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Grand Rounds: Healing Wisdom for a Complex World

Grand Rounds: Healing Wisdom for a Complex World

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Grand Rounds: Healing Wisdom for a Complex World

Lunghezza:
458 pagine
6 ore
Pubblicato:
Jul 28, 2015
ISBN:
9781311977236
Formato:
Libro

Descrizione

What makes for a truly Holistic Medicine?

True Holism in Health transcends any words that would try to capture it. How can it be any different for the truly Holistic? How then does one denote and describe a book that is written to defy description? How does one become prosaic about prose that are meant to be read as poetry? How does one deliver a straight line from a circle? This is the dilemma of my authorship. As such, I leave to you, the reader, a choice of description for this wayfarer’s guide book that best suits your own fancy:
1.Can it be that our modern obsession with disease is misplaced, taking our collective attention away from the real problem: disenchantment? Have you ever wondered how such diverse experiences and worlds as cybernetics, Bushmen healing, the modern ICU, gardening, complexity science, martial arts, Molluscan mating behavior, epistemology, orthopedics, improvised performance, radical constructivism, laying of hands, Chaos theory, jazz music, Greek mythology, paradox, hypnosis and psychosis, evolution and embryology, ethics, snakes eating their own tails, a fictional post-apocalyptic strategy game, a New Orleans funeral, and finger painting are intimately related to Health: including the health of you, the health of me, and the health of the world we live on? If you are the least bit intrigued, then know there is hope for us all. Join Dr. William Sutherland on this tour de force of tall-tale telling and let the “patterns that connect” embrace you as you begin your reintegration back into Wholeness. Welcome to the enchanted woods of Complexity Medicine, where one can truly see the forest through the trees.
2.A deeply embodied and thoughtful foray into the philosophy, science, and phenomenology of Chaos, Complexity, Holism, and Health. Take a transformative journey with the Doctor and be glad that you will never be able to see the world the same again!
3.Dr. Sutherland is about to prescribe you six words that you are unlikely to hear in any other doctor’s office but which are absolutely vital to your vitality: Service, Sensuality, Performance, Beauty, Ceremony, and Love. Intrigued? Just wait till you experience the Good Doctor’s healing ministrations in a metaphoric and mythological appointment that you will never forget.
4. Join the Good Doctor on a holistic journey starting with our species’ earliest healing expressions, then on through the ages to the emerging Science of Complexity; connecting the dots in between as we go. Grand Rounds is a healing balm to our collective individual, cultural, ecological, and evolutionary ails. Come and enjoy the magical & mirth-filled medicine that Dr. Sutherland has prescribed.
5.One word: Relationship.

From the Forward:
I have known Dr. Sutherland for many years, beginning when he asked to have a conversation with me when he was a teacher of the martial-arts. I have watched him make his life more complex by immersing himself in the arts, cybernetic thinking, ancient healing culture, and contemporary medical practice. I can testify that he is a damn good doctor and that his good doctoring is held inside a deeper holding than outcome studies based on simplistic probability theory. He stands on wisdom and fears not to encourage his colleagues to be more human and more healing in their manner and being. He goes past “primum non nocere” (first, do no harm) and moves toward “praescribens vitae” (prescribing life), acting so as to expand both the medical universe and the choices for action that may arise whenever doctors and patients face the mysteries of how life and death, as well as wellness and sickness, dance together.
Bradford P. Keeney, PhD

Pubblicato:
Jul 28, 2015
ISBN:
9781311977236
Formato:
Libro

Informazioni sull'autore

Dr. William Sutherland is the innovator of the Complexity Medicine concept and the founder of the Institute for Complexity & Connection Medicine. Moved by the spirit of Lewis Carroll, Dr. Sutherland found himself going down the rabbit hole from an early age, each path taking him to another door; each door to another world. Bonded to his Jazz drumming grandfather in his childhood, fascinated and pulled by the natural world, later to be immersed and schooled into the martial ways of Japan, and from there spring-boarding into a deep mentorship into indigenous and traditional healing ways around the globe; all of this was to serve as the foundation for a future career in medicine, the seed of which was always present from the start. Holism, of course is funny that way. It inevitably finds you and, once so enticed, it does not let go. Having caught a hold of you, you can never see the world again in a disenchanted, dispassionate way. As well, Holism becomes the shaper of everything you do, and of everything you perceive. It is these living verities and experiential truths that have served to form (and inform) Dr. Sutherland throughout his healing journey and path of discovery, leading to the bringing forth of a medicine that is an embodiment of complexity and wholeness, that is to say a Complexity Medicine. Presently, Dr. Sutherland is an Adjunct Assistant Clinical Professor at McMaster University and a Research Fellow at the Waterloo Institute of Complexity and Innovation. As well, his clinical practice time includes general practice psychotherapy, functional medicine, and emergency department care. In all of these diverse clinical settings, he works to embody and impart the feeling central to a practice of Complexity Medicine. Moreover, he is the father of four children, an avid gardener, and a blessed husband whose lovely wife Lisa gently and artfully helps him to remember to apply his principles of holism in medicine to the broader aspects of his life.

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Grand Rounds - William Sutherland

Author

Foreword

It has been fashionable for several decades to argue for an alternative and/or complement to conventional allopathic medicine. Whether they call them holistic, mind-body, complementary, integrative, or by some other metaphor, proponents of these approaches promise a revolution, or at least an expansion of the beliefs and practices that may legitimately address sickness and wellbeing. In spite of the proliferation of best-selling authors and popular medical gurus in the whole health marketplace, it is seldom asked if any paradigmatic change has actually been enacted. For a paradigm to truly change, the premises that define legitimacy first must be altered in a discernible manner. It is time to question whether any of the calls for a new medicine have actually delivered an alternative, or simply a new fad or business venture, masking what is actually more of the same old medical way of thinking and behaving.

One primary example is the replacement of synthetic pills with plant-based (presumed more natural) pills. This offers no exemplification of a change in what legitimizes medicine. The only difference introduced is that between natural and synthetic and the marketplace in which they are sold. Both forms of pill are argued to be effective for the same reason and through the same means of validation: socio-statistical outcome studies determine whether a chemical bullet hits the pathogen target or triggers the body’s defense against sickness. Here there has been no shift in paradigm or Weltanschauung, as the same authority that determines what is valid medical treatment remains intact. The result is that any claimed alternative offered by natural treatments is now held inside the paradigm of allopathic medicine. The latter becomes even more all-encompassing, now appropriating even that which formerly promised to be different.

Similarly, when a non-material intervention such as prayer, meditation, or positive thinking is treated as if it were a pill, the same established court of legitimacy rears its head and conducts an outcome study to see if it is effective. Then a doctor can write a prescription for prayer, suggesting that it be administered once, twice, or three times a day as if it were aspirin. What has been missed by so-called medical science is that its idea of science promotes a self-verifying protocol that first and foremost validates its own version of the scientific model.

Here we find a hidden circularity: medicine applies its own premises about science to prove that its premises deliver a true science, blind to the way this recycled bias transforms belief into presumed fact. Alfred North Whitehead’s critical lesson is ignored; namely, the primary premises that organize any system of thinking, including science, are first invented beliefs that require faith, rather than hypothesis-free facts that constitute an objective means of description and analysis. Subsequent activity inspired and limited by these beliefs only serves to maintain the beliefs and their accompanying invented means of legitimacy.

As a consequence of medical science’s blind spot to the way its clinical trials participate in self-producing its version of evidentiary discourse, few scholars have critiqued the particular choice of science that medicine has wed. There exists more than one model of science and the methods of mainstream medicine, along with its proposed alternatives and complements, are more often than not organized by a lack of relationship with more recent advances in what constitutes knowing, science, or their formal means of legitimacy.

This holding back of the evolution of medicine is perhaps most easily recognized in the way diagnosis remains an archaic means of categorizing and reifying what should be better understood as dynamic process rather than frozen stasis. The latter is better encountered through interactional knowing; that is, seeing how our interactions with the patient contribute to bringing forth their experience of health and sickness. Here we find both western and eastern medicine stuck in diagnostic naming rather than being more attuned to interaction, relationship, and ecology. Many schools of medicine, throughout diverse cultures, are in need of treatment for ‘hardening of the categories’.

Finally, a book has arrived that brings an authentic paradigmatic difference to the understanding and practice of medicine. Dr. William Sutherland’s Grand Rounds marks a noticeable difference that can make a difference in medicine. His call for a circularly organized systemic logic that challenges the simple cause-and-effect lineal thinking of outcome-based evidence handling. Beware the implications of this shift from flat line to rounded thought; the guardians of legitimacy are now subject to challenge.

Dr. Sutherland comes to his subject with the kind of training and background that few, if any, physicians are fortunate to have accrued in their formative years. He has been well-schooled in the circular sciences and circular arts, the ways of knowing and practice that are based on interaction rather than blind allegiance to reified construct and fossilized oath. As a cybernetically-organized physician, he is able to bring medicine back to its earlier wisdom, when so-called empirics, inspired by the ancient Greek empeirikos doctor, have relied on experience alone. Here the unique here-and-now interactions between attempted treatment and observed, immediate outcome guide subsequent intervention, rather than unquestioningly following a manual that treats conceptual categories while blind to the patients, each inside their own unique treatment-interaction circularity.

What is fascinating from the history-of-ideas perspective is that the contemporary advances of complexity science, initially voiced by cybernetics, mirror ancient epistemologies inherent in many indigenous healing practices. Both prior to and following the reign of Newtonian billiard-ball science, circularity and paradox were regarded as indications of a more complex wisdom, pointing to the ecological nature of all living processes, including doctor-patient communication and performance. An African healer, jazz improvisationalist, systemic therapist, martial arts master, and postmodern complexity scientist shares more understanding than anyone equipped only with the present conceptual tools of medical science. Suffice it to say that early cybernetic thinkers like Gregory Bateson long ago lamented the sorry state of the science, and its non-complex machinery of legitimacy, that underlie medicine. With Dr. Sutherland’s wake-up house call, it is no longer necessary to continue down that dead-end course.

Fear not throwing out the Newtonian baby with its muddled water for the new complexity science holds on to whatever works – in spite of its having been right for the wrong reason – while expanding the ways in which we are able to go further with both understanding and practice. Complexity medicine, in the able hands of Dr. Sutherland, enables medicine to have a more complex science that has no fear of healing wisdom, art, or imagination. Here prayer is not treated like a pill nor is a plant medicine regarded as necessarily different as that produced by a pharmacological industrial plant. Complexity is the name of a vaster context that is able to host a garden of either-ors, both-ands, both, either, or neither. It cares not to colonize cultural healing paradigms outside its own, but holds a variety of ways of practice and diverse means of legitimacy.

Dr. William Sutherland’s many years of being involved in painting, storytelling, comedic performance, as well as being a friend to numerous indigenous healers throughout the world, have uniquely prepared him to convey their circular truths, and readied both himself and the future of medicine to become well-rounded. In his remarkable presentation of ideas in the conversations of this book, we find the tributaries of circular medicine. In the virtuous pursuit of health we move past being lost in the vicious circles of pathological focus and perception.

I have known Dr. Sutherland for many years, beginning when he asked to have a conversation with me when he was a teacher of the martial-arts. I have watched him make his life more complex by immersing himself in the arts, cybernetic thinking, ancient healing culture, and contemporary medical practice. I can testify that he is a damn good doctor and that his good doctoring is held inside a deeper holding than outcome studies based on simplistic probability theory. He stands on wisdom and fears not to encourage his colleagues to be more human and more healing in their manner and being. He goes past primum non nocere (first, do no harm) and moves toward praescribens vitae (prescribing life), acting so as to expand both the medical universe and the choices for action that may arise whenever doctors and patients face the mysteries of how life and death, as well as wellness and sickness, dance together.

Dr. Sutherland deserves to be the next important leader of medicine, bringing it out of the dark ages of overly-simplistic causality and the kind of arrogance that a paucity of complex knowing/know-how breed. He stands for the whole that can make medicine holy. His Grand Rounds is an invitation to return to Hippocratic aesthetics, the art of fostering healthy personhood rather than merely attacking any dis-ease with disease. Welcome to the complex age of medicine, as medical doctors return home to embrace ancestral ceremonial ground and make room for reawakened wisdom.

Bradford P. Keeney, PhD

www.keeneyinstitute.org

Author of Aesthetics of Change & Way of the Bushmen

Back to the Table of Contents

Grand Rounds: An Introduction to the Concept

Grand Rounds:

(noun)

1. An organizationally closed, circular, recursive or reiterative system. A complete cybernetic circuit versus a partial arc. Necessary feedback.

2. An observer observing his own observing.

3. Dogs chasing their own tales. Snakes eating theirs.

4.Physicians attending to their patients accompanied by their charges for the purpose of teaching, lecturing, and exhibiting to junior doctors.

In your hands you now hold an odd sort of a book: an alchemical text of a kind. Specifically, it is a collection of tales that, ultimately, are both a reflection and critique of some of our deeply held cultural myths, including those of our medical practices. It may strike you as a heretical statement for a Western trained physician to speak of modern medical thought in terms of a mythology. Mythologies, after all, are anachronisms of primitive, preliterate, and irrational people; aren’t they? Simple legends told around campfires, and ancient sacred rites that brought a sense of control and meaning to what often seemed like an uncontrollable and unpredictable world, full of uncertainty and ambiguity. Certainly, in this meta-modernistic age, mythologies must be considered a vestige of a bygone era. But regardless, whether we are aware of it or not, all practitioners of the healing arts – physicians included – must subscribe both to a guiding ethos through which to make ethical decisions, and some mode of body-mind relations¹. By entering into this contract, they invariably must construct their own collective mythos. It is through our mythologies, and the fundamental organizations that underlie them, that all of us order our environment through the biological process of difference making, thus creating a world. Mythologies are part of what defines us as living. That being said, however, all mythologies are not created equal. Having a choice, I personally would want to live in a rich world of perceived enchantment, mystery, reverence, and awe, rather than a disenchanted one, impoverished and imprisoned by its own hand such that it even forgot it had a mythology to begin with.

This book, then, serves as a compendium of mythologies, legends, parables, and fables. Contained within, you will find a number of different body-mind schemas and ethical stances that, I believe, are infinitely richer than our present societal modus operandi, thereby setting a stage for an invitation, invocation, and initiation into our collective holistic coming of age.

Before going further (you can still turn back!), I must give you a proviso; a wayfarers warning if you will for the world you are about to enter. While writing the early chapters for the book, I was in the habit of reading my initial drafts out loud to my family. My somewhat precocious son, Nathaniel, who was seven at the time, was listening closely and attentively. After I had finished reading Nathaniel spoke up in true Socratic fashion: Dad, he said, Is your book going to be for sale in a bookstore someday?

That would be nice if it happened, wouldn’t it? I replied.

Will I have to buy a copy or will you give me one? he asked with his impish grin.

Of course I will give you one, was my answer.

Good he said, Someday I am going to take that book you give me, and read it to my wife, and when I am finished reading I am going to say to her; ‘who is the crazy man who wrote this?’ and then throw it out! Advice out of the mouths of babes…Consider yourself sufficiently warned, and now to the subject at hand.

Within the field of medicine it is a truism to say that, as a patient, you neither want to be known as interesting or complicated. Both of these are euphemisms for there is nothing else left that I can do. At this point it is common (if unspoken) medical practice to blame the patient for his predicament. It was said once that a surgeon coming out of the operating room was asked by the next of kin how the surgery went. The surgeon replied that, It was a flawless operation, a perfect textbook procedure. It was just a damn shame that the patient had to go and die…anyway, you get the gist. These interesting and complicated patients are, of course, the ones that make it into case-studies in journals, or become the fodder for medical students, interns, and residents in patient rounds. Students and residents make a point of searching out this population of patients while practicing physicians avoid them at all costs, for they are sure to make a busy day busier, and they guarantee that the doctor will not be making it home for dinner on time…again.

Now patients are placed on the hierarchy of interesting based on the severity, voracity, virulence, complexity, or quantity of their disease processes. Disease, after all, is the focus of orthodox medical practice. It is the object of the physician’s gaze. There is, however, a truth to the idea that in medical practice, doctors can only see what they know to look for; to the rest they are blind. With this being said, Western physicians are very good at finding disease, and Western patients are very good at accepting the veracity of their diagnoses. But what are these things we call diseases that stalk us from cradle to grave, and that we work so hard to avoid, prevent, treat, and cure lest we fall victim to their ravaging? They are like so many imps, trolls, goblins, giants, and witches, of our fairytales and myths that frighten children at bedtime, and make us hesitant to venture into the dark woods – no matter our age.

In fable and myth, there is no end to the nastiness and viciousness that can befall a hero in his moment of darkness, but all of these adversities are nothing when compared to the unified focus of his heart and mind: the hero’s quest. Although the hero’s enemy may be legion in number, there is only one Holy Grail or a singular Golden Fleece to draw him onward in his journey. For a moment, let’s imagine – as a physician or as a patient – how our story could be different if we shifted our gaze from the monsters and mayhem of disease to the collective holistic metaphor of the hero’s journey. With this in mind, I put forth the question to you: how would our medicine (and, indeed, our world) be different if we turned the attention of our shared medical mythology away from disease and instead towards health? Would this be a more interesting and compelling story than the one we presently possess? What if patients were found to be interesting and complex because of the nature of their health, rather than their disease? Would we all celebrate such an encounter? Would our conception of our very selves in relation to each other and to the world at large transform? I don’t know the answers, but these questions form the beginnings of a noble quest for those of us who dare to brave such things.

During the writing of this book, people would often ask me: what kind of book is it? I would tell them it is part personal manifesto, part philosophical meditation, part intellectual primer, and part performance art-piece. It was a significantly vague enough answer that most people would stop their inquiry right there, nevertheless, the occasional few would push on, and for them I would continue with my response.

This book, at its heart, is an expression of a set of morphing, internal tensions that have run throughout my life as a type of theme, shaping my decisions and thus creating the course of my path. These tensions have always been held by a polarity of thought and feeling (at times, creative, at others, destructive) in how they played out in my life.

Over the years, in response to these pulls, a movement began within me. In my younger days it led me to take up the Japanese martial arts. This culminated in my first trip to Japan when I was 17 years old. Over the two years in total that I lived in Japan, I had an opportunity to study their martial, meditative, and healing ways. Again, in the search born of these polar tensions within myself, I was drawn to the world of indigenous and traditional healing. Consequently, I have lived and worked with traditional elders and healers from North America, South America, Asia, and Africa. Ultimately, through these relationships, I began to see the focus of my personal longings: the place to which my internal tensions were driving me. All of this movement was generated by an impulse, not ever fully conscious, to embrace and be embraced by wholeness. Thus there was always a meta-polarity, if you will, of wholes/parts or unification/separation that was both the source and the subject of my quest. This was what I was being drawn to.

Ironically, it was through these traditional healers, under their direction and guidance, that I found my way back to orthodox Western medicine. As a child, until the age of 14, there was nothing else that I wanted to be other than a doctor. At 14, however, my life changed with the discovery of karate. Through the trajectory set in motion by this passion, I left behind the idea of being a physician. Over the course of my life, I travelled abroad, studied at the side of traditional martial art masters, healers, and elders, started university twice, and dropped out twice, married, had four children, worked as a karate instructor, and once again I found myself back at school. I finished a Bachelor of Science and an additional Bachelor of Science in Nursing, after which I worked as a rural emergency department nurse.

Through all of this, however, my old dream to become a physician reemerged, and with the urging of my elders, mentors, parents, and my wife Lisa, I made the decision to apply to medical school. As the Fates would have it, right after the auspicious birth of my fourth child, the acceptance letter came, and I once again found myself back in school, soon to complete my MD with a subsequent residency in Rural Family Medicine. My first job was as a solo physician working as a general practitioner on a Mi'kmaw Indian Reserve in Cape Breton, Nova Scotia: circles completing circles.

Of late, I find my musings have turned to contemplating the nature of the underlying foundation that supports and holds these tensions in my life. I find myself asking: is there a unified stance in all of this, in Life as a whole, and how do we grow in our learning in such a manner that we may embrace paradoxical positions?

I am often asked by friends and colleagues on both sides of the traditional healing/ Western medicine spectrum how I can be comfortable on either side of these apparently contradictory or adversarial worlds. I tell them I have never seen it as a conflict, because for me it has never been a question about modalities or explanatory frameworks; rather it is about the quality and pattern of relationships, and the rightness of what is required in a given moment. With this frame in place, I have only ever seen a unity between the two positions.

Nevertheless, through the experience of daily living, issues of congruence do come into play. A movement towards wholeness, and a reverence for the complexity found in Life has become my guiding ethos (of course I recognize the paradoxical nature of this statement, as we are all already intrinsically whole). Consequently, not all aspects of traditional healing or Western medicine are resonant with this adopted ethic or world-view. In my practice as a physician, I have always loved emergency and acute care medicine. Why? Because such an undertaking with the acutely suffering is congruent with my thoughts on wholeness. Broken bones, dislocations, trauma, heart attacks, raging infections, life-threatening illness, and pain: all of these things need to, and often can be dealt with in a timely manner. Addressing and treating them is what is most appropriate, and is the needed holistic care of the moment. It is what is required to maintain the integrity of the whole person in light of their immediate trauma.

Unlike the ER, the structure and organization of the family medicine office was often a source of frustration, limitation, and incongruency for me. Now, don’t misunderstand me in this; I treasure the doctor-patient relationship, and the inherent trust when people place themselves and their families under my care. The source of my dis-ease, however, was in the reductionist model through which I was being asked to view my patients. Chronic diseases, multiple ailments, numerous medications, limited results, side-effects, treatment without meaningful personal context, along with many other nagging thoughts hiding at the edge of my mind, made me question my role in family practice. To be sure, there were many successes as defined by both myself and the patients, but never enough to push away the feeling that what I was doing was in separation from the spirit of wholeness.

That being said, these thoughts and ideas were born of a sense of dissatisfaction within me, and they are not meant to be a commentary on or a maligning of the practice of other physicians. Doctors work very hard in difficult, and often limiting circumstances. There is an ever-increasing burden of illness putting almost impossible demands on their time, and the medical system itself is fraught with difficulties. Furthermore, I want to unequivocally state that the family doctor’s office has been a source of healing for me during some of the hardest times in my life, and I have been blessed with the care of a great family physician, along with the support of the remarkable men and women whom I am happy to call my colleagues.

This book, then, is a personal manifesto. It is my public statement affirming the principles of wholeness and healing in medicine as I have experienced them. It is a declaration of my life-stance on the matter at hand. Hopefully the reader – whether physician or lay-person – will find sympathy in their own experience with the words herein, for this work, first and foremost, is about the nurturing of relationship. Medicine, in the greatest attribution of that word, is a part of all of our lives, as wellbeing and illness is inextricable from the human experience. In this spirit, it is my hope that there will be some appeal in these ideas for all readers regardless of their background.

Beyond a manifesto, this book is also partly a philosophical meditation. Before we can even begin to critique our medicine, we have to first understand its philosophical underpinnings, initial premises, assumptions, axioms, presuppositions, and first principles. Although we often take the validity of modern science and medicine as a given, it always strikes me as interesting that we would just blindly accept this as so. It is said there is no work for philosophers any more (with artists often equally unemployable), and this seems to me to be a real shame, for without the scrutiny of their questioning, we lose a source of needed wisdom to rein in our ever-burgeoning knowledge and technology. In the pages that follow, we will begin to explore such branches of philosophy as epistemology (the nature of knowing), ontology (the nature of reality), metaphysics (the nature of being), aesthetics (the nature of beauty), and ethics (right action), as they apply to holism in medicine, and more broadly to the position of holism in our lives.

Next, the book also acts as an intellectual primer. In a search for a medicine of holism verses one of reductionist orientation, we find a potential ally in the emerging scientific paradigms of cybernetics, complexity, complex adaptive systems, and the mathematics of chaos. These are vast fields of specialist expertise. Being neither a specialist nor an expert (as a family doc I am a true generalist at heart), I have prepared herein a hopefully humorous Fool’s Guide (where I am the fool, and this is my guide) as a working introduction to this field of exploration, with thoughts on how it is relevant to our conceptions of medicine. This is an emerging area of inquiry full of intellectual giants, grand ideas, and discovery. The shoulders available for us to stand on are broad. My perspective in all of this, of course, is that of a physician’s; that is to say it is informed through my actions and experience as an applied physiologist and anatomist. In this fashion, my gaze is necessarily grounded in our living biology. As a practicing clinician, I am neither a professional scientist, nor philosopher. I apply science to my work, yet I am obliged, in doing so, to also reflect on the lives of my charges as they transition from cradle to grave. In this way, I am both a practitioner of the natural sciences, and of a natural philosophy. Nevertheless, my own experience and curiosity withstanding, know that I stand with you throughout this exploration in our collective not-knowing rather than engaging in the fallacy of forcefully imparting my knowledge to you. It is my humble hope that as a small introduction to this paradigm of thought, this book will whet your appetite for more, and serve as a starting point for your own fruitful investigation as you apply these understandings to your own life and practice.

Finally, this work is an artistic endeavor. As I initially struggled to find my voice, after many false starts, I realized that this book had playfully and unintentionally taken on the form of a play-script, and although it is not meant as a stage production, the metaphor is a useful one. One of my mentors in the writing of this story, Dr. Bradford Keeney, sagely advised me that when you start a piece, no matter what you think it will be in the beginning, the story will take the shape it needs to, surprising you along the way. As authors, we inevitably write the book we need to read, as long as we remain true to our process. This introduction is one of the final chapters that I have composed, as for most of my time writing I have been unsure about what I would be introducing. Like a friend, I had to develop a relationship with the ideas before I could formally introduce them. That being said, in hindsight, I also realize that the work has been whole in its entirety from its inception.

In introducing the writing as an art-piece, it would seem reasonable to look at the body of the work’s form and function from an aesthetic stand-point. The book centers around a character called The Doctor, part autobiographical and part fictional, with the boundaries between these two aspects intentionally blurred. This approach has allowed me to draw on both theory and experience in the creating of the structure and process of the work.

The telling is centered in and around the institution of Grand Rounds in medicine. Traditionally, Grand Rounds have been an essential part of the teaching pedagogy in medicine, as well as an important ritual in a physician’s coming of age. Originally, staff physicians, residents, and students would gather at a patient’s bedside to examine the patient, review the diagnosis, and discuss the relevant medicine of the case for the purpose of teaching. Over time, however, Grand Rounds have changed, and more often than not are likely to be delivered in a lecture style in an auditorium, with the patient no longer present. Grand Rounds differ, then, from the daily rounds of the doctor in hospital where he visits all his patients on the ward individually for the purpose of monitoring and treatment.

You will find the chapters of this book divided into two alternating sub-divisions: Day Rounds and Night Rounds. The Day Rounds are presented in the format of modern Grand Rounds; a lecture where The Doctor, in this case, presents reflective and introspective ideas around the role of complexity science in medicine in the hope of challenging his audience to think more deeply about these topics, with a vision for the future always in mind. The Night Rounds², however, are very different. During the Night Rounds, The Doctor has a series of dream visitations. In these dreams, he receives tutelage in the intricacies of Complexity Medicine³ from his visionary mentors. The characters he encounters in the Night Rounds are based on the historical personages of my paternal Grandfather, William Sutherland the 1st (The Master of the Game), my maternal Grandfather, James Swann (The Jazzman), Gregory Bateson (The Professor), Milton Erickson (The Wizard), Pythagoras (The Philosopher), and Hippocrates (The Physician), along with a fictional Bushman tribesman (The Ancestor). Similar to The Doctor, the presentation of these characters, along with their bodies of work, is part biographical and part fictional. Their spoken passages are not necessarily literal and unadulterated reconstructions of their ideas. Instead, as characters, they held the frames required to direct my raw inspiration, and as such, gave form to my expression. They became mirrors of my own learning reflecting it back to me in a way that I could never have accomplished in isolation. In my involvement with them, I found the needed voice in my writing to convey the thoughts and relationships of ideas that I was exploring. As such, each of these character’s voices should not be considered a scholarly presentation of their collective ideas, as I have mixed their thoughts with my own, further adding the voices from other scholars farther afield whenever I felt it was appropriate. These characters represent a focal synthesis of a number of concepts, and are holders of the spirit of the material that is being presented to The Doctor. Throughout the book, you will find a series of citations and references that I drew upon, and I would encourage you to further delve into the primary sources listed if you are so drawn.

Unlike traditional story writing, there is no emphasis on character or plot development in this book. Rather, the primary focus is the creation and nurturance of metaphor, not just as a literary device, but as a central mode of communication. Likewise, there are varied themes and symbols found throughout these pages, but they are not laid out in a linear fashion. Instead, we experience them vis-à-vis their non-linear and recursive nature; at times, like waves crashing back on themselves, at others subtle undercurrents that pull the reader into deeper waters.

The metaphorical nature of the book provides for us the necessary aesthetic ground through which the content and the themes of our inquiry are planted, nurtured, and grown. As I have mentioned, the writing of this book quickly took on the quality of a play or a theatrical performance. As such, it would be good for you to consider each chapter as a separate act within the play. The acts, within the book, alternate between The Doctor lecturing during his Day Rounds, and then subsequently receiving an education of a highly different order in his Night Rounds. The form and presentation of these acts shifts formally between a monologue in the Grand Rounds of the Day, and dialogue in the Grand Rounds of the Night. Despite these stylistic distinctions, however, the spirit of the monologues and the dialogues is meant always to be that of a dialogic dance. Lastly, even though this play is more involved than most, don’t worry, for there are also s and intermissions to stretch your understanding, breathe fresh air into your imagination, and to refresh your spirit.

Relationships are interesting things. No two are exactly the same, and they are always changing. Ironically, change is the only true certainty in this world. Because of this, you will need to chart your own way forward in the reading of this book, forging your own relationship with the spirit of its contents. You may decide to take my son’s advice of reading it out loud to your significant other, and then throw it out, or perhaps you will read it many times until the pages are tattered and ear-marked. I will say, however, that I didn’t write the book for fast consumption. It is designed to be savored slowly. There is admittedly some difficult language and concepts to wrestle with. I know, for I have had to do so myself. Moreover, despite its conveyance in prose, the material in hand is better experienced as poetics. I continue to enjoy the feel, the flow, texture, and rhythmicity of the language on these pages. In truth, this writing at its core, has been first and foremost a sensual act, that is to say an aesthetic as much as an intellectual one. Language can be a rich thing if we allow it.

The form of the book is challenging in that it is, by necessity, non-linear. It weaves, and twists, and turns, and often leaves the reader hanging. Many questions are eventually answered, but just as often they are not. No doubt further questioning will be generated through your investigative process. Hopefully I have found the right balance between imagination and rigor⁴ in the work. I encourage you to remember Aristotle’s wisdom that, The whole is more than the sum of its parts. This is the core of the book’s pedagogy. In that regard, I encourage you to hold the diverse ideas herein even if you don’t fully grasp them at first, or even necessarily agree with them. Give them time to ferment. Return back to them as need be. Let them mix with your own experiences, thoughts, and emotions. In time, they will create their own unique connections and relationships, forming a seamless whole that is representative of your individual understanding, character, and outlook, further embedded in the context of your life. This is the essence of learning within the human experience. If you stay the course on this

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