A guest blog by Marie Bourgeois.
Today, I am angry.
As medical practitioners, we are often not equipped to deal with human complexity. We were taught to deal with pathology. We were told we would have to explain to our patients what they have to expect for their future. We were told that we might not be able to fix some people and that they will probably need surgery. But we were not prepared for the enormous teaching role that our work involves.
Six months ago, I saw a teenager. 17 years old, a student beautician, wanting to have a long and beautiful life with a future husband and children.
First time I saw her, she was paralyzed by fear. She couldn’t move really more than 10° in each lumbar plan, she was dealing with an awful pain… And she didn’t want to be here. She cried during all the session… and yet, I didn’t even ask her to move more than what she did to come to the clinic.
She was crying because of fear and anxiety. She was crying because she already had a physical treatment and – as can happen – it hurt her, without any benefit. She was crying because she had been told that, as her dad had to go (twice!) to surgery because of a herniated disc, it would be probably the same to her – sooner or later. She was crying because she had been told that a job as a beautician, with low back pain, is not a job for her. She was crying because she had been told pregnancy would be difficult to her because of her lumbar spine. She was crying because she had been told the day she would give birth she will not have epidural anaesthetic because of her lumbar spine.
17 years old, and she was paralyzed by fear. 17 years old and she couldn’t picture any future she wanted without pain and suffering in either her private or professional life.
I was angry. I was sad. I felt ashamed because the practitioners she was examined by were probably thinking they were doing the right thing. As I have done to other people: I have told other patients, for their own good, they had to change the way they live.
« For their own good »…
We are all guilty of overly paternalistic care and one-way advice giving at some point. We are not prepared to deal with humans. Only with pathology… And sometimes, when we don’t know, it is easier to say that this activity is bad to the patient than saying “I doubt I am the best to help you to do this again.”
I changed. I am far away from perfect, and I have a lot of things to improve. But changing helped me to deal with this young girl. To help her to feel better. This helped me to not focus on the pathology but on the human I had in front of me.
She worked hard, and she is smart. She understood a lot of things. She felt better, she smiled again, and she finally was feeling better than before her pain crisis. Everything was fine…
… Until she experienced pain again.
I had a session with her yesterday. She spent the entire session crying again. She had pain in her leg, “Like my dad”. She had paraesthesia, “Like my dad”. Sometimes, her legs barely supported her, “Like my dad”.
I am angry because of the communication problem there was with this young girl. I am angry with myself because I seriously thought she had overcome her fear. I am angry at the system because we are not prepared to deal with the complexity of human emotions, to deal with the brain. I am angry because she knows it’s going to be better. She knows it’s hard, and yet her pain is going to improve again. And she is still as scared as the first time I saw her. She is still thinking her life is ruined. And yet, nothing is damaged inside her back. But she is now paralyzed by fear every time she feels pain.
I am angry. We, as medical practitioners, are inducing and conditioning fear in others. Even though our bodies are equipped with some amazing abilities to self-repair. We, as medical practitioners, are inducing ongoing pain… by doing what we think is the best for our patients. I am angry. We never learned how to deal with human conditions, how to explain complex problems to somebody, to explore feelings, to overcome fears, to promote happiness. As a student, all I was taught was how to deal with the pathology, and to ensure that, “You don’t involve yourself too much, you have to put a therapeutic distance between your patient and you.”
I am angry. And I will try not to forget this young girl next time I have to explain something. Words are like toothpaste. Once they’re out the tube, you can’t put them back in!
Thank you for reading.
Marie is a French physiotherapist who works in Toulouse.