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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Narrative Medicine Monday: Bedside Rounds

John L. Wright’s poem, “Bedside Rounds,” speaks to the apprentice-like training of physicians. It is a passing on of skills from the experienced to the inexperienced, from the knowledgeable to the clinically naive. Most medical students, unless they have a background in another medical field, have little to no real experience in the hands-on component of medicine. They take years of study – biology, anatomy, pathophysiology – and translate that book smarts into skills of diagnostic touch, suturing skin, prescribing treatment. 

One method of transforming head knowledge to a practical skill set is through bedside rounds: a gaggle of medical students and resident and fellow physicians (still in training) following after an experienced attending physician. Each morning this group travels from bedside to bedside, discussing the patient’s disease, the patient’s prognosis, the patient’s progress, the patient’s treatment plan. In recent years, medical schools have worked on making this process more inclusive of the patient who, after all, is the subject of the discussion. 

Wright’s poem touches on the experience of that patient, ill and incapacitated, being talked over in a cryptic language, determinations being made about the status and plan while the patient may still be steeped in a cloud of confusion. 

Wright finds himself in a comparable situation when his landscape architect brings her intern along with her one day. As this professional passes on her skills to her protégée, discussing his yard in detail, Wright begins to feel something he hadn’t expected: “I begin to resent them—the little games they play.”

Writing Prompt: Think of a time you’ve experienced bedside rounds as a physician, as a patient or while visiting someone in the hospital. If you were the patient, how did you feel when the medical team discussed your case in front of you? Did they include you in the discussion or explain what they talked about? If you’re a medical provider, choose a memorable bedside rounding experience: running rounds for the first time, being a brand new medical student, noticing something significant with the patient’s demeanor while their case was being discussed. Write for 10 minutes.

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Narrative Medicine Monday: Architecture of Mental Illness

This fascinating National Public Radio story by Susan Stamberg reviews an exhibition at the National Building Museum exploring the links between architecture and mental health. It outlines the history of Washington, D.C.’s St. Elizabeths Hospital, first opened in 1855 and championed by Dorothea Dix, a pioneering advocate for more humane treatment of mental health patients.

The article states that Dix “‘believed that architecture and landscape architecture would really have a role in curing people.'” Do you agree? Have you witnessed physical surroundings play a significant role, either positively or negatively, for a patient or loved one with mental illness?

Some of the photos included in Stamberg’s story conjure up a dignified 19th century hotel. Dix was a proponent of having beautifully manicured grounds and St. Elizabeths was designed specifically to have “natural light and views of the outdoors” and “heat, tall arched windows and screened sleeping porches where patients could catch summer breezes.”

Writing Prompt: Use one of the photos from Stamberg’s story as a writing prompt for a free write. Imagine you are one of the patients (or nurses) in the St. Elizabeths Hospital of the 19th century. How does the space make you feel? Alternatively, if you’ve visited or worked in a contemporary inpatient mental health facility think about the design of the place. How could it be improved on? How do you think the features affect the inpatients? Write for 10 minutes. 

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Narrative Medicine Monday: The Colostomy Diaries

With humor and candor, Janet Buttenwieser writes in “The Colostomy Diaries” about awaiting her gastrointestinal surgery and the aftermath that leaves her with a colostomy. 

I like Buttenwieser’s use of visual details, putting the reader in the room with her, receiving this disappointing news: “‘You’ll have to have your entire rectum and anus removed,’ my surgeon told me over the phone as I sat in my living room, an unread newspaper on the table, cherry blossoms blooming on the tree outside my window.” 

Buttenwieser faces difficulty getting the trash can she needs to dispose of her colostomy bags at work. The humiliating barriers she encounters illustrate the ridiculousness of much “beurocratic red tape.” After her surgery, she struggles with how many details to disclose about her sensitive change in physical status, even to friends. 

Buttenwieser’s candid anecdotes of everyday challenges post-surgery, such as shopping for clothes and dealing with an emergency malfunction of the colostomy bag while out with her small children, show why her new book Guts, set to be released in 2018 by Vine Leaves Press, is likely to be an entertaining and enlightening read. 

Writing Prompt: Think of a time you’ve dealt with “beurocratic red tape” in relation to a medical condition or the medical field. List all of the obstacles you encountered. Can you infuse some humor into the piece, despite the frustrating experience? Write for 10 minutes.

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Narrative Medicine Monday: Locked-in Syndrome

Pakistani bioethicist Anika Khan reviews Jean-Dominique Bauby’s remarkable story in her essay “Locked-in syndrome: inside the cocoon.” In it, she describes how Bauby, an editor of a prominent magazine who suffered a debilitating stroke, lived out his days entirely paralyzed but with mental clarity completely intact. Bauby’s only method of communication, and how he eventually wrote his 1997 book The Diving Bell and the Butterfly was by blinking with his left eyelid. He used a French alphabet provided by his speech therapist to painstakingly blink his way to communication with the outer world.

Khan relays some of Bauby’s remarkable insights into living in such a state and she also reflects on how medical providers need to take a “more empathetic look at the incapacity and helplessness experienced not only by patients with locked-in syndrome, but by analogy, other patients who have no way of giving voice to their experience of sickness. Often, patients become diseases, numbers and syndromes to healthcare professionals who have repeatedly seen illness and have lost the capacity to relate to the experiences of patients.”

Writing Prompt: Have you as a patient ever felt misunderstood by your medical provider? What were you trying to relay and what was the response that revealed to you the miscommunication? Think about your visceral reaction to this encounter. As providers, what specifically have you done to combat the risk of patients becoming “diseases, numbers and syndromes?” How do you maintain this empathy while still preserving some emotional boundaries? Write for 10 minutes.

 

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Narrative Medicine Monday: The Sink

Author Kate Ristau writes about her son’s heart surgery in “The Sink.” She starts the essay remembering her mother’s farmhouse sink, then describes the simple motions she went through at her own kitchen sink the morning of her son’s surgery.

I like how Ristau uses a common utilitarian object as a focal point in this piece. She describes in detail washing her hands at the sink in the hospital waiting room. She implies that these actions grounded her – loading her dishwasher, washing her hands – during this tumultuous life event. Ristau relays the telltale sign that her son, when well at home, has actually brushed his teeth: “That’s how I know he brushed them–the splash of color sliding down the porcelain.”

The reader is thrust into the narrator’s experience waiting for her son to wake up from anesthesia. When he does, the details she provides allow the reader to enter into her experience as the mother of the young patient: “…we used words like valves, clots, stitches, glue and morphine. Complications, IVs, shots, and applesauce, along with fluid in his chest cavity and so many possible futures balanced on the edge of his hospital bed.” Ristau reflects on how her son eventually asks for something quite surprising, out of his usual character, when he is finally able to get up and out of bed. The reader gets the sense that, on the other side of this surgery, he is changed, as is Ristau.

Writing Prompt: Think of an object in your home or workplace that is also found in a doctor’s office or hospital. Consider a plate of food, a chair, a computer, a bed. Describe the experience of that object when at home versus when you or a loved one were ill. Write for 10 minutes.

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Narrative Medicine Monday: New York Lungs

In her poem, “New York Lungs,” medical student Slavena Salve Nissan writes of the intimacy of knowing a patient “underneath her skin fascia fat.”  Nissan notes how her beloved city left a mark on her patient’s lungs. She thinks about the people who loved her patient and how even they didn’t know that the patient looks “like a frida kahlo painting on the inside.”

Place is a central theme in this poem. I like the subtle imagery of the medical student and her patient breathing the same air, from the same city, in and out of their lungs. This commonality, too, connects them.  

As a medical provider, we experience intimacies with patients that are both strange and surreal. It is a great privilege that our patients allow us, for the purpose of diagnosis or treatment, to perform these intrusions: cutting into the skin, sampling cells from the cervix, looking into the ears, listening to personal stories, palpating the lymph nodes. Over time this can become routine to the medical practitioner, but I do still wonder, and hope I never lose keen curiosity, about the lives of my patients beyond the exam room. 

Writing Prompt: Reflect on the vulnerability between a patient and physician. Is it surprising that we can be so open and trusting with a near stranger? Think about such a time, perhaps a surgical procedure or mental illness or embarassing symptom, when you put your complete trust in your medical provider. What was that like? Write for 10 minutes. 

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Published: Timeline

I’ve tried to write a piece like Timeline several times. It’s simply a chronicle of my typical work day, but, in the past, I never was able to get it just right. It didn’t flow sufficiently, wasn’t a clear reflection of the exhaustion I feel at the end of the day. 

When I discovered Pulse’s “More Voices” column theme this month was “Stress and Burnout,” I felt compelled to finish this piece for submission. It was initially much longer, but I think the confines of the short word count (less than 400) was helpful in honing it to only the necessities. Previous versions of this essay were written in first person or third person. Second person, I’ve discovered, suits the purpose of the piece. My goal is to place the reader in the shoes of the primary care physician, feel the weight of her day, the exhaustion inherent in the constant churn of a general practitioner’s practice. I hope this piece provides a snapshot of a day-in-the-life of a family physician, and evokes a thoughtful reflection on the state of our health care system and the very real crisis of physician burnout. 

I’m grateful to Pulse for publishing Timeline and for their regular promotion of issues relevant to patients and medical providers through narrative medicine poetry and prose.

Writing prompt: When do you feel most stressed at work? When do you feel energized? Have you witnessed signs of burnout in your colleagues or your own medical provider? List your own timeline of a typical workday. How do you feel when you read it back? Write for 10 minutes. 

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Narrative Medicine Monday: The Last Heartbeat

Cortney Davis’ “The Last Heartbeat” explores her competing identities as daughter and nurse at her dying mother’s bedside. Davis opens the poem as she holds her mother’s hand, counting her last heartbeats, witnessing her last breath. She ends with greater questions of life and soul as she walks with a friend through a cemetery.

Writing Prompt: If you’ve been at the bedside of a loved one as they died, what do you remember most? What have you forgotten? What about at the bedside of a terminal patient? Did this experience prompt greater questions about the soul? Write for 10 minutes.

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Narrative Medicine Monday: How We Wrestle Is Who We Are

Writer Brian Doyle’s son is unexpectedly born with a heart defect. Doyle reflects, a decade later,  about his memory of this diagnosis and subsequent surgeries in “How We Wrestle Is Who We Are.” He describes the heartbreaking clarity of that time, “thinking that his operations would either work or not and he would either live or die.” Faced with the potentially catastrophic outcomes of the situation, Doyle also asks himself some difficult, honest, heartrending questions. Do you agree with Doyle’s assertion that “what we want to be is never what we are?”

Writing Prompt: Consider a time when a loved one or patient was gravely ill. What thoughts and questions did you wrestle with? Consider writing a letter, as if to a friend or to yourself, about your struggle. Write for 10 minutes.

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