Rachel Naomi Remen, M.D., looks at life from a unique vantage point. She is a physician who has been a patient herself for 43 years. A philosophy major who went to medical school, Remen segued out of a conventional career as a pediatrician to set up a private practice counseling people with cancer.
She is a woman filled with stories who believes firmly that through real-life stories, healing is possible even when there is no cure.
In “Kitchen Table Wisdom: Stories That Heal” (Riverhead), Remen shares a life’s worth of powerful, stories of pain and courage, hope and healing.
She tells about her uncle, a physician who received a medal for bravery for his actions in ministering to the wounded under fire during World War II. When her uncle came to visit, after having been profiled in a newspaper story, Remen, a 2nd grader, found a moment to climb into his lap and tell him how brave she thought he was and that she was sure he was never afraid of anything. On the contrary, he told her he had been more frightened than ever before in his life. “But why did they give you a medal then?” Remen blurted.
Gently her uncle explained that being being brave does not mean being unafraid. It often means being afraid and doing it anyway.
Remen, who was afraid of the dark at the time and deeply ashamed about it, writes that knowing her uncle, a hero, had been afraid too made her feel “there was hope for me as well. I had been stopped by my fear, humiliated by it, wounded in my sense of self. By telling me of his fear, my uncle had freed me. His heroism became part of my story as well as part of his.”
When she was a child, Remen says, people sat around kitchen tables and told their stories.
“It is not just a way of passing time,” she writes. “It is the way the wisdom gets passed along. The stuff that helps us live a life worth remembering. Despite the awesome powers of technology, many of us still do not live very well. We may need to listen to each other’s stories again.
“In this culture we’ve lost our sense of community. We’re a frontier culture. The values we carry with us are independence, self-sufficiency and competence. The downside is loneliness.
“When people become ill, they reach back for support. All these support groups (that have sprung up) are people telling each other stories and finding strength in that, finding community.”
It is support that may be provided rarely by doctors who concern themselves with “fixing” patients and leave them to cope with the emotional side effects of surgery and illness on their own.
Remen, who calls her medical training “a disease it took 10 years to recover from,” says that the process of becoming a medical expert teaches doctors to devalue the parts of themselves that their patients really need–things like heart, intuition, soul.
They become technicians rather than healers in the belief that this enables them to be of greatest service to others.
“We talk about objectivity and our training gets in our way,” Remen contends. “It actually diminishes our effectiveness in helping people recover a sense of themselves and live with the diagnosis they need to live with. Objectivity (holds that) truth can only be known at a distance. No. Truth can only be known up close and personal.”
Remen, 58, a native New Yorker, comes from a family of doctors. Her grandfather, who died when she was 7, left her money in his will to pay for medical school.
She entered Cornell University School of Medicine when women in the field were scarce. In her years of intensive training, she says her male colleagues frequently called upon her to deal with their distressed patients who were crying. Although she allows that she was no more comfortable in those situations than they might have been, she realized early that this was part of her “ticket to acceptance.”
But soon, listening to patients’ concerns and their experiences in living with the disease the doctors had diagnosed became more compelling to her than the medical process.
At age 15 Remen had been diagnosed with Crohn’s disease, a chronic, progressive intestinal disease, and told she would be dead by the time she was 40.
Patients’ stories, she says, eased a certain loneliness she felt as a young woman struggling with a disease that would necessitate seven major surgeries, including removal of a large part of her intestine and an ileostomy, an opening in part of the intestine for an appliance to collect partially digested food.
After completing her medical training, Remen eventually joined the faculty at the Stanford University School of Medicine. During the early 1970s, she became interested in the fledgling holistic health movement and began exploring different ways of dealing with good health and healing.
When she was about 35, she received an unexpected significant faculty promotion just as she was wondering how long she could continue practicing medicine in a conventional way.
“I was being given too much affirmation, too much reinforcement. I resigned.”
Her decision wasn’t about abandoning medicine. “It was about evolving. I have not abandoned it. I’m an associate professor at the University of California-San Francisco School of Medicine.
Working from the outside
Remen says that while she admires those who change the system from within, that wasn’t her way. She worked with people facing life-threatening illnesses in an effort to return the human element to a medical system increasingly dominated by technology.
Remen has had a private practice counseling cancer patients for 20 years, and she is co-founder and medical director of the Commonweal Cancer Help Program in Bolinas, Calif., which was featured prominently in Bill Moyers’ 1993 television series “Healing and the Mind.” She is also co-founder and director of a training program there for physicians in “relationship-centered care.”
“The way I was trained was disease-centered,” Remen says. “Then medicine moved to (being) patient-centered, but that’s not enough. We need relationship-centered medicine, because who the doctor is and who the nurse is do matter.
“More and more people in the medical system have asked to be trained. And now I go back into the (medical) system and give grand rounds and write in medical journals. I feel you cannot change the system if you are dependent on it for approval. You have to have the freedom to speak the truth.”
The medical culture, according to Remen, concentrates all the strengths and weaknesses of the culture at large, so that people who go through medical training devalue their feelings and intuition.
In her program traditional doctors–oncologists and surgeons–are trained to work with people who have life-threatening illnesses, and after they complete the program they teach a course called the healer’s art to medical students.
When Remen started her counseling practice, she says she was drawing on a lot on her own experiences as a patient.
“Listening is possibly the thing that we need most to start a (new medical) system,” Remen says. “I think this is not a listening culture. It’s a culture of doers, and we don’t receive a great deal. Receiving is seen as something weak. Yet it is such a powerful way to make a change.
“When you’re listening to people, especially if you’re listening not just to their pain but listening to their strength, you create a situation in which that strength can come out. Sometimes for the first time. It’s about creating a relationship.”
She tells a story about a cancer patient she counseled “who learned how to work with the unknown because he’s a sailor, a white-water sailor. He had not made the connection before between what he does when he sails and how he’s going to deal with his cancer. That experience with white-water sailing may be the thing that leads to major recovery, not my expertise necessarily. We look at what we’ve got and then build something out of it together. That’s relationship.”
What happens to people when they tell their stories?
Remen smiles. “The first thing that comes to mind is what happens to me when people tell me their stories,” she says. “I get a feeling of strength. It gives me new eyes. I learn from their lives.
“What happens to people as they tell their stories is that they recognize that who they are matters. Their life matters. Their suffering matters. As they tell their story, they suddenly understand what the story means, what’s important to them.”
Remen tells the story of a woman named Sara who had endured more than 14 abdominal and joint surgeries over 30 years. The ordeal left her chronically depressed and feeling like a victim, but, with therapy, that eventually changed.
Then one day Sara’s husband returned from work to find his wife sitting in her bathrobe, deeply depressed and unwilling to talk. Alarmed, he called Remen and brought Sara to her office.
Sara said that she had gone to the dentist, who diagnosed an abscess in a bone and told her she needed root canal surgery. “This straw breaks the camel’s back,” she said.
Remen encouraged her to relax and suggested trying a visualization exercise involving standing before a closed door, that had worked so well in the past. Sara proceeded to open door after door of the many hospital rooms she had frequented in her life, recounting operations and setbacks.
When she got to her 18th surgery, her voice got stronger and she sat up straighter. Suddenly she started to laugh. “Root canal, schmoot canal,” she said. “I can do this itty-bitty surgery with one hand tied behind my back.”
Remen pauses. “I always think that because I come from California now, I sound like a flake. There’s a difficulty in putting these things into words. You can only tell about it through stories.”
