Touro College Acupuncture Internship Program at Lutheran Medical Center

The Qi-Unity Report interviews Claudia Citkovitz

QUR: Please introduce yourself and tell our membership a little about your job.

My name is Claudia Citkovitz. I run the Touro College acupuncture internship program at Lutheran Medical Center, a community hospital in Brooklyn, NY, where we treat inpatients in the neurology, oncology, and labor and delivery units. We’ve also been doing research in these labor and delivery units for about two years now, and we’ve started a postgraduate training program there. We’re training our second cohort now with a third coming up in May, and after that we’ll look at cloning the program for other departments, probably neurology first, then med/surgery, behavioral health, and oncology.

QUR: How long have you worked in a hospital?

I just passed the four year mark, which feels like a milestone because that’s the amount of time most residents are there before becoming physicians.

QUR: Hospitals use a lot of tests. Is there anything wrong with using scientific tests to determine health?

Well, in public health in general there’s a procedural bias towards lab results that give you numbers on a printed page, so they’re deemed objective, versus practitioner assessment, which is inherently subjective. But I don’t think anyone would argue there’s any lab test that determines health per se. And that’s our greatest strength--as practitioners of OM we look at the big picture elements of health – are you running hot or cold, do you have enough qi, blood, fluids? Are they moving OK? These are the giant elephants in the room that really shape a person’s experience of being in their body as they go through their day, and all the more important when they’re sick. So our treatments seem to have a much closer relevance to quality of life than biomedical treatments.

QUR: Is “quality of life” something that can be compromised by the hospital setting?

Oh, my god, have you been in a hospital? It’s a nasty smelling, sterile, uncomfortable place full of sick people that gives you a stress response when you’re feeling fine, let alone when you’re sick and just want to be at home. Add to that, they take away your clothes, put you in a gown that doesn’t close in back, you share a room with a stranger and their family, there’s noise and fuss all night so you don’t sleep a wink, you hate the food, and even if you’re well enough to get out of bed there’s pretty much nowhere else to be. And you’re frightened. If your qi wasn’t in a knot when you got there, it will be soon!

QUR: Do you think the push to create a sterile atmosphere in a hospital affects a patient’s healing path?

Sure, but then so does a staph infection. It’s a question of what precautions are really reasonable and necessary. Like, for most of the women we work with in labor and delivery, they’re not sick, so I always try to tell people to bring a nightie they like and feel powerful and sexy in. I tell them there’s no need for a gown, and if they decide to go for an epidural they can always change. Or the rules about eating and drinking – the idea is to keep their stomachs empty to prevent vomiting and aspiration if there’s a C-section – but how many C-sections and complications happened because people got exhausted after 24, 36 hours in labor and no food? If you don’t study an outcome, you don’t see it.

QUR: How does affirming a person’s health influence labor?

Well, beyond affirming health, we try to actually promote it by taking a symptom as a sign of a constitutional imbalance and helping to rectify that. But even if you’re just talking about affirming it verbally, it’s crucial to remember that the flow of qi in your body is your emotional life, and vice versa. If you’re alone in the room with your partner and neither of you has ever done this before, how do you know how it’s going? A lot of your emotional energy goes into trying to figure out if everything’s OK or not. If there’s someone in there who can say, in all honesty, in 99.9% of cases I’ve seen a ton of labors and, honey, you’re doing a great job, you can do this. You’re affirming the health of her qi, her basic adequacy for this task, and she takes her emotional experience out of pensive mode, racing around trying to figure out if it’s OK, and just lets her body do what it knows how to do. The labor has its own qi flow, and it usually goes fine if the caregivers can just keep from interrupting it with interventions before they’re necessary.

QUR: Are you saying labor has its own qi-- its own morphology?

Gee, I guess I am. I take it as one of the fundamental understandings of OM that the universe is holographic, that you can look at any subset of it and see yin/yang and the five phases. In the hospital in general, they tend to show up really clearly – you see bright red tongues, or thick white coats like toothpaste, or a thick coat on half the tongue and nothing on the other. And it’s really clear in L&D because the main characteristic of labor is that once it’s going, it progresses, it moves. So you pretty much walk into the room, and you can feel if the labor’s going or not. And then if it’s stalled, or we work with a lot of women where it hasn’t really gotten going yet but for medical reasons they’re in the hospital and they need it to go, then you tease out what’s blocking the movement of the yang qi. Is the qi itself deficient, or is there stagnation blocking it, or damp? And then in the treatment, it’s not just what needles you choose, it’s also all the choices you make about what you say and how you use your voice: are you trying to move stagnation or nourish deficiency? With damp patients, for example, it’s much less important exactly what points you do than that you keep changing it to keep her from bogging down.

QUR: Do you think your work’s impact extends beyond labor? If so, how?

I think that having a negative or a positive labor experience really sets up your physical and emotional experience in those critical first days and weeks getting to know the new person in your life. It has to make a difference if you’re feeling completely shattered and beaten down by the birth versus if it was basically a positive experience and you’re tired but happy. I personally believe the birth experience needs to be better studied in relation to postpartum depression.

QUR: How does the way labor goes influence the likelihood of post-partum depression? Could you elaborate on that?

Childbirth is one of the most challenging things that a human being does, and when it goes well, like any challenge you meet and surmount, it builds you as a person. And also if you’re in a relationship, if it goes well, the partnership is immensely strengthened. It’s a great preparation for all the sleep deprivation and crises of parenthood. But when a birth experience is negative, it can be really bad. People question their own decisions, bad enough – if I hadn’t gotten the epidural maybe wouldn’t have had the C-section, if I hadn’t gotten the pain shot maybe we would have bonded better and he wouldn’t have ADHD – all of that. But also, it happens that in a particularly difficult moment a woman genuinely believes that she can’t do it, she’s not good enough, she’s not strong enough. Whatever her partner support and coping mechanisms are, in that moment they’re not enough for her.

In Chinese medicine terms, I’d say her shen are scattered. Usually the moment passes, and it just becomes part of the challenge that she overcame. But if that period of despair lasts a too long or if there’s a less than optimal birth outcome, I think that it has the potential to undermine rather than build a person’s sense of her basic capabilities. There are women called birth Doulas, who basically just hang out with you during your labor and help it to go smoothly and positively. It seems to me that acupuncture can provide a more focused version of that, where we’re using the understandings and techniques of Chinese medicine to keep the labor smooth on a physical level – pain relief, boosting contractions, helping dilation – and also on an emotional level.