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Ear To The Ground

Ear To The Ground

Fall seems to be making its way into the Memphis area finally. The air has become more cool and crisp, leaves are turning color and patients are complaining that their allergies are acting up. I find the fall season to be my favorite season of them all. It signals the transition of the old giving way to the new, but not in an unhealthy way. It is the perfect metaphor for the healing arts.

Many of you have read the updates of one of my favorite patients: the young woman with Gillian-Barre Syndrome. She is one of those young, energetic adolescence girls that has endless optimism and believes that the world is more than herself. She has withstood the onslaught of unbearable stomach pains, weakness, fatigue, progressive paralysis, recent infusions of IVIG, severe headaches probably due to the infusions of IVIG, weight loss and sleep deprivation. Last week, when I spoke with her and her mother, she had found the land of desperation and had decided that her adventure in illness needed to come to a close soon. She no longer believes there is a light at the end of the tunnel, now she sees the dark tunnel extending another few miles with no exit. She has grown tired of the pain, tired of taking medications, tired of experiencing the side effects of the pain medications and she was exasperated that she could no longer be just a normal, healthy young woman trying to find her passion in life, a place to make a stand and possibly mature into someone who will contribute to the greater good of mankind. Her illness has been stealing bits and pieces of her Spirit, the same one that has kept her mind off of the possibility that the remedies to her stomach pain may never be found.

Nature is mysterious. Humans are a part of nature in all of its beauty and disappointments, its health and its illnesses, its birth and its mortality. I often wonder why someone like her, so vibrant and full of life would have to walk a path so disturbing that most of her peers would have already folded their cards and move on to the next hand (if there was a next hand). But not this young woman. No. She has weathered the storms and much of her weakness and inability to walk. In the last few days, she is able to perform a few normal daily activities, functionality is starting to return to her weak and malnourished body. She has made great strides in her physical recovery, however her medical misadventures have taken a great toll on her Spirit.

Sleep is one of the most important dimensions in the human healing process. Patients who succumb to illness tend to lose their normal circadian rhythm of slumber. Forced insomnia is a powerful torture, worse than almost all other forms of human persecution. Illness induced insomnia almost always guarantees suffering in one form or another. Lack of cognitive acuity, brain fog, daytime hypersomulence, depression, anxiety, paranoia, loss of appetite and anger all seem to emerge in a patient who becomes sleep deprived. Small insignificant disturbances are magnified to huge mountains that block any kind of optimism. But the greatest disturbance caused by a lack of sleep is the absolute destruction of a patient's perspective on their illness and loss of an effective strategy to combat the everyday assaults on their psyche. Patients begin to dwindle, some fall into the rabbit hole believing that all is for naught. Their minds begin to play tricks on their reality, often making them believe that any medical or pharmaceutical answer to alleviating their symptoms will lead to just more intolerable side effects. Their thoughts becomes infected with a virus or protein that seems to replicate the idea that they are never going to heal, and that all options for healing are either useless or fraught with so many side effects that the healing benefits are obscured. Sometimes insomniacs stand in irons as if the winds of change have all but died down, wondering if being dead would be more useful than being alive. Their past is past, their present is unbearable and their future holds nothing but misery and suffering. No words can console them, no touch can revive them and they stay numb to all that is good, only to be aroused and affirmed when anything bad happens. The scales are artificially tipped and any gain that is made is dismissed, even if they return to totally normal function. They continuously wait for the other shoe to fall.

The young woman sat in a chair receiving an intravenous infusion of thiamine. She had just finished her fifth infusion of IVIG. Everything hurt; muscles, joints, abdomen and head all were on fire. She had no restorative sleep for days. She could barely keep her eyes open as she struggled to have a meaningful conversation with me about her pain and suffering. Her mother sat patiently, holding her hand and trying not to cry as she saw her most precious treasure just hanging on, talking and many times looking confused and incoherent. As I spoke to her and tried to tease out more information about her illness and its change for the better or worse, she tried and tried to be cooperative, humorous and effective in her communication with me. But the sum of the insomnia, IVIG treatments, medications and her disease all but imprisoned her, she was shackled by the all-of-it, no matter how hard she tried to escape.

I changed her medications around. Found a few drugs that she could try to help alleviate her stomach pains and help her sleep at night. She has nightmares of being in LeBohneur Hospital, something that is totally understandable given the care and compassion she and her family received for two or more weeks there. The most important next step of therapy at this moment is to get her brain to shut down her frontal lobes and prefrontal cortex, while she sleeps eight to ten hours every night. Healing occurs best at night under a good night's sleep.

This young woman has courage. Her illness will resolve in the near future, of that I am sure. Why am I certain? Because I can hear those who's will penetrates the heavens and the greatest good for mankind mandates that she restores her health. Her current fate will change for the better. How am I going to help her? By watching her unfold as I change her therapies.

I have changed her medication again, how she responds, good or bad, will dictate the next change. Eventually she will heal and this entire episode will be a dark, mysterious safari through a distant jungle of disease and mystery. Until then, I'll have to keep looking, keep questioning myself about her illness and keep listening for any sign of improvement.

So if you see me putting my ear to the ground listening, I'm listening for what needs to be changed next. Being open is the first step to listening for the answers. Thank goodness I am still open to novelty and I can still put my ear to the ground and get back up. Can you?

Doc

Posted by Amanda Sanders at 10:06 AM
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