Friday, December 1, 2017

The Choice to Serve Life

So I wrote this as I began my PhD, a few too many years ago. But as I can't find it published anywhere I thought I would share it now. 

**
Where servant leadership can sometimes suggest ONLY serving those you wish to lead, "serving life" serves everything.  What I find I need to do is explore the meaning and value of "choice" and "service".

For now I will focus on service.  Is service "Whatever you say I will do?"  Is that a good servant leader?  No.  While that is exercising one's choice, I think that method is very limiting in the "big picture".  A CEO who says to his company "whatever you say I will do" will soon realize someone else is leader.  But maybe that is where the PEOPLE are.  And they say, "whatever you say we will do."  Again, I find that will be limited as a mode of service.

To offer the best of one's service had come to mean knowing somethings about one's "self".  Who am I?  What are my strengths?  What do I believe?  What are my weaknesses?  What are my boundaries (can I do that which I believe to be wrong)?

Service and being a servant then do not suggest to me "doing whatever the people I am serving want".  Choosing to be a servant is a choice to serve from my best, from who I am.  While I have found the core of who I am to be fairly stable, the expression of that and many of the details have changed overtime.  Thus I conclude that who I know myself to be evolves over time.

"Life" on first look is "easy".  EVERY thing on this earth is life.  Every thing in the universe is life.  While that seems easy to me to say, the difficult part is uniting my being "a servant of life".  Life is me and all I am am.  It is my wife Trixy and all she is.  It is our dog Jordan.  It is our yard and all that creeps and crawls in it.  Life is our neighborhood and town and all the people and things in it.  Life includes the wilderness areas, cities, crime and goodness.  Life is healthy and unhealthy.  Life includes the bonds that unite people together.  Life includes the wedges that divide people.  Life includes belief systems of all sorts: those who believe in some form of God and those who do not.  Life is "the big picture" and everything in it.

The choice to serve life:  I must serve myself.  I must learn to love who I am while not being selfish  complacent.  I have growth to do.  I must serve my wife.  I must learn to love who she is, encourage her to love herself, yet not be complacent (MUCH harder to do).   I extend this to my friends; coworkers; bosses; employees.  Every time "love" must be present.  I MUST learn to love people I don't like.  But how do I show "love" to my neighborhood, town, wilderness areas, people I have never met?  My mind sometimes just spins at the thought of it.   

As I reflect, the choice to serve life is the choice to serve the big picture.  I need not try to love those I don't know and haven't met and may never meet.  By my serving life where I am, in what I do, in my attitudes, in my communications, I WILL serve those I don't know and haven't met.  

Some illustrations come to mind:  

A child who is learning to walk.  S/he takes a step or two and falls down.  Do we focus on the fall? or do we focus on the next step?  I believe serving life focuses on the next step.

Learning to ride a bicycle (walk a balance beam etc), do I focus on my feet?  Do I obsess with my shakiness?  or do I look forward?

There is a country where if you injure someone you must pay their hospital expenses, but if you accidentally kill them you pay the family $300.  Or where the penalty for killing a cow is more severe than for murdering a person.  The choice to serve life must examine these for the big picture.  

When I think on these things I realize that the choice to serve life is not limited to Christian, or others who profess belief in God.   The choice to serve life is for anyone, just as any one in any belief system might NOT be serving life.

But I will close my thoughts with this:  My belief system suggests that anyone serving life from the root of "Love" (unselfish, unconditional, agape), is serving God, regardless of any identity, culture,  race, creed, or religion.  My faith system indicates that only God's true children love as God loves.  The God I worship and admire loves his entire creation and is the ultimate example of the choice to serve life. And therefore isn't limited to the box of my personal beliefs or faith tradition.




Friday, November 17, 2017

Friendship: A reflection

It was the summer of 1994 when I first made a real effort to understand the meaning of "friend" and "friendship".   Until that time I took friendly relationships for granted - at least I think that is how it was with me.  

Perhaps I had contemplated the terms and meanings before, but simply not given them "voice".  I have, over the years, had many friends.  There comes an ebb and a flow as people move around, change and grow, and so on.  On Facebook I have many "Friends".  Some I know very well from personal contact, others only through technology.

And so it was in the summer 1994 that I gave voice to my understanding and thoughts.  To this day I continue to refer to these observations.

***

Friendship is defined by Webster as 1) the state of being friends 2) attachment between friends 3) friendly feeling or attitude; friendliness.

Friend is defined as 1) a person whom one knows well and is fond of; intimate associate; close acquaintance 2) a person on the same side in a struggle; one who is not an enemy or foe; an ally 3) a supporter or sympathizer 4) something thought of as like a friend in being helpful, reliable, etc.

The word "friend" finds its root in the old English "freond" which was used as friend, lover, similar to the German "frijon" - "to love". The
Indo-European root goes back to the word "free". The root meanings here are -- not in bondage, noble, glad, illustrious, to be fond of, and to hold dear. In using "free" with "friend" then it could be concluded that a friend is 1) not under the control of the other person; that each friend is able to act or think without compulsion or arbitrary restriction; having liberty and independence 2) a friend is able to move in any direction; not held, as in chains; not kept from motion 3) a friend is not held or burdened by obligations, debts or discomforts 4) a friend is allowed to leave at any time and is not confined to the usual rules or patterns; not limited by convention or tradition 5) a friend is not restricted by anything except their own limitations or nature and 6) a friend is generous, liberal, frank and straightforward.

Friends and friendships then are a gift.

***

So in my religious philosophy I believe that God sees each person as a friend - even if that person may consider God an enemy. God wants a relationship with me and has chosen to extend love towards me.  Of course not only me but each person, those I care about and those I don't.  

Friendship with God is, by definition then, reserved for those who choose to enter into a "friend" relationship with God.  But what does this relationship look like?  I believe it is unique to each person.  I realize that not everyone agrees with me.  Yet it is my world view that God exists.  Given that as my baseline (and I accept that there are other views in which God does not exist).  But I am working to make sense of my own world view(s).  I am quite sure I cannot make sense of anyone else's.  Given my view that God exists, no longer does it matter to me if any one else thinks God exists.  

And so I am coming to the conclusion that I can be a friend regardless of another person's response or opinion of me.  I may not agree with their opinions, insights, or world views on any variety of topics.  

Friendship is reserved for those who respond.  I am not being a friend so another will reciprocate.  If they do - wonderful.  

When I try to restrict some one I profess to love I exclude myself from friendship with them.  Nor will a friend require from me anything I cannot freely give.




Monday, May 16, 2016

The Quarry

So 31 years ago I wrote this for a literature class. Enjoy.

The white sun reflects off My white body, it is spring
Trees are budding, flowers blooming, I am nervous
My feet are heavy, My stomach churns, My ears ring
Before Me is the quarry, its walls loom ominous

Standing atop her walls I look down
Down into the dark murky water, My heart pounds
How deep dare I go, will there be pain, will I drown
I teeter at the edge . . . JUMP . . . I hear strange sounds

People screaming, moaning, yelling, groaning . . . SPLASH
Blackness, silence, coldness, is this what its like to be suspended in time and space
i am alive, i have learned, i am different . . . FLASH
The warm white sun reflects off the cold dark water into my face

Amazing Grace! I was blind but now i see
Amazing Grace saved a wretch like Me


© 1985 Bill Colwell Jr

Wednesday, March 23, 2016

A Tale of Two Stomachs


 “Drag your thoughts away from your troubles...by the ears, by the heels, or any other way you can manage it.”  ― Mark Twain


A/N: As usual, these patient scenarios are composites of my experiences. No one person is represented. As the movie disclaimers read: ‘Any similarity to any person living or dead is merely coincidental.’ The essence of the dilemma remains the same.

“Ohhh… doctor! My stomach!” the young woman cried clearly distressed as she moaned and rolled disturbingly close to the edge of the exam bed on which her generous body habitus nearly flowed off.  “My stomach is paining.” She clutched her abdomen to emphasise her point.

“Where is it paining you?” I asked as I tried to write a coherent history in her medical book at my desk, making observations as we spoke. I checked her vital signs; all were rock solid and normal. (She wasn’t dying at least.)

“All my stomach!” she groaned and winced as another wave of abdominal cramps overwhelmed her. “Owww…”

“Do you have any fevers?”

“No.”

“Any diarrhoea?”

“No.”

“Vomiting?”

“Any belches, pain when you pee, vaginal discharge?”

Essentially, in the end, she wasn’t having any problems except excruciating abdominal cramps. I stood up and went over to the examination table where she looked over at me with tear-brimmed eyes. “Please doctor, the pain is too much.”

I checked her eyes. Not pale. Good. She wasn’t having internal bleeding. A thorough palpation and auscultation of her ample belly did not reveal anything life threatening.

“But, doctor, the pain is too much.”

“We’ll give you some medicine for the pain and check for any infections,” I reassured her. “Your stomach pain will cool soon. Be patient just a little longer.”

She nodded.

In the interim while waiting for her malaria smear (standard on almost anyone in Africa) and typhoid test, she received a dose of IV Spasfon (an anti-spasmodic) medication to calm her cramping. When that wasn’t enough, we gave her a second injection of Novalgin IM, basically an injection form of a drug in the category of NSAID (same category as ibuprofen). My nurses took her over to the hospital where she gradually calmed down on one of our unoccupied patient beds.

This wasn’t the first time that Ms H had come to the hospital with the problem of acute abdominal pains. The first time she’d come, one nurse took me covertly aside. “Doctor, Ms H has been having this kind of pain in her stomach for a long time. Her mind ‘de over worry’.”

“So what usually happens?” I queried, curious to hear what my predecessor had done in the past. Had the former physician done a work up on her to find any signs of celiac disease or an inherited autoimmune inflammatory bowel disease or gallbladder stones, pancreatitis, diverticulitis, kidney stones, pelvic infections, dysmenorrhoea, endometriosis, giardia, amoebas, etc. After all, the list of diseases that might cause abdominal pain in a young woman is infinite.

“She usually just checked a few labs and gave her tablets for pain,” my nurse explained with a shrug.

“So she never figured out what was causing her stomach pain?” I hoped perhaps she might have come up with a diagnosis.

“No,  she just gets better after a few days.”

“Ok. I think I am getting you,” I frowned. I was still a little confused but marginally reassured that Ms H has survived similar attacks in the past without any apparent long-term detrimental effects. I moved forward with my treatment plan.

There are a limited number of tests one can do in a mission hospital, especially on a woman with limited financial resources. Certainly she couldn’t afford to see a specialist in the big city of Douala. She didn’t seem to be in such serious condition as to necessitate a CT scan of her stomach. And the value of an X ray  to diagnose her problem was questionable enough to tip the balance in favour of cost outweighing benefit.

In the end I checked the malaria and stool analysis. We did a rapid blood test for typhoid.

“It looks like you have a little infection in your stool,” I sat down next to her at her bedside in the hospital where she was resting much more comfortably. After a few hours of spasmodic abdominal pain, she could smile. The nurses had found her clean hospital sheets and she was resting comfortably.

“I can’t say exactly what infection might be going on, but there are some white blood cells in your stool that could mean you have an infection.”

She nodded.

“We’ll give you some ORS (oral rehydration salts) with zinc and ciprofloxacin along with some more anti spasmodic medication and paracetamol to help with the pain. You’ll be ok in a few days.”

I smiled at her. Part of medicine is letting the body heal itself. In this case, I wasn’t sure the antibiotic was essential but given the inflammatory white blood cells in her stool, it might help.  The odds of an infectious form of diarrhoea is high in Africa where sanitation is less than ideal sometimes. The good news was that her symptoms were improving.

She would get better – of that I was certain. Time was my biggest alley. Her labs and my physical exam assured me she wasn’t dying. With a little magical ‘tincture of time’ she would soon be back to normal.

Ms H gave me a tired smile. “Thank you so much, doctor.”

“You’re welcome. Just be patient, you’ll be fine.”

As Ms H gathered up her things and headed home from the clinic the following morning, she saw me and rushed over. “Doctor, thank you!” She hugged me and then as a parting gesture, she placed her hand on my shoulder and gazed into my eyes, “God will bless you,” she earnestly bestowed this tender and honoured gift upon me and the ministry.

A warm glow filled me.  I had contributed very little and yet her gratitude was immense.

******

And so, it was with a sinking feeling that some time later I saw Ms H sitting disconsolate in the waiting area of our clinic.

“It’s paining again, doctor,” she cried. “I’m sure something else is wrong inside my stomach. Can’t you do an echo (ultrasound) and look?”

“But an echo won’t show everything that could be wrong?” I explained.

“There might be something though. My stomach keeps paining. Can’t we make sure everything is ok?”

Perhaps it was the curly eyelashes and liquid brown of her pleading eyes, or perhaps I was feeling a bit more generous than usual that day, I’m not sure, but, in the end, I caved to her pleas. “You’ll have to wait until I finish seeing the other patients, then we’ll do a little echo, ok?” I bargained with her.

“No problem. I’ll wait,” she eagerly promised.

She spent the next six hours waiting in our hospital compound, chatting with my nurses and other patients, while I continued my day-to-day consultations. At last there was a break in the flow, “Come on back, Ms H, we’ll check your stomach.”

“Everything looks ok,” I cheerfully proclaimed as she watched anxiously at the moving grainy black and white pictures on the ultrasound machine.

“Then why do I keep having this pain?” she sat up and dressed.

“Well, there are many reasons for the pain that don’t show up on the ultrasound.” I helped her down from the exam table. “The inflammation can take time to clear up completely in your stomach and the pain to cool completely? You’ll be ok. We’ve made sure there is nothing else that we need to treat.”

“Ok, doctor. Thank you so much for checking. God bless you. You are so kind.”

“Just remember, try to relax your mind and not worry. You’ll get better soon.” With much reassurance from me, reinforced by our nurses, she eventually went home.

Over the following week, the local community visited Ms H and comforted her with a plethora of ‘ashias’ and distracting company. She unburdened her troubles through countless conversations with her friends. Although she lacked family support, neighbours and church members stepped in as her surrogate family and talked her through her panic over the future.

A few weeks later, I ran into Ms H at the market. “How are you?”

“I’m fine, doctor,” she smiled. “It wasn’t easy. I really suffered.” She shook her head at the memory. “But, now I’m fine.”

“Praise the Lord.”

“Oh yes!” she agreed with enthusiasm. “Without Him I couldn’t have survived. God is good.”

“Amen.”
 *********
Ms H would go on to have other attacks of her mysterious stomach pains. The attacks had a habit of occurring during times when there were increased stressors in her life – worries over finances,  schooling, or children. Each time she came to visit us, she received compassionate care. She found a hospital where nurses prayed with her and gave her prompt attention. Although I doubt we will ever find an organic reason for her pains, we do a standard examination of her with a physical and basic labs to ensure nothing out of the ordinary is suddenly attacking her body each time.

Friends often pray with her and come and sit with her at home when she has these pains that typically last a few days. Eventually they always go away – probably more due to her own body’s inherit healing rather than any medications we administer. She’s always grateful and later comes with fruit or vegetables to share with hospital staff. My predecessor was correct in her diagnosis of her abdominal pains: ‘over-worry’. 
 *********************

Stomach 2 (Ms T)

Ms T was a 20 something year old female who came in with her stepmother. She gave me a fleeting soft smile that could immediately put the most anxious at ease. Clear blue eyes shown out from under a mass of unruly red hair. Outside of being having a high BMI, she appeared healthy. That is, until one opened her medical chart!

Pages and pages of doctor visits, blood tests, procedures, tests, and even surgery. She was barely 20. How could someone so young already have such a medical saga?

I sat down across from Ms T.

“What can I do for you today?” I began our interview.

“It’s my stomach,” she answered flatly.

“Oh?” I left my sentence open for her to elaborate.

“Pain.”

“Ok?” I tried to give her free rein to continue her narrative.

She sat silent in the chair in the exam room. I wasn’t sure what to do. I looked over the list of various problems in her medical chart and felt mildly overwhelmed. What was wrong with this young lady with such a complicated medical history? Perhaps I was not the right doctor for her. Why wasn’t she seeing her specialists?

“Why don’t you give me a little recap about your stomach pain since this is the first time we’ve met?” I encouraged.

“Well, I’ve been having pain in my stomach and it’s still there.”

“OK. How long have you been having this stomach pain?” I decided to be a little more directive in my queries.

“Years.”

“More than five years or ten years? Can you be a little more specific?”

“Since I was in school,” she shrugged without emotion. “No one can seem to figure out what’s wrong.”

“Oh? So you’ve had a lot of tests already? Have they found out anything?” I attempted to ascertain what her own understanding of her medical condition was.

“Well, first they said it was stomach ulcers but the medicine didn’t do anything.”

I nodded, listening. “And what else?” I prompted after she fell silent.

“Well, then they said it was Celiac and put me on a gluten free diet but that didn’t really help.”

“OK,” I still wanted her to continue her narrative.

“Then they said I had asthma.”

That explained the inhaler prescriptions in her chart.

“But they didn’t do anything either.”

“I see you’ve also been diagnosed with depression too,” I prodded.

“Oh yeah, they keep telling me I’m depressed but the drugs they give me don’t do anything,” she answered. From her lack of interest in her health, I did wonder if this might have been more accurate than she gave it credit.

As we went through the litany of various diagnoses that she’d been labelled with such as depression, anxiety, cholecystitis, pancreatitis, acid reflux, peptic ulcers, gastritis, gluten sensitivity, asthma, angina, irritable bowel, chronic pelvic pain, etc. I could sense an aura of fatalistic opposition. Ms T expressed a confusing puddle of passive victimization. She had a mysterious ailment of her stomach that doctors couldn’t figure out. When she mentioned the complementary and alternative providers that she’d been to see, I began to wonder what I was going to contribute. In my few minutes allotted to our interview, what would I discover that so many before me had failed to address? She gave the impression of having lost all faith in the medical community. I wondered what she hoped to gain by her office visit today.

“It looks like you’ve had a pretty thorough work up for you problem,” I commented. “Colonoscopy…”

“Yeah, that was no fun,” she muttered.

“Endoscopy (tube down the throat). Rheumatology work up (lots of blood tests). Electrocardiogram. (lots of wires) CT scans (lots of IV sticks and scary machines)… Quite a lot of tests.” I turned to her. “And you had your gallbladder out too?”

She nodded to the affirmative. “It didn’t help though.”

I looked at Ms T. Really, there was nothing left for me to investigate. Every conceivable test had been done. Already she’d been exposed to enough risks associated with invasive procedures, anaesthesia, and surgery, and radiation. Her chart was riddled with a long list of problems from psychological to biological but way too many for one patient just barely out of high school. Every time a medical professional opened her chart, he or she would be inundated with a mountain of extraneous labs, procedures, and specialist reports without really understanding the true issues or the person underneath the burden of medical reports.

“Why don’t you describe for me, in your own words, all about your stomach pain? How it began? What it feels like? What makes it better or worse? How you’ve treated it in the past? That kind of thing,” I rewound her story and decided to let her start the slate clean. I prayed for wisdom.

She blinked and stared at me for a few moments. Finally she shrugged and in her characteristic monotone that I’d started to get used to told me the details I needed for my history. It was not as complicated as I was afraid of at first. In fact, her history was rather similar to another young female patient – a Ms H.

As I reassured myself that I was not missing anything life threatening with a thorough physical exam, I inquired into her own understanding of her illness. “Is there anything you’re particularly afraid you might have? Something you are concerned that could be wrong? You’ve had a very comprehensive work up for all the dangerous things that could be wrong,” I reassured. “But perhaps there’s something that you’ve read about or heard on TV that you’re concerned about?”

Ms T sat up and thought for a few moments. She shook her head no and shrugged. “Not really.” she leaned back in her chair as if challenging me to come up with a new diagnosis for her to defy. Another label for her symptoms, another pill for her to proclaim useless, another reason to distrust the medical professional community.

“Ok.” I sat and gave her some time to think. I didn’t have a new label for her. She’d been labelled with everything already. I was at a loss of what else to do for her. I typed out the history she’d given me in the computer while she sat with her arms crossed, watching me tap away on the computer keys.

Mid keystroke, she decided to speak up. “Doctor, do you think this could be due to panic attacks?”

“It’s possible,” I answered hesitantly. “Why do you ask?”

“Well, I always get them when I’m stressed out, like when I have a deadline at work to meet.”

“Why don’t we have you keep a diary of when your stomach pains occur and see if we can correlate them to certain stressors?” She agreed to our plan.

At the end, she left with a promise to reinvestigate what stressors might be triggering her pain along with a refill of a mild anti spasmodic to use at times when her pains were particularly interfering with her ability to work.
***********************

So now I sit back and reflect on the contrasts between these two young women with stomach pains. Similar situations in regards to life transitions and stress but different countries and different cultures. Both boiled down to stress-induced stomach cramps or ‘over-worry’.

Ms H had multiple doctor visits, stool tests, and one ultrasound. She recovered with a tincture of time and community support after each attack. She was an honoured member of society and went about her business between attacks. She knew most of our staff at the hospital and was always welcomed when she needed treatment. She made her own decisions and was content with the treatment given.

Ms T, in a similar fashion, had multiple doctor visits and stool tests. She also had multiple specialist consults, invasive diagnostic procedures, radiation-filled imaging, blood draws, and dietary restrictions. She is dependant on the charity of friends and family for housing. She distrusts the medical community and yet remains apathetic regarding decisions about her health. The real person, that disarming blue-eyed lady with a kind soul, is lost under a mountainous medical record. She is unhappy with her medical care and hopes that one day she’ll find the magic doctor or test that will diagnose her pain and alleviate it forever.

Is there a moral to this comparison? You choose. I simply make the observations.


Wednesday, March 9, 2016

Reflections on the Past and International Women’s Day



“Does the walker choose the path, or the path the walker?”   ~ Garth Nix

Technically, I should have written this about 3 ½ months ago, my one-year anniversary from starting a new job in the U.S. after completing a 5 year mission term at Buea 7th day Adventist Health Centre in Cameroon.

One year would have been December 15, 2015.  That date was a day overflowing with memories. Good memories from Cameroon but paralysing fears regarding the future. 

I used to have goals to work toward. There was always something in the future that infused meaning into the present labour.  There was a confidence that the present trouble was a stepping-stone for reaching higher and better accomplishments.

And now?

Now I wonder if the past five years in Cameroon were the pinnacle? Will my identity culminate with living overseas for five years? Was service in Cameroon my destiny? Is there anything left for the future?

The Pacific North western culture is different. The art of medicine is different here as well. I haven’t seen a single case of malaria. There’s been only a small handful of cases of traveller’s diarrhoea, none of which were Typhoid.  A typical clinic visit might be exemplified by Ms Ariel:

Ms Ariel is a hybrid that represents a commonly encountered scenario that occurs on a daily basis in my office. In the interest of privacy, I have created an amalgamation that preserves the essence of my work in American healthcare but doesn’t identify any personal details of one individual.

I knock on the patient’s door.

“Come in,” she answers absently from the chair she’s seated in scrolling through her Face book alerts on her iPhone.

As I seat myself on the stool in the room and log into her electronic medical record on the computer, she eventually tucks her phone away in her purse and turns to face me.

“Cool hair,” I comment on her recently dyed tri-coloured hair, transitioning from royal blue to aqua turquoise. It is eye-catching and somehow seems to fit with her multiple body piercings that compliment her tie-dye skirt and tall leather boots.

“Thanks,” she smiles.

“Did you dye it yourself?”

“No, my friend wanted to practice,” she shakes her head. “She’s going to cosmetology school.”

Now that I have her attention, I glance down at the paper in my hands on which my medical assistant has written the main concern today, “palpitations”. The paper also reminds me to ask Ms Ariel to schedule her pap smear and get her flu shot while also filling out the questionnaires to screen for alcohol abuse and depression.

“Yea, in the past few weeks I keep feeling like my heart is going to jump out of my chest,” Ms Ariel begins. “I feel like I can’t breath sometimes.  I can feel my heart flip flopping like a fish inside my chest, especially when I’m in bed trying to sleep.” She stops.

“Anything else you notice with these feelings of your heart beating too fast?” I prod. “Other symptoms that seem to be associated or bring them on? Did anything change in your life recently before these palpations began?”

“I get headaches sometimes,” she replies. Her iPhone rings and she reaches over to retrieve it and turn off the ringer.

I wait. “Is there more stress in your life recently? Have you ever had these palpitations in the past?

“I recently started a second job at the service centre,” she remembers. “My boyfriend and I broke up after that. I haven’t been sleeping well either. And, that’s another thing I wanted to mention, doctor,” she looks at me. “I need something to help me sleep at night. I can’t fall asleep until after midnight and then I wake up after a couple hours. My friend gave me one of her sleeping pills and it helped. I want to see if you can give me a prescription today.”

I nod in recognition of her change in topic. “And has your lack of sleep made your palpitations worse?” I try to steer her back to her original reason for consulting.

“Yes, I think so,” she answers after a pause. “I had palpitations before when I was a teenager, I think,” she continues. “The doctor gave me some kind of medication and eventually they went away. I stopped taking the medicine. I don’t remember what it was now.”

“Have you ever fainted during these spells? How long do they typically last? Do they just go away on their own eventually?” I attempt to garner more information to assess the severity of her palpitations.

“No, I have never passed out,” she answers, “except for that one time when I was really sick with some GI virus and I was vomiting and having diarrhoea. I was headed to the bathroom when all of a sudden the next thing I knew I was on the bathroom floor. I couldn’t remember how I got there. My mom says I fainted. I don’t know how long I was out. Probably only a few minutes. I guess I was sicker than I thought. I was also feeling dizzy at that time too…”

I take a deep breath and interrupt her meanderings to direct her back to our original problem. “So what do you think is going on with your palpitations? Do you think they might be related to the recent stressors in your life?”

“Probably,” she answers after a thoughtful pause. “They don’t really bother me except that one time when I was at work and my boss had just brought me back to tell me I needed to meet certain deadlines. She was upset and it made me upset and then I started having a panic attack and I couldn’t breath and the room was going all dark and my heart was beating too fast. I actually had to take the rest of the day off, doctor.” She looked at me for a moment then continued. “Usually these episodes I feel now go away in a few minutes. Really I haven’t tried anything for them because they’re not that much of a bother. I know I can be a bit of a hypochondriac about my health but I just don’t want things to get worse, you see.”

I nod while she continues her monologue.

“Honestly, I think the palpitations will go away on their own. I don’t think they’re really dangerous, do you doctor?” Without waiting for a reply she continues, “Anyway, I don’t want to take any medication. I don’t like having to be dependant on a pill every day. Maybe you could just write me a prescription for that sleeping medication that my friend let me try? That way I could use it as needed when I can’t sleep. I tried melatonin already and then my naturopath suggested some teas and meditation techniques but really, they’re not the same as taking that pill when I really just need to knock myself out.”

Attempting to reorient myself to her new concern, I answer. “So, you think your palpitations are related to more stress and not sleeping. And, if you can sleep, you feel your palpitations will go away?”

Ms Ariel nods and taps a reply on her phone. “My friend just texted me the medication name, “She says it’s called lor-az-e-pam. I’m sorry if I didn’t pronounce it correctly.”

“You did fine,” I reassure her. “I understood the name.”

“And what kind of things do you think will help you manage your stress better so you can avoid the heart palpitations, the panic attacks, and the sleeping pills?” I query as we negotiate the safety concerns of a benzodiazepine.

Ms Ariel shrugs. “I don’t know.

“Would you be interested in talking with a counsellor to learn some strategies for handling stress better?”

“I don’t think I have time, doctor.”

“I’ll give you some things you can practise at home with deep breathing and progressive muscle relaxation,” I add with a resigned nod regarding her thoughts on stress management. “You might also find yoga helpful. It’s good for the brain and your muscles, particularly your core back muscles. It could help the lower back pain you’ve had before.”

“Oh, that’s another thing I wanted to ask you,” Ms Ariel suddenly remembers as I type my orders into the medical record and complete her printed visit summary. “Can I have another referral to my chiropractor? I’ve been having pain in my neck recently.”

Already past our appointed time, I sign back into her electronic records and we go through the requirements of a chiropractic referral.

As I type in the orders and fill in the allotted questions, Ms Ariel watches. Suddenly she blurts out, “You know, I think I might have ADHD. I can never remember anything and I can’t seem to concentrate at work. My boss is always reminding me to focus. I’m always forgetting something. I should probably be evaluated for it. I was thinking that I might be allergic to gluten too. Maybe I should get tested for that?”

I complete the entry for the chiropractic referral. “Let’s try to get you sleeping regularly and in a better place with stress levels, first. We can talk about your concerns with concentration and focus at your next visit, ok?”

As I finish typing her note in my office at the end of the day, I sigh. Ms Ariel represents a multitude of relatively young, stressed-out, women that I see every day. So many life stressors that affect their health in ways they can’t imagine, or are willing to admit. And there never seems to be enough coping skills and supportive relationships to help mitigate the affects of such stress.

From a physician’s perspective, it’s often less-than-satisfying to identify the problem and yet be unable to vanquish the problem. I cannot eliminate Ms Ariel’s stressful job. I cannot be that nurturing shoulder to cry on as she goes through the break-up with her boyfriend. I cannot find her a replacement boyfriend. I cannot force her to exercise, go to yoga class, practise deep breathing and relaxation techniques, eliminate caffeine and incessant texting, and choose healthier food options. A sleeping pill, even the less addicting option that we agreed upon today, is only a temporary patch for the real problem that keeps her awake at night. Her spinal pain will continue to plague her. I doubt she has clinical ADHD. She’s an intelligent, functioning women. She’s also distracted and under enormous stress without the time or relationship skills to cope.

I should have written this 3 ½ months ago. I was distracted and unprepared to cope though. I have a tough time concentrating and focusing. I have difficulty finishing tasks and find it impossible to sit down and actually type a complete thought. Perhaps I have adult ADHD? Haha. Perhaps I just need to turn off my technology and take a real holiday.

Happy International Women’s Day!!! (March 8)