Column

How do you live a life more ordinary?


Hester Wilson


8/11/2019 2:05:35 PM

When a ‘broken’ man came to Dr Hester Wilson, she was faced with the limits of what medicine could offer.

Isolated man looking out window
Can people press the play button on an ordinary life?

In our first consultation, Gene described to me what his life used to be like.
 
He’d been a surfer and musician, travelling around Australia as a drummer in bands. He loved drugs and the muso lifestyle. He was building up a collection of tattoos. He told me of his leather jacket collection, black jeans and chunky silver jewellery – the full muso look.
 
Life was perfect.
 
These days, Gene still has the tattoos and jewellery, but that lifestyle is gone forever.
 
To supplement his freewheeling life, Gene had been working as a labourer whenever he returned to Sydney – when he wasn’t chasing waves, of course.
 
That was fine until, suddenly, it wasn’t.
 
Gene’s first life ended abruptly when he slipped and fell two floors to the ground on a building site.
 
Rather than taking him to hospital, the building contractor dropped Gene at his mother’s front door. She describes coming out and finding him as being like a horror movie.
 
‘He was broken – covered in blood, incoherent and unable to move,’ she told me at one of our joint consultations.
 
As she called an ambulance, her son lapsed into unconsciousness.
 
He had severe facial injuries, head injuries, and had fractured his pelvis, ankle, right hand, left wrist and multiple ribs. He spent months in hospital and rehabilitation.
 
Gene returned home to his parents and tried to restart his life.
 
And now he was here in my consultation room, accompanied by his mother.
 
It had been 10 years since the injury. The Gene who was once the life of the party was not the same one sitting before me.
 
Now in his 40s, Gene was living with his elderly and ailing parents, who both played a big role caring for him.
 
Gene had come out of rehab, but would never fully recover. He told me of his grief at finding he couldn’t play his beloved drum kit. His physical pain and limitations, coupled with his brain injury, meant it was impossible.
 
‘I couldn’t move in the same way. I couldn’t think how to put it all together,’ he explained.
 
Gene told me his pain was severe, his sleep poor and his mood miserable. He used cannabis, opioids and benzodiazepines to try to manage his suffering.
 
But nothing was improving. He told me of withdrawing into his room.
 
Now, his only human contact came from his loving and worried parents, his GP for repeat scripts, and his friend and cannabis dealer who would visit him at home.
 
Gene had been referred to me by his GP, who had tried many options to help him with his pain. Adding medications. Reducing medications. Ceasing medications. Specialist referrals. Nerve blocks. Botox injections.
 
Gene found his psychology appointments left him feeling worse and he refused further offers of help for his mental health.
 
Gene has been living like this for 10 years.
 
‘It’s like I am in a permanent revolving, repeat state,’ he said.
 
‘All day I long for the end of the day, and all night I long for the morning.’
 
Over a number of appointments, Gene and his mother share their experience. I slowly learn his story and begin to understand his experience.
 
But while I feel great empathy and a desire to assist Gene and his family, I find myself torn. Because I know there’s not much I can do to change the real problems of his chronic pain. He’s already tried everything.
 
So what do I do now? There are no easy answers, no quick fixes.
 
Gene is not alone, of course. This is the reality for so many of my patients. Deep down, I know there is very little I can do to change the materiality of his life.
 
For Gene, though, even this precarious existence will not last. His parents are getting older and frailer. His father recently had a mild stroke. His mother – who is in her mid-70s – tells me she knows that a time will come where her son will either need to care for himself, or be placed in care.
 
She asks me if there’s anything new we can try.
 
I ponder it. Here we had a man in his 40s, incapacitated by a serious injury. The pause button has been pressed on his life. He is in a state of suspended animation. The truth is he’s the only one who could press the play button – and I’m not sure he’s physically able.
 
But I see her desperation and I vow to try.
 
So we start tinkering around the edges. His mother comes in with him for the first half of every consultation, leaving for the second half so Gene has space to talk about anything freely.
 
It is a therapeutic intervention – Gene attends the appointments and he talks freely.
 
Over time, we dial down his dose of diazepam. He limits his use of cannabis to bedtime. I flag the fact that his opioid use is unlikely to be helping much with his pain. He says he will think about changing it.
 
A real strength I see is the connection within this family. Their deep love and concern for each other is palpable. Gene tells me he feels lucky to have a family like his.
 
Slowly, slowly, there are small signs of improvement.
 
Gene gets a little more active as his diazepam and cannabis doses decrease. He helps his mother with shopping, chopping veggies for dinner. He’s talking about getting into the gardening. In one consultation, he tells me of his plans for his own veggie patch.
 
I am pleased that his life has improved a little. But I know, still, that we will never get his old life back. And even as I help and encourage him, I wonder how much more can change. I feel I’m doing talking therapy by stealth.
 
His life can never return to the first one he had and loved – that free time of music and surfing.
 
In his mind, that first life has become mythical, a wonderful time before what he saw as the sad limited reality of life ‘after’ that fateful fall.
 
But I do wonder whether the real change might be still to come.
 
I wonder if, over time, he will start to see that an ordinary life can be lived even with these limitations.
 
I hope he can choose this path. That he can press the play button on an ordinary life, rather than mourning the Gene he used to be.

Login below to join the conversation.



chronic pain dependency mental health



Login to comment

Dr Andrew Keith Horwood   9/11/2019 7:16:04 AM

Thanks so much, Hester. I've been a quiet admirer of yours, respecting the wisdom with which you write. This article in particular struck me, with your ability to encompass this man and his family and creating open space for conversation in which you patiently waited for new possibilities to emerge from within, were so vital. This article speaks loudly of the value of patience and acceptance of the patient as they are, finding a way to get alongside them and see where the journey takes you together, as vital skills in a GP's armamentarium for what have been described as "heart-sink" patients. As a GP specialising in pain management, I concur with your sentiments heartily and love the way you've articulated the process. Thank you


Dr Andrew Carr   9/11/2019 9:14:00 AM

Hi Hester,
Have you read Man’s Search for Meaning, by Viktor Frankl?
Viktor Frankl was a Jewish psychiatrist, who was a survivor of the Holocaust. Through his suffering he conceived logotherapy.
The book is worth you having a read, ... at least then you can make a decision as to whether this would be an appropriate for Gene. I don’t know him, so please take my advice with a pinch of salt.
I recommend this book to patients in the scenario where there is an adverse major life change (or, lack of a desired positive major life change) and the individual feels helpless.
Gene may very well never play drums at a concert again, but as a drummer, he’s excited by rhythm. There are other ways to spark that joy. He could start, for example, start tinkering around with drum machines and synthesisers inside a programme like cubase or logic. You’d probably find a local charity which does audio/sound production/ tech etc. Good luck to him in any case.


Dr Charlene Fungai Chideme   9/11/2019 9:45:31 AM

Thank you so much for sharing this heartwarming story. To me, it speaks volumes about how amazing you are as a person and GP- he is truly privileged to have you to walk this journey-whatever path he chooses. I am truly inspired.


Dr Lucas William Parry   9/11/2019 10:45:53 AM

Thank you for this important article on a "non-sexy" topic. Also inspiring for me as a young GP, where cases like this seem to be actively or passively avoided by professionals. I seem to attract and retain patients like this, which I consider as a feather in my cap, but absolutely echo what you say about not knowing how to move forward in our evidence-based paradigm. Thank you very much for the insights and encouragement!


Dr Fiona Pringle   9/11/2019 3:41:27 PM

Thanks Hester for another well written article. Acceptance of realities in a patient- directed space with a sophistocated practitioner can still achieve incremental improvement. Another Wilson pearl of wisdom that I will incorporate into my mode of practice. Thank you.


A.Prof Christopher David Hogan   9/11/2019 7:40:02 PM

Our task is not to fight death- for that is often futile & cruel
Our task is not to heal- because we often cannot
Our task is to care- but not to the point where it damages us.
Our task is to listen for that solves many problems
Sometimes medication stops people dealing with their emotional pain & traps them in a loop of despair & merely dulls their memories- especially benzodiazepines & narcotics (which is why they are so popular with survivors of childhood sexual abuse).
If they accept their pain & leave the false comfort of medication sometimes they can move forward.
Sometimes, reducing medication just makes things worse.
The skill lies in being able to pick the person suitable to reduce medication & the right time to attempt it.


Dr Barry Sam Fatovich   10/11/2019 1:07:10 AM

I have great admiration for the task that Hestor is taking on and especially inviting comment. Prof Ian McWhinney spoke of the importance of our relationship with the patient, this is the cornerstone of GP. The story is about how the relationship can heal, Jung once said, "we fix by what we know, we heal by who we are". Perhaps the task is less about getting Gene back to where he was, but to move to a new understanding of what the meaning of his life is. It may be the focus needs to change from 'what was' to 'what is', a la Tolle and his focus on living in the present moment. Gene has a richness of life experience, that he can share with others, should he choose to, which he is sharing with Hestor who is sharing it with us. His life has a new rhythm, all any of us can do is play our part in contributing to the music of the universe. This is what real General Practice is about.


Prof Geoffrey Keith Mitchell   13/11/2019 12:15:36 AM

Thanks for a great article Hester. And thanks Barry Fatovich for reminding me of Ian McWhinney's wonderful contribution to our understanding of our profession. Can I suggest also taking a look at an article by Dr Hayley Thomas who decided to see what the world literature says is whole person care. Her model highlights the importance of the Dr Patient relationship, and of the humanity of the GP being essential to the process of whole person care.
Thomas H, Mitchell G, Rich J, Best M. Definition of whole person care in general practice in the English language literature: a systematic review. BMJ Open 2018;8:e023758. doi: 10.1136/bmjopen-2018-023758.