Barrett L.
Dorko P.T.
There is a poem by David Wagoner that I learned years ago
and memorized, forgot, then memorized again. Something about it draws me back,
and reminds me of various aspects of my life and my clinical work. I’ve used
it in my teaching in the past, and I’ve recited it to any number of patients,
but I’ve never used it as the basis for any writing that I can recall. Today
seems to be the day for that, and the poem is entitled Lost.
The poet David Whyte explains that Wagoner’s poem is
based upon the advice given young Native Americans by their elders should they
become lost in the forest. The first line is “Stand still,” and the
last; “The forest knows where you are. You must let it find you.”
There’s a whole lot of important stuff in between these
two lines, of course. But for my purposes here, the first and last lines of
advice about being lost will suffice. In fact, they form all I want to say about
the problem of being lost and how to see it. Theoretically, I could leave you
with that much and you would eventually work out the meaning for yourself.
But don’t worry. As usual, I have a lot more to say.
Whyte says, “The ability to be lost is striking. It makes
you attentive.” I agree. And I’m speaking here of being lost within the
complex problems of clinical life. You know, the seemingly intractable pain that
doesn’t follow any consistent pattern of referral, the increasing neurologic
deficit that has no anatomical origin, the patient whose story changes daily
though they appear to be perfectly reliable. There are more examples of how the
clinic can confuse us, confound us and make us feel helpless than I can list
here. In short, we spend a portion of every day “lost” and casting about for
something to help us decide where to go next. At least, I do.
Having felt this way regularly for many years, I find that
any method of management that implies that it can pretty much eliminate my being
lost makes me uneasy. I feel that my clinical competence is dependent
upon the uncertainty offered me in every haltingly spoken history, every
equivocal or possibly irrelevant finding. If I remember that each patient is
unique enough to offer me a different path through to the resolving of their
problem, each turn will surprise me a bit, and sometimes a lot. Without these
surprises my attention wanes, and, for me, that makes the clinic less like a
forest and more like a desert.
There are methods of care out there that tell us that the
way to navigate surely and quickly through each problem is to follow the form of
questioning, the sequence of testing, and the algorithms created by the experts.
They give us a map, and they imply that the terrain of the patient is
predictable and commonplace. Well, maybe that’s true for some diagnoses, but
for primary complaints of pain that involve neural deformation, it isn’t.
Now, finally, back to Wagoner’s poem. He says that when
you’re lost, you should “stand still.” Fair enough. So much
of manual care involves an immediate attempt to reproduce the customary pain
with movement both active and coercive that the way the patient is, as
opposed to what they do is never really seen. Without any stillness on
the part of the therapist, the answers that might be inherent to the patient’s
being are missed. I’m speaking here primarily of ideomotor activity. To
stand still means to put a tremendous amount of attention into the patient’s
presentation. Admitting you’re lost at this point will focus that attention on
small and, possibly, important things.
“The forest knows where you are. You must let it find
you,” implies (in this context) that the patient has a lot to contribute
to his or her own recovery. This is a concept very familiar to therapists. Of
course, this contribution is usually thought of as a willful effort only. I’m
always suggesting that it is the effortless and nonconsciously motivated
movement that resolves painful problems.
Ultimately, it is our willingness to become lost, to admit
that that’s what’s happening, and our courage to look carefully for the
answers within the patient that characterizes the kind of care that just might
surprise everyone involved. Becoming lost is when real change begins, and, with
the attention it brings, the path toward home becomes clear.
For more information about the work of David Whyte, go to his web site http://davidwhyte.com or email: mrivers@davidwhyte.com or write Many Rivers Company PO Box 868 Langley, Washington 98260