Narrative Medicine Monday: The Dilemma Doctors Face

The spotlight has recently been on the opioid epidemic ravaging our country. As a primary care physician, I’m acutely aware of this issue and the challenges it poses to individuals, medical providers and the public health system as a whole. NPR’s The Takeaway recently did a program on understanding this crisis and approached it from many angles. Dr. Danielle Ofri wrote short a piece in Glamour magazine that gives a primary care physician’s perspective. In “The Dilemma Doctors Face,” Ofri notes that chronic pain is very real but differs from other chronic disease in that there is no definitive test or measurement for pain, it is subjective. “Chronic pain is real. It can ruin people’s lives. But the anvil of addiction and death can’t be ignored.” Ofri asserts that one challenge is that a system that doesn’t often pay for other ways of treating pain, such as physical therapy, acupuncture and massage, makes it easier for the medical provider to “just write a prescription.” Can you relate?

Writing Prompt: Have you or a loved one struggled with chronic pain? What were the challenges you faced when trying to find appropriate treatment? Have you or a loved one struggled with opioid addiction? What was the first sign that this had become an issue? If you prescribe opioid pain medications, how do you approach counseling patients about the risks and benefits of taking these medications? What are some of the challenges you’ve faced in having this discussion? Write for 10 minutes.

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Free Write Friday: Exercise Equipment

She’s tried gym classes, Jillian Michaels DVDs. She’s run around the track, jogged over wooded trails studded with stones. She’s done two-a-days, eager teens taking turns running drills, hard stops at the line, lifting barbells in the weight room behind the lunch room behind the theater where they held the high school dances. 

She’s bought stretch bands, barbells, balance balls, plastic steps with risers. She found a pull up bar for free on the local mom’s list serve. They buy and sell fancy rain boots and football tickets and ask each other for advice on family-friendly resorts in Zihuatanejo and the best estate planning attorneys and drop-in childcare and ways to get kids involved with climate action and places for Santa photos over the holidays. She fits right in.

She’s taken yoga classes – not hot – that seems unnecessarily suffocating. Spongy mats laid out on the hardwood floor, downward dog and sun salutations with arched backs into flexed toes. Tree pose her favorite: upright and accomplished, easily mastered with her gift of balance and big feet. 

She’s taken pre-dawn boot camps, meeting a group of head-lamped women exclaiming encouragement as they huff up dozens of stairs, breath billowing into the chill morning, sweat trapped under layers of workout gear. She liked having others to exercise with, run hills or jump into burpees, but the classes just weren’t sustainable after having her own children. The other demands of the morning, of harried family life took reign. 

She’s had an online trainer, focused and encouraging but intimidating with her exposed washboard abs. She’d never dieted but for the first time in her life she paid attention to what she ate, limited her junk food, her evening snacking; stopped eating sweets and bags of chips and salsa and glasses of wine whenever she wanted. She stopped indulging in huge bowls of homemade popcorn, puffed and crunchy, doused in hot butter, sprinkled with salt, handfuls melting unceremoniously in her eager mouth, absently stuffed while watching another Netflix episode of Breaking Bad or The Wire or Game of Thrones. She got enough sleep. Felt strong, empowered. 

She’s pushed an unwieldy jogging stroller around the lake, 3.2 miles of sneakers pounding on damp asphalt, muddy gravel, swerving this way and the other to avoid the deep ruts, the many pools of murky water that coalesce after a spring rain. She got to know each curve of the path, each puddle, each turn of season that marked the route like an aging backyard maple, imperceptibly swelling trunk, leaves changing and falling and budding again.

And maybe that’s fitness: fits and starts and seasons and patterns. Lately she’s fallen back into her flesh, into her routine, into her strength and stamina; the muscles build, the mind clears and her body is her own again. 

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Those Winter Sundays

I was at the Write on the Sound Writers’ Conference all weekend, so wasn’t able to prepare a Narrative Medicine Monday post for today. I’ve been reflecting, among other worthy writerly thoughts, about how I attended WOTS last October, just one year ago, as my first ever writing conference. At that time I gingerly entered each room, compressing myself into an imposter, sure that I would be discovered as a fraud. I imagined my fellow attendees, accomplished published authors thinking, “What are you doing here?” The entire writing world, culture, was foreign to me. I struggled to fit pumping in between conference sessions, even nursed a four month old baby in the car briefly while my family was passing through town. I’m now done with the harried, urgent stage of pumping; have retired my trusty Medela Freestyle and all its various plastic components for good. It’s remarkable to me that it’s only been one year. In those twelve months I have developed detailed writing goals, including a complete nonfiction book proposal, a regular blog and platform plan and have my eye on contests, training programs and retreats and residencies to further my work and aspirations as a writer. 

I’m currently taking an online poetry class, which is stretching my every writing muscle. I’m back to basics, learning about sound and syntax, metaphors and consonance, iambic pentameter and anaphora. Both my poetry class and one of the weekend conference sessions highlighted this poem by Robert Hayden: “Those Winter Sundays.” As a mother myself, entering middle age, reflecting on much of my perceptions and misconstrued moments of my youth, this poem spoke to me this week. Try reading it out loud and note the tools Hayden uses to portray his father and his perception of his father, both in his youth and looking back as an adult. What speaks to you in a poem? Have you tried reading poetry out loud? I’m grateful to be learning more about poetry this fall and hope to share more with you in the coming months. 

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Free Write Friday: Bike

We walk the bike to the cul-de-sac, center the powder blue contraption in the middle of the street. My dad’s leathered hand holds the back of the white banana seat. I clamber on, gripping the handle bars till my knuckles whiten. I lean too far forward as the bike teeters precariously side-to-side. A white wicker basket hangs from the front, adorned with plastic daisy flowers in bright colors; it is the consolation prize for a hand-me-down bike from my brother, meant to transform it to an acceptable level of femininity.

I push one sneakered foot down, then circle the other. My ankles waver as my dad trots behind. I glance anxiously over my shoulder; is he still there? Pumping my legs, the sudden transition to stability is exhilarating. Wind slapping my face, wisps of dark hair waving behind. I’m flying!

I suddenly panic, remember: I’m unsteady, I’m unsure, this is new. Is he there? I turn just slightly, a glance for comfort. But he’s gone, far behind me. As he grows smaller in the distance, the angst in my own chest expands. “Keep going! You’re doing it!” He shouts. But the trembling, the uncertainty have already taken hold. Anxiety disrupts and I topple: bloodied knees, gaping frustration as I crash down.

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Narrative Medicine Monday: Lithium and the Absence of Desire

Virginia Chase Sutton’s wrenching poem “Lithium and the Absence of Desire” warns of what may be lost in taking a necessary medication. She deftly describes the world before starting lithium and the reader is entranced along with her, “dozing in light and soaked color.” Despite side effects causing a graying of her world, the author dutifully takes “the medication as prescribed.” Written in second person, the reader is drawn into her longing for what she has lost and together we collectively struggle in vain: “Strain all you will but you have given desire away.”

Writing Prompt: This poem describes a negative, even devastating, side effect of a medication, yet the writer recognizes there was “No choice since you must take the pills.” Have you experienced a minor or life-altering side effect from a medication? Describe life before and after starting the medication. Did you keep taking the medication as prescribed, or did you search for a different treatment? Write for 10 minutes.


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Free Write Friday: Birthday

When she was a kid the coolest birthday parties were hot tub parties. Skinny seven-year-olds wearing Care Bears swimsuits would pile into the spa, overflowing the water, grinning through their giggles, secrets whispered past wrinkled palms as bubbles rose from the churning jets. Some parents would let them snack in the tub: sticky caramel corn or lollipops. After soaking there’d be cake and ice cream, opening presents and receiving favors dropped in plastic handled bags. 

She didn’t have a hot tub at her house, always admired the girls who did. One year though her mom threw an elaborate birthday party, a carnival theme. Their sloped backyard was transformed, different stations set up for children to explore. Her mom manned the face painting, tiny lions and rainbows inked onto rosy cheeks as she perched on the picnic table bench. Her older brother told fortunes in the green canvas play tent, towel fashioned into a turban as he passed predictions on to the little partygoers. There were balloons and plastic door prizes. With three kids in her family, it was rare to have such an elaborate birthday celebration. All her best friends and girls she wanted to be her friends were there; she was overcome with glee. 

Her mom always made the birthday sheet cake, sprinkles on top, tube frosted lettering: Happy Birthday! This was before Pinterest, long after and decades before handmade was considered worthier, the hipsters’ and modern moms’ claim to superiority. It was the progress and image-obsessed eighties: Hypercolor t-shirts, squared polyester shoulder pads and blue eyeshadow were king. She always, ungratefully, wished she could have a store-bought sheet cake or an ice cream cake from Baskin Robbins; perfectly frosted corners and magenta lettering sprayed on. Her parents were frugal though, and her mom’s cake surely tasted better. Two facts lost on a child who wouldn’t know, until decades later, what was best for her. 

Now, with three children of her own, she bakes tiered birthday cakes, carefully procures themed party favors, plans activities and decor to suit each child, so their memories will be bright. But she’s also exhausted in the stretched way every modern mother is; she’s gained perspective. Maybe every other year will be a big birthday party when they’re young. Sometimes store bought treats, sometimes just one friend over for a special outing. Because she knows: you really only need one outstanding birthday party memory to last a lifetime. 

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Narrative Medicine Monday: Primum Non Nocere:

Emma Barnard is a visual artist and researcher focusing on fine art and medicine. Her latest installment, “Primum Non Nocere,” reflects the patient experience. Barnard’s work is influenced by her own interactions with the medical world as a patient and her research into this arena, including Michel Foucault’s term ‘medical gaze,’ used to “denote the dehumanizing medical separation of the patient’s body from the patient’s person or identity.”

I’m interested in Barnard’s method of creating art, where she follows a patient into the exam room and questions them right after, producing a drawing based on their response. She notes that many of the physicians are surprised at the resulting artwork: “During the consultation process patients show little emotion; it’s quite difficult to read how they really feel about the impact of the words spoken during the clinical encounter.”

Barnard also incorporates the physician and surgeon perspectives. Could you relate to her images of a physician’s experience in a busy clinic practice?  I could certainly identify with the depiction of others superseding the “self” and various demands of work and home life feeling compartmentalized. Do you agree with the neurosurgeons’ statement that as physicians we view a division between us and patients and that we have to understand this alienation “if we are to find ways to soothe it and become connected to our patients and to the essence of medicine?”

Writing Prompt: As a patient, have you ever experienced Foucault’s ‘medical gaze,’ where you perceived a provider as seeing you only as a body, rather than recognizing your personhood? What did that feel like? As a medical provider, have you ever caught yourself interacting this way with a patient? How can we work to overcome this tendency? Write for 10 minutes.

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Free Write Friday: Hair Accessories 

I used to play beauty parlor with my best friend. She didn’t like the game of coiffing, but I enjoyed the tugging on hair, taming her strawberry blond curls, selecting and applying the ribbon or hair clip just so. I would stand back and admire my handiwork, wisps and strands situated as I commanded. They succumbed to my coercion and I was satisfied. 


My hair was cut too short in fourth grade and I never got over it. It was a “boy” cut, not the cute Dorothy Hamill kind made popular by the 1980’s figure skater. Instead of a bobbing bowl cut, it’s as if the hairdresser took clippers to the back, the sides, the whole mass of thick dark tresses. It was too short for any hair clips and headbands gave me a throbbing ache at my temples. I wore a blue and red and white knit button up sweater in my school picture that year. I liked the sweater, the fanciful snowman perched near the hip pocket. My smile though was strained as if I knew the aberrant hairstyle would haunt my year. 

I went skiing once that winter with my brother and as the attendant was helping us onto the chair lift, toes frozen in clumpy boots, I heard a distinct, “There you go, boys!” He was being friendly but I was mortified, this mistaken identity at a time when all begins to hinge on your perception of what others think about you, molding what you come to think of yourself. 


My son gets upset that I can’t braid his hair like I do for his big sister. I pull out accessories: clips and bows and headbands in an attempt to give him alternate adornment. He seems placated, a thin line of a smile as I pull back a strand of his bangs with the royal blue polka dot clip. He steps back, but doesn’t scurry away to admire himself in the mirror as my daughter would. No, it’s the participation that matters to him. He rushes downstairs to show off his fancifulness. 

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Narrative Medicine Monday: Erasure

Student and poet Thomas Nguyen writes of memories and loss in “Erasure.” In his poem Nguyen is instructional, warning how time affects our connection to those we’ve lost: “Accept that time makes things distant, that his absence doesn’t bleed into your memories as much as it used to.” There are only a few significant people in my life who have died, but I can identify with Nguyen who needs to try “harder and harder to remember the last time” he saw his mentor.

Nguyen notes that the patient speaks of his melaonmas as if they were part of his garden: “My dermatologist taught me how to care for them.” Nguyen goes on to contrast this with the green moss on the windows of his home. Do you agree with Nguyen that “life always adds?” Do you find this contention comforting or suffocating, or both?

Writing Prompt: Have you spent time with a loved one or patient who was nearing death? If time has passed, how have your memories of this person been affected? Recall the last time you saw them. Outline the details, like Nguyen’s memory of “neatly-pressed khakis.” Write for 10 minutes.


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Free Write Friday: Purge

You have the sudden urge to purge. You spend a long holiday weekend sorting through all of your children’s clothes; the Space Bags stuffed beneath twin beds and dressers, the lost items at the back of their closets. You match socks, discard pliable hand-me-down infant shoes. You sort through stained sleepers used by three, maybe four children. You organize clothes too small, too big for your three children. You find dusty discarded tights hiding behind a dresser. 

Then you move on to your own closet. Haphazard piles of clothes in four different sizes, maternity pants with stretchy elastic waistbands, nursing shirts with openings for nipples to peek through. Some are worn and gigantic, others are new with tags, bought on sale on a whim early postpartum when you were self-conscious about the extra chub, in need of pants that actually fastened but didn’t accentuate an after-baby muffin top. 

You try things on, everything that is “regular” now that you’re not pregnant or nursing. You’re done with that phase, toss those clothes into donation piles enthusiastically. You revel in your body back, no longer a receptacle for another’s development, no longer a conduit for sustenance. You kneel on the closet rug, toss items out the door into organized heaps. You slip one leg into old jeans, boot cut, out of style. You still have a hard time getting rid of things that fit but don’t provide true comfort. Each spared item should elicit the thrill that comes from a piece that feels just right on your skin, in your bones. You’re a goldilocks who holds on to the chair that is just a little too small, a little too big; if only you had the strength to keep only that which is just right.

After folding and organizing all shirts, all slacks, all dresses, all jackets, you sit back and admire. It’s a thing of beauty, a sigh of release to have it all there, visible, organized. That momentary satisfaction is enough to propel you downstairs into the next project. 

You tackle the junk room, meant to be a playroom. It became a dumping ground in the last 12 months, initially out of necessity, then out of sheer exhaustion. There were too many urgent demons swirling to even acknowledge this minor chaos existed. But now you have a window: the strength, the energy to sort, to discard, to organize. Bags of ski gear, gift wrapping, party decorations weigh down the child’s train table, buried under clutter. Boxes of camping gear, partially deflated sports balls, missing pieces of random toys are unearthed as you dig, excavate further into the room. 

This takes longer, more endurance, more muscle. You lift heavy items, find you’re missing ski gloves and appropriate boxes for storing camping gear. It takes more emotional energy to decide what toys to keep for your youngest child, to gauge which winter hats will still fit your oldest two. It doesn’t end with the same satisfaction, the playroom purge. Piles of equipment, of clothes, still line the hallway, boxes of trash and donations in the mud room. But the door can open, the children can play. You set up the train tracks on the squat table, lay out two trains heading in different directions. You can’t explain it, but it felt necessary to get this all done, right now. You were desperate for an ordered respite; seemed the antidote to a season of chaos devoid of calm. 

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