Narrative Medicine Monday: A View from the Edge

Dr. Rana Awdish is a critical care physician turned advocate for training in compassionate care following her incredible near death experience in her own hospital. Her essay “A View from the Edge” in the New England Journal of Medicine provides an overview of her 2008 experience as a critically ill patient cared for by her colleagues.

In her book “In Shock,” out this October by St. Martin’s Press, she outlines her harrowing near-death illness and recovery. I’m eager to read Awdish’s book and hear more about how her experience led to advocacy for “compassionate, coordinated care.” In her NEJM essay she describes how “small things would gut me. Receiving a bill for the attempted resuscitation of the baby, for example…. A trivial oversight, by a department ostensibly not involved in patient care, had the potential to bring me to my knees.” After recovering, Awdish channels her grueling patient experience into a drive to transform the way we receive and provide medical care. She contends “we need to reflect on times when our care has deviated from what we intended — when we haven’t been who we hoped to be. We have to be transparent and allow the failure to reshape us, to help us reset our intention and mold our future selves.”

Writing Prompt: Have you noted an erosion of empathy among medical providers? If so, think of a specific example and write about how you felt as the patient. If you’re a medical provider, have you ever been cared for by colleagues at your own hospital? What was it like to be on the “other side,” as a patient? Did you come away from the experience with new knowledge and empathy that you then incorporated into your own practice? Write for 10 minutes. 

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Free Write Friday: Candy


Her favorites were just candy canes, really, root beer and cherry, ribbon of contrasting color twirled around the candy stick. She liked how they were organized by flavor into sturdy glass jars, fanned out, as if leaning, calling to a child’s eager hand. She’d struggle with the wrapper, ask a parent for help. She was the type of child to keep the wrapper on, roll it down slowly, avoid sticky fingers and prolong the treat by keeping it intact. She never bit into a Tootsie Pop until the last minute, resisting the final satisfaction of the chocolatey core. 

She liked Smarties, similar to Sweet Tarts. Smooth discs of sugar cradled on her tongue, easy to savor incognito. She could keep a roll in her pocket, swing across the monkey bars and pop another in her mouth. Portable and practical. Anything gummy was appealing too: severing bear’s heads with her tiny teeth, the novelty of a cola flavor in chewy candy form. 

On Halloween she’d sort her sweet lot, save the best for last. Some years she waited too long, and the prized candy bar would be lost or forgotten. She was good at self-discipline, sometimes to a painful fault. Her best friend’s mother rationed their Halloween candy, doling out one treat a week. It lasted her well into the other holidays, Thanksgiving and Christmas peppered with the distant memory of a costumed past. 

She never liked Snickers, any nutty interruption to the palate seemed intrusive, unwelcome when enjoying a sweet. Instead, she preferred caramel, coconut. Almond Joy and Mounds, 100 Grand and Three Musketeers. She knew this wasn’t a popular opinion, that she should prefer Snickers like all the rest. 

She watched Willy Wonka & The Chocolate Factory in awe, wanted to float via Fizzy Lifting Drinks with Grandpa Joe, savor an Everlasting Gobstopper, dance with the Oompa Loompas, search for a golden ticket with the rest of the world. Years later, she’d visit Harrods’ shiny Candy Store in downtown London, stroll through the sleek abundance of Disneyland’s Main Street Candy Palace. Even as an adult, she’d savor the innocence in indulgence of pure sweetness, find comfort in an overwhelm of treats in a world that often runs sour. 

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Narrative Medicine Monday: Wernicke-Korsakoff

Poet and medical student Sarah Shirley describes an evolving interaction with a patient in “Wernicke-Korsakoff.” The patient initially finds complaint with everything: “the too soft too hard bed, the lunch that came with only one spoon though clearly two spoons were required.” Shirley struggles to connect with the disgruntled patient, who clearly wants nothing to do with her as an intrusive medical student.

Throughout my medical training and career I’ve encountered patients, like in “Wernicke-Korsakoff,” where “everything is thrown back.” They were angry at their disease, angry at the medical providers, angry at the system, angry at the world. At times, I’ve been one of those patients myself. There’s no doubt health and illness affect our mood. Many of those who are suffering build a shell to cocoon themselves off from the damaging world. Often they are rightfully skeptical of a medical system that has many failings. Shirley finally breaks through to her patient in the end, after searching for the right connecting point. 

Writing Prompt: Think about a time you were sick. How did being ill affect your mood and interactions with others? Were you inclined to cling to others for support or did you find yourself “raging against the world?” Perhaps you experienced both. What about a time when you were caring for someone who was sick? Did they allow you to connect with them right away or was it a struggle? Write for 10 minutes.

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Free Write Friday: Camping


We move by the light of the skies. Time untethered to seconds, minutes, hours. 

Shadows cast onto nylon tents, faded grays and greens meant to blend into earthy surroundings. Toothpicks of trees stretch heavenward, branches and bark punctuating a pale sky. Bikes laid flat on their sides, like fallen dominoes, line the campsite. Brightly colored helmets are scattered asunder. 

They grab their bikes and pump legs up the hill to the playground nestled in the trees. They twirl and slide, climb and spin, dust rising underfoot. Teeth bared, faces upturned with glee, taut with playful exertion.

They return to home base, tumble in the dust, twist in the hammock, balance on the yellow slack line situated between two sturdy tree trunks. Footprints of sneakers and toddler Crocs pepper the campsite. Dirty feet, caked with dust, the reminder of an earth long forgotten by more bourgeois days spent indoors: at school, at work, at homes walled off from such grime. Here, we can’t get our feet clean, no matter a 3 minute token shower, no matter a towel wiping down, no matter a dip in the cold ringing canal, uneven stones and oyster shells underfoot. Still the dark mark of filth between toes marks us. 

Down at the water they zig-zag across the rocky beach, search for colorful stones, treasures of abandoned sea creature skeletons, slimy seaweed. Our backs align straight in the kayak as we glide through the seafoam green toward the hazy hills beyond. A little one dips an appendage or two in the water, leaning from the front unexpectedly as I struggle to stay balanced and centered on the stand up paddle board. 

A burn ban has a dampening effect; we gather around the citronella candle as the skylight fades, skin graying to ashen. Headlamps alight, artificial and glaring. Canvas camp chairs unfold around the would-be campfire. It’s too dark and we succumb to the arc of the heavenly bodies, one seceding as the other takes reign in the sky. 

Camping is a children’s glory: timetable discarded, dirt embraced, leisure activities and food prevail unencumbered. They chase each other through the brambles, swing gleeful in the hammock, unearth large stones to discover tiny crabs frittering sideways, eager to find a new hiding place. Grime accumulates under their fingernails like dust clinging to the mantle at home. It marks them unconcerned, free from the shackles of the modern urban childhood of after school activities and rationed screen time. 

We wake to birds rustling, charcoal light reversing gray to green to sky. I arise despite myself, soak in the soreness of my bones. The light, the earthen air call me to get up, get out, move myself into the surroundings I was meant to inhabit.

We move by the light of the skies. Time untethered to seconds, minutes, hours. 

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The Summer Day


I’m camping with family today so taking a hiatus from Narrative Medicine Monday. Instead, enjoy this classic poem by Mary Oliver. May you be “idle and blessed” this summer day.

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Free Write Friday: Jewelry Box


On her tiptoes, she sneaks, carefully slides open the tiny drawers of her mother’s bedroom armoire one by one. A musty wave rushes toward her tiny nostrils, itching at excitement of fanciful objects just within reach. Each item considered carefully, she knows her favorites. 

She likes the amber shine of a pendant necklace, smooth oval jewel in her tiny hand, silver links slipped over her neck. The scarves slide through her fingers, smooth as the silken tofu her father slurps with his morning miso soup. A similar disjointed juxtaposition, her own squat neck against the designer scarves, printed floral, geometric navy and regal red. The clip-on earrings hang heavy on her tiny lobes, faux jewels shine just as bright as the real thing to her undiscerning eye. She is suddenly transformed: bejeweled, an empress, a queen. 

She wonders why her mother never adorns herself, with all these treasures at her disposal. If it were her (it will be her) she’d drape herself in accoutrements, dazzle with accessories daily.

Years later though, despite an endless array of accessory options, she wears minimal makeup, stud earrings, her wedding ring only most days. She inherits her mother’s designer scarves, her grandmother’s antique beaded purses. But, like her own mother, she learns to cultivate other treasures, she finds different priorities in her daily routine. 

She looks at her own young daughter and wonders: why the obsession with adornment, with makeup, with appearance? Her daughter watches in amazement as she puts on mascara, mimics her intently as she applies blush, begs to wear a shiny statement necklace around the house, strutting in her plastic high heels. 

Maybe we all want to appear to be more than we are sometimes, live into our imaginations. Maybe it’s okay, even necessary, to try on different, more glamorous selves. Maybe that’s part of growing into, and revealing, who we really are.

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Narrative Medicine Monday: #3 In Line

Eliza Callard imagines a lung transplant in her vivid poem “#3 In Line.” She begins by describing the surgeon’s actions lifting “the sodden lungs out,” but then pauses to wonder about the patient: “Where will she be for all this?” Callard touches on the desperation following any transplant to get the foreign object to “stay, stay,” to trick a body into accepting an imported organ as one of its own. 

Writing Prompt: Imagine an organ transplant: liver, lung, kidney. Write about the transplant from several different perspectives: that of the patient, her body, the transplant surgeon, the patient who donated the organ, even the organ itself. Write for 10 minutes. 

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Free Write Friday: Lockers

You have nightmares about lockers. Narrow gray sheets of metal from ceiling to floor, endless rows line the halls. You circle the maze of corridors. You’re turned around, pressured, panicked, late. You can’t find it at first, the one that belongs to you. You pause at one, then the other: all wrong, all empty. 

Others watch you, they laugh. Or, worse yet, they ignore you. You’re insignificant. If you finally find what you’re looking for, it’s shut, impenetrable. You spin the lock to the right, to the left, to the right again. The white notches of the knob blur and you realize your numbers are wrong, it’s all wrong. 

Something’s off, you can’t remember. You missed whole assignments, entire courses, a full year of your life passed by all wrong; you forgot to pay attention. You rush for help, but it’s no use. You can’t recall time and now it’s too late. You won’t resign yourself to fate, so instead you struggle. You keep spinning the lock back and forth, back and forth until it clicks open. But it doesn’t matter now. Instead of relief you feel grave, an ominous weight when you unlock what you’re looking for. The moment, the urgency, the purpose, it’s passed you by. 

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Narrative Medicine Monday: An Expert in Fear

Author Susan Gubar writes about cancer making her “An Expert in Fear” in her timely essay. She asserts that this anxiety has become more acute in the recent political climate, with debates about major changes to healthcare, Medicaid and insurance coverage in the forefront of our national discourse.

Gubar contends that cancer fears fuel other fears and that cancer patients become “experts in fear.” If you’ve dealt with cancer, has this been your experience? She also highlights the detrimental impact fear can have on our health, and that severe financial distress has been found to be a risk factor for mortality in cancer patients. Gubar feels there is no appropriate word for the dread she experiences today. It is a “fear of fear spiraling into vortexes of stunning trepidation” and has, in fact, become all-pervasive and metastatic. 

Writing Prompt: What fears do you harbor related to health and illness? Have you found that the political climate impacts that anxiety? Do you agree with Gubar that fear is pervasive in today’s world? Write for 10 minutes.

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