In search of lost time

Dr Adrien Proust (1834-1903) was an epidemiologist and the Chief Physician at Hotel Dieu in Paris. His work on cholera across Russia, Persia and Europe might well be seen as his most significant contribution to medicine, but notably he was also father to one of France’s greatest authors, Marcel Proust (1871-1922).

<em>In Search of Lost Time</em>, Marcel Proust’s crowning work, is a 4,215-page reflection on such ideas as memory, death, loss, separation anxiety and the wandering narrative of life. If we are to hold credence to the Buddhist philosophy that ‘pain is inevitable but suffering is optional’, maybe Dr Adrien Proust addressed much of Paris’s pain for a time, but his novelist son, Marcel Proust, may have provided a relief to suffering to all the world for over 100 years.

As physicians we routinely focus on addressing our patients’ pain during the brief meetings we are afforded in a clinical encounter; often very aware that with additional time we could address many more of our patients’ anxieties, fears, questions and relationships to their condition. We have refined our skills to address pain with a laser-like focus, but at times we can leave our patients without the knowledge or resources to manage their suffering. This suffering may be a paucity of understanding of a condition, of its time-course and consequence, but also in how their lives may change or indeed may not.

When a patient leaves the room, the resource most likely to be of counsel to them, are other patients. Patient support and advocacy groups, such as breast cancer, diabetes and heart disease support groups, provide a wealth of advice ranging from the challenges of dealing with the existential crisis of end-of-life care, to the hyper-practical recommendations for where to get the best wig when hair loss follows chemotherapy, for example. Knowledge of and referral to such groups can be an enormous source of support long after the patient has left the room.

As a cardiologist I spend much of my time counseling on health literacy and optimal lifestyle behaviours, but in reality this is a process that can take years rather than minutes. As often as I prescribe a medication, I ‘prescribe’ a website or smartphone app that can be of assistance; in terms of learning more about a condition, tracking and optimising behavioural traits, or functioning as a tool to monitor biometrics that can be reviewed at a subsequent visit. 

Providing our patients with the insight and tools to better self-manage their condition stands to reduce pain, but also suffering, by empowering patients to have a greater sense of control and involvement in their illness.

Beyond the provision of selected educational resources and tools, many of those we see struggle with anxieties related to having a particular disease and the limitations it can impose. A new diagnosis may be the catalyst to reflect on certain health-related anxieties or even their own mortality for the first time. While the <em>BNF</em> doesn’t have a section on ‘Managing the existential nature of the human condition’, we are fortunate enough to have greater minds that have reflected on these very issues over the millennia.

A wonderful resource to reference in such situations is the book <em>The Novel Cure</em>, a compendium of pieces of literature linked to a host of human sufferings.

Gambling an issue? Maybe Luke Rhinehart’s <em>The Diceman</em> is what is needed. Maybe it’s a fear of death and Gabriel Garcia Marquez’s <em>One Hundred Years of Solitude</em> is best prescribed. For more bite-sized installments, as opposed to entire pieces of literature, the British philosopher Alain de Botton’s brainchild <em>The School of Life</em> is an incredible YouTube series of three-to-five minute videos on issues ranging from thinking about death to why we go off sex. For somewhere in between, the work of Maria Popova of BrainPickings.com is a daily reflection on pieces from Oliver Sacks’s musings on self-identity, to Walt Whitman’s thoughts on what makes life worth living.

For those who wish to make this exploration themselves, developing the skills of mindfulness and meditation are profoundly useful. Headspace, Calm and Breathe are among such freely available online tools.

The treatment of pain and the reduction of suffering are key pillars of what we aim to achieve as physicians. Although we are in ‘search of lost time’ to find space to counsel our patients, the menu of options we can recommend to manage their suffering are indeed limitless.

So maybe physicians will primarily play the role of treating disease, as the epidemiologist Dr Adrien Proust did but, when possible, think of his author son Marcel Proust and try writing a  prescription for something that isn’t listed in the <em>BNF</em>; you might be surprised as to its efficacy.