As a patient, and as a doctor, I’m frustrated. No, that doesn’t really say it. I’m pissed off. I’m angry about the way people are treated by their doctors, their HMOs, PPOs, even their health savings accounts. I’m angry about the way that people are treated because they’re not treated as people at all. They are units of currency, pieces of meat sitting on butcher paper in ill-fitting robes, feet dangling off the end of the table. Vessels into which pills will be poured. Skin-bags full of blood and bones who may or may not fall into that class of people who can handle anti-depressants or non-steroidal anti-inflammatories just long enough for the body to take care of itself anyway.
Walk into most medical clinics, most hospitals, and you will be greeted not with a friendly face and an empathic look, but by a stoic head behind a sliding plate glass window and a room full of other folks solemnly leafing through weekly newsmagazines. Show up on time and wait an extra hour for your appointment with the ‘expert’ on you; someone with whom you’ve spent less cumulative time interacting than the barista who makes your lattes. This person, whose wall tells you more about themselves than they do, will ask you to disrobe and divulge some of your most challenging, private, embarrassing issues in the comfort of a small, cold room through which thousands of people have come before you.
You’ve been living with pain for too long, and it’s interrupting your way of life to such a degree that you’ve been forced to choose this route. The one where a state-certified authority will tell you who you are, what’s happening inside of you, what you should be doing instead, and what the likelihood is that you’ll ever again be the person you were before or would like to be in the future. After all the waiting, filling out forms, and being shepherded through various doors, you will have a few minutes between you and your practitioner to solve your problems.
Pills. A referral. A shot of cortisone, a nerve block. Perhaps a surgery, followed by physical therapy. Maybe some massage, exercises you’ll never do, and then…
That hopeless feeling. It didn’t work. Now it hurts not only where it used to hurt, but in new places, too. You have to take medication indefinitely, some with side-effects that add to your growing list of problems. The sleep cycle is off. Exhausted all the time. Eating habits change. Not able to do what you used to do. “I’m falling apart. It’s happening all at once. What’s happening to me? Maybe I’ll try some unusual forms of medicine. My friend’s mother has a chiropractor she swears by. That guy on TV said acupuncture saved his life.”
At this point, you may be realizing that the medical system is just that: a system. “A complex of methods or rules governing behavior;” “an organized structure for arranging or classifying.” (wordnetweb.princeton.edu/perl/webwn) Your behavior since you’ve started this journey has been governed by rules you have barely questioned. You have been classified by a medical system as someone with a certain complex of diagnoses, who has therefore been run through a discrete set of steps in search of a standard outcome. That outcome is your health, and what you may begin to realize is that it didn’t ‘work;’ that there was always a lot of hope involved. Hope that your medical practitioners and their expert advice would reclassify you with new words and push you out the other side as a whole person again.
Now that you have been processed through the medical digestive system and have come out feeling like crap, you may also come to understand what all experienced practitioners know. Namely, that every time we as practitioners see someone, no matter what we name the condition or how we treat it, we are hoping that our suggestion or intervention will work or appear to work. We’re bluffing–doing a complex, shamanic dance. We’ve read books on what has appeared to work before, what constitutes a legally-defensible treatment for your condition. We’ll modify your identity, your sense of who and what you are, by attaching long descriptive subtitles to your name from a big book, perhaps two or three names. Once we’ve done that, then we will start a war against your new subtitled identities, using anti-identities such as anti-biotics, anti-inflammatories and the like, hopefully without adversely affecting your own natural antibodies. It’s the standard of care. It worked for other people. It worked in test tubes and on animals of different species, so maybe it’ll work for you as well. If it doesn’t, you must be doing something wrong. Try an anti-depressant and maybe you just won’t think about it so much anymore. You think too much, anyway.
Where’s the humanity in all of this? Where did medicine lose its way? When did doctors become mortal gods, and why isn’t anyone protesting the fact that the puppet-masters of medical treatment are not trained medical professionals or anyone with your best interests in mind, but insurance companies and lawyers, who determine what kind of care you are permitted based on your ability to pay and how uncreative the doctor can be in treating you? Because creativity in medical practice, having an open mind, saying “I don’t know” or “let’s try something new,” may mean expensive tests and extra liability. Because malpractice insurance is so expensive that doctors need to see as many people as fast as possible just to pay their bills. It’s so much faster to write a prescription for drugs or to send someone to other people than it is to actually look someone in the eye, get creative, or tell a patient what you know. Which may be something as simple and truthful as, “I don’t know.”
At a certain point, as a consumer of healthcare, you begin to see the Matrix (like the movie of the same name). Having experienced much of what the system has to offer and yet still being symptomatic, you see that the people who wore the white coats and have the offices full of news magazines are just agents of hope, but not necessarily agents of change or even health. It didn’t work for you, anyway. The blinders are now off, the system has been exposed, and a period of deep disappointment, disillusionment, and perhaps depression ensues as you begin to question yourself. “In what other important areas of my life have I fundamentally given over my trust? What do I have faith in that perhaps I should not? Is hope really just a precursor to disappointment? What should I believe in now, and how can I ever prove that what I trust is worthwhile?”
This is the moment of truth. This is the bend in the road, the threshold, the choice. Will you choose to drop into depression, continue to allow yourself to be a hopeless subtitled character, walking through the world barely protecting the tiniest flame of hope that perhaps someone, somewhere is the expert you’ve been looking for? Or will you take the other path, the harder one, the hero’s journey. The one that has not been charted, because you have to walk it alone, relying only on yourself, your inborn knowledge and wisdom to be your light through the dark. Finding your own internal and external resources. Connecting to others in your situation. Being your own primary source and being the master of your destiny.
You’ve read this far, so I’ll give away the ending. The goal of health, and its very definition, is not to be out of pain, or “all better.” It’s about flexibility and quality of life. In Chinese medicine, the term “Qi” is thrown around quite a bit. It’s a word, a character, that cannot be wholly and accurately translated into English, but one way of looking at it is to call it ‘function.’ Qi is both the capacity and the realization of function. Something without Qi is medically dead. Health is about focusing on what you want, need, and are able to do, how you function in the world. It is not a focus on what’s missing, what hurts, except to the degree that the hurt keeps you from what makes your life worth living. A good medical practitioner, a wise one, will focus not on curing you (something none of us, when we’re honest, know how to do). They’ll focus on maintaining your quality of life. On helping you get back to what keeps you getting up each morning. You may be forced to take permanent detours. You may have to stop walking and learn to swim. You may have to learn to do things without one of your parts being as involved as it used to.
Is this view a bad one? Does it mean our medical system is falling apart? That those who are not helped by the current system are doomed? We have our opinions about what constitutes good medical treatment in this day and age, but in the final analysis, a full medical journey is near its end when we return full-circle to ourselves. When we realize that there is no real safety net. That doctors and nurses and physical therapists and acupuncturists are tools, nexuses of specialized information that may or may not be a propos to our individual condition and fate in this world. When we realize that we are indeed all alone, and yet, there are billions of us, side-by-side, in the same communal situation, we’ll understand the nature of our reality.
We all have our own hero’s journey offered up to us. Will we embark on the road less traveled, the risky one without established signposts empowered by ourselves? Or will we continue on the path of flickering hope that someone else will magically save us from ourselves? Either way, the path ends in the same place, and the way we look back on our journey will be through the lens of the quality of the lives we lived to get there.
Treat yourself. Be your own expert. Redefine what health is, and you may be surprised to find that you were healthy all along.