Narrative Medicine Monday: When Patients Mentor Doctors

When Patients Mentor Doctors: The Story Of One Vital Bond” tells of physician Aroonsiri Sangarlangkarn’s longitudinal relationship with a patient she comes to call a friend. The bond between them affects her views on what can be gained through understanding patients on a more personal level.

Sangarlangkarn first meets Roger as part of a medical school program that matches up aspiring physicians with geriatric patients who provide mentorship on medicine from a patient perspective. She then encounters him again after she has finished her training and he is hospitalized under her care. She reflects on the value of her deep knowledge of his personality and history.

I liked reading about Sangarlangkarn’s own lengthy description, written years prior as a medical student, of the patient’s social history. It included intimate details such as Roger’s parents’ names, his boyhood aspirations and his favorite board game. When I was a medical student I remember taking a very detailed history of a woman who was in the hospital for treatment of her malignant tumors. I spent over an hour with her, just chatting with her about her history. No physical exam, no review of medications. The final typed up document I turned into my advisor was over two pages long. Now, as a busy primary care physician, I, like Sangarlangkarn, can see how the emphasis on efficiency causes time constraint that makes it difficult to have meaningful patient-physician conversation that could contribute to helpful personal knowledge. Sangarlangkarn laments that “our interactions with patients have become so regimented and one-dimensional that we no longer get to know the multifaceted person outside the hospital.”

What do you think about Sangarlangkarn’s suggestion regarding the value of patient home visits? This is often done for patients in hospice care or who are unable to physically get to a clinic. Home visits because of the time they require seem much more costly to the system but Sangarlangkarn argues that the value – the ability to get to know the patient on a different level – provides invaluable information. She writes: “To effectively provide care for someone, it’s important to learn who they are, what they eat, how they breathe.” She, in fact, due to her detailed knowledge of the patient, is the only one who eventually can get him the end of life care and support he needs.

Writing Prompt: Think about a time you visited an ill person at home, whether that be an apartment, house or adult family home. Describe what you saw, what you smelled, what you talked about, how you felt. What do you think can be gained by entering into a person’s living space? Alternatively, consider a patient you’ve known for years, maybe decades. What do you know about that patient because of a longitudinal relationship that might be of benefit to you if you had to deliver bad news or discuss different treatment options or medications? Write for 10 minutes.

 

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Narrative Medicine Monday: Published!


Starting the year off sharing some great news! I recently received in the mail the Fall 2016 Edition of OUHSC’s Blood and Thunder Journal, which includes two of my essays. I’ve had several pieces published in online journals but there is a special kind of excitement that comes from seeing your name in print on a tangible page. I’m humbled that two of my favorite shorts “Expectant” and “Burst” found a home in this narrative medicine collection.

“Expectant” chronicles the very first delivery I witnessed. Obstetrics was a revelation to me as a young medical student, especially never having had children myself. I was in awe of the entire process and this short essay reveals my own insecurities as I was christened into the world of medicine.

“Burst” is about my first continuity delivery in residency training: a pregnancy meant to be followed throughout all nine months to completion. I was a new physician and had much to learn about the unpredictable nature of obstetrics.

One of my writing goals for 2017 is to make significant progress on a book-length collection of narrative medicine essays.  I’m starting the year off taking Creative Nonfiction’s online course “Writing Your Nonfiction Book Proposal”. Finding time to edit and submit my work has been a continual challenge but writing classes provide encouragement and structure to make the time, harness the energy and muster the gumption to keep at it. I’m eager to let go of the draining and perfectionist tendencies of 2016 and write on in 2017. Holding a palpable culmination of my writing efforts is an encouraging way to embark on a new year and I’m grateful.

 

 

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Free Write Friday: Hospital

 

1997

She’s volunteering, decided what she wants to do. She catches the bus to the hospital from campus, heavy backpack weighing down her slight shoulders. She has a badge, a short powder blue jacket. She works in the playroom: coloring, washing toys, light streaming through the wall of windows as she stoops to read aloud a picture book or set up a seasonal craft on the low plastic tables. The children come in wheelchairs, heads bald or misshapen or shaved with intention. Tubes may be in their nares or arms. All of it is foreign and she doesn’t know how to act naturally so she smiles a lot, maybe too much. Sometimes she delivers a toy to a child confined to their own room: in isolation. Before entering she puts on a crinkly gown and a mask and latex free gloves, just as she was trained to do. She plays with the child, chats with the teen, tries to connect, but her own awkwardness and all the barriers for protection get in the way.

2003

She’s in medical school, deciding what she wants to do. She rotates through the hospital, a shadow of a doctor in a short white coat, tagging along after her resident. Her pockets are weighed down with too much: laminated cards on how to run a pediatric code, a clipboard with preprinted index cards to keep track of each patient’s labs and history, black ball point pens to record chart notes, gum. She learns she always needs to have gum on hand. She walks the halls, familiar but transformed now she’s armed with some knowledge. She gets to know the palpable quiet of the hospital in the middle of the night. The ceilings here are low; everything is miniaturized to make children feel more comfortable, in this place where discomfort distinctively reigns.

2007

She’s in residency, an MD after her name. She doesn’t wear a coat, but instead a black fleece vest with zippered pockets. Sometimes she’s mistaken for a nurse, but she still doesn’t wear the long white coat; it’s just not the way things are done. She monitors her patients and her medical students. She presents each case to the attending each morning at rounds. She knows what she wants to order in the cafeteria when it opens at 2 a.m. for all the providers who are there overnight on call. She’d rather sleep than eat, but that’s not the way things are done here. Residents review the progress of patients with the medical students, with each other, over the mid-night meal. The lights are turned down low and the children are in cribs and in isolation rooms and can’t breathe well or can’t eat well and most certainly won’t sleep well. The nurses page her and talk in quiet voices. Many patients get better and she discharges them. Some are known by all the staff and roam the halls with their IV poles like tiny emperors, because this place, this hospital, too, is their home.

2016

She brings her infant, the youngest of her three, in to see the specialist. She parks in the newish garage built in the same place she used to catch the bus up the hill. She wheels her baby in the stroller. She waits in line to check in, gets an adhesive visitor’s badge with her picture and her child’s name. There’s a Starbucks downstairs now, in this new wing, but she doesn’t have time to stop for a latte. Her child is crying and she’s late. She wears a red raincoat, her pockets filled with the random items of a mother: a used tissue, a miniature toy construction truck, a purple hair clip, a binky, her smartphone. She’s anxious about seeing the specialist, about the prognosis and treatment plan. She has already texted her friend, the pediatrician, who made helpful recommendations, gave expert advice. She now has the luxury of giving and getting medical opinions in an instant, a byproduct of years of training and now experience as a practicing physician. She waits in the waiting room with other families. Some children read, some run, some sit in laps, some in motorized wheelchairs. Her child’s name is called and her baby is weighed, measured. She sees the physician. Her baby is prescribed medication, which she gets from the pharmacy. A girl waiting in line behind her talks animatedly about a book she wants to read. When she turns to check on her baby she can see the girl’s shaved head, the scar from surgery. So many children here so ill, so resilient. As a mother, she always feels grateful, feels guilty, in this place.

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