July 28, 2010

Thoughts from the Front Line

I’m going to do something a little different this week and write something a bit more personal this week, something a bit more, well, extemporaneous. I’ve been working on being sick for the last couple of weeks and of course the day it comes to a head is the day I have an article that needs writing. So, I’m going to aim for a little less polish and a little more from the hip this time, and my apologies if it’s not the most pristine bit of prose you’ve ever read because, well, I’m a bit under the weather. It’s likely to be more questions than answers today, but for some reason I felt that rather than pontificating I needed to show the other side a bit. Here we go.

A collection of thoughts about being in practice.

1. It’s hard being a natural medicine practitioner when you’re relatively sickly. I’m a fairly good sized guy.When I was

born my mom’s OB/GYN declared I was going to play for the Tampa Bay Buccaneers when I grew up. (This was not a curse, I’m from Tampa.) You don’t really think “poor health, very deficient” when you look at me. However, I’m kinda sickly and I’ve kind of been that way my whole life, for reasons multifarious. I feel like I’ve come a long way in the last few years, but I still tend to be on the weak side, not able to do all that much in the way of physical activity, coming down with things a lot, etc. (When I moved in January, afterward I was sick until sometime mid March). The point here is that I frequently find myself (like today, for instance) in the middle of a diagnosis with a patient thinking “How exactly is this person supposed to believe in my ability to improve their health when, despite my best efforts, my own personal health is so poor?”

2. Treating chronic disease is an exercise in patience and frustration management. Chronic disease is what I look for, my preferred type of case. The really difficult, chronic, life-crippling stuff. This is because these are the patients I most want to help, whose lives would be the most changed by a positive result. Despite having the tools at my disposal to do just that and making observable progress, it’s still a very frustrating process. Sometimes these things really do take four or five years to pull off, and that with hitting a home run every week. Patients get frustrated and drop out, really committed patients have other disasters befall them or are being crippled by their Western treatment regimens, patients that are doing absolutely everything right still continue to suffer greatly in the process of improvement. Some days it’s hair-pulling. Some days it’s heart breaking. This is part of the acupuncturists life that they seemed to have missed in school.

3. Doing things in the right order takes a lot of faith and self-confidence. I have multiple patients who have some sort of chronic pain who, to my mind, are great examples of the Neijing maxim that “all pain, sores, and itching come from the Heart.” They have chronic pain that

is being directly or indirectly caused by upper jiao blockage due to emotional distress followed by a walling off of the psycho-emotional energies of the Heart and Lungs. In both cases a powerful resistance to dealing with the loss of loved ones is crippling circulation and leading to a variety of additional symptoms, like dysmenorrhea. However, it’s not the easiest thing in the world to be charging a pretty good sized sum of money to someone who has come to you for elbow pain which isn’t really getting better and having to tell them “look, we gotta keep focusing on that emotional blockage first in order to get to your pain, otherwise we’re just knocking our heads against the wall.” Is it the truth? Absolutely. Do I still kinda worry that it’s going to make me and every other acupuncturist alive look bad and one day she’ll stop coming in and tell her friends about what a waste it was and…you bet. After all, you can’t have a good neurosis without a lot of work.

4. Some days you feel like you did everything wrong, and yet everything right happens. I’ll never understand this one. You needled these two points and…just didn’t “feel it.” Like there was no real connection. You had to more or less guess on the formula and just kinda threw it out there, not really knowing what would happen. You were too beat to take a proper pulse and so had to work out what to do from other angles, and even then things didn’t seem right. You were sure that what you did was going to fail utterly. However, the next time you talk to the patient, they’re thrilled with the results. Go figure.

5. Some days you feel like you did everything right and the case barely budges. See #2

6. You really do have to get used to the idea that patients are frequently so closed off, out of touch with themselves/reality, and self-unaware that they have no idea what’s really wrong with them. Frequently they can’t even tell you if things are better or worse because they literally have no idea. See #3

7. The practices of other practitioners is going to make you really mad some days. You’re going to hear about people who are essentially running a health food store/supplement supply under the guise of a medical license for all the hawking of goods they do. They will practice lousy medicine, though their patients probably don’t realize it. They will have evolved into the Monte Hall model by force of necessity, because their actual CM acumen is so poor. So in order to survive, they will pull in every modality, every product, everything in existence into their practice and sell it all. Their practice will be bigger than yours, they will be making more money than you, their car/address will be nicer, they will be in the local magazines. They will still not know what they are doing, they will not be reaching the level of results our ancestors expect from us, however they will be feeding the consumer culture of our society, and that is why they will be doing well. You will know this, but it will still make you mad.

8. Your practice is going to make you really mad some days. You will find yourself saying “if this stuff is so great, if I’m practicing such a superior modality, if my herbs are such high quality, if I have it on absolute fact that I am doing what my patient needs when they need it, then why in the hell aren’t any of them completely cured? If my way is better, then why is it such a small operation? If I’m so great then why do I ride the bus instead of my Mercedes/Porsche/whatever? Why aren’t I better at treating emergency/acute/chronic/mystery/women’s/men’s/children’s/animals illnesses? Why do I have so few answers?” Again, neurosis takes work.

9. All of these things will come and go along with this thought: man, this stuff is really great and I feel good. Yin transforms into Yang and Yang transforms into Yin. Good days, bad days, they’re all part of it it seems. I personally think that people who only have good days (residents of Portland notwithstanding) need psychological evaluation and a lie detector test. Just try to remember that when things are bad that soon it will turn around and that when things are good that you don’t have all the answers just yet.

Thoughts from the Front Line