Medicine For People!

January 2014: Resilience and Its Enemy

Bounce not Blame

Adversity Builds Strength

One of the more surprising things I've learned as a doctor is how much resilience nature has given us. I've seen adversity build strength and health. This is not just theory. Children who grow up in the allergen-rich environment of a farm actually suffer fewer allergies than those raised in a sanitized urban environment. People who carry certain intestinal parasites are more resistance to inflammatory bowel disease. All of us, in fact, live in tension and symbiosis with trillions of microorganisms, and enjoy better health as a result, as you can learn in our January 2009 newsletter. Athletes push themselves to physical stress most of us cannot imagine, yet despite the occasional well-publicized injury, enjoy far better physical capacity than average. And US children, given every advantage, fall further and further behind, physically, emotionally, and academically, than children in less-advantaged countries.

Taking Responsibility Enhances Resilience

Waylon had severe back pain. Exam and imaging studies both pointed to a pinched nerve. The trouble was, Waylon was a self-employed welder without insurance. When the Seattle surgeon gave an estimate for the cost of surgery, Waylon came back to Port Townsend and went back to work, pinched nerve and all, to save up money for the surgery. He thought two years should do it. When I saw him over two years later, and asked how the surgery had turned out, he told me that over the time he was saving up his money, the pain resolved on its own.

Sabotaging Resilience

Most people I've taken care of have shown resilience right up to the end. One of my cousins died of breast cancer. Near the end she seemed to worry more about her young adult children than herself. She typifies many people I've cared for with terminal cancer-these folks usually express thanks for each day, not despair.

In contrast, a few people seem to sabotage their own resilience.

Braylin, another real back pain patient with a fake name, came from Port Angeles to see me for a second opinion. In his case, as his back pain began at work, the Department of Labor and Industries had paid for the work-up and an extensive course of physical therapy. Even though exam and imaging studies had shown no evidence of a pinched nerve, they had taken his word for the pain and were now offering him rehabilitation therapy in Bremerton. Braylin, single and 25 years old, explained to me how the payments on his house and boat had stretched his finances to the limit and how no doctor in Port Angeles was treating him fairly; he objected to the cost of driving back and forth to Bremerton for the rehab. His medical records showed that the Department of Labor and Industries had already gone the extra mile for him. Yet in his view everyone was making him a victim and he needed my help in gaining better consideration from the Department of Labor and Industries.

Braylin, in this case, was actively turning away from his own resilience and recovery.

A Look Behind the Medical Curtain

In the matter of back pain, if a patient with an identifiable pinched nerve loses muscle strength, we know that surgery can usuall y reverse that. Otherwise, the cases of Waylon and Braylin were similar but for their contrasting attitudes.

And just to give you a brief look behind the medical curtain, doctors and nurses in the ER know that the dramatic complainers are, most often, the patients least at risk. We know the quiet ones are much more likely to be in real trouble. Most ill and dying patients don't engage in drama. They are already pretty occupied with their own particular misery. They give voice to their discomfort with reluctance. People have even apologized to me as they asked for pain relief.

Bounce, Not Blame

In my own life my parents and various teachers have led me, not always gently, to understand that self-discipline and challenges can be life's best friends. That's turned out to be true. When we stress our immune system with a vaccine, it becomes stronger. When we stress our bodies with exercise, we become stronger. When with difficult problems we stress our minds, they become more powerful.

I hope that Braylin, mentioned above, eventually discovered that.

A New Year's Wish

As we enter this New Year, let me remind you that adversity, paradoxically, seems necessary to the most robust life. Let me encourage you to resist the siren call of victimhood as an excuse not to push yourself to greater effort to overcome the challenges you face.

This new year of 2014 and every day in it brings you an opportunity to take on new challenge. Meeting those challenges with the best that is within you will bring you better health. Nature has endowed you with the wonderful gift of resilience, your natural ability to bounce--stay in touch with that!



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Medicine for People! is published by Douwe Rienstra, MD at Port Townsend, Washington.