As I write this, I am sitting in a hospital room with my wife. She had the sudden onset of severe chest pain and neurological symptoms and was admitted through the emergency room.
The tests showed evidence of cardiac stress but gratefully no heart damage. However, she also has multiple neurological deficits, the worst being that her left leg is paralyzed. When I asked the cardiologist what could account for simultaneous cardiac stress and severe neurological deficits, he said he didn’t deal with the nervous system. When I asked the neurologist about the connection, he had a similar response: he wasn’t interested in heart problems.
I should not be surprised. But the lack of intellectual curiosity concerning what would cause the simultaneous occurrence of cardiac and neurological symptoms was, to put it mildly, stunning. They never asked, “What is the underlying pathophysiology that would explain what has happened here?”
It is a perfect metaphor for, and sad commentary on, the direction of Western medicine today: a reductionist approach that compartmentalizes the body into parts and fails to appreciate that everything is connected. The evaluation of patients is divvied up to specialists and sub-specialists, each with their own areas of competence, but none with the whole picture. In theory, primary care practitioners assemble the specialists’ reports and put it all together. In practice, PCPs see 20 to 40 patients a day; they have neither the time nor the expertise to connect the dots. It’s like the blind men and the elephant—none of these physicians see the whole patient.
Our work as physicians and healers is to see the whole patient. Instead of focusing on one organ system, I want to know everything. The diagnostic challenge is to discern patterns of insults, symptoms, and lab tests that correlate with specific microbes, specific organ dysfunction, specific diet issues, and environmental exposures. We keep asking questions until we detect patterns in the chronically ill patient that correlate with any number of overlapping issues such as infections, hormone deficiencies, immune dysregulation, toxic exposures, and diminished capacity to detoxify. And then we explore the interrelationship of all these problems. Differentiation then integration.
I think of these overlapping patterns on the physiological level as horizontal issues. But there are also vertical issues: emotional health, support networks, resource capacity, belief systems, and spiritual wellbeing. The concept of mind-body connection is a misnomer; the mind and body are one universe, and our perception of self in the world is a template on which we manifest all levels of being.
We who are blessed with the opportunity to help others are obliged to be objective and discerning, but also to hold a space of safety, acceptance, compassion, and respect. As I watch the nurses’ interactions with my wife in this hospital, I appreciate their competence, but I am awed at their depth of caretaking, their kindness, and their humanity. My prayer is that we physicians can dissolve our headstrong egos and be fully present with our patients.
Daniel Kinderlehrer is a physician and author of Recovery from Lyme Disease: The Integrative Medicine Guide to Diagnosing and Treating Tick-Borne Illness.
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