Narrative Medicine Monday: Still Not Convinced You Need a Flu Shot?

Aaron E. Carroll provides a straightforward explanation as to why getting the flu shot is imperative to a healthy community. In his New York Times article “Still Not Convinced You Need a Flu Shot?” he notes we may be passing on the virus without realizing it, to people much more vulnerable than ourselves: “You can infect others a day before you show any symptoms, and up to a week after becoming sick. Children can pass along the virus for even longer than that.”

Carroll points out our lack of concern about the flu virus, so familiar every winter, is illogical: “Because the flu is so common, we tend to minimize its importance. Consider the contrast with how the United States responded to Ebola a few years ago. We had a handful of infections, almost none of them contracted here. One person died. Yet some states considered travel bans, and others started quarantining people.” He argues that we should be much more concerned about the flu, noting that influenza is the “only cause of death in the top 10 that could be significantly reduced by a vaccine. Lowering risks of heart disease, cancer or Alzheimer’s are much, much harder to do.” We have a way to decrease the morbidity and mortality from a common illness yet we choose not to harness that opportunity.

By looking at the history of the varicella vaccination, Carroll illustrates the benefit we gain through herd immunity and the ethical consideration of getting immunized even if you yourself are not at high risk. He notes that babies were dying from chicken pox prior to implementation of the vaccine, but “as rates of vaccination rose, the rates of death from varicella were low…. But more significant, from 2004 through 2007, not one child younger than 1 year old died in the United States from chickenpox. What was amazing about this finding was that we don’t vaccinate children that young for chickenpox — therefore, those babies’ deaths were not prevented because they were vaccinated. Their deaths were prevented because we vaccinated their older siblings.”

In a previous Narrative Medicine Monday post, I highlighted a New York Times article written by Dr. Danielle Ofri that I’ve used when teaching narrative medicine courses to medical professionals. It illustrates the challenge of communication between physicians and patients and why there often is a disconnect. How can we improve the dialogue to better inform the public and, ultimately, save lives?

Writing Prompt: Do you get your flu shot every year? Why or why not? Do you feel that you understand the reasoning for immunizations? What information might help you better understand? If you’re a medical provider, have you struggled to convey such information to patients? Think of such a time and write for 10 minutes.

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Free Write Friday: Dressing

He brings his stack of neatly folded clothes, procured the night before, into the master bathroom. He likes to dress with Mama in the morning, inky sky evolving outside the frosted windows.

He puts his socks on first, insists they match. So I bought him twelve pairs of athletic socks, all white, identical. He can pull them up and over his calves, a satisfiable stretch.

Next is the underwear, logoed with superhero emblems, bright elastic trim. They too come in plastic wrapping, in neat sets of six or eight or ten. I never understood the “days of the week” underwear until I had children: it’s exhausting for them, for me to watch, to choose what to wear each day, even undergarments.

Next is the t-shirt; can’t be too tight on the neck, on the arms, must hang just so. He likes orange, bright colors. Pixelated hamburgers, paper airplanes, whimsical animals dance on the silk screened front. He pulls them overhead, sometimes his mousy head gets stuck, needing a tug from Mom to help his straining face emerge.

Last, the pants. He likes elastic bands: comfortable, practical. He pulls one leg through, then the other. Doesn’t bother to regard himself in the mirror; instead he rushes off to gather other treasures and accessories from his room.

He shuffles back in, rainbow suspenders in hand, clip-on tie already attached to the front of his waffle t-shirt. “Can you help me, Mama?” His legs shuffle back and forth impatiently; he wants his outfit completed. I clip on the suspenders, straighten his orange necktie. He smiles broadly, proud as he sashays into his day.

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Free Write Friday: Couch

He cried when they took the old couch away. It sat on the front lawn unceremoniously as they carried in the new one: grey heathered tweed, low back, firm cushions, stylish, contemporary.

The old couch looked bulky, awkward in comparison. Beige and bought on a whim over a decade before, soon after we were married. We needed a new couch and had money to spare. Two professionals, no children. We stopped at a furniture store on the way to my brother’s house one day and chose it quickly, unresearched. Unusual for a measured, calculated shopper like me. I was anxious to make our new house a home; real furniture seemed imperative and urgent at the time.

But it served us well through two homes, three children. Substantial back cushions held their form all those years. Good building blocks for fashioning forts. The length just right to stretch out for naps, our toes barely brushing the armrest. We’d pull a hand woven blanket over us, cocooning for a winter hibernation or a spring siesta in the waning afternoon sunlight.

I brought my babies home to that couch, Boppy pillow on my lap, tiny infant swaddled in my arms. The cushions held me through the uncertainty, the exhaustion, the stinging pain of an aching postpartum body nursing all hours of the night and day.

We let the kids jump on it; by the time they came around it was already worn, no need to keep up appearances or needlessly coddle the not fragile.

We’d greet friends, old and new. Birthday gatherings, movie nights, holidays with family, interviews with potential nannies. All of them sat, back upright, feet sturdy on the floor or reclined, elbow cocked back, plate full of potluck fare tidbits in hand.

He cried when they took the old couch away. I felt it too, the tug, the wrenching. So much contained in that substance of wood and fabric.

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Narrative Medicine Monday: Air Hunger

The narrator visits her mother in the hospital in “Air Hunger,” a striking short essay found in University of Virginia’s narrative medicine journal Hospital Drive

Two months have passed since she last saw her mother, but in the interim the narrator notes her mother has “become a patient.” The details the writer shares give us a glimpse into how her mother’s illness has changed her over time. Her mother barely touches the lunch tray beside her hospital bed: “She picks at her food, but it’s air that she’s hungry for.” The narrator wants to ask her mom how she feels, but already knows the answer: “I can see what I see, I can hear what I hear.”

Writing Prompt: Have you witnessed a loved one’s deterioration of health over time? What was it like to see them in one light and weeks or months later note a dramatic change? Do you remember a moment when they became, either to themselves, to you or to others, “a patient?” Write for 10 minutes. 

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Free Write Friday: Eclipse


1991

I remember standing in a small field on Kauai, thick kelly green blades of grass underfoot. The square glasses, opaque cellophane-like lenses didn’t seem to do much at all. I was told to look up, face skyward. My older teenage brother had built a box, a contraption that revealed a projection of the eclipse. It was all underwhelming, the tiny crescent in the sky, projected on the cardboard. I remember thinking, ungraciously: This is it? I don’t remember it getting cold or dark or being moved in any significant way. After the novelty of the moment wore off, I wanted to get on with it, proceed with our vacation day. Head to the pool, play at the beach. I had only a vague concept of what I was looking at, looking for. 

2017

He starts to cry as the temperature drops. I want to take it all in, but he’s a heap on the wet grass, weeping beneath his paper solar eclipse glasses stapled to the back of a child’s tiger face mask. Why does the sun have to disappear? Why does it have to happen only today? He wants to ride his bike around the perimeter of the park but Dad says let’s wait until after 10:20 a.m., the point of maximal partial eclipse, 92% in these parts. He collapses into the whimpering mess of a typical three-year-old: unpredictable, unintelligible wailing. 

We begin to feel a chill, our friends put on sweatshirts. I’m unprepared and goosebumps emerge on my bare arms. There’s a festive feel, the large field peppered with strangers in lawn chairs, blankets splayed out with picnic foods, cardboard contraptions and eclipse glasses at the ready. My son is hugging his knees, sitting on the gravel path. His wails drown out the crowd, focused skyward, as they start cheering. 

I’m anxious about my one year old, afraid she’ll gaze directly at the sun. All faces turned upward, leering at the spectacle. She’ll follow suit. But I have to attend to my three-year-old, whimpering about the sun, the moon, a desperation in misunderstanding. I think about the historic panic about such an event: the sun disappearing momentarily. Of course it would feel like an omen, a harbinger of doom. He’s channeling that historic angst, knowing that the sky darkening midmorning is unnatural, feels off. 

I crouch beside him, rubbing his back, trying to convince him it’s all right. I can’t tell if he’s upset because the sun is disappearing or because I can’t keep the eclipse from remaining for another day so he can see it tomorrow. It doesn’t matter. It’s the illogic of a three-year-old tantrum. 

The air seems filtered, a hazy Instagram “Nashville” tainting the late summer morning. Time speeds up and suspends, as if the eclipse causes a filtering of moments, a sifting of time. As if heavenly bodies aligning requires all to pause ceremoniously, a recognition of our minisculeness. And yet nothing waits for the three-year-old angst. He rocks in my arms until the typical light returns and all is as it should be again. 

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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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Free Write Friday: Makeup


She pulls out the shiny magenta case, like a tackle box but smooth at the edges, a mirror secured inside the lid. “I have to fill it with my makeup!” She exclaims, moving from room to room, collecting her beauty things. “Mom, have you seen my mermaid lipstick?” No, I haven’t. I hid it away somewhere and promptly forgot where I put it; a parent’s prerogative. It’s not really lipstick, just rose tinted chapstick, gifted to her by a well meaning friend. I got rid of it as soon as I was able to without her immediate protest. 

I suspect she suspects me as the thief, the culprit discarding of her treasured beauty trinkets, but I have to accept her eventual disdain for my actions. She’s five. She loves long flowy dresses, she’s gravitated toward high heels since she was two. She collects hair accessories like they’re candy, items to be savored and adorn her mousy brown locks. I worry. Will she be superficial? Will she self-scrutinize? Will she be consumed by what she looks like, how she appears to herself and to the world? Of course she will. But I want to temper the inevitable, preemptively find a way to help her emerge from the challenges of girlhood with the foundation of a healthy identity intact. 

She watches me hawk-like when I put on my own paltry morning makeup, scrutinizing every move: sponge applies a tinted moisturizer, brush of peachy blush, a swipe of eye shadow. I just started wearing mascara again a few months ago, conscious of my aging beauty regimen and tired mama eyes. She studies me like an artist regarding a celebrated sculpture, trying to deduce the method of craft. I’m self conscious as she analyzes me, defensive at my feminism and wondering at my hypocrisy in wanting her to avoid the trappings of the beauty counter world.

She and her brother used to stand below me as I regarded myself in the mirror, applying my cosmetics for the day. They’d ask for a makeup sponge and imitate my movements, swiping over their face and neck. Eventually they’d bore of this and use the sponges to “clean” the bathroom walls; perhaps a more appropriately concrete activity to occupy their imagination. 

She doesn’t really have any makeup of her own, so she fills her plastic box with sparkly headbands and large hair bows. She corrals her tiny hairbrush and her brightly colored elastic bands. I want to protect her from the self-scrutinization, the self-criticism of being a girl in this superficially focused world. I want to adjust her own lens, swap it out with one that filters with self-acceptance, appreciation of variation and an ability to discern a deeper beauty, the kind essential to all that matters.

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