Book review : Healing uncontrived

The bear's embrace: a true story of surviving a grizzly bear attack Patricia Van Tighem Greystone Books, Vancouver; 2000 256 pp. $29.95 (cloth) ISBN 1-550-548077 On a sunny fall day in 1983, Patricia Van Tighem and her husband Trevor set out on a weekend trip to Alberta's Waterton Lakes National Park ... . But the following morning something happened that would change their lives forever: they crossed paths with a grizzly bear.” So says the cover of this remarkable book, in what is really quite an understatement. In “crossing paths” with a bear, Trevor and Patricia were severely mauled and suffered extensive injuries. Seventeen years and numerous surgeries later, Patricia has chronicled their experiences in The Bear's Embrace. This is a must-read for any physician involved in the treatment of severely traumatized patients. It is truly hard to put down, not because it makes for particularly comfortable reading, but because of the riveting reality it discloses. This is no feel-good account of some particular therapy that helps make everything all right. On the contrary, The Bear's Embrace ventures into despair, starkly revealing the experience of disfiguring trauma from a patient's viewpoint. But this is a patient with a difference, one who has been on both sides of the medical fence. The struggles that Patricia, a nurse, goes through to find healing are truly monumental, and the support she finds in her physician husband speaks eloquently to the power of a committed relationship. Patricia is well acquainted with the culture of hospitals, medicine and nursing. Yet her interactions with doctors and nurses, many of whom had been her colleagues, sometimes leaves much to be desired. The book shows all health care professionals what it might be like to find ourselves suddenly on the other side of the fence: a patient in a large impersonal institution. It is not altogether a pretty sight. In spite of everyone's presumably good intentions, it seems that many patients — Patricia included — experience invalidation from a profession disconnected from the people it purports to serve. Such invalidation is by no means universal, of course; as Patricia points out, many individual physicians and nurses are indeed caring and compassionate. But those exceptional individuals struggle within a system that doesn't appreciate the value of subjectivity in medicine. There is little doubt that our scientific stance, based as it is in a contrived objectivity, has distanced us so far from the opinions and feelings of our patients that the result is a medical system in the service of itself. She records her disappointment in her own profession, the nurses who are efficient and jollying. I am brave they just tell me. Just look at all I have been through. Later, I push the call bell. I ask a nurse to sit with me. She returns with some Ativan. The gulf between doctors and their patients comes across time and again. Take, for example, the doctor who on his first visit comes right to her bedside: Sees me stiff on the bed, bloody gauze covering the new hole in my head, my mouth twisted and crying. I make the mistake of looking directly at him with my right eye, beseeching him for relief. Every day after that he comes only to the door, asking brightly from there how things are going. But perhaps more disturbing is the fact that such aloofness occurred even in psychiatry, where one might be forgiven for thinking the staff would try to be a bit more personal. Instead, Patricia faced the dogma of behaviour modification, administered with little love or caring, in which the patient who behaves in an acceptable manner gets rewarded with a discharge, while those who honestly express their feelings are labelled as difficult and treated as psychotic: My reputation as a difficult patient precedes me. Along with chronic pain and recurrent infection, I now have a psychiatric history. In many doctors' eyes, I have no credibility. Throughout her ordeal of repeated facial surgeries, unrecognized retro- orbital abscesses and inappropriate psychiatric diagnoses, Patricia manages to maintain a centre from which she is able to reconstruct her shattered existence, eventually finding peace with the bear through an experience of integration that, remarkably, arose spontaneously in a dream. And although this experience is relegated to a single paragraph right at the end of the book, it is probably the key event that brings balance and wholeness to this incredible story: it is here, perhaps, that the true meaning of illness is revealed. It is through a nonrational embracing of the illness experience that healing arises, not through rational therapeutic interventions or the clever manipulation of behaviour. And even when apparently straightforward surgery is contemplated, attention to this notion of embracing is not misplaced. Without an experiential sense of integration, the most sophisticated surgery in the world will not heal the wounds to mind and spirit that lie behind the physical manifestation of illness. The Bear's Embrace demonstrates graphically the direction in which medicine needs to go if it wants to shed the reputation of being impersonal and inhumane. Despite the technical marvels that emerge daily, we must not forget to work with love and acceptance. At the end of the day, in spite of the loving support of her husband and growing family, Patricia has to find that love and acceptance for herself.

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