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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Free Write Friday: Pool

2017

I hold her squirming, slippery toddler thighs, evasive like slick eels. She clomps her feet down, uneasy steps in the little pool, even with the extra buoyancy of the chlorinated water. She likes to open her mouth, like a great whale, letting the pool seep in, then out through her widely spaced teeth, two on top, two on bottom. She, surprisingly, exults in going under, seems to fall purposely: Oops! Silly me! Throwing her head back, eyes squeezed tight shut as she leads with her upturned chin, mouth open, nostrils flared, beckoning the water toward her until she is fully immersed, sinking, trusting that I’ll catch her, lift her upright to breathe clear air. As she emerges, a look of unadulterated glee followed by just the faintest hint of melancholy. A mermaid she wishes she could be.

1990

She is so thin and graceful, wearing an electric blue bikini, mousy hair. I’m surprised when she approaches me poolside. Overweight and awkward, I wear my pudginess like armor; it keeps me humble, it keeps me introverted. I long to be charming, liked. Don’t we all at this preteen age? (At every age.) I can’t believe it: friends with me? She’s inquisitive, chatty, polished. I feel more elegant just being near her. It is revealed eventually, this is the truth: I am just a means to her end, a conduit for connection to my tall, older brother. He has reached the golden age: past gangliness, past acne, post-braces. I’m in awe of him too. 

1983

I’m learning to swim in the side pool, previously a hot tub but converted to what we call “the baby pool.” A bridge of dark brown tiles, just an inch under the surface, divides the tiny pool from the larger. Like a stumpy appendage, a bleb of an outgrowth, the small pool protrudes. The older kids like to coast back and forth on their tummies, sliding like monk seals. I can barely touch the bottom, on my tippy toes I bounce along, suspended for just a moment, like a moonwalking astronaut. A perimeter ledge for seating, I leap from side to side arms outstretched with orange inflated “muscles,” skinny legs flailing behind me. Sometimes I sink under with the effort, sour liquid up my nostrils, eyes stinging from chlorine. I grab the a handhold of smooth tile, turn, and try again.

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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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Mothers in Medicine

I’ve long been a fan of Mothers in Medicine, a collaborative blog of supportive mama docs. Many of the contributors are still in medical training and the community is made up of various different specialities. I’m delighted to come onboard as a regular contributor to MiM. You can find my posts under “MP.” I’m so grateful for this community of mama docs who get it. If you’re a mom or momma-to-be and at any point in your medical training or career, I recommend checking out Mothers in Medicine as the candid posts are honest and instructive about the challenges of holding these two important roles. 

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Free Write Friday: Cliff

Note: This week I’m trying something new with the free write – a prose poem incorporating synesthesia. I was inspired by a Till writing workshop I recently attended, presented by poet Jane Wong. As always, feel free to use the photo above as a prompt for your own free write. Consider joining me in experimenting with an unfamiliar format this week. 

***

Crackling of palm tree, fronds brushing carmine in the breeze. Squawk and tweet of birdsong, just beyond ear’s reach, punctuating high above. The turquoise wash of crashing waves below, colliding onto ebony rocks stoic as the spray recoils, resorbed by the expanse. Memories of jumping off, sound muffled, then expanding beyond into the greater sea. I climb the cliff, handholds of familiar crevices. I swim into the current, decades of tracing the reef map a mind’s fingerprint of coral phalanges. Thick blades of grass underfoot infuse the yellow taste of papaya. Nenes swoop in, then saunter through air thick with humidity. Specks of snorkelers flap fins, return to lie beached, their skin leathered like dragon fruit. Cloud shadows caress the ridged mountains, marking them like a bruise, feeding them with rain. One drop, then two trickles. The sea turtles gulp the air then dive into dry sweetness. They disappear but I never saw them, only heard shells cracking from a memory decades old. Momentary waft of plumeria, ginger, coconut, lilikoi, banana leaves suspends in the air just long enough for it to roll on my tongue, breathe into my lungs, absorb through my skin leaving an imprint, marking me home. 

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Free Write Friday: Pier


Tourists flock to the historic pier, smart phones in hand, they extend their arms to capture snapshots of pink faces with emerald mountains regal in the distance. They stroll down the concrete walkway, flip flops flapping, gazing side to side. 

Slender sailboats dot the bay, punctuating the azure waters. Vacationers cool down with a swim or awkwardly attempt use of a boogie board to ride a wave. Children kneel on the beach, legs caked with sunscreen, industriously patting at the wet sand to form castles with heaped towers and scooped moats. 

On the other side of the pier sunset catamarans embark where the river meets the bay. Crimson kayaks coast toward the ocean at the outlet, stand up paddleboarders glide along the shoreline. In the distance, pods of surfers catch wave breaks in the hazy early dawn light. 

A roof offers shade at the end of the pier. People linger at the edge, waiting to see if the local fisherman will make a catch. Teens taunt each other to jump off the blocky corner. Signs warn: “Shallow. No Diving.” But they’re not seen, or ignored. The clear waters allow visualization to the sandy depths from high above.

Eventually, the revelers will meander back. Maybe grab a carne asada or fish taco from the food truck for lunch. Sitting on the south side of the pier, a half moon of ridged mountains astound. The pier juts silently into the breathtaking panorama.

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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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Till


I’m at a long weekend writing retreat so, ironically, won’t be posting a free write today. The space is lovely, set on a converted farm. I’m looking forward to writing workshops, long stretches of sitting in silence and conversation with the best kind of people. May your weekend be filled with the same. 

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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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