Sometimes it is easy. The problem is in front of you and the solution is clear and defined.
Sometimes though, the solution requires a journey–an odyssey, with a faithful companion.
The experienced clinician knows this but the new patient does not.
Recently, I found myself in a stressful situation; stressful for many reasons, not the least of which was because it was previously unknown to me. Unknown equals scary.
My advisor, a phenotypically-looking wiseman, said to me in a calm and confident manner, “John, it is like we are at the edge of a deep dark forest. You haven’t been through it before, but I have. I have seen every path, and I know the best way. I will guide you, and we will get through it.”
Hearing this helped me. A lot. Ok, I trained in Indiana; I am still a bit gullible.
I think of this phrase frequently while seeing patients for arrhythmias. This week, I saw two AF patients back-to-back who were at opposite sides of the forest.
One had just emerged from the forest. His AF journey commenced years before, and now he was gratifyingly free of medicine and symptoms. The forest was rough on him. There were setbacks, delays, and long climbs. But we made it–ultimately unscathed. In fact, he said, “if I knew I could feel this good two years ago, I would not have retired.”
The very next patient was here for AF too. She was terribly unnerved by the butterfly sensations in her chest, the breathlessness and the fatigue. These sensations were new to her. Remember: unknown equals scary. One day she was well, and now she was not. She grabbed her neck; “it is doing it now.” (I remembered feeling my neck when that same feeling struck me.). She was approaching the forest and it looked intimidating.
I relayed (not in overtly metaphorical terms) to her that the likelihood is that she and I will successfully navigate the forest. I tried to convince her of this, offering some initial guidance, (information), some contingencies, some possible pitfalls and also, always, an idea of the ideal treasure: a cure without pills.
Some journeys are longer and rockier than others, but as any regular mountain-biker will tell you, knowing the trails makes a huge difference.
Most doctors still love helping patients through the forest. And with our new tools, it is gratifying to pass previously impassible objects, like curing a previously incurable disease or implanting a life-saving device.
Or, perhaps our most triumphant exit from the forest is when a patient says, “just talking with you made me feel so much better.”
JMM