It was bleeding peptic ulcers that brought Mr Perry to the hospital in the early 1960s. I remember him well-48 years old, a successful businessman with a loving wife and 2 children, and with a great personality and attitude toward life. I was the senior student nurse assigned to his care.
During preconference, the students reviewed their assignments with our instructor and each other. My patient, Mr Perry, was experiencing his third hospitalization in 5 years for the same condition. Courses of antacids, dietary interventions, and admonishments about living a less "stressful" life were the cornerstones of treating this condition. "Focus on the stress issue," my instructor advised, "stress is the leading cause of ulcers and must be faced." Through, what I believed to be a sophisticated use of my skills at interviewing, and with copious notes written during lunch break, I was ready to give my best assessment of Mr Perry's situation in post conference.
When my turn to present arrived, I gave a history of Mr Perry's 3 bouts with peptic ulcer but reported that I could not find either in the chart or in the interview data, any stressful precursor events that could be associated with onset. "How deeply did you delve?" my instructor asked.
I carefully described both my interview process and the results, which by all accounts revealed a rather "normal" family man. I had observed his supportive wife and children who visited often and his 9-to-5 work life as an accountant, which appeared rather normative. My conclusion was that in the case of Mr Perry, stress could not be the culprit. By the end of the post conference, everyone concluded that I had missed some dark secret; some unrevealed stressors that were the precipitating factors in this case. My instructor predicted that I might get better at "interviewing" once I had completed my psychiatric nursing rotation. I was embarrassed at the suggestion that I had failed to get Mr Perry to disclose. However, I was steadfast in my undisclosed belief that stress was not the cause of Mr Perry's ulcers.
Imagine my delight 20 years later, when 2 Australian researchers, Marshall and Warren, determined that a bacterium, Helicobacter pylori, was the cause of 90% of peptic ulcers that could be easily treated with short courses of antibiotics instead of surgery.1 I was vindicated from that embarrassing post conference at last, but more importantly, I had renewed respect for the profound importance of evidence rather than soft, untested theories, in determining the cause and course of illness events. The term "holistic" means that biological, psychosocial, spiritual, and cultural factors should be given equal consideration in crafting care and intervention. Considering lifestyle and stress as the primary drivers of illness can be a subtle form of discrimination, of blaming the victim. So, the next time the patient's experience of illness does not fit the prevailing theory-keep an open mind. There may be undiscovered evidence that will lead to an uncomplicated intervention, and what can be more holistic than that?
-Gloria F. Donnelly, PhD, RN, FAAN
Editor
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