On Shrinking or Growing

We doctors like to think that each day brings another stream of contented patients, leaving our rooms with their health bolstered by the edifying power of our erudite and well-considered advice. And maybe each day a few do just that. We know, however, that lives are far more complex, that the doctor only plays a minor role in any individual healing journey – and that the patient may play no small part in the journey of the doctor also.

“Our patients are our greatest asset,” was what my former senior partner, Chris Jagger, said to me when he invited me to join the practice over ten years ago, and the longer I have been in General Practice the more I have understood what he meant – that the people I am meant to be helping will have an important role in teaching me and shaping me as a doctor.

One such lesson, which I come back to again and again, happened a year or so ago when a patient said to me: “When something bad happens to you, you can shrink or you can grow – and you do have a choice.” These wise words are well worth holding on to, storing somewhere safe and retrieving whenever the need arises.

They say that you can’t tell if a bridge is well made when a cat walks over it – but if a train crosses the same bridge then it has been well and truly tested. The woman who gave me this gem of wisdom has experienced the odd express train over the years, and so I know that this advice is born out of real life rather than the theoretical musings of someone who has never known adversity.

I have just come across a powerful example of someone choosing to grow despite impossible circumstances when I read The Diving-Bell and the Butterfly by Jean-Dominique Bauby – a book that I would recommend to everyone as a remarkable source of inspiration and hope. It is only 135 pages long and consists of short, disjointed chapters with no sense of a plot and so it makes an unusual read, but it is compelling nonetheless.

The book is the account of its author about life with “locked-in” syndrome. This aptly named, profoundly tragic condition occurs when the brainstem is devastatingly destroyed – usually by a stroke. The brainstem is the connection point between the thinking part of the brain and all the body’s functions. A person with locked-in syndrome can think, hear, and see, but cannot speak or move. Conscious yet totally paralysed – this is no ordinary express train to test the structure of your bridge. A stroke was the cruel force behind Jean-Dominique Bauby’s reduction from Editor-in-Chief of the French Elle magazine to locked-in patient at the frighteningly young age of 44. He had only the slightest residual movement – he could blink his left eyelid – and with this he communicated with the outside world, and ultimately dictated this book.

What is remarkable about the book is the author’s lack of bitterness and the strong sense of hope that permeates its pages. Bauby is honest – he does not hide the reader from the pain, frustration and humiliation inherent in his situation – but he has a determination to see the beauty of little things that we don’t normally notice, the ability to dwell in the moment and seize every opportunity to bring a richness to his existence – using his imagination to take him to places that were denied him when he was free to roam. For someone who could apparently do nothing, he was always busy – seeing, thinking, listening, and latterly composing, reworking and memorising the chapters of this beautiful book, ready to laboriously dictate them the next morning.

When someone shows as much courage in diversity as Bauby has shown there is a danger that the inspiration we might receive is tempered by a deep sense of inadequacy by comparison. Here, Bauby helps the reader to stay connected to him by making it clear that he is far from a perfect saint. He is open about his own inadequacies, particularly from before his illness, and you get the impression that he would have been hard to live with at times. He laughs at himself, cracks bad jokes and never gives up hoping for a cure. You feel that you can relate to him – here is a normal guy who has learnt, for the most part, to hold on to that most human of traits – hope – and choose to grow despite it all.

In our success-driven modern world we like to live our lives pretending that adversity won’t happen to us, but if you work in health-care you are reminded daily that it frequently does – and so I commend this book to you, and I will hold on to my patient’s advice. I only hope that, with God’s help and grace, I will always be able to choose to grow when I have the opportunity.