“The high and only mission of a physician is to restore the sick to health, to cure, as it is termed.”
Easier said than done, Dr. Hahnemann! But of course challenges are great opportunities to learn and learning is a continuous process at the New York School of Homeopathy. I am a 4th year student and I have just completed two years of clinic work which encompassed case taking, case management, and case analysis. I am learning to recognize and select the important words and themes that will guide me to the correct remedy.
There are times when my remedy selection is close to what is prescribed and that gives me great satisfaction, but then there are those times when my selection is so disparate that I get discouraged. However, often after the class discussion I end up thinking that the correct choice was pretty obvious and I wonder “what was I thinking?” That experience in itself is a big part of the learning process.
Remedy selection is not always an easy process, as the case below will illustrate. Nevertheless, there is always beauty in seeing the correct remedy finally work.
This case was initially taken in 2006 by a 4th year student homeopath, supervised by Susan Sonz. It was taken in a traditional style and analyzed using big ideas and the repertory.
Several short forms or punctuations might be used throughout the case. This NYSH legend below explains their usage.
P = The client
CAPITAL LETTERS= The homeopath’s questions
My comments are in [square parenthesis]
HG = Hand Gesture
SD = Spontaneous Denial
bold Indicates significant statements made by the client
CONF= confluence or repeated idea
Pat has been a patient at the NYSH clinic since November, 2006. She was 16 when she first visited. She is a large girl, rather overweight but quite pretty. She is an only child and is very close to her parents. They are a very religious family. She does not indulge in partying or clubbing.
Her chief complaint is severe swelling (edema) in her feet and ankles, worse on the left. The morning would start with little or no swelling and as the day progressed the swelling got worse. She wanted to study hard and do well and get good grades. She expressed a desire to become more independent. She did not exhibit any anxiety of health. She was concerned, though, about getting her work done. Her main concern about her swollen feet was that she couldn’t wear nice shoes. She said, “I like having fun!” and when asked what fun meant she said, “reading the dictionary and learning new words”.
Using big ideas, supplemented by rubrics, the class decided on Calcarea Carbonica. She seemed very mineral like, and the big ideas matched those of Calcarea carbonica; she was careful, cautious, studious, and hard working, and she had edema, a famous symptom of that remedy.
She started with a 30C potency. There was some impressive relief which did not last. She was given higher potencies, 200C, 1M and even daily doses of lower potencies, over the course of a year and a half. The pattern was the same; she would get rather impressive relief that would last days or sometimes weeks and then swelling would return. When the swelling returned it was always with the same intensity.
The class re-took her case in April, 2008. Her concern regarding the swelling was that she could not ‘wear different kinds of shoes’ and ‘it cramped her style’. She was uncomfortable because her ‘feet felt pressed down’ in the shoes. She wondered if it was a ‘chemical imbalance’ in her body. She wanted to look good and ‘fit in’ with others in school. She felt trapped like in ‘quicksand or mud’. She wanted to break through her shell, her shell was a ‘container’. She said, “A shell is like a womb – it protects you from certain things. As I’m getting older I want to get away from being cramped up and grow”. It feels like I’m just stuck in a container of protection. I don’t need to be contained much longer”. She wanted to ‘pop out’ and this would be ‘rejuvenating’ and she could then ‘face the world’. She even said, “my friends say my mom and I never cut the umbilical cord!”
These big ideas still suggested the mineral kingdom but now indicated the 2nd row with the idea of Separation as described by Jan Scholten and Rajan Sankaran, along with the idea of the 3rd row Relationships. She was given Borax 200C, which is a compound of Boron (2nd row) and Natrum (3rd row). Every now and then the swelling in her feet went down, but it always returned. She went through various potencies and was given Boron as well. The class finally decided to go back to Calc Carb since that had worked the best so far.
Pat again took Calc Carb in varying potencies for a few months. The pattern was the same. The effect would not last.
She returned to the clinic in March 2010, when I was part of the clinic class. Pat’s case always looks the same essentially, but she emphasized some different ideas each time. At this follow up she spoke a lot about pressure. She was tired from studies and being tired was a lot of pressure. What she worried about was ‘doing well in class, wanting to get better grades’. And she needed good grades because, “it means a career, an internship. I am taking accounting so I have to have grades to back up my credibility”.
She goes to City College and still lives with her parents. She spoke about her Mom being afraid to let go of her and that her mom had “some sort of control over me”. She said, “She doesn’t try to mentally control me or even physically, and she’s not holding me down” (SD). When we asked about holding me down she went on to say, “Like someone sitting on you, like a person trying to get up and you force them to sit down, with a lot of pressure“.
She then spoke about free will and choices, “free will is so many options, the opposite would be a black and white cookie cutter- fixed.”
P: “Fixed is stable and the opposite is unstable. Unstable feels like I can’t cope with it, can’t depend on it. It’s like in chemistry if elements got combined with wrong ones they could blow up. Chlorine is unstable and Oxygen is stable.
Unstable is also like a building falling because something may add pressure or something inside makes it weak. Something inside the structure or something outside might be pushing or poking.
Buildings needed a stronger structure, or would collapse under pressure. Worn down elements of the building may be without pressure and can stand but if there is too much rain or if there is too much pressure it will collapse. This pressure is something constant, something very heavy, constant wear and tear. Constant pressure in one place.”
We again had no doubt that Pat was speaking from the mineral kingdom. She was duty bound; she needed to do her tasks and work and do well. We went back to the 4th row Security and Task and she was given Kali Chloricum and then Kali Muriaticum. Neither of these remedies affected the swelling in her feet.
We saw that Pat did show a lot of the 4th row ideas about ‘security and task’. But she also spoke of the issues of the 2nd row. A salt of the 2nd row and 4th row still seemed indicated and in fact one had worked for her before; Calc Carb.
There was something about Pat that was strange. As she got older, the lack of anxiety about her health seemed even stranger. She would sound almost bored during her interviews. Her mother had undergone treatment for breast cancer. She did not show much emotion about that, in fact, there was a kind of indifference about it. She was more concerned with the issue of how would the bills get paid. She said that she tried not to think about it and was not worried.
This ‘disconnected’ and ‘insensitive’ characteristic about her was puzzling. She does not seem callous to other people, it was more like a strange practicality or lack of expressiveness. She was emotionally “smooth” – nothing really ruffled her. A typical Calc carb would have been very worried about losing her mother. The class was looking at remedies from rows 2, 3, 4. We were all theorizing at this point, and feeling rather desperate and confused. Some cases are difficult, especially if ‘well chosen remedies do not work’, or have worked in the past but no longer. It is tempting to theorize when selecting mineral remedies because mineral remedy people often use ‘human specific words’. We found that we had really gotten caught up in our theories.
Luckily, we had done a previous homework assignment on rock remedies (yes our dear teacher, Susan Sonz, assigns homework; we moan and groan, but we learn).
The provings on Limestone and Marble do describe a similar indifference. It is not detached like a gas or like a drug remedy, but can look expressionless or indifferent.
Pat’s lack of anxiety and emotions and very matter-of-fact way of speaking about everything sounded like that. She is very pleasant to talk to but does not appear to have a connection with things that would normally cause concern in others. She needs good grades because she just does. She needs a good job because ‘that’s what you do after college- you get a good job.’
DO YOU HAVE CLOSE FRIENDS?
P: Not really, I don’t talk about family to anyone. I have a friend from high school who I sometimes talk to but I never really express that much. I’m more the one who listens. Friends call me, sometimes with a problem or if they are excited about something, I’ll listen. I’m always the one to listen. I wouldn’t confide everything. But I’m always there and willing to give advice, I’m caring, reliable, available.
A rock is made up of 2 or more minerals. Limestone and Marble are primarily calcium carbonate. Limestone is sedimentary and Marble is metamorphic. When the earth’s crust moves, it causes rocks to get squeezed so hard that the heat and pressure causes the rock to change. Marble is an example of a sedimentary rock that has been changed into a metamorphic rock.
The pressure experienced by a rock during metamorphism is due to the weight of the overlying rocks.
Even the purest of the metamorphic marbles, contain some accessory minerals, which can form a considerable proportion of the mass.
With all the mention of pressure we considered a metamorphic rock, Marble (lap-mar-c). The remedy has been made from white marble from the Inagh Valley, Ireland, (proving by Nuala Eising).
Marble is known for its decorative appearance and strength.
The marble proving, done by Eising, brought forth the following themes:
- Feeling attractive
- Feeling pleasant
- Calm and clear
- Anxiety about future
- Emotional coldness
- Self centered, selfish
- Indifference toward welfare of others
- Demanding, but in a quiet manner
- Dreams of escape, dreams being pursued
The most interesting symptom in the proving for us was about ‘feeling attractive’. Pat’s biggest complaint about her swelling always centered around fashion and wearing stylish shoes.
These are some words from the proving about the indifference that seemed to fit well:
” I noticed a real couldn’t-care-about-anyone attitude. It’s hard to describe. Like I’m so self-contained – why should I care about you?”
That reminded us of Pat’s comments about her container, her shell. There are three ‘indifference’ rubrics under marble, and these seemed to fit the case as well. A few of Pat’s dreams were about escaping from a situation and the proving showed similar dreams.
We were still theorizing and we knew it, but we had to try something so we decided to try marble. She started with 200C and after two doses we went to 1M. The first time she took a dose of 200C she said the swelling came down in a couple of hours. After a few repeats of 200c, 1M was prescribed with the hope that the amelioration would last longer. It did, and so for the past eight months Pat has been taking a monthly dose of marble 1M.
So the far the swelling in her feet has stayed down. Sometimes there is a mild swelling/puffiness towards the end of the month and when she repeats the remedy, it goes down. There has also been noticeable change in her connection with people, her job, and her attitude toward her studies.
In recent follow ups she has mentioned ‘I like interacting with people, I have been able to break out of my shell’. About school she said, “I feel I want to study it (the subject) and am not just doing it for the grade”, and about life in general, “I have opened up, my personality has opened up”.
This has indeed been a very difficult case and, in fact an odd case for us to present here. But it is an honest account of how confusing some seemingly clear cases can be. Because the proving of Marble is relatively new and therefore, not well-represented in the repertory, this could not have been a successful repertory case. It seems that in this case, we needed to theorize. We needed a remedy that was like Calc carb but made under pressure.
We are learning in class to try to keep it simple and recognize the patient’s actual experience, and then stick with it. It is often challenging to recognize the experience and keep that focus, especially in mineral kingdom cases where they speak of very human concerns like work and relationships. We are learning to give importance to the patient’s words that show the real experience, and if we do, we can then use any system for analysis; repertory and material medica, big ideas, kingdoms and groupings, or sensations.
The Calc Carb appeared to fit well. But because it did not work deeply enough, we went in other directions that all seemed to make sense. We finally arrived at Marble which seems to be working for Pat on a much deeper level. We will see how the remedy holds up for her as time goes on.
This case really put our clinic class to the test. But with serious, persistent effort from all the students, and with Susan’s continued guidance, we were able to come to a collective understanding of Pat’s case and choose a remedy that seems to be working well for her. This was a tremendous learning experience for all of us.
This is a great article!
I love the way your class (and tutor) kept at this case until you found the correct remedy to bring down the swelling. When Calc Carb didn’t work I would have thought of a nosode – was this considered? It probably wouldn’t have helped of course…!
We learn most by our mistakes don’t we?
Thank you for sharing this case.
Rhóda Uí Chonaire (Ireland)
I am readng a case of Lap Mar C from Louis Klein and considering it and Granite of Nuala Eising…brilliant collaboration and if we could all work that way would continue in spirit of Proving Union of Hahnemann thru to todays cross fertilization work of our modern day masters…love Nuala’s way of dreaming her provings into existence and this too is more collaboration – of subconscious realm being joined with our reality to bring rxs into existence. Tx for this case and hope now your practice is continuing in same way…evolving beautifully. Best, Laura