If Your Patients Aren’t Breaking Your Heart, Are You Really Doing Community Acupuncture?

(Happy Valentine's Day)

Art by A. Cohen

This past weekend, POCA Tech’s Cohort 11 had a big discussion about who community acupuncture is for.

A lot of class time at POCA Tech — and a lot of this Substack, as you might’ve noticed — is devoted to topics that fall under the heading of “why we do it this way instead of that way.” Especially since “that way” is currently the dominant paradigm for acupuncture. Sometimes the easiest way to explain why we’re different is to talk about who we prioritize.

Before I get into that, I wanted to share a research article: Super-Users at an Acupuncture Teaching Clinic: Demographics and Unique Clinical Characteristics. A few months back, subscriber Amy Zahm sent it in, and I think the concept of super-users is helpful. You could say that WCA and POCA Tech are built for our super-users. What we do in our clinics is what works for them. Everybody else is welcome to it too — but we don’t provide additional services that wouldn’t work for our super-users, which means unlike a lot of other acupuncture clinics, WCA doesn’t have a menu of options. Even if some other patients might prefer a menu.¹

Final Published

187KB ∙ PDF file

Download

Download

In 2021, one of WCA’s super-users passed away, which was a big deal for us so I wrote about it. Let’s call her T.

T. had been coming to WCA Cully for five years, sometimes every day but mostly twice a week, for a number of complaints including COPD (emphysema), anxiety, depression, and reactions to the pain medications her doctors prescribed. She always brought her emotional support dog, let's call him Frankie, with her. Frankie, a chihuahua mix, would hop up into her recliner and snuggle under T.’s lap blanket while she got treated, and afterwards they would both hang out in the lobby, visiting with staff and volunteers while they waited for their medical transportation to show up. (Which could take awhile.) When T. first started coming to the clinic, she brought an oxygen tank, but after awhile she didn’t need it. She was on a waiting list for a lung transplant — she had to establish a year of sobriety before she qualified — but she never received it.

As one of the WCA acupunks put it, T. was an “anchor” patient. Anchor patients aren’t just people who use the clinic regularly; they stabilize us in our mission. They’re the people who make the clinic what it is, who help set the tone of our organization, who remind us why we do what we do and make us want to keep doing it.

When you lose an anchor patient, you feel it. Everything’s wobbly for awhile. A punk who often treated T. quipped, “If your patients aren’t dying, if you’re not experiencing loss, are you even doing community acupuncture?” It was a moment of gallows humor but it’s also a good way to think about who community acupuncture is for.

A few weeks after T.’s death, her brother stopped by the clinic and introduced himself. He said, “I wanted to thank you for helping my sister. Acupuncture helped her a lot, and this place was important to her.” “Thank you,” the punk on duty said, “she was important to us, too.” That’s the thing about anchor patients and their clinics: they’re mutually important to each other. (T.’s brother happened to have Frankie with him, perched on the front seat of his truck with his own dog. This was fortunate because everybody at WCA Cully was worried about Frankie. It was a relief to see he was doing okay.)

Another WCA punk wrote, “I was rarely the person to treat T., but I had the pleasure of pulling her needles which was our special time together to catch up... She was a friend in the community I woke up from nap time to greet. T. would often times hang out in the lobby available to chat but never pressing, demonstrating to new patients that this was a space to feel welcomed to. Her constant presence and dedication to the space has contributed to an environment of comfort and community for me. Like most of my patients, she’s someone I got to learn from and grow with.”

Art by A. Cohen

People like T. benefit enormously from acupuncture. They’re also very likely to be unable to pay for the amount of acupuncture that they need to help manage life-threatening conditions like COPD (because it's a lot! T. received hundreds of treatments.) T. came to WCA through an ongoing relationship we have with CareOregon.

Another WCA punk wrote, “It's good to notice that our target demographic sometimes can't pay for treatments the way we need most people to do... It's a gift to have relationships with organizations with similar enough missions and ways to help pay the way for some of these good-fit patients. Regardless of having other orgs to help foot the bill, it's a good feeling to treat T. and others in a similar place as a reminder of why we are doing this service at all. Mostly, patients with many barriers to accessing care are just as easy to care for as any other patient. T. was one of our community. It feels good to show up the best we can for our community. Part of the money breakdown in a community acupuncture clinic seems to me to include a percentage of free or almost free care.”

Another punk who treated T. said, “I think one of the most important things the clinic provided for T. was a total no-judgment zone, a place where she could be where she was at and not get any negativity about it, subtle or otherwise. She would talk about having cravings for alcohol when that came up for her, she would talk about what her siblings were going through. Just having that nonjudgmental space was a big thing.”

Because she depended on a medical transportation service that sometimes didn’t show up when it was supposed to, she didn’t have any control over whether she was on time for appointments. There was a note in her file to just fit her in whenever she arrived, and that worked fine for us and for her.

WCA also had to be flexible about needle management. A WCA punk said, “I did a lot of local chest points on her, plus whatever distal points made sense based on her main concern that day. She responded to everything — acupuncture really worked for her — but I learned quickly that if I put too many needles in, she would take out the ones she didn’t like. And of course she didn’t really know how to take them out, so when I came to unpin her there would be a pile of needles on her lap and after she left, there would be needles scattered everywhere that I had to clean up. So I stopped doing the points that I knew she’d take out. Goodbye Triple Warmer points on the arm, she just didn’t like them. I thought that being flexible around how she dealt with needles was a type of accommodation she needed from WCA, so it was fine.”

In terms of Liberation Acupuncture, what WCA was doing with T. and what T. was doing right back, was accompaniment.²

A patient like T. would be difficult to accommodate in a conventional one-on-one private acupuncture practice. She couldn’t pay for the treatment she needed³, she couldn’t show up to her appointments on time, and she wasn’t a good candidate for transformation through lifestyle counseling. In a different kind of acupuncture clinic, one that wasn’t built for her, she would have been a problem. But she was an integral part of WCA.

Which isn’t separate from her breaking our hearts. Remember the “holding space” diagram, with the acupunk on their rolling stool as the nucleus, at the center of a little electron cloud of patients?

Art by Moses Cooper

Acupunks and potential acupunks should ponder that little cloud of humans resting in recliners and realize:

a certain percentage of those people are going to break your heart;

those are the same people who make the whole arrangement make sense;

you have to treat a LOT of other people, just to create the clinic you need, in order to treat the people who will break your heart;

it’s so worth it.

1. A term for this from Liberation Theology is “the preferential option for the poor”.

2. A little later, WCA received this letter in the mail:

“I’m a friend of T.’s and I’m sad to tell you that she passed away last month due to her poor health. For awhile she was going to acupuncture almost every day, and you helped her a great deal. She was quite sure she wouldn’t have survived as long as she did, and been able to deal with the pain she was having, without your help. You asked her, at one point awhile back, to write about how acupuncture helped her (LR: I think this was in 2018)...I typed this from her handwritten notes:

First of all, I’d like to thank my God for healing and for putting people in my life who’ve helped me along the way...I can’t say how grateful I am for the people, the wonderful people at Working Class. I enjoy the downtime as well, doing prayer and meditation. When I first started coming I was very, very sick, on oxygen 24/7. Now thanks to God I only use it during naps and at night. I truly believe they held my hand, helped me through some of my hardest times ever, just to talk with me. I consider them my family, my other family. My doctor gave me one or two years to live. That was three years ago. I feel I am truly blessed. Thanks so much for saving me.

Acupuncture makes me feel more relaxed and sort of in balance with myself. I sometimes sit back and relax and literally feel the blood flowing in my body. It also serves as downtime from worries, stress and pain. It gives me a sense of healing the body after some of the years I abused it, being a recovering alcoholic. I have three years clean. I first tried acupuncture many years ago, just for help with triggers. I had no idea how many things it could be used for. I do now. (The staff) are wonderful to me. I bring my puppy Frankie with me to acupuncture. He likes it there...I love him lots. I am truly grateful to God for almost everything.”

3. T’s acupuncture treatment plan was basically “unlimited treatments forever” and I don’t know of any normal insurance plan that covers that, even though it helped keep her alive.