Living with the past

Tonight I went to a drug company dinner at a fancy restaurant. I never do these things, but ... well, I guess never is suddenly an exaggeration. The doctor presenting was a thoughtful guy who does pain management as well as sub abuse treatment. He talked about how a patient's time orientation was a good predictor of how they would do medically. Those oriented to the past - "I used to be able to X", "I wish I could do Y like I used to" - tended to do poorly compared to those who lived in the present or planned for the future.

That got me thinking about the things that get me stuck in the past. Childbirth is one of them. I had a horrendous experience having my son - 3 days of labor, 24 hours with an epidural, legs swollen beyond recognition, a doctor who didn't want to assert herself at all, and a C section in the end followed by utter and complete exhaustion, a baby who wouldn't nurse, an obstetrician who forgot to round on me at all, well, that was just the start.

Sometimes at night I lay in bed and remember all that, remember the helplessness and the frustration and the inability to say what I needed, and the inability to just trust that my doctor knew what to do. I ruminate on it, and wonder what I might have done differently, what might have improved the outcome for me. I figured out that I should have listened to the faint whisper that "this is a good fit" when I met the obstetrician that did my amniocentesis. That the whisper should have led to a major change in my medical care just didn't occur to me at the time.

I look at my son and know that whatever I may have gone through was worth it to have him. Still, I wish I had been less traumatized, less exhausted, and more emotionally available to him and my husband, instead of only being able to cry and feel like a failure. I wish I didn't lay in bed at night and have all of that awful experience come back to me.

There are a few other things that get me stuck in the past, too, all centering around some kind of traumatic experience. It is hard to pull out of those ruminations, that stuckness. My stucknesses are things I don't share with others. Talking to my husband today and telling him I wished we'd gone to that obstetrician we liked seemed to help me. Talking to my father after my mother's death seemed to help him deal with the thoughts that he should have done something different, seen a doctor sooner, something.

There is a list of things I don't talk to anyone about, though. I don't get stuck on them often, but they do come back to me from time to time. Like the childbirth experience, they all deal with being misunderstood, helpless, silent, inarticulate, overwhelmed. I am a survivor; I've suffered through a lot in my life. I focus on the future to a fault sometimes. But being stuck on the past doesn't help me grow beyond it. Maybe I'm procrastinating getting my mammogram because I don't want to risk another bad medical experience. Maybe I avoid conflict because I can't stand the flood of emotion that is so strong I can't articulate what I feel. Maybe I get stuck because no matter how many times I think about things, there is nothing better I can figure out to have done differently.

The guy giving the lecture today also talked about how past events shape the way patients live their lives. He described a woman who had been sexually abused as a child. This experience came back to her when she married. She wanted to please her husband sexually but couldn't deal with the memories, so she stuffed herself with food to numb the emotions and ultimately became obese and less desirable to her husband, which also allowed her to avoid sex and the recurrence of those memories. Surely there is a better way to live with our traumas. She lives to avoid them. I live despite them. Is there a way to live because of them?

That question sounds logical but I'm not exactly sure why. I read a story in JAMA today about a doctor whose daughter had leukemia and how that experience nudged him to talk to residents and students about the emotional cost of patient care. Because of my experiences with medical trauma as a young child, I've had that orientation all along. I was the only doctor on the family practice faculty that didn't just inquire about the welfare of the patients, but about the welfare of the residents and students as well. I knew the residents couldn't take care of the patients if I didn't take care of them. I teach creative writing to medical students. In return they teach me about their lives, their difficulties, their sorrow and suffering. I hope that having the chance to deal with what is happening to them at the time it happens will keep them from getting stuck later.

Maybe that is what I needed then, those experiences that make me stuck today. Maybe having someone look me in the eye and recognize I was having a hard time and step in and at least let me figure out how to say what I was going through is something that would have prevented stuckness down the line. Maybe getting the story out now, being free to say "I wish", to figure out what might have made the difference, would help me move past it today. Avoiding it surely doesn't work. One of my patients writes short stories about children. In them she writes childhood the way it should have been for her. Maybe she's on to something. Maybe all this stuckness is just a sign that we need a more formal way, a more open way, not of recounting the past, but recreating it. Or maybe we can write about how to keep the same things from happening in the future. Maybe in stead of saying "I wish I hadn't lost something in the past" we can now say "Next time, it will be different."