Narrative Medicine Monday: E.R.: Port-au-Prince 

H. Lee Kagan reflects on one memorable night working in a Haitian Emergency Room in “E.R.: Port-au-Prince“. What is Kagan expecting of his experience? When I’ve worked overseas, often in a wholly different medical system and in a resource limited environment, I’ve had similar anxieties, drenched in insecurity. Usually I come to realize I was worrying about all the wrong things. Kagan finds himself unsure how to respond when a patient who was raped arrives in the E.R. He questions himself after this encounter. Do you think he should have done something differently? What did Kagan learn about himself?

Writing Prompt: Have you experienced working or living across cultures or in a different system than the one you’re used to? What was different? Did you learn something about yourself or about medicine? Consider re-writing this piece from the point of view of the patient, the nurse who steps in or the volunteer nurse who can’t sleep. Does this give you new insight? 

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Free Write Friday: Homework


In high school I used to work backwards. The answers to the odd questions were always in the back of the book. If I was stuck I’d flip to the last pages of my paper covered textbook, look up the answer and work my way back to how it came to be. Usually this helped me figure out the way forward on the even problems, the assigned homework. Sometimes I’d have to get help from my parents; my mom I went to for social studies or English, my dad for geometry or chemistry. But usually I’d keep it to myself, struggle through concepts I didn’t quite grasp. Maybe it was grit. Or maybe it was shame; the beginnings of an imposter syndrome already taking hold in my adolescent self.

 ***

I remember sitting at our dining room table, the brown protective cover shielding the glossy wood beneath. On Sundays I’d trudge through my Chinese homework worksheets, everything was right to left instead of left to right. My characters were lopsided, like a kindergartener’s first words spelled out, the letters mirror images of their true selves, looking as if about to topple over, bent in the wrong place. Repetition, repetition. My hand cramped with the recurrent motion of my pencil. I remember sitting in Saturday school class in the dusty church basement, surrounded by black haired children who knew what they were saying, understood what the teacher asked of us. I stared down at my pencil case, chosen carefully from Uwajimaya, the local Japanese superstore. My classmates were comfortable in this parallel universe, the weekend school environment. They played together loudly, boisterous and free, hanging from the monkey bars at the truncated recess. I couldn’t understand. I was the outsider, unfamiliar with the language, with the culture, like I’d been transplanted as an immigrant into a foreign land just for that sliver of a weekend morning.

***

It was my favorite class, the teacher who lived on an island and woke at 4 a.m. to take the ferry and drive 45 minutes to teach middle school English. I always did the extra credit homework, not because I wanted the points but because I loved the work: creative writing, poetry, reading novels about complicated characters making their way through a simpler time. I labored over a book of poetry and prose all year, the culmination of a year’s diligence of writing and art. That teacher gave us grades, no one else did in middle school. I think she got in trouble for this. She thought highly of us. Maybe it was considered too much to expect greatness out of such awkwardness. The writing assignments gave me a thrill, a satisfaction I hadn’t yet experienced. I should’ve known then, recognized a calling, but I foolishly was lured by so many other distractions. Writing was the work that wasn’t work; it reflected backward, propelled me forward, it whispered to me an understanding of self and of the world that I’m still learning to claim. 

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Narrative Medicine Monday: How to Tell a Mother Her Child Is Dead

Naomi Rosenberg, an emergency room physician, writes a gripping essay in the New York Times entitled “How to Tell a Mother Her Child Is Dead”. She writes her detailed and heart-rending instruction in second person. Is her use of second person effective? Can you see yourself in this situation, having to deliver the most terrible news? Those of us in medicine have had to deliver bad news, often frequently: a cancer diagnosis, a chronic debilitating illness diagnosis, a loved ones imminent or unexpected death. Rosenberg brings the reader into her situation and hints at the lessons she’s learned on how and how not to approach such a grueling task.

Writing prompt: Have you ever had to deliver bad news? If you’ve had to do this many times what lessons have you learned? If you’ve received bad news, how was it delivered? How do people respond differently to difficult news?

 

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Free Write Friday: Hospital

 

1997

She’s volunteering, decided what she wants to do. She catches the bus to the hospital from campus, heavy backpack weighing down her slight shoulders. She has a badge, a short powder blue jacket. She works in the playroom: coloring, washing toys, light streaming through the wall of windows as she stoops to read aloud a picture book or set up a seasonal craft on the low plastic tables. The children come in wheelchairs, heads bald or misshapen or shaved with intention. Tubes may be in their nares or arms. All of it is foreign and she doesn’t know how to act naturally so she smiles a lot, maybe too much. Sometimes she delivers a toy to a child confined to their own room: in isolation. Before entering she puts on a crinkly gown and a mask and latex free gloves, just as she was trained to do. She plays with the child, chats with the teen, tries to connect, but her own awkwardness and all the barriers for protection get in the way.

2003

She’s in medical school, deciding what she wants to do. She rotates through the hospital, a shadow of a doctor in a short white coat, tagging along after her resident. Her pockets are weighed down with too much: laminated cards on how to run a pediatric code, a clipboard with preprinted index cards to keep track of each patient’s labs and history, black ball point pens to record chart notes, gum. She learns she always needs to have gum on hand. She walks the halls, familiar but transformed now she’s armed with some knowledge. She gets to know the palpable quiet of the hospital in the middle of the night. The ceilings here are low; everything is miniaturized to make children feel more comfortable, in this place where discomfort distinctively reigns.

2007

She’s in residency, an MD after her name. She doesn’t wear a coat, but instead a black fleece vest with zippered pockets. Sometimes she’s mistaken for a nurse, but she still doesn’t wear the long white coat; it’s just not the way things are done. She monitors her patients and her medical students. She presents each case to the attending each morning at rounds. She knows what she wants to order in the cafeteria when it opens at 2 a.m. for all the providers who are there overnight on call. She’d rather sleep than eat, but that’s not the way things are done here. Residents review the progress of patients with the medical students, with each other, over the mid-night meal. The lights are turned down low and the children are in cribs and in isolation rooms and can’t breathe well or can’t eat well and most certainly won’t sleep well. The nurses page her and talk in quiet voices. Many patients get better and she discharges them. Some are known by all the staff and roam the halls with their IV poles like tiny emperors, because this place, this hospital, too, is their home.

2016

She brings her infant, the youngest of her three, in to see the specialist. She parks in the newish garage built in the same place she used to catch the bus up the hill. She wheels her baby in the stroller. She waits in line to check in, gets an adhesive visitor’s badge with her picture and her child’s name. There’s a Starbucks downstairs now, in this new wing, but she doesn’t have time to stop for a latte. Her child is crying and she’s late. She wears a red raincoat, her pockets filled with the random items of a mother: a used tissue, a miniature toy construction truck, a purple hair clip, a binky, her smartphone. She’s anxious about seeing the specialist, about the prognosis and treatment plan. She has already texted her friend, the pediatrician, who made helpful recommendations, gave expert advice. She now has the luxury of giving and getting medical opinions in an instant, a byproduct of years of training and now experience as a practicing physician. She waits in the waiting room with other families. Some children read, some run, some sit in laps, some in motorized wheelchairs. Her child’s name is called and her baby is weighed, measured. She sees the physician. Her baby is prescribed medication, which she gets from the pharmacy. A girl waiting in line behind her talks animatedly about a book she wants to read. When she turns to check on her baby she can see the girl’s shaved head, the scar from surgery. So many children here so ill, so resilient. As a mother, she always feels grateful, feels guilty, in this place.

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Narrative Medicine Monday: An Enlarged Heart

Cynthia Zarin writes a detailed account of a time her daughter fell ill in “An Enlarged Heart”. She explores her own realization that her daughter was significantly sick and also documents her encounters with the medical system on the path to diagnosis and treatment. 

Writing prompt: Write about a time when you were caring for a loved one with an unexpected illness. How did you respond? What were the challenges you encountered with the health care system? What, if anything, did you struggle with yourself?

 

 

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Free Write Friday: Rain


I remember the winter it rained for ninety days straight. It was some sort of record. Some days it was just a drizzle, grey clouds menacing, threatening but only producing a trickle of condensation. The dampening effect was lasting though. I was forlorn, a college coed struggling with my own gloomy tendencies. The constant rain seemed to confirm my dramatic melancholy.

I had a yellow rain coat, slick and bright, rubber and durable. I don’t know why I chose the bright yellow, sunshiny and pure. It wasn’t a trendy choice; my fashion sense was not yet refined enough to choose statement pieces. An umbrella was seen as taboo for any true northwesterner, a weather crutch not to be used for its actual purpose. This fact was clear: use of an umbrella would border on blasphemy. So daily I trudged across campus, damp with a constant drizzled sheen, ground ebony and bare; the glory of the autumn colors long decayed to brown and dissipated into the soil, reclaimed to become fodder for the following spring’s renewal.

But that winter the grey reigned, the gloom maintained through the dreary days, weeks, extending into months until even the air seemed to weep. Light and brightness forgotten, buried somewhere deep below, hidden high above.

I remember walking across the center of campus, careful steps on the slick bricks, rumored to have been designed specifically to be slippery, easier to hose down and dispose of protesters should a group of young idealists take to the arena with picket signs and voices raised high. That day, though, it was just ordinary students making their way to lecture halls and labs, the library and the dorms. I stopped midway, and gazed at the sky, willing it to show me a break, a glimmer of respite. Instead, the drops fell large and solitary, coalescing on my upturned face.

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Narrative Medicine Monday: What the Nurse Likes

Cortney Davis’ poem “What the Nurse Likes” reveals what it’s like to care for patients. She notes in her commentary about her poem that she realized “it is necessary for caregivers to say shocking things occasionally about the type of work that they do”. This poem has helped me reflect on what I enjoy about my work and consider what may seem interesting or odd to those outside of the medical field.

Writing prompt: What do you like about caring for patients? What do you dislike? What do you like about receiving medical care? What do you dislike? Write for ten minutes. Think about if any of these things may be shocking to others. Did you surprise yourself?

*Cortney Davis’ website has some more excellent prompts to try.

 

 

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Free Write Friday: Reading Peter


The cream cord spiraled on the Formica counter. My mom lifted me up as I held the receiver to my ear. My grandmother was on the other end, eager to hear what I had to say. I balanced the book on my lap, turned the worn pages with sage lettering and delicate drawings of a defiant rabbit, an angry gardener and a new jacket left behind.

The letters still swam, but I sorted them out, plucked each from the recesses of my mind: a pool of shapes and lines intersecting and crossing, curving around. Then I linked them together, like one boxcar to the next. I paused with each sound so they were connected but staccato, not quite cohesive.

I remember it being difficult, and then all of a sudden it wasn’t. Some synapse connected and I could read. I could make sense of the shapes strung together like Christmas lights. Like magnets they drew themselves together; like a baby babbling they sounded themselves out. I didn’t have to work at it anymore; it was automatic. Like breathing or the beating of the chambers of the heart: involuntary and subconscious. I only thought about it if I stumbled, skipped a beat.

My grandmother listened patiently as I read each page, pondered each picture. I later wondered if I was actually reading, if it was all a farce, if I simply memorized the whole thing, not knowing what memorization really was; it only came as the vaguest sense that maybe I was an impostor, deceiving my loved ones. I felt uneasy.

I still feel unsettled sometimes, like maybe I am an imposter in this life of mine, pulling a ruse over all those involved. My insecurities linger, from that five-year-old sitting on the counter, grandmother on the line. I wonder have I really achieved what I think I’ve accomplished, or is it simply an elaborate mimicking of all that I should know.

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Narrative Medicine Monday: My Patient Doesn’t ‘Do’ Vaccines

The New York Times Well column features many excellent pieces about medicine from the patient, physician and public health perspectives. Danielle Ofri’s “My Patient Doesn’t ‘Do’ Vaccines” is a snapshot of an every day encounter for a physician: a patient disagrees with the recommended care plan. Although immunizations are one of the most common areas of disconnect these days, this can and does happen in many other situations as well: a patient requests antibiotics for a viral illness, a physician recommends a procedure that a patient doesn’t want, a patient requests labs or studies that aren’t indicated, a physician recommends a medication that a patient is hesitant to take. Instead of just letting the situation pass by during a busy clinic day, Dr. Ofri decides to become curious, to engage her patient and educate him on the medical science. He, in turn, is able to voice his concerns and viewpoint.

Writing Prompt: Write about a time there was a disconnect between you and your physician or your patient. Were you curious during the encounter to understand the other person’s fears, concerns or hesitation? Why or why not? As providers, how best can we address valid concerns while staying true to evidence based care? How do our backgrounds color our perspective and ability to engage others?

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