Ray Blunt has worked in public service for 35 years, stewarding large ideas including public policy and strategic planning. His life mission and vocation for the past 20 years—“To help grow the next generation of servant leaders.” Larry Bergstrom practices “Integrative Medicine” at the Mayo Clinic in Scottsdale Arizona. Integrative Medicine aims to see health as not just disease or the absence of it, but uses conventional and unconventional therapies with the goal of helping people to become as healthy as possible.
Steve Garber: What led to your meeting at the Mayo Clinic? What was going on in your life, Ray, and what made you be the one that Ray met at the Clinic, Larry?
Ray Blunt: One morning in 2000 I awoke with the unexpected return of clinical depression accompanied by a bone deep fatigue. As the days turned into months my identity as a man of energy and physical activity fell apart. I began what we now call “the magical, medical, mystery tour.” I underwent every feasible test, endlessly researched Chronic Fatigue, and, in all honesty, was mentally preparing myself to die from an unknown disease. The attempted string of solutions became more desperate and intense—even dabbling in a set of fringe medical solutions such as “mold eradication.” This was a dark night of the soul. Finally Steve mentioned he had a friend at Mayo Clinic in Minnesota that I should call. I was unsure if I wanted to take my portfolio of medical failure to them, but out of desperation I agreed to one more round of the “tour.” Steve’s friend, a pathologist at Mayo, secured an appointment with “the best diagnostician” Mayo had, Dr. Larry Bergstrom.
Larry Bergstrom: I never thought I would leave Minnesota but I was asked to move to Mayo Clinic Scottsdale Arizona to start a Program in Integrative Medicine. In retrospect I see how God created situations that guided me here. I have been “sent to the desert”, not “exiled to the desert.” Mayo Clinic has a reputation for a hundred years as a place to go when no one else can diagnose your health problems. Some of the most difficult health problems we see are chronic disease, disease not treatable with surgery or a bottle of pills. Ray came to see me as a referral. I remember I thought he was the senator from Missouri. Luckily I found out he wasn’t in time to cancel the marching band.
Steve Garber: What do you remember of the conversation? For Ray, what was similar and dissimilar to other doctor’s offices? For Larry, what eyes and hears do you bring with you into the examining room?
Ray Blunt: Rather than simply reviewing my previous tests and symptoms followed by several additional tests, Larry did something odd. He talked with me. For what seemed like two hours we had a conversation. I remember being hungry and needing a bathroom by the end. He did go over my test records and symptoms, but mostly he asked about almost every area of my life—relationships, spiritual life, sins, long past medical situations—things with seemingly little to do with being so darned tired. In the end, I took a stress test and a few other tests. When I returned to Larry at the end of two days, we talked again and offered a few avenues of treatment.
What stood out was Larry saying something I never heard a doctor state before: “There are some things we simply do not understand and therefore cannot treat.” He posited that no test could adequately diagnose what I was experiencing.
Larry Bergstrom: I re-read the history and physical I wrote on Ray. It looks like I did everything my conventional training taught me but I also asked more questions about Ray’s life history. He brought 100 pages of records from all his previous medical evaluations. For my patients he holds the record for the number of tests (especially esoteric tests) done. This sheer volume of tests is an example of how conventional medicine perceives disease. If you feel bad there must be a way of measuring it with a test. If the first tests are normal, we repeat them a few times and order more and more tests. I can’t imagine how much was spent on Ray’s evaluation. I was disappointed because it seemed like I didn’t have much to offer Ray.
Steve Garber: What has been the story since then? How are you doing, Ray? And what have you learned since then, Larry?
Ray: My fatigue is gone and I am pretty normal for a man entering his 70s: I bike, took up kayaking, and walk most days and backpack a couple of times a year. From a seemingly innocuous question about whether my wife complained that I snored Larry accurately diagnosed the situation. A sleep test led to a diagnosis of sleep apnea, which was solved by wearing a CPAP mask. I still did not have all the energy I wanted, but it significantly decreased my fatigue.
Larry: I think I heard from Ray a year or so later, and was pleased to learn he found some value in the visit. He told me one of my supplement suggestions hadn’t helped, but his sleep was more restful with a device to treat sleep apnea. I have seen perhaps 3000 to 4000 people with fatiguing illnesses like Ray since, and have a much better understanding of what to ask. I make sure everyone has a thorough conventional medical evaluation and then focus on helping the patient become healthier rather than focusing the disease. No matter what other diagnosis a person has—whether Chronic Fatigue, diabetes or cancer— they can be healthier. I cover exercise, nutrition and stress reduction. It may seem odd but these are not part of conventional medicine’s response because they do not focus on disease. We are too busy handing out pills and operating to tell people how to become healthy.
Steve Garber: What thoughts do you have about health, and medical care, as you both have experienced it?
Larry: There are thousands of patients with fatiguing illness like Ray who are desperate for an answer. Often their health has been taken away in the most productive part of their lives. The conventional health care system has no clue what to do with them because it defines disease as “abnormal test results.” Most fatigue related illnesses have no significant measurable abnormalities. We regularly tell patients they can’t feel that bad because our tests say they are healthy. We make them feel guilty for bothering us. A very distressing part of modern medicine is how instead of dealing with patients, we treat diseases. Patients with chronic illnesses receive particularly poor treatment because our health care system is set up to care for acute illness. In an acute illness, we make a diagnosis, treat the problem, you get better and go on your way. Chronically ill patients don’t have an endpoint. They face changes not only with their health but also with their self-image, their careers, their familial roles, community and business. By focusing only on their disease we ignore what may be the most important issue the patient faces: “Who am I now?” People facing this question are the people I see, and I hope to treat the whole person, not just their disease.
Ray: The medical profession relies too much on medical science and not on “medical art.” I remember reading The Medusa and the Snail, Lewis Thomas’ marvelous little book of reflections on the health profession. He tells the story of his father, a doctor—all he had to offer most of the time was presence, reassurance, and palliative relief. Lewis wrote that he felt the ubiquity of medical tests and liability made the practice more abstract and less human.
But the patient, (me) also is complicit. I often pressured doctors to give me a test I’d just read about or lobby to take two weeks of some pill. They were so stumped they often caved as the ten-minute appointment window was closing. Perhaps only a Mayo can afford to let someone like Larry spend so much time talking to get to the bottom of things. I do not know.
Steve Garber: As you situate your lives within the Story that makes sense of all stories—the metanarrative of creation, fall, redemption, and consummation—what does healing mean? Stretched taut as we are in the now-but-not-yet of this life, what do we hope for?
Ray: In a real way, I think I found good health along the way as a result of this eight year experience. It has prepared me for something I desire: to finish well. Slowly, I discovered the good health I had been blessed with for decades was not an end unto itself; that the best end to life was not a heart attack on the jogging trail at 85. Enjoyable work, good relationships, new opportunities, time for reflection, a walk in the outdoors, should all be cherished despite not feeling tip-top.
If the gospel is for all of life, then we need to see health and disease in a different light. Age brings its problems to us all. One of the most radiantly healthy people I know is dying of ovarian cancer. Yet amidst this her delight in discovering beauty and joy is a glimpse into heaven, giving flesh to the presence of the resurrected Christ. She is finishing well. I hope that because of the lessons Larry and Steve have been a part of I learn to finish well. It’s a matter of persisting toward the Light and relying on the strength in the risen One.
Larry: I talk to patients about their “spiritual health,” asking them: “Do you have a spiritual part of your life that is helpful to you?” Many give a pat religious answer, while others say nature, or doing good, and so on. Many look at me and say they have no idea what I am talking about. I then broaden the question to: “What gives your life meaning?” It is a sobering question for many because they can’t think of anything. Then they may talk about family, work, pets, hobbies, altruistic works, or sports. These are the things that answer the question: “Why do I get out of bed each day?” These relationships give us meaning, purpose, and are the source for our everyday energy. The reality is they can lose everything on their list if they are disabled. Imagine the marathon runner who loses their leg. It doesn’t have to be illness that causes the change. Retirement can do it to someone whose whole life has been work. The empty nest syndrome can do it for mom whose identity involved her children. Everyone has something meaningful within the limits of what their life and health give them. To ignore the reality of the effect the patient’s health plays on their lives dishonors them. The Christian has an answer to this most profound question and as a doctor I have the privilege of bringing this up when the patient is open.