Tuesday, March 30, 2010

Medicine and Society

Contemporary medicine in and of itself is complex: Trying to find a professional & personal "home" amidst the tethers and freedoms becomes an even more intricate task when an academic appointment is added to the clinical practice mix. This is on my mind recently, having passed the halfway mark of this Palliative Medicine fellowship. In earlier times, physicians were accountable primarily to their patients and their colleagues. Now they are accountable to governments, institutions and commercial organizations for their competence, performance and productivity, not to mention the cost-effectiveness of their activities.
 
The word cloud above was created from text in the article below. Food for thought: The authors explore relationships between health care's multiple stakeholders, particularly focusing on society's expectations of a physician and a physician's obligations toward society. Selected words have been assigned greater prominence to emphasize their significance in the source text. 
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Sunday, March 28, 2010

Is There a Difference Between the Soul and the Spirit?

Waterhouse painted "The Soul of a Rose" in 1908. I thought about this image the other day after seeing a patient with a reduced sense of smell. He breathed through a tracheostomy, bypassing the nose and the olfactory (sense of smell) apparatus because of prior total laryngectomy to remove vocal cord cancer.
The word soul brought to mind the quote "Nothing can cure the soul but the senses, just as nothing can cure the senses but the soul" Oscar Wilde  
That led to "You don't have a Soul. You are a Soul. You have a body" CS Lewis From there, I spent the remainder of the evening on an interesting Internet and eLibrary journey, reading and thinking about the soul and the spirit, how these words are defined and how they tend to be used in the Palliative Medicine literature.

Here is a sample of what I read:
  • Our Spirit represents our true self, the spark of light. The Soul represents human/animal physical being. The Spirit is the life force that uses the soul (the body).
  • Is there a difference between the Soul and the Spirit? The Greeks certainly thought so as they had different words, with completely different meanings, to describe each one. The Greek word for 'spirit' is pneumatos which means air, or wind. Wind/air (breath) is associated with the quality of having life, or being alive. The word 'Soul' derives from the Greek root psukios, which means mind, the seat of human consciousness, and cognition. Today, the soul and the spirit are mostly viewed as being the same thing, but the topic allows for an interesting exercise in describing the spirit as the expression of our soul while we are alive (with abilities and senses) in our bodies. Burke McKay 
  • The human mind comprises the brain and all its workings — memory, perception, reason, emotions. It is, in other words, the “hardware” of human existence. The human soul is what governs the human hardware — the “software” of human existence, our very own “operating system,” unique to each of us. The human spirit is the “electricity” that animates us. 
  • Our spirits are the expression of our souls in relation to how we feel, what we sense, and how well we are able to feel and sense. Our senses are gratified by movement, tasting food, breathing fresh air, seeing, smelling, touching and hearing. If we are in pain, our spirits may be more limited than when we feel well, how much more difficult it is to interact with and enjoy the world when pain is present. Sometimes our spirit is broken. Rarely is it ever said that the soul is broken. Perhaps the combination of body and spirit serve to develop our souls until we no longer have functioning bodies. Then life continues in the form of the soul and the spirit, in pure form, with no need for sensory inputs or for physical interaction with the world. Elizabeth M. Young
  • The soul is the essence of humanity’s being; it is who we are. The spirit is the aspect of humanity that gives us the ability to connect with a higher power (God). The word “spirit” refers only to the immaterial facet of humanity. The word “soul” can refer to both the immaterial and material elements. Unlike human beings having a spirit, human beings are souls. In its most basic sense, the word soul means life.

Tuesday, March 23, 2010

It Really is This Simple

"The secret of the care of the patient, is in caring for the patient."
Francis Weld Peabody 1881-1927
Peabody F: The care of the patient. JAMA 1927;88:877-882.

"The treatment of a disease may be entirely impersonal; the care of a patient must be completely personal. What is spoken of as a 'clinical picture' is not just a photograph of a man sick in bed; it is an impressionistic painting of the patient surrounded by his home, his work, his relations, his friends, his joys, sorrows, hopes and fears..."

From the Art Blog by Bob:
No other artist ever painted sickness and death quite like Edvard Munch. Munch, most famous for his iconic (and frequently stolen) 1893 painting The Scream, knew death intimately from a young age, watching siblings, family members, and friends all suffer through long illnesses against the backdrop of the cold, bleak winters of his native Norway. The Sick Child (above, 1885-1886) represents just one of his many depictions of illness.

Saturday, March 20, 2010

It is Possible to Die Healed

"It is possible to die healed". I read this sentence in a Palliative Medicine text recently. The author, Balfour Mount, suggested the word 'healed' embraced the concept of human wholeness. As I was pondering my definition of healing, I was transported back to Epidavros, Greece, remembering a trip to commemorate medical school graduation and the profound impact of simply sitting on the amphitheatre steps contemplating the legacy of medicine.

The ancient Greeks were treated in Asclepions. These were healing sanctuaries named for the mythological god of medicine, Asclepius. When the philosopher-physician Hippocrates, a descendant of the asclepiad began his practice he introduced observation and study of the human body. His approach provided a physical & rational explanation for illness previously attributed to superstition, disfavor of the gods and evil spirits. He believed in the natural healing process of rest, a good diet, fresh air and cleanliness and ascribed to the philosophy of physician as "healer of the sick", rather than "curer of disease". Hippocrates believed the body must be treated as a whole and not just a series of parts.

When Thomas Egnew began his PhD studies on the meaning of healing, he was surprised to learn that despite references to the word healing since ancient times, medicine had no accepted definition of holistic healing. He hypothesized that ill persons undergo transformations in which they are unable to be the persons they once were. This threat to wholeness generates suffering that involves the physical, social, psychological and spiritual dimensions of personhood. He concluded by proposing that healing is the personal experience of the transcendence of suffering and is related to themes of wholeness, narrative and spirituality.  As an aside, the term medicine is derived from the Latin ars medicina meaning the art of healing.

To read Egnew's article, click on his name in this post, then select Full text (PDF) from the right column.

Thursday, March 11, 2010

Hallelujah

After many hours of searching the Internet and chasing false leads, this site, soundcloud.com gets the nod as the third party audio file web hosting platform for the music on this blog. It has taken a few more hours of fiddling with HTML embed codes, sound bars and colors in order to reload the musical selections in various posts. Today, it works. Tomorrow, lets hope it works. And right now, I feel like celebrating. Here is kd lang's version of the Leonard Cohen song, Hallelujah...from the Hymns of the 49th Parallel album:

Sunday, March 7, 2010

Music malfunction

Mailboxdrive.com, where the music files for this blog are stored, has 'crashed'. They are working to rectify the problem. In the meantime, none of the musical selections contained in PalliativeChronicle posts are working. I am looking for other music hosting sites but am hopeful (and hoping! - converting files, uploading and re-formatting the player icons takes a bit of work) all will be fixed next week.

Saturday, March 6, 2010

Noble Silence ~ Meditation & Yoga Retreat


 Learn to be quiet enough to hear the sound of the genuine within yourself so that you can hear it in others ~ Marian Wright Edelman

 
In this sense, the word noble takes it's derivation from the Greek gno (as in gnosis), meaning wisdom or inner illumination. Noble Silence is the practice of intentional silence in the Buddhist tradition. No radio, phone or television, no reading, writing or talking, no communication with anyone in the group by gestures, eye contact or sign language. Yet, the silence was about presence, not absence. A day to focus on all five senses; sight, sound, taste, smell and touch, cultivating higher levels of perception and sensory awareness.  Encountering silence, listening to your inner voice. 
Photo obtained under creative commons license http://www.flickr.com/photos/h-k-d/

Friday, March 5, 2010

The Power of Presence

In meditation class the other night, we stood facing a partner and settled into mountain pose, standing tall, feet ‘anchored’ to the floor. One member of the pair, with eyes closed, slowly raised their hands above their head and began the exercise, noticing every sound, feeling, thought, sensation, emotion and movement experienced 'in the moment', speaking each one out loud as it passed through their consciousness… “cool breeze on my feet”, “car passing by outside”, “shoulders starting to ache”, “feeling calm tonight”….  Their partner observed silently, concentrating, paying attention, and really being present. The exercise lasted 8 minutes, a chime sounded and without saying a word, we reversed roles. It was very powerful, giving the gift of presence, cultivating respect for the other person’s dignity.
The experience reminded me of a moving narrative published recently in the Journal of Palliative Medicine. It is a mother's story about caring and the power of presence.  The significance of the Phil Collin's song "You'll Be in My Heart" becomes apparent toward the end of the article.
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