Article: The New Language of Medicine

THE NEW LANGUAGE OF MEDICINE:
WHAT TO SAY WHILE YOU'RE
WAITING FOR THE
AMBULANCE.

by

J. Acosta, LCSW, CHT

"During periods of great stress,
words that seem immaterial or are
uttered in jest, might become
fixed in the patient's mind and
cause them harm..."
(American Academy of Orthopedic Surgeons, 1987)

*

You're walking down the road. A man is hit by a car in front of you. He rolls and lands at your feet.

"Oh, my God! Oh, my God!"

After a few mili-seconds of horror, we naturally and correctly think of what we can DO, meaning calling 911, applying compresses, covering a person with a blanket, etc...

So, you call 911. And let's assume you use all your first aid training or CPR appropriately. The ambulance is on the way. When you're done DOING, what do you SAY?

"It was the worst feeling I'd ever had. I did all the right things, everything I'd learned as a paramedic. But she looked at me, like she wanted me to comfort her in some way. She was hurt so badly. I just didn't know what to say. I just kept repeating 'It's all right. It's all right.' It was a feeble attempt. I knew it wasn't all right at all."

N.A., a skilled and well-respected Westchester paramedic, had been standing with a woman hit by a car. She had broken bones, multiple lacerations, profuse bleeding. She was in pain. In a class of paramedics, he spoke at length about how he wished he knew what to say, even though, as a paramedic of many years experience, he was sure of his field technique. He knew what to do, but not what to say. Intuitively and wisely, he knew she needed to hear something, but he didn't know what it was or what would help her.

WORDS AS HEALING TOOLS

Knowing the right words at the right time can make a critical difference-sometimes the difference between life and death. Maybe you've taken CPR. More than likely, you have a First Aid book on your shelf in the kitchen. But when the crisis hits, after you've called 911, what do you do? What do you say? "Hang in there, Joe," while heartfelt, is not exactly helpful.
Words, well-chosen, well-said, can facilitate rapid healing of burns, lower an elevated blood pressure, reduce pain and increase compliance.

Conversely, words ill-chosen, thoughtlessly used, can cause great damage by encouraging hyperventilation, increasing anxiety and thereby pain response and bleeding, destabilizing heart rate and pulse, and over-stimulating the immune system, to name but a few of the ways. Dr. Dabney Ewin, MD, Clinical Professor of Psychiatry & Surgery, who teaches medical hypnosis to the students at Tulane University Medical Center in New Orleans, has said that words are extremely influential in the processing of information and our physiological responses. "Our pharmacopoeia in hypnosis is the dictionary. Just as you pick the right drug in practicing medicine, you pick the right words in practicing hypnosis." He has also warned other physicians that "our patients are frequently frightened and we need to be careful what we say."

Everyone who grew up in the U.S. within the last 75 years remembers the ditty: "Sticks and stones can break my bones, but words can never harm me." Well, that may not be entirely the case. What you say to a person who's been hurt can significantly influence the outcome. As much as what you do.

How is that? How do words have such a profound impact on our physiological processes?

It happens all the time. Let's take a look at an example in an ordinary life: If you are embarrassed, pointed out and laughed at, blood would flood the capillaries in your cheeks, your heart rate would probably increase, gastric juices would rise, adrenaline would probably be released. That's quite a marshalling of physical responses to a couple of words.

With this perspective on the body-mind connection, it is all the more easy to understand how in some cultures it was considered an act tantamount to murder to embarrass someone. They believed that the 'blush' was akin to a mortal wound.

Consider another example everyone has at one time or another experienced: If you have a frightening dream, which consists of little more than images in your mind, you might wake up sweaty, your heart palpitating, your muscles tired and twitchy. Indeed, a special chemical is required during sleep to paralyze us so we don't physically respond to our dreams as if they were actually occurring.

The point: What we think, see in our mind's eye, the images we form in response to the words we hear have very distinct physical consequences.

In situations of trauma or where there is danger, the likelihood of an image or thought eliciting a strong physiological reaction is even higher. People who are frightened are highly suggestible and are looking for guidance from a trusted authority figure. And if you're the one helping, you're the authority figure for the moment. What you say will most definitely have an impact on that person in ways you might not have ever imagined.

Some people have likened this response to herd instinct. A herd leader (either lioness, gazelle, or horse) that senses danger will run in a particular direction or take a specific action that the rest of the herd will follow by scent trail. For humans, words take the place of scent. While an antelope may emit certain pheromones that scream, "Hey, this way," a human will express himself verbally.

A person in pain, fear, and trauma most often wants and needs the same thing. Biological processes can be marshaled towards a person's survival and healing when we know what to say and how to lead them.

MINDBODY EVIDENCE

Hippocrates, the father of medicine, said "A patient who is mortally sick may yet recover from belief in the goodness of his physician." Our perceptions were included in the healing process as long as two thousand years ago.

In 1919, in The American Review of Tuberculosis, Dr. Tohru Ishigami found that the prognosis for a TB patient depended more on what the "patient has in his head than what he has in his chest." He was watching certain patients follow rather predictable paths to recovery when some suddenly became severely ill. What he discovered upon examining their histories was that those who died had almost all experienced some kind of trauma-a loss, a crisis-gone into despair and given up.

In 1971, a striking example of the power of mental images was documented by Dr. Carl Simonton, a radiologist at the University of Texas. He was treating a patient with advanced, terminal throat cancer. He weighed 98 lbs. and his odds for survival were only 50%. Weak and severely ill, he still needed radiation. But Simonton knew that it was very unlikely that he would survive it. Desperate, he turned to visualization, asking the patient to "see" or form a mental image of his immune system as white blood cells successfully attacked the cancer as he received the radiation. The patient saw it as snow covering a black rock. The result was a complete remission.

The anecdotal evidence, both from the literature and personal experience, is virtually endless. What we think and feel, the images we see in our minds, the things we tell ourselves (and hear others tell us and believe) have a profound impact on our bodies.

How does this work?

Some physicians, such as Dr. Dabney Ewin, have speculated that in shock, injury or illness, a patient's left brain function is over-ridden. We don't need to analyze, we need action to survive. When a person is scared, they tend to be more pessimistic and to rely more on the immediate impact of right brain input, specifically imagery.

With the right words and intention, our voice, in essence, becomes the substitute for the left brain, guiding, through its authority and proper use of positive imagery, the patient into the recovery process as much as possible.

Other researchers, like Candace Pert (the co-discoverer of endorphins) pursue the notion that there is an intelligence in all of us that is NON-LOCAL. Some, such as Dr. Joel Elkes of the University of Louisville, believe that this intelligence is the immune system. He calls it the "liquid nervous system" and says it seems to operate in and through the body as an additional sense.

To think, to feel, to be conscious, it seems is to practice brain chemistry. And the truth is, no one really understands fully how it works, although we know that it does.

WHAT TO SAY
For the lay person there are three major components to remember:
1. Presentation
2. Rapport
3. Suggestions for Healing

A brief overview is possible here, but a more thorough and necessarily detailed understanding is presented in the book The Worst Is Over.

Presentation
Whether you are the helper, the loved one, the friend, the doctor or the good Samaritan, for the time that you are with the victim, you are the authority. Your presentation-your approach and your attitude-is contagious. Whether you are calm or in a state of panic, the way you feel will be communicated and, in all likelihood, recreated in the person you are trying to help.

Paramedics know intuitively that it's always best to take a moment to center yourself whether through a deep breath, a brief moment of prayer, or by collecting your thoughts. It may only take a fraction of a second. But in that briefest of pauses, you can create the calm confidence that may be just the medicine that's needed.

You're there because you want to help. Remember that frightened people tend to focus their attention on the person who seems most sincere. Speak in a calm, clear, kind voice. Praise positive responses. But keep realistic. There is no better way to present insincerely than by diminishing, invalidating, or dismissing a person's genuine discomfort or fear. Stay away from comments such as "Everything's fine" (unless you are absolutely certain!) or "Oh, that's nothing!" If you can think of nothing to say, hold the person's hand (if you can safely do so) and tell them, "The worst is over. Help is on the way. I'm staying with you."

Rapport

In essence, this is a state of understanding, trust and positive expectation. Without it, many contend that very little in the way of true healing can occur. While it is a strong bond once formed, it is also fragile and easily broken in its early stages, especially in a crisis. There are numerous techniques a person can use to gain rapport with another person: Direct Contract, Pacing, Diversion, among others. No matter which technique you use, the same principles apply. We want to be respectful, realistic, and confident. We want to project some authority (without being demanding) and keep our comments uncomplicated. A few examples are as follows:
Direct Contract
"I'm Jane. I'm going to help you. Will you do as I say?"

Pacing
"You're really scared, I can see that. I'm going to help
you now."

Keep in mind that when in doubt, leave it out. If you're not sure whether what you're about to say is a good idea, forget it. You can listen, hold a hand, lend your support in many other ways. You don't need to use words to be a compassionate and helpful presence. Although if you're going to use them, it helps to know how. Unless you're very sure of your medical knowledge, make no specific references to physiological processes. Keep your comments general and positive.

Suggestions For Healing

This is the crux of the matter. Once you've mastered presentation and rapport, and you know the person trusts you, you are prepared to deliver therapeutic suggestion. This concept is the most exciting and demanding of the three and demands a great deal of time and concentration in our workshops. However, there are some basic rules of thumb. Again, keep it simple. If you don't know what to suggest, you can rely on a rather general healing statement, such as: "You can relax knowing the healing has already begun." Know that imagination is more powerful than knowledge, particularly in a stressful time. The person's responses will be coming from imagined possibilities, not from the facts. In VERBAL FIRST AID, we describe in more detail how a person can imagine a burn injury being "cool and comfortable" and reduce scarring, inflammation and pain. Every thought or image can cause a physical reaction. So, it's up to us to make that reaction a healing one.