Doing a sub-internship in the ICU is, well, intense. On the first day, I was completely overwhelmed by seeing so many sick patients, most of whom were sedated, ventilated, and on at least one pressor. In just a few weeks, this came to seem perfectly normal.
However, what continued to stir me were the extreme emotions I saw patients and their families experiencing. I couldn’t help but feel those emotions myself. The most difficult day—thankfully the only day I was able to save my tears until I was safely at home—was due to the culmination of three very different encounters.
I began the day reviewing my patients’ charts with the hope that this would enable me to answer any questions they might have. I first saw a young man who had intentionally overdosed on antipsychotics. I helped admit him when I was on call just two nights before. I stood at the head of the bed during his intubation, cleaned off vomited charcoal, drew an arterial blood gas, and placed a nasogastric tube and Foley. I felt I had actually participated in saving this man’s life and was curious to see him again after my day post-call.
He was angry, still intubated but awake, and frustrated at my inability to understand what he was trying to mouth with his endotracheal tube in place. I offered him a pen and paper. He wrote some inappropriate things. I left, saying that was unnecessary and that we would get the tube out as soon as possible. Surprised by the amount of anger I felt, I took a few deep breaths and proceeded to my next patient.
The next patient was also intubated but was able to squeeze my hand, his other hand constantly held by that of his loving wife. After 67 years of marriage, these two were still best friends. It was so touching to see this that I was reminded of a poem by E. E. Cummings entitled “i carry your heart with me(i carry it in.” I even worked up the courage to read it to her, awkwardly and loudly because she didn’t have her hearing aids and because halfway through I noticed his nurse waiting outside the door.
Later that day we would have a family care conference. The patient’s wife and children all seemed surprised when we suggested the need to discuss palliative care and terminal extubation for this 92-year-old gentleman with Parkinson’s disease, dysphagia and aspiration pneumonia. The room was filled with tears as the children tried to find the right balance between letting their mother make decisions and supporting her by making the most difficult ones themselves.
My third patient painted the classic picture of acute exacerbation of chronic lung disease: a thin “pink puffer” who was still smoking cigarettes up until this most recent episode. She had been intubated for over a week and we already had a very similar conversation with her family. They were certain she would never want a tracheostomy and PEG tube, so we waited. On my post-call day she had been successfully extubated and I was thrilled to finally hear this woman’s voice, to see her more alert, and to see her joyful family.
Three very different stories filled with very different emotions, all on the same morning. Part of my struggle was the feeling that I was simply a bystander.Like some object floating in an ocean, the waves of others’ emotions crashed over me so that I felt them as if they were my own, but there was nothing I could do about them. I wasn’t the doctor making decisions or answering questions. I wasn’t the nurse who had been by the patient’s bedside all day. I was just there.
In these difficult moments there was one small thing that helped me to feel like I had a bit of control, like maybe I could make some small contribution or, at the very least, comfort myself. As I walked from one room to the next or sat just outside of the circle of family members, I gently held my left thumb in my right hand and after a minute or two methodically switched from one finger to the next, finally holding the palm of my hand in the other. This is one of the simple hand holding techniques of Jin Shin Jyutsu.
Jin Shin Jyutsu originates from ancient Japanese healing practices and was brought to the United States by Mary Burmeister in the 1950s. It entails placing the hands on oneself or another in specific ways for specific ailments based on energy pathways, much like the energy channels that are thought to be responsible for the benefits of acupuncture in traditional Chinese medicine. Each finger corresponds to one of the emotional and organ pathways of the “five element theory.” For example, the thumb corresponds to worry, the stomach and the spleen, while the index finger corresponds to fear, the kidney and the bladder, and so forth.
I imagine you are probably rolling your eyes, if I haven’t lost you altogether. I get it. I tend to have the same reaction when the “e” word gets thrown around too much. I learned about Jin Shin Jyutsu at an integrative medicine conference and my knowledge is pretty much limited to that, so I’m certainly in no position to defend the practice or to proclaim its wonders.
At the end of the presentation, one conference attendee asked if the benefits of using this with patients—teaching them hand holds or using other techniques that involve touching the patient—was due to the actual particular hand positions, or simply that it was calming, or that patients feel comforted by their doctor’s touch. The presenter brilliantly asked him what he thought. His response? “Well, randomized controlled trial if you really want to know, but it doesn’t seem all that important to me.”
I tend to agree and have found it helpful in situations where it’s good to feel like I have a bit more control, at least over my own emotions. In the end, I think the point is that we will experience difficult situations and we won’t have time to process everything right on the spot. It’s important to have something that helps you to feel grounded, to feel like you are still yourself. This little ritual with ancient roots does the trick for me.