Dear Colleagues,
A few things on my mind. The beauty of this winter 鈥� white snow is falling gently outside my window as I write 鈥� provides a stunning contrast and perhaps an apt metaphor for the experiences of those we care for and the potential in our work. After all, winter is metaphorically a time of death, of bare-leaved trees, of temperatures incompatible with life. And yet, as I round the bend of the Chemin Olmstead on my cross-country skis these last two weekends and take in the view of Lac aux Castors, there is an explosion of life: the laughter of families speeding unexpectedly down the sledding hill, the earnest and involved conversations of couples walking or skiing up or down the mountain, crowds of skaters figuring eights in the rink across the pond. And we know that beneath the surface of the snow, life crackles and renews.
I think back to Michael Kearney鈥檚 lecture this month - the first of our National Grand Rounds series, and the one named in honor of Balfour Mount (who we were delighted to have attend) 鈥� and his discussion of healing and its possibility - for our patients, for us 鈥� and the importance of deep resilience. Part of what contributes to my own resiliency in this work is the recognition of the beauty around us. Not just in nature, or what can be seen through hospital windows, but the scenes of families huddled around the bed of a dying relative; the laughter that emerges from behind a door ajar to a hospital room; the warmth that rises within me when connecting deeply with patients and families. Fundamentally, I believe our work is to help beauty and joy persist and emerge in what is otherwise only seen as a moment of darkness. We do this by helping them feel better, but also by recognizing and celebrating the whole people that precede the illness. More than any other field, we embody Osler鈥檚 maxim that 鈥渋t is much more important to know what sort of a patient has a disease than what sort of a disease a patient has.鈥�
滨鈥檝别 started what strikes me from the first pages as an important contribution to our literature, a book by Joe Wood called Cicely Saunders and Total Pain: Holism, Narrative, and Silence at the End of Life. A beautiful pink book that one would judge well based on its cover, it provides a deep dive into the thinking and writing of Cicely Saunders on the subject of this radical idea. I will share more about this as I dig into it, but it affirms from the first page that 鈥淪aunders used 鈥榯otal pain鈥� to reframe the relationship between medical professionals and dying patients.鈥� I will admit to being troubled when I hear 鈥渢otal pain鈥� used as a diagnosis, an explanatory model for the incomplete relief of physical pain from our standard approaches. It suggests that 鈥�total pain鈥� resides in the cortex, a bundle of social, spiritual, and existential distresses. I think it diminishes the construct to apply it in a way that reifies the concept that it fundamentally undermines. Or, to be less abstract, this use of 鈥�total pain鈥� reinforces the cartesian duality of mind and body that permeates all of medical practice and gives cover to our inevitable inadequacies at diagnosing all facets of disease and the human condition. In any event, 滨鈥檓 intrigued to learn in the introduction that Cicely Saunders herself was inconsistent in her use and description of 鈥�total pain鈥�, so I look forward to reporting back to you.听
And one more thought, partially formed: I read a profile in The New Yorker of a philosopher, L.A. Paul, and her work on what she calls "Transformative Experience" in her book of that title. The subject is 鈥渢he special types of situations that change not only what we know but also who we are. These transformative experiences provide new knowledge that previously would have been inaccessible to us, and with that knowledge our preferences, values, and self-conception are fundamentally altered.鈥� The transformative experience that brought her to this thinking was the experience of having a child. But, as you might imagine, I couldn鈥檛 help but be drawn into thinking about the experience of having a life-threatening illness. In writing about her own labor, she wrote that 鈥渟he had felt like 鈥榓 medieval machine, a giant wheel cranking and slowly pulling giant heavy doors open.鈥� She was overwhelmed, unable to comprehend what was going to happen. When she had imagined the scene, it had always been in the third person. Now she was that person. 鈥� 鈥楾hey鈥檙e not the same perspective, and there鈥檚 no way for them to come together.鈥�
滨鈥檓 wrestling with this. We talk about the importance of eliciting patients鈥� goals, values, and preferences in the setting of their illness, of discovering and acknowledging the whole people in front of us. But what does it mean if people themselves are fundamentally transformed by illness such that part of their suffering is the fundamental rupture from their previous selves.
These are philosophical questions, for others, and unformed thoughts, for me. 滨鈥檓 going to read this book also and do some more reflecting. This is one privilege of our work as academic clinicians. If anybody wants to join me, we鈥檒l have a chance to discuss at our Palliative Care 9I制作厂免费 retreat on April 4 at the 9I制作厂免费 New Residence Hall. If you haven鈥檛 saved the date, please do so. We鈥檝e taken feedback from last year and input from across the community to put together what we hope will be a stimulating and restorative program for the day.
There are some important events in the next week. The Annual Assembly of the American Academy of Hospice and Palliative Medicine is next week in Denver, Colorado. If you plan to be there 鈥� I know there are at least a couple of you 鈥� please let me know so that we can try to meet up. As people have hopefully seen, there will be a for Bernard Lapointe next week. The details for that are here. I will plan to be there on Saturday the 8th to celebrate Bernard and mourn our loss. We are also planning for an event in early April 鈥� in advance of the retreat 鈥� to remember Bernard as an academic community.
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