Sara K. Schneider's Skin in the Game

Reflections on body, culture, and spiritual practice

A Re-membering Human

Sometimes I look to their bodies for a definitive answer to my ongoing prayer for understanding. I remember how I felt when I touched my grandfather’s scars, those deep imprints left by Cuba: I was a blind child reading the past in Braille, understanding for the first time the vast plantation, the raging river, the cattle, the dark jail, the soldier’s clubs. When I ask my patients to undress, I think of him. … Funny how I never feel [their] pain, though I can often reproduce it in them as I press and poke the indicated region. Pain must be too personal, held too deeply with the body, to be known without actually experiencing it. Though my grandfather’s smile emphasized a certain scar on his forehead, and therefore could feel like a blow to the head, so bitter and full of loss, I never felt the pain he must have known. I can only imagine it.

–Rafael Campo, The Poetry of Healing: A Doctor’s Education in Empathy, Identity, and Desire

Twenty-five years of virtually constant computer use: what do you expect? (Hint: If you’re thinking of something between the fingers and the forearms, you’re getting very, very warm.)

To give them credit, the office staff had mentioned that the diagnostic procedure might be “a little uncomfortable,” but nothing more than the slight shock to the system than one might expect from acupuncture needles. The NCV/EMG test would help us find out whether my carpal tunnel syndrome (so much for the pride of being an early adopter!) had involved any nerves in the neck. “More data”: I’m on board!

For the first portion of this test, the physician sets electrodes along the arms, chest, and neck and administers electric shocks; she wants to time the velocity by which the electric signal is conveyed along the nerve. In the second part, the examiner inserts needles into the muscles, asks the patient to contract her arm, and again tests conduction speed (of the pain impulse!). All I can say is, the speed of the pain impulse was something I understood a whole lot better through experience.

I was lying on the examining table when a white female physician and the medical resident who was shadowing her entered the testing room, the former brusquely and if she were determined not to waste a single motion. I wondered whether the force with which she moved didn’t include some overkill. I noticed my new doctor’s almost aggressive efficiency as she set up her equipment and slapped electrodes onto my chest, neck, and arms. Scarcely speaking to me, she instead directed her words to the medical resident, who I guessed was from South Asia. The language was technical, dealing (I think) with how to read the metrics they were about to extract from my body. The resident’s movement contrasted deeply with the doctor’s: she moved in a more spacious, diffuse way, as if uneasy of her place in the triangulated encounter.

When it came time to test my upper body nerves (so to speak), the doctor applied the shocks at different points as if searching for a stud behind drywall. I was astounded by how quickly I experienced what seemed a projection of inanimacy upon me. My new physician was testing my body as if my self had already left it. I hoped that happenstance was still years off but had to reckon with a moment of uncertainty as to whether I was perhaps the person or the state of consciousness she touched me to be. Fighting my own reactivity, I thought I would try some temperate inquiry, ultimately to try to learn not why the tests were being done, but why she was doing them in such a depersonalizing way.

Do you do these tests every day? I asked her. Pausing and staring past me for an instant, she replied, no, only on one day each week, on Wednesdays. Experience had taught her she couldn’t handle on a daily basis the volume of patient venom that would be directed at her during these tests; one man had even jumped off the table and fled the office, electrodes still on, for good. She offered that it worked better for patients if she administered the shocks quickly, as that would minimize the length of time patients had to experience pain.

Her pain or the patient’s? I wondered. The nerve conduction velocity test was physically arduous; after all, the point of the test is to cause and then study nerve pain! But the physical challenge of the test, I soon realized, was a relatively minor part of what I was feeling on the table, which largely derived from experiencing being touched as if I were not alive.

She didn’t “play me like a violin,” at least not in the seamless melding between player and instrument played, or the kind of unity experienced by the dancer who is also danced. Instead, she played me, as the Italian composers might have said, bruscamente: brusquely, abruptly. Dolores Krieger, the inventor of a bodywork modality called Therapeutic Touch, urges therapists to remember that, as humans, “we don’t stop at our skin.” The brutality of the touch had little to do with its mechanics, much more with with what led to each prick and shock and how that intention sank in.

Physician-author Danielle Ofri writes of the “singular intimacies” between physician and patient, a connection that, though not a romantic one, “is an intimacy nevertheless.” But what of professional boundaries? Aren’t caregivers–particularly those with doctoral degrees–supposed to maintain an appropriate level of professional distance? As the progenitor of bioenergetics, a body-based psychotherapy, Alexander Lowen actually urges that professionals learn how to touch patients as part of both diagnostic and healing processes. I’ve substituted “professional” for “therapist” in sharing Lowen’s thoughts: “A professional’s touch,” he writes, “has to be warm, friendly, dependable and free of any personal interest to inspire confidence in touching. … One should expect a professional to know the quality of a touch, to recognize the difference between a sensual touch and a supportive one, between a firm touch and a hard one, and between touching that is mechanical and that which has feeling.” But the touch has to be with “clean hands”: free of the provider’s own need-seeking.

As a culture, we tend to give greater emphasis to outward transgressions of touch boundaries with vulnerable populations–violations of children’s sexual integrity by some clergy, the potential for sexual exploitation of students by teachers or college faculty–than we do to the opportunities for healing that are lost to professionals’ unwillingness to examine how their own needs may inhibit healing. The withdrawal or withholding of a touch that had an opportunity to heal can also be traumatizing.

Some argue that it is in the very nature of Western medical training to objectify the patient in order simply to be able to handle the constant onslaught of human suffering a professional faces every day, that the desensitization is a unavoidable and concomitant in the work. But how encompassing must this be to allow the health-care worker to provide healing to the patient before her and to maintain her own sanctity and integrity to serve future patients well?

Practitioners in many fields–teaching and spiritual guidance come to mind as readily as does health-care–might consider trying the practice following, allowing you to consider the healing power of your own professional touch–given, misgiven, and withheld.

How have you experienced the “singular intimacies” of the care given you by health-care, spiritual, or educational professionals? How have you known when and whether their touch, given or withheld, has helped or harmed you?

To subscribe to Skin in the Game’s monthly newsletter, send an email with “subscribe” in the subject line to sks@thinkingdr.com. To view past issues, click here.

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April 30, 2010 - Posted by | Health, Medical Practice, and Healing

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