I'll Be Back In A Week

I'll be visiting my parents for a few days and will be back blogging in a week.


I leave you with this terrible travel pun:





A vulture boards an airplane, carrying two dead raccoons. The stewardess looks at him and says, "I'm sorry, sir, only one carrion allowed per passenger."

Grand Rounds Is Up At Emergiblog

Please be sure to check out Grand Rounds at Emergiblog. I am honored to have been included for my posting on the benefits of fighting with you partner. Kim has collected a diverse and intriguing range of postings; and she used the theme of Beatles' music to weave them together.

I really do miss the Beatles, don't you?

Fighting With Your Spouse Can Help You Live Longer

From a January 23 Reuters article:

"Fighting with your spouse can actually be good for your health with people who bottle it all up found to die earlier, a new study shows.

Researchers at the University of Michigan School of Public Health and its Psychology Department released preliminary findings after 17 years of following 192 couples.

The couples fell into four categories: where both partners expressed anger when they felt unfairly attacked, where neither partner expressed their anger, and one category each for where the wife suppressed her feelings and where the husband did so."

"I would say that if you don't express your feelings to your partner and tell them what the problem is when you're unfairly attacked, then you're in trouble," said Ernest Harburg, lead author of the study, in an interview.

The study found that those who kept their anger in were twice as likely to die earlier than those who don't."

"'When couples get together, one of their main jobs is reconciliation about conflict,' Harburg said."

Here's the press release about this study.

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Musings

It's not surprising that the ability to express anger and to reconcile conflict is healthy. We know this in our bodies. We can almost feel the sludge of silent resentments and veiled bitterness congeal our arteries and stiffen our limbs. Forcing one's face into a mask of neutrality when the heart has been poisoned by unacknowledged wounds eventually dilutes the ability to express any emotion with full authenticity. When we constrict rage, we limit joy. When we hide from fear, we lose love.

This may sound illogical, contradictory.

I believe we have an emotional range that stretches from the horrible to the sublime, from the purest hate to the profoundest love. The pendulum of our awareness swings back and forth over this spectrum. If we limit its sweep on the dark side, its reach into the light is similarly checked. Babies know this and show us how it's done. When they awake in the middle of the night they shriek with the terror of utter aloneness. When Mom or Dad appear the world is restored, and there is no higher joy or sweeter smile.

The key lies in Harburg's statement: "When couples get together, one of their main jobs is reconciliation about conflict."

How to reconcile, to experience and express the caustic edges of rage and then find the path back to intimacy. To be so divided and then to reintegrate. T.S. Eliot asks of us, "After such knowledge, what forgiveness?" We might ask of ourselves, where there is love, after such knowledge, what else but forgiveness.

So back to the key -- how to reconcile after the anger and the desperate disappointment have left their stain on our memory. The key lies in the difference between feeling and expressing. In our private cell, we may feel the violence. But in the space between that zone and our partner's heart, we must take a moment to build a cradle to carry our feelings, a cradle cushioned with the remembrance of love.

There are practical ways of reconciling, of bringing what seems broken back together again. But that's for another posting.

Grand Rounds is up at But You Don't Look Sick

Grand Rounds is the week's pick of the best of the medical blogsphere. This week it is hosted by But You Don't Look Sick, one of my favorite sites. The theme was a cold or the flu. Please check it out.

I am honored to have been included.

What Do You Do When the Caregiver Gets Sick?

When I was at one of many low points with my chronic pain condition, while my doctors remained mystified, and I was still chasing after every new wonder treatment I read about on dubious web sites, Richard got sick. My sweetie, my caretaker, the only one I let inside my black hole of pain and fear, started sniffling and coughing.

I was in a very precarious state. I had been sick long enough to finally know that this nightmare was not a random spasm that would just unwind and disappear. But I hadn't yet found the right balance of care and was still cobbling together a patchwork of treatments that weren't very coherent, and were, at times, contradictory. On the alternative front, my chiropractor instructed me not to bend forward, while my physical therapist prescribed a routine that included toe touches. My homeopath warned me that my acupuncture might be canceling out the effect of her remedies. My acupuncturist scoffed at the idea of anyone seeing a homeopath. My neurologist, gastroenterologist, gynecologist, and uro-gynecologist, had resigned their place on my treatment team with the good news that they could find nothing wrong. All this left me flailing around for an anchor point. Richard was it.

Day by day, his nose got runnier, his eyes blearier, and his cough more pneumonic. This wasn't our contract. I was the sick one, and he was my hero. My pain claimed all the illness space. His cold was puny, a two-bit player in a high stakes game. He took antihistamines and tried to ignore any further leakage. Whenever I asked him how he was feeling, he would wipe his nose and wheeze, "OK."

But there was one aspect of his cold that we couldn't ignore. The contagion. The possibility of infusing his cold into my already mangled nervous and immune systems was untenable, for both of us. The only protection was to remain separated by at least two feet of air or a closed door.

We decided to try this approach. However, after a few days, I only felt more alone in my misery, and Richard felt bereft. He was unable to perform his role of comforter, which was his only shield against his sense of his own helplessness to make me better.

We kept this segregation going for a week -- speaking to each other across thresholds, sitting on opposite sides of the couch. Richard gargled salt water and popped vitamin C and echinacea, as I watched from a distance. The loneliness we each felt was brutal, and we knew we couldn't endure it much longer.

Then, Richard's brother telephoned. He listened as Richard explained our contagion vs comfort conundrum. Mark sagely said, "Get in there and hug her. The absence of touch is doing more harm than a two week cold could ever do."

Richard crossed the threshold and cradled me in his arms. We both felt like babes who had been reunited with the good mother.

I never came down with a cold.

When Illness Enters, Both Partners Suffer

This came to me in an email from a blog reader whose partner is ill. It is so truthful and eloquent, I wanted to share it, with the author's permission.


The biggest change for us, and the biggest adjustment we have to make to keep our relationship strong, is that this is really the first time in our life together that the door of mortality has been opened, if only a crack. In some ways, an age of innocence has passed. My wife has had surgical procedures before, for kidney stones, but “potentially life-threatening” has never been part of our vocabulary. Her current condition isn’t really either, not statistically or realistically. But even the thought of cancer, however remote, however treatable, however excellent the prognosis, is a change that requires an emotional adjustment by both of us.

A change has occurred in the way we look at one another and at our relationship. And there is a feeling of loss attached to that. And I guess for me the most important thing I am working on is trying to remember that both of us are suffering from this condition and this uncertainty, that this is something we must both go through together as a couple, that the pain, fear and anxiety this has aroused is something we share equally. And most important, that this condition is something that offers an opportunity to bring us closer together instead of tear us apart.

I know from past experience, when my wife has been operated on before, that sickness can leave the well partner (me!) feeling isolated, separated and alone. There’s the physical separation in that awful moment when the surgeons come into the pre-operative area to wheel your wife to surgery while directing you to sit alone in a waiting area because you’re not allowed or welcome to be with your loved-one right now. And that hurts at an emotional level, never mind the anxiety about the outcome of surgery. And then there is the separation you feel when you see your loved-one drowsy and sprouting tubes in recovery, barely able to recognize or communicate with you. And that is a lonely feeling, eased only by the relief surgery is over and has gone well.

And then there is the process of recovery when your partner of necessity must turn inward and use all her energy to heal herself, instead of devoting that energy towards connecting with you. That’s when I find my need for emotional reassurance the strongest, even as I sometimes scold myself for selfishly even secretly adding to my wife’s burdens, however normal and natural I recognize these emotional demands to be. We rely so much on those little words and gestures and attentions that reassure us that, to our partner, we are the most important person in the world. And it hurts when circumstances prevent us from getting that reminder in the way we want, when we want, even for a time.

What has helped me to ready myself for the emotional chaos I know lies ahead is to constantly remind myself that Tara is not the only one who is sick. She’s not the only one who is a patient. We both are. Both of us will be going through the surgery in our own way. Both of us will be waiting for the results, enduring the recovery and looking forward to good health again. So long as we go through all of this together as a couple, with a full awareness of how it is affecting the other, then these next few scary months need not drive us apart but can bring us even closer together. Thank you again for your thoughts and affirmation. It made me feel better knowing that I wasn’t alone in what I am feeling right now.

Care for the Caregiver

I always thought that I'd rather be the one suffering the illness rather than the partner witnessing and feeling helpless to make it all better. Even though Richard, my partner, went to extraordinary lengths to make my life as comfortable as possible, his quiet tears fell daily because even his most heroic efforts could not stop my pain. Luckily, he had a brother, friends, and business partners who sustained him.

I recently was informed about a caregivers' support organization: Well Spouse which is a national, not for profit membership organization that, for a nominal membership fee, gives support to wives, husbands, and partners of the chronically ill and/or disabled through support groups and information on a wide-range of practical issues facing spousal caregivers.

Richard didn't use a support group, and neither did I. I'd be interested in hearing from caregivers about what support you found helpful; and also where were you disappointed in seeking support. If some of you check out Well Spouse, please let me know about your experience.

A Story About Trauma: Harry & Adele

This is a true story. All identifying information has been changed to protect confidentiality.

Harry fell, again, the second time in two months. He is in severe pain and can't walk.

Eight weeks ago he was blown over by a fierce wind and got badly bruised. He developed infections in both legs, probably from skin lacerations, and his doctor wanted him to remain immobile. He stayed in his armchair, watching Patriots football games, eating take-out Chinese food, and falling asleep to the 11:00 news.

He is 82, bald, overweight, and one of the most benign spirits his daughter, Sarah, knows. He tries to do good. When his mother was in a nursing home, he brought bagels for the staff every time he visited. He gives to many charities, often anonymously. He is the family communications hub -- celebrating good news, commiserating with tales of heartache, and trying to repair rifts. He is a light in his daughter's life.

Adele, Harry's wife, is 80, has the puckered skin and raspy voice of a dedicated smoker, and has succumbed to old age as if it were a gift delivering her a rare form of freedom. She sees Harry as unbearably controlling. While they live together, she has cut him out of her world as cleanly as one might excise a splinter from a finger, permitting only brief exchanges of necessary information.

Adele tries to do good. She is an ardent helper -- babysitting grandchildren, visiting ailing aunts and uncles, feeding people. When her daughter Sarah was in the thick of dealing with recently diagnosed fibromyalgia and uninterested in eating, Adele would make quarts of her favorite soup. Freeze them. Then ship them overnight to Sarah. She was unable to stare Sarah's illness in the face. Long distance soup became her get well card. Sarah feels the love in her mother's efforts and has learned to respond to that love and not get entangled in the snares that lie beneath.

Helping is not he same as doing good. Lodged in Adele's core is a sponge that soaks up the approval she receives, converts it into a facsimile of self esteem and then leaks out the leftover drops in the form of helping. The help arrives disfigured by her hunger for recognition. Harry has enough solid goodness lodged in his essence that even his belabored cautions about driving safely and staying warm come out shining.

Yesterday, Harry fell again while trying to get up out of his chair. He is in the hospital, and the family is waiting for the doctor's report on his condition. Adele is at home, planning on visiting him later tonight. Sarah can't imagine what the two of them will talk about when Adele visits.

Harry and Adele's story is a sad one. They were once two beautiful, young people who laughed, worked together, had children. Somewhere along the way the lights went out. In the dark, they stopped talking and started detaching. And now that they are both in their 80's and illness has inserted itself into their relationship, Sarah, their daughter, is afraid that her mother's helping and her father's goodness just won't be enough.

Seven Medical Myths & Seven Myths About Couples & Illness

7 medical myths. How many did you believe to be true? (I would swear that at least 3 are)

• People should drink at least eight glasses of water a day
  
• We use only 10% of our brains
  
• Hair and fingernails continue to grow after death
  
• Shaving hair causes it to grow back faster, darker, or coarser
  
• Reading in dim light ruins your eyesight
  
• Eating turkey makes people especially drowsy
  
• Mobile phones create considerable electromagnetic interference in hospitals.

For the research behind this, check out Medical Myths on BMJ. I originally saw this list on Dr. Val's excellent web site.

Here are 7 myths about couples & illness:

• Love is all you need (sorry, not true John Lennon)

• It's better to keep busy and not dwell on the illness (sometimes yes and sometimes no. Partners need to cue each other when they need distraction and when they need to talk about illness)
  

• Talking about suicide only makes the possibility of doing it stronger (if your partner alludes to suicide and you ignore it, those self destructive feelings won't go away; they'll only go underground)

• It's better to face the harsh truth rather than sustain fading hope (no one has the inside track on truth or hope)

• If you cater to your ill partner's needs, you'll be fostering an unhealthy dependency (the dance of couples and illness is about perpetually seeking a balance between meeting each others' needs and supporting each others' strengths and autonomy)

• Illness trumps intimacy. If one of you is sick and in discomfort, sex drops off the list (intimacy does not de facto equal intercourse. You and your partner need to talk about what is comfortable and what is not)

• If your partner is sick it's your obligation, your vow, to stay by his/her side, no matter what (this is a very painful issue, and there is no one size fits all answer. Some couples stay together through illness and find new dimensions of loving; some couples stay together and make each other sicker, or at least miserable; some couples who separate find that the physical distance permits greater emotional closeness).

Grand Rounds Are Up At Other Things Amanzi

Not only are is there a very diverse collection of submissions, but Bongi posted some amazing pictures of African wildlife. I am honored that he included my piece on the inequalities of health care access.