Holding Space: Navigating Disease with Holistic Health in Mind

Establishing Care

Raina was a new patient with type 2 diabetes. I began the visit with the typical open-ended questions to establish care. Exploratory questions can be a blessing for listening therapy. My colleague, also a nurse practitioner, took the words right out of my mouth, “Sometimes I’m the therapist.”

For those who don't know, the Hemoglobin A1c is an average measure of blood sugar levels for the past 3 months. Values above 6.5% involve an increased risk for complications related to diabetes.

Raina reported that her sugars are usually well managed to an A1c < 5.7%, but that she is “going through problems.” Nowadays, her A1c is elevated at 10.9%.

The Choice to Withold

With a look of uncertainty because this was a choice description to withhold information, I asked Raina, “Do you mind elaborating on your problems?”

There are many reasons why someone might suppress information during a medical visit. Many times, it can be that they don’t want to be a burden, as though the problem was not relevant to the purpose of our appointment.

Are her problems related to finances where enrolling into a Patient Assistance Program could be of benefit? Is she having side effects of a medication and can we consider stopping or lowering the dose? Did her circumstances change at home, making lifestyle difficult to manage? When approaching care, it is important to embrace a holistic perspective to gain a better understanding of the situation and to also do root-cause analysis.

The Physiology of Grief

In fact, the problem had nothing to do with these possibilities. Raina told me she was experiencing deep familial hardship involving two of her family members. Sometimes when our beloved children rise against us and said children have not yet mastered the art of forgiveness, mothers have no choice but to demonstrate their own unconditional love while brokenhearted. This was happening simultaneously while mourning the loss of a loved one. Suffice it to say, she was having a hard time, and most of the root cause was psychological in nature.

Anytime our nervous system experiences emotional arousal and negative emotions (ie: sadness, grief, anger, anxiety), we have a higher level of cortisol in the body. The lower vibration of energy subsequently kickstarts what is known as the sympathetic nervous system — also known as the Fight-Flight-Freeze system — where, if chronically dysregulated, you may have a risk of cardiovascular disease (including impaired glucose control), immune dysfunction and Major Depression.

Holding Sovereign Space

Raina wiped back tears that continually flowed throughout our conversation. It was self-explanatory that her mourning for all of this was causing much of her exceptional hyperglycemia. I had the greatest compassion for this soul because of the similar experiences happening in my own life, but was mindful to ground myself with sovereign energy and to be of service.

I was careful to maintain silence through all of this, not making it about me and allowing her to take up space to navigate not just through the discussion to answer my question but also to traverse her own emotional processing. She cried and cried, and I mentally coached myself not to react but to be the even keel she needed to move through her energy.

Feeling better and more composed, she was readying herself to return to the topic of blood sugar. Prior to fully steering back the conversation, I said to her, “Raina, I realize you had a choice to share some highly sensitive and personal information. That took a lot of courage. I want to take the time to thank you for trusting in me to hold that space for you.” I made sure she had a psychiatrist and psychologist to help address her problems, to confirm that she had a social support system, and ensure she was not a danger to herself.

Personalized, Holistic Care

I refined her treatment regimen. It was personalized to her current emotional well-being, level of comprehension, and what she can handle for change. It is important to me to have the capacity to address her diabetes with holistic health in mind — which also included spiritual care! No matter how behind I was in my schedule and how many patients were waiting for me in the exam rooms, I took time to sit in the back office to use my energetic grounding techniques. I left my desk refreshed and ready to go on with my schedule.

I feel that this was a great example of what it means to be acquainted with one’s holistic health in order to provide holistic care to others. Not interrupting people with comments or reactions which signifies your own self-soothing. Not talking at people to teach them how to change. Not trying to psychoanalyze or therapize people. Not losing patience or putting my ego into the conversation. Just caring. Caring for the invisible hardship that people hold; caring about the emotional and spiritual well-being of the person; and caring about who this person is at the soul level. At the end of the day, it is not about Western conventional medicine, pharmaceuticals, or lab results. It is, however, about wholeness.