Chapter 05: Chronic Pain, Working with Cancer Patients, and a Digression on Photography

Title

Chapter 05: Chronic Pain, Working with Cancer Patients, and a Digression on Photography

Files

Loading...

Media is loading
 

Description

In this chapter, Dr. Baile first touches briefly on his next job (Director, Maryland Center for Pain Management at the University of Maryland Hospital in Baltimore, Maryland, 1983-1986), discussing current psychiatric theories of pain as well as his own theory that chronic pain sufferers had conversion disorder. He describes the Pain Unit and notes a publication he placed. He notes the period of depression he suffered after the Pain Unit was closed. Dr. Baile then focuses on his next role as Chief of the Psychosocial Medicine Service at the H. Lee Moffitt Comprehensive Cancer Center and Research Institute (South Florida School of Medicine, Tampa, 1987-1994). He observes that his is “imaginative and creative” and able to take on different roles. Dr. Baile then digresses and discusses his interest in photography, mentioning several photographs he has taken. He then returns to the topic of his work at the Comprehensive Cancer Center. He talks about the overall, crisis theory approach to working with cancer patients, noting that the quality of interaction with patients makes the biggest difference to them. He discusses the “powerful role” that caregivers have on patients, who experience not merely grief, but extreme loss.

Identifier

BaileW_01_20160823_C05

Publication Date

8-23-2016

City

Houston, Texas

Topics Covered

The Interview Subject's Story - Professional Path; Professional Path; The Researcher; Professional Values, Ethics, Purpose; The History of Health Care, Patient Care; Politics and Cancer/Science/Care; Cultural/Social Influences; Ethics; Critical Perspectives; Human Stories; Offering Care, Compassion, Help; Patients; Patients, Treatment, Survivors; Cancer and Disease; Discovery, Creativity and Innovation; Post Retirement Activities; Definitions, Explanations, Translations

Transcript

T.A. Rosolowski, PhD:

So tell me, I want to keep this—this is all fun, but I want to keep this a little on track with our work here.

Walter F. Baile, MD:

Absolutely. Sure, sure, sure.

T.A. Rosolowski, PhD:

(Laughs) I know, I’m sitting here thinking, “Wow, I could tell him that this that I’ve done, or that,” and it’s, like—but I’ve got to be out of it. So you had this great experience, and had the opportunity to see the systems at work, and see community support also for mental health patients that work, and this first job at Baltimore Hospital, or Bayview Hospital in Baltimore. Why did you leave that job? Because you went to a general internal medicine residency program, ‘80 to ‘83. What was that move about? Or were you at the same place and you shifted status?

Walter F. Baile, MD:

No no, I wasn’t at a general internal medicine for—

T.A. Rosolowski, PhD:

That’s what it says here. Oh, director of psychiatric education.

Walter F. Baile, MD:

Yeah. That was at the hospital, just a title.

T.A. Rosolowski, PhD:

Got you. OK, so it was a title change. So what did you do in that role? Oh, so that was concurrent. I’m sorry, I’m, like—

Walter F. Baile, MD:

As I say—

T.A. Rosolowski, PhD:

I haven’t committed your CV to memory.

Walter F. Baile, MD:

Yeah. So I helped train some of the residents in psychiatric issues, and contributed a chapter to a book in general internal medicine.

T.A. Rosolowski, PhD:

OK.

Walter F. Baile, MD:

And then I moved over to the University of Maryland.

T.A. Rosolowski, PhD:

There is—’83. OK. So tell me about that, because that’s pain management. So what was that shift about, or wasn’t it a shift, really?

Walter F. Baile, MD:

It was an era in which chronic pain was considered to be, for all practical purposes, a “psychosomatic problem.”

T.A. Rosolowski, PhD:

Oh, gosh.

Walter F. Baile, MD:

So it was very, very interesting. Because these were people who had injuries, but never recovered from them, either physically or emotionally. And so I opened a unit at University of Maryland to treat these folks, and I got Blue Cross/Blue Shield, because most of them had that, allowed me to treat them over six weeks in the hospital. So it’s kind of like a rehab facility.

T.A. Rosolowski, PhD:

Now, OK, so the prevailing wisdom was, this was all in their heads. What was your understanding of what these patients were going through?

Walter F. Baile, MD:

That they had conversion disorders.

T.A. Rosolowski, PhD:

And what does that mean?

Walter F. Baile, MD:

A conversion disorder is a somatic representation of an unconscious conflict.

T.A. Rosolowski, PhD:

Hmm.

Walter F. Baile, MD:

So you remember the old literature that people would get paralyzes, and they’d get hysterical blindness?

T.A. Rosolowski, PhD:

Mm-hmm.

Walter F. Baile, MD:

Well, pain became the contemporary conversion to (inaudible).

T.A. Rosolowski, PhD:

Interesting.

Walter F. Baile, MD:

So people became blind because they didn’t want to deal with a certain reality, right? They became paralyzed in one arm because of—I mean, so some people with a primary need and a secondary—a primary—hang on a second – a primary gain and a secondary gain. I’ll explain the difference between them. Supposing that you grew up in an environment where you were always criticized, and you had low self-esteem. So you would marry an alcoholic so you wouldn’t have to—so you could take care of them and wouldn’t have to deal with asking for anything, because you knew that you would get it. Why do people marry alcoholics? Right? Because they have own issues. Right? They have low self-esteem, and so they marry people who wouldn’t ask them for anything…. Emotionally. That’s primary gain. Secondary gain is when you’re able to leave the house and go to your mother and lean on her shoulder.

T.A. Rosolowski, PhD:

OK.

Walter F. Baile, MD:

So the primary gain for people with chronic pain disorders is that they are getting their dependency needs met. So when you dig down deep into the personalities of these people, a lot of them came from abusive families, especially men, alcoholic fathers who beat them. Or women who were sexually abused. And so the way that people dealt with that was to, instead of becoming dependent, they acted the opposite way, and they became hyper-independent. A lot of these folks took their first jobs when they were just out of grammar school, and they become really strong, like Donald Trump, bup, bup bup, you know? However, you get burnt out doing that. That only lasts a while. Then they get an injury, and the injury was the trigger for allowing them to get the dependency that they never had because of the family life they had. And then they get an operation, which reinforces their dependency, and that’s the secondary gain.

T.A. Rosolowski, PhD:

Interesting.

Walter F. Baile, MD:

So I have a paper called, “The Psychodynamics of Chronic Atypical Facial Pain,” and it’s all about this—you know, what happened to these people early in life, and how that played itself out in pain syndromes.

T.A. Rosolowski, PhD:

Interesting.

Walter F. Baile, MD:

So I ran this unit, and I had family medicine involved with the physical part, and I had groups, and I had PT. And it was wonderful for, I think, a year and a half, two years, until Blue Cross started cutting back on the hospitalizations. That’s when I got recruited to the University of South Florida.

T.A. Rosolowski, PhD:

OK. To do the same thing?

Walter F. Baile, MD:

No. I ran—it’s a cancer center.

T.A. Rosolowski, PhD:

Oh, yeah, OK. Right.

Walter F. Baile, MD:

That’s the Moffitt Cancer Center.

T.A. Rosolowski, PhD:

OK, so how did you jump from the pain management to—tell me about that recruitment process, and how there was that jump.

Walter F. Baile, MD:

Well, they closed the unit, because Blue Cross wasn’t paying anymore.

T.A. Rosolowski, PhD:

OK.

Walter F. Baile, MD:

And I went through this period of depression, because, you know, they took away the rug very quickly. And so I was really morbidly depressed for about two weeks. And then I ran into this guy named Tony Reading at a meeting, and he said, “Do you want a job?” I said, “What’s it about?” He said, “Well, we got a new cancer center down here.” Tony was one of my mentors at Hopkins. “We got a new cancer center down here, and we need a psychiatrist.” I said, “OK. Let me come down to take a look at the job.” So I went down and looked at the job. And it was a brand new job. There weren’t a whole lot of faculty then, so I became chair of the Ethics Committee, chair of the Credentials Committee, chair of these really important committees for a while.

T.A. Rosolowski, PhD:

Yeah?

Walter F. Baile, MD:

And then I stayed there, I think, for five years.

T.A. Rosolowski, PhD:

Do you consider yourself a start-up guy?

Walter F. Baile, MD:

Well, I have some ideas of things that I would like to invent.

T.A. Rosolowski, PhD:

Well, I’m just saying because it sounds like you kind of get in on the ground floor of a lot of things.

Walter F. Baile, MD:

I’m very imaginative and very creative. Now I like to start things up and then move on. Of course, I have a little ADD like that, in when I sort of get into things, I have to re-invent them a lot so I don’t stay bored. For example, I did the website. It’s up, it’s over with, it’s a thing other people can use; now I want to move on.

T.A. Rosolowski, PhD:

And you’re talking about the website for ICARE?

Walter F. Baile, MD:

Yeah.

T.A. Rosolowski, PhD:

Yeah.

Walter F. Baile, MD:

Yeah. I’m doing workshops; I need to find ways of introducing more creative things into the workshops. So it’s just that I need—I like novelty. I think that’s—I mean, that’s why photography is so appealing. It’s just I could go from a pair of shoes in a shop sitting on a sill to the stairway. I read in the New York Times—in the Washington Post this morning that two researchers developed an algorithm that tells from people’s snapshots how much depression they have.

T.A. Rosolowski, PhD:

How much depression they have? That’s interesting.

Walter F. Baile, MD:

Yeah. So people who apparently like a lot of dark stuff like photos, they found out they have a preponderance to depression. So I was glad I had these two color things out, because I’ve been doing a lot of black and white lately. (Laughter) A lot of black and white!

T.A. Rosolowski, PhD:

Things are looking up.

Walter F. Baile, MD:

Well, these are older. But I’ve gotten into black and white lately, because the contrasts are just so incredible.

T.A. Rosolowski, PhD:

And textures really come out.

Walter F. Baile, MD:

Oh, yeah, so I have a bunch of stuff. I may even have a picture—

T.A. Rosolowski, PhD:

Actually, if you want to send me jpegs, I can put them right in your transcripts, since you’re talking about these images.

Walter F. Baile, MD:

Yeah.

T.A. Rosolowski, PhD:

Yeah, that’d be cool.

Walter F. Baile, MD:

But I have a captive audience, you know. I have to see if I have at least just one photo to show, because this is supposed to actually move photos over. But—

T.A. Rosolowski, PhD:

What kind of camera do you have?

Walter F. Baile, MD:

I have a Panasonic camera that fits on my hip. But it has a 30x telephoto lens.

T.A. Rosolowski, PhD:

Oh, that’s cool!

Walter F. Baile, MD:

So let me show you one which I really like a lot. So this is a photo I took.

T.A. Rosolowski, PhD:

Oh!

Walter F. Baile, MD:

In Budva, Montenegro.

T.A. Rosolowski, PhD:

Wow, that’s lovely!

Walter F. Baile, MD:

I looked down an alley, and I saw these newlyweds just kind of kissing.

T.A. Rosolowski, PhD:

Yeah. It’s a beautiful moment.

Walter F. Baile, MD:

Well, she has her hands at her side, just like this—it’s just so—I haven’t blown that up yet, but I will.

T.A. Rosolowski, PhD:

Yeah, because it’s lovely because the diagonals are so strong. They’re subtle, but they’re strong.

Walter F. Baile, MD:

The diagonals are strong, and the lines are strong. So that’s one thing that—kind of thing that I do.

T.A. Rosolowski, PhD:

That doesn’t look like a very depressing photo to me.

Walter F. Baile, MD:

No, it’s not. It’s not depressing. But it’s—so I found that you need to take thousands of photos before you find one that you really, really like, that represents who you are and what your skill is. And this is a cemetery.

T.A. Rosolowski, PhD:

Oh, the cloud is great, in the center.

Walter F. Baile, MD:

On the island of—

T.A. Rosolowski, PhD:

Wow.

Walter F. Baile, MD:

—that’s off the coast of Croatia.

T.A. Rosolowski, PhD:

That’s really neat.

Walter F. Baile, MD:

Hvar.

T.A. Rosolowski, PhD:

Now, do you Photoshop these at all before you—

Walter F. Baile, MD:

No. I haven’t learned how to Photoshop yet, you know? That’s—and I’ll show you one more, and then we’re done with that. That is just really—now, this has to get blown up. But if you could see this when it’s bigger, that’s a seaplane just taking off—

T.A. Rosolowski, PhD:

That’s really—

Walter F. Baile, MD:

—down the East River.

T.A. Rosolowski, PhD:

Yeah, that’s very cool. That’s very cool. Yeah.

Walter F. Baile, MD:

And it’s so much more powerful in black and white than it is in color.

T.A. Rosolowski, PhD:

It is. Yeah. Like the cityscape, you know, it’s almost like the buildings are just slightly less contrasty—or, slightly more contrasty than the clouds.

Walter F. Baile, MD:

Now, this one, I’ve blown up, too. That’s looking through a window in Barbados in a restaurant, on a sailboat. And I have that blown up into a three-foot by two-foot thing on my kitchen wall.

T.A. Rosolowski, PhD:

So you really—like you’re looking out the window.

Walter F. Baile, MD:

Yeah.

T.A. Rosolowski, PhD:

Yeah.

Walter F. Baile, MD:

So anyway...

T.A. Rosolowski, PhD:

Well, I’ll make a note, and you can send me—

Walter F. Baile, MD:

Yeah, I’ll send you PDFs of things, if that’s—

T.A. Rosolowski, PhD:

Oh, yeah. And just with anything, you know, anything we talk about, or that you’d like to append here, we can do that. That’s the neat thing about all of this process. Barbados. All right. I’m making a note of images so that we can get those.

Walter F. Baile, MD:

Sure.

T.A. Rosolowski, PhD:

That’s cool. So you were in a period of depression, and Tony, is that his name?

Walter F. Baile, MD:

Dr. Tony Reading.

T.A. Rosolowski, PhD:

Tony Reading snapped you out, by saying, “Do you want a job?”

Walter F. Baile, MD:

Yeah. It was very coincidence. (Laughter) I was at a meeting.

T.A. Rosolowski, PhD:

Yeah. So you said yes.

Walter F. Baile, MD:

So then I went there for five years, opened up the place, organized this wonderful service, because it was a—it was really a service, it was a psychiatry service that had social work, chaplaincy, psychology, and psychiatry all in one unit. So I really did a lot of teamwork with the social workers, you know.

T.A. Rosolowski, PhD:

Now that was how the folks in Florida had originally conceived it, or did you contribute to that—

Walter F. Baile, MD:

Yeah, that’s the way Tony conceived it.

T.A. Rosolowski, PhD:

OK, cool. Very cool.

Walter F. Baile, MD:

And it was wonderful, because we were able to be very inventive and work together. And so—

T.A. Rosolowski, PhD:

What were some—were there any special issues that you saw emerging? Because this was suddenly in a cancer center, and neuro-oncology on top of it. So were there things that you began to understand about cancer patients?

Walter F. Baile, MD:

Well, this wasn’t neuro-oncology. Neuro-oncology—I was in neuro-oncology in my next job.

T.A. Rosolowski, PhD:

Oh. So it says, “Department of Neuro-Oncology” on your CV?

Walter F. Baile, MD:

That’s here. That’s not at Moffitt Cancer Center.

T.A. Rosolowski, PhD:

Oh, it actually says that it was. It actually does say it, so sorry about that.

Walter F. Baile, MD:

No, it’s not the Department of Neuro—it’s the Department of Psychiatry. I think that it’s my secretary who typed that in.

T.A. Rosolowski, PhD:

Well, good. All right. Well, that’s why I was making—that’s why I was asking that question.

Walter F. Baile, MD:

Oh, OK.

T.A. Rosolowski, PhD:

OK. So but there’s—

Walter F. Baile, MD:

It should be just—psychosocial inter-service (inaudible) Moffitt Cancer Center. There’s no (inaudible).

T.A. Rosolowski, PhD:

All right.

Walter F. Baile, MD:

That was here.

T.A. Rosolowski, PhD:

Yep. But, you know, it was at a cancer center, so the more general question holds. Were there things that you were seeing that you were thinking, huh, this is specific to cancer patients?

Walter F. Baile, MD:

Well, cancer is a very scary disease because it has a social stigma. Because what’s the first thing you think of when you say, “Cancer?”

T.A. Rosolowski, PhD:

Well, actually, I don’t have a social—don’t think of social stigma. But I guess a lot of people say you brought it on yourself because of your lifestyle, or whatever.

Walter F. Baile, MD:

Maybe. What else?

T.A. Rosolowski, PhD:

I don’t know. Oh, well, that you’re going to die, or...?

Walter F. Baile, MD:

Right.

T.A. Rosolowski, PhD:

Yeah, well, that—

Walter F. Baile, MD:

Right. Isn’t that the thing that comes to people’s mind?

T.A. Rosolowski, PhD:

The whole dissonance thing.

Walter F. Baile, MD:

Am I gonna die of this, right?

T.A. Rosolowski, PhD:

Yeah, right. Right. Yes.

Walter F. Baile, MD:

Right. I mean, people don’t think the same—it isn’t—caused the same amount of anxiety as a diagnosis for ALS does. You know?

T.A. Rosolowski, PhD:

Yeah, yeah.

Walter F. Baile, MD:

Not only die, but die an excruciating, painful death.

T.A. Rosolowski, PhD:

After many failed treatments.

Walter F. Baile, MD:

After they chop off your arms and your legs, and poison you, and give you peripheral neuropathy, and everything else, right?

T.A. Rosolowski, PhD:

Right.

Walter F. Baile, MD:

So here’s the thing, though. You know, people haven’t written about this, and I should have written more about it. Do you know anything about crisis theory?

T.A. Rosolowski, PhD:

No.

Walter F. Baile, MD:

OK. What’s the first thing that people do in a crisis?

T.A. Rosolowski, PhD:

Get scared and hunker down.

Walter F. Baile, MD:

Then what do they do?

T.A. Rosolowski, PhD:

Well, is it sort of like the stages of grief? You start denying that it’s there, and then you finally get—

Walter F. Baile, MD:

No.

T.A. Rosolowski, PhD:

Some people get mad and they do something.

Walter F. Baile, MD:

Right. What do they usually do? What do people do when they get cancer? They pick up the phone, and they look up the phone number for MD Anderson, right?

T.A. Rosolowski, PhD:

Yeah, yeah.

Walter F. Baile, MD:

So people reach out for help. In most crises, people look for support or help, or something that helps them resolve the crisis. Right? So what do people do when they break up with a significant person in their life?

T.A. Rosolowski, PhD:

Well, they tend do—

Walter F. Baile, MD:

They pick up the phone and call their girlfriend, or they go to the bar and have a few beers. I mean, it’s stereotyped—

T.A. Rosolowski, PhD:

Connecting kind of thing.

Walter F. Baile, MD:

—in our culture and in our films and things of that sort. But what they want to do is, they reach out for help, OK, because they’re anxious, they’re scared. People naturally want to lean on support from other people. So, you see, cancer caregivers have a tremendous advantage of helping people. That’s the stupidity of this, that we think the drugs and that make a difference. What makes a difference is that cancer patients are vulnerable. Therefore, the little things that you do make an enormous difference. And this is what I’ve been trying to teach doctors. Sitting down, holding a patient’s hand, looking them in the eye—how comforting that is when you’re afraid of dying. Can you imagine? And people don’t realize that. They think the chemo makes a difference. Well, in 50 percent of our patients, the chemo’s not going to make a difference, is it? Because (inaudible) mortality rate. But what people remember, what cancer patients remember negatively is the drugs they got. What they remember positively is the people who were caring toward them.

T.A. Rosolowski, PhD:

Yeah.

Walter F. Baile, MD:

Right? So how do you teach caring-ness? People think, oh, it’s something amorphous, you’ve got to hook people? No. You have to respect them. You have to learn who they are as people, like you’re doing with me, right?

T.A. Rosolowski, PhD:

Not patronize them.

Walter F. Baile, MD:

And everyone has a story to tell. So you ask people, “Tell me about yourself. Where were you born? Where did you grow up? What did your dad do for a living?” Start trying to connect with people because they’re vulnerable. So this little bit goes a long way. And that’s the crisis theory model.

T.A. Rosolowski, PhD:

Hmm.

Walter F. Baile, MD:

You know?

T.A. Rosolowski, PhD:

Interesting.

Walter F. Baile, MD:

It’s the same thing that people do when their child gets involved with drugs or something, you know? What do you do? You talk to your sister-in-law, whoever it is. So that’s the powerful role that caregivers have. People regress. And then there are so many losses with cancer. So people are grieving all the time. What do they lose? They lose their body parts, they lose financially. You lose your connection with your friends. You lose your autonomy, because everyone is telling you what to do, right? You lose your ability to function normally. So loss is a major theme in cancer. And it’s not the stages of grief thing. It’s the fact of feeling sad, because you’ve lost so much. Now, some people have resilience, as you say. Other people can take advantage of the support system to get through that. But, you know, I can’t tell you how many consult requests that I get, “Patient crying,” give me a break, huh? Who wouldn’t cry? It’s not normal if they don’t cry. So I try to tell my colleagues, if the patient doesn’t cry or get more upset...

T.A. Rosolowski, PhD:

Then you really need a consult. Oh, I’m sorry. I mean, somebody who’s that—I mean, some people are really repressed, and then I wonder where it comes out later on.

Walter F. Baile, MD:

That’s right. Grieving is healthy. Grief is a disease, and we need to let it kind of take its course.

T.A. Rosolowski, PhD:

Do you find that—is that a message that was easy for practitioners to embrace early on?

Walter F. Baile, MD:

Practitioners feel that doing is more important than being. Doctors and health professionals are brought up in the “fix-it” mode. That’s their prime reflex, is to try to fix it, right? No matter what it is. If it’s mental, if it’s physical, if it’s social, they’re going to try to fix it. So what I have to teach is, resist the impulse to fix people’s feelings, because you can’t do it. Just acknowledge them. This has been a really tough road for you. You know? Not, “Oh, we’re going to find another seventh-course of chemotherapy for you.” So we psychiatrists have a lot to offer to people who are taking care of medically ill people, because they’re all feeling a bit helpless and regressed and sad and anxious. So what better opportunity is there for someone to come along and hold your hand? Powerful stuff. It’s very hard to teach people how powerful it is, because they forget about the time when they had children who had a boo-boo on their knee, and needed just to be held while they cried. Same thing. Hard to teach that message. Because we’ve been seduced by biomedicine. But if you read the old stuff, before we had all these powerful things, people were much more focused on healing. So that’s sort of good.

T.A. Rosolowski, PhD:

We’re at about twenty minutes after 2:00 right now.

Walter F. Baile, MD:

Oh—

T.A. Rosolowski, PhD:

I know you’ve got other stuff to do. And I’m thinking we’re at a stopping place, so we could maybe set another time?

Walter F. Baile, MD:

Yeah. I think we have another time in our calendar.

T.A. Rosolowski, PhD:

OK. I think we do, yeah.

Walter F. Baile, MD:

We do. Sometime—I think it’s next week. I’m not sure.

T.A. Rosolowski, PhD:

I think it’s the week after. Well, let me just thank you for sitting today.

Walter F. Baile, MD:

You’re welcome.

T.A. Rosolowski, PhD:

Let’s—I’ll look forward to talking to you again.

Walter F. Baile, MD:

Yeah.

T.A. Rosolowski, PhD:

Let me just say for the record that I’m turning off the recorder at twenty minutes after 2:00.

Conditions Governing Access

Open

Chapter 05: Chronic Pain, Working with Cancer Patients, and a Digression on Photography

Share

COinS