Khoo Teck Puat Hospital
(from The Magazine of The American Holistic Association, Spring 1998 edition. Please note that this article is Copyright material of Dr. Claudia M. Cooke; no part may be reproduced or used without expressed permission from the author.) — by CLAUDIA M. COOKE, MD, MPH
I grew up on a farm and had a love of going off with shovel and trowel to dig for buried treasure. Antique glass, shards of pottery and old bones were precious finds. My father told me that if I dug deep enough and long enough, I would find my way to China. This possibility intrigued me, though I knew I would not get so far with the garden trowel. China and the Orient were of continuing fascination to me as a small child. My paternal grandfather had been doctor to the King of what was then Siam, and in his house was an imposing photographic portrait of the King. His demeanor of composure was attractive to me. Then it was on my sixth birthday that I received a book of Chinese fables from a boy called Akana, a childhood sweetheart. I read that book numerous times and indulged my eyes on its lavish illustrations.
Then there was the Encyclopedia Britannica, central in my childhood education. My favorite pages, which I thumbed over and over again, were the anatomical transparencies in volume 1, “A to Anno”, under Anatomy. Layer upon multicolored layer revealed male and female anatomy from skin to muscles to viscera to skeleton. What is it about skeletons that intrigues and amuses children so much? Perhaps it is the apparent sameness across the species at the bare bones level, despite surface differences. With my grandfather’s passing before my fifth birthday, except for these anatomical transparencies and the rare visit to the pediatrician which I detested, my exposure to medicine ended. There was one other thing. My grandfather’s dowager sister gave the game of Uncle Wiggly for my fifth birthday. the object of the game was to get this arthritic, endearing rabbit through snares and pitfalls to Dr. Possum’s house for his rheumatiz cure. Perhaps it was these innocent childhood diversions that impelled me towards medicine and acupuncture years later. Perhaps , too, Uncle Wiggly has been allegorical for my circuitous progression ever in search of the elixir of health and happiness, something like the acupuncturist’s dream of the single needle treatment, or the classical homeopath’s search for the single remedy.
Shortly after President Nixon’s historic trip to China, my girls’ school sponsored a China weekend so we could learn more about this distant gargantuan country. Among a variety of speakers was a Chinese MD from Yale University. He spoke to us about the ancient Chinese tradition of acupuncture. I can no longer remember the details of his talk, but only the positive impression the person and his purport left etched deeply in my mind. For four years before starting medical school, I had the good fortune to sit in the presence of a most gifted teacher. Soon after reading the fundamentals of yoga,. I met its author, Dr. Rammurti Mishra. Dr. Mishra was both a medical doctor with specializations in neurology, neurosurgery, and endocrinology, as well as a Sanskrit scholar, acupuncturist, and not least of all, brilliant expounder of yoga philosophy and practice. It was his repeated contention that there was no involuntary function of the body which is not amenable to our voluntary control. Favorite aphorisms of his were, “health of in the body is the experience of bodilessness”, and “Meditation is the best medication.”
Only months before I began medical school, my third positive encounter with an acupuncturist occurred in Brazil, my country of birth. I visited his university-affiliated clinic and watched as this doctor, trained in China for three years, successfully treated one patient after another. Most memorable for me was watching him treat a woman with a severe migraine whose headache dissipated during the treatment.
During those years before medical school I had a number of contacts both with allopathic trained MD’s working with alternative modalities, and non-physicians working with alternative modalities, completely outside the medical establishment. It seems that reform in any arena is carried out either from within the establishment in question, or completely outside it. What was apparent to me, and dismaying, was that many of those who chose the outer camp in the health arena who were spurning the inner sanctum for its arrogant and dogmatic positions, were holding up an alternative vision, albeit with an equal measure of dogma. Perhaps that’s a necessary movement in the transition. Happily, it seems that we are moving ever more quickly towards dialogue across that interface. In any case, I resolved that I would take the establishment route, would submit to its discipline, would carry my convictions with me. I wanted to study anatomy and physiology, wanted to know the body in its various layers and guises, wanted a Western clinical schooling.
The first year in medical school was a rude awakening. It was a bloody, tear-strewn entre. During my first rocky semester, so much discipline evaporated. My rising level of adrenaline and the craving for meat that accompanied it brought five years of vegetarian diet to an end. My daily practice of hatha yoga and pranayama dwindled. I had wanted to combine traditional Western medicine with alternative approaches. And so, one self-imposed pre-requisite followed another from medical school with combined MPH, to three years residency in internal medicine, to 5 years full-time stint as a New York City emergency room attending. I reasoned that this would help me to deal with whatever might arise clinically wherever I might land in the future. Besides, in keeping with my Eastern focus, the ER was certainly a wonderful opportunity for practicing yoga, that is, for being in the moment.
After all that time credentialing myself in the allopathic world, and practicing medicine in a well-established institution, by dint of good luck and good timing, I finally found my avenue to studying acupuncture. I left the Manhattan hospital I had worked in for eight years, let go of my Manhattan apartment, and left New York behind with many other things associated with that part of my life. And after two years of diverse clinical and personal experience, obsessional acupuncture studies, and many long walks in distant lands, I now find myself much to my own surprise, back where I began, in Manhattan, launching a holistic medical acupuncture practice with the goal of working with a group of like-minded colleagues. Only now do I begin to permit myself to speak freely of my ideas for medical care for the 21st century.
The therapeutic question which has most challenged me when faced with a person’s pain and illness and their self-destructiveness exercised in so many insidious ways is this one. How does one as a physician motivate the patient to make the health-promoting, life-giving, love-affirming decisions for himself? It is only in my own transitional moment that I have come to realize that it is in making the necessary choices for ourselves as both physicians and individuals that we become more potent catalysts for our patients so that they, too, can make the choices they desire. Facing these choices is at time both risky and scary, at others exhilarating, for them and for us. Perhaps it is for this that I went into medicine.
Or perhaps it was for the stories that I went into medicine. I am fascinated by people’s stories. The way in which they interpret themselves and their experiences and the way in which they translate this into bodily experience. In medical school Osler’s dictate is drummed into us: “History is 90% of the diagnosis.” Despite our technological expertise and whatever we may imagine is our level of clinical acumen, the history is inescapable. There is a penalty we pay in not hearing it as practitioners. I remain firm in the conviction that it is in the telling of one’s story and in being heard that the impulse for self-help is nurtured. In each story, subtle clues offer themselves helping to unlock the diagnostic puzzle. If we give short shrift to the listening, we compromise ourselves in the diagnostic exercise and we rob the patient of this opportunity. It is not, after all, the knowledge within the physician that it is essential; it is this knowledge married to the patient’s story that it is essential to arriving at the diagnosis.
So, I find myself, after these two years of learning more about acupuncture and myself, wondering how will today’s Western medical system, whose primary focus seems to be cost-containment and litigation management, support this all important physician-patient dialogue? We have never had a dominant feminine model for health care in the West, nor likely ever will. However, we can still hope and strive for a balanced integration of masculine and feminine within our profession. If it is an integrative model of medicine for which we are striving, then perhaps the most fundamental integration to be achieved is that of masculine and feminine within the collective institutional psyche, towards a system which moves from being fear-based to love-based, which values collaboration over competition, from diatribe to dialogue, from censorship to sponsorship. It is in the fear, the angry invective, the attack, wherein lies the separation, the disintegration.
The health profession is not made up just of health care practitioners, but of insurance companies, managed healthcare conglomerates, hospital management firms, and each of us as patients ourselves. As T. S. Eliot so eloquently put it in his Four Quartets over half a century ago, “The whole earth is our hospital.” Hospitals functioned through most of our history as places where people went to die. The 1992 Harvard study revealed that the annual national death rate due to iatrogenic causes was approximately 130,000. With this statistic, we may justly question how much the function of hospitals has changed. Nonetheless, the concept of the hospital as a place where people go to heal is a relatively recent one. Can we look at each element in our hospital and medical office environments as a vehicle for positive, health-promoting transformation, from the color of the walls, to the lighting apparatus, to the acoustic background, even to the organizational structure itself within which we function? As we strive for essential wholeness within the collective psyche, we grope an alternative and integrative paradigm. If we merely transpose the old bureaucratic, vertically integrated structure into healthcare in the next century, we will miss the opportunity to transform ourselves and each other.
I don’t know yet what this picture will look like or where the questions will lead me, but, it is in the process of inquiry that I trust my practice will develop. Part of the challenge and the fun and the fear of being in this situation is the freedom to ask the questions.