Who Are You?

Who are you?

It seems like an easy question. We have all kinds of ways we identify ourselves. From our name, to our occupation, to our religion, to the people we associate with, we have a plethora of ways to define the different facets of who we are.

So why do I ask you this question?

Why do I care how you answer such a simple question?

Because it is essential to your health.

What you enjoy — what rejuvenates you, and gives you life — is essential to who you are. As a doctor, if I ask you to remove something that is an intrinsic part of you, I’m likely going to be met with resistance.

If you view yourself as the guy who always carries a pack of cigarettes, or always knows how to have a good time at the bar, asking you to cut back on smoking and alcohol is not just a health suggestion, but rather a request to change an intrinsic part of who you are.

Are you a plate clearer? Do you load mounds of food on your plate at the buffet and plow through it proudly? Portion control is not going to go over well.

Sometimes, changes to the elements which you use to define yourself are neither voluntary nor within your control.

Providers working with wounded warriors must often address not just the physical wounds, or the psychological trauma of being injured in war, but the change in identity. Soldiers, marines, sailors, and airmen tend to strongly identify themselves by their service. They are defined as a service member by their proficiency in performing their tasks as a service member. Any loss in capability and virility in these individuals whose physical capability is tied to their purpose in life and definition of self needs to be addressed and managed to ensure positive outcomes. When servicemen are sent home after being injured, a large part of their definition of self has been disrupted. What they see in the mirror is no longer who they expect to see. They have gone from warrior, hero, and virile specimen to someone weaker and often dependent on others. These individuals need not only rehabilitation, but a new sense of purpose, reason for being, and ultimately self.

One portion of their identity that often remains is a drive for independence. Assistance is often perceived as both pity and dependency. They often need independence and purpose as much as they need rehabilitation.

When we move from wounded warriors to considering the long-term care of the aged and those fighting for life, understanding and maintaining what you can of a patient’s identity goes a long way to keeping them alive and in the fight.

I saw this in my paternal grandfather. When he was no longer able to drive and provide for his wife, his health declined. As he became more dependent on others he clung more tightly to the relationships he had fostered over the years. As the people he knew and loved -- brothers, sisters, friends, and his wife -- all passed away, his fight left, and he passed away. The only reason we think he lasted a year after his wife died is some late-onset dementia allowed him to keep forgetting that she had passed away.

Sometimes hope is the key ingredient.

The promise of a return to who you were before a diagnosis or an injury is what can drive many. When hope is lost, the descent is quick.

My other grandfather was diagnosed with esophageal cancer when I was young. For his generation, cancer was understood as a death sentence. He underwent surgery and chemo like the doctor suggested but lived only a few months past his diagnosis.

My uncle had a massive hemorrhagic stroke secondary to prolific cancer throughout his body. The doctors were amazed that he survived. However, one of the strongest men I knew went from a mid-seventies virtuoso, bucking hay bales and tending his farm like a thirty-year-old, to a bed-bound cyborg capable only intermittently of squeezing one hand. He survived long enough to say good-bye to the five generations of his family and died minutes after the last farewell.

The intrinsic character that makes us who we are can fuel our fight… until we lose it.

My mother was never all that adept physically. She found a new doctor every time she was prescribed exercise. What she lacked in physical strength she more than made up for in wit and elocution. Before you even knew you were arguing she could take you from as far afield as possible onto her side of the argument and back, all before she even let you know you were wrong. Verbose and passionate arguments were brought tumbling down with a well-timed quip and a smirk. Her free time was filled with puzzles and stories and news articles. Her domain was that of the mind. So, when metastatic breast cancer took her ability to get around the house, no problem. Unable to work? Social security was enough to keep the roof over her head and food on the table. Chemo made everything taste metallic? She wasn’t that hungry anyway. She eventually deteriorated to the point that my god-send of a father had to pick her up, put her in a wheel chair, take her to the restroom, and occasionally manually assist her bowel movements, and yet she continued the fight. Day after day, treatment after treatment, she fought.

Then it happened.

Mom got a staph infection. The resultant inflammation caused the cancerous lesions in her brain to swell, and she lost her words. She was no longer able to hold a conversation or do her puzzles that had given her such joy. I still have her last puzzle book. Occasional letters are haphazardly scrawled on random pages. Nothing like the careful script I had attempted to forge in my younger years. That’s when she threw in the towel. Her words were gone, and so soon was she. In moments of lucidity she managed to get her final affairs in order. Other times she had long, quiet, nonsensical conversations with the neighbor that passed 5 years prior, cousins long dead, family far removed, and other angels. They put her at ease, and soon she found her rest.

Mom stopped fighting when she lost her words.

“The intrinsic character that makes us who we are can fuel our fight... until we lose it. ”

My uncle stopped when he lost hope.

My grandfather stopped when he lost his love.

They all lost their will- their drive, when they forever lost who they were. Your patients will be no different.

You are no different.

So, I ask you again:

Who are you?

Josh Stanfield

Osteopathic Medical Student - 2nd year (OMS II)
Executive Vice President, Student Government Association
Pacific Northwest University of Health Sciences