We get a glimpse into both the patient and the physician’s perspective of a manic presentation in Maureen Hirthler’s “Jefferson’s Children“. Her dramatic opening (“If you don’t do something right now, I’m going to hurt my children.”) inserts the reader into the mindset of the patient, desperately asking for help to make sense of her racing and disturbing thoughts. As the emergency physician enters the scene, the narrative shifts and the reader becomes the provider, trying to make a definitive diagnosis and determine an appropriate treatment plan.
The physician feels the patient should be admitted for psychiatric evaluation and treatment but is unable to find a bed for her and meets resistance from both the patient and her superior. Can you feel her frustration? Have you ever been in a similar situation?
The lack of appropriate, affordable and available psychiatric treatment has been discussed and debated much in recent years. What are the barriers you’ve noted to getting yourself, your loved ones or your patients the mental health care they need? If you could create the ideal mental health system, what would that look like?
Writing Prompt: Try writing from the first person perspective of a manic patient first arriving at the hospital or clinic. What about a severely depressed patient? A very anxious patient? Now write the same scene from the perspective of the medical provider (physician or therapist). How does the scene change?
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?
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?