Sunday, October 9, 2011

Holding Hearts, Alternative Medicine and Acting Class Flashbacks . . .

Today I held a human heart in my hands for the first time. I have been taking Anatomy for several weeks now, but somehow this was different. There is no escaping the symbolism of the heart. I got to it by having to saw through the ribcage, cut through various muscles, scrape away fat, and there it was. As much as my team and I wanted to move on to our tasks and locate vessels, valves, and segments, we all paused to recognize that the organ we were holding had, at one point, been beating for 52 years to sustain this man's life. There is is something about getting that close to the center of another human being that demands a moment. The moment was too short; we soon jumped into our clinical tasks. But perhaps if we had lingered longer, we would have understood why the heart has such literary significance as being the seat of emotions like love, despair, longing, excitement, romance, when it is anatomically an elaborate pump. Perhaps we might have been reminded of the scripture in Proverbs that says "Guard your heart for out of it flow the issues of life." I love how much I'm learning, but I wish we had more moments to pause . . .

This week also featured a visit to a Complementary and Alternative Medicine practitioner. The idea of this is to expose us to other viewpoints and methodologies in medicine. Far from being simply fringe and quacky many of these approaches are being increasingly used and being integrated into the practice of medicine. I was assigned to an Alexander Technique teacher.

This was a fortuitous assignment as I had encountered the technique before in my MFA Acting program before medical school. In that context, I was learning how to enhance the physical expressiveness of my body as an actor. I was therefore curious to learn about broader applications of the technique in a medical context.

The first element that stood out to me was the concept of “awareness.” I have always been interested by this idea, the tremendous challenge of being in the present. In this context, we were challenged to consider our bodies in action. What did we do and was this optimal? Clearly, interrupting our breathing and restricting freedom of movement were easily ingrained habits that could seem “natural” over time. As an actor, I was always being challenged to observe, truly take in my environment, including my own body. Apparently, the physician too, must take a moment to take stock. I think this process is easily overlooked in the intellectual rush to assimilate and process information. It is possible to never “see” the patient. I find the point of awareness to be especially crucial for the doctor.

If the sitting position revealed the importance of awareness, the lying position was instructive about the idea of control. Several times, the practitioner would say something “May I have your arm?” which meant, “You don’t need to help me move it.” But our tendency is to want to do something. This allows us to remain in control; it is at this level that Alexander helpfully departs from simply “posture training.” Training posture often comes down to “quick fixes” like “sit up straight!” The approach is “Tell me what muscle to tense, and I’ll take care of it.” In Alexander, the result is often achieved by release, by not doing instead of doing and thinking through an action, not in a cerebrally detached manner, but in an integrated fashion. Again, I think the concept of control has clinical implications. Do we have the courage to release, to let some else expand what we can do, to let the skills of the team lengthen our reach? I found that Alexander principles often had both metaphorical and literal implications.

Of course, somewhere in all this wonderful, interdisciplinary flights of fancy, the intellectual demand in my mind for concrete effectiveness was bound to intrude. I was, therefore, pleased to receive a randomized study from the practitioner providing a measure of empirical evidence for Alexander’s effectiveness. If CAM techniques like Alexander can meet a reasonably rigorous scientific standard, then the application of such techniques will come down to courage. Are we as future physicians willing to move beyond the safe zone of familiarity to the unknown? Are we willing to work through intellectual culture shock? I, for one, think that if such courage results in better care for our patients, then there is really not much tension left in the question. CAM becomes much than “complementary” or “alternative”, but rather part and parcel of the primary options for care. 

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