Narrative Medicine

Narrative Medicine Monday: Narrative Gatherings

No Comments

The first Medical Humanities Twitter Chat, or #medhumchat, happened January 2nd and was curated by Dr. Colleen Farrell, an internal medicine resident. Although I wasn’t able to fully participate (bath time for my three kids, as often is the case, was not a well-controlled event that offered much down time for a Twitter chat), I was able to go back and read the lively conversation.

Farrell notes in this follow up post the role the humanities play in helping “make sense of the seemingly senseless suffering and heartbreak I witness daily as a doctor.” This seems a common sentiment among medical providers today, as varied opportunities in narrative medicine expand.

Farrell’s blog post lists the Medical Humanities Chat readings and questions, along with a few responses from participants. It’s an interesting format to interact with medical professionals and patients from all over the world.

The next Medical Humanities Chat will be this Wednesday, January 16th at 9pm EST, on the topic of Racism & Medicine. I’m hoping, bath time willing, to be able to participate in this important discussion.

Locally, I recently attended the Northwest Narrative Medicine Collaborative‘s inaugural Seattle event, a medical moth with the theme of “My First Time.” The event sold out in just a few weeks and the stories told were varied, often humorous, and resonant with the crowd of both medical providers and the general public.

The next Seattle NW Narrative Medicine Collaborative event is yet to be announced, but I know is already in the works.

The popularity of these opportunities to share our stories, consider a narrative, process the intimate and at times wrenching role we as medical providers play in health and illness, highlights the thirst for such contemplation and conversation among increasingly burnt out physicians and frustrated patients. I find myself, ten years into my own career in primary care, seeking out such community, eager to help cultivate ways to gather and share.

I hope, wherever you are, you can find or foster similar opportunities to share your story, consider your patients’ narratives, and use the humanities as a tool for further introspection and connection.

Writing Prompt: Consider reading the pieces Dr. Farrell selected for the first #medhumchat and answer the questions posed in written form. Were your answers similar to the ones posted during the live chat? Did you gain a different perspective after reading through the conversation? Did any of your answers or reactions to the readings surprise you? Write for 10 minutes.

Continue Reading

Narrative Medicine

Narrative Medicine Monday: Leaving the Body

No Comments

Author Lisa Knopp shows how we can be drawn to the presence of a body even following death in Hospital Drive‘s “Leaving the Body.” After her mother dies, Knopp lingers in her hospice room, asking to stay as a woman enters to wash her mother’s body and ready her “for the people who are coming to pick her up soon.”

Knopp initially wonders about “the point of bathing my mother, since her body will soon be ash.” The nurse’s aide speaks to Knopp’s mother as she wipes her face and arms. Knopp finds this “comforting, this informing my mother of what’s about to be done to her, since I can feel that something of her is still here.”

When the aides remove the woman’s gown, Knopp is filled with wonder at her mother’s naked body. “Even though she would feel shamed by my scrutiny, I want to savor and memorize the details.” This body holds memories for Knopp, the substance of a mother-child relationship, connection: “I know their shape so well: large knee bones, slightly bowing calves, like those of her mother, and thick ankles. Just below her right knee on her inner calf is a blue vein, an inch or two long that has been there as long as I can remember.”

In these moments right after her mother’s death, Knopp finds herself “starving for her physicality” and tells the aide she’d like to touch her mother. She kisses her forehead and strokes the top of her head and wonders, “What is it that I’ll be missing now that my mother’s heart has stopped beating, and she’ll soon be turned to ash?” Her mother has died, but Knopp is still drawn to her physical body, the familiarity of her mother’s form that will cease to exist. Knopp shares that her greatest regret will be that “we didn’t spend more time in each other’s physical presence” and that this final sponge bath is her “last chance to see and touch and smell my mother, flesh of my flesh, my first home.”

Knopp recalls all of the beautifully mundane things she and her mother chatted about on the phone, though they rarely discussed her cancer or the grander questions Knopp yearned to ask her dying mother. The loss Knopp highlights in her essay isn’t so much about the flesh itself, but more about her experience of her mother that was contained in that body: her “voice, words, thoughts, laughter, and silences.”

Knopp reflects on the waning importance of physicality in our modern world, how the dean of her college encourages faculty to have more screen time and less face time with students, how so many interactions with friends are via social media and not in person.

At the end of the essay, Knopp combs out her mother’s hair, braids it with care and cuts a lock of hair as a token. Knopp is unsure what she will do with the lock of hair, but the gesture seems satisfying in the moment, keeping “more than just memories of her body” before they wheel her away.

Writing Prompt: If you’ve been present with a dead body, either a loved one or a patient, what did you experience while in that space? Was it difficult? Healing? Both? Did you feel drawn to touch the body, as Knopp did? What are your thoughts about Knopp’s observation that we spend significantly less time face-to-face? How do you think spending less time in the physical presence of others might affect us? Write for 10 minutes.

Continue Reading

Narrative Medicine

Narrative Medicine Monday: Intern

No Comments

I’ve written about physician and author Dr. Sayantani DasGupta’s concept of narrative humility before. The first piece I read of DasGupta’s was in Lee Gutkind’s 2010 collection, Becoming a Doctor. Her essay, “Intern,” is a compelling snapshot of a brand new physician.

DasGupta writes the piece in third person and reveals the things that she “hoarded.” The essay is reminiscent of Tim O’Brien’s classic “The Things They Carried.” I relate to DasGupta immediately, the hoarding of “Xeroxed protocols and carefully transcribed antibiotic regimen[s].” DasGupta brilliantly captures the unsure medical intern, who “hoards” in order to feel prepared for anything in a very unpredictable new profession where lives are at stake.

In describing the things hoarded, DasGupta outlines the life of the intern. She notes the importance of keeping “bottles of chemical developer” to look for occult blood in stool. They were always “impossible to find when you needed them” and “there was nothing worse than standing in a patient’s room with a gloved finger full of excrement and nowhere to put it.”

As the essay progresses, DasGupta’s hoarding becomes more figurative. She “hoarded her patients—especially the usually healthy infants,” who, she admits, during a hard night’s call provide an escape “just to hold and rock a baby.”

DasGupta describes hoarding her senses, “taste, primarily, because she found herself so empty” and the hand cream she rubbed on as a ritual, because “[s]he missed the feeling of her own skin.” She hints at how a career in medicine becomes all consuming, that “no matter how much she bathed, or how expensive her soap, her nose seemed filled with the smells of the hospital, the sick, and her own stale and sticky body.”

She is sincere about the toll arduous medical training takes on her sense of self, her physicality, her sexuality: “despite all the pain, she often found herself yearning—aching—to be touched.” DasGupta reveals the challenges to her own marriage during this intense time of training and that, as an intern, there is little space to think of anything else but the work: “In that stillness, she allowed herself to consider—would he wait until the end of internship to leave her? For the rest of the day and night, there would be no more time for such thoughts….”

Of course, DasGupta speaks of sleep and time, the difficulties of each as an intern working all hours of day and night, the pressures unceasing: “She hoarded sleep when she could get it, in the darkened backs of lecture halls, on the cheap, scratchy couches in the residents’ lounge….”

Ultimately, DasGupta’s essay reveals the inner dialogue of a new physician’s arduous first year, gives a glimpse of the challenges to those outside of medicine, and evokes memories for those of us who lived through it.

Writing Prompt: If you’re a physician, think back to your intern year or your first year of medical school. What did you hoard? Make a list. If you’re not in the medical profession, think of when you first started a new job — what did you gather around you to make you more confident, better prepared? Write for 10 minutes.

Continue Reading

Narrative Medicine

Narrative Medicine Monday: The X-ray Waiting Room in the Hospital

No Comments

“The X-Ray Waiting Room in the Hospital” by author Randall Jarrell thrusts us into his “big shoes and wrinkled socks,” and one of those “much-laundered smocks” that all the patients wear. Jarrell laments “[t]hese new, plain, mean / Days of pain and care…” and that “routine / Misery has made us into cases.” He describes the “machine” that each smocked patient suffers in, and the reader gets the sense that Jarrell is referring to more than just the mechanics of the x-ray, but also the greater “machine” that is medicine.

Jarrell was an American poet and critic who lived in the mid 20th century but his commentary on the patient’s experience of modern medicine still rings true. Jarrell wants each “nurse and doctor who goes by” to acknowledge him and each patient as an individual, but instead finds that “we are indistinguishable.”

Jarrell concludes that instead of trying to “make friends” with the medical professionals and get them to recognize his individuality, “It is better to lie upon a table, / A dye in my spine.”

Writing Prompt: As a patient, have you ever felt “indistinguishable” from other patients to your medical provider? If you’re a medical professional, do you agree with Jarrell’s assertion that “this routine / Misery has made [patients] into cases?” Can you think of a time when a patient has become merely a case, to you or a colleague? What are the consequences of this, to both the patient and they physician? How can we help doctors and nurses to see patients as individuals again? Write for 10 minutes.

Continue Reading

Narrative Medicine

Narrative Medicine Monday: Brilliance

No Comments

Poet Mark Doty’s “Brilliance” shows a dying man changing his perspective near the end of life. In Doty’s poem, the man has “attended to everything, / said goodbye to his parents, / paid off his credit card.” He gives away his pets, finds the risk of owning too great, realizes that he “can’t have anything.” When someone suggests he get a bowl of goldfish, he replies “he doesn’t want to start / with anything….” For just a moment, the man allows himself to imagine the goldfish he might like: “hot jewel tones, / gold lacquer.” The fantasy, though, is fleeting because “I can’t love / anything I can’t finish.” Eventually he recants that decision, saying “Yes to the bowl of goldfish. / Meaning: let me go, if I have to, / in brilliance.”

Writing Prompt: Have you ever been at a place in your life when you didn’t want to start with anything new? What prompted that feeling? If you’re a medical provider, think of a time you’ve seen a shifting perspective in patients near the end of life. Write for 10 minutes.

Continue Reading

Narrative Medicine

Narrative Medicine Monday: Reasons for Admission

No Comments

I opened up a nondescript brown package last week to discover Bellevue Literary Review‘s latest issue, showcasing a beautiful new redesign.

In this 35th issue, Gaetan Sgro’s poem “Reasons for Admission” reveals the complexities surrounding modern day hospitalizations. Sgro notes that often the reasons are contradictory: “Having just gotten insurance. Never having had insurance…. Because you are terrified of dying alone. Because you are terrified of living alone.” Sgro is clearly attune to the many and varied kinds of hospital admissions, including the seemingly non-medical. I like Sgro’s play on words that shows two hospitalization realities: “Because of a broken system. A positive review of systems.”

Writing Prompt: This poem is part of Bellevue Literary Review‘s “Dis/Placement” issue. Why do you think this poem fits this theme? If you work in a hospital, list the reasons, obvious or more subtle, each of your current patients was admitted. Alternatively, think of a patient who has been admitted for one of the reasons Sgro lists in his poem. What was their story? Write for 10 minutes.

Continue Reading

Narrative Medicine

Narrative Medicine Monday: How Storytelling Can Help Young Doctors Become More Resilient

No Comments

Physician and author Dr. Jessica Zitter shows “How Storytelling Can Help Young Doctors Become More Resilient” in her recent essay in the Harvard Business Review. We know that this issue is vital to increasingly stretched and stressed medical providers, the consequences of which are discussed in previous Narrative Medicine Monday posts here and here. I wrote a short piece in Pulse for their “Stress and Burnout” issue that outlines a typical day for a modern primary care physician and have also studied and taught narrative medicine as a tool to better care for our patients and ourselves. Zitter has a unique perspective on the particular challenges for physicians and patients in end of life care, given she is board certified in both critical care and palliative care medicine.

Zitter addresses this issue through a “new program which uses storytelling to help young doctors reflect on how they handle the emotional and psychological toll of caring for suffering patients.” She opens up to a group of new physicians about running the code of a young woman in the ICU, the resistance to letting a patient go, even when nothing remains other than suffering: “We are expected to be brave, confident, and above all, to never give up.  And all the more so in particular cases, such as when a patient is young, previously healthy, or has a condition that appears reversible on admission. And in cases when our well-intended but risky interventions might have actually made things worse, it is almost impossible to let go.”

When the experienced Zitter suggests that they instead institute pain management and sedation rather than attempt resuscitation the next time her heart stops, the physicians-in-training bristle. She questions a culture that promotes doing everything, including “this technique, that intervention, a whole host of options that would never have saved this woman.” Zitter admits she gives in to the other physicians, decides to fight “to the end, the way real heroes do.” The result is tragic. “The patient died a terrible death.”

Zitter reflects on this experience and shares it in the hope that it will help other young physicians who will certainly encounter the same, given that our culture and medical training makes it so “we often feel unable to question or diverge from scripted approaches — ones which may actually cause more suffering than benefit.”

To combat this, Zitter looks to storytelling, asserting that “[d]ata show that the use of stories to process the challenging experience of being a doctor increases empathy, enhances wellness and resilience, and promotes a more humanistic health care culture.” After Zitter shares her story with the group, others begin opening up about their own experiences and a “genuine conversation proceeded, one which addressed the emotional pitfalls and psychological challenges of this work.”

Zitter is also part of a 2016 Netflix documentary called “Extremis.” This short film takes a hard look at the grueling decisions patients’ families, and the physicians who inform them, make near the end of life in the ICU. In it, you can appreciate the need to “provide safe spaces for healthcare professionals to reflect on and process their own suffering. Then we will be fully available to do the hard work of patient-centered decision making in the moments when it is really needed — at the bedside of a dying patient.”

Writing Prompt:  Have you had to help make decisions for a patient who is critically ill in the ICU? What issues came up? How was your interaction with the medical team that cared for your loved one? Alternatively, consider watching the short documentary “Extremis” and write about a moment that struck you or perhaps changed your way of thinking about end of life care. If you’re a medical professional, think of a time you witnessed an end of life situation when the patient experienced more suffering than was necessary. Do you agree that our culture contributes to performing “risky interventions” that “might have actually made things worse,” because we insist on fighting “to the end, the way real heroes do?” How do you think sharing such stories might promote wellness? Consider writing about a challenging situation from the perspective of the attending doctor, the resident, the patient, the nurse, the family member. Write for 10 minutes.

Continue Reading

Narrative Medicine

Narrative Medicine Monday: Caring for Ms. L

No Comments

Dr. Audrey Provenzano explores the difficulties in treating opioid use disorder in The New England Journal of Medicine‘s “Caring for Ms. L.” Provenzano has already developed rapport with Ms. L when one day the patient admits to her doctor that she had “taken a few of the oxycodone pills prescribed for her husband… [a]nd like a swimmer pulled into the undertow, she was dragged back into the cold, dark brine of addiction.” Ms. L is eager to try a treatment called buprenorphine but Provenzano doesn’t have the special license or training to prescribe the medication. Ms. L expresses disappointment at needing to establish care with a different provider. She trusts her doctor and doesn’t want to tell anyone else about her addiction.

Provenzano confesses that “the reason I didn’t have a waiver to prescribe buprenorphine was that I didn’t want one…. Every Friday I left the office utterly depleted, devoid of the energy or motivation it would take to spend a weekend clicking through the required online training.” She admits that more than anything, she avoids the training because she “did not want to deal with patients who needed it.” Provenzano had witnessed the toll addiction can take on a patient’s relationships and life and “[a]lready overwhelmed, I did not want to take on patients with needs that I did not know how to meet.”

Most primary care physicians can relate to Provenzano. There is already an alarming amount of burnout that exists among today’s physicians; the thought of adding another degree of complexity seems untenable to most, especially if it seems the therapeutic need is insurmountable.

Provenzano notes, though, that when Ms. L returns to her for diabetes treatment after seeing a colleague for the buprenorphine “a space had opened between us.” Ms. L doesn’t return for follow up and it is a year later that Provenzano learns that Ms. L died of an overdose. Provenzano experiences a “profound sadness” for Ms. L’s family, though “it was the shame that kept me awake.” She can’t help thinking that, given the strong patient-physician relationship they had previously developed, if Provenzano had treated Ms. L herself things might have turned out differently.

Provenzano goes on to get buprenorphine training and experiences both the therapeutic and complex social aspects of managing patients with opioid use disorder. She advocates for moving beyond just the training needed to prescribe medications for this chronic disease, but also urges us to “recognize, name, and talk about the social issues that must be addressed” and establish “team-based behavioral health and social work resources.”

Provenzano eventually finds treating patients with opioid use disorder “the most meaningful part of my practice.” She ultimately experiences great satisfaction in providing some normalcy to patients who are “roiled by overdose and estrangement.” Have you experienced the same?

Writing Prompt: As a patient, can you understand or appreciate Dr. Provenzano’s hesitation at first? If you’re a physician, have you experienced a similar hesitation? If you’ve suffered from addiction, what has been the most therapeutic intervention you’ve received? Think about an experience with addiction, either on a personal level or with a patient, that was particularly difficult. Then consider an interaction or moment that was a breakthrough. Write for 10 minutes.

Continue Reading

Writing

Autumn YAWP

No Comments

For the second year in a row, I’m attending Centrum’s Autumn YAWP (Your Alternative Writing Program). It’s quickly becoming a favorite retreat as it’s designed just for introverted writers like me. Late morning is an optional gathering for a communal free write, the rest of the day is for your own writing, revision, reading, and exploring.

The setting is serene and includes trails, beaches and modest comfortable accommodations at Fort Worden. Nearby Port Townsend provides plenty of cafes, restaurants and a wonderful bookstore and theater.

I have specific goals for the weekend, including developing a new syllabus for a Literature & Medicine program I’m leading for physicians, working on a book proposal for a new manuscript, and final edits on a poem I plan to submit soon. Grateful for the time and spaciousness of this place to read and write and rest.

Continue Reading

Narrative Medicine

Narrative Medicine Monday: My Human Doctor

No Comments

Dr. Sara Manning Peskin writes in the New York Times about the fallibility of physicians and its emotional toll in “My Human Doctor.” Peskin introduces us to her patient, Shirley, who was given a diagnosis of multiple sclerosis. This patient finds that in assuming this chronic, often debilitating, disease, even the very word itself “crippled her. She’d stopped driving, stopped working, and adjusted to the stigma of having a chronic disease.” After a hospitalization due to a serious reaction to one of her medications, it was discovered that “Shirley might not have had multiple sclerosis at all.”

Peskin reflects that in medical training we do discuss errors but “[w]e don’t talk about the emotional trauma of hurting a patient. Instead, most physicians cope with guilt, self-doubt and fear of litigation in private. After our patients, we become ‘second victims’ of our mistakes.” Given the recent spotlight on depression and burnout in medicine, Peskin highlights an important point that we ignore to our peril. Some organizations are realizing this and offering more programs such as Balint, peer support groups, and expanded counseling services to explore and address this emotional trauma.

When Peskin suffers the consequences of a mistake made by her own physician, the response she receives is “‘I can’t turn back time.'” Peskin experiences first hand that “[a]pologies are difficult for doctors, not only because we have to cope with hurting someone, but also because we are scared of the legal implications of admitting culpability.” Peskin outlines how the U.S. system differs from many other countries, where the “‘no-fault’ system is based on injury from medical care and not on proof of physician negligence…” and “doctors and patients remain on the same side, and more patients get paid.”

Peskin does end up apologizing to her patient, Shirley, for the misdiagnosis of multiple sclerosis. They were then able to move forward in the doctor-patient relationship and discuss Shirley’s adjustment to the “possibility of not having a chronic disease.”

Writing Prompt: Think of a time your doctor made a mistake. How did they approach the error? Did they apologize? If you’re a physician, think of a mistake that you or a colleague made that is particularly memorable. What happened and how did you respond? How did the situation affect the patient-physician relationship? Consider writing about this experience from both the patient and the medical provider’s perspective. Write for 10 minutes.

Continue Reading
1 … 3 4 5 6 7 … 14