I have been busy dealing with a neighbor with a loud stereo. It is hard to write when the Insane Clown Posse has taken up residence in my home. Time to move (sigh). My next post will be about how to fix healthcare, but for now, I will repost "Angels and Bolters", which originally appeared at CancerLynx.
Angels and Bolters: a Field Guide to the Wildlife of Cancer
When you are diagnosed with cancer, strange things happen to other people. Cancer will probably change you, but it also changes people around you, people you thought you knew.
People behave in unexpected ways. Some you thought were friends disappear. Others hang around. And of those who keep coming around, you will be glad to see some, and less glad to see others.
You will find out who your friends are, as the saying goes. As if that’s a good thing. As if anyone ever really wants to find out who can be counted on and who can’t. Someone you rarely saw and didn’t feel particularly close to may turn out to be the person who is most supportive, who most understands what you are going through.
Although each person’s cancer experience is unique, there are some commonalities. The following is a guide to the creatures you may encounter.
Preachers
Preachers are anxious to give you advice and information. They are convinced that they know what is best for you, and they go out of their way to share their answers. They bring you books and CD’s, herbs and pills, or they know where you can send money – usually a lot of money – to obtain a product that is guaranteed to cure you. This guarantee, on closer examination, turns out to be more like a strong opinion.
So they will assure you that vegetarians don’t get cancer, or meditators don’t get cancer, or those who think happy thoughts. None of which is true. They bring you tofu and sprouts when you really want a pizza, and then you feel guilty for eating pizza at all. They insist that you think positive, at a time when you are bald and nauseated and have a temperature of 104 and a major body part is missing.
Preachers are usually well-meaning and sincerely concerned for your welfare, so they are hard to ignore. They are convinced that the one thing they promote is the thing that will cure your cancer, if you only do it correctly. This last part is the kicker – if it doesn’t work, you must not be doing it right.
Clueless
The clueless make inane comments. These comments usually fall into one of three categories:
• Cancer is not really a problem. (e.g., losing your hair/body part/health is not really a problem.)
• Cancer is really a blessing. (You’ll find out who your friends are. Cancer is a gift from God because you are so strong.)
• You caused your cancer. (Remember that time you had a negative thought? You are not praying hard enough.)
There are an infinite variety of idiotic remarks. When you have cancer you are liable to hear one or two that are amazingly thoughtless.
If preachers are honestly concerned for your welfare, the clueless are primarily concerned about themselves. They want you to be cheerful because it makes them more comfortable. (This includes some health care personnel.) Those who deny their own sadness and grief do not want to hear about yours.
The clueless want to believe that the world makes sense, that it is fair and just, that people get what they deserve. They are willing to ignore any evidence to the contrary. They don’t really understand your situation; they cannot see your illness from your perspective. They are not interested enough to understand, or they are too fearful of their own well-being.
But their ignorance is not your problem. Education of the clueless is extremely time-consuming and frequently doomed. It should be undertaken only in desperate circumstances, or out of sheer boredom. These people are exhausting. You may have to decide whether their company is worth the emotional cost, as you are likely to end up taking care of them.
Bolters
Bolters disappear when you are diagnosed with cancer. The bolter is someone who was always around before you had cancer, but now does not call and does not show up. Bolters may or may not send a card before they leave.
When questioned, bolters make excuses: they knew you were tired, or they knew you would ask if you needed anything, thus blaming their absence on you. Like the clueless, their distance reflects their own discomfort. They stay away because they are afraid of their own sadness or their own mortality.
A related creature is the virtual bolter. Virtual bolters may be physically present but act as if you were no longer there. They ignore you, as if you were invisible. You find yourself not invited to events, as if you didn’t exist. You are suddenly excluded from a weekly meeting you have attended for years.
Like the clueless, bolters are generally resistant to logic and are thought to be incurable. When they are caught and questioned they blame others, and it may be best to simply let them go.
Angels
Angels know what to do, and they know what you need. They drop by with a bag of groceries or they offer to walk the dog. They will listen when you need to talk, or they can just sit next to you and be there without having to do anything or say anything. They know that just being there is doing something. Angels tread lightly because they have no agenda of their own.
They treat you like the person you always were. They know that despite the cancer you are still you.
Sometimes angels just know what you need, and sometimes they need to ask. An angel knows how to listen to the answer, how to listen to what you say and to what you’re not saying. You can cry with angels and you can laugh with them, sometimes both at the same time.
Some are born angels. Others have to learn, which takes time and may be awkward at first.
Fellow Travelers
For fellow travelers, your cancer journey is their journey. Family members become fellow travelers out of necessity. Others stick with you by choice.
When you have cancer, they have it too. And in some ways their journey is harder, a time of frustration and powerlessness. While you can fight the cancer, they can only observe.
Fellow travelers want to be supportive, although at first they may not know how. They can become angels but it will take time. Most of us are not good listeners, and it takes a while to learn. You can help by being patient and by asking for what you need.
The clueless are right about one thing – there are good things about having cancer. The best is the opportunity for a closer relationship with those who care about you. And, of course, you learn who your friends are.
from Angels and Bolters: Women's Cancer Scripts
copyright Karen Ritchie, M.D.
all rights reserved
Thursday, July 30, 2009
Thursday, July 23, 2009
Health Insurance – I’m Not Buying It
I haven’t paid much attention to the debate about health care. It didn’t seem to affect me, until I heard that everyone would be required to buy health insurance. OK, now I’m listening. Now I’m getting the knitting ready.
Let me explain. Although I have practiced medicine for over 30 years, I haven’t had health insurance for ages. I don’t go to doctors, can’t remember the last prescription medication I took. I don’t use health insurance and am not willing to pay for it. The knitting? I remember that when Murphy Brown went to jail for not revealing her sources, she spent her time knitting. I figure if I don’t buy health insurance and they put me in jail, I can get caught up on my knitting.
I am a psychiatrist. Recently I have worked at several Veterans Administration clinics, where most of the veterans I saw had post-traumatic stress disorder. I found that none of the pills or therapy we were using were as effective for this condition as a technique called EFT, Emotional Freedom Technique. This technique is like acupuncture without needles. The veterans can do this technique themselves at any time, even in the middle of the night, and they don’t have to re-experience traumatic events as they do in traditional therapy. Now, EFT is not formally accepted in most VA facilities. I had to do it under the table (you know that’s just a figure of speech, right?) I didn’t hide the fact that I was doing it; I just didn’t ask permission.
According to an article in the Journal of the American Medical Association, there were 628 million visits to alternative health-care practitioners in 1997, 243 million more than visits to all primary-care physicians. This was twelve years ago. So which is alternative and which is mainstream? And who decides which is which?
Some people prefer not to be part of the conventional medical model, with its aggressive, disease-is-the-enemy, the-body-is-stupid, dying-is-losing approach. Some don’t want the mercury in vaccines. Conventional medicine is not everyone’s preference, it is not the only game in town, and it is not necessarily the best for every problem. It is the most expensive without being the most-used. Think about that.
Let’s say that you wanted to understand how an electric outlet works. You could dissect it and examine all the parts. With a high-powered electron microscope, you could see the very atoms of the outlet. You understand how the plug fits in and what keeps it in. But then you say, “There is no evidence of this ‘electric current’ you’re talking about. It doesn’t exist. Trust us – we’re the scientists and we have the equipment.” That is the mainstream medicine approach to humans. Anything that is not reducible to three dimensions is invisible. You could gather bushels of evidence for the current and it would still be ignored because it doesn’t fit preconceptions.
The word science is used as a thought-stopper. Anything scientific is to be believed, no questions asked. But science, like accounting and economics, can be distorted to meet other aims. And medicine is beholden, to a stunning extent, to the drug companies. (I appreciate Senator’s Grassley’s efforts to show the industry’s effect on psychiatry.)
Evidence, to Aristotle, meant that you observe for yourself what is going on. Evidence, to modern medicine, means something very different. The only thing that counts as evidence is enormous, expensive, elaborate studies. For the most part, only the drug companies have the money to pay for those studies. So we have this evidence only for newer drugs, still in patent, that make the drug companies money. Older, cheaper drugs have no evidence. Anything not connected to a pill, machine, or surgery that makes someone money has no evidence. We are currently making a big effort to save money in an industry where any inexpensive treatment is not allowed. And we wonder why we haven’t solved the problem.
My job is to determine what is and what is not crazy, and this industry is crazy. Congress may get away with this – citizens seem awfully passive these days. But I’m tired of being passive. No vaccines for me, and I’m not paying for health insurance. I’m thinking of sending some knitting needles to my legislators, just so they know.
Let me explain. Although I have practiced medicine for over 30 years, I haven’t had health insurance for ages. I don’t go to doctors, can’t remember the last prescription medication I took. I don’t use health insurance and am not willing to pay for it. The knitting? I remember that when Murphy Brown went to jail for not revealing her sources, she spent her time knitting. I figure if I don’t buy health insurance and they put me in jail, I can get caught up on my knitting.
I am a psychiatrist. Recently I have worked at several Veterans Administration clinics, where most of the veterans I saw had post-traumatic stress disorder. I found that none of the pills or therapy we were using were as effective for this condition as a technique called EFT, Emotional Freedom Technique. This technique is like acupuncture without needles. The veterans can do this technique themselves at any time, even in the middle of the night, and they don’t have to re-experience traumatic events as they do in traditional therapy. Now, EFT is not formally accepted in most VA facilities. I had to do it under the table (you know that’s just a figure of speech, right?) I didn’t hide the fact that I was doing it; I just didn’t ask permission.
According to an article in the Journal of the American Medical Association, there were 628 million visits to alternative health-care practitioners in 1997, 243 million more than visits to all primary-care physicians. This was twelve years ago. So which is alternative and which is mainstream? And who decides which is which?
Some people prefer not to be part of the conventional medical model, with its aggressive, disease-is-the-enemy, the-body-is-stupid, dying-is-losing approach. Some don’t want the mercury in vaccines. Conventional medicine is not everyone’s preference, it is not the only game in town, and it is not necessarily the best for every problem. It is the most expensive without being the most-used. Think about that.
Let’s say that you wanted to understand how an electric outlet works. You could dissect it and examine all the parts. With a high-powered electron microscope, you could see the very atoms of the outlet. You understand how the plug fits in and what keeps it in. But then you say, “There is no evidence of this ‘electric current’ you’re talking about. It doesn’t exist. Trust us – we’re the scientists and we have the equipment.” That is the mainstream medicine approach to humans. Anything that is not reducible to three dimensions is invisible. You could gather bushels of evidence for the current and it would still be ignored because it doesn’t fit preconceptions.
The word science is used as a thought-stopper. Anything scientific is to be believed, no questions asked. But science, like accounting and economics, can be distorted to meet other aims. And medicine is beholden, to a stunning extent, to the drug companies. (I appreciate Senator’s Grassley’s efforts to show the industry’s effect on psychiatry.)
Evidence, to Aristotle, meant that you observe for yourself what is going on. Evidence, to modern medicine, means something very different. The only thing that counts as evidence is enormous, expensive, elaborate studies. For the most part, only the drug companies have the money to pay for those studies. So we have this evidence only for newer drugs, still in patent, that make the drug companies money. Older, cheaper drugs have no evidence. Anything not connected to a pill, machine, or surgery that makes someone money has no evidence. We are currently making a big effort to save money in an industry where any inexpensive treatment is not allowed. And we wonder why we haven’t solved the problem.
My job is to determine what is and what is not crazy, and this industry is crazy. Congress may get away with this – citizens seem awfully passive these days. But I’m tired of being passive. No vaccines for me, and I’m not paying for health insurance. I’m thinking of sending some knitting needles to my legislators, just so they know.
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