Answer me this....

Recently I asked 100 patients 4 questions. In Spanish. And in English.
The questions involved their acupuncture experience in terms of Courtesy; Communication; Pain Reduction; and Continuity of care.

They could choose from 3 answers: a) Above Average; b) Average; c) Below Average. There was also a space below for additional comments regarding any areas of dissatisfaction. It was the first time in my 4 years at the hospital that I stepped out of the box of 100 patient visits a week to actually get a birds-eye view of patient satisfaction. And a valuable tool that I had left inside the door when I exited a 25 year career in advertising and P.R..

Feedback is not something that should be relegated to bats. To keep them from crashing into objects in their path. Our questions asked of those we serve can add trajectory and velocity to our flight as well. And make our navigation more precise and unerring.

This experiment reminded me of a training I did in Constructive Living Therapy with it's  founder David Reynolds about the same time I began my Acupuncture Study. He requested that we ask 3 questions regarding our key relationships:
What have I received from you?
What have I given you?
How have I harmed you?
I dare you.

And how does this work.....exactly.

It's the "exactly" that throws me. Every time. It happened again yesterday. From an attending. He had finished writing up a recent case of mine for presentation at an upcoming Anesthesia Conference. This was a 22 year old Hispanic girl with a small calibre through-and-through gsw entering at the left scapula and coming out through the left upper chest wall, barely missing her heart, but severely affecting her brachial plexis. She had come in for a nerve block, but had no driver to take her home. The attending asked if I could do anything for her, and I gave my standard answer. Sure.

I was introduced to her by the attending. She was crying. Her PCP had told her she had a 2% chance of regaining any use of her arm. 5 minutes later, with needles in Gall Bladder 34 and Stomach 38 on the opposite leg, hooked up to e-stim, she was raising, lowering, and rotating her arm. And opening and closing her fingers. I recorded a video of it on my cell phone, with her permission. I didn't want either of us to forget. Lift-off Houston.

Over the next 10 weeks I would see her once or twice a week, with less and less regularity. At that point she was working part-time as a hostess at a restaurant downtown. And able to drive with 2 hands on the steering wheel and flip the turn signal with her left hand to get there. She didn't really need me. She had "flown the coop". But there was the ever-lingering question. Curious minds want to know. How does it work?

My answer to the resident was standard. How does heating a point on the ouside corner of a mother's little toe (Bladder 67) cause her breach baby to flip head down? Not knowing doesn't seem to effect the outcome.  Trained monkeys could do it. Happy New Year!

"Who ever touches them last is it!"

She came to the clinic for acupuncture for her stubborn back pain, on a scale of 8 out 10. Her tongue was pale, with a bright red tip, and thin white coat. While taking her pulses I noticed a small bruise over the heart pulse position on her left wrist. The pulse was knotted, intermittently intermittent.  I asked her about the bruise. She said she went to ER a few days earlier, with chest pain, and, because they couldn't do an inguinal angiogram, they retried from her left wrist.
In the process she had an allergic reaction to the dye. And her blood pressure dropped to 70/25.

Hearing this I had our nurse take the patient's  blood pressure. It was 96/66. She also mentioned that her cardiologist had put her on a new prescription, and had given her his cell phone number to call him at the first sign of trouble. At that point I walked across the hall and asked our Attending Pain Physician if he would consult with her, and possibly tweak her pain meds, since I was not comfortable doing acupuncture. I told him, based on a classmate of mine who found a heart patient dead on his table, following a potty break,  I told him I was guided by the rule, "who ever touches the patient last, before a major health breakdown, is it."

After I triaged her to the Pain Physician, I later asked him how things went. He reported that during the consult she mentioned that while she was in ER her heart stopped and they had to give her a shot to restart her heart. Bad odds. High risk. Not a good acupuncture candidate.

Acting Like A Cripple (cont'd)

The second time back the Champ  brought his daughter, his biggest fan, and cheerleader. She watched as I threaded needles through the Zhu back and hip points on his scalp again. This time we did one leg standing, then the other.  Then one legged semi squats. This time he had a family witness. No backsliding. Someone who knows who he is when he forgets.

 The hospital where he was hurt wants to make nice. Do another surgery. He wants nothing to do with it. He's gone on facebook, and the surgeons are getting concerned,  running a little scared. Sooner or later, as he continues to improve, he will get pressed up under the horns of a dilemma. Get  better, and miss Payday for Malpractice, or back-off the breakthroughs of recovery, and finesse the difference in payback for pain and suffering. (the way not to get impaled on the horns of a dilemma is to grab one of them fiercely ).

He has had a lot of that (suffering).  Stuck in a wheel chair having food spooned into his mouth,  in-between sucking down Narco. That's  when I turned him on to Tolle's The Power of Now. And asked him how good he could stand it.?

Secondary Gain Can Cripple

He staggered into the pain clinic barely able to walk. Out-patient back surgery had turned into a nightmare of extended in-patient recovery (sort of). When I called his name, and slowly walked with him to my office, he grabbed my arm and said "I wanna be a champ.  Can this make me a champ?"

He comes from the barrio, and has that Rocky Balboa toughness. So I took a chance, and said yes. (This is what the panel of Docs at the VA, assembled for my vetting there, sternly warned me to never do. Never mention possible postitive outcomes. CYA?) But that is another hospital, another saga.

Back to Rocky. Within minutes of my placing needles in the Dr. Zhu scalp points for his back and left leg, he was walking up and down the corridor without his walker, and more importantly, sitting and standing from his chair without holding on to the arms. I finished with a ASP darts in his left ear, and whispered into it, "Stop acting like a cripple!"

Of course I can't be this bold with everyone who comes to the Pain Clinic. But the opportunity, when one meets a Lion, is to play like a Lion. And the art is to distinguish them from the antelope.

Patients as teachers

It happens all the time. It happens every time. Patients teach. They tease out our skills. We just have to listen. To look. To touch. Carefully. Without prejudice. Someone once told me, "we hold the space for their wellness to show up in". And sift the root cause of their illness. Example.

Last Friday two patients thanked me. One for referring her to ER, where she subsequently had a stroke. The second for referring him to ER, where they discovered he had kidney stones. A nickels worth of needles would have delayed the inevitable.
 Knowing when not to treat, based on the muted advise of the patient. Not just their recitation of what went wrong, way back when. But right now, piercing the veil of Story. Filled with disappointment, frustation, and overwhelming, grinding pain, reveals what really needs to be known. To make a quantum leap out of the morass of misery.

The last patient of that day was a first-timer with us. She spoke only Spanish. Which warranted getting a translater on the Speaker phone, and the delay of translating questions from me, and answers from her. As well as translating questions from her. And answers from me. But the body is universal.
Her right shoulder and neck were very painful. More importantly, she had a history of breast cancer, a left side mastectomy, chemo and radiation.
 She was disappointed when I used only one needle on the opposite leg to restore 80% of her mobility. And significantly reduce her pain. As an afterthought I also did a Wind point on the back of her neck. Given the Weather's rapid 20 degree change to cold and snowy.

We wound up with about 30 minutes of talking, and 10 of acupuncture. I promised her more later. She will teach me more then.

NONE LEFT BEHIND

He came to the PTSD Clinic with a death sentence for his leg.  The VA docs said he would continue to lose function and gain pain from the gift of shrapnel stitched in his right thigh and groin from a landmine 30 years ago. Later he had rolled a jeep and crushed his shoulder.  For some fluke of fate he had gotten significant relief of that on a riverboat cruise in China, from a boat- bound acupuncturist who used a combination of bone-setting, needles and tuina massage to make it whole.  Hope from that is what drove him to my doorstep at the National teaching clinic.  One scalp needle got rid of the pain and restored function in minutes. His follow-up 2 days later confirmed he had gotten 75% improvement with that first salvo.  Treatment two focused on the shoulder with a needle through St 38 to Bl 57 points with similar results, followed by the 5 NADA ear points for the deeper, PTSD scars.  He, his wife, his farm (he sits on his tractor without pain) and his VA friends are thankful beneficiaries.  Happy July 4th ya'll.