“If I wished to shake this tree with my hands, I should not be able to do so. But the wind, which we see not, troubles and bends it as it lists. We are sorest bent and troubled by invisible hands.” -Thus Spoke Zarathustra
I hope you have had a chance to learn about the Adverse Childhood Experiences study (better known as the ACE study). The study demonstrated an association of adverse childhood experiences with health and social problems as an adult. On a personal level, the findings made me stop and ask a very basic question in regards to my daily work as a physician: “Is there really a connection between our emotional and physical health?” That question was answered many times for me since I was introduced to the study. However, one particular circumstance profoundly changed my view of the issue.
Her name was Lise, a beautiful name with northern European roots. She had a unique personality. I would describe her as caustically spirited (and she would laugh and thank me for the compliment). She had an abrasive delivery but warm eyes and a warm heart. Her humor was both intelligent and witty. I met her one afternoon after she was admitted to the hospital for shortness of breath and chest pain in the context of her metastatic lung cancer. She had recently been discharged from a major medical center after receiving aggressive treatment for her lung cancer only to have experienced multiple complications from the treatment. Her symptoms of pain and shortness of breath stemmed from bone involvement of the cancer and from fluid in her lungs. She knew that our healthcare delivery system had very little to offer and so did I. We certainly were not going to fix her underlying problem. One could even argue that any further treatment would only make matters worse for her as she struggled to manage her symptoms. Recognizing her vulnerability and admitting my helplessness, I decided to do the only thing I could do. I sought to connect with her as a human being and not as a physician. In discussing her life, she shared an experience that brought the findings of the ACE Study alive for me.
After much discussion, I asked Lise if she were afraid to die. She started by telling me about her belief system. She had a complex, variably influenced perception of afterlife. It was a mix of traditional Judeo-Christian, Eastern, and American Indian concepts. I found the explanation well developed and comforting. She assured me that she was not afraid to die. I told her that while I trusted her statement, she appeared to have conflict regarding the resolution. At that point, she clarified her struggle. She noted that her mother had died previously. Her biggest concern was “meeting her again.” I waited a moment and she looked at me squarely and said, “I hated her. I don’t want to see her again.” With a pouring out of emotion, she told me a detailed account of the day that she started smoking at age 13. She specifically recalled walking out “the back door of the house with a cigarette in hand” as her mother was screaming at her. She used the cigarette to express her defiance. She did not provide specific details but openly spoke of the emotional and physical abuse she had endured as a child. Smoking was her way of “getting back at her.” More than 40 years later, she was reaping the consequences of her only means to self-treat her trauma. She was dying of metastatic lung cancer.
Lise was as helpless to defend herself as a child as I was to help her as an adult. My job was to cure disease. However, her disease was incurable. Or was it? Lise and I talked multiple times by phone in the next two weeks before she died. She thanked me for helping her explore her struggle. I thanked her for trusting me with her story. I promised I would not let her story die with her. Yes, we all die. Nevertheless, Lise taught me something very valuable. If we experience trauma as a child we will make choices to treat ourselves in any way we can no matter the consequences. If individuals and society prevent rather than treat those traumatic events, we can change the course of people’s lives. I promised Lise that I would. Will you join me?
About the author:
Dr. James H. Mooney, M.D. is a Hospitalist physician in central Ohio who explores the connection between a person's emotional and physical health.