Free Write Friday: Current


I was a cautious child, hesitating to do anything that might jeopardize a fragile status quo. But I grew up spending my summers on the beaches of the north shore of Kauai and grew comfortable with the fickle ocean, the swells of the sea, the ebb and flow of the tide.  

In the afternoon sun I could float on my body board for hours, waiting to catch a wave. I got to know the patterns of the ocean; a swell would come and I could predict if and when it would crest, white foam spilling over onto itself. I could anticipate if the swell would falter, just a tease of a wave really, petering out before it reached the sandy shore. 

Sometimes I’d get lost in my own reverie, daydreaming with the hypnotic rise and fall of the waves. I’d look up to realize I was far from my mom on the shore who was pretending to read a book. A worrier, like me, I suspect she was always half watching us rather than lounging, making sure we weren’t caught in a current or by a wave we couldn’t withstand. 

Sometimes her arms would flail back and forth over her head, like windshield wipers, her miniature form signaling from a distance. Maybe it was time to go, head back to the condo to wash off the sand that stuck in nooks and crevices of sunburned skin or was trapped beneath the mesh lining of my Lycra swimsuit. Or maybe she had noticed all the swimmers veering off to her left or to her right, a strong current carrying away her babies in tow. She’d put down her unread novel and signal us to the safety of the shore. 

A momentary flash of panic, my mother’s voice echoed in my head that it was better to swim parallel to the shore, not directly perpendicular, if caught in a riptide or strong current. Not the most direct route, it seems counter intuitive, but it’s the key to safely reaching solid ground. I’d heed her advice, tanned arms pumping overhead, one after the other, slowly carrying me back to white sands. 

When I reached the shore, my feet on solid ground, and looked back at the water it all looked so innocuous, so unassuming. But the metal warning signs posted on sturdy rods stuck deep in the sand and my mother’s furrowed brow admonished: don’t underestimate its power, be careful. If you’re not, it might just carry you away.

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Narrative Medicine Monday: County Hospital Residents

Abby Caplin’s “County Hospital Residents” profiles immigrant physicians, re-training in an American residency program. Caplin’s poem begins with the more general–where a physician is from–and contracts into the more intimate details, the sequence of events that brought this person into this profession far from home.

Writing Prompt: Have you encountered an immigrant physician as a patient or through your own medical training? What was their story? Imagine leaving your home country to practice medicine and live your life elsewhere. What would be the greatest challenge? What does the diversity and experience of immigrant physicians bring to our medical community? Write for 10 minutes.

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Free Write Friday: Spoon


He carries the spoon everywhere, has for the last few weeks. It’s a wooden spoon, sturdy and stick-like, good for digging and rapping along a concrete wall on the way to preschool. His constant companion, the spoon is good for a lot of things.

He has an affection for the spoon, like he does his cozy blankets or baby sister. The spoon can’t be left at home without an uproar. It accompanies him to bed for naps and nighttime, it rests on his lap for episodes of Octonauts, it’s enclosed in his hand when he’s having his diaper changed or in his car seat, it lays in front of him when he’s brushing his teeth or eating his yogurt.

He knows never to use it to hit others but he brandishes it enthusiastically, swinging this way and that as he gestures emphatically telling animated stories. It’s become an extension of his upper appendage. I have to remind him to not accidentally knock his baby sister on the head. It’s been a magic wand, a shovel at the beach, a fishing pole, a drumstick, a golf club. 

He’s had obsessions before: rope, treasure maps, kites. But the spoon in its simplicity, its practicality, has staying power. It stirs, it points, it protects. It’s a tool, it’s a weapon, it’s a musical instrument.

The spoon is a steady, sturdy companion to rely on; I can see why he keeps it by his side. I know at some point he’ll move on to his next obsession, the next important thing in his singularly focused world. But I suspect he’ll always remember this ratty spoon fondly, and treasure it as so much more than it seems to be. 

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Narrative Medicine Monday: Dinosaurs

Ophthalmologist Maria Basile writes of the evolution of surgery in “Dinosaurs“, part of the Poetry and Medicine column in JAMA. Her poem reflects on innovations in how surgery is performed and is a commentary on the constant churn of medical reinvention. 

Have you or a loved one personally benefited from a recent medical innovation? Can you think of something important that might have been lost through adopting a medical advancement? Also consider the challenges posed by some new medical procedures and breakthroughs. When kidney dialysis first emerged as an option for treatment of kidney failure and there was very limited availability. Decisions needed to be made about who would receive this treatment. Sometimes a medical innovation raises unforeseen and difficult ethical challenges. 

Writing Prompt: Think back to when you first started medical training. How has medicine changed since that time? What were considered the greatest innovations or bioethics questions of that time? What are they now? Alternatively, think about what was considered a medical marvel when you were a child. How is that innovation viewed today? Write for 10 minutes. 

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Free Write Friday: Band


We played musical chairs in the high school band, every few weeks had the opportunity to challenge the seat in front for a better position in the concert band hierarchy. The director limited the frequency of a challenge so it wasn’t an incessant churn. It was a matter of pride, a source of anxiety. On the designated day we’d draw slips of paper to tell us who would perform first. The challenged and the challenger would retreat to the hallway behind the band room for the sake of fairness, ensuring anonymity, playing the chosen piece, notes echoing across the linoleum floor. 

I played the clarinet because my older brother played the clarinet and I suspect my parents didn’t want to buy another instrument. So I was convinced that the clarinet was the only instrument I wanted to play. A practical choice, a safe choice, a non-choice. Easy to lug home as a fifth grader, enough compatriots to sink into a sea of black woodwinds. Disappearing was the thing you wanted as a preteen anyway. Some brave souls chose the French horn or the tuba, the cello or the oboe. The coolest kids played the drums or saxophone.

I did practice, was decent enough. No real musical talent but I could play with feeling. It got me far enough to be one of the first few chairs. I was challenged or challenging all the time. Sweaty palms, I’d retreat behind the heavy classroom door with my opponent, often a friend. Fingers slipping off the silver rings, compressing and popping in cadence. I liked to go first because I got it over with. I liked to go second because I could tailor my performance to the weaknesses of my opposition. I liked to win first chair; felt full of myself, a boost to my fragile teen self esteem. I liked to be second chair so I didn’t suffer the angst of playing solos in the heavily attended concerts. 

Now, decades later, I have nightmares that I’m supposed to play in a band concert and haven’t practiced at all, can’t read the music, don’t remember how to play a single note. I’m embarrassed, mortified I arrived so unprepared. I try to disappear into the sea of instruments, remain undetected. Instead I realize that not contributing to the wave of melody is just as problematic as inserting an errant note. 

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Narrative Medicine Monday: When Patients Mentor Doctors

When Patients Mentor Doctors: The Story Of One Vital Bond” tells of physician Aroonsiri Sangarlangkarn’s longitudinal relationship with a patient she comes to call a friend. The bond between them affects her views on what can be gained through understanding patients on a more personal level.

Sangarlangkarn first meets Roger as part of a medical school program that matches up aspiring physicians with geriatric patients who provide mentorship on medicine from a patient perspective. She then encounters him again after she has finished her training and he is hospitalized under her care. She reflects on the value of her deep knowledge of his personality and history.

I liked reading about Sangarlangkarn’s own lengthy description, written years prior as a medical student, of the patient’s social history. It included intimate details such as Roger’s parents’ names, his boyhood aspirations and his favorite board game. When I was a medical student I remember taking a very detailed history of a woman who was in the hospital for treatment of her malignant tumors. I spent over an hour with her, just chatting with her about her history. No physical exam, no review of medications. The final typed up document I turned into my advisor was over two pages long. Now, as a busy primary care physician, I, like Sangarlangkarn, can see how the emphasis on efficiency causes time constraint that makes it difficult to have meaningful patient-physician conversation that could contribute to helpful personal knowledge. Sangarlangkarn laments that “our interactions with patients have become so regimented and one-dimensional that we no longer get to know the multifaceted person outside the hospital.”

What do you think about Sangarlangkarn’s suggestion regarding the value of patient home visits? This is often done for patients in hospice care or who are unable to physically get to a clinic. Home visits because of the time they require seem much more costly to the system but Sangarlangkarn argues that the value – the ability to get to know the patient on a different level – provides invaluable information. She writes: “To effectively provide care for someone, it’s important to learn who they are, what they eat, how they breathe.” She, in fact, due to her detailed knowledge of the patient, is the only one who eventually can get him the end of life care and support he needs.

Writing Prompt: Think about a time you visited an ill person at home, whether that be an apartment, house or adult family home. Describe what you saw, what you smelled, what you talked about, how you felt. What do you think can be gained by entering into a person’s living space? Alternatively, consider a patient you’ve known for years, maybe decades. What do you know about that patient because of a longitudinal relationship that might be of benefit to you if you had to deliver bad news or discuss different treatment options or medications? Write for 10 minutes.

 

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Free Write Friday: Chair

I found the chair on sale at a furniture store on the Eastside. Strolling past birch bunk beds and white washed dressers, I pause to consider the price and design of each rocking chair. Tucked in a corner in the back of the large display room, I sink down in the buttery striped cushions, rocking gently in a natural way. A bonus! Pulling a concealed lever reclines the entire contraption; head back I can snooze, envision holding my first baby in my tired arms. 

*

A carefully orchestrated nursery in my parents’ basement bedroom, painted a gender neutral green. Mid-winter in a chilly basement, as a new mom I dutifully get up every couple of hours to feed my newborn, wearily lower myself into the reclining chair, sturdy in the corner. Freezing, chest uncovered, I shiver uncontrollably in the black hours of the night, hormones swinging hot and cold. I lash out tearfully at my unsuspecting husband, begging for space heaters to warm my weary body.

*

The chair fits two: a toddler and a newborn baby boy, story time for extra cuddles. It sits comfortably in the newly remodeled bedroom corner, flanked by a large window and floor lamp. We know better now, use it mostly for reading and rocking, not for middle of the night feeds. It’s still the most comfortable place to nurse, cocooned by cushy armrests, a gentle flex of my toes provides the soothing back and forth. I look out the window at our backyard, a hill of our city beyond; I look down and find my two arms full.

*

It’s wedged at the edge of the baby’s crib, a twin Jenny Lind bed frame lodged against the opposite wall. The two girls share now, eventually the oldest will turn preteen and retreat to the basement bedroom but for now she savors sharing space with her little sister. My youngest baby is almost a baby no more, a few short months and a toddler she’ll be. I savor the early morning and bedtime nursing, rocking gently in the dark quiet room. Occasionally the door bursts open with exclamations from my three year old about treasure maps, from my six year old brandishing school artwork to admire. My baby and I pause for a second, then resume the rocking, suckling. She gazes up at me through long lashes, wrapped in a patterned throw my grandmother crocheted of flowers and hexagons decades ago.

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Narrative Medicine Monday: Things My Daughter Lost In Hospitals

Toni L. Wilkes reveals her daughter’s illness journey through her poem “Things My Daugther Lost In Hospitals” in the journal The Healing Muse. I’m struck by how she alternates between the physical, tangible losses (“a pear-shaped gallbladder”) and the more unexpected costs (“her husband’s patience”). As a reader, I almost miss the surprising and heart wrenching losses, placed innocuously among the more conventional ones. I’m compelled to return to each line and deconstruct the poem, in search of these melancholy nuggets that reveal the true toll.

Writing Prompt: List all of the things you’ve lost or gained by being a medical provider. Alternatively, list all of the things you’ve lost or gained through an illness. Consider the concrete (i.e. money) and the more intangible (i.e. time). Write for 10 minutes. 

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Free Write Friday: Baby Food


She starts kicking her legs vigorously as I place her in the high chair, a physical exclamation at the excitement of an anticipated meal. I can’t get the candy-colored bib fastened to her neck soon enough, can’t assemble the tiny coated spoon or stout glass jars fast enough. She’s impatient for nourishment. 

There’s a pop as I twist open the jar of apples and blueberries, banana cinnamon oatmeal, sweet potatoes and chicken. Her legs kick again, pistons pumping. Her tiny mouth opens mechanically, a trap door to her gustatory system: open, shut, open, shut. She knows the loaded spoon is coming and the hatch complies. I know when she’s eager like this she’ll complain if I don’t shovel fast enough, if I don’t keep up with her hunger for more. 

If I feed her a taste she disapproves of there’s a pause in the rhythm, she considers for a moment and gives a tiny grunt. She might accept another small bite of the spinach and peas or grainy carrots. I imagine her letting it roll on her tongue but the texture or consistency or substance just doesn’t agree. So she’ll shove out her lower lip in defiance and reject the offensive flavor, sealing her mouth tight to reject the advances of my spoon. 

I quickly switch to an alternative option, a fruit I know she’ll accept: the old reliable apples or pears. A little dribble of saucy food on her chin, I scoop it up and into her mouth. This is a dance between us two, coordinated and practiced, we each anticipate the next step. It takes effort, these three meals a day. It’s messy and repetitive. I’m still nursing in between the solid food servings and the combination makes some days feel like my only job is to provide her sustenance.

I look at my two older children who shovel their own food, who can make their own pb&j sandwiches, who can take their own dishes to the sink and help unload the dishwasher. It won’t be long before this baby won’t need me; she’ll be able to feed herself.

I know when she slows her tempo, I can follow suit. Her legs stop pumping so frantically, her squeal of impatience subsides. She looks around the room, turns her head to the side, regards her siblings. I imagine her savoring the food a bit more carefully, considering what this mama of hers is providing, developing her own tastes, her own preferences, becoming the person she is.

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