Holism versus reductionism.

Sometimes I despair. Where are we going with this reductionist, target driven medical care?

Mary was referred to my morning surgery by the nurse. She was 83 years old. Her blood pressure was 160/90. For goodness sake she is 83!

Protocol guidelines say that her blood pressure should be 140/90. Mary had been taking tablets for her blood pressure for 15 years and her blood pressure had not altered over the last 4 years. But guidelines are guidelines.

She asked me if it was her nerves that maybe had put her blood pressure up. I asked what she meant and of course what she really wanted to do was tell her story. She had been a widow for 20 years and she was finding it increasingly difficult to look after her elder brother that lived nearby. She was getting more and more tired having to cope with him as well as her own house. She did all the shopping and looking after the bills. A cleaner came in once a week. Her family lived by and helped out when they could but she did not want to bother them too much with her troubles.

We as doctors want to check her blood pressure presumably to lower her risk of a stroke. Or is to reach our targets and get paid? She wants someone to listen to her story and offer a bit of support and advise. I hope she left feeling she had shared her troubles. After she left I contacted social services to see if they could offer some help for her brother.

My mother's death

Last week my mother died. She was 94years old and had been in a nursing home for 3 years. However up until the last 6 weeks she was alert and interested in everything around her. Despite her difficulty with speech when visiting her, she was first to ask how you were. She took a keen interest in everyone’s life. She always looked on the bright side. She was a happy, generous caring soul and that is how I will remember her, not the frail body of the last 6 months.

As a holistic practitioner we need to acknowledge that things happen to us and affect us too. We often deal with others grief and distress but how do we deal with our own? Who do we look for support? Doctors generally are not good at this and tend to deny many of the feelings and carry on at work regardless. If it happens to you, have time off to reflect and learn from the experience. It will help you develop and be a better doctor.

What did I learn? The most important thing when sitting with a dying person is the state of your own mind. I focused on creating a peaceful atmosphere for my mother. I ensured that she was physically comfortable then spent time meditating in her presence. I focused on love, light and peace. I felt calm and a comfortable feeling was created in the room. When the nurses came to attend her they commented on it.

One evening I went through all her own photograph albums, which gave me a perspective on her life. I felt many of the special people in her life were close and ready to welcome her. Although she was not responding for the last three days I spoke to her softly and reassuringly of how much she had given to life and how much she had been appreciated. It was now OK for her to go when she was ready and that everything was in order.

In the end it was very gentle and peaceful passing. Of course we will miss her, but I feel good that it was a good death.