Don’t underestimate patients’ emotions

There’s a saying in medicine that: “If you’re holding a hammer, everything looks like a nail.” It’s our way of acknowledging that we all suffer from a particular set of blinders unique to our own specialties. Usually, our focused way of viewing the patient facilitates our ability to serve them, to see their problem, and fix it. Occasionally, it prevents us from seeing that there may be a deeper meaning to the patient’s problem.

That meaning is often carried in the emotions that precede or accompany the illness. Usually, there is a relationship between the patient’s underlying emotional state and the symptoms for which they seek treatment.

Being difficult to quantify or measure, emotions receive little regard in Western medicine. This is not to say that a patient’s physical symptoms are “all in their head,” but rather, that emotions can have physical and very real manifestations that are often wrongly attributed to an exclusively organic source. When we fail to entertain the possible emotional message manifesting in the body, we may miss an opportunity for greater healing.

What we call a symptom may actually be a message of ancient wisdom, offering healing rather than posing a threat. It is only our blinders that prevent us from seeing the messenger for what it is.

The first time I realized this, I was still a medical student.

Mrs. Jones’ husband of many years had died recently, and she was struggling to make sense of her life without him. They had been high school sweethearts. They had married, raised several children, and fawned over their grandchildren. Their children teased that they still behaved like newlyweds. Without warning, a ruptured brain aneurysm took him from her. Following his death, she sank into a deep grief, despairing that he had betrayed his promise never to leave her.

“He said it was forever, “she told me tearfully. “He said I was his one true love and that he’d never leave me.”

My heart broke for her as we sat together in our pre-op area while the nurses readied her for a procedure.

Mrs. Jones was scheduled for electroconvulsive therapy, a rigorous treatment reserved for the most difficult cases of depression. Her psychiatrist, a well-respected physician whom I knew to be compassionate and professional, if a bit conservative, believed she suffered from major depression with psychotic features. Simply put, her depression was so severe it caused her to have disturbing hallucinations.

She had sought treatment because of a recurrent experience that was causing her great distress. She reported that every night she would awaken to see a wolf sitting at the foot of her bed. She was quite certain that she was not dreaming, insisting she was fully awake. Knowing wolves to be predators, she was puzzled by his demeanor. He didn’t growl or bare his teeth and was not threatening in any way. He simply sat at the foot of her bed, watching her with a steady gaze. Still, she was distressed by his presence.

Her psychiatrist, steeped in science, viewed the situation through the lens of Western medicine and interpreted the wolf to be a hallucination. I wondered, though, if there weren’t another possibility, one that offered both explanation and healing.

In Native American culture, it is believed that when wolves die, they return to their clan members to teach and share healing. They are pack animals with a strong sense of family. Most auspiciously, wolves mate for life and are fiercely loyal. Was it possible that the wolf was a loving visitation from her husband? Had he come to show his faithfulness to her? Was he, like a loyal dog, keeping watch over his beloved as he had always promised?

I mentioned this possibility to the psychiatrist, who immediately dismissed the thought. “No,” he had replied with certainty. “This is major depression with psychotic features, plain and simple.”
As I was just a lowly medical student, I didn’t push the issue, nor did I mention it to the patient.

We proceeded with the electroconvulsive therapy, repeating the treatments every few days over the span of several weeks. During that time, Mrs. Jones’ hallucinations slowly abated. The wolf’s visitations became less and less frequent until he finally disappeared altogether.

Although still suffering greatly at the loss of her husband, Mrs. Jones felt relieved for the wolf to be gone, and her psychiatrist deemed the treatments a success. I was left with a sense of missed opportunity and uncertainty that we had actually served Mrs. Jones well.

Sometimes to understand the Mystery that is our Universe, we must remove our blinders. Left in place, we may cure the disease, but fail to heal the patient.

Michelle Grua is an anesthesiologist.

Image credit: Shutterstock.com 

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