On Affairs of the Heart
In the wake of several posts addressing the need for more dispassionate adherence to facts, figures, and documentable evidence, I am inspired to hold forth about the value of the wisdom of the heart and soul. Indeed, one of the factors that makes this site attractive is CM’s insistence that fact be separated from opinion, and that assertions of fact should be backed by the appropriate documentation. This is a laudable guideline when applied to energy and the economy, and perhaps a bit less so, to the environment. But I would argue that while it is useful, it is insufficient in itself in guiding us in our decisions regarding people. In the Community Forum, there’s been an interesting ongoing discussion of the framework necessary for a thriving community, and one of the [as yet] undisputed characteristics proposed is that the ideal community is of human scale. The need for human scale is evident in the ineffectiveness of our [U.S.] federal government in meeting the needs of individuals and families . . . . . . The scale is wrong. . . . . . massive programs are simply of the wrong scale to deliver the goods that nurture the heart and soul . . . . . . . . and what differentiates us from a highly developed form of AI*, if not the heart and soul of man?
All of that is just so much rhetoric, so, at the risk of hearing the collective groans of those hearing yet another Tale of the ICU, I offer the following:
Some years ago, I received a unique patient in the ICU at the community hospital where I worked. This case was right-up-my-alley, as the patient was completely atypical: she was only 19 years old, and though there were no known risk factors (such as birth control pills), she had suffered a massive left hemispheric stroke. For those without medical background, this usually means complete loss of the use of the right side of the body, as well as loss of receptive and expressive language skills (speech). (For those who are well versed in these things, she was right-handed). When the CAT scan films arrived, I put them up on the viewer, and literally gasped . . . . . . . . for all practical purposes, the entire left side of her cerebral cortex was gone . . . . . . the first question was “how did this happen?” The stroke was occlusive in nature, not hemorrhagic, so an aneurism was ruled out. Some kind of congenital anomaly could not be ruled out. There was a boyfriend with a violent history, but there was no physical trauma evident . . . . . It was just one of those mysteries that would never reveal its secrets.
Needless to say, this young woman was in dire straits . . . . . she was hemodynamically unstable, unresponsive, and her pupils were fixed and dilated (a condition associated with severe brain damage and/or brain death). As no two patients are the same, this one was unusual in that, though comatose, her eyes remained open . . . . . . but fixed and dilated. Even for a seasoned ICU nurse, it was a bit eerie.
As always, I continued to talk with the patient, with little hope that she could hear me, offering comfort and encouragement, and letting her know what I was doing. As I moved around the room, her open eyes were fixed, that is to say, they did not “track” me around the room. Her pupils were huge and black, nearly completely obscuring the color of her irises. As I would pass in front of her line of sight, as it were, though there were no outward signs of it, I had the eerie and distinct sense that she could see me. Try as I might, with all my training in objective assessment, I could not find a shred of documentable evidence that this was so. But going on my gut, I would position myself in her line of sight when I spoke to her in earnest.
As fate would have it, one evening, on my initial assessment, I found the technical data on this young lady indicating that she was dehydrated, and concerned about the perfusion to her already traumatized brain, I called the intensivist. It wasn’t like him to inadvertently allow his patients to be inadequately hydrated, so I shouldn’t have been surprised when he told me that he wanted her “dry”, to ensure that her organs were not spoiled by overhydration, since he planned to harvest her organs soon. Well, that took me back a step, and gathering my thoughts, I stumbled forth with: “Doctor [Name Withheld], I have nothing but my gut to base this on, but though her eyes do not track, and her pupils are fixed and dilated, when I walk in the path of her line of sight, I sense that she sees me.” The line was silent, so I leapt into the breach, saying, “I’m basing this entirely on my gut, but I’ll stake my reputation on the assertion that this patient is nowhere close to brain dead.” This was our premier intensivist, and I secretly wondered whether I had just killed my career . . . . . . the line was silent for what seemed like forever, and then: “OK, I’ll give you three days”. Well, that was all this crusty old nurse needed. I related the story to my colleagues, and we went to work . . . . . . within the requisite three days we demonstrated a sufficient response that the intensivist, who was supremely competent, was fully onboard. I knew that half the battle was won . . . . . . .
About a month later, needing to move to the day shift, I had filled a slot on the stepdown unit, and was delighted to hear that my patient had followed me. She had been to Hell and back, and still had a tracheostomy and paralysis of the right side. It was assumed that she could not speak, though that could not be confirmed due to the tracheostomy, which bypasses the larynx, precluding utterance.
And oh my, oh my! Was she angry! No, she’d have none of that “I’m so grateful you saved me” stuff. She was right and truly outraged that we had saved her to live on as a “cripple”. Though she could not speak, her eyes and body language told the story clearly enough. And oh! When we got her up in the chair to improve her respiratory status, she was livid! (Skip to the next paragraph now if you’re squeamish). This little whippersnapper would reach up with her good hand, pull down her trach collar (delivers oxygen), and hurl phlegm at us with all her might! Well, that, and her despair simply had to be dealt with . . . . . .
Though it was not in the “care plan” that had been scientifically developed by the hospital’s bean counters, I went down to the gift shop, and bought a squirt gun. I loaded it up with sterile IV fluid (so no one could complain about the “risk” factor). With the usual struggle, we got this young lady up to the chair, and I handed her the squirt gun. I explained to her that if she could hit me with it, she could go back to bed. Well, what fun we had . . . . . . No, she was not smiling, but, yikes! She was determined to punish me! I got quite a workout whenever I had to visit the patient next to her room, ducking behind the station, and doing variations on the “GI crawl”. I knew that we were on the right track when she finally “got” me . . . . . . . the satisfied look and involuntary smile said it all!
Eventually, I bundled her up, wheelchair, O2 tank, suction canister, feeding apparatus, IV fluids, and all, and took her outside on a mild summer day. My colleagues thought I had completely lost my mind, and my not-so-young charge was not initially enthusiastic. But when we got outside, and she felt the wind in her hair and the sun on her face for the first time in months, the tears rolled down her face, and I knew that the battle was won.
Several months later, I was rewarded, when, back in the ICU (on day shift!), I was interrupted in my work because “somebody is here to see you”. My colleagues knew full well who the visitor was, but played dumb so they could see the look on my face when I saw this young lady walk in, with a splint on one leg, and say, “I just wanted to thank you”. . . . . . . . Even I, who was initially her only believer, was dumbfounded. She not only could walk and talk**, but she had just won back the custody of her 2-year-old son.
So, my, that story got long . . . . . . . I apologize for that, but my point is this: that while the data are very useful, sometimes it takes a human heart, courage, and a heaping dose of faith to make the right decision. To my knowledge, none of those are quantifiable by scientific means.
So, how is this applicable to community at large? Far be it from me as a lover of the oscilloscopes and LEDs available in the ICU, to negate the value of technology, appropriately applied science, and objective data. Without these, modern civilization would not be possible. But also, without the unquantifiable values of the heart and soul, civilization, as I understand the concept, would be equally impossible. I tremble to envision a society in which we worship the trinity of technology, science, and mathematics. It’s not hard to imagine the rationalizations that could be made for infanticide, euthanasia, cannibalism, and the mythological soilant green. It is not hyperbole to understand that these are the potential endpoints of logic unchecked by the human heart and soul. It’s a slippery slope, my friends . . . . . . let’s check the slide with our roots firmly grounded in the hearts and souls with which we are so generously endowed.
An with that, I declare, that I am, for better or for worse, truly "back".
* Artificial Intelligence
** Though the vast majority of right-handed individuals are left-dominant, that is to say, the capacity for speech is located on the left side of the brain, this young lady turned out to be one of those very rare individuals who are both right-handed and right-dominant, so her ability to communicate was preserved. I wasn’t present, but I can, from experience, well imagine the first choice words that came out of her mouth after the tracheostomy was resolved!
While I do sometimes support a rational approach and pragmatism (especially on this board, it seems), I am most definitely a "gut feeling" girl. (For those of you who care about MBTI personality theory – I’m a dyed-in-the-wool INFP). All the data and rational argument in the world will never convince or sway me if I feel, deep down, that the opposite is true or there is something missing. It has taken me a long time to balance my feeling side with my thinking side so that I don’t go off half-cocked; but that feeling side definitely trumps all. I absolutely will not ignore a bad ju-ju feeling ever again!
I think that our culture now blindly worships Science and the Rational in way that is just as unreasonable as Mysticism and Superstition. We need both our heart and mind to make good decisions! A person will always have a preference toward Thinking or Feeling… but it’s important to develop the weaker one so they’re more in balance. Thinkers can stand to be more compassionate and Feelers can stand to be more pragmatic. Balance in all things, Grasshopper.
BTW – I loved your brain trauma story. Since my neurophysiology is anomolous, I love hearing about others who came out ahead of the curve because they were built all wonky! When I was younger, I was in a bad car accident and took a healthy crack to the noggin. At the ER no one realized the extent of my concusion because I was writing and talking and tracking, etc. But one nurse noticed a little thing that got me into the CAT scan really quick… I was writing with my left hand now and she remembered I was using my right hand when I came in. Since I am ambi, I can write just fine with either hand, and since my right hand wasn’t working quite right, I was doing everything left handed! If she hadn’t gotten, or paid attention to, that niggling feeling that something wasn’t as it should be, it’s possible that they could have sent me home or I could have coded in observation!
Welcome back Cloud, thank you for your ICU story, that is a great example of the value of intuition and instinct (and lots of heart and creativity). You patient was fortunate to have such a dedicated and observant nurse. Hi Plickety.
I think some intellectual types rely on gut more than they realize and then find the facts to support their feeling. I have read that one of the originators of the double helix theory of DNA based his final theory on a dream and then completed the scientific research to back it up. I love science, have loved it since I was a kid, but not everything is quantifiable by our limited intellects. We are not smart enough to quantify and prove every truth, are we? As Dr. Martenson says, "trust yourself". There is not the luxury of a research study to prove what you know is true at every turn. Of course opinions can be biased and lies can be used to mislead people and this has to be factored into the equation I think.
I think there is sometimes a tendency for people to try to dismiss the things that we don’t understand because of anxiety over our confusion. One day I hope we can understand how intuition (gut feel) and instinct occur, how we process the information to make these gut feel decisions, I bet it can be put in scientific terms when someone is smart enough to figure it out.
Your report of your experience in the ICU is very objective, like a naturalistic study or Case Study, both of which have served as the basis for important medical research over the centuries….the initial studies of HIV started with around 3 case reports published by concerned physicians in northern California, if you recall. There is not enough credence given to these individual reports now that the FDA and much of Big Pharma are so focused on profits instead of healing. JMHO.
I will certainly have some things to say/stories to tell on this thread, but time isn’t there right now. But soon…
Glad you’re back, c1oud.
Viva — Sager
What you’ve written above has put into words how I feel …
I talk with people every day as best I can to get the message out about CM.com and the Crash Course. It is part of a daily ritual, day by day. I found that I can give a grand description of how many $1000 dollar bills will stack up in miles times by 80 will give a figure beyond the scope of the human mind, or, I can find a clear and precise answer for whomever doesn’t get the enormity of the issues ahead by finding a humane, heartfelt and soul filled comparison along the lines of how it affects their daily lives. The result is that no amount of pushing, however passionate, will lead them toward watching the course, going through all of The Six Stages of Awareness, fluctuating over hours, days, weeks and months, without a true emotional focus, even if a true plan of action comes from studying facts. You cannot have one without the other in the purist of senses and I for one wouldn’t be writing here just for my ability or the ability of this site to compile facts. It is much more than that and more than frankly illusive …
… to put it into words without a metaphor for me is also beyond my scope ordinarily …
Lets just say that for myself, I’m driven from the core on gut feeling and reaction, and only then will I be able to compile facts …
Rosemary Sims linked this short lecture from the Ted catalog a while ago. I think that Jill Bolte Taylor will take many on quite the journey from the perspective of someone that ordinarily derives facts from study than from such an impressively emotional and personal standpoint … :-
PlicketyCat, as ever, I find you fascinating …
That was an amazing story that I will never forget. Welcome back.
I just keep thinking about how one should never underestimate the power of a human being who refuses to give up.
Awesome story, c1oudfire! It is good to have you back.
I’ve been away from the ‘puter for the past day, so I apologize for the delayed response to everybody’s amazing posts:
Ah, Plickety! As usual, you’ve hit the nail right on the head with your characteristically colorful way of saying exactly what you mean . . . . . . Balance, indeed, is key . . . . . . And, I loved hearing your head injury story. . . . . . indeed, you were fortunate in not having one of those let’s-just-get-through-the-shift nurses. It’s funny how these things work out, isn’t it? BTW, I’m pleased as punch that you’re made "all wonky" . . . . . . it’s personally enriched my life on more than one occasion . . . . . .
Hi, again, Denise . . . . . So good to have another healthcare professional weigh in on this . . . . . Yes, I remember reading that about Watson and Crick’s "discovery" of the double helix structure of DNA, and I’ve experienced the same phenomenon myself, though not with such earth-shaking consequences. And (I hope he’s not listening), I have often suspected that Dr. Martenson’s conclusions draw not only on facts and figures, but also a healthy dose of intuition, or at least, I hope so. After all, raw data is just a smattering of numbers . . . . . . it requires a human mind to make sense of them on a human scale.
With regard to scientifically studying intuition, I am truly not certain that will be possible. From my experience, it seems that while one can access and to some degree integrate "information" from both conventional intellect and intuition, there are inherent problems in "quantifying" (conventional intellectual function) the intuitive. But, I think it’s an interesting area of study as long as we aren’t tempted to negate intuition based on a failure to quantify it.
Paul; I owe the recollection of this patient’s story to you, as you shared your nurse-mum’s story with me. Thank you. As usual, your encyclopedic mind has pulled up the perfect clip to demonstrate that you truly "got it", and to take the expression one step further: http://www.ted.com/index.php/talks/jill_bolte_taylor_s_powerful_stroke_of_insight.html. My husband and I were both moved to tears, hearing this woman’s story, and her explanation of the interaction of the right and left hemispheres was simple, direct, and elegant. I was giggling at every turn of her description of the battle between her left and right hemispheres, as I experience much of life that way on a day-to-day basis. . . . . . As Plickety so aptly pointed out: it’s the balance that counts. Jill Bolte Taylor said it quite well when she emphasized the need to be able to access both the linear and intuitive brain functions, as needed. During my historical Zen practice, I developed the rudimentary skill of shutting off the left hemisphere (which theretofore had been my preferred method of knowing). Later, as I learned the drawing skills necessary to express my garden designs, I had to take that one step further, and learn to quiet the left brain just enough to let the right brain see things as they really are, rather than as I conceptually understand them, all the while keeping enough left brain function to manage the "quantitative" aspects of design, such as spatial requirements. Indeed, it is a matter of balance, Grasshopper.
Hi, Becky; I am glad to hear you were touched by this woman’s story. I’ve always had a soft spot for "fighters". Indeed, that’s what I saw in this young lady’s eyes from the beginning . . . . . she had "spirit", and rather than being annoyed by her angry "shenanigans", I found in them the seeds of hope . . . . . . apathy and whining just weren’t in this lady’s repertoire, and I respected that. My colleagues knew (only too well) that if they wanted to punish me for some perceived slight, all they had to do was corner me into caring for the ever-present token "whiner" on the unit . . . . . it was the one personality characteristic that was like fingers on a chalkboard for me, lol. Give me the lady who was spitting-mad any day, but please don’t make me answer the dreaded whiner’s call light!
Collectively, thank you, all, for affirming my sense that community is an empty concept without heart and soul. And a special "thank you" to you who, behind the scenes, have renewed and inspired me. Indeed, as intuition is the capacity that allows us to "connect the dots" of economic data, heart and soul are the glue that hold a community together.
This thread reminded me of a discussion I was having the other day about fairies, elves and other things "supernatural". My argument being that it’s entirely possible these things exist, but our rational mind dismisses them and our instruments just can’t measure them. Perhaps the reason we can’t find any positive evidence is because we have chosen not to… through our culture or whatever. Perhaps the reason that children believe in these things is not because they have fanciful imaginations, but because they haven’t learned to be rational and jaded yet. A classic example of the rational killing the intuitive.
I have always found it quite ironic that people can have faith in God, the Devil, angels, demons and saints; but refuse to even accept the possibility of ghosts, ESP, goblins, gnomes and pixies. It’s almost as if we’ve decided that only a certain amount of intuition and faith are allowed! Personally, since I can neither prove nor disprove any of these entities and aspects, I have to accept the possibilty of their existence. But Science doesn’t like loopholes like that… if it can’t be quantified, it must not exist! Humans are odd little creatures – ROFL.
I’m a sucker for fighters myself, especially if they are underdogs. I swear, there have been days I think I survived on the sheer force of my will alone. I might whine a little just to vent frustration, but can’t imagine completely giving up and giving in. Anytime I get tired and feel like giving up the good fight, there is such an upswell of anger that I think "well, screw that!" Everyone wants to make anger "bad" these days, but healthy anger is a natural response to not having your needs met. If you’re pissed off enough, you’ll fight to fix the problem!