In the last twenty years that I have been caring for people as a family physician through all of the chapters of their lives, I feel fortunate to have co-created meaningful relationships that are deeply connecting. The front row seat to the spoken story of another vulnerable human is a privilege I have never taken lightly. I realize now that the intense, decades-long educational path to become a physician was, more than anything, a prelude to receive the most sacred learnings from my patients. Expertise is more than ability; it is a portal into a trusted space with others. In that liminal space, we co-create plans for healing.
Sitting and listening with my patients illuminates that community and sensed belonging can make a harsh diagnosis or a chronic illness a much softer place to live within. It is a thing of great beauty to hear of the meal trains that ensure my patients with cancer do not have to worry about making dinners for their families during brutally fatiguing chemotherapy sessions. Beautiful, also, are the support groups where patients can find others who understand their worry and pain and share the enormous range of emotional intensity surrounding their health issues. These things do matter, because loneliness is a disease in and of itself. There is plenty of research to back this us up: A study done in 2010 showed that people who had weaker social ties had a 50 percent increased likelihood of dying early than those with stronger ones. Being disconnected, in fact, posed danger comparable to smoking fifteen cigarettes a day, and was more predictive of early death than the effects of air pollution or physical inactivity. My lonely patients are of all ages, from teens to elders, and while the circumstances of their loneliness may be vastly different, there is often a common prevailing sentiment of an all-consuming sense of feeling sad about this aloneness. It is the sense of belonging to something bigger than oneself, and the tangible support that comes from this sense, that feels vital; connection is so vital to us as humans that without it, we wither and can even die. In our early months of life, we are being held and kissed and hugged, and, along with eye contact, receiving loving touch and hearing our names being spoken to us. This patterning sets up our brains to know and depend and expect for this to continue for the rest of our lives.
We are wired for this. We are wired to belong to each other.
Searching for models and ideas for community building has become a way of life for me. On two such journeys, I have travelled to Cuba to study the public health system, regaled as being one of the world’s best despite being less resourced than most countries. As a medical student, I was assigned to a Cuban family doctor for several weeks, and followed him around to all his house calls and clinic visits. Even visually, it was obvious that the neighborhoods of Havana had so much that American neighborhoods didn’t. Chess tables with a grouping of folding chairs were permanent sidewalk fixtures, occupied mostly by elderly men playing for hours in the day. Young children took dance lessons in the street, bikes and cars and people shifting paths to give them space, music playing from a boom box. Each morning all the seniors living in a four-by-four block radius had an outdoor exercise and dance class led by an instructor assigned to the neighborhood—this was government sponsored.
Everyone in the neighborhood knew each other by name, and often knew much more about each other, like who had high blood pressure or diabetes, who had not been visited by a best friend in many weeks, and who was not feeling good that day, which they communicated to the doctor as in, “Tia Elena has not gotten out of bed today. She said she is feeling cold and sick to her stomach.” We would walk over and the doctor would check her vital signs and examine her and hold her hand. He held a lot of hands. After we would finish with the diagnosis and treatment plan he would share the plan with loved ones and trusted neighbors so that they could check on Tia Elena and keep him posted. This was the kind of medicine that shaped my early notions of what it meant to heal. First and foremost, healing requires community. Outdoor chess and music and dance and daily movement helped too, but it was the togetherness and the palpable ethereal sense of sharing space and life that made it all so powerful. I think that if we can create places and spaces that give us what we seek—connection to nature; interaction or physical proximity to each other; a structure that provides opportunity for co-creation of fun, service or learning—then we can bloom together in the light filled spaces. We can be like fireweed.
Fireweed and I became friends on a recent family trip to Alaska. In summer, this bright, purplish-pink wildflower’s showy blossoms blanketed entire meadows and seemed to be smiling in the many light filled patches of the cool birch forest floor. Summer in Alaska is a constant twenty-hour bath of warm light, shining at various slants through the trees, casting shadows that change in angle, but not intensity. When the sunlight glowed upon them, the flowers seemed more apt to be named fireworks than fireweed. A forest ranger explained that fireweed is so named because it grows when fire takes down the trees and leaves the forest floor open to sunlight, allowing for their tenacious and tiny seeds to grow into tall, stately and sweet communities of flowers. Fireweed grew in the clear cuts, along the roadsides, and in the patches of controlled burns. It dotted the forests we hiked through. These flowers are living the truth of how communities grow and thrive in the spaces where they can, often because of the challenges they face to find space and light to exist. Fireweed finds a place to belong within the world first and foremost by belonging to itself and its needs.
Nature does this. Every day and by design. I think we can too.
Plant communities are in constant adaptation to their environments—growing deep tap roots when the water is scarce, night blooming to prevent dehydration, growing bright, colorful flowers to attract pollinators. Together they create ingenious ways to survive and thrive even in harsh deserts and tropical forests filled with predators. Humans too are striving to find the connection to our land, to each other, to ourselves. We are longing for belonging, and are working constantly to adapt to the stressors of isolation and separation that we face and often create. As research and experience shows, with the weakening of our social ties and lessening of our sense of belonging, we lose one of the great buffers to the stressors of life.
The COVID-19 pandemic reveals through the hardships of our continued isolation and distancing, that we are a species that has a deep need for connection. Like mycelium communicating in a web below the stems and roots of mushrooms, a good human community functions like a massive underground support system, allowing us to bloom and shine above ground, in our individual bodies. Looking to nature for models of living and healing makes sense to me, and it is where I find wisdom when I am weary.
There are examples of excellent health care systems and medicines everywhere. They are literally looking at you, and you are looking at them. I am not trying to be romantic or cinematic here. Really, many of the most successful models of health are outside your window, and they are based in community. Here in the Midwest, writing as autumn begins, I look out the window to a massive forest of pines, cedars, maples, and oaks. They are in various states of change; many are bare already and some are holding on to a few multicolored leaves. They are alive, but the throbbing pulse of energy is not visible as they head into the winter. Trees of course, don’t die in winter, but they do go dormant. Dormancy is like hibernation in that everything within the tree slows down—metabolism, energy consumption, growth. Since they aren’t making food in the winter, they release the leaves, which require a great deal of energy to maintain. In these autumnal days, trees transfer water into their cells, and as the temperature drops, they move that water from inside the cell to the tiny spaces on the outside, in between the cells. This prevents the trees’ cells from freezing.
Even in this dormant state the trees are communicating through their root structure, sending nourishment to the smaller trees around them who need it, and protecting each other by sending chemical messages of impending threats. They work in community. Nature is literally showing us the path to health: Let go of what is no longer serving you and also sucking your energy, slow down, hydrate. Communicate and be close to those you care about. Some answers for us, right there, out the window, if we look up from our laptops and phones to stop, listen, and take it all in.
Without dormancy, energy conservation, leaf shedding, rest, restoration, a wildly different appearance, and the added benefit of a collection of trees nearby, a tree will not survive for many seasons and with the much-needed energy to thrive and collect sun and energy. With these adaptations, a tree can make it through a challenging season.
The simplicity in this lesson is not lost on me in the complexity of medicine. There are many patients who are burning their energy on all fronts: work, family, conflict, poverty, violence, stress from multiple sources, keeping children safe. A chronic health condition like cancer or lupus or fibromyalgia adds exponentially to the depletion. And while the discussion will be different for each person, the message of becoming tree-like may be the same. The disease condition is creating a winter, and the inner health and strength must be conserved by limiting the outer energy expenditures in whatever ways are possible. Having a community to lean on—one that can lean in when winter is upon you—can make a significant difference for healing, mental health, and spiritual stability. Ultimately, like the trees and the fireweed and the mushrooms, we belong to ourselves first, and can tend to our wounds and needs as we care for each other with the same tenderness.
Certainly, there are days that my work exhausts me emotionally, especially in these recent times of bearing witness to so much tragedy and despair. We are all on the frontlines of our own mortality, and health care workers are not the only ones who have had to dig deep within to find the life force to come back to our work day after day. Ultimately, for me, it is the magnetic pull to be in connection with other people, to be of service and use, or at the very least to listen and empathize, that is life giving. We do not have to do anything so wildly different or unique or special to create communities to which we can all belong. We can show up for each other and invite each other into the light when we find it. When the seasons of the Earth and of our lives are changing, we can communicate in small, meaningful ways so that even the most weakened among us has the chance to come up from underneath the soil of a day or a decade and grow towards the sun. These healing medicines are all around us—accessible, free to those who can see them. The medicines have always been there. And I think we can take care of each other in these sacred ways and look to nature for mentors and guides. We can be like fireweed and grow together in the places where the light peeks through.
 National Academies of Sciences, Engineering, and Medicine. 2020. Social Isolation and Loneliness in Older Adults: Opportunities for the Health Care System. Washington, DC: The National Academies Press. https://doi.org/10.17226/25663