What Would You Like to Say to Future Physicians?

The blog Edwin Leap, is hosting Grand Rounds and had asked for submissions on the topic - "What would you like to say to future physicians?"

Here's what I would like all doctors to have engraved on their frontal lobes.

ILLNESS IS ABOUT NOT JUST THE PATIENT. IT'S ABOUT THE COUPLE.

When you're in a relationship and serious illness hits one partner, both lives are dislocated. Illness becomes the uninvited third party in the relationship. The changes are profound ones. Two people are suffering.

Doctors should understand that in treating the ill partner, they are also affecting the well partner. If they do this with consciousness and clarity, both partners stand a better chance of surmounting the challenges of illness.

As I was searching for help with a chronic pain condition, I once had a chance to read my medical record for a series of visits with a specialist. He wrote, "Patient appears to be nervous - she brings her husband to every appointment" -- as if nervousness and including my partner were somehow aberrant behaviors.

My partner was my driver (I was in too much pain to get behind the wheel), my memory (I didn't trust my own memory to hold onto the doctor's words), and my main support. And not only that, but he wanted to be there. He felt as much inside my experience as I did.

And he suffered -- fear, helplessness, frustration anger, loneliness, disappointment, and more fear.

Doctors should not only invite the patient to bring his/her partner into the consultation room, doctors should take a few moments to turn to the partner with interest and compassion and ask, "So how are you doing?"

That simple question can not only help the partner feel validated, but it may also help him/her find the strength to go on. And if the partner can go on, chances are, so can the patient.

ILLNESS IS ABOUT NOT JUST THE PATIENT. IT'S ABOUT THE COUPLE.

Grand Rounds is Up

Have a look at Florence dot com.

What Do You Say to Yourself When You Have a Relapse?

Damn. I had been doing so well for so many months. Then WHAM. From nowhere. The pain started snaking its way back in. Was it the stress of a presentation I had to make in front of a prospective client? Was it the humidity? The unseasonal chill in the air? The baba ganoush?

My first reaction is to churn with anger. No. Not now. Go away. Damn you to hell.

But then I realize that the anger only riles up the neurotransmitters that fuel the pain. And besides, the pain is part of me, and there's no sense in raging against my self.

So, what do I say to myself to get through this episode? This may sound a bit crystal-headed, but it works for me. I say:

"All the healing forces in the universe pass through my body."

With each breath, I take in the surrounding molecules and the ones they have come in contact with, and the ones they have come in contact with, and the ones they have come in contact with - to the end (or the beginning) of time and space. It all flows through me. And some of it must be healing.

What do you say to yourself when you have a relapse (or when your partner does)?

Grand Rounds is Up at ACP Internist

Check out this week's collection of posts from the health care blogosphere at ACP Internist.

And there's a new blog carnival for patient bloggers. Check out the first edition at Duncan Cross' blog.

How Couples Can Deal With Crisis

From an article in Examiner.com by Janet Clark

Judith S. Wallerstein and Sandra Blakeslee, authors of The Good Marriage, identify nine specific tasks couples must tackle in order to create a good marriage. The fourth task is a tough one: "to confront and master the inevitable crises of life, maintaining the strength of the bond in the face of adversity." This is probably the last thing a young couple is thinking about when they fall in love and look at each other-and life-through rose-colored glasses. But there is no doubt they will have to deal with some serious issues during the course of their marriage.

It's sometimes said what doesn't kill you makes you stronger. The same thing can be said about a marriage: tragedies, crises, difficulties have the potential to make or break a marriage. Couples will face illness, death of loved ones, loss of jobs, problems with children, and a host of other challenges throughout the course of a lifetime. The couples who pull together in times of trouble follow certain steps, according to Wallerstein and Blakeslee. First, they look at the situation realistically and are able to think how their lives, and the lives of other family members, would be affected. They avoid"awfulizing" the situation: while they recognize the realities of the challenges they are facing, they're able to also take time out from dealing with the problem and try to enjoy life.

They don't blame each other or say, "I told you so," because they know everybody's human and prone to error. "In fact, they went further by trying to protect each other from inappropriate self-blame," the authors said of the couples who managed this task successfully. "They protected each other against self-reproach and shame." But they don't have to pretend everything is hunky-dory: they are able to acknowledge their fears, anxiety, sadness, and anger in appropriate ways, and sometimes not so appropriately. They can allow themselves, and their partner, to lose their cool once in awhile (without being abusive) and not take it too seriously.

Finally, "they blocked the crises they could see coming," said Wallerstein and Blakeslee. "Rather than waiting until a spouse's drinking or acting out or depression was overwhelming, they intervened at an earlier stage." They don't allow their partner to go over the edge in response to whatever crises is at hand: they let them know how much they care about them, and also let them know they will not stand by and watch their partner self-destruct.

What Would You Miss About Illness?

I know this is an odd question. For many of us, our conditions don't necessarily disappear, but maybe they do fade in and out. Perhaps some of you (both the ill and the well partner) have luckily had the experience of being without symptoms long enough so that you can think of life as a journey and not just as an intermission between pain or fever spikes.

I had the good fortune of being in a symptom free phase for a few weeks and I started to notice that I was forgetting to do things like a sick person. I wasn't planning my days around the phases of pain. I bought tickets to a play three weeks ahead -- not out of hope that I would be ok, but out of forgetfulness to take my condition into consideration. Out of the irrelevance of pain.

One day, perhaps perversely, I starting reflecting on the question: "What do I miss about my pain condition?" I realized that I missed a kind of intimacy I had with Richard when pain was the major force in our relationship.

We see each other a lot more when I'm in pain, mostly because I don't really go anywhere. And we sit quietly, in the same room, not necessarily talking or reading -- just being. It's not that I want pain back so we can reclaim this kind of intimacy. I just want to remember to call on my consciousness to create this intimacy and not wait for pain to dictate the terms we engage on.

What does your illness do for you? What do you, or would you, miss about your illness should it fade for a week or two?

Kept From A Dying Partner's Bedside

What a senseless infliction of suffering on a couple already in pain. What is it going to take to put compassion before politics, prejudice, stupidity, and insane legalities? What is it going to take to change laws that are just plain wrong?

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From a May 18 New York Times article by Tara Parker Pope

KEPT FROM A DYING PARTNER'S BEDSIDE

"When a loved one is in the hospital, you naturally want to be at the bedside. But what if the staff won’t allow it?

That’s what Janice Langbehn, a social worker in Lacey, Wash., says she experienced when her partner of 18 years, Lisa Pond, collapsed with an aneurysm during a Florida vacation and was taken to a Miami trauma center. She died there, at age 39, as Ms. Langbehn tried in vain to persuade hospital officials to let her visit, along with the couple’s adopted children.

“I have this deep sense of failure for not being at Lisa’s bedside when she died,” Ms. Langbehn said. “How I get over that I don’t know, or if I ever do.”

The case, now the subject of a federal lawsuit in Florida, is being watched by gay rights groups, which say same-sex partners often report being excluded from a patient’s room because they aren’t “real” family members."

Grands Rounds at Health Blawg

Some interesting posts. Check it out.