Medical Malpractice

Lt. Costello (name and place changed, but the story is true) sat behind a large, conspicuously clean desk at the Tarrytown Police Station in N.Y. He was cool, composed, and seemed as uncluttered mentally as he was physically. The awards on his book cases and certificates on the wall attested to a long, successful career.

"I paid my dues,"he said and smiled as he scanned the room and the work it all represented. As he saw it, however, his career really started in Vietnam when he was only a teenager serving in the U.S. Army. It was there, assigned to an armored car division sent deep into the jungle, that he learned what it took to survive physically, mentally, and emotionally.

He was on a mission in the Delta, it was summer and the temperature outside had reached upwards of 115 degrees Fahrenheit before noon. Inside the tank it was at best unbearable under normal conditions. On one particular day he still remembers with stunning clarity, it was life-threatening.

"It must have been 130 or more inside. It was hot in a way I had never experienced before. I couldn't stop sweating, couldn't drink enough, couldn't just get up and go to the bathroom. I was burning up. I don't mean that metaphorically. I was literally burning up and I had to lower my body temperature somehow or I was going to die. Funny how it didn't scare me. It was just as clear to me as the coffee in front of me now. It was a fact. I had no air conditioning. I couldn't get out of the tank. There was nowhere to go except a POW camp, if I was lucky enough to get caught and not killed right away. I remember thinking that I should have been panicking. Instead, I was utterly, crystal clear. It was in the space of such a small moment that I realized it was completely up to me. Whether I survived or not was between me and my own mind."

The lieutenant sat forward, his body compressed with the intensity of the experience, still vivid in him.

"For some reason, I thought about something I'd heard about some monks in the Himalayas, how they went outside in sub-zero temperatures and howling winds to meditate and never suffered any ill effects. They raised their own thermostats. And I figured if they could do it that way, I could lower it. To this day I don't know exactly what I did or how I did it, but I imagined cool water inside me and around me, like I was dunking myself into a cooler filled with ice or skinny dipping in the lake back home. And hell if it didn't work. I'm here. I never forgot that," he sat back.

"This," he pointed to his head," was my greatest weapon of all. And it has served me ever since, no matter what or where the battle."

Post-9/11 Sensibilities

Since 9/11 the two ratings-building spin words are survival and emergency. Today, Americans are fed a regular diet of security alerts, color-coded for those who need the visual aids, preparedness strategies, complete with thousands of products one can buy for only $49.95 plus shipping and handling, and countless medications courtesy of the pharmaceutical industry to help us all manage the resulting anxiety, depression, and despair. This is not all that different from the build-a-bunker-mentality of the anti-communist frenzy during the cold war and the subsequent pill-popping that ensued. We had to protect ourselves then no matter what it took.

And we feel the same urgency now. But most of the people who are building bunkers today, anxiously watching the colors flip back and forth from orange to red alert status, packing enormous first aid kits when they go hiking on local trails, or getting into armored tanks that can put holes through mountains are prepared in almost every way except what scientists are now coming to believe is the most important way. And that is the way of the mind.

The images we hold in our minds seem to be held in our bodies as well. What we think is what we are. What we feel determines how we heal. Dr. Larry Dossey, best-selling author and one of the foremost proponents of mind/body medicine, has written, "Images create bodily changes just as if the experience were really happening. For example, if you imagine yourself lying on a beach in the sun, you become relaxed, your peripheral blood vessels dilate, and your hands become warm, as in the real thing."  

If this is even partially true, it is an astonishing statement. The case to definitively establish the link between mind and body was opened almost 1,500 years ago when Hippocrates wrote that a person might yet recover from his or her belief in the goodness of the physician. Belief, image, thought--these were all clinical givens long before the advent of modern technology.

In 1912 one doctor reported that tuberculosis patients who had previously been on the mend, when given bad news (e.g., that a relative had passed away) took sudden turns for the worse and died. It was not called stress medicine or psychoneuroimmunology at that time, but the concepts were the same. And today the data supporting the connection between thoughts and health, indeed between mental images and survival, are mounting.

Images and Immunity

"We now can measure changes in immune cells and the brain in ways that give us objective scientific proof of the connection between them," says Mary Jo Kreitzer, director of the Center for Spirituality & Healing at the University of Minnesota. In psychotherapy circles, it is now considered common knowledge that people under hypnosis can be given suggestions and make them manifest in their bodies immediately. For example, a person who is given the suggestion that he is being touched by a burning cigarette will produce a burn blister even though the object that was actually touching him was neither hot nor cold.

People known to suffer from multiple personality disorders have even been documented with allergic responses when presenting in one personality but not in the others. Muscle movement is no different and, according to researchers, anyone who's ever watched a movie has personally experienced the physiologic power of thought or imagery. In one study, movie-goers were monitored (via machines which record galvanic skin responses) and found to unconsciously mimic what was occurring on screen with micro-muscle movements. When someone in the movie jumped, the muscles ordinarily responsible for jumping in the person watching the movie made similar movements.

Brain scans have similarly shown that when we imagine an event, our thoughts light up the areas of the brain that are triggered during the actual event. Sports psychologists have been responsible for extensive work in this area. In one study, skiers were wired to EMG machines and monitored in a manner similar to the movie-goers except that they were being monitored for electrical impulses sent to the muscles as they mentally rehearsed their downhill runs. The skiers' brains sent the same instructions to their bodies whether they were doing a jump or just thinking about it.

What does this mean for a person out in the mountains who suddenly finds himself stuck in a downpour and unable to get out before dark when the temperature is expected to fall nearly 40 degrees? How does this help someone with an asthma attack in the middle of a lake or a person with a broken leg one hour from the nearest ranger station? How does this help a rock scrambler or skier have the performance of a lifetime and keep themselves calm and healthy? What some people claim is that it can mean the difference between life and death.

The simple notion is that the words we say (to ourselves and to one another) do matter, that they affect us both physically and mentally, there are ways to speak that make those words healing no matter what the situation. By saying the right words in the right way we are able to speak directly to the body, reduce an inflammatory response, help to slow down or stop bleeding, change the way an event is interpreted so that it is experienced differently IN the body.

Thinking Past Illness

The scientific community seems to be coming to this conclusion. "There is ample evidence that negative thoughts and feelings can be harmful to the body," says Lorenzo Cohen, director of the Integrative Medicine Program at the M.D. Anderson Cancer Center in Houston. Stress is known to be a factor in heart disease, headaches, asthma and many other illnesses.

Studies by Janice Kiecolt-Glaser and Ronald Glaser at Ohio State University show once again how even relatively minor stressors--a job interview or a speaking engagement, for example--can sufficiently compromise the immune system so as to predispose one to illness. The researchers found that a marital spat delays wound-healing and that the stress of caring for an Alzheimer's patient leaves the caregiver more vulnerable to illness even years later. 

What Can We Do, What Can We Say: Verbal First Aid in Real Life

Deepak Chopra begins to answer that last question when he uses the metaphor of two people in a roller coaster. The following example is an adaptation and elaboration of his story:

Two people are getting into a roller coaster. One is a young cowboy-hardly moving off the platform yet, but his arms are already in the air and he's hootin' and hollerin' with anticipation. His heart is pounding. He's smiling. The woman next to him has her hands clamped down onto the metal rod in front of her. Her heart is pounding but she is not smiling. Both are in the same seat, on the same ride, but they are clearly not experiencing the same thing. The difference? Their thoughts.

The young cowboy in the roller coaster sees that the woman next to him is nervous. He turns to her. She looks to him, her eyes wide. She says, "How can you be so relaxed?" He smiles, points to his hat, "It's my magic hat." He takes it off his head and hands it to her. "You hold on to it while we ride, okay? It's easier to enjoy the ride when you know you've got magic with you." Her hands loosen their grip. She takes the hat. Tentatively, she smiles.

According to medical experts, anxiety (or fear) and pain are inextricably woven together for the vast majority of people. A great deal of human discomfort comes from our anticipation of it and our perception of it. Unfortunately, there is nothing marketed as vigorously in this country as is fear. If we're not scared to death by a headline, it's a radio report, a movie, a video game, or a television show. We're literally bombarded by images and ideas

that promote fear. We are propelled by it and sold by it.

If the science is correct, the good news is that we can change it on every level-from the conscious to the autonomic. When we alter our thoughts, are soothed by a kind authority, or are assured that we are in good hands, we can begin to feel the changes in our bodies-the softening of muscle fiber, the opening of bronchial tubes, the quieting of pain, the start of healing. This is why so much of  Verbal First Aid in the field is directed to the alleviation of anxiety through the development and utilization of rapport. In rapport, a person will feel, "She understands me." "He is going to help me." "I'm safe, now."

When we feel understood, our anxiety is reduced. And when anxiety is reduced, pain is relieved. Even if we are entirely alone, clinicians and scientists agree that what we say to ourselves matters and we can direct our thoughts so that our chances for survival are enhanced.

Whether you're speaking to yourself or to someone else on the trail, how you approach someone mentally and emotionally is at least as important as the medical expertise you have, according to Winnie Maggiore, former Asst. Chief of Placitas Volunteer Fire Brigade, paramedic, former Asst. D.A., and now a malpractice defense attorney.

"We saw the same things in the wilderness that we saw locally-snake bites, mountain bike wrecks, breaks, falls, cardiac conditions-but the injuries in the wilderness feel worse to the patient in that he's away from familiar surroundings. Most of what we had to do in rescues was anxiety management. The first step is to let the person know you have the expertise to help. This conviction allowed us to say 'do this' in a way that motivated compliance."

The other major ingredient in dealing with crises on the trail, according to Maggiore, is giving people some sort of control over what is happening to them. "When we were just learning emergency medicine, we were given a course in hypnosis so it could be used in pain control, because it could be all we'd have to work with out there. The worst part for patients was being out of control so put them back in control as much as we could, gave them something positive to focus on. Panic is a patient's worst enemy."

People normally want to reassure with blanket statements, e.g., "you're fine." When this is obviously untrue, it's the sort of statement that breaks rapport. It's better to say, according to the experts, that the worst is over and you're there to help. Your caring presence is the cornerstone of the healing process. If you don't know what to say, say nothing and listen as you wait for help or do standard first aid. Your care can do more than you might imagine.

The following are just two examples of ways we can talk to someone in distress so that they are calmed, their pain is reduced, and they are moved steadily towards healing.

Asthma in the Sandias.

Sam and his son, Jared, went for a hike up the Tunnel Springs trail. Sam was sure Jared had packed his inhaler. Jared was sure his dad had packed it. When they got up to the first crest, Jared was straining for breath. When they realized they'd forgotten it, Sam was smart enough to take a deep breath himself so that when he turned to his son he was calm, focused, and sure-footed.

Sam: Jared, I can see you're breathing but that it's a little tight?

Jared: (Nods, but can't speak.)

Sam: Sit with me here and lean forward like this. Put your head forward like this so your bronchial tubes can open and smooth out. [At this point, Sam's voice drops in pitch and slows down so that it's soothing and controlled. He "paces" his son's breath with his own, carefully so as not to hyperventilate, just enough so that there is a joint rhythm. As he speaks to his son, his breathing slows down just a little bit at a time, "leading" his son back to normal breathing.) And as you do, you can remember very clearly how your inhaler feels when you take a puff on it, a little cool, a little tingly and how it opens you up pretty quickly, you can remember how it feels when it's working...a little more open now...a little more open, a little cooler, until you can get a really good deep, slow, even breath...

A Tumble Along the Trail

The La Luz trail in New Mexico, full of crumbled granite that feels like a trot on a field of ball bearings, has brought more than one person to his or her knees. Cuts, abrasions, bites are exceedingly common crises. For that reason, while it's always smart to pack along a first aid kit, it's even smarter to know what to say to stop the bleeding and initiate a healthy immune response.

Sandra skids down the trail and slides into a sharp rock. When she gathers herself up, blood is pouring

down her leg from a 3-inch laceration along the side of her calf. Her friend Kim, well-prepared for a full day

hike, pulls out some Betadine, cleans the wound, applies sterile gauze on top of it and wraps it with a

clean, cotton bandana. As she does, she speaks to her friend so that the bleeding stops and healing begins.

Sandra: Damn it! It's really bleeding.

Kim: It is and that's actually a really good thing so that it cleans outthe wound. As soon as you've washed it through enough, you can stop [Kim emphasizes "stop"] the bleeding.

Sandra: Damn it. That was so stupid.

Kim: It happens to everyone. I know you've gotten cut before and you've stopped the bleeding before just like you're stopping it right now. You can hold it tight like this. Y'know even as we're sitting here, it's already starting to heal and the bleeding has slowed to a stop so we can walk down the rest of the trail.

Points to Remember

1. What we think, we feel. What we feel determines how we heal.

2. In shock or stressful situations, we are more suggestible. What you say to others and to yourself is translated quickly into physiological reality.

3. No "nots."  Keep your thoughts and your words simple, positive and concrete. If you want a person to survive, tell him to "stay with you." Telling someone not to die leaves them with only one image in his mind: dying. Even in ordinary circumstances, no one can imagine a "not."  We only see what you are telling us to not see.

4. Be authoritative. When a person is scared, they are looking for a pack leader, an authority to help and reassure them. If you're with someone who's hurt (even if that someone is yourself), you have to assume that role if you want to be of help. It requires a calm, centered, and confident approach.

5. If you don't know what to say, use a calming presence and say nothing. A touch of your hand, your presence can do a great deal to help a person when she's hurt or ill. 

Mental survival-regardless of where a person is, whether that's in the extremes of battle or a backpacking expedition-is often a matter of recalling or being made aware of the resources one already has. As Lt. Costello learned the hard way, the mind is the greatest weapon of all.

c. Judith Acosta, 2009. All rights reserved.