Janette Tolich

How do we find colour in the clinical encounter?

March 2, 2020

It is difficult manoeuvering in the normative healthcare space, which, typically, is constructed and confined by questions and answers. It is difficult to find room for my whole person-oriented language, to find a whole person space for the patient and me to occupy, and into which the storied metaphors of our human suffering and complexity can arrive.

These stories come veiled, hidden behind a welter of medical histories and conclusions, packaged, over and done with, and destined to remain outside the clinical space. The patient gets a fix-up, and the stories are hopefully left in the past. But, no, they surface again and again, arriving here or there, with someone else, tumbling through conscious and unconscious awareness, searching for a place to be seen and heard. They wait for us to put the light back on.

We face the challenge of how to tune into a person’s rich and utterly human experiences in a setting which constantly sucks us into a unidimensional materialistic vortex.

As clinicians, knowingly or not, we have trained in a room where the table has already been set. The person’s story, often tragic, experienced, constructed, enacted, and endured, is not invited and certainly not yet heard in its full and compelling coherence. But despite our attempts to reduce healthcare to questions and answers of a certain kind, the patient’s story is and was ‘always already’ with us, even when we are unable or unwilling to look.

The whole person space, deliberately encouraged, allows a multi-dimensional relational encounter.

Letting the colour that is personhood enter the room. Shining a light on what is ‘real’ before us, a rainbow appears. Tragic and overwhelming stories bring colour again as the untold, unheard, suddenly makes its appearance in this once prohibited intimate space.  The real ‘life world’ is revealed in the stories. In the whole person space and encounter we, the patient and the clinician, find a match, a resonance, and new understandings unfold.

The other day I asked a patient, ‘What are you travelling with? What sense are you making of this disruption to your life, your breathing?”  Suddenly, she says, ‘I am surrounded by death’. It tumbles out: a troubled world, a horror living within a nightmare, death on all sides, rearing its ugly head way before it should, in our should be world. A big announcement, indeed. Right here, right now; at least our interaction doesn’t die, ironically it comes alive, a story of colour, arriving now, to explore together.

Liveliness and colour emerge when we invite the ‘story’. Our patients have been looked at, but not seen. Packaged as conditions and diseases, they have been added to the database, but there is no record of the colour. The passion and the liveliness sit at the door in a closed suitcase. We only bring in the broken parts.

Putting the joy back in.

How do we make it fun again? How do we reignite our bright-eyed student’s fascination with the wonderfully made body, the human story, and the awe?

We all come with a story, loved ones with difficult prognoses, daily struggles to breathe, walk, work, and sleep. The urge to fix it all up, without attending, can be tremendous.

The other day we had a clinic scheduling problem, and as a consequence I was assigned to take a patient through what at one level could be seen as a mundane exercise programme, a prescribed, fixed format. I was the one who got to ask the routine questions, and to hear the answers. But I started to see the colour too. We met on another level. The kick in my step returned. The algorithmic process surrendered and we came alive through the creative moments together.

It made me think of the joy in relationship that brings colour, and of the light that had been missing. When it is this kind of fun, the joy returns, we are now on the way somewhere, together, and light of step; all in stark contrast to the weight and burden of the same old insoluble, relentless stream of biomedically-constructed problems and the continuous experience of being stuck shared by both patient and clinician.

People, together, in pursuit of the unknown, untouchable. It becomes lively and colourful. The problems no longer weigh so heavily, and frequently become surmountable obstacles.

When it is this kind of fun, I am HIT with something, with response, with our human wholeness. The steep corners in the loose gravel road are navigable. The smooth manoeuvring. The rush of it coming back, exhilarating, dust rising in my/our wake, unsettled, disturbed and yet settling too.

When it is fun it is soul, spirit and colour, our call to be, with one another, the delight of persons alive, where happiness and sadness can meet, where hopefulness is the rudder. There is wind in the sails.

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Janette Tolich is a physiotherapist and Tai Chi practitioner who coordinates and manages a Breathing & Living rehabilitation clinic for the clinical placements in cardio-respiratory physiotherapy as part of the Akoranga Integrated Health Clinic, AUT University.

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