An Ode to Patience

Intelligent, circumspect and considered

Anthony was a deeply contemplative man. The father of a dear friend, he was well known for driving his tractor right past the gate to his own farm, so deep in thought was he. Intelligent, circumspect and considered, he owned two chess sets – one for everyday games and one set up apparently mid game, as if the competitors had merely stepped out for a break.

The latter was in truth a game underway – an ongoing chess game being played between two friends across the oceans. Anthony’s childhood friend and he were bound in comradeship by a love of chess, and even when his friend left to become a priest they continued to play games when he returned on holidays. When Anthony’s friend eventually moved to California, as many did before him, they remained in constant communication by letter.

Bishop g2 to c6++

Every week a letter would arrive with the latest news and instructions about which move the Monsignor wanted Anthony to make on the chessboard. The Monsignor’s move was completed, tactics and strategy were contemplated and a reply written, complete with local news and instructions for the next move to be carried out in California. And so it went, back and forth. Weekly letters with news and unfolding chess moves. Over each year two full games of chess were played patiently, one letter at a time at other ends of the world.

During the annual visit home, the Monsignor and Anthony visited each other’s houses on alternate nights playing their game and catching up. When it was time to leave, the game was merely continued by correspondence. And so, once again, two chessboards an ocean apart. Such a lovely testament to friendship and of course… to patience.

Reflections on a virtue

Patience. Now there is something I have been reflecting on. Wishing to be bestowed with it in abundance, I have been wondering if you can in fact acquire more of it. How do those lucky people who have it naturally make being patient look so easy? It sometimes feels like a fatal flaw to be impatient. I like to think that some good things have been born out of it: perhaps an invention or two; a shortcut taken which led to the discovery of a new land; the curing of an illness or the creation of some extraordinary culinary delight when patience wore thin! Maybe this is the song of the deluded. For patience, we are told, is a virtue, which means that we all should want it, even if we don’t have it.

Treating patients with complex pain states can require even more patience than normal. A failure to explain pain in a way that makes sense to the patient can lead to frustration. Surely patience is one of the foremost components in a good relationship with our patients, allowing us to listen effectively, gain their trust and gradually challenge long held beliefs. Every aspect of the interaction from initial assessment, to building up a clinical picture and giving space for the patient to tell their story, all require it.

On that note, how many of us can say we are patient all the time? Have you ever considered those who left and did not return? The ones who slipped through the net when they did not improve in line with expectations? Did they sense your frustration and go elsewhere? If the clinician is impatient, how must that feel for the patient who is living with the pain? It certainly seems obvious that patience is fundamental to a good therapeutic alliance and so perhaps a short reflection on its merits for us all, may not be a bad thing.

Blanaid Coveney

Blanaid is a practicing physiotherapist in Dublin, Ireland. Her professional interests include Chronic Pain, Epidemiology and all things brain related.

This blog was first published on noijam.com  on 22nd April 2016. https://noijam.com/2016/04/22/an-ode-to-patience/

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SIMs at work

Lovely thoughts on the beneficial impacts of work from noijam.

noijam

The pleasures of work

The Pleasures and Sorrows of Work, by Alain de Botton is a beautiful little book exploring this facet of life, that in many ways, dominates our time, social interactions and even who we are. de Botton considers the love-hate relationship that many people have with work, and points out that the jobs that a majority of people have were chosen years before by their much younger and inexperienced 16 year old selves.

The Book of Life, an online ‘book’ published by The School of Life, de Botton’s brain child, has an entire chapter on work – finding it, losing it, ‘misemployment’, unemployment, why work is easier than love, and the pleasures and sorrows associated with it.

On the pleasures of work, The Book of Life explores the deeper, more meaningful Good Sides of Work:

“We’re used to thinking about the good sides of work purely…

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The pain reducing power of humour

The pain reducing power of humour
Published on “noijam” by  NOI Group, December 4, 2015

A symphony of bad decision making

I had occasion to be in A&E yesterday. Unfortunately I slipped on my stairs and sailed down the last four steps in inelegant fashion. It was a symphony of bad decision making – books on the stairs, arms full, and too much haste! Trying not to catastrophise I told myself that the damage was probably just ligamentous, but the clearly deformed leg told a different tale. The pain was horrible, but telling myself that I was safe and the worst case scenario was that it was broken, did help.

Amazonian air disasters and A&E

Opposite me in the A&E department a man sat glancing at the TV from time to time. Others were transfixed. I became aware of the narrator speaking in a breathless manner describing two planes on a potential collision course over the Amazon jungle. With tones ever more grave he described in detail the human error, computer failure and pilot inexperience leading up to the crash. Ending with the statement that the Amazon jungle was not a good place to crash your plane! There’s a good place to crash your plane, I asked myself?

My ultimate SIM

I was thinking that the Air Crash Investigators might not be the most prudent programme to be showing people who are already stressed, worried and possibly in pain when the man opposite me, in dead pan fashion said, “Don’t worry, love, Medical Mishaps is coming on next!” The A&E waiting room fell about laughing. Worrying about my leg and the consequences of the injury was a heady enough concoction without the disaster celebrants on TV. But, in one fell swoop the humourous banter dissolved the atmosphere of anxiety and replaced it with something altogether less threatening. And so homeward bound with a box set of the Marx Brothers and Laurel and Hardy under one arm. Humour; it is my ultimate SIM. It makes everything better.

Does it work for you?

-Blanaid Coveney

Blanaid Coveney is a practicing physiotherapist in Dublin, Ireland. Her professional interests include epidemiology, pain and all things brain related.

SIMsafety in me. Things which have the power to reduce pain by creating a credible environment of safety in your brain. For a powerful description of what SIM’s and DIM’s here is a brilliant explanation . tohttp://noijam.com/2015/03/12/dim-sims/

 

Alarm Bells

Alarm Bells
By NOI Group, August 21, 2015

From our good friend Blanaid Coveney:

Buying some time

Most people know how hard it is to explain pain to patients especially … well … when they have ongoing pain! The endless touring of different clinicians and specialist clinics in pursuit of a cure is common. Ingrained belief systems mean that hunting for the source of the pain is often a driving force. Explaining pain can be tricky and from time to time can lead to a patient heading for the hills never to be seen again. You can nearly see yourself losing them in slow motion. Anything which makes it easier to explain pain is always welcome. On occasion you may come up with something which resonates with the patient and buys you time so you can gradually introduce new concepts which may challenge/change the patient’s belief systems.

“Chronic”

The other day, one happened by chance. A patient and I were chatting. He has ongoing pain. I can never say the word chronic to the patient. It seems like the ultimate nocebo. Did anything good ever get paired with the word chronic? Did you even hear of chronic success or chronic romance or being a chronic winner? No! Seemingly endlessly negative things are paired with the word “chronic” like anxiety, debt or disease. So, ongoing pain it is.

Finding a metaphor

Anyway, over time, this patient’s pain was being triggered by less and less stimulus. Naturally he felt that this meant his disc disease was worsening. As we were chatting, something came to me which was surprisingly useful. I asked him whether he had a burglar alarm at home. Having confirmed he did indeed have an alarm, we spoke about the merits of a good burglar alarm, principally the safety in knowing your valuables are protected and your personal safety is assured. Obviously you want the alarm to go off when you are being burgled … but what if the alarm is so finely tuned that it goes off when it is windy or if there is thunder and lightning or when Man United are beaten ? Then, its a pure nuisance and of no benefit to you.

Hitting home

Explaining that his brain was continuously evaluating the threat level and was a little too sensitive

was a surprise to him. Comparing his brain’s current response to the perceived threat level with a too-finely tuned burglar alarm really hit home. Finding ways of reducing the sensitivity of the alarm in a wide variety of ways now seems to make sense to him . Sometimes you get it right. So often you don’t. There is a long way to go but perhaps changing things one patient at a time is not too bad.

Blanaid Coveney is a practicing physiotherapist in Dublin, Ireland. Her professional interests are around epidemiology, pain and all things brain related.