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The Art of Medicine

In the darkness, the lotus

Katers, Laura A. MS, MCHS, PA-C

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Journal of the American Academy of Physician Assistants: September 2019 - Volume 32 - Issue 9 - p 58
doi: 10.1097/01.JAA.0000578804.00170.83
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I did a silly thing recently. My 8-year-old cat, Lili Fang, gets separation anxiety, so I found a purple stuffed cat online with a nose that, when pushed, purrs. A real cat purr, for 2 minutes! I thought I could program it for her when I was away. When it came in the mail, I sat on the couch, pushed its fuzzy nose, and cat purrs from a thousand childhood memories cascaded over me. I promptly fell asleep. I knew then that the purring purple cat was mine. In buying it to ease Lili's anxiety, I had happened upon a new tool to self-soothe, for me. Lili got her own cat the next day.

It took me most of my early adulthood to realize I had misplaced a piece of the foundation of self-soothing that seemed to come so naturally as a youngster. Thus, I've focused a large part of my professional life on finding my way back to those golden memories and strategies, so that I can share the practices with others. Working in primary care and now in pain management, I routinely ask adult patients how they cope with difficult situations or tough news. The responses I get make it clear that many of us are caught off guard when asked what we do to cope. We have gradually learned ways to distract ourselves from discomfort instead of settling into it. Pain, in its many colorful manifestations, is messy and hot. It consumes body and mind, loved ones and work. Adults find external things to help them relax or rev up, to numb or check out from discomfort. As Buddhist teachings go, our moments of great discomfort or confusion also are opportunities for moments of great wisdom. But who wants to wait for that wisdom?

The night I gave the purple cat away saw a rare spring storm, the hospital vibe reminiscent of full moon fiction. I was called to room 644 to see Daria, a young woman whose past was filled with desmoid tumors, extensive abdominal surgeries, a shoddy immune system, loss of her colon, and loss of grace in many moments when the trauma of her past reared up. Described as “a borderline” in every chart I read, she was a few days past another surgery.

Clinicians often frame others with big emotions as problematic, as “moody,” or—least compassionately—as having borderline personality disorder (there is a movement to rename it emotional dysregulation disorder). Whatever descriptors they used, staff were transfixed on Daria's challenging behavior. She fired providers and demanded things no one could do. But as a pain specialist, when I hear words like borderline, crazy, or difficult, I first see a person, often with a complex illness, loss of function, and poor quality of life. I see hope in the gutter. I see trauma and pain (both existential and real), and what I know to be true is that both make us into versions of ourselves we'd rather hide away.

Humans who grow up sick or struggling often have big emotions. As a kid, coping takes a back seat to survival. The nervous system is always heightened. The brain alters itself, learns to see danger even if none is present. Such a child develops differently than a child who is surrounded by safety and good health. But no matter our upbringing, nearly all of us grow up believing we can control our emotions, our reactions to things, our gut instinct, even other people if we are keen enough. None of that is true, though. The only thing we ever truly control is our breath. One breath in; one breath out. If we spend most of our lives attempting to control everything around us, fear and uncertainty often mean we stop breathing altogether.

The second silly thing I'd done was take the purple cat to work. The purring calmed me on hectic nights. And when I first met Daria in the shadow of her postop recovery, I knew she needed real attention, because even though she had armor and knew how to use it, she pushed everyone away so no one would see her suffering.

Around midnight, when I checked on Daria, I offered her the purple cat. A wild grin spread across her face as she hugged it, pushed its nose, and stroked its back, uttering, “This is amazing!” The child in me bowed to the child in her. It's not a friendship that arises from such gestures, but sheer trust, and it's the only way I know of to care for another human being. That night Daria let me help her.

Later, I ordered 10 purring cats. If a $6 item could bring this much joy to a woman whom no one had seen smile, could help her discover or remember how her body feels when it is calmed, and safe, and seen, that's more than medicine. That's how we heal. And that's where the wisdom comes.

Copyright © 2019 American Academy of Physician Assistants