Part II: Nourishing
Review
While I
have targeted the Review of Systems to be replaced by the Nourishing Review, it
is by no means a pure swap in terms of information. A comprehensive Hx/Life
Story often can involve taking a ROS, however, I would like to suggest that
from a holistic, functional perspective, we are an interconnected human
organism and classifying signs and symptoms by individual systems only truly
serves the purpose of complete documentation as well as the concern for
potential malpractice suits by not addressing an underlying pathology. The fact
that at any given time, one may be suffering from an illness that predominantly
manifests as symptoms attributable to one system, doesn’t mean we should treat these
symptoms in isolation or disregard the entirety of the human body. Our ever
increasing understanding of the vast array of illnesses attributable to
disrupted intestinal enterocyte integrity along with a disturbed intestinal
microbiota reveals that isolating and attributing symptoms to single systems or
anatomical locations is downright wrong.
It is often
said that we should treat the patient not the disease, but I think what is more
apt is saying we should treat the human being not the pair of kidneys. In order
to do this we must individualize our assessment and treatment and change our
perspective on what can actually provide healing. To start, we can take 5
minutes to ask the patient a simple, yet incredibly personal question: What
nourishes you? Now I’m not talking explicitly about the eggs and bacon you ate
for breakfast, but rather about the people, places, events, sensory
experiences, and activities that provide the happiness, the joy, the fun in
your life. What can sometimes follow this question may be things like:
chocolate cake, having a cold beer, laying in bed on a Saturday morning for
hours, or gnawing on popcorn while binge-watching a show on Netflix. And while
I most certainly can attest that these activities are probably incredibly
enjoyable and provide hedonistic pleasure beyond typical day to day happenings:
they are not what I would call “nourishing.” When trying to paint a picture of
true nourishment I often describe the renewing flames to your internal fire:
the energy that keeps your candle burning, the drive moving you to share your
light with all those in your life. Hopefully it is very clear from this
description that most likely chugging a Big Gulp Slurpee really isn’t
nourishing, but spending a morning enjoying a cup of tea with a significant
other while watching the sunrise probably is. Over the past month, I have
recently embarked on creating my “Nourished By List” and I have been astounded
by what I have found. Simply giving yourself the time and space to think about
the things that truly bring you happiness and joy is amazing on its own right. And
the process is continually evolving, dynamic and never complete. Sometimes we
feel so pressured by our daily routine, we do not even get a chance to actually
take the time to realize what it is that we love to do, who we love to be with,
or where we love to be. Expectations abound in our society and upholding or
obliging to these expectations can often lead to a complete loss of who we
really are. Making a “Nourished By List” can provide you with the template to
live a fulfilled life and stay true to your essential being. This list is your
recipe for healing during any illness, regardless of what the drug
prescription, chest x-ray or blood chemistry may say.
As a physician it is not
my job to make you better by external means, it is simply my opportunity to
engage in a healing journey that allows you to realize what it is that you
should do to heal and return to a vital state of being. I’ll take a patient’s
Nourishment List over a complete Family History and ROS any day, and best of
all, I don’t have to spend the time asking yes or no questions- I can simply
listen and allow the patient to construct this list all on his or her own. To
me there is probably nothing more pleasing than engagement in purposeful
thought followed by the realization of what it is I can and should be doing to live
a happy and meaningful life. Okay, maybe subsequently doing a fulfilling
activity or being with someone that nurtures my true happiness is even better,
but you can’t get there without the silent contemplation beforehand, so in that
case, we can all benefit and enjoy the mindful awareness that allows us to see
how we can find our inner bliss.
