Narrative Medicine

Narrative Medicine Monday: Throat

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Gabriel Spera writes of how our body changes in sinister ways in his award winning Bellevue Literary Review poem “Throat.” Spera speaks of how aging can alter a previously cherished reality, in this case, a love of food: “… life takes or twists what we hold most dear, / the heart’s fire of youth swapped for the heartburn / of middle age, which ends each feast at the medicine chest.”

In the midst of these bothersome symptoms, Spera’s friend gets difficult news: “She spoke bluntly, the doctor, as though hiding her chagrin / at all the time they’d wasted chasing red herrings— / ulcers and reflux, bacterial infection. They’d begin / with the chemo right away…” This is a constant fear, a threat with any ailment. During a visit, I often ask patients what they are most concerned about to ensure I’m addressing whatever issue weighs heavily on their own mind. Sometimes I’m surprised at their response, their occupation with a worry I would not have considered in the differential of likely, or even possible, causes. Often there are concerns about the least likely but most serious cause of a symptom: a headache is a brain tumor, a cough is lung cancer, a skin change is melanoma. Most of us have a tendency to worry about the worst case scenario.

In this case, the man is eventually diagnosed with that worst case —cancer. Spera’s lyrical descriptions of the ensuing treatment are infused with detail. The IV bag of chemo: “The tube: a string gone slack without a puppeteer / to tug it, a sleeping viper, a vine, a spill / of vermicelli, a nematode keen to disappear / into the cool earth of his arm…” The radiation is “like a cluster bomb / of atom-sized suns. Then the fallout, the scorched earth / of his flesh, the fatigue, the itch of skin too numb / to scratch.”

The reader is transported into this suffering body, the treatment itself causing “A backlash, a body blow: What stunted the tumor stunned / his muscles, his neck’s whole scaffold rigidized / like leather left to the mercy of the sun…” Within the details of this devastating illness and its treatment lies broader truths. Spera reflects that “Sometimes, what leaves us frees us, and what remains / holds soul enough…” Ultimately, the conclusion is that “despite conflicting evidence, / even the least life is worth what it inflicts.”

Writing Prompt: When there is a recurrence of cancer, the patient questions if “He’d had enough, or rather, no longer had / enough to keep losing chunks of himself, ill-equipped / to envision any future worth suffering further for.” Have you had an illness that caused you to question if you’d had “enough?” Have you had a patient who told you that they’d had enough? What does “enough” mean? Write for 10 minutes.

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Narrative Medicine Monday: Karyotype

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Poet Rebekah Denison Hewitt is one of Narrative Magazine’s poetry contest winners this year. Her “Karyotype and Other Poems” are a sequence of three poems that reveal different aspects of motherhood, from fetal testing to the fear and risk inherent in parenting.

In “Karyotype,” Hewitt illuminates the process of cell-free DNA extracted from a mother’s blood around ten weeks of gestation, a test that provides genetic information about the fetus. Hewitt’s genetic counselor “begins / to list every disorder / a lab can find in a fetus….” When this relatively new test became available with my third child, despite my medical background, I was still struck, as Hewitt seems, by the wonder of it, these fragments of my baby’s DNA floating through my veins: “The needled blood / from my arm a soup / of genetic code.”

Though Hewitt recalls a high school quiz “matching symptoms to disorder,” there is a turn in her reflection on the soul: “I think souls must exist / in wanted things. Dogs go to heaven, not roaches.”

Hewitt notes there is a calculation to how much information we really want to know: “Just trisomy 21, 18, 13? / Or microdeletions, too?  / My blood contains the risk / of something missing—a malformation / of the head—or worse.” Ultimately, though, she brings the question back to the essentials of what makes us human, beyond that of just our strands of DNA: “What makes this body inside me / more than an animal, clawing its way out…”

Writing Prompt: Hewitt writes about what she learned of some genetic disorders in high school and how she recalled this later when she was getting cell-free DNA testing. Think of something you learned in a science class that, many years later, manifested in an unexpected way in your life: genetics, biology, chemistry. Alternatively, think of a time you had a medical test done and the broader issues (what constitutes a “soul?”) that test might’ve brought up for you. Write for 10 minutes.

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Narrative Medicine

Narrative Medicine Monday: In Search of Collateral Beauty

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Writer Kat Solomon is “In Search of Collateral Beauty” in her recent Ploughshares essay. Solomon describes being wheeled into the Neonatal Intensive Care Unit to see her premature newborn, noting that “time has slipped away” but that “now, I am a mother.” Solomon provides a vivid description of the NICU, the “little room [with] its own symphony of beeps and blips,” the “plastic isolettes and incubators.” Her baby has arrived five weeks early. The first night, untethered to any tubes or isolation, her daughter is simply monitored, Solomon told she may be released the following day.

The next morning, though, they find the situation drastically different, their baby “sleeping in an enclosed isolette with an incubator like the kind I have seen on television, and she is connected to several wires and blinking machines.” Solomon has difficulty registering the change, and reaches out to touch her daughter: “I put my hand through the sleeve in the incubator but before my fingers reach her forehead, a nurse enters behind me. ‘Don’t touch her!’ she snaps. ‘She has a long day ahead of her.'” As medical providers we often forget that this is a foreign world to our patients and their families, a point Solomon expands on throughout her piece.

Though assured otherwise, Solomon can’t shake the thought that her baby’s feeding difficulties “must have happened because I was not there—would not have happened if I had been with her.” Solomon’s irrationality is relatable. As mothers, we often, even with evidence to the contrary, blame ourselves.

The language of the NICU strikes Solomon, a writer, as rich with metaphor. She Googles preterm infants and finds that “thirty-five weekers” are called “changelings.” Solomon sees her daughter as a changeling, noting the ephemeral quality of existence: “I’ve made a life, I think, but only now do I understand that in doing so I have also made a death.”

The young NICU doctor asks Solomon and her husband to sit and she realizes that this is an ominous request: “he has bad news, like on television.” The doctor explains that their daughter needs more tests to determine how best to treat her persistently distended abdomen. Solomon asks if it will resolve on it’s own, but the doctor replies that spontaneous resolution is no longer likely.

During Solomon’s experience in the NICU, she thinks of Lorrie Moore’s story “People Like That Are the Only People Here: Canonical Babbling in Peed Onk.” Moore’s story describes a child who suddenly becomes ill and her mother’s experience in the other “country” that is pediatric oncology. Moore’s short story is insightful and even humorous, and is one of my favorites to discuss with health professionals. The mother in Moore’s story finds a way to navigate this foreign land of pediatric oncology, but not without difficult interactions with medial providers, and the system, along the way. Solomon, too, finds much in Moore’s story relatable.

Solomon has a wrenching wait while her daughter has more tests, and eventually is called with the good news that the blockage resolved. She is, of course, relieved, but also angry, “directed completely at the doctor who told us that this outcome was no longer likely.” Can you relate to her experience? For those of us saturated in the medical world, it’s easy to forget the impact our prognosis, our words, may have, the fear they may instill.

Remaining in the NICU for observation, Solomon’s daughter has a “spell” where she stops breathing and this, the nurse informs them, means five more days in the hospital. This frightening episode ends up being the last of their “trials” in the NICU, but Solomon later reflects that, similarly to the mother in Moore’s story, there is a grief inherent in the “imagined version of the way things were supposed to go, the false sense of security that bad things only happen to other people.” I think those who suffer from severe illness, or care for those who do, often feel this kind of grief. Even when things improve, we, like Solomon, know in comparison we should feel “lucky” but can’t help but can’t help but mourn the loss of a cocooning naiveté.

Writing Prompt: What comes to your mind when you hear “changeling” or “spell?” What are some of the words we use in medicine that have other meanings, and what effect might these have on the patient or their family? If you’re not in medicine, think of words that you’ve heard in the hospital or clinic that conjured a different thought or a metaphor. Alternatively, read Lorrie Moore’s “People Like That Are the Only People Here: Canonical Babbling in Peed Onk” and consider if you agree that, even with illness, “there’s a lot of collateral beauty along the way.” Write for 10 minutes.

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Artist Trust Grants for Artist Projects

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Publishing is rife with rejection. As a physician, I wasn’t prepared for this reality when, several years ago, I began venturing into the writing world, taking classes and submitting pieces with little understanding of the industry or norms, without any concept of what I might expect.

As I’ve delved more seriously into writing, I’ve learned to accept frequent rejections, listen and learn from the talented and established artists and editors around me, and I hope become a better writer myself in the process.

Given how gray my Submittable account usually is (you writers all know what I’m talking about!), I was absolutely thrilled to get the very unexpected and welcome call that my 2019 Artist Trust grant proposal was accepted. Artist Trust supports Washington State artists by encouraging “artists working in all disciplines to enrich community life throughout Washington State.”

My grant will support professional development to further my book manuscript exploring mental illness and identity. This award came at a time when I was questioning my validity and voice as a writer, so this support is not only a financial boost to my project, but also serves as an inoculation against the imposter syndrome lurking within. I am indebted and honored to be a GAP award recipient, especially among such outstanding artists.

I’m so grateful to Artist Trust for the important work they do to amplify and energize Washington State artists, and I’m particularly appreciative of the recognition and encouragement the GAP award provides.

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Narrative Medicine

Media & Medicine

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I’m an introvert. I recently took an online Myers-Briggs test a work colleague sent me, and I scored a solid INTJ. This categorization has been stable for me since high school. Though I do enjoy social events and meeting new people, as a true introvert, I find conferences exhausting. Medical or otherwise, the constant introductions, social navigating, and personal storytelling involved can prove daunting.

Last April, I was in Boston at a medical conference and had lunch with a group of women physicians. I struck up a conversation with the woman sitting next to me, trading the standard questions: where we’re from, our medical specialty, our interests. I told her about my passion for writing and narrative medicine and storytelling and physician wellness and bioethics and the humanities and, in turn, heard all about her upcoming book and the wonderful work she was doing in Boston.

A month later she emailed me, saying she had just attended a narrative writing event at her hospital, run by Dr. Suzanne Koven, and that what Dr. Koven was doing seemed very much aligned with my interests and the work I hoped to do in Seattle. Would I like a virtual introduction?

And that, as they say, is history. At least for my work and life. I spent over an hour speaking with Suzanne, learning about her path in both medicine and writing, and how she formed the Literature & Medicine program that has been running for over a decade. I knew I’d like Suzanne immediately when her first words to me were, “Well, let’s discuss our mutual favorite topic: narrative medicine.”

Under Suzanne’s guidance, I went on to establish a Literature & Medicine program at my own institution in Seattle, and she has since become Massachusetts General Hospital’s first Writer-in-Residence.

So when I heard that she and Neal Baer were starting a Media & Medicine course at Harvard, looking at how we can use storytelling to address pressing public health issues, I knew I wanted to be involved.

This past week, the inaugural Media & Medicine class met together in Boston for five days of lectures and networking, community and conversation. With a cohort of 50 people from all over the world, there was rich discussion and consideration of how we can use journalism and podcasting, op-eds and plays to address issues in healthcare.

I was impressed with the many innovative ideas, including implementing design thinking to tackle complex healthcare problems, weaving public health education into television and plays, and using solutions journalism to show that “better is possible” to enact change. Keynote speaker Dr. Leana Wen urged us to start with our authentic selves and stick with the voice we know. We collectively wrote op-ed pitches, practiced playback theater techniques, critiqued podcasts, and turned partner stories into playdough and pipe cleaner art.

I met an impressive group of healthcare professionals from all over the world, eager to expand on work in public health, mental health, health disparities, physician wellness, and chronic disease. We learned from each other, advised each other, helped with networking solutions and built our own community of advocates for storytelling and listening, which we’ll continue to grow over the next six months as we work on specific public health projects.

I had so many rich conversations, and heard from experts in media and storytelling. I’m leaving Boston invigorated and exhausted. I can’t wait to work on my own project, focusing on mental illness, and support and champion the work of my fellow colleagues. Although taxing for introverts like me, I’m so glad I had that conversation, shared my story with the women physicians I met at that conference back in 2018. It speaks to the power of personal connection, of telling our stories with vulnerability and hope, and this, I think, is what the Media & Medicine program is all about.

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Narrative Medicine Monday: Flamingos

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Poet Zeina Hashem Beck’s “Flamingos” in The Southeast Review reflects on the normalcy that persists, even in the midst of a child’s illness.

She begins in second person, as “the nurses pushed your bed into the OR.” The context quickly takes shape, the way a promise is made in response to outstretched arms “to see the flamingos / in the hospital garden downstairs.”

Hashem Beck signals there are expectations when caring for a loved one who is ill, but that we sometimes do the irrational: “The worried aren’t supposed to be hungry, / but I ordered food because it was reassuring.” The food represents a comforting nourishment, even if not consumed.

In “Flamingos,” Hashem Beck shows the divide between the “outside” world and that of the world of illness: surgery, the ICU, hospitals. In caring for her daughter, she is so removed from this alternate world that when she returns home for the simple act of a shower, she stumbles with the cadence of normalcy: “hair dripping, my arms full / of laundry, for a second I must have forgotten / my step, twisted & cracked my ankle.” A friend helps her to the emergency room, and all she can do is laugh, tell the doctor to “to fix my ankle, quick, I have a daughter / waiting in a room upstairs…”

“Flamingos” is a reflection on how life goes on, how “life will sometimes infect your daughter’s lung / & fracture your ankle in the same week.” There is a kind of apology, a stream of motherly advice in the end. The wisdom that even on mundane days, the days “the car doesn’t break down, / & the children are healthy, & your husband / loves you … you will be terrified nevertheless, / & sometimes empty. It’s ok if you forget / to put one foot in front of the other.”

Writing Prompt: When you or a loved one is ill, do you feel the divide between the “outside” world and the one you’re living through? In what moments does that divide manifest? I like the allowance the poet gives, that’s it’s okay to forget to put one foot in front of the other. Have you ever experienced a situation when it felt like all you could do was put one foot in front of the other? What happened, or might have, if you didn’t? Write for 10 minutes.

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Narrative Medicine

Narrative Medicine Monday: Jamaica Kincaid’s “Girl” and the Challenge of Growing Up in Medical Training

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I first read Jamaica Kincaid’s “Girl” as part of a generative writing workshop during a summer writing residency. Our small group gathered folding chairs around long tables set up in an old barn near the Stillaguamish River in rural Washington. I was taken with each of the readings poets Jane Wong and Claudia Castro Luna had us read, but “Girl” struck me most, with its unusual punctuation, jarring directness, and call to re-examine the lessons we receive.

Emergency physician and writer Dr. Naomi Rosenberg explains in a recent JAMA article how Jamaica Kincaid’s “Girl” resonates in a very different environment–with new physicians in a narrative medicine workshop.

Rosenberg comments on the unexpected “striking similarity” these physicians have to Kincaid’s young girl, joining “a system that demands they quickly learn the skills of their craft, the rules of survival, and the values they will fight for all while navigating their instinctive psychological responses to illness, injury, healing, injustice, and grief.”

Rosenberg and the “burgeoning narrative medicine department” at her urban hospital have used “Girl” in the residency didactic curriculum, medical school electives, and writing workshops for all health care system employees with a goal to “constantly explore ways to help physicians, nurses, staff, and students ‘develop attention.'”

She describes how when they ask the residents to read “Girl,” intially they are met with resistance. How could this lyrical prose about coming of age in an island culture relate to healthcare professionals who “treat gunshot and stab wounds, deliver babies, diagnose cancer, unclog dying hearts for a living?” And yet, the new physicians quickly make the connection: “‘It reminds me of residency,’ one obstetrics-gynecology resident tells us, ‘a million instructions and things to do. It’s all over the place, and rapid fire.'”

At the end of the session a simple writing prompt is given, “metabolizing their own experiences and taking a moment to string words together—something young physicians today rarely, if ever, get a chance to do.” The result is surprising: “an exploration of hierarchy, medical education, and the silent curriculum of growing up.”

I wrote about my own experience at Columbia’s Narrative Medicine workshop, where we did a similar exercise and I again encountered Kincaid’s “Girl.” I love Rosenberg’s use of this piece to help new physicians still finishing their training grapple with the accelerated nature of a medical residency, the growth and expectations that come with modern medicine. It also was interesting to learn that Rosenberg herself used “Girl” as inspiration for her own wrenching New York Times essay, “How to Tell a Mother Her Child Is Dead” which I wrote about here and is one of my own favorite pieces to use for reflection and discussion among healthcare professionals.

As Rosenberg recognizes, literature has a way of “again and again, deepen[ing] our inspection and understanding of the internal and external worlds.”

Writing Prompt: Take a cue from Rosenberg’s exercise and respond to “Girl” by writing instructions on how to be a healthcare professional (nurse, physician, pharmacist, etc.) Alternatively, write instructions on how to be a patient, or a patient’s parent or partner or child. Write for 10 minutes.

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Narrative Medicine Monday: Cooper’s Heart

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Writer Rebecca Gummere writes in Oprah about the unimaginable loss she experiences when her infant son dies suddenly in her essay “Cooper’s Heart.” Gummere begins by describing the heart, how it starts in gestation, how it pumps throughout life: “Even the heart of a baby who lives just 42 days will pulsate more than 6 million times before its final, fluttering beat.” She then returns to October 1982, to the time when her son Cooper was born.

Just before discharge from the hospital, her pediatrician hears a heart murmur and suggests evaluation by a pediatric cardiologist, who performs an x-ray, then an ultrasound. The cardiologist receives the results and ushers the young couple into his office: “‘Do you know what a heart looks like?’ he asked, and I remember having one distinct thought: We should run.” Gummere captures the indelible urge as a patient, as a family member, to flee when faced with a difficult diagnosis.

The cardiologist breaks the news that their newborn son will need urgent surgery. The surgery is successful and Cooper is admitted to the NICU, a place Gummere describes as being “neither night nor day but another kind of time altogether.” Cooper improves and Gummere is able to bring him home. He gains weight, “and once he was in a regular feeding routine, he was able to sleep. His cheeks grew round, and he kicked his legs in excitement. I let myself breathe.”

That December, when Cooper is 6 weeks old, Gummere notes one night that he seems cold: “Then this: He wakes, fussing, squirming. I change his diaper and notice he is cool, so cool to the touch, and his skin has gone white, his surgical scar now a harsh purple line against his pale torso.” Her husband is away on a business trip. She calls her pediatrician, who eventually suggests Cooper be hospitalized. She calls a neighbor and readies her toddler son, only to realize that Cooper “…is not breathing,’ I say, and I know it is true. ‘Call 911,’ I shout, and then everything is changed.”

Everything is changed, as Gummere describes her own pleading with God: “‘Please, God, not my baby, not my baby. Please don’t take my baby.’
At last one of the paramedics pronounces what we all know: ‘This baby is deceased.'” In the wake of this tragedy, Gummere, though devastated, consents to the mandatory autopsy that is required of a death at home, “allowing the hospital to do what it must.”

Gummere tells her 2-year-old son that “God is taking good care of our baby, but I am not sure I believe it, not sure at all.” We can sense her wrestling with the idea of a higher power: “I want God to be real. I need there to be Someone in charge, and I need there to be a heaven, some place where I know my baby is safe and cared for and loved.”

Several times after Cooper dies, Gummere asks God: Where are you now? Often when we face difficult or traumatic situations as patients or as healthcare professionals, our perception of God or a higher power can be alterered or challenged. Have you ever asked this question of God? Did you get an answer?

Over a year after her son’s heartbreaking death, Gummere delivers a healthy baby girl and she is “filled with joy and fear.” Understandably, she is constantly “on guard,” ready for the worst. As the years pass though, Gummere shares that “I am forgetting altogether about dusting the pictures of Cooper on the mantel.” What role does time play in Gummere’s experience?

Gummere begins searching for reasons, for some semblance of answers, and enters seminary. She shares her varied identities: “I am part scholar, part detective, both parts waiting to be struck like Paul on the road to Damascus, knocked facedown in the dust, then renamed, remade, given new eyes to see some revelation of God woven in the very fabric of the universe.”

Her understanding and faith, though, continues to be challenged. Throughout seminary, when a friend is diagnosed with an inoperable brain tumor, when a local teen dies by suicide, she wonders to God: Where are You now?

Seven years after he son’s death, Gummere enters chaplaincy training. Against her adviser’s advice, she chooses the local Children’s hospital where her own son was cared for and died. During this training, Gummere meets the same pathologist who performed Cooper’s autopsy. At her request, the pathologist goes over her son’s autopsy in great detail and then shares “his role in training medical students and his special area of interest, the heart-lung system, describing how he procures and preserves the organs during the autopsy to use them in teaching…. He is quiet for a long moment and then says, ‘I still have your son’s heart and lungs. Do you want to see them?'”

Gummere describes what she finds in the morgue, how the pathologist reaches “down into the bucket, he brings up all that remains of my son, and in the next instant I hold in my hands the heart that had been inside the infant who had been inside of me.”

She is eventually able to “begin to do a new thing, to move beyond grief and guilt into wonder, to celebrate what I was part of creating— not what was lost but what was alive, what moved and pulsated deep inside of me, what seems to be in some way part of me still.”

Gummere asks “What is God?” And shares that her own answer to this question has shifted over time. Ultimately, Gummere discovers that there is no answer, but “there is love, the kind that binds us to each other in ways beyond our knowing, ways that span distance, melt time, rupture the membrane between the living and the dead.”

Writing Prompt: Think of a tragedy you’ve encountered – in your own life or in the life of a patient. Did this experience affect your view of God or a higher power? Alternatively, think of a time, for you or a patient, when “everything is changed.” What happened in that moment and what questions did you struggle with afterward? Did the passage of time alter those questions or the answers? Write for 10 minutes.

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Narrative Medicine Monday: Who Heals the Healer?

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Dr. Huma Farid asks “Who Heals the Healer?” in her recent essay in JAMA, and her answer might surprise you. Farid describes weeping alongside her patient early in her obstetric training when she delivers a stillborn baby. The gravity of this experience affects Farid deeply as she reflects on human suffering, recognizing “that my work would encompass taking care of women at some of the worst times in their lives.”

As Farid progresses in her career, though, she realizes that she no longer has the same reaction, the same connection to the suffering of her patients: “My eyes dry, I wondered, when was the last time I had truly connected with a patient, empathized with her sorrow, and allowed myself to feel a sliver of her pain?”

Farid acknowledges that at that time she was also going through her own personal difficulties, and that despite this, she did her best to “remain empathetic and kind” to her patients: “I tried to give as much of myself as I could, but I felt like I had a finite, limited reserve of empathy.” Do you view empathy as a finite resource, or have you experienced a similar limited reserve to connect with your patients?

Farid’s commentary really resonated with me. It seems a simple statement to say doctors are human too, but it’s a reality we often forget. Most doctors are incredibly resilient and, even so, it only takes one personal life stressor to topple the precarious balance of mental and emotional rigors that come with being a physician in today’s healthcare environment. As Farid notes, the decline in empathy “may be driven by the demands of modern medicine and exacerbated by personal experiences.”

When I experienced my own significant personal life upheaval a few years ago, I, like Farid, “was still able to perform my clinical duties and to provide good patient care despite struggling to be empathic. However, studies have demonstrated that physician empathy improves both patient outcomes and patient satisfaction….” Ideally, for both the patient and physician’s sake, we would find ways to combat the decline in empathy that is an inherent byproduct of the current healthcare environment.

Ultimately, Farid determines that empathy “enables us to understand and connect with a patient’s perspective, an invaluable resource in an environment that has become increasingly polarized and rife with divisions.” Farid describes an interaction with a patient where she “mostly listened” and, in return, receives heartfelt thanks and hugs. Through that emotional and physical connection, Farid regains a piece of her “profoundly and imperfectly human” self. May we all find a way to move in that direction.

Writing Prompt: Farid wonders “what it meant for me that I had lost some ability to feel a patient’s pain.” If you’re a healthcare professional, have you lost some of that ability throughout your medical training or career? Think about a time you failed to have empathy for a patient’s suffering or, as a patient, that you felt your healthcare provider had little empathy for your pain. Alternatively, describe a time that your empathy has been “rekindled.” Write for 10 minutes.

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Narrative Medicine Monday: The Oncologist

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Poet Carole Stone writes about “The Oncologist” in the Bellevue Literary Review. Stone starts with the questionnaire she receives: “Do you have an appetite? No. / Are you anxious? Yes.” I think of all the questionnaires we hand out to patients to save time, to make sure we get vital history, to screen for other issues that might not be readily apparent just by looking at the reason the patient came in. As a primary care physician, I can’t tell you how many times I’ve seen a patient for knee pain or seasonal allergies or a Pap smear, who actually wants to discuss their depression or panic attacks or fear of developing the same chronic illness as their cousin.

In Stone’s brief poem, though, she reveals the multitude that is assumed, that is missed, by these questionnaires and by the rote interventions that follow. Stone shares her inner dialogue when the woman suggests counseling and a writing group: “I imagine an unsharpened pencil, / and a blank page, / tell her, no.”

In the end, the patient and the oncologist miss a connection. Stone asks herself “Is this denial?” But verbalizes only that she has “nothing to say.” In modern medicine’s pressured office visits, sometimes the most important communication, how the patient is really feeling, what they are thinking, the opportunity to get to know a person beyond their disease, gets lost in all that goes unsaid between patient and doctor.

Writing Prompt: Stone declines the woman’s offer to try counseling or a writing group, commenting on her “stranger’s eyes.” Have you encountered a similar situation with a medical professional where they felt like a stranger? What is the balance of intimacy and intrusion when caring for someone who is gravely ill, has cancer or a debilitating chronic disease? Consider writing about a medical questionnaire you received and what it did and did not reveal. Alternatively, try writing about this exchange from both the patient and the oncologist’s point of view. Write for 10 minutes.

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