What have we discovered about healing?

Living systems keep repairing, adapting, healing, and sometimes surprising us. Healing is a process inside of uncertainty.

Medicine supplements the body’s own response when the need for repair becomes urgent. But biologic and medical repairs typically strive for continued living, without certainty.

Therefore, biologic and medical repairs are probabilistic rather than perfect, at times. So how do people learn to live in biologic partnerships with uncertainty?

Living With Uncertainty

We don’t promise to remove uncertainty, rather we are hoping to give people moments of clarity, perspective, and perhaps even wonder while they’re living with it. We want individuals to identify their fears and settle into something beautiful, encouraging positive choices even while living with uncertainty.

Scientific Understanding of the Various Repair Processes Changes The Human Experience.

What happens when your lived experience becomes more complex than you expected? That is, when your misfires of particular biological cells are long-term, and continuous what happens? When your diseased cells don’t stop misfiring or multiplying what do you do?

When do your repair crews (biologic-internal and medical-external) change their intervention plans? When the complexity of your treatment is introduced and explained further to you, how/who identifies the need for a repair? How do you determine when the  medical repair crews are more necessary than your biologic repair crew for your survival?

Now that you understand biology differently, how will you live differently? Understanding does change your emotional experience.

Imagine four concentric circles.

Center:

Biology

Next:

Medicine

Next:

Human Experience

Outer ring:

Meaning

Given the above model, when/where does meaning for an action plan for intervention come from? From where does your understanding of your various treatment options come? 

Greater understanding often helps people participate more fully in their treatment decisions and may reduce fear by replacing uncertainty with knowledge. Why? Because when you participate in your treatment decisions, as a member of the team, you enrich your human experience and make informed decisions beginning with consent.

Moving Away from a Simple Explanation of Biology: Expanding the Model

Given real human lives, living under real conditions with disease, changes our view of biological repairs. Our model has to expand again.

Medicine is practiced under uncertainty. Every treatment represents a careful balance between anticipated benefit and known risk. Patients consent to treatment because they and their physicians hope the expected benefit outweighs those risks. When unintended consequences occur, a deeper understanding of the diagnosis, and recognizing the complexity of caring for  your living body is necessary.

Some examples for the repair crews facing high-stakes during biologic repairs include a patient who experiences acute system stress (high-intensity intervention+ biological fragility+ unsuccessful treatments).

This situation may cause an emotional response to their biology.

The emotions accompanying serious illness are real and deserve respect. Fear, grief, frustration, uncertainty, and hope often coexist. This framework does not ask us to deny those emotions. It simply suggests that, over time, another perspective may become available—one grounded in curiosity, collaboration, gratitude, and wonder at the extraordinary work still taking place within us.

There are other issues linked to uncertainty. Medical intervention is not a purely physical science. It is based on hypotheses and outcomes from clinical trials. The human body does not always respond similarly to each treatment as human beings are not identical. They are not clones. Humans are not carbon copies of each other. Human beings, presenting various physical conditions, health status at the time of treatment, age, diets, exposure to toxicity over their lifetimes, and so forth introduce variables which may not always be controlled during treatment, and may then link to uncertainty.

The very name “clinical trial” implies an understanding of clinical variability. The patient signs a permission form acknowledging such in hopes of success for their particular illness. 

A Multi-Condition Model of Lived Biology: Intervention Becomes Complex

The currently proposed model  has  three responses: repair, persistence, and response. Lived experience is introduced, and so expands the model to include a fourth – experience.

Responses may be layered (body + medicine+interacting under stress).

There are times when treatment and disease together create conditions of significant medical risk. During my decade of survival, there have been unintended consequences from treatment, what I term collateral issues. Specifically, consequences having a history with sepsis, bacteria, a macular hole, dehydration, and potential blindness, to name a few, led me to propose a multi-condition model for intervention.

Let me provide one example of an application for the Multi-Condition Model:

Review the facts within the story, and then answer proposed questions:

On a Friday afternoon I was not feeling well. I texted my PA and asked for an antibiotic. She told me to go to the emergency room. I went, was examined and ended up being admitted to the hospital. I had never been in an emergency room in my life, nor admitted to a hospital. Suddenly, I was alone and called my son in another State. My little dog was left home alone.

I texted my PA and explained that I was admitted to the hospital. The hospital physicians went into swift action, administering three antibiotics through IV. I was told I had sepsis! They sent a physician in who said I needed immediate surgery. I texted my PA again who told my doctor. My doctor phoned me to say “Do not let them do surgery, and he needed to speak with them.” I explained I felt I had no control. He set up a group chat on the phone with the medical team in the hospital. He did not have doctor’s affiliation with that hospital group.  I continued to wait, with a medical flurry around me. I must admit that, at that point, I felt fear.

On Saturday they were planning the surgery. My oncologist  had spoken with the on-call surgeon explaining that I was under treatment with infusions (chemotherapy) and I would not heal from surgery because of the Avastin. They continued to be in and out of my room. A different physician set up home health care minimally for one month with IV antibiotics ongoing. I waited. My son arrived. I was less fearful now, and learning.

Early Sunday morning I was surprised to see my oncologist walk into my hospital room smiling. He examined me and left to meet my doctors in the hospital.  After their meeting, he stopped by and said I was being dismissed from the hospital and on Monday I would go to another one of my physicians for examination and continued care. Immediately, thereafter the doctor from the hospital in which I was admitted stopped in and said, “You sent your gyno doc in after us! We  will discharge you today”. I thanked everyone. I was now in awe and wonder, and I felt joyful.

During this two day ordeal, I reflected on my situation. I now had sepsis. My mother had died from sepsis just before her appointment to see her cardiologist. My sepsis was advanced, and my health placed me at significant medical risk. I felt confused as I had always expected I would die from my multiple cancers, yet now I could die from sepsis, a collateral condition, unintended from my treatment. I also had just learned that my chemotherapy, while saving my life on the one hand from the persistent accumulating biological cells, was prohibiting my body if and when I needed a surgical, medical repair crew, because of the way in which the chemo impacted the growth of blood vessels. I learned something new.

I continued with various doctors’ orders, engaged in multiple ongoing conversations, developed a new action plan, continued to receive multiple antibiotics for weeks, and continued to live. I never forgot that for a day I had a choice to be treated for sepsis and/or cancer. How might I die?

Looking back, I realized something that had never occurred to me before. My cancer was no longer the only medical problem being treated. The treatment itself had become part of the biology that every physician now had to consider. My repair crews were no longer working on one problem. They were working on an entire living system.

Sit with the details shared within this story for a moment before answering several important questions from the evidence:

Why did intervention become complex?

1. Consider the urgent that had to be made about treatment(s).
2. What physical findings warranted the rapid response?
3. Who were the medical providers interacting under stress?
4. What were the conditions of significant medical risk?
5. What might have been the unintended consequences from treatment?
6. What do you notice about how the treatment and disease together created conditions of significant medical risk?

Do you recognize the various factors we have been discussing throughout this series?

• multiple repair crews
• conflicting interventions
• uncertainty
• collaboration
• informed consent
• changing treatment plans
• biological complexity

1. Consider the urgent decisions that had to be made about the treatment(s).

The treatments included multiple rounds of IV antibiotics and ongoing chemotherapy. One urgent treatment would have been surgery.

2. What physical findings warranted the rapid response?

The physical findings included blood tests that indicated sepsis in the blood stream. The physical findings also discovered the development of a fistula that needed immediate surgery to prevent further spread of infection throughout my body.

3. Who were the medical providers interacting under stress?

The medical providers were two sets of physicians within two different hospital settings. The medical providers had different backgrounds, training, and practices in their specialities: oncology, infectious disease control, general surgery, emergency care. Their stress was exaggerated by the occurrence over a weekend, when the doctors were on-call or not available.

4. What were the conditions of significant medical risk?

The conditions of significant medical risk included possible death from the infection throughout my body (sepsis), and the possibility of my body not healing and therefore blood loss after surgery. Without the surgery one group argued possible death. With the surgery one group argued possible death.

5. What might have been the unintended consequences from treatment?

The unintended consequences from any of the treatments might have been continued infection and/or death. The infectious diseases team plan was further complicated by the present of a port in my chest. Home health care teams typically administer IV meds through a vein. That was not possible in my case, I would have had an at-home care team without proper training to meet my particular medical treatment need.

6. What do you notice about how the treatment and disease together created conditions of significant medical risk?

All proposed treatments: surgery, IV infusions or treatments, medications to treat infection were contraindicated. Fortunately, my oncologist persuaded the surgeon and other physicians to stop moving towards surgery, to discharge me, and I was sent on Monday (next day) to yet another medical setting where a plan was developed to continue to treat the sepsis and cancer.

Through this example, one should see that the repair crews moved away from a simple explanation of biology. The balance between an anticipated benefit and known risk was lost, but an new alternative plan was developed and “living” continued.

This experience is an example of a  moment when biological misfires and their treatment become urgent, so the system was forced into rapid, high-intensity response.

This is one example of a collateral issue during which a complex intervention plan was necessary, and the previous repair crews’ plans were modified. Misfires, persistence,  rapid accumulation, and both the biologic repairs and medical repairs were not successful, thus a high-intensity medical intervention was rapidly developed. All medical teams discussed each option with me and each other, and we selected the presumed best option together. Our action plan was effective.

This example is applicable beyond discussions of the disease of cancer.

The framework proposed in this series is offered for anyone who has ever had their confidence in their own body shaken.

Cancer.

Heart disease.

Autoimmune disease.

Major surgery.

Neurologic disease.

Serious infection.

Unexpected diagnosis.

While the biology may differ, the uncertainty does not.

This multi-condition model of lived biology has layers:

Normal repair

Persistent misfires

Long-term adaptation

High-intensity medical intervention

The model has three responses…

repair

persistence

response

lived experience becomes the fourth.

Up to this point, we’ve been asking readers to expand their thinking regarding biology. Here, we are beginning to ask them to rethink their relationship to biology. This discussion makes interventions with “live biology” more complex.

Structurally, the framework is beginning to move through an understanding of four different stages:

1. What is a biological misfire?
2. How does the body repair itself?
3. What happens when repair is overwhelmed?
4. How should we live when biology remains uncertain?

I would offer another layer: mindfulness, or mindful interpretive responses.

Earlier in the series, we discussed “being aware”, “looking around”, “taking notice”, “paying attention” and “taking action”.  Biologic repairs, and medical repairs are positive actions on the patient.  

The emotional and interpretive responses, part of the human condition, from the patient typically will be positive as well, after the initial fear, grief, and frustration noted when a patient first learns of their diagnosis of disease. Responses like wonder, understanding, collaboration, sincerity, and thankfulness are frequently observed responses within the multi-condition model of lived biology as intervention becomes more complex.

Summary

What do we discover along the way from disease to health? We understand that “We must go on Living!” 

We live through uncertainty, but we continually expand our model basing the expansion on:

1.  real-life experiences, 
2. participation in your own treatment, and 
3. increased knowledge regarding available treatment options, as a
4.  member of your intervention team.

Reflections

•  If you were to summarize your thoughts after reading this discussion on Living how would you describe your real Living Biology? 

• What are the various layers/available treatment options you have experienced, if any?  

• Did you review several different treatment options?

• Do you see that treatments are not lost, they keep building on each other?

• Has the process of decision making , even under uncertainty become a bit clearer?

Remember Living is your end goal. Your body is always working for you!   

As always, I hope you may view your life with wonder and find peace.

Note: The final part of this series will focus on your future. 

The proposed ending is changing, just as our framework has changed, has extended.

The essay will suggest “Come With Me”.  Several possible visual images will be presented, with the message:

“Choose the image that helps you continue living. Choose one, or keep all. They have become companions for me.”

Soon… it is coming…..

#gratitudeultra