No one likes to be wrong. No one likes to admit that his or her
medicine is not the best. When a patient walks into the room
seeking treatment, we each want to be the one to say, "Yes, we can
help you." While acupuncture has successfully treated the masses
for thousands of years, and has been recommended by the World
Health Organization for dozens of conditions and diseases, it's not
the only tool in the shed in 2015.
On Thursday at Cook County Hospital, I sat at the computer in a
treatment room entering the subjective information from an existing
patient presenting with a new chief complaint -- left calf pain.
We'd treated her in the acupuncture wing of the outpatient pain
clinic before, but her chief complaint was usually lower back pain.
Initially, I thought "another case of sciatica," as I worked
through her SOAP note and mentally scanned the best acupuncture
points for the job.
"Sharp pain in the back of my leg," she said, gingerly touching
her left calf. I asked, "When did it start, and have you had this
pain before?" "Yesterday, and NO," she snapped back at me. "It's so
swollen and the pain is sharp right here," she added. She confirmed
that there had been no trauma to the area, and I released my grip
and let the pack of needles slide deeper down into my lab coat
I'm kind of new here, and I readily admit that my weakness as an
acupuncture intern is ruling out contraindications and sorting out
red flags before I start sticking needles into the patient. Can I
still needle you if your blood pressure is 150/90? Some books say
yes, some sources say no. Acupuncture lowers blood pressure, so
shouldn't we go ahead and do it? Refer out! Confusion. "It's
normal," everyone assures me. "You'll gain that confidence through
clinical experience over time." Well, as a third year acupuncture
student, I don't feel like it's been enough time. I walk into the
head clinician's office and start presenting the case. Something
just feels...off...with this patient.
The beauty of my internship at Stroger Hospital is that although
it's not set up to be an integrative treatment experience for each
patient, it can transform into one in under 60 seconds. Our calf
pain patient came into the acupuncture wing of the pain clinic, but
upon suspicion of an emergency situation (yes, we were all thinking
"Deep Vein Thrombosis" or "DVT" at this point in the show), we went
two doors down the hall and snagged an MD intern to evaluate her
presentation from a western perspective, too.
He quickly assessed her signs and symptoms and agreed that we
needed to rule out a DVT before moving ahead with her regularly
scheduled acupuncture treatment at that time. Within seconds, our
integrated team had changed course, explained the testing process
to the patient, called over to the ER, and had a nurse transport
For thousands of years the expansive Chinese empire developed
what we now call "Traditional Chinese Medicine," or "Oriental
Medicine," of which acupuncture and herbs form the foundation. A
complete and effective medical system, the doctors not only placed
needles, administered herbal formulas, gave hands-on manipulations,
moxibustion, and cupping treatments, but also did bone-setting and
any other emergency medicine that was required. Today, in the
United States, our scope of practice is generally not so extensive
as to include bone-setting, but we respect the completeness of the
TCM system in its entirety.
This does not mean, though, that we ignore the
advancements of other medical systems or technologies. It means
that instead of blindly accepting the often too-invasive and
side-effect ridden treatment plans of the mainstream western
medical system, we utilize only the elements that we see as truly
necessary or complementary to a holistic treatment plan. In short,
I LOVE DIAGNOSTIC IMAGING. Sure, it's wrong sometimes, giving false
positives and false negatives alike, but overall it gives us a
somewhat clearer look inside the human body than what we can piece
together by looking at a patient's tongue and feeling her
I'm not saying that modern diagnostic imaging is necessary for
an acupuncturist to be effective in treating modern patients, but
it is another tool in the shed nowadays. The shed has grown larger
in the past 50 years, but it's also full of a lot of junk. Often
the expert walks in, picks up the best tool for the job -- the one
he's trained to use most confidently -- and steps over the rest.
The skill is being adept in choosing those tools that are best
suited for the situation, even if they aren't from the same
"The doctor of the future will give no medication, but will
interest his patients in the care of the human frame, diet and in
the cause and prevention of disease." Thanks, Thomas A.
Edison. I like that quote. Doctors of Oriental Medicine,
herbalists, and acupuncturists generally give herbs as part of a
complete treatment plan, but giving a pill to pop -- whether
pharmaceutical, peppermint, or deer antler-- is not the only way to
The doctor of the future will be truly integrative. He will
skillfully diagnose the patient's whole body, mind, and spiritual
condition, drawing from both hands-on examination findings and
high-tech imaging of internal structures. In the future, when the
patient presents with the new chief complaint of acute calf pain
and swelling, we can use modern imaging to quickly rule out the DVT
and then use acupuncture to treat her condition and balance her
body. We can give her qi gong exercises and dietary changes to
support her long-term health and wellness. Thomas Edison will be
Further Reading: The Patient Will See You Now: The Future of
Medicine is in Your Hands by Eric Topol
"Give her a Brazilian in Room 1!" This is the new catchphrase
around Stroger. That's right, we're giving Brazilians at the pain
clinic in Cook County Hospital. I occasionally worry that a passing
doctor thinks I'm waxing ladies in the treatment room, but the
concern quickly fades as I get down to business. This Brazilian is
all in the ears, and the only intimate part is the bleeding. I
always think bleeding is sort of a personal interaction.
According to a successful acupuncturist in Brazil, the best
treatment for relieving joint pain with heat signs is to tonify the
energy of the major internal organs, direct it towards the affected
joints, and then bleed it out of the body. How do we do this
exactly? Here's a sample case: inflammatory knee pain, let's say on
the left knee. It's painful, the area is red, swollen, and warm to
the touch. The patient often reports feeling warm, the pulse is
slightly rapid, and the tongue is often red.
The Brazilian technique is essentially a three-step process.
First, we needle the following points on the ear of the
non-affected side: Shen Men, Sympathetic, Liver, Kidney, Heart, and
Lung. Six needles so far, if you're counting. Then, we needle the
corresponding painful body parts on the ear of the affected side of
the body: Knee. OK, we're up to 7 needles so far. Totally doable.
Now we let those needles rest for a while while we enter the SOAP
note in the lovely electronic medical records system at
After about 10 or 15 minutes, we take those needles all out.
Next step, we get intimate. It's time to bleed the Ear Apex on the
affected side. I like to give it a few hard squeezes to ensure I'm
stealing as much hot blood out of this person's body as possible.
Don't worry -- it's usually just a drop or two.
What happens next? Well, it varies. Often times, though, it goes
like this. The patient stands up, wiggles around to "test" for any
perceptible changes in pain level and range of motion, and starts
to smile. "I feel better!" Pain levels are dropping from 10/10's to
4/10's in that 15-minute treatment time. Is it unorthodox?
Somewhat. Is it effective? Seems to be. Will we keep giving
Brazilians at Stroger? You bet.
Dr. Yurasek and I scrubbed into the isolation unit, donned our
masks, and needled an in-patient right in her hospital bed. I knew
that shift would be different. It was only my third day, but it
just felt different when I punched in that morning...and I was
Between our usual out-patient pain
clinic cases at Cook County Hospital, Dr. Yurasek, the other
morning interns, and I were discussing some of the more remarkable
results achieved with auricular acupuncture. That's putting needles
on ears, for the laypeople reading today. He told us about a
patient in a wheelchair who rolled in with several bullet wounds
and walked out the same day after the acupuncture
treatment. We told him about patients whose pain level went from
10/10 to 0/10 after their acupuncture treatment. It was basically
"one time at band camp" day at Stroger.
Dr. Yurasek was explaining that these types of staggeringly
effective results are the reason that acupuncture has been making
its way into the world of western medicine. Specifically, he said
it was the "portal to acupuncture ecstasy." That's actually the
start of an entirely different "one time at Stroger" story from
last week... but we aren't talking about that one here.
The point was that with the obvious decrease in patient pain
after a 10-minute needling and tui na treatment, it's hard
to shut the door in the face of the acupuncturist who wants to
treat the people. Let us into your hospitals! Share your space with
us, MDs! We were all on board... but how would we get the
administration to give us the time of day?
Then, the call came. The sixth floor
had an in-patient in acute abdominal pain, and her doctor wanted
the acupuncturist to come up and lend a hand -- a hand with a
needle at the end of it. And, since they called Dr. Yurasek, it
would be a big hand with a really, really big needle on the end of
it. We all know he likes those 6-inch needles. I don't even
near-faint anymore when he whips them out and drives them into a
patient's leg. I still look at the other side, though, expecting to
see the needle sticking out back there... I do still do that.
I had just hooked up my patient to the E-Stim machine and dimmed
the lights in her treatment room, when Dr. Yurasek peeked his head
in my room and said, "Let's go." Where were we going? I didn't know
yet. He calmly said, "There's an inpatient on the 6thfloor in acute
abdominal pain, and we're going up to needle her." Alrighty. If you
say so, sir. I walk next to him, fumbling through the pockets in my
white coat, knowing I probably needed to be bringing supplies or
Halfway upstairs he, very casually, mentions that the patient is
actually in an isolation unit, and we'll need to take extra
precautions. OK, ummm, is it too late to go back downstairs? What?
Thoughts of bringing home some exotic virus (other than the ones
I've already had) to my kids were flying through my mind.
Well, now I'm so nervous that I don't even know
where I am. Where are we heading? East wing? West wing? Where's the
lake? Finally, we make it to her unit. The nurses glance up at us
like, hey, no big deal, go on in. She's through that set of doors,
and then through that next set of doors... the ones with those red
signs taped to the window. OMG. "Droplet isolation"! I don't even
know what that means, but I'm nervous. Very nervous. We scrub in,
the nurse finally steps in and helps us with our facemasks before
we tied them on backwards, and basically pushed us through the next
set of doors.
Well, too late to back out now. Here we go. Luckily I had
needles in my pocket. Or he did, I can't even remember. The next 30
minutes were a blur, mostly because I was nearly passing out from
the recirculating carbon dioxide in my facemask. How do people wear
those for extended amounts of time? Clearly I was doing it wrong.
First timers, right here.
"Where's your worst pain right now," Dr. Yurasek asks the
patient, who I definitely thought was unconscious when we first
walked in, splayed out in her bed with the usual useless hospital
gown covering her nothing. "My back, and my leg, all the way down
to my foot," she says. Well, she's conscious. Great news for my
burgeoning anxiety. Abdominal pain, back pain, she's got it all,
but her back hurts the most right now. So, we treat her back pain.
Cue the 6-inch needles into the ancient secret lock-and-key points
now called "Gall Bladder 30" and Gall Bladder 34." Sciatic pain
relief on the way!
The patient is in less pain and is visibly more relaxed in her
body tension. She was in the middle of telling us a story, but then
she suddenly passed out asleep. OK. As long as she's not dead, I'm
going to make it. I run around like a crazy person in a crazy mask
looking for a gauze pad so we could take the needles out, and
finally, our job is done here. We walk back downstairs to the
outpatient pain clinic and resume our day.
"How's your internship at Stroger going," people keep asking me.
Awesome. It's freaking awesome. If you have the opportunity to
intern at Stroger, and you're not doing it, you're missing out.
I get this question all of the time: "Do you acupuncture
Yes, kind of, not really, I don't know what I'm supposed to say
exactly. Do I put needles in people? Yes, of course. Should I?
Well, that's where you've got me. Technically, I'm not a licensed
acupuncturist yet, so I take that to mean that I can't
charge people for acupuncture yet. Is it safe for me to
needle people? Well, I do have my Clean Needle Technique
certificate filed away somewhere....
Do I know what I'm doing?
Can I help someone feel better? I don't want to be a pretentious
jerk and assume the answers are "yes" here, but over the past year
I've certainly had some good feedback. As a sometimes full-time and
sometimes part-time student in the acupuncture program, I'm
somewhere around Tri 5. I've completed a large chunk of the
coursework, the whole observation phase in the clinic, and now I'm
actively practicing on everyone who schedules an appointment with
me in the AOM clinic on campus.
For the next year, I'll continue along in this internship,
enjoying the opportunity to test out treatment strategies, hone my
diagnosis skills, and figure out if "patient consents to treatment"
actually belongs in the "A" or the "P" portion of the SOAP note.
I'll do intakes; I'll form diagnostic impressions; I'll pow-wow
with Dr. Cai, Dr. Stretch, and any other clinician I can find. I'll
needle patients; I'll moxa their cold feet; and I'll do as much
moving cupping as my forearm strength permits. If you're really
special, I'll do tui na and I'll gua sha you
afterward. Want some herbs? Sure, we have raw, granules, or patent
pills. Right this way!
While the patient visits are the most important and most fun
parts of the clinic internship experience, the clinic lottery is
the part that causes the most anxiety among the interns. "Will I
get my same shifts next tri?" "Which clinician will I work under?"
"Which interns or observers will be on my shift?" All of these
panic-stricken questions and many more can be heard all over campus
right now -- the infamous Week 12 clinic sign-up and resulting
lottery has arrived!
interns get to sign up for their preferred shifts and locations for
clinic internships. We AOM students have the luxury of choosing the
on-campus Lombard Whole Health Center clinic or driving to Stroger
(Cook County Hospital) in Chicago for an off-site experience. My
45-minute commute is plenty, so I try to keep it simple and stick
to the main campus. There we all are, fluttering around the sign-up
sheet in the clinic lounge room, which is busting at the seams on a
regular day, elbowing the interns who are actually trying to sit
nicely and write SOAP notes that day.
If all goes well, there is a nice white empty slot shining and
waiting just for you on the day and time that you've decided would
be perfect for your upcoming trimester. In reality, someone else
probably agreed and already signed up for that one. In the end,
many interns are able to secure an acceptable shift and everyone
survives the sign-up week. Some lucky individuals end up in the
clinic lottery, where randomly drawn numbers allow devastated
interns to play a sort of game-show rendition of "This will be your
life next trimester."
In my two years at NUHS, we haven't lost anyone yet! The sign-up
process can be stressful for some, but by the time the next
trimester rolls around, we're all just excited to start treating
our patients and working with our clinicians to hone our skills. I
have one more year of this endearing learning process, and then
it's out into the real world for me (again). No more clinicians to
ask questions of, no more easily accessible chiropractors down the
hall to consult with on orthopedic issues (thanks, Dr. Anderson!),
and no more half-days of work! Maybe this whole clinic deal is
pretty great after all....
• So What Is Chinese Medicine?
• Jabbing Nerves with Needles
• Mission in Nicaragua
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