Narrative Medicine Monday: Erasure

Student and poet Thomas Nguyen writes of memories and loss in “Erasure.” In his poem Nguyen is instructional, warning how time affects our connection to those we’ve lost: “Accept that time makes things distant, that his absence doesn’t bleed into your memories as much as it used to.” There are only a few significant people in my life who have died, but I can identify with Nguyen who needs to try “harder and harder to remember the last time” he saw his mentor.

Nguyen notes that the patient speaks of his melaonmas as if they were part of his garden: “My dermatologist taught me how to care for them.” Nguyen goes on to contrast this with the green moss on the windows of his home. Do you agree with Nguyen that “life always adds?” Do you find this contention comforting or suffocating, or both?

Writing Prompt: Have you spent time with a loved one or patient who was nearing death? If time has passed, how have your memories of this person been affected? Recall the last time you saw them. Outline the details, like Nguyen’s memory of “neatly-pressed khakis.” Write for 10 minutes.

 

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Narrative Medicine Monday: The Permanent

In “The Permanent,” Amy Burke Valeras takes us back to the 1980s when perming your hair was a thing. In the first half of the poem, Valeras opens up about her struggle with her hair; I could relate. I similarly begged for an ill-advised perm the same year, the same age as the author. I like how Valeras makes her hair a central character of the poem. We battle along with her preteen self as she tries to tame the “frizzy poof.” We can understand when, two decades later, she is told she has cancer but all she can think of is: “My hair!”

Writing Prompt: Think of an every day aspect of your life, of your body, that you took for granted or had a different relationship with until you became ill. Consider level of energy during a bout with the flu, walking with a sprained ankle; maybe you have lost your hair to chemotherapy or a breast to invasive cancer. Write about your relationship with this aspect of your body before you became ill and after. How did things change? Write for 10 minutes. 

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Narrative Medicine Monday: Wernicke-Korsakoff

Poet and medical student Sarah Shirley describes an evolving interaction with a patient in “Wernicke-Korsakoff.” The patient initially finds complaint with everything: “the too soft too hard bed, the lunch that came with only one spoon though clearly two spoons were required.” Shirley struggles to connect with the disgruntled patient, who clearly wants nothing to do with her as an intrusive medical student.

Throughout my medical training and career I’ve encountered patients, like in “Wernicke-Korsakoff,” where “everything is thrown back.” They were angry at their disease, angry at the medical providers, angry at the system, angry at the world. At times, I’ve been one of those patients myself. There’s no doubt health and illness affect our mood. Many of those who are suffering build a shell to cocoon themselves off from the damaging world. Often they are rightfully skeptical of a medical system that has many failings. Shirley finally breaks through to her patient in the end, after searching for the right connecting point. 

Writing Prompt: Think about a time you were sick. How did being ill affect your mood and interactions with others? Were you inclined to cling to others for support or did you find yourself “raging against the world?” Perhaps you experienced both. What about a time when you were caring for someone who was sick? Did they allow you to connect with them right away or was it a struggle? Write for 10 minutes.

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The Summer Day


I’m camping with family today so taking a hiatus from Narrative Medicine Monday. Instead, enjoy this classic poem by Mary Oliver. May you be “idle and blessed” this summer day.

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Narrative Medicine Monday: #3 In Line

Eliza Callard imagines a lung transplant in her vivid poem “#3 In Line.” She begins by describing the surgeon’s actions lifting “the sodden lungs out,” but then pauses to wonder about the patient: “Where will she be for all this?” Callard touches on the desperation following any transplant to get the foreign object to “stay, stay,” to trick a body into accepting an imported organ as one of its own. 

Writing Prompt: Imagine an organ transplant: liver, lung, kidney. Write about the transplant from several different perspectives: that of the patient, her body, the transplant surgeon, the patient who donated the organ, even the organ itself. Write for 10 minutes. 

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Narrative Medicine Monday: Bedside Rounds

John L. Wright’s poem, “Bedside Rounds,” speaks to the apprentice-like training of physicians. It is a passing on of skills from the experienced to the inexperienced, from the knowledgeable to the clinically naive. Most medical students, unless they have a background in another medical field, have little to no real experience in the hands-on component of medicine. They take years of study – biology, anatomy, pathophysiology – and translate that book smarts into skills of diagnostic touch, suturing skin, prescribing treatment. 

One method of transforming head knowledge to a practical skill set is through bedside rounds: a gaggle of medical students and resident and fellow physicians (still in training) following after an experienced attending physician. Each morning this group travels from bedside to bedside, discussing the patient’s disease, the patient’s prognosis, the patient’s progress, the patient’s treatment plan. In recent years, medical schools have worked on making this process more inclusive of the patient who, after all, is the subject of the discussion. 

Wright’s poem touches on the experience of that patient, ill and incapacitated, being talked over in a cryptic language, determinations being made about the status and plan while the patient may still be steeped in a cloud of confusion. 

Wright finds himself in a comparable situation when his landscape architect brings her intern along with her one day. As this professional passes on her skills to her protégée, discussing his yard in detail, Wright begins to feel something he hadn’t expected: “I begin to resent them—the little games they play.”

Writing Prompt: Think of a time you’ve experienced bedside rounds as a physician, as a patient or while visiting someone in the hospital. If you were the patient, how did you feel when the medical team discussed your case in front of you? Did they include you in the discussion or explain what they talked about? If you’re a medical provider, choose a memorable bedside rounding experience: running rounds for the first time, being a brand new medical student, noticing something significant with the patient’s demeanor while their case was being discussed. Write for 10 minutes.

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Free Write Friday: Cliff

Note: This week I’m trying something new with the free write – a prose poem incorporating synesthesia. I was inspired by a Till writing workshop I recently attended, presented by poet Jane Wong. As always, feel free to use the photo above as a prompt for your own free write. Consider joining me in experimenting with an unfamiliar format this week. 

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Crackling of palm tree, fronds brushing carmine in the breeze. Squawk and tweet of birdsong, just beyond ear’s reach, punctuating high above. The turquoise wash of crashing waves below, colliding onto ebony rocks stoic as the spray recoils, resorbed by the expanse. Memories of jumping off, sound muffled, then expanding beyond into the greater sea. I climb the cliff, handholds of familiar crevices. I swim into the current, decades of tracing the reef map a mind’s fingerprint of coral phalanges. Thick blades of grass underfoot infuse the yellow taste of papaya. Nenes swoop in, then saunter through air thick with humidity. Specks of snorkelers flap fins, return to lie beached, their skin leathered like dragon fruit. Cloud shadows caress the ridged mountains, marking them like a bruise, feeding them with rain. One drop, then two trickles. The sea turtles gulp the air then dive into dry sweetness. They disappear but I never saw them, only heard shells cracking from a memory decades old. Momentary waft of plumeria, ginger, coconut, lilikoi, banana leaves suspends in the air just long enough for it to roll on my tongue, breathe into my lungs, absorb through my skin leaving an imprint, marking me home. 

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Narrative Medicine Monday: New York Lungs

In her poem, “New York Lungs,” medical student Slavena Salve Nissan writes of the intimacy of knowing a patient “underneath her skin fascia fat.”  Nissan notes how her beloved city left a mark on her patient’s lungs. She thinks about the people who loved her patient and how even they didn’t know that the patient looks “like a frida kahlo painting on the inside.”

Place is a central theme in this poem. I like the subtle imagery of the medical student and her patient breathing the same air, from the same city, in and out of their lungs. This commonality, too, connects them.  

As a medical provider, we experience intimacies with patients that are both strange and surreal. It is a great privilege that our patients allow us, for the purpose of diagnosis or treatment, to perform these intrusions: cutting into the skin, sampling cells from the cervix, looking into the ears, listening to personal stories, palpating the lymph nodes. Over time this can become routine to the medical practitioner, but I do still wonder, and hope I never lose keen curiosity, about the lives of my patients beyond the exam room. 

Writing Prompt: Reflect on the vulnerability between a patient and physician. Is it surprising that we can be so open and trusting with a near stranger? Think about such a time, perhaps a surgical procedure or mental illness or embarassing symptom, when you put your complete trust in your medical provider. What was that like? Write for 10 minutes. 

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Narrative Medicine Monday: The Last Heartbeat

Cortney Davis’ “The Last Heartbeat” explores her competing identities as daughter and nurse at her dying mother’s bedside. Davis opens the poem as she holds her mother’s hand, counting her last heartbeats, witnessing her last breath. She ends with greater questions of life and soul as she walks with a friend through a cemetery.

Writing Prompt: If you’ve been at the bedside of a loved one as they died, what do you remember most? What have you forgotten? What about at the bedside of a terminal patient? Did this experience prompt greater questions about the soul? Write for 10 minutes.

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