Narrative Medicine Monday: Someone Else’s Pain

Brenna Working Lemieux’s poem “Someone Else’s Pain” illustrates the struggle to understand what others are feeling, how challenging it can be to fully grasp another’s suffering. The patient experiences “some driven-screw anguish that flares” that they attempt to explain. Lemieux can only “nod or shake [her] head.”

I can relate to Lemieux; medical providers regularly face the challenge to decipher a patient’s explanation of illness or pain. I delivered babies for many years before I had my own children. After I experienced labor for the first time myself, I cringed recalling many of the comments, modeled after other medical providers, I had made to laboring patients prior to experiencing that pain myself. I had been sympathetic to their pain but could not embody empathy in the same way I could after I had gone through a similar experience. I had no reference point to the crushing agony of contractions that I would later understand. Of course, we can’t fully experience everything our patients go through. However, we can become better at listening and responding to the story they are trying to tell.

Lemieux likens listening to the patient describe their pain to the focus she had in art class, “trying in vain to capture” an image of her hand. Her poem illustrates the nuances and importance of narrative to medicine, the need to hone our listening and storytelling skills to improve the relationship between patient and physician and, ultimately, medical care as a whole.

Writing Prompt: What is the biggest challenge in understanding another person’s pain or illness? Have you ever tried to describe such an experience to a friend or healthcare provider? Think of a time you were on the explaining or the listening end of such a conversation. Write for 10 minutes.

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Narrative Medicine Monday: Heroin/e

In Cheryl Strayed’s essay “Heroin/e” she writes about our ways of facing death, dying, grief and the will to live. Strayed loses her mother to cancer and suffers her own descent into addiction. Strayed’s love for her mother is evident and the loss she feels is acute. When her mother first learns of her diagnosis, Strayed recounts them silently entering the restroom, “Each of us locked in separate stalls, weeping. We didn’t say a word.” Strayed describes the numbing of pain and the warping of time for each of them: “The days of my mother’s death, the morphine days, and those that followed, the heroin days, lasted only weeks, months–but each day was an eternity, one stacked up on the other, a cold clarity inside of a deep haze.”

Writing Prompt: What does it feel like, in a physical sense, to suffer from addiction? From grief? Do you think addiction and grief are linked? Why or why not? Think of your own experience or a time you’ve witnessed this in a patient. Write for 10 minutes.

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Narrative Medicine Monday: The Dilemma Doctors Face

The spotlight has recently been on the opioid epidemic ravaging our country. As a primary care physician, I’m acutely aware of this issue and the challenges it poses to individuals, medical providers and the public health system as a whole. NPR’s The Takeaway recently did a program on understanding this crisis and approached it from many angles. Dr. Danielle Ofri wrote short a piece in Glamour magazine that gives a primary care physician’s perspective. In “The Dilemma Doctors Face,” Ofri notes that chronic pain is very real but differs from other chronic disease in that there is no definitive test or measurement for pain, it is subjective. “Chronic pain is real. It can ruin people’s lives. But the anvil of addiction and death can’t be ignored.” Ofri asserts that one challenge is that a system that doesn’t often pay for other ways of treating pain, such as physical therapy, acupuncture and massage, makes it easier for the medical provider to “just write a prescription.” Can you relate?

Writing Prompt: Have you or a loved one struggled with chronic pain? What were the challenges you faced when trying to find appropriate treatment? Have you or a loved one struggled with opioid addiction? What was the first sign that this had become an issue? If you prescribe opioid pain medications, how do you approach counseling patients about the risks and benefits of taking these medications? What are some of the challenges you’ve faced in having this discussion? Write for 10 minutes.

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Free Write Friday: Pain

I notice it gradually, while exercising one morning. It’s a familiar routine, but that day bending over to touch the floor, leg lifted behind, I can’t hold the pose and my back gives way. The pain is insidious, then persistent. I go to work, hobbling throughout my day. Coworkers ask: What happened? Do you need something? Then they suggest: Try my chiropractor. Try downward dog. Here’s a hot pack. This is the only thing that helped my sciatica years ago. They’re all trying to be helpful but I can only wince. I can hardly walk. The pain is shocking, debilitating.

As a physician, I see people in pain every day. Pain from overexertion, pain from chronic illness, pain from medication side effects, pain from heartache. But to experience it myself, the slowing of body, the unexpected twitch of muscle with a movement, the limitations imposed by a body that isn’t working as it should, by a body that is a conduit for pain rather than a vessel for function: it’s humbling.

I don’t exercise for a week, then two. It’s hard to explain to others who only see me as able-bodied. They don’t realize. I shuffle as I cross the street; my husband and children walk casually ahead, so far ahead, on the crosswalk. I feel slow, I feel invalid. I get massage therapy, apply heat therapy, ingest ibuprofen religiously. The pain, initially searing in my back, flares unpredictably, shooting through my hip as I rise from sitting, as I twist to respond to a question, as I bend to pick up my baby from her crib.

A week into the flare, I just want to lie in bed, not get up, not go out. Though I am loathe to just lie there. I resent the creeping sluggishness. I want to defeat the lethargy and, simultaneously, be enveloped in it. I can suddenly see how people succumb: to numbing medications, to despair. Pain steals all functionality until the pain is all that’s left. And then it becomes your only companion. It is a cruel tease. One day or moment might feel a bit better, hope rises. Then, cruelly, it dissipates as the pain roars back.

One day I wake and can sit up without wincing, can walk with only a slightly antalgic gait. Everyone asks: How are you feeling? I feel tentative. I feel better. I feel anxious that it might come back, might return to level me again. I’ve learned now, it’s taught me. Pain is a presence, but also a thief.

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