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Saturday, September 1, 2007

Miracles reside in comforting and healing: Dr. Bernard Lown

Dr. Bernard Lown on healing without curing

Even when cure is impossible, healing is not necessarily impossible. The miracles reside in the capacity for comforting and healing.

This was brought home to me by Mrs. J., a well-composed, articulate woman in her mid-seventies. Over the preceding five years, she had become increasingly disabled with weekly paroxysms of atrial fibrillation, although a multiplicity of tests revealed a structurally sound heart. Several drugs tried singly or in combination were largely unavailing, and a number of them caused troublesome complications. The episodes of arrhythmia left her drained for days, and fear of unpredictable recurrences circumscribed her activities and kept her homebound. As I listened to her problem, it was eminently clear to me that no stone had been left unturned. I could think of no easy measures to effect a cure, and I was therefore astonished to hear myself express a certainty of resolving her problem. I did, however, leave a clever escape hatch by indicating that it would take time.

When Mrs. J. returned some months later, the problem was largely ameliorated. I was impressed with this remarkable turnabout, though the basis was self-evident. I had reassured her that the arrhythmia, while troubling, was not dangerous, and I had discontinued many of the drugs that were responsible for a host of symptoms previously ascribed to the heart. She was now able to sleep through the night, and with more sleep, arrhythmic recurrences were reduced in severity. I had prescribed a larger dose of digitalis whenever a paroxysm did emerge, so her heart rate during the arrhythmia was slowed and the bout became more tolerable. While the fundamental problem remained unresolved, she was able to resume a normal lifestyle.

Yet I could not give myself credit for the outcome. The patient herself had largely effected the extraordinary change. She could be helped because she had become reconciled to an improvement rather than a cure. She welcomed small changes for the better and was ready to exploit these to the hilt. I could expeditiously come to grips with essentials because she was sharply focused and not hypochondriacal.

If a patient is ready to be helped, even a little, and grateful for the marginal, it enhances the doctor's commitment to fostering a relationship between equals. Only such a relationship, bonded by understanding and respect, can deepen into a true healing partnership. This encourages, in the words of Lewis Thomas,
"the capacity for affection," the essential element for healing.

Advice to patients: Be ready to be helped, even if a cure is not possible.

Read a story on physician/patient rapport, or read Dr. Lown’s book, The Lost Art of Healing: Practicing compassion in medicine.

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