Curing the Incurable: The Basics of Medical Intimacy

One day about twelve years ago, Sam walked into my treatment room desperately seeking help. Sam suffered from trigeminal neuralgia — extreme nerve pain in his face. He had been referred to me by one of the best neurologists in the area. The neurologist had tried everything he could think of to eliminate the pain, including surgery, but nothing had worked. Having heard local reports of my unique approach to health care and my success with difficult cases, the neurologist had started to wonder, What could this guy, Coram, do for my patients? So he sent Sam to me.

This man was in horrible agony when he walked into my office. His facial pain was like sticking a hot poker in his cheek and leaving it there all the time. The memory of it still makes me cringe. Of course he was taking antidepressants and pain medications because the pain had gone on for six years.

I told Sam, "It's not going to do any good if I do things that other people have already done for you — things that haven't helped."

So I started exploring with Sam other aspects of his life. We talked about his work, his family, his recreation, and whatever else came to mind. "This is going to seem crazy," I told him, "but is there anything you have ever done that made the pain worse, or better — anything that changed the sensation?"

"Oh yeah," answered Sam, "but I told my doctors about that years ago, and nobody believed me or paid any attention to it."

Wow, I thought, that's a neon sign right there. "So what is it?" I asked him.

"Well, I have a rowing machine at home," said Sam, "and when I'm doing the exercise, my face seems to feel better. But the doctors didn't seem to be interested. They said I was using the muscles of my arms, not my face ..."

Immediately I asked Sam to take his shirt off. "I want you to reach for the ceiling," I told him, "while I take a look at the muscles in your back."

Sam lifted his arms up, and the scapula on the side of the pain didn't move. Normally, when a person lifts his arm up, the whole scapula moves up with it. You can't extend your shoulder completely without the scapula moving.

Sam proceeded to tell me that he had worked for twenty years at John Deere. He worked on a line, and his job every day was to repeatedly pull a lever with that arm. What happens with any repetitive stress injury is that we get micro-tears, and cumulatively over the years we get micro-scars. I concluded that over time the micro-scars had probably glued his scapula in place.

"Let me see what I can do with that stuck scapula," I told Sam.

At least I knew it was in the neighborhood of the facial pain and therefore worth addressing. So I worked at getting under the scapula with my hands. That's all I did. It was painful, but he was a tough guy, so I was able to free up his scapula in only two visits. After that, his facial pain was gone. That was when I first started discovering soft-tissue issues that no one else had been addressing.

What did I add to the mix that allowed Sam to finally get rid of his almost unbearable facial pain? How did I, in a small town in Iowa, get a reputation for helping to cure the incurables? First, very simply, I actually listen to what these patients say.

The power of listening — the patient knows what he or she needs if we will just listen. Over and over again, I have seen in my practice that the patient knows what is wrong, and he or she knows with some innate inner awareness what to do about it.

If we are willing to just sit there, to honestly listen and be open to them, patients will express what their needs are and how to fulfill them. They won't use the complicated clinical words — that's for the doctors to figure out. A doctor can't demand that a patient rise up to some high level of technical jargon before he or she will take the patient seriously. He or she can't take the attitude of, "You, lowly patient, come up here and communicate with me at this high technical level if you want me to do something to help you." The doctor is the person with the training. He or she needs to translate his or her technical knowledge into everyday language. Doctors need to talk to their patients just like any person talks to any other person and try to understand what they are saying. The worst thing they can do is just dismiss whatever the patient is trying to communicate.

So this is how I create that lovely feeling of relaxed intimacy that patients always feel in my office. They report often feeling as if they are talking with their best friend. And nothing can shake their sense of safety, so they can say anything.

When I use the term medical intimacy, I mean a relationship with the patient that is sensitive and attentive enough to allow the free flow of true communication, where the patient feels safe enough to speak freely and trusts the doctor enough to know that what she says is actually being heard. For true healing, this same quality of intimate communication must be developed within each patient. The patients must feel safe enough to listen to their own inner truth and free enough to communicate their inner truth to themselves and to others.

But building a sense of intimacy, either with oneself or with others, requires many elements. The first is listening with an open heart and an open mind. The second thing we must add is trust. That's what a lot of doctors don't do anymore. They don't trust. They don't trust their patients. And that encourages their patients not to trust themselves. If the patients stop trusting themselves, that impairs their healing process. They can't communicate with themselves intimately if they don't trust themselves. So if we are going to talk about intimacy, trust is a huge part of it — a huge part.

A lot of people show up at a doctor's office with problems, and the doctors don't believe them. "You're exaggerating," the doctor says. Or he or she dismisses the patient altogether with, "You're making more of it than it really is." I've even heard of local doctors telling their patients, "You think your back's hurting? I've got a lot of back pain myself!" In fact, doctors will even argue with their patients.

Many patients report that when they go into a doctor's office and the doctor doubts what they say to him, they either have to doubt themselves or doubt the doctor. Either way, they need to put some distance between themselves and that doctor. The sense of pulling away to protect oneself, that separation, is the opposite of intimacy. The relationship with that doctor at that point is no longer a creative one in which both parties are free to share their thoughts and feelings in an uncensored manner. This is the opposite of what people are looking for when they are dealing with a health problem that doesn't have an obvious solution. When they look to a doctor for help, they are looking for an environment in which the doctor and the patient can discover new ideas together, possible solutions we're not already aware of. They need to broaden their awareness in the doctor's presence, not squash it.

We need to realize that many patients in the distress of sudden illness go to a specialist they have never met before. They are faced with a possible diagnosis, second opinions, quick life-altering decisions, and maybe surgery, all in the presence of people who are complete strangers. This is shocking, especially if there is not a sense of intimacy and connection felt with the doctors and nurses who are literally invading one's body — while also stimulating a huge range of delicate feelings. People who are ill feel vulnerable, overwhelmed, and often helpless. The big issues of life and death pop up in their faces. These are moments of extreme physical and emotional delicacy. Having a strange doctor the patient has never seen before cut into his or her body and crack jokes while he or she is operating inside the patient's tissues can feel it as a deep violation — like a rape.

I do realize that when I use the word intimacy, sexual intimacy comes to many people's minds. I chose intimacy, along with the implications, deliberately. I wanted to find a universal metaphor. Almost everyone understands the language of sexuality. Sexual experiences are compelling, deep, and basic to our very lives. Every one of us was born from a sexual act. If I describe our medical relationship problems metaphorically in sexual terms, everyone understands what I am talking about.

For example, doing surgery on a patient without the prerequisite foreplay — getting to know the patient, finding out his or her unique story, and addressing his or her very individual needs — is a violation, a rape. People can die in the process. Name tags get switched. Allergic reactions happen. Presumptions and lack of information lead to misdiagnoses, oversights, and infections. And worst of all, the patient's natural healing response, which is the only real healer, gets damaged or displaced.

I believe we need to go back to old effective medicine, where the family doctor treats generations of the same family and knows his or her patients well.

But more important is the quality of the relationship that a doctor or nurse has with his or her patients, no matter how long they have known each other. To be of any help at all, I must listen to my patients deeply enough to know what they need. Then I can draw on my expertise and be open to inspiration for a creative, out-of-the-box solution. Ultimately though, the most important relationship of all is my patient's relationship with himself or herself. When I foster a relationship of openness and intimacy in my treatment room, I lay the groundwork for my patients to discover within themselves the magic of their own healing. I allow them to become more intimate with themselves. That is the ultimate healing relationship.

Giving Back Hope

Recently a patient named Sarah fell from the second-story loft of her new house and landed on a heavy wooden ladder. The ladder staircase leading to the loft had come loose while she was climbing up, and both Sarah and the ladder had crashed nine feet to the floor. Luckily no bones were broken, but her body was badly cut and bruised. Several weeks after the fall, her left leg was still extremely swollen with a huge dark bruise that was not fading. So she was referred to my office since I had worked with athletes in the past, and one of my areas of expertise is treating sports injuries.

In the month after her first visit, I noticed that Sarah began doing a lot of new and positive things in her life. She found a new weight-loss program that seemed doable and started following it. She began exercising regularly and lifting weights, and she attended to some paperwork she had been putting off. When Sarah mentioned these positive changes to me during one of her visits, I immediately replied, "Well, that's to be expected."

Why wasn't I surprised by these good shifts in Sarah's life but felt they were to be expected? Are they the result of some magical powers that I zap my patients with in order to create shifts for the better? Actually, it's simpler than that. I've found that the biggest miracle worker in improving a person's health is simply hope.

When a patient becomes hopeful, I've come to expect to hear reports of all kinds of positive changes in their lives. Greater changes than I could even imagine. Let me explain.

The first time I saw Sarah, her leg was so bad. The natural tendency we all feel when we have a wound is to avoid touching it. We want to avoid doing anything with it and just wait it out. So people sometimes will be in this holding pattern. They might have a desire to do something to help themselves, but they hesitate to do it because they don't want to mess it up. So in Sarah's situation with that battered and swollen leg, I wanted to get a lot of changes going quickly. There were some concerns because as fluid sits, it starts destroying tissue, so you can get secondary problems. I really wanted to make a lot of changes in that leg right away. So as I was doing all that intense work, deeply massaging and manipulating her swollen, bruised leg, what came up for her was the realization, Well, if he can do all of that without really hurting me, then maybe I can do some things I've been afraid of doing. Maybe my fears that I would hurt myself doing those things aren't valid.

I talked to Sarah as I worked, even while I was intensely and vigorously working on her leg. "I know this hurts," I said. "I get that. But we need to make these changes right away." I told her, "When this fluid goes away, circulation and balance can be restored, and your leg can become normal again. I need to work all of that fluid out of there." She was able to trust me enough to handle that. She may not have made a conscious connection between my work on her leg and other possibilities for her life, but I think on some level she realized, Gosh, I guess I'm not as fragile as I thought I was. Maybe I can start to do a lot more things!

My work is about restoring hope. Clinicians ask me, "What kind of homework do you give them?" But I don't like to give them a lot of homework because my homework would be too limiting.

I want my patients to go home and live their lives. And they'll go home and try something, and they'll see, Oh, that doesn't bother me so much anymore. And then they'll try something else ... And when they come back, they are doing ten times more than I could have made up for them to do the last time I saw them. "You're doing all that?" I ask in amazement. "Great, that's good."

So I help my patients notice how amazing their progress actually is, and that what they now experience as their normal behavior would have been extraordinary a few weeks ago. Wow, that's a solid basis for hope — hope that real healing is possible and that real healing is actually happening. There's no mysticism here, just simple caring.

That is what I want other clinicians to understand, that it is a human thing I do, not a special thing. And we need a lot of other clinicians out there to create a revival of hope. My intention is to bring all this back to a spiritual level. Let's bring out our finer selves, our inner angels. Let's bring out all the sensitivity, the resourcefulness, the great reservoirs of kindness and compassion that brought us into the field of healing in the first place. Let's awaken that angel within all of us so we can better serve and care. We've heard about this problem in medicine for years, and I've written about it again and again in the papers — that doctors take away hope. They take the hope away.

All I end up doing with many people is just giving them back the hope they have been looking for, the hope they really want to give to themselves, the hope they have been nearly convinced is unrealistic, pie-in-the-sky, unsupportable. I help them prove otherwise. I help them notice, through their own experience, the indisputable evidence that their hope is realistic. They are improving. They can get better.

"Here it is," I say to them. "Yes, here it is. Hope." I just give them back their own hope. And when I do, they find the healer within themselves. I just set up the necessary conditions and get out of the way so they can continue with their own very personal healing process.

This nurturing of hope needs to spread beyond the doctor-patient relationship to all the relationships in a patient's life — family, friends, workplace, church, school, community — and most importantly, to his relationship with his inner self.

Notes from a Wider Perspective

I am frequently asked this question: "Is emotional healing always a precursor to physical healing?" The answer is no, not always. There are, in some cases, physical conditions that are just physical conditions. For example, when I work with athletes, they often sprain their ankle. Usually there is no emotional precursor to that injury. Unfortunately, I have seen in the nontraditional medical world a common tendency to assume that everything, whether it is an injury or an illness, is an emotionally based issue. This is not always true. If we don't heal the physical wound when it occurs (and this happens with athletes), it will become an emotional problem as well as a physical problem. The emotional baggage will tie itself into the physical condition and block fixing that physical condition.

I don't limit myself to using just one approach to healing when working with my patients — for example using only spiritual work, or only emotionally based work, or only physical work. What I have found in some of these difficult, complex cases is that patients weren't getting results because there were parts of their being that weren't being addressed. Physical conditions, if they are only physical conditions, can be treated successfully with physical treatments alone. That's true. But the longer we hold onto a physical condition, the more it permeates the being, which then can affect the emotional and the spiritual part of the person, and then we need to use more than just one approach to healing for it to be successful.