There is a poem by David Wagoner that I learned years ago and memorized, forgot, then memorized again. Something about it draws me back, and reminds me of various aspects of my life and my clinical work. I ve used it in my teaching in the past, and I ve recited it to any number of patients, but I ve never used it as the basis for any writing that I can recall. Today seems to be the day for that, and the poem is entitled Lost.
The poet David Whyte explains that Wagoner s poem is based upon the advice given young Native Americans by their elders should they become lost in the forest. The first line is Stand still, and the last; The forest knows where you are. You must let it find you.
There s a whole lot of important stuff in between these two lines, of course. But for my purposes here, the first and last lines of advice about being lost will suffice. In fact, they form all I want to say about the problem of being lost and how to see it. Theoretically, I could leave you with that much and you would eventually work out the meaning for yourself.
But don t worry. As usual, I have a lot more to say.
Whyte says, The ability to be lost is striking. It makes you attentive. I agree. And I m speaking here of being lost within the complex problems of clinical life. You know, the seemingly intractable pain that doesn t follow any consistent pattern of referral, the increasing neurologic deficit that has no anatomical origin, the patient whose story changes daily though they appear to be perfectly reliable. There are more examples of how the clinic can confuse us, confound us and make us feel helpless than I can list here. In short, we spend a portion of every day lost and casting about for something to help us decide where to go next. At least, I do.
Having felt this way regularly for many years, I find that any method of management that implies that it can pretty much eliminate my being lost makes me uneasy. I feel that my clinical competence is dependent upon the uncertainty offered me in every haltingly spoken history, every equivocal or possibly irrelevant finding. If I remember that each patient is unique enough to offer me a different path through to the resolving of their problem, each turn will surprise me a bit, and sometimes a lot. Without these surprises my attention wanes, and, for me, that makes the clinic less like a forest and more like a desert.
There are methods of care out there that tell us that the way to navigate surely and quickly through each problem is to follow the form of questioning, the sequence of testing, and the algorithms created by the experts. They give us a map, and they imply that the terrain of the patient is predictable and commonplace. Well, maybe that s true for some diagnoses, but for primary complaints of pain that involve neural deformation, it isn t.
Now, finally, back to Wagoner s poem. He says that when you re lost, you should stand still. Fair enough. So much of manual care involves an immediate attempt to reproduce the customary pain with movement both active and coercive that the way the patient is, as opposed to what they do is never really seen. Without any stillness on the part of the therapist, the answers that might be inherent to the patient s being are missed. I m speaking here primarily of ideomotor activity. To stand still means to put a tremendous amount of attention into the patient s presentation. Admitting you re lost at this point will focus that attention on small and, possibly, important things.
The forest knows where you are. You must let it find you, implies (in this context) that the patient has a lot to contribute to his or her own recovery. This is a concept very familiar to therapists. Of course, this contribution is usually thought of as a willful effort only. I m always suggesting that it is the effortless and nonconsciously motivated movement that resolves painful problems.
Ultimately, it is our willingness to become lost, to admit that that s what s happening, and our courage to look carefully for the answers within the patient that characterizes the kind of care that just might surprise everyone involved. Becoming lost is when real change begins, and, with the attention it brings, the path toward home becomes clear.
Author s note: For the full text of Lost by David Wagoner, see Who Shall Be the Sun? University of Indiana Press 1978