Monday, February 6, 2012

Carnage of Symptoms

Photo by D'Arcy Norman via Flickr, used
under the Creative Commons License.
By Lise Alschuler, ND, FABNO
AANP Past-President (2008-2009)
If you were to walk into my study, you might think that an enormous massacre had taken place. A duck lays across a chair, its beak dangling over the edge of the seat. Below the duck, a monkey can be found sprawled on its back with a rooster, a look of alarm on its face, oddly resting its head on the monkey’s belly. Across the room, there is a red bird unceremoniously toppled to its side. A few feet away lies a giraffe, long legs tangled helplessly. And then, towards the back of the room sprawls the hunter, exhausted after this convincing display of prowess, legs and ears all comfortably splayed on the ground.
Despite the fact that the subjects of the scene of carnage are stuffed animals and the hunter is my dog, it is eerie nonetheless. As I look out on this scene, I think about how cute it is and enjoy a swelling feeling of pride in the playful delight of my dog. And yet, the scene really is rather horrific. As I continue to survey the landscape over the rim of my computer, I am struck by how much I can determine about how my dog has spent her time, just by looking at the display of critters. I can tell which ones she snuggled with, which ones she ignored and which ones she chewed on. I can imagine her making her way from one to another until she finally gave into the pull of happy exhaustion.
In many ways, the symptoms that our patients manifest, like these animals littering my study floor, are the end-results of various processes – processes linked together, perhaps by their own narrative, but often not. We often must draw upon our training and clinical experience in order to piece the symptoms together and to generate a pathway from one to another. Our sequence of events ends with the patient sitting before us and presents an explanation for their current state. And then, very much like I am about to pick up these animals and return them to their proper box, we physicians apply our therapies and attempt to remove each symptom from the landscape of the patient’s life. We often dig deep and have to do some major rearranging to get at the root of certain symptoms, but if we are persistent and attentive, we can successfully restore a more serene state of health in our patients.
This may seem like a silly analogy, but as I reflect on this, I find it oddly reassuring. Things are messy, sometimes the way they get messy is rather fun, tenderly sweet or perhaps not. The consequences can be distressing, perhaps even dangerous, but we are trained and capable of restoring order. And, unlike my dog and her toys, we can also empower patients with the tools that they need to effectively pick up after themselves.  

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