Still on the Journey to Ithaca

It is commencement season, a time of new beginnings and setting forth on new adventures. This week is also Nurses Week, a week set aside each year to honor nurses. I have been reflecting on my nearly four decades in the nursing profession...what I imagined as a young nurse setting sail into the world of healthcare and where I have found myself so many years later.

Several of my nursing colleagues and I have been thinking about our stories or narratives as nurses -- where have we been, where are we going, what has shaped us and what gives our work meaning? #WhyINurse

So, in the spirit of this reflection and with immense gratitude to those who have allowed me to learn from their lives and teaching, I share the commencement address I gave several years ago as I completed my graduate work at the Tufts University School of Medicine. Several years later, I am happy to say that I am still discovering my way to Ithaca. My wish for each of you is for your journey to be long and circuitous as well.  ~Pam




Commencement Address
Tufts University School of Medicine: Pain Research, Education and Policy Program

To the faculty, administration, fellow graduates, and especially to my wonderful family; I am both incredibly honored and extremely humbled to stand before you today. 

It has been 32 years since I last wore a cap and gown and I am reminded today of that spring day so long ago in Ann Arbor, Michigan.   In 1979, the adventure on which I was embarking appeared so clear and direct, much like Homer’s Odysseus as he set off from Troy enroute to Ithaca.  But as with Odysseus, we often find our journeys far more complicated than we ever anticipated…meeting not only with trade winds and gentle seas but also with violent storms and towering waves that can batter us and throw us off course.  And so it is for the patients we meet each day in healthcare.  They, too, are voyagers on their own Homeric journeys, each filled with unique, authentic stories waiting to be told. It is up to us, in healthcare, to elicit, acknowledge, and honor these stories, to bear witness to their individual journeys and to help them navigate through difficult passages.   
When we first enter the world of healthcare our mission seems clear and direct – we want to quickly fix what we see as broken, to cure what we see as diseased.   While this is a noble mindset, we often miss the opportunity to heal when we blindly set out in this direction.  What I have learned is that often we cannot cure, no matter how desperately we try, but the potential for healing is always possible.  This statement may seem  incongruous to what we see as the measurement of medical success.  But, as we look broadly at what healing really is… isn’t it all about reducing pain and suffering…about living and dying with dignity, grace, and a sense of purpose?  We meet our patients at many points on their journeys and I see our work as assisting them in gathering the necessary tools of healing to find safe passage on their voyages. 

During the course of my studies here at Tufts I have discovered many tools of healing.  The Pain Research Education and Policy program was not on my navigational charts when I set off in 1979, but I am so grateful that I found my way here.  Through my work with inspirational faculty mentors, especially Dr. Bradshaw, Dr. Glickman-Simon and Dr. Carr, as well as Dr. Gualtieri in the Health Communications program, I have explored pain not only as a physical manifestation of injury or disease, but also as a complex pattern of psychosocial and cultural components that contribute to a sense of suffering.  Addressing the suffering has a direct impact on reducing the sensation of pain.  The Pain Research, Education and Policy Program has allowed me to explore the intersection of modern medicine, technology, ancient healing practices of the body and mind and spirit, and the innate human desire to survive adversity.  It has given me a voice in advocacy and scholarship by helping me to articulate the meaning of pain and suffering for individuals and society.  For this I will always be grateful.   

Some of you may be familiar with the poem, Ithaca, by Constantine Covafy.  It is a poem that has kept me company on my journey and I would like to offer it to you as a metaphor for this commencement, as each of us sets forth on new journeys and adventures:  

When you set out on your journey to Ithaca,
pray that the road is long,
full of adventure, full of knowledge.
The Lestrygonians and the Cyclops,
the angry Poseidon -- do not fear them:
You will never find such as these on your path,
if your thoughts remain lofty, if a fine
emotion touches your spirit and your body.
The Lestrygonians and the Cyclops,
the fierce Poseidon you will never encounter,
if you do not carry them within your soul,
if your soul does not set them up before you.

Pray that the road is long.
That the summer mornings are many, when,
with such pleasure, with such joy
you will enter ports seen for the first time;
stop at Phoenician markets,
and purchase fine merchandise,
mother-of-pearl and coral, amber, and ebony,
and sensual perfumes of all kinds,
as many sensual perfumes as you can;
visit many Egyptian cities,
to learn and learn from scholars.
 Always keep Ithaca on your mind.
To arrive there is your ultimate goal.
But do not hurry the voyage at all.
It is better to let it last for many years;
and to anchor at the island when you are old,
rich with all you have gained on the way,
not expecting that Ithaca will offer you riches.

Ithaca has given you the beautiful voyage.
Without her you would have never set out on the road.
She has nothing more to give you.

And if you find her poor, Ithaca has not deceived you.
Wise as you have become, with so much experience,
you must already have understood what these Ithacas mean.

And so, as you set sail from this commencement for your Ithaca…I wish you a long and prosperous journey, the privilege of listening to many stories, and the wisdom of healing.
Thank you and Bon Voyage.

Pam Talks Pain

What a title...did it capture your attention?  I had a great time guest hosting with Tufts Pain Research, Education and Policy Program the weekly WEGO Health Health Activists' Tweetchat on March 13.  I am passionate about bringing more visibility to the invisible epidemic of chronic pain.  It is time we recognized that chronic pain (pain lasting more than 3 months) is not just a symptom but should be thought of as a disease entity that needs complex and multidisciplinary treatment.  Thanks again to the WEGO Health folks who do an amazing job amplifying the voices of health activists and advocates locally and globally.

#HAchat Recap: The Invisible Epidemic: Pam Ressler Talks Pain


130 million people in the US are chronically ill, and 116 million of these people suffer from chronic pain.  With so many suffering, it’s amazing that chronic pain is something rarely talked about and a constant source of tension between those who suffer from pain and their healthcare providers (HCP).  Why don’t people talk about chronic pain? Why is there stigma against those who suffer from chronic pain? As HealClick pointed out, no one has ever questioned the “stomach ache”, so how can HCPs doubt “unbearable pain”?

This week’s chat was hosted by Pam Ressler (pamressler), a current faculty member of the Pain Research, Education, and Policy (PREP) program at Tufts University, registered nurse, social media enthusiast and pain research advocate.  Wendy Williams (TuftsPREPpain), Associate director of the Tufts Prep program also joined in on the conversation.

Perceptions of Pain
pamressler: Huge problem…pain is invisible! It’s not something you can put under a microscope or cover with a bandage, and this is the biggest reason it’s so hard for physicians and HCPs to understand, it’s something that they can’t exactly put their finger on.  Many doctors seem to be under the impression that chronically ill patients “just want to swim in opiates” as TiffanyAndLupus put it, and they label these chronically ill patients as drug-seeking.  They are also hesitant to treat pain because they don’t want to get labeled as “dealers” of pain medication.  Then it’s the fact that there are different types of pain.  julianna12369: “There seems to be a breakdown when it comes to visits to hcp’s for chronic vs acute pain.” Co-morbidities can also stay a doctor’s hand when writing a prescription:  julianna12369: “There is a lot of stigma. As soon as someone sees I am #bipolar and I have #lupus, that’s it for taking much of my pain seriously.”  In this way, suffering from multiple conditions may undermine a patient’s “pain credibility” with their doctor. 
ArthritisAshley #HAchat I have anxiety & rheum arthritis, chiari, celiac, palindromic rheumatism, DIL, POTS, thyroid issues but anxiety is all many docs see -#HAchat
hockeygrl1:  i wish my dr would listen more. She attributes pain to #frbro & gives me antidepressants, sometimes i need more #hachat
kimmieCollas @hockeygrl1 & some of us can’t TAKE antidepressants (manic episodes & other nasty effects #HAchat
And even if you find a doctor who understands your pain, ER trips can lead to accusations of drug seeking behavior.  In the end pain has a bad reputation amongst both patients and caregivers. For patients, it’s a life altering inconvenience.  For HCPs:  ArthritisAshley “I hate that chronic pain disorders are associated with hypochondrism, pill-popping etc.”
But it’s not just about the pain. It’s about how others perceive your pain and how you perceive yourself.  It’s one thing to not have your doctor believe in the severity of your pain, but what if members of your own family were in doubt? hockeygrl1I agree on the family worried about pain medications. My daughter mentioned that she thought I refilled mine too soon. not true”.  What about all of the things that result from chronic pain, such as fatigue or depression? How do you treat these symptoms without throwing anti-depressants at the problem? Susanmees: “docs need to ask what else is happening in someones life, not just physical pain, mental &stress issues too”.

Thinking outside the doctor’s office
The chromatically ill and those suffering from chronic pain seem to be some of the biggest advocates of alternative therapies, even when doctors are not: kimmieCollas “most of the MDs I’ve talked to abt integrative therapies say there’s no proof – I say if it helps, I don’t care if there’s proof .”  Here are some therapies our Health Activists have tried:
@pamressler: We need to expand our tool box for chronic pain…meditation, yoga, tai chi all can play a role #hachat
@FabulousandSick: I totally agree. We also need to add diet changes to our tool box.. #HAchat
TiffanyAndLupus T1: This month I have been learning meditation and taking a chronic pain yoga class. BOTH are helping to relieve my pain! #HAchat -
bitogoth Finally started meeting with a therapist to address anxiety/stress aggravating chronic pain, and nice versa #HAchat
PainCHAS massage therapy is smart conservative solution. also should not forget about psychology
bitogoth Heat, hydro and electrotherapy all help for me, but not always accessible (hydro) #HAchat -


Writing your own pain scale
Just as different therapies work for different people, pain is different for everyone.  We often talk about how each patient is unique and that no one deals with their condition in the same way, reacts to medication the same way, or has the same needs in terms of their treatment or care. The same goes for pain, which is another reason pain is so hard for doctors to treat.  julianna12369I would like pain scale thrown out. I want my hcp to know that years in pain make my 5 diff then that 5″.  But how is a doctor supposed to treat that?   How does he or she know that your 5 is worse than someone else’s?  ArthritisAshleyMy pain & symptoms are always in flux. I could be fine one minute & immobilized the next”.
bitogoth suggested defining your own pain scale:  “I wrote my own scale for my doc- very specific. Has helped much in communicating pain”.  It will lead to a better conversation with your doctor about your pain, and also help your doctor decide on the best course of treatment.  You should also define your expectations with your doctor. While it’s important to strive for a pain-free life, it seems that most of our Health Activists found this to be unrealistic:  julianna12369I don’t expect to have ZERO pain, I think that’s unrealistic. Healthy people have SOME pain. Just manage pain.”  As always, communicate your needs to your doctor and come up with a plan to address them. Like patients in any other condition, the chronically ill and those suffering from pain are just expecting for their doctor to listen and respect them: julianna12369: “so my expectation of my HCP is to listen, believe, communicate, and try. And for me as a patient, the same.” TiffanyAndLupusI would like my Drs to know I am coming to them for help; because I don’t have answers.”
Finally two pieces of wisdom to carry you through the week.  Last week we heard from an HCP that doctors hear empowered groups more than empowered individuals, so don’t forget: TiffanyAndLupus Alone we are one; together we are strong. @HealClick: 130 million total chronically ill… The epidemic no one knows about.
And though we doubt you need a reminder of why it’s important to talk to your doctor about your pain: ArthritisAshley – “I had a doctor tell me it was “all in my head.” It was but NOT how he meant it – I had Chiari malformation & needed brain surgery.”

Do you have other alternative ways to deal with pain?  Additional tips for communicating with your HCP about pain?  Feel free to send additional ideas to editorial@wegohealth.com!
Make sure to join us next week for more on Health Activism and Healthcare Professionals!


Commencement ~ The Journey Continues

Last Sunday marked a milestone in my life.  Thirty-two years after my first university commencement, I again crossed the stage; this time collecting a diploma in recognition of my graduate work at the Tufts University School of Medicine's Pain Research, Education and Policy Program. Perhaps because of the years that have passed since I set out in 1979, this commencement was very poignant for me, filling me with gratitude for all those who have guided,  mentored, and walked beside me over the years; my family, friends, patients, clients, students, teachers, colleagues, neighbors and fellow life travelers.

I was honored to be selected to deliver the commencement address for my program, and I share it here with you, my readers.  I welcome your thoughts and comments on your journey.

May 22, 2011
Tufts University School of Medicine 
Pain Research, Education & Policy Program Commencement Address
by Pamela Katz Ressler, M.S., R.N., HN-BC
To the faculty, administration, fellow graduates, and especially to my wonderful family; I am both incredibly honored and extremely humbled to stand before you today. It has been 32 years since I last wore a cap and gown and I am reminded today of that spring day so long ago in Ann Arbor, Michigan. In 1979, the adventure on which I was embarking appeared so clear and direct, much like Homer’s Odysseus as he set off from Troy enroute to Ithaca. But as with Odysseus, we often find our journeys far more complicated than we ever anticipated…meeting not only with trade winds and gentle seas but also with violent storms and towering waves that can batter us and throw us off course. And so it is for the patients we meet each day in healthcare. They, too, are voyagers on their own Homeric journeys, each filled with unique, authentic stories waiting to be told. It is up to us, in healthcare, to elicit, acknowledge, and honor these stories, to bear witness to their individual journeys and to help them navigate through difficult passages. When we first enter the world of healthcare our mission seems clear and direct – we want to quickly fix what we see as broken, to cure what we see as diseased. While this is a noble mindset, we often miss the opportunity to heal when we blindly set out in this direction. What I have learned is that often we cannot cure, no matter how desperately we try, but the potential for healing is always possible. This statement may seem incongruous to what we see as the measurement of medical success. But, as we look broadly at what healing really is… isn’t it all about reducing pain and suffering…about living and dying with dignity, grace, and a sense of purpose? We meet our patients at many points on their journeys and I see our work as assisting them in gathering the necessary tools of healing to find safe passage on their voyages.


During the course of my studies here at Tufts I have discovered many tools of healing. The Pain Research Education and Policy program was not on my navigational charts when I set off in 1979, but I am so grateful that I found my way here. Through my work with inspirational faculty mentors, especially Dr. Bradshaw, Dr. Glickman-Simon and Dr. Carr, as well as Dr. Gualtieri in the Health Communications program, I have explored pain not only as a physical manifestation of injury or disease, but also as a complex pattern of psychosocial and cultural components that contribute to a sense of suffering. Addressing the suffering has a direct impact on reducing the sensation of pain. The Pain Research, Education and Policy Program has allowed me to explore the intersection of modern medicine, technology, ancient healing practices of the body and mind and spirit, and the innate human desire to survive adversity. It has given me a voice in advocacy and scholarship by helping me to articulate the meaning of pain and suffering for individuals and society. For this I will always be grateful. Some of you may be familiar with the poem, Ithaca, by Constantine Covafy. It is a poem that has kept me company on my journey and I would like to offer it to you as a metaphor for this commencement, as each of us sets forth on new journeys and adventures:

When you set out on your journey to Ithaca,
pray that the road is long,
full of adventure, full of knowledge.

The Lestrygonians and the Cyclops,
the angry Poseidon -- do not fear them:
You will never find such as these on your path,
if your thoughts remain lofty, if a fine
emotion touches your spirit and your body.

The Lestrygonians and the Cyclops,
the fierce Poseidon you will never encounter,
if you do not carry them within your soul,
if your soul does not set them up before you.

Pray that the road is long
That the summer mornings are many, when,
with such pleasure, with such joy
you will enter ports seen for the first time;
stop at Phoenician markets,
and purchase fine merchandise,
mother-of-pearl and coral, amber, and ebony,
and sensual perfumes of all kinds,
as many sensual perfumes as you can;
visit many Egyptian cities,
to learn and learn from scholars.

Always keep Ithaca on your mind.
To arrive there is your ultimate goal.
But do not hurry the voyage at all.
It is better to let it last for many years;
and to anchor at the island when you are old,
rich with all you have gained on the way,
not expecting that Ithaca will offer you riches.

Ithaca has given you the beautiful voyage.
Without her you would have never set out on the road.
She has nothing more to give you.

And if you find her poor, Ithaca has not deceived you.
Wise as you have become, with so much experience,
you must already have understood what these Ithacas mean.
And so, as you set sail from this commencement for your Ithaca…I wish you a long and prosperous journey, the privilege of listening to many stories, and the wisdom of healing….Thank you and Bon Voyage.









Communicating the Experience of Chronic Illness Through Blogging

What does blogging have to do with communicating the experience of illness?  Quite a bit.  I have been exploring the intersection between narrative medicine, coping with illness, and blogging for my research in the Pain Research, Education and Policy Program at Tufts School of Medicine.  Blogging creates a unique and accessible way for individuals who are isolated with chronic illness to be able to express and communicate their experience beyond the medical diagnosis. It provides a way for patients to tell their story and begin to make meaning out of what has happened to them, in real time. 

I recently was interviewed by Helen Osborne, Health Literacy Out Loud, about my research on use of tools of blogging and social media in health care. If you are interested in hearing more about communicating the experience of chronic illness through blogging, I hope you will listen to my podcast with Helen by clicking here.

Stress So Bad It Hurts

An article caught my eye in today's Wall Street Journal..."Stress So Bad It Hurts -- Really" by Melinda Beck. The article presents a patient's perspective on being told that chronic physical pain is caused by stress and it is "all in your head". Without further explanation, the patient feels indignant and angry that the health care provider does not believe their pain is "real". The medical community is slowly becoming more comfortable with the notion that psychological stress can exacerbate and even produce physical pain in individuals. Yet, we currently do not have a health care system that is set up to be multidisciplinary in response to chronic pain. There are initiatives going on around the country that begin to address multidisciplinary ways of dealing with complex pain issues. I am currently involved in graduate work at Tufts University School of Medicine's Pain Research, Education and Policy Program, the only one of its kind in the United States. As an initiative to share information and dialogue about pain management, we have started a blog (http://www.go.tufts.edu/pain) on the complex subject of pain research, education and policy and would welcome your voice. I hope that as President Obama considers health care reform, we as health care providers and consumers take on a vocal role of advocating for a multidisciplinary approach to true "health" care and not procedure oriented "illness" care. Only when we begin to acknowledge the innate connection between the body, mind and spirit will we truly begin to understand the complexities of the human body.


I would love to hear your thoughts!