Hoofprints - Stanford Medicine and Horses

The Doctor from Hell at EAGALA - by B Kane, MD

What is everyone's nightmare about the worst possible doctor-patient encounter? Sharon and I just got back from...

Impact

H&M's impact seems to be quite varied across our illustrious lot. For me, the impact was more subdued. I think this was partly because of my expectations of a skills training rather than an insight building program for lack of a better descriptor. But, I think that it was mostly due to being fortunate enough to have had very similar if not identical exercises in my youth and in different organizations in my past, sans horses of course. In attempting to think about the things we did from the perspective of someone who was never exposed to arm-brain type activities or delineating between perceptions and interpretations, I can see how these things could be very powerful. And, I can certainly appreciate the link between insight, self-awareness, and being in control of one's nonverbal communication. On the flip side, as someone who appreciates the subtle techniques of nonverbal communication with humans, I think that a horse's reliance and sensitivity to nonverbal communication gives a great opportunity to hone one's nonverbal skills. And I hope that future classes further use the horses' sensitivity more as a tool in that regard.

Feeling Inspiration

Sometimes it is hard to know what sticks with you, which memories will persist and which will fade away. So 2 months out is not a bad time to check in and see what's still bouncing around between the gyri. And I must say, the memory that seems to be the strongest was feeling the horse breathe beneath me during out bareback ride. Perhaps because it was unexpected, perhaps because it was something new, perhaps because it was a different kind of connection made. Not quite the same as feeling ribs expand with your hands, definitely not the same as listening through a stethoscope.

Image at the Last Day of Class

When Beverley asked us at our last class, what image comes to mind when you think of this class--many impressions came to light. The rolling hills behind Webb ranch. Our first silent walk up to the corral on the hill. The four of us attached in a silly way as limbs and brains. But what came to mind most was something not visible. Or rather, not physically visible, and that is the community and bond our class formed during the five short weeks we were together. Perhaps one of the most valuable lessons of Horses and Medicine is the bond that can form between different human beings when they are genuine, honest and open to learning and getting to know others. It has been an honor to spend time in such an unusual and unique setting with fellow medical students and community members. Thank you for all that I have learned about horses, horsemanship and patients!

Anna

My balancing ride

It was out last meeting for M&H, and it was our turn to experience "therapeutic riding". Divided in two teams of five, we worked together to guide and take care of the one of us who was riding bareback on one of our horses. I enjoyed being a 'sidewalker' (to make sure that our rider feels, and is safe on the horse), and I most definitely enjoyed the riding experience. First and foremost, I felt safe when I was riding, so much that I felt comfortable letting go my sidewalkers and even closing my eyes. While we were not trotting, riding bareback allowed me to fully feel the horse's body moving, and my own. I felt my leg moving within my hip joint (acetabulum, for those of us) as if I was walking!!! When we had time to do one more round, I wanted to ride backwards (with my back facing the front of the horse), and this was a relaxing and balance-testing experience. I feel fortunate to having experienced first-hand what horse therapy can do to the spirit and body. Thanks to all whom with I shared this 5 week experience with!!
MA

Therapy and Horses

This week we went and watched some therapy involving horses. There were some inspiring stories of how this type of therapy had really helped people. I think there is a real opportunity for physicians to know more about physical therapy and different options for severly disabled children. I'm not sure what will be covered in the official cirriculum but I'm glad to be aware of an option that might help some of my patients in the future.

My -un-informed consent

Hi all!! I hope you are all having a good week. I would like to reflect on M&H experience from last week (10/24). Besides the fact that I got to get away from the Stanford campus, I got to participate in the 'informed consent' exercise with the horses. This exercise is an analogy to having a patient sign an informed consent form for a medical procedure. The exercise consists of having a horse walk over a reflective, crinkly blanket. I was the first one to go, and selected Mocha, a small horse who seemed youthful and therefore -I figured- would be curious to participate in this. As I approached and guided Mocha towards the 'procedure' we seemed to be on the same page. I took a detour inside the horse pen, to give us some time to bond. As soon as we came to the edge of the blanket Mocha stopped, looked at the shiny surface and started making sounds I have never heard horses make (a grunt of some sort)... I patiently reassured Mocha, with what I assumed would be 'comforting' rubs along Mocha's neck and body, and speaking to Mocha sotfly. As I was growing slowly more anxious about 'getting the signed consent' I also made sure to not let Mocha back out too much. I could tell Mocha was curious about what lay ahead, but the curiosity did not overcome the fear. Anticipating that Mocha would be reluctant to 'sign the consent' I did not want to be forceful with Mocha, and therefore waited and reassured some more. Almost at the end of my exercise I 'called for an attending' figuring that I needed experienced help (which is allowed in a clinical setting).
Overall, this was an enlightening experience and the rest of our day was wonderful.
MA

Left limb, Left brain-Right brain, Right limb

Today we worked as a team--by taking about the body. Luckily, not our own body, nor that of our patient or horse. But rather we virtually "created" a body, by four of us coming together. Each person played one role: left limb, left brain, right brain or right limb. I was lucky enough to start as the left brain. As an undergraduate neuroscience major, I had a hard time unlateralizing (if that's a word) brain function and activity. I kept thinking that the left brain was going to move the right limb and vice-versa. However, physical proximity to our respective limb helped (as left brain I was immediately adjacent to the limb I was to move, the left).

A projection experience

Mounting research suggests that much of our decision making is made well before we are aware of it, leaving some to wonder what exactly our consciousness is for beyond our own amusement and/or torment. I would posit that, among other things, our conscious experience is used (for better or worse) in long term planning, where our awareness gives our "old brain" the stimulus for which to make a decision. Novel experiences, moments where our bodies' associations are lacking, are the moments where our awareness is not much help and our "old brain" gives its best guess. Seeing an old friend give you a look of annoyance isn't projection, that is knowing your friend. Seeing a new friend not laugh at your joke and thinking he doesn't like you/is sad/is not funny is projection. That being said, horses are more or less novel experiences to me, and I found myself projecting a mood onto Dream yesterday. As she stood still while we struggled to put her saddle on, I thought I saw a resignation, the type of general malaise that would come with the territory were I to be subjected to a master/subject environment. The moment was fleeting as I quickly reminded myself that I have no earthly idea what a horse expression for resignation might look like...but my associations were just giving it their best shot. And as we sat for our debriefing , I happened to look over someone's shoulder only to see Dream, standing there, in the same stance she had while she waited for someone's left brain to tell someone's left side to do something. Same stance as before, same ears, same angle of the neck, same look on her face...different projection. I thought to myself, "ha, what a silly assumption, well, then again, that is projection, and now I have something to blog about."

-Alex

Confidence in your actions

It was an honest challenge to try and convince a horse to cross the spaceblanket today. Thinking through how to convince anyone to do something that they are truely scared of was an interesting aspect of the exercise. Techniquesthat we generally use for getting someone to do something include bribing them or trying to coerce them. It takes a specific kind of patience and dedication to get someone to agree to do something that they are initially uncomfortable with. I also realized that when I'm stressed, I am less clear with my leadership. Though I would generally say I can give clear direction, I found in several exercises today, I backed off when I was unclear about what I was supposed to do or not sure that I was doing it correctly. This made the horses (and me!) nervous. It is good to know that your manner and confidence can be so clearly mirrored in your patient. I'm hoping that these next two weeks will give me some more good insights into pitfalls for doctors in training.