Curing the Incurable: The Basics of Medical Intimacy

One day about twelve years ago, Sam walked into my treatment room desperately seeking help. Sam suffered from trigeminal neuralgia — extreme nerve pain in his face. He had been referred to me by one of the best neurologists in the area. The neurologist had tried everything he could think of to eliminate the pain, including surgery, but nothing had worked. Having heard local reports of my unique approach to health care and my success with difficult cases, the neurologist had started to wonder, What could this guy, Coram, do for my patients? So he sent Sam to me.

This man was in horrible agony when he walked into my office. His facial pain was like sticking a hot poker in his cheek and leaving it there all the time. The memory of it still makes me cringe. Of course he was taking antidepressants and pain medications because the pain had gone on for six years.

I told Sam, "It's not going to do any good if I do things that other people have already done for you — things that haven't helped."

So I started exploring with Sam other aspects of his life. We talked about his work, his family, his recreation, and whatever else came to mind. "This is going to seem crazy," I told him, "but is there anything you have ever done that made the pain worse, or better — anything that changed the sensation?"

"Oh yeah," answered Sam, "but I told my doctors about that years ago, and nobody believed me or paid any attention to it."

Wow, I thought, that's a neon sign right there. "So what is it?" I asked him.

"Well, I have a rowing machine at home," said Sam, "and when I'm doing the exercise, my face seems to feel better. But the doctors didn't seem to be interested. They said I was using the muscles of my arms, not my face ..."

Immediately I asked Sam to take his shirt off. "I want you to reach for the ceiling," I told him, "while I take a look at the muscles in your back."

Sam lifted his arms up, and the scapula on the side of the pain didn't move. Normally, when a person lifts his arm up, the whole scapula moves up with it. You can't extend your shoulder completely without the scapula moving.

Sam proceeded to tell me that he had worked for twenty years at John Deere. He worked on a line, and his job every day was to repeatedly pull a lever with that arm. What happens with any repetitive stress injury is that we get micro-tears, and cumulatively over the years we get micro-scars. I concluded that over time the micro-scars had probably glued his scapula in place.

"Let me see what I can do with that stuck scapula," I told Sam.

At least I knew it was in the neighborhood of the facial pain and therefore worth addressing. So I worked at getting under the scapula with my hands. That's all I did. It was painful, but he was a tough guy, so I was able to free up his scapula in only two visits. After that, his facial pain was gone. That was when I first started discovering soft-tissue issues that no one else had been addressing.

What did I add to the mix that allowed Sam to finally get rid of his almost unbearable facial pain? How did I, in a small town in Iowa, get a reputation for helping to cure the incurables? First, very simply, I actually listen to what these patients say.

The power of listening — the patient knows what he or she needs if we will just listen. Over and over again, I have seen in my practice that the patient knows what is wrong, and he or she knows with some innate inner awareness what to do about it.

If we are willing to just sit there, to honestly listen and be open to them, patients will express what their needs are and how to fulfill them. They won't use the complicated clinical words — that's for the doctors to figure out. A doctor can't demand that a patient rise up to some high level of technical jargon before he or she will take the patient seriously. He or she can't take the attitude of, "You, lowly patient, come up here and communicate with me at this high technical level if you want me to do something to help you." The doctor is the person with the training. He or she needs to translate his or her technical knowledge into everyday language. Doctors need to talk to their patients just like any person talks to any other person and try to understand what they are saying. The worst thing they can do is just dismiss whatever the patient is trying to communicate.

So this is how I create that lovely feeling of relaxed intimacy that patients always feel in my office. They report often feeling as if they are talking with their best friend. And nothing can shake their sense of safety, so they can say anything.

When I use the term medical intimacy, I mean a relationship with the patient that is sensitive and attentive enough to allow the free flow of true communication, where the patient feels safe enough to speak freely and trusts the doctor enough to know that what she says is actually being heard. For true healing, this same quality of intimate communication must be developed within each patient. The patients must feel safe enough to listen to their own inner truth and free enough to communicate their inner truth to themselves and to others.

But building a sense of intimacy, either with oneself or with others, requires many elements. The first is listening with an open heart and an open mind. The second thing we must add is trust. That's what a lot of doctors don't do anymore. They don't trust. They don't trust their patients. And that encourages their patients not to trust themselves. If the patients stop trusting themselves, that impairs their healing process. They can't communicate with themselves intimately if they don't trust themselves. So if we are going to talk about intimacy, trust is a huge part of it — a huge part.

A lot of people show up at a doctor's office with problems, and the doctors don't believe them. "You're exaggerating," the doctor says. Or he or she dismisses the patient altogether with, "You're making more of it than it really is." I've even heard of local doctors telling their patients, "You think your back's hurting? I've got a lot of back pain myself!" In fact, doctors will even argue with their patients.

Many patients report that when they go into a doctor's office and the doctor doubts what they say to him, they either have to doubt themselves or doubt the doctor. Either...