Patient: "Bill" (name changed)
Age & bio: 69 year old retired teacher, married, 5 adult children + grandchildren
Presenting Complaint 🌿
Bill came in this week with pain down his right leg. Usually, it’s his left side that bothers him, so this was a change. He’s been living with chronic back pain for more than 30 years, following an injury that eventually led to an L5–S1 fusion.
When I asked what he’d been up to, he told me he’d been changing tires for someone who needed help. And as he started telling me the story, I recognized something we’ve come back to many times: Bill had said yes to more than his body could comfortably manage.
Let me tell you a little about Bill, because you may have someone like him in your own practice.
Clinical Course đź©ş
Bill is a lovely man. He’s kind, thoughtful, active in his church, and always ready to help. He’s the person people call when they need a favour. The trouble is, those favours often turn into physical labour, driving, or responsibilities that are far too much for him.
Even his original back injury happened while he was helping someone. More than 30 years ago, he helped move a piano at his church, taking on a heavy job he wasn’t equipped to do. That injury led to surgery and decades of pain that still limit his daily life. And yet, when someone needs something, he’s still ready to step in.
He’s also been through an extraordinary amount medically. Bill was born with a heart condition and recalls being told he might only live to around 40. He’s turning 70 this year. Along the way, he’s had more than 14 pacemaker-related surgeries, an aortic aneurysm repair, and, most recently, radiation for prostate cancer that his medical team was certain had metastisized. He reports that he’s now in complete remission.
His faith is a big part of his life, and I do wonder how it helps him hold onto hope through all that uncertainty. I'm certain Bill believes that his faith was a significant factor in why he was able to recover so well despite the initial medical prognosis.
Bill recently moved to a new community, away from relationships where he was often being taken advantage of. Obviously this became a wonderful opportunity for a fresh start. But already, he’s finding himself in some very familiar situations.
Back to the tires. This was a friend of his wife’s who had recently separated from her partner. She thought her ex had deliberately damaged them. So there was a whole story surrounding the flat tire, with plenty of urgency and drama, and there Bill was, right in the middle of helping.
While I was treating him, I mentioned how much drama seems to come with these situations. And he told me he loves the drama. That was the part of our conversation where the flags went up.
Clinical Reasoning 🤔
I found myself wondering what he gets to feel when he steps into these situations. Useful? Needed? Involved? My sense is that helping gives Bill something that matters deeply to him, and perhaps the drama makes that feeling even stronger. That’s something I’d want to explore with him, rather than assume I already understand.
If saying yes feels good right now, it makes sense that the physical cost might get pushed into the background. Someone needs him, and he can do something about it. The pain comes later. So “Bill, you need to stop doing so much” probably doesn’t get us very far on its own.
The move is interesting to me, too. He’s changed communities, but he still seems to be finding his place by becoming the person who helps. And I'm left asking myself, how do we support him in feeling connected somewhere new while making room for what his body can actually manage?
Of course, the right-sided pain had some fairly obvious structural aspects to it and given my structural findings - rotated lumbars, and a right on left SI joing the tire story makes a lot of sense for the pain he's experiencing. But I also wonder if the right hip, the part of the body that moves us forward, typically with action, isn't just telling us what the core issue is - someone seeking to use action, any action (familiar action) to "move forward".
The Outcome âś…
The flags for me was Bill saying that he enjoys the drama. That's actually a really concrete place to start when wearing our emotional anatomy hat. That gave our conversation somewhere useful to go. I could be curious about what draws him into these situations, and what he enjoys about being part of them.
I don’t yet know whether that conversation will lead to different choices or a change in his symptoms. For now, it’s at the very least an opening to explore how he can keep that sense of purpose without asking so much of his body.
Emotional Anatomy Reflection 🪞
This is where I keep coming back to the heart as a metaphor for giving. It sends blood out to support the rest of the body. And when I think of Bill, I can see why that image resonates: so much of his attention and effort goes toward looking after everyone around him while oftentimes ignoring himself.
But the heart needs its own blood supply, too. Its coronary circulation supplies the very muscle doing all that work. Even the heart depends on receiving support.
So something to sit with: how is the person who gives so much being cared for? I’m using the heart here as a metaphor, not suggesting that Bill’s generosity caused his congenital condition, aneurysm, or cancer.
What I do see is a man who keeps putting his body into situations that ask too much of it. He wants to help, and that desire seems to take priority over what he has the capacity to give.
I wonder how much of Bill’s sense of value is tied to being needed. If you’ve spent your whole life being the person everyone can count on, what does it feel like to say, “I can’t do that”? There may be a lot wrapped up in those few words.
That’s where I think we can be helpful as practitioners. We can get curious with someone about ways to stay involved that feel good and are physically manageable. For Bill, that might mean helping arrange roadside assistance or keeping someone company while they wait, with someone else doing the lifting and changing the tire.
And underneath all of that, I’d want him to know that we can enjoy his company and value who he is even when he isn’t doing anything for others. He deserves to be cared for on an ordinary day, too.
Clinical Pearl 🦪
When someone keeps overextending themselves, get curious about what saying yes gives them.
You might start with: “What do you enjoy about being the person people turn to?” Then, “Is there another way you can help while making this easier on your body?” This leaves room for the good that helping brings to someone’s life.
A small thing I asked him to try is a pause before the next yes: “What can I comfortably offer here, and what needs to be done by someone else?” For Bill, that could sound like, “I can help you arrange it, but I can’t do the physical work.”
The hope is that caring for himself he can help others, not through his doing, but through his genuine, kind and generous demeanour.
Reflection Question ✨
For your patients, or for yourself: If you were unable to help anyone today, would you still feel worthy of care?
💛Geneviève
PS. Please feel free to share your thoughts/comments below or bring it to the community. The community space is like a lab- a place where we can share these kinds of observations and get feedback on your real cases! And if you don't quite get how the community piece works just reply to this email - I'm happy to help!
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