Understanding what my role is as an Acupuncturist, within an acute medicine context has been a difficult endeavor. I am currently on my second placement this time on the acute internal medicine ward. It has only been a week but it has felt like several months of learning.
When we work from a preventative standpoint the details are the key, details that are often invisible at first glance. What is it in a clients diet, or perhaps in their life style that may tip the balance, what areas of discomfort should be addressed first and what is the root of the problem(s)? These are all the questions on my mind in a preventative setting. I want to know the details, I want to know the source of imbalance, I want to work with the client in establishing a plan of action to fine tune the amazing and intricate system that is the human body. We are looking at the subtle energies at work that could lead to more threatening problems if unaddressed but at the moment remain dormant, or perhaps merely stirring in their sleep.
The acute internal medicine ward is the polar opposite end of the health care spectrum. The pathologies at this point are immediately life threatening, there is nothing dormant about them and 90% of the time they are present in groups. Not one but a handful of diseases all co-existing in the body’s most extreme state of imbalance, at times teetering on the edge of life and death.
The moment I walk in to the acute medicine ward, the details overwhelm me and the time constraints are such that I can’t possibly figure out how to help anyone, a feeling of helplessness and fluster set in. It is easy to become distracted by the many branches stemming from the big tree growing within the distress of illness. The branches are all the various symptoms that can be very loud, call attention and easily distract from ‘tree’ which is the more life-threatening issue.
At first, still in the mindset of a preventative approach, I wanted to address all aspects of each issue. An interesting anecdote made me realize that this was a vastly different world of medicine. It would be similar to getting distracted by attempting to find the cause of severe knee pain, and spending even more time attempting to fix the issue, but soon thereafter discovering that the patient is likely to have their leg amputated due to severe gangrene caused by the rapidly progressing diabetes, which is causing them sepsis and putting their life at risk. A different perspective indeed.
As the days progress and I take time to step back, it becomes evident that the issues at hand are on a grossly different scale. My questions may be the same but it is no longer the details that stand out. When a person is presenting with COPD, congestive heart failure, poorly managed diabetes, and is struggling to stay alive my role as a practitioner is so vastly different that it almost a feels like a different career all together. Our goal is no longer to address the root of the problem, it is no longer to ‘fix’ it, but in this setting, on the acute internal medicine ward, our role is to help keep people alive, mobile, prevent any further complications, and aid them in recovering enough that they can return home, or to another facility for further treatment.
It is a steep learning curve, and I feel out of my element, but I am so grateful to be exposed to such extremes ends of our healthcare system. It may even be that the very definition of health shifts from one end to the other, as disease progresses.
It is undeniable that prevention, whenever possible, is key.