would make you feel better?’ I ask.
As the conversation continues and the mother feels seen and heard, I notice that she and her baby both start to relax. The atmosphere spreads, and I sense that the mother of a second baby in the room is also feeling better. It’s as if we’re collectively tuned into an environment of loving attention, support, shared intention and understanding.
We move from room to room, listening and offering soothing words, doing what we can to bring comfort, and I sense something unusual is happening. As we build this loving energy on the ward, it is also increasing within the team. All these people are coming from their individual households, living their own stories and then ‘click’, they bond as a team to help spread this feeling! It’s amazing, like an energy field or crystallization point.
The atmosphere of care and compassion is starting to feel quite natural, and it’s infecting everyone! Everyone is ‘in the zone.’
‘Hey Simona, would you be so kind as to fetch one of those small firm cushions so we can position this baby a bit better and help her breathe?’ I call. And from the other end of the corridor the response comes back: ‘Sure, I’m just getting them. Will be right there!’
‘I want whatever you had for breakfast today,’ laughs Mrs Berger, the young mother in Room 13.
Laura, our new pediatric resident is the only one not tuning in.
In fact, she is clearly irritated. After the round, I take her aside: ‘What’s going on Laura?’ She looks exhausted, overworked and has tears in her eyes. ‘What are you worried about?’
‘Making mistakes,’ she mutters, looking down at her shoes. ‘I have a hard time applying all the knowledge I’ve acquired and keeping it structured, specifically during rounds like this one. I am not good enough and I feel like resigning.’
‘OK. So what would be a dream scenario for you to feel good enough?’ I ask, gently.
‘I would be with patients and heal them with what I’ve learned.’ Laura is still staring at the floor.
‘And what is in the way?’ I prompt.
‘The knowledge I’ve learned…I am not on top of it…I have a hard time following the algorithms and quality standards. How can I be compassionate and humorous when I struggle myself?’ She sounds angry, confused.
‘Yes, I know that feeling. And what’s more, we’ve been told not to listen to our “gut feeling” or our emotions, as they don’t have the blessing of science and are not considered evidence-based medicine, right?’
‘Yes, that’s right.’ Laura looks up at me, curious.
‘The good news is that you have learned in medical school “what” to diagnose and “what” to treat.’
‘Now it becomes truly fascinating when you add the “who” to diagnose, “who” to treat, and “who” is making the diagnosis.’
‘OK? It’s just a shift of perspective which I find liberating every day. Are you ready to add this facet of healing?’
Laura nods, and I know her true work is just beginning.
The story above is based on personal experiences. Places and names are fictional.
Mrs Smith is the 24-year-old mother of Laura, her two-month-old baby girl. As she sits on the other side of the table in my consultation room cradling her daughter close to her chest, I notice that even her elegant use of makeup can’t disguise her tired eyes and dry lips. She seems to me typical of mothers with young babies who are often dehydrated and not getting enough sleep.
‘Last night Laura cried for more than three hours and I couldn’t console her,’ she sighed heavily. ‘Believe me, I tried everything. We walked around the flat for hours before going outside for another walk. Then I breastfed her, sang songs, massaged her tummy. We tried a warm bath, I even took her to bed with me but nothing would work. I’m really worried.’
‘Did Laura fall asleep at some point?’ I asked.
‘Yes. But something must be wrong with her. She has never done this before.’
I continued to ask a series of technical questions to help me figure out why Laura had been crying.
As I looked across at Mrs Smith I realised we had lost eye contact and she was looking down at the floor. She shifted impatiently in her chair.
‘Shall we take a look at Laura?’ I prompted.
Her mother agreed, but seemed more distant than at the beginning of our conversation.
I started examining Laura but there was no cause for concern.
‘I can’t find any reason for Laura’s crying last night,’ I reassured her. An unusual feeling of insecurity and helplessness came over me. I knew I was missing something but couldn’t think what it might be. As far as I was aware, I’d asked all the right questions, followed best practice and given the baby a ‘textbook’ examination. So why did I feel like I’d failed this young family?
And then I realised. My brain, with all its knowledge and experience, wasn’t going to give me the answer.
It was time to stop and listen to my heart for advice.
As this thought occurred to me, a lecture on quantum physics came to my mind. This was a real surprise, and quite a worry because I consider my understanding of physics to be close to dangerous! But I was remembering that the observer is always an inseparable part of the experiment. It is essentially impossible to observe anything without having an impact on the experiment. I was about to dismiss this call from the past as just a trick of my mind, when I started to ponder what I could do differently. How could I get past my helplessness, ignorance and failed attempts to make a diagnosis?
I decided to put my doctor’s hat aside and to let go of my attempts to either find a cause for Laura’s crying or to dismiss her mother’s concern.
I just relaxed back into my chair, accepted my ignorance and helplessness, compassionately tuned into Mrs Smith’s fear and helplessness, and stayed silent with her. It felt like an hour but it was probably just twenty seconds or so.
Immediately, the wrinkles on her forehead smoothed out, her shoulders dropped down and a subtle smile appeared on her face.
I couldn’t believe it when she said: ‘Thank you Doc. Thank you for listening.’
‘I felt alone all night because my husband is on a business trip. I was really afraid that something would happen to my precious Laura. All your questions made me feel even more alone and stupid as I didn’t have an answer to most of them and maybe I should have as a good mother. When you told me nothing was wrong with Laura I was not convinced and started worrying again … but just now I didn’t feel alone, I felt how much you care about us. Somehow I’m more confident about the night ahead.’
I had tears in my eyes, but couldn’t put it all together while Mrs. Smith was still in the room. I said goodbye to her with some pieces of advice and recommendations for what’s normal. I’m almost certain that she hardly heard any of it.
It took me until the next morning to appreciate the significance of what I had learned from Mrs Smith:
My inner state of mind and heart does not only influence what I hear, but also influences who I listen to.
It’s as if the receptor of information influences the source of the information. Was this not what I learned during the quantum physics lecture? I still have no clue about quantum physics but somehow something with a much better understanding than my own transmitted wisdom that I determined to follow from that day on.
In many cultures, healers are an integral part of the healing process. They prepare for healing sessions far beyond the accumulation and delivery of knowledge-driven interactions. Also every experienced physician knows about the importance and significance of the patient-physician relationship. Even in conventional medicine, the usefulness of intervision and Balinth groups is recognized, indicating that the physician can be voluntarily or involuntarily touched and moved by healing encounters.
The importance of forming a therapeutic alliance between patient and healthcare worker has been recognized in psychology for a long time.
However, following more than a century of justifiably booming biotechnological advances, I feel that we have forgotten the skills to consciously listen deeply beyond the words, to connect with the patient in compassionate care as part of a joint diagnostic and therapeutic process.
I feel called to explore the healing power of compassionate care as a basis for everything else I have learned in medical school and since then in my practice.
If you feel the same, please comment and let me know about your experiences.
The story above is based on personal experiences. Places and names are fictional.
My mother’s beautiful face is etched in my mind, creased by a soft pattern of a million tiny wrinkles which resonate with me as the signature of a life spent smiling, happy. Aged 85, with short grey hair and a healthy complexion, she warms the hearts of everyone who knows her.
Although she often takes small steps when she walks, bending slightly forward to compensate for some back and hip pain while she gets up slowly from her chair, she usually radiates good health and humour.
So it was a surprise when I received a message from my father to say my mother was in the hospital.
‘What happened Dad?’ I asked as soon as I could free myself from the emergency unit at the children’s hospital where I worked.
He explained that the previous evening as my mother had walked from the living room towards the kitchen, her right foot hadn’t quite negotiated the doorstep and she’d fallen into the kitchen.
My father had rushed to help her and had managed to help her stand, though she couldn’t put any weight on her right foot. Dad had supported her and guided her to a chair where he examined the foot. Although it was exquisitely painful, my mother felt otherwise fine.
My father continued: ‘We phoned Dr. Jo and he came to the house and examined her a couple of hours after the fall. He was concerned about her mental state – he felt she was confused, not her usual self. Your mother was complaining of a numbness on her right side, so the doctor referred her to hospital, concerned she may have had a stroke…
‘Where are you now?’ I interrupted, with some urgency.
‘We’re in the emergency unit in the hospital next door to you. She’s been examined and they’ve decided she needs a brain scan, a bunch of lab tests and a 24-hour ECG. And she needs to go to the stroke unit tonight.’ My father sounded worried.
‘How is she now?’
‘Perfectly fine, although her right foot is still painful and swollen. Everything else has returned to normal.’
‘Don’t worry Dad, I’ll come over as soon as I get out of here,’ I reassured him, and hung up to attend another emergency. It was after 11pm when I finally left my ward.
When I arrived at the adult’s hospital next door, the porter wouldn’t let me in because visiting hours were over.
‘But she’s my mother!’
‘Sorry, sir. You’ll be able to see her after eight thirty tomorrow morning.’ The porter was not budging for anyone. I noticed my right hand had been squeezing my laptop bag just a bit too hard and was about to raise my voice when I realized how far apart we were. I lowered my eyes, struggled with my inner dispute and turned away, a big lump forming in my chest.
The next morning, I was on duty as usual long before visiting hours began, while the night porter was no doubt still resting at home. I called the unit for news about my mother and was relieved to hear her warm, clear voice.
‘How are you, Mum?’ I asked, tenderly.
‘I don’t know why I’m in hospital, Jan. My foot hurts, that’s all. Sorry, I need to hang up, the doctor’s here.’
‘No, wait, let me talk to him,’ I urged.
The doctor kindly picked up my mother’s phone and in the following five minutes I learned that they had run tests and scans on her half the night.
As a result they’d put her on medication for high blood pressure, raised cholesterol, stomach acidity and pain.
They’d prescribed a blood thinner and she was now wearing a modern, light, but huge ankle splint. She was attached to a 12-lead ECG and an oxygen monitor, had a drip in her left hand and had been woken up every hour during the second half of the night for repeated neurological assessments.
The doctor reported that none of the scans showed she had suffered a stroke. He explained that she may possibly have an issue with amyloid, a specific protein in her blood vessels and iron deposits on the surface of her brain, which may have caused her symptoms and would require treatment with an antiepileptic drug on top of all the others. She’d also torn a ligament in her foot and a bit of bone had been ripped off with the tendon.
Translated to my world, I was grateful to hear that she hadn’t had a stroke, although she possibly had some ‘electric wiring’ issues and a tiny stable fracture in her right foot. The rest of it made absolutely no sense to me.
The doctor had planned to discharge her at 2pm but when I called my father at 6pm to find out how things were back at home, he replied, sounding exhausted: ‘We are still in hospital.’
I’d had enough and rushed to the hospital, determined to pick her up. As I expected, my mother was displaying no signs or symptoms of a stroke and was perfectly well. ‘Let’s get out of here,’ I urged.
‘No, we have to wait for the orthopedic surgeon’s opinion on the fracture. They need to determine whether they want to operate,’ my mother relayed to us.
‘What?!’ I couldn’t hold back my frustration any longer. ‘You’re prepared to wait another 6 hours for an opinion on an x-ray?’ I glanced at the nurse, whose eyes told the whole story. She spoke quietly, ‘They’re still in theatre and will get out in about three hours.’
I whispered to my mother and father, ‘Just trust me on this, no one will operate on you tonight or even tomorrow. Let’s get out of here.’
Fifteen minutes later we left the hospital “against medical advice”. As my mother walked, the only thing causing her problems were the large immobilizing splint and the effects of all the drama and lost sleep of the night before. The new antihypertensive drugs were not helping either. My mother was an elderly woman who’d been suffering from low blood pressure for 50 years and now whenever she stood up she felt dizzy and faint.
We settled Mum at home and I changed her splint for a light ankle aircast, which meant she was pain-free and could walk easily without crutches. The long list of prescriptions went straight into the bin and I advised my mother to discuss the hospital’s recommendations with Dr Jo.
My father was curious. ‘Why did you feel so confident about leaving and not taking the drugs and changing the cast, Jan?’
I sighed. ‘Because I know the game, I’ve been in it for 20 years. I know how decisions are often made under stress in hospitals and I saw the signs that a large team of overwhelmed physicians were treating the disease and not the patient.
It’s a bit like that expression ‘When you have a hammer, the world is full of nails!’
I explained further: ‘When there’s a drug you can prescribe for hypertension and the nurse tells you that a stroke patient has raised blood pressure while you are in ER sorting out a head trauma, what are you going to do? It’s a quick decision to issue instructions to start the medication and protect the brain from further damage. It makes perfect sense when you think of it in terms of pathology. It makes no sense at all when you know who you are treating.’
My father sat back in his chair. ‘I feel like we’ve just been put through a machine and have been spat out the other end!’ he said with feeling.
‘Hopefully your kids will be lucky enough to receive next-generation medicine where time is spent getting to know the patient and personal care regains its importance.’
That’s why Heart Based Medicine was created.
The story above is based on personal experiences. Places and names are fictional.
Just before I’m due to start my morning round with the residents, nurses and students in Pediatric Ward A, my phone rings. Caroline, the lead nurse on Ward B speaks with some urgency:
‘Dr Bonhoeffer, I need you in B21 please. We have a nine-month old baby girl in respiratory failure. Her name is Jasmina. She weighs about five kilos, has a heart rate of 180 and a respiration rate of 80 per minute.’
As I make my way along the sand-coloured hospital corridor, past two empty beds and a steel breakfast trolley, I notice the commotion building steadily through the half-open doors of Ward B. Four nurses and the resident are clustered around the child, her mother at her bedside. While I sanitize my hands before entering the room, I collect my thoughts, recalling what I know about the patient. Not much really; I’ve never met her and know only what I’ve learned at the handover.
Jasmina has SMA Type 1, a genetic disease marked by progressive muscle weakness that only a few survive beyond childhood. Now she has fever and a lung infection with the RS virus. Realising this is going to be a situation where everything is decided in real time, I make sure I’m fully present as I step quietly into the room, closing the door gently behind me.
Striding slowly but purposefully towards the child’s mother, I catch a tiny grunt then a scream from somewhere in the midst of the flock of medics. My eyes scan the monitor: the oxygen levels in the baby’s blood are low and her heart is racing.
‘Good morning Mrs Shah,’ I greet Jasmina’s mother, holding her hand and meeting her worried gaze. ‘Come with me. Let’s take a look at Jasmina and see how we can best help her, okay?’
We continue to hold hands while we observe her baby girl, and I ask everyone except the attending nurse, the resident and the child’s mother to leave.
I gently examine Jasmina while improving her body position, clearing her airways of phlegm with a suction tube, and starting high flow oxygen through a nasal cannula. She seems better immediately, but still struggles to breathe. Little Jasmina is pale, drowsy, irritable and restless.
‘It looks like she can’t get rid of CO2, please check her blood gases … and give her a dose of chloral hydrate to relax her’ I request the nurses. Jasmina meets all the criteria for admission to intensive care, but I haven’t spoken to her mother yet. I sense we’ve been given a moment before rushing her around.
‘Mrs. Shah, please sit down and hold Jasmina gently. It would be good for her to hear your voice.’
Mrs. Shah begins to hum a quiet song while caressing her baby and holding her close. After a few minutes, they both seem visibly more relaxed.
The emergency frenzy in the room is gone.
Grateful for the quiet gap that gives me a chance to talk to Mrs. Shah and build an alliance with her before we address Jasmina’s impending respiratory failure, I move to the other side of the baby cot and rest my hand on Jasmina’s hot head. She is sweating and breathing with the best of her abilities, yet her underlying muscle disease doesn’t allow her to breathe fully, nor to cough up the phlegm.
‘How do you see Jasmina’s condition?’ I ask gently.
‘I am afraid, she’s dying isn’t she?’ Mrs. Shah whispers.
‘We don’t know for sure Mrs Shah, but she’s certainly not well and needs a lot of support to stay alive, if that’s possible. We think it’s best if Jasmina doesn’t receive mechanical ventilation or any other intensive care measures that would extend her life artificially. How do you feel about that decision?’
Mrs Shah looks at me with her clear brown eyes and we hold our gaze for a few minutes. I am open to any possible answer. With a deep breath, she relaxes, looks across at Jasmina and speaks in a gentle but grounded voice: ‘She will guide us.’
‘Yes, she will guide us.’ I acquiesce.
We agree to quench her thirst, to give her as much oxygen as she needs, to keep her pain-free and reduce the fear often connected with breathing difficulty. However, we also agree not to admit her to the intensive care unit. Our decision is to support and comfort Jasmina whether she is able to pull through this with her own strength or chooses to leave her body.
I request the nurse to block the second bed in the room for new admissions and to bring two adult beds so that we can create a space for mother, father and child to be close together. We stock up with cushions, warm blankets, swabs to moisten Jasmina’s lips and a supply of intravenous fluid and medication.
I also invite Mrs Shah to call her husband to the hospital. She asks him to bring a candle – strictly against hospital policy – but I don’t object. The nurse understands our intention and covers the neon bedside light with Mrs Shah’s silk shawl, lending the room more intimacy. The windows are ajar and the room is scented with essential lavender oil and eucalyptus, bringing calm and easing Jasmina’s laboured breathing.
Jasmina responds well to the change of atmosphere.
We form a close circle around the baby. Hardly a word is spoken and gradually one of those mystical moments emerges where everyone seems connected in compassion for Jasmina and as a group. The next few hours are spent providing for Jasmina’s medical needs and supporting each other.
We are totally in sync with each other, merged in an unusually strong field of heartfelt connection.
Increasingly, there are pauses in Jasmina’s breathing. The gaps between breaths get further apart until eventually, after a few hours, she takes her final breath as she rests quietly in her mother’s lap. While we witness Jasmina’s life energy fade, our care for her and deep connection as a group remain strong, and we continue to sit in silence together for at least an hour.
I have seen people of all ages pass away, yet Jasmina’s death stays with me in a special way. Not because of her short time on this earth, but because her transition occurred in the arms of care and compassion, a rare grace for everyone concerned.
Jasmina’s brief visit has changed the lives of everyone in the room. Mrs Shah has since started a foundation named after her daughter (www.jasminasoraya.ch) , created to support parents who are about to lose their children or who have already lost them.
‘I am called to pass this onto others’, she says. Mrs Shah has become pure love, as far as I’m concerned, and I am privileged to serve her organization as a medical advisor and sometimes help support these families.
As I grow in experience, I have learned to recognize those rare moments of heart-connection and make them an active part of the therapeutic alliance with my patients. Sometimes it feels like Jasmina is peeping over my shoulder and whispering in my ear:
‘Let yourself be guided. Remember?’
If you have similar end-of-life experiences to share, we’d love to hear about them.
I have always thought that my role as a pediatrician was to reduce suffering and help set patients on a fast track to a positive state of health.
Success has traditionally been measured by the absence of the initial symptoms or what we usually call ‘the patient’s presenting complaint.’
The faster they were pulled out of suffering and got back to normal, the better, as far as we were concerned.
To give you an example, Enya, my own five year old daughter contracted influenza a few weeks ago. She felt really poorly, ‘presenting with’ a high fever, aches and pains all over her body and deep-seated coughing which produced a lot of phlegm. She wasn’t drinking, had no appetite and slept almost constantly for the first three days of her illness. Surrounded by family life, lying on a mattress on the floor in the living room, she was essentially sleeping.
So I was quite worried and wanted to give her medicine to reduce her cough and anti-inflammatories to reduce her fever, make her feel better, see her smile again.
‘I don’t think that’s a good idea, love,’ Jessica said gently as I approached our daughter proffering a spoonful of medication.
‘Why would you want to give her drugs, just to get her to sit up? Can’t we just let her go through this process?’ queried my wife.
‘Look, she’s not drinking properly, she’s not well, and she’s suffering! I love her, of course I don’t want to see her suffer,’ I offered.
‘Why don’t you want to see her suffering?’ Jessica prompted.
That shocked me. ‘Who wants to see their child suffer?’ I begged. ‘It’s obvious to me that we would want to give her drugs so she doesn’t need to suffer anymore, right?’
Our discussion continued in a way that made no sense to me at the time. But my wife was adamant. Finally I gave in. ‘OK, I hear your point.
The drugs aren’t really curing her illness; they’re just reducing her immune response so she can feel better in the short-term.
And you’d like us to consider other approaches that will make her feel better in the long-term. Is that right?’
Jessica nodded quietly, her eyes full of compassion.
‘Then I want to be at her bedside and hold her hand while she fights the virus,’ I explained as one part in me listened to the other part speaking.
As I lay down close to Enya, holding and comforting her, she responded immediately. She opened her feverish eyes and looked deeply into mine. Then she cuddled up as if she was seeking shelter and drifted back to sleep. Being able to help her without resorting to drugs appeased my conscience and I felt more deeply connected to my little daughter as we went through this difficult time together.
Caring for Enya meant that I couldn’t keep to my work schedule, nor could I stick to the promise I’d made myself to get up at 4am every day to make recordings for Heart Based Medicine. But none of that mattered because I was with my daughter when she needed me.
When I look back, I’m really grateful for what that bout of influenza taught me. I’d learned what was truly healing and contributed to good health for both of us. Although anti-inflammatories would have been a short-term solution, the most holistic approach was lying down alongside her, providing love and comfort and strengthening her confidence in her own body’s ability to overcome the illness.
The bonus? As Enya’s immune system got stronger, so did our relationship.
I was even grateful when the influenza spread to everyone in the family! It gave me a chance to be at home with each of my kids, holding and supporting them. Our whole family dynamic changed as I grew into a new understanding of fatherhood.
This was a true demonstration of Heart Based Medicine in practice.
I’m certainly not wishing influenza on anyone – it kills a lot of people every year. Nor am I claiming that anti-inflammatories are the bad guys; they can be a blessing. But I have learned to appreciate the value of another perspective.
This experience provoked a major change in the mindset of a conventional infectious disease and vaccine specialist. It was revealing to discover that my specific knowledge of influenza as a potentially life-threatening illness with all its signs, symptoms, and complications, was too simplistic. My training as a biomedically trained pediatrician blinded me to its many facets. And it proved useful for me to prioritize Heart-Based Medicine before turning automatically to allopathic medicine.
In the future, I’d like to think my decision making will be less schematic and more loving. I will advise parents differently and start to raise their awareness that if they are able to give their children emotional support and special care while they are suffering, it will strengthen their bodies and their resilience.
As well as developing within their children the foundation of basic trust in their own self-healing ability it will also teach them the value of staying together as a family during times of suffering.
Disease is an important part of life, and not necessarily one that has to be changed just because it is not in line with my preference or an idea of ‘normal’ which was learned mostly from a textbook. Symptom relief certainly has its place, but not as a replacement for heartfelt care and sensitivity. This is the true blessing of heart-based medicine.
The story above is based on personal experiences. Places and names are fictional.
The day I signed up for medical school, I strode towards the University, gliding on invisible wings. I felt the sun on my skin and inhaled the crisp morning air like a nourishing breakfast.
Entering the building, I steered towards the chancellery like someone who already knew their way. Every cell of my body fizzed and tingled, the leaves in the courtyard dancing in the wind as the morning light bounced off the windows of the long corridor. It was like being ‘in the zone’ during sports.
I was 23 years young and a new phase of my life was about to begin.
I was following my calling.
Perhaps you can remember a similar experience, that moment when you realise you’ve already made a silent agreement to serve, to follow an intangible path?
I was determined to learn everything about the human body, mind and soul so that I could serve people well. Healing had always held a fascination for me, even as a small boy.
Aged just 7, I remember browsing through a folder where my parents stored all their passports and important documents, giggling at the photos of their younger selves. My eyes fell on a tiny leaflet and I asked my parents what it was. Smiling warmly my mother replied ‘It’s my first-aid certificate’.
That resonated with me and my desire to help people feel better sparked into life at that moment.
‘I want to learn this too!’ I declared. My mother was a professional actress, keen to nurture empathy, compassion and emotional exploration within her young son, so she took me along to the Red Cross ambulance hub the following week.
‘My son would like to take a first aid course. Is there one for kids?’ she asked a big, bold man in a white and orange uniform. He was very supportive of my decision but explained that I was a bit too small.
‘Why don’t you come back when you’re about 14 years old?’ he suggested. My little world collapsed around my ears. But there was no choice, I would have to be patient.
Meanwhile my father would spend countless hours satisfying my enquiring mind with science and observation. His favourite question was ‘What did you learn from this?’ as we took morning strolls together, identifying songbirds by their songs. Together we would conduct chemical experiments, surprised at our results. As we peered through the microscope and telescope, he would awaken me to the beauty of life’s creative expression.
Seven years later at the ripe old age of 14, I signed up for my first aid course which eventually led to a paramedic apprenticeship. I was still at school when I completed the full training, so had to spend all my weekends and holidays studying and even worked several nights during the week. It was a fascinating journey.
With over 2,000 hours of experience on the road as a paramedic I had seen far too many accidents and a great deal of trauma. Although I’d learned many techniques to save lives there was still a sense of longing inside, a yearning to understand and serve at a deeper level.
As I sat on the deck of the ambulance hub, reflecting on our mission the night before and remembering my admiration for the anesthetist who’d taken charge of the scene, the road ahead became clear. I would become an emergency physician.
During the following 6 years at medical school, this desire to learn was fully satisfied. More than two-thirds of my fellow students would fail before their final exams, so I was determined to get through. That meant countless hours of discussion, debate and study, memorizing thousands of pages from a huge stack of medical books.
During one histopathology lecture, I recall joy and awe bubbling up inside me as we admired nature’s beauty and witnessed miracles through our microscopes. I felt like a small boy again, and nudged my neighbour who was equally awestruck.
The harsh voice of our disgruntled professor blasted through the loudspeakers:
‘Quiet please, gentlemen. This is not a kindergarten. Some people are trying to study here.’
So much for life-inspired enthusiasm!
During our years of study, we learned that the main approaches to overcoming disease were a variety of drugs and surgical approaches. There was no course in how to promote health at the time. Even preventive health measures such as vaccines or the importance of clean water were not taught. And there was definitely no mention of love and compassion as part of the syllabus.
To the contrary, during medical school, what I learned was how NOT to take care of myself! How to ignore my needs, work crazy hours in stressful situations and perform under tremendous pressure.
Certainly, we acquired a lot of knowledge, but were we trained as healers?
During 18 years of work as a resident, fellow, attending specialist and researcher, I focused on scientific methods, standardization, public health statistics and evidence-based facts. If I actually made it home to rest, I went to bed so tired that I could barely remember what I’d done that day.
‘This is how you learn,’ was the mantra.
‘It’s all about hours on the ward and the number of patients you see,’ they made me believe.
Of course there is some truth to that, but there is a major price to pay. And the cost is not the leisure time or the friendships you sacrifice, it’s not the work-life balance.
It is the subtle flame of compassionate love, the access to our healing hearts and the consequences of gradually kindling or slowly suffocating this flame that burns inside every one of us.
Looking back, I believe that we would have benefited so much more from heart-based medical training that embraces the mastery of health as well as learning how to perform surgery and prescribe drugs. Not only would it convey a more complete picture of healthcare, but it would change the way healthcare is delivered today throughout the world.
Heart-based medicine is all about bridging that gap.
It seeks to enable an environment in which we can allow ourselves to be in loving presence with one another, where we can appreciate nature’s individual expression in every patient. It is about cultivating an inner disposition and awareness of each person as an intricate expression of life in all its beauty and complexity. It is about using everything we’ve learned and continue to learn as just one of many approaches to healing, including compassionate attention.
If you’re ready to rekindle the inner flame that first motivated you to set foot on this path to becoming a master of healing, join us.
The story above is based on personal experiences. Places and names are fictional.
‘Requesting admission for a previously healthy 14-year-old girl, found unconscious. Cause unknown. Expected time of arrival on the hospital roof is 30 minutes.’
As a young resident training in pediatrics I was getting used to receiving emergency calls from the national rescue helicopter service. It was my third night shift of the week. Heavy rain was hammering against the dark window of my small neon-lit office and I’d just finished my fourth coffee from the vending machine. After checking with the head nurse on call I confirmed our availability.
As the double doors of the intensive care unit swung open, I was swept by a wave of cold air carrying the distinct smell of kerosene and disinfectant. The rain-soaked paramedic team rattled the squeaky-wheeled stretcher along the corridor at speed. Adrenaline surged through my tingling body as I hurried ahead in an attempt to get the earliest possible impression of what was going on.
I saw the girl’s pale and wet face, framed by shoulder-length brown hair, eyes closed. A transparent plastic tube fed into her mouth and was held in place by crossed tape over her lips as if to mute her. The tube was connected to a machine attached to the side of the stretcher, which pushed life-giving oxygen into her lungs. Another smaller tube was inserted in her nose to drain her stomach. A large intravenous drip and a selection of syringes delivered drugs into her bloodstream. The rest of her body was swaddled in a grey rescue blanket tied together by a set of belts attaching her to the stretcher.
The short, stout anaesthetist declared: ‘Good evening, this is Rebecca, a 14-year-old girl, about 45kgs with an unknown cause of coma. Glasgow Coma Scale of 6, heart rate 82, blood pressure 125/75. She has no signs of trauma or intoxication. Blood glucose is normal. We intubated her for airway protection. Intubation and ventilation well tolerated. No cardiovascular support required, transport smooth and without complications.’
Looking at him while he gave his report, I found myself impressed by his tanned and wrinkled face. I noted ‘This is what you look like when you are about 55 and your face is marked by working in all kinds of weather with a life dedicated to rescuing patients in emergencies.’
But in spite of all the paramedics’ experience and their high tech equipment, it was clear to me they didn’t have a clue what was wrong with Rebecca.
‘Thank you for the handover,’ I acknowledged and turned to examine Rebecca while the nurses connected her to our monitors and machines. I felt like a robot calculating algorithms in the face of a beautiful unconscious girl. Her body was present but she seemed detached from her personality, her daily life and her family.
After several hours of tests on Rebecca’s blood, urine and brain fluid her parents arrived by car. Her young father was nervous and stressed and her red-eyed mother had clearly been crying a lot. The acrid smell of cigarettes wafted from them both as they pressed to see Rebecca. At her bedside, the consultant on call explained everything that had happened since her parents had last seen her at home.
Both parents reported that they had tried to contact all her friends and relatives in the search for a clue to her present condition. But all they could conclusively offer was: “Rebecca was a bit more ‘closed’ to us in the last few days but we thought it was just part of being a teenager.”
My consultant explained: ‘Unfortunately, we haven’t been able to identify the cause of Rebecca’s coma so far. However, her condition is stable and we’ll need to wait for a series of pending test results until we can get more clarity. You can be with Rebecca anytime, but we have a room next door especially for parents with children on our unit. It’s probably best if you rest there for a while and we’ll call you if anything changes or as soon as we have more news.’ The parents decided to sit with Rebecca for a bit longer. They held her hand, spoke to her, stroked her, but there was still no response.
Much later, I stood at her bedside and reviewed the charts from the last hours for clues. The unit was quiet, the light was dim. Rebecca lay motionless in a room with four other children accompanied by beeping monitors and hissing ventilators. The tube had been taken out of her airway and she could breathe by herself again. However, when I re-examined her, she was still unconscious without any response to words or even light pinching.
As I gazed into her expressionless face, I was overwhelmed by a tremendous sadness. I had no idea where it was coming from. There was nothing in my life at the time to give rise to this feeling. I was struggling to hold back the tears as I pulled up a chair and sat down next to her. I found myself holding her hand, looking into her face, uttering these words:
‘Rebecca, I would really like to find out what is going on with you and how I could possibly help you.’
I was amazed when she actually opened her brown eyes, squinted at me and closed them again! Like a vivid daydream the entire story of the last few hours played out in my head. I ‘saw’ her being found unconscious, then all the dramatic and painful things she had experienced since, including a venous puncture and the intrusion of a plastic tube being inserted into her airway and removed again. I sensed the cold rain, the helicopter flight – all of it raced through my mind. I could not possibly compute how she could have experienced all this without any response!
Suddenly she opened her eyes again and whispered: ‘Really? Do you?’
Lightheaded, goosebumps all over, I could not move. I just looked sincerely into her eyes, nodded and whispered ‘Yes! Tell me!’
After a little while she continued in a whisper: ‘You know, I felt lonely…like really… as if there was no one else…there was nobody I could talk to and I just didn’t feel like myself anymore.’ Slowly she revealed the full story. ‘Someone really hurt me, so deep I don’t want to live anymore. I feel ashamed, I don’t want my parents to know, and I just want to die.’
Rebecca didn’t want to talk about it further, but agreed to at some point. ‘So did you feel any of what happened to you since the paramedics picked you up?’ I asked.
‘No I couldn’t feel anything. But I saw everything.’
‘From where?’ I asked.
She startled and said ‘Just like that’. Still suspended in disbelief, I asked her how she could explain that her vital functions didn’t show any stress response. She just shrugged her shoulders. ‘I guess I turned everything off.’
That night I learned about the power of the invisible in patients and the impact of compassionate presence on healing.
We spent the hours talking in between rests and I called for her parents in the morning. All the tests came back normal and we decided that it was best for Rebecca to be transferred to a psychiatric ward for crisis intervention.
So that was it. She was transferred to another hospital and I did not see or hear from her again.
When I told this story to a dear friend, he asked, puzzled ‘What happened to her, Jan? What was the trauma? How is she now?’
My confusion was obvious. ‘I don’t know.’
‘What??’ he exclaimed in bewilderment. ‘You haven’t heard from her again? You have no idea what happened to her? How is that possible?’
I explained ‘Well, I had done what I could on intensive care.’
‘Yes, but how can you have such an important moment, such an intimate encounter with a patient who’s fully vulnerable and opening up to you – trusting you – and then you refer her on and do not even know what happened?’
A very good question and one I find uncomfortable even today. I still regret not following up with Rebecca.
It took me a while to understand that I had become numb during the first years of my training. I felt medical objectification was normal and I had devalued the sacredness of human to human connection in favour of evidence-based medicine, professional distance, and good conduct in a highly structured health system.
It became more and more apparent to me that the system was primarily designed to manage disease.
Unless the healthcare professional manages to cultivate a sympathetic healing environment within the constraints of the system there is not much room for compassion.
If you’ve experienced a situation where you found yourself numbed by your medical education or over-constrained by the healthcare system and you are ready to tell your story, please share it here.
The story above is based on personal experiences. Places and names are fictional.
It’s Friday lunch time on a cold winter’s day. Long queues of doctors, nurses and therapists all dressed in white wait in the neon-lit hospital canteen for their turn at the counter.
I sit at a table with my colleagues John and Mary, hastily eating my sandwich and quickly downing an iced tea. It’s almost time for me to be back on my pediatric ward ready for the next admission from the emergency room. ‘Mary looks exhausted’, I’m thinking as I take in her wrinkles and grey hair. She takes a bite of her lunch, followed immediately by another, and swallows hard to clear her mouth before answering the insistent ring of her phone.
‘How many years have you been doing this work now?’ I ask with my own mouth full.
She puts down her fork, eyebrows raised, and looks at her plate for a moment. ‘Twenty-five years… next summer.’
‘Wow, and we’re all still working around sixteen hours a day and hardly ever get to enjoy a quiet meal,’ I observe.
We go back to devouring our lunches, eating so fast we barely have time to chew.
But this is where the conversation takes a different turn.
‘I talked to a nine year old girl on my ward today for more than an hour,’ I continue. ‘Veronica has disabling pain in her knees and right ankle. She’s been relying on crutches for the best part of two years and has hardly walked at all for the last three months. When she spoke to me her eyes were full of tears.
“None of the doctors I’ve seen so far have found anything. Please don’t make me have any more painful tests.”’
‘Did you meet her mother?’ asked John.
‘Yes’ I reply. ‘Interesting woman. A successful business leader, very well organized, wearing black Japanese designer wear. Everything very precise. Nothing free-flowing. She said to me, “You know doctor, Veronica is top of her class in all her subjects. We’ve invested so much in finding out the cause of her pain; we truly need an answer now. The family is on the brink of collapsing under the pressure of Veronica’s pain and suffering.”’
A knowing smile was playing around Mary’s mouth. ‘So doctor, do you have an answer?’
‘Of course not. Though I have the feeling that this is not somatic, and that putting up a large interdisciplinary team is not going to lead anywhere.’
‘Sounds psychosomatic to me,’ Mary reflects, ‘but our team is not really equipped to handle chronic pain patients.’
I sigh. ‘I wonder to what degree all the so-called causes we learn about are actually the real causes? Maybe the cause of disease is much deeper than what is revealed in the textbooks and papers.
After all, when we test mice and seventy out of a hundred get sick after encountering a bug, we assume the bug must be the cause. But what about the other thirty mice? We put this down to chance or host factors – just because we don’t fully understand. I wonder whether anyone is looking into this? I also question what Veronica needs to learn by being grounded the way she is. I would love to tap into her heart directly and find out from the source.’
‘Mmm,’ Mary agrees. ‘When you’re young and in training you tend to be interested in all the tricks and buttons, the technology and how to conquer disease. But as you grow older you become more interested in deeper questions like yours.’
Intrigued by her comment I invite the others’ views.
Even more fascinating is that all of them agree that compassion makes up more than fifty percent of what we offer when working with chronic disease patients.
Next I ask ‘Were you ever trained in being consciously compassionate or how to contribute to healing with loving attention, sympathetic awareness and just open-hearted human love?’
Everyone looks down at the table.
Finally Mary voices what we’re all feeling. ‘We all know this Jan, and the longer we’re in practice the more we rely on “experience”, our sixth sense or intuition, and we offer loving attention and compassion in addition to what we learned in med school.’
I am jolted out of this rare reflection with my colleagues by the jarring ring of my phone. Another emergency. ‘OK, I’ll be right there.’ And I race from the canteen.
Eight hours later at the end of my shift, my wife Jessica picks me up for a family weekend in the mountains. In the car’s rearview mirror, I glimpse six big brown eyes looking back at me. My heart fills with joy and gratitude that all three of my children are blessed with good health.
The next morning on the ski slopes I sit on one of our wooden sledges and watch Jessica laughing, at ease while she plays with the kids at the top of the hill. Without warning my conversation with Veronica and her mother bubbles up in my mind. I ponder why my kids should be so blessed with the joyful experience of playing in the snow while Veronica can hardly move without pain, and am filled with a nagging sense of guilt about my insufficiency to truly help and heal her.
Veronica is trapped within the confines of conventional medicine and I am the ignorant messenger of its current theory “There is nothing wrong with your body. Might it be psychological?”
However, something deep inside me knows that this is not the full story.
Two years later, I am in my office opening a letter from a leading European hospital which specializes in psychosomatic disease and psychological counselling for patients in pain. I learn that Veronica spent 6 weeks in a hospital-like institution without her parents and there was essentially no change to her condition on discharge.
I feel deeply tired and recline my seat, a hand on my chest as if to hold onto my heart as I speculate out loud. ‘Kids with such illnesses often come from affluent families with alert, cultivated minds, often with a refined sensual awareness of their bodies,’ I reason. ‘Maybe their issues are less rooted in the material world but reflect a lost wholeness. This could well present with pain and the inability to move freely’.
‘They also tend to be kids of somewhat stressed and uptight parents’, I realize, visualizing Veronica absorbing and harbouring the tensions of her parents until their overflow caused disease in her.
‘It’s almost as if she is part of a new generation living in a more stressful environment while being more aware and sensitive to physical sensations of stress. With no immediate role models who could show her how to handle stress, perhaps her body and mind are absorbing the negativity in her surroundings, resulting in painful paralysis and a feeling of not being understood.’
‘Is Veronica expressing her parents’ collective pain to bring attention to the family dynamic? Did I examine her as if I was looking at a broken valve rather than realizing that she was a healthy valve in an overheated pressure cooker, attempting to heal her family’s or generation’s condition?’
A warm feeling of understanding sweeps across my heart.
‘Maybe Veronica is a true pioneer of a new generation and is expressing its collective “growing pains” to use a clumsy analogy. Perhaps instead of a doctor running tests or parents looking for biomechanical or psychological causes of her pain, what she needs is to be asked what would make her feel loved and respected as a guide for all of us who surround her. How could we support her in expressing what might be a healthier environment for her to exist in without pain? I would imagine such an environment might be healthier for all of us.’
Veronica’s story is not unique. I’m sure many of you reading this blog have encountered similar patients in comparable situations.
What interests me is how many of my medical colleagues and peers have ever felt a knowing beyond what our textbooks have taught us?
Are we missing a vital piece of the puzzle whenever we classify a medical condition as psychogenic or somatogenic?
That is the territory we’re exploring here at Heart Based Medicine.
I’d love to read your comments below.
The story above is based on personal experiences. Places and names are fictional.
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