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The hero’s journey

When I was a young hippie back in the early ’70s, I used to read tarot cards.

Honestly, even then I was skeptical of the cards’ prognostic abilities. Still, I did love the images and the way universal experiences were expressed in the random patterns of the card spreads.

I was good at it, too. People would exclaim with wonder at how I had understood the depths of their current dilemmas, at how I had discerned their hopes and fears and answered their half expressed questions. Sometimes I wonder if I could have made this an actual career had I not been such a practical person.

Around that time I read Joseph Campbell’s The Hero with a Thousand Faces. It made me realize that the tarot cards were about the hero’s journey, the very human quest seek to achieve wholeness. Since all of us are the heroes of our own lives and we’re all on that quest to make our lives meaningful and whole, this resonated with the people I was reading for. 

When we care for patients, we can think of them as being on their own version of the hero’s quest.

Before getting sick, they’re in the everyday world, the mundane world of work, family, material striving, day-to-day-ness and health. Sometimes there is a sudden fall. Like the Fool in the tarot deck, the patient has not noticed the growing “not rightness” of their inner world, and they fall headlong into illness.

Cancer is the most dramatic of those diagnoses which change people’s lives in a moment. This week I saw my patient who came in for a routine postpartum visit.  She complained that she had been coughing and had a low grade fever for a few weeks. When I examined her I found a large lymph node in her armpit. Her left lung had absolutely no air entry.

That exam, and her history of Lymphoma, started a whole cascade of unwanted and undesired changes. Once that mass is felt, the image is seen, the biopsy result returns, a person’s life is irrevocably changed. They leave the known limits of their world and venture into a dangerous realm, where they do not know the rules and boundaries and threats and dangers surround them.

While the entry into this valley of fear is most dramatic with cancer, it is equally there with any new life-threatening disease. Diabetes, heart disease, even appendicitis enters the patient into an unasked for adventure, what is called in mythology a “liminal space.”

Sometimes in the myths, the hero refuses the call to adventure and becomes mired in denial, unable to summon the courage to make the difficult changes demanded. I recently watched a resident seeing a relatively young patient with diabetes. His latest tests showed the beginnings of all the complications in the eyes, feet and kidneys. He was already on maximal oral meds. “We have to start Insulin,” the resident said. I looked through the screen at the young man, large and athletic looking, in the examining room. I had an idea. “Can you ask him what he is actually taking?”  

“But it’s all in the chart,” the resident replied, as I cocked my eyebrow. “Oh, OK I will ask.” She said reluctantly. When she asked him which meds he was actually taking. The patient blushed, shamefaced. “None of them,” he confessed. “I just don’t want to be sick,” he said while the tears flowed down his face. He thought keeping his body’s betrayal hidden he would get control over it. Like King Minos of Crete, this young man thought if he kept the monster of his disease hidden and locked away, it could not destroy him. Yet it kept demanding its tribute of his health and wellbeing as he was in the Labyrinth of denial. 

I also accept that people may not tell me the whole truth. They have their reasons to hide things. I recently had a young immigrant couple come in where the pregnant woman screened positive on the chlamydia test. (Hooray for universal screening!) Both partners denied any extramarital sexual activity, both were positive. So, I guess, somebody is lying. I am assuming that there is a reason that is compelling to them.

In my head I have made up my own scenarios; the woman was raped and does not want to tell her husband, he is gay and not telling her, they are both swingers and hiding it from me, because they think it will affect their refugee claim. I will be vigilant but respect their need for secrecy. Sometimes the Devil Card, needs to be played.

As physicians, we are people’s guides, not their kings or queens. We should not command them to change. If we think that people will do just what we tell them to do, “because we said so, that’s why!” we will be constantly disappointed. It is not only the height of paternalism, but it condemns you to the damage being angry at patients all the time does to your own soul’s journey.

Our mission is to find the best way to help people grow along their own path. In the tarot deck, these guides come in many guises: The Magician, the Hermit, and the High Priestess cards represent some of the classic forms that guidance can take. Ultimately we do not have the power to change people’s lives. We have to be willing to change as they change, to be the person they need today, so that they can become the person they want to be.

We have this opportunity and privilege to help our patients achieve wholeness and integration to grow to be their best selves, and in the process we, too, become better.