Ramblings

Medicine and Mothering on the Front Lines of COVID-19

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Two weeks ago I picked my kindergartener up from after-school basketball on a routine weekday afternoon. He bounded up to me, backpack in hand and asked, “Mom, do you know about coronavirus?” His teachers had discussed the viral outbreak and the need for good hand-washing skills. My budding epidemiologist went on to explain how the virus spread from bats to another animal to a human to another human to even more humans and so on. I tucked him into bed that night, marveling at his teacher’s skill in stressing hygiene and explaining the novel virus to a group of 6-year-olds.

Of course now coronavirus, or COVID-19, is all anyone is talking about, reading about. Coronavirus has uprooted my personal and professional life. As a family medicine physician working in Seattle, and as a mom to three young children, COVID-19 has consumed my day-to-day activities and workplace. As a primary care clinician and parent at a U.S. epicenter of the outbreak, there is no other word for home or work right now than upheaval.

I am also a writer, a creator of art. But I have struggled to find the time and emotional space to articulate and explore all the layered questions this crisis has presented to me—as a physician, as a mother to young children, as a creative being in this world. Fragments of essays, lines of poems, pour out of me as I wake with anxiety in the middle of the night, as I run around a deserted Seattle park, as my children beg to gather with their friends, as I discharge a clinic patient who pauses as she exits the exam room: “Thank you for being a doctor.”

As a participant of Harvard Medical School’s inaugural Media & Medicine program, I’ve recently been trained in writing Op-Eds for the public, in discerning misinformation and disinformation in the media about healthcare issues, in thinking creatively about how we can use podcasting or plays or poems to tell stories that make a difference to important public health topics. My classmates and I, healthcare professionals from all over the world whose projects focus on varied themes from mental health to vulnerable populations, from physician burnout to cancer awareness, suddenly find ourselves in the middle of a pandemic, sharing stories from our respective locations worldwide.

My work right now, though, is focused here, on my community: the people I hold most dear and the place I grew up in, I trained in, I live. My colleagues and community are at the forefront of this pandemic. I feel the rising sense of fear, the wave of overwhelm, the steady thrum of kindness.

For now, I offer this. Anyone who attended medical school with me knows I like to make lists. I approach a seemingly insurmountable task by compiling, organizing, and splitting it up into manageable components. Over the last two weeks, as local healthcare systems faced rapidly changing recommendations, confusion about suggested protocols, differing messages on testing capability, questions about adequate protection and supplies, as schools closed and family schedules were upended, I gathered information. Here is my contribution, my list of reliable resources and information for the worried, weary, and hopeful among you.

Despite my own swirling anxieties, I’m grateful for the work I’m trained to do, in medicine and in the humanities. I’m thankful for my colleagues—every aspect of the health care team—who are committed to serving our community’s most vulnerable, and each other, through an uncertain time. I’m bolstered by the parents sharing resources and tips about how best to support our children through unprecedented upheaval. This, I know: we are distilled in a crisis to the best, or the worst, that is in us. May we cling to the best, stand firm in sound science, look to compassion and art that sustains our souls, and encourage others to do the same.

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Narrative Medicine

Media & Medicine

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I’m an introvert. I recently took an online Myers-Briggs test a work colleague sent me, and I scored a solid INTJ. This categorization has been stable for me since high school. Though I do enjoy social events and meeting new people, as a true introvert, I find conferences exhausting. Medical or otherwise, the constant introductions, social navigating, and personal storytelling involved can prove daunting.

Last April, I was in Boston at a medical conference and had lunch with a group of women physicians. I struck up a conversation with the woman sitting next to me, trading the standard questions: where we’re from, our medical specialty, our interests. I told her about my passion for writing and narrative medicine and storytelling and physician wellness and bioethics and the humanities and, in turn, heard all about her upcoming book and the wonderful work she was doing in Boston.

A month later she emailed me, saying she had just attended a narrative writing event at her hospital, run by Dr. Suzanne Koven, and that what Dr. Koven was doing seemed very much aligned with my interests and the work I hoped to do in Seattle. Would I like a virtual introduction?

And that, as they say, is history. At least for my work and life. I spent over an hour speaking with Suzanne, learning about her path in both medicine and writing, and how she formed the Literature & Medicine program that has been running for over a decade. I knew I’d like Suzanne immediately when her first words to me were, “Well, let’s discuss our mutual favorite topic: narrative medicine.”

Under Suzanne’s guidance, I went on to establish a Literature & Medicine program at my own institution in Seattle, and she has since become Massachusetts General Hospital’s first Writer-in-Residence.

So when I heard that she and Neal Baer were starting a Media & Medicine course at Harvard, looking at how we can use storytelling to address pressing public health issues, I knew I wanted to be involved.

This past week, the inaugural Media & Medicine class met together in Boston for five days of lectures and networking, community and conversation. With a cohort of 50 people from all over the world, there was rich discussion and consideration of how we can use journalism and podcasting, op-eds and plays to address issues in healthcare.

I was impressed with the many innovative ideas, including implementing design thinking to tackle complex healthcare problems, weaving public health education into television and plays, and using solutions journalism to show that “better is possible” to enact change. Keynote speaker Dr. Leana Wen urged us to start with our authentic selves and stick with the voice we know. We collectively wrote op-ed pitches, practiced playback theater techniques, critiqued podcasts, and turned partner stories into playdough and pipe cleaner art.

I met an impressive group of healthcare professionals from all over the world, eager to expand on work in public health, mental health, health disparities, physician wellness, and chronic disease. We learned from each other, advised each other, helped with networking solutions and built our own community of advocates for storytelling and listening, which we’ll continue to grow over the next six months as we work on specific public health projects.

I had so many rich conversations, and heard from experts in media and storytelling. I’m leaving Boston invigorated and exhausted. I can’t wait to work on my own project, focusing on mental illness, and support and champion the work of my fellow colleagues. Although taxing for introverts like me, I’m so glad I had that conversation, shared my story with the women physicians I met at that conference back in 2018. It speaks to the power of personal connection, of telling our stories with vulnerability and hope, and this, I think, is what the Media & Medicine program is all about.

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Narrative Medicine

Narrative Medicine Monday: Having and Fighting Ebola

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I wrote yesterday about how I attended a summer institute in Paris that focused on health beyond borders. The final keynote speaker was Dr. Craig Spencer, who shared his work rescuing and treating migrants in the Mediterranean.

Dr. Spencer has worked extensively in global health, and in 2015 wrote an essay published in The New England Journal of Medicine about contracting Ebola when he was treating patients in Guinea. He was a clinician who became a patient, fighting for his life.

In Spencer’s piece, he outlines how the “Ebola treatment center in Guéckédou, Guinea, was the most challenging place I’ve ever worked.” Though there was no clear breach of protocol, Spencer still returned home having contracted Ebola, becoming “New York City’s first Ebola patient.” Spencer shares both the anxiety and compassion he felt in caring for patients with Ebola: “Difficult decisions were the norm: for many patients, there were no applicable algorithms or best-practice guidelines.”

Dr. Spencer shares how, back in New York, after “the suffering I’d seen, combined with exhaustion, made me feel depressed for the first time in my life.” Though immediately presenting to the hospital the moment he exhibited any sign of illness or elevated temperature, Spencer is vilified in the media, his activities upon returning home scrutinized and “highly criticized…. People excoriated me for going out in the city when I was symptomatic, but I hadn’t been symptomatic — just sad. I was labeled a fraud, a hipster, and a hero. The truth is I am none of those things. I’m just someone who answered a call for help and was lucky enough to survive.”

Spencer calls out the panic that ensued after his diagnosis, how politicians “took advantage… to try to appear presidential instead of supporting a sound, science-based public health response.” He points out that “At times of threat to our public health, we need one pragmatic response, not 50 viewpoints that shift with the proximity of the next election. Moreover, if the U.S. public policy response undermined efforts to send more volunteers to West Africa, and thus allowed the outbreak to continue longer than it might have, we would all be culpable.” Spencer notes not only the misguided response to his own infection, but also the ripple effects this policy could have had on the outbreak worldwide. His is a cautionary tale of how a response to any public health situation must be grounded in steady pragmatism and based in scientific fact. Lives depend on it.

Writing Prompt: Dr. Spencer shares how, after witnessing significant suffering through his work with Ebola patients, he felt “depressed for the first time in my life.” If you are a medical provider, have you experienced similar secondary trauma? How did this manifest? Where did you find support? Alternatively, consider that Spencer urges us to “overcome” fear. Reflect on what you are fearful of, from a public health standpoint or otherwise. Is it a rational or irrational fear? How might it be overcome? Write for 10 minutes.

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Narrative Medicine

Narrative Medicine Monday: Still Not Convinced You Need a Flu Shot?

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Aaron E. Carroll provides a straightforward explanation as to why getting the flu shot is imperative to a healthy community. In his New York Times article “Still Not Convinced You Need a Flu Shot?” he notes we may be passing on the virus without realizing it, to people much more vulnerable than ourselves: “You can infect others a day before you show any symptoms, and up to a week after becoming sick. Children can pass along the virus for even longer than that.”

Carroll points out our lack of concern about the flu virus, so familiar every winter, is illogical: “Because the flu is so common, we tend to minimize its importance. Consider the contrast with how the United States responded to Ebola a few years ago. We had a handful of infections, almost none of them contracted here. One person died. Yet some states considered travel bans, and others started quarantining people.” He argues that we should be much more concerned about the flu, noting that influenza is the “only cause of death in the top 10 that could be significantly reduced by a vaccine. Lowering risks of heart disease, cancer or Alzheimer’s are much, much harder to do.” We have a way to decrease the morbidity and mortality from a common illness yet we choose not to harness that opportunity.

By looking at the history of the varicella vaccination, Carroll illustrates the benefit we gain through herd immunity and the ethical consideration of getting immunized even if you yourself are not at high risk. He notes that babies were dying from chicken pox prior to implementation of the vaccine, but “as rates of vaccination rose, the rates of death from varicella were low…. But more significant, from 2004 through 2007, not one child younger than 1 year old died in the United States from chickenpox. What was amazing about this finding was that we don’t vaccinate children that young for chickenpox — therefore, those babies’ deaths were not prevented because they were vaccinated. Their deaths were prevented because we vaccinated their older siblings.”

In a previous Narrative Medicine Monday post, I highlighted a New York Times article written by Dr. Danielle Ofri that I’ve used when teaching narrative medicine courses to medical professionals. It illustrates the challenge of communication between physicians and patients and why there often is a disconnect. How can we improve the dialogue to better inform the public and, ultimately, save lives?

Writing Prompt: Do you get your flu shot every year? Why or why not? Do you feel that you understand the reasoning for immunizations? What information might help you better understand? If you’re a medical provider, have you struggled to convey such information to patients? Think of such a time and write for 10 minutes.

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Narrative Medicine

Narrative Medicine Monday: The Art of Translating Science

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Lise Saffran emphasizes the importance of meaning in public health communication in “The Art of Translating Science.” This conversation is imperative amidst a culture where many important topics become highly polarized and politicized. Saffran argues that it is important for scientists to not just speak more plainly, but emphasize understanding of a concept. She notes that this is more challenging today because “when it comes to politicized topics, our ability to understand is often overwhelmed by our inability to hear.”

As a primary care physician, much of what I do in my daily practice is translational work: explaining a diagnosis, a lab test result, the need for a certain medication, the risks and benefits involved in preventive screening. The goal is to ensure the patient understands the meaning of the medicine, not just the facts. As Saffran notes, “a single word may change the meaning of the whole story.” A physician is also interpreting the patient’s story, taking the narrative they provide about their illness and using this information to determine best next steps toward diagnosis and improving their health. A scientist communicating about public health issues needs to convey concepts on a much broader scale. Our ability to translate effectively will dictate our health as individuals and as a society going forward.

Writing Prompt: Think of a time when you didn’t fully understand what a physician was saying to you. Perhaps it involved a specific diagnosis or importance of a new medication prescribed or test ordered. Did you get the facts but miss the meaning? If you’re a medical provider, think about a time that you missed a significant part of a patient’s narrative. Did that lack of understanding affect their diagnosis or treatment plan? Alternatively, consider a time you read an article on a public health topic such as climate change or vaccinations. Did you understand the underlying purpose of the piece? Have you had a conversation with someone who disagrees with your viewpoint on such topics? What might have increased your ability to understand each other? Write for 10 minutes.

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Narrative Medicine

Narrative Medicine Monday: The Quiet Room

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Trauma surgeons Drs. Masiakos and Griggs outline the public health crisis that is gun violence and the need for further research and action to combat this persistent threat. In “The Quiet Room,” they achingly describe delivering the devastating news to a mother that her child has died. They note that “we tell ourselves that this senseless dying must end. But it doesn’t end. Another child is shot, and another mother is heartbroken.” They go on to outline the epidemic of gun violence, asserting that “whether on the streets of Chicago or in the churches of Charleston and Sutherland Springs, [it] is a national health emergency.” These trauma surgeons, along with many other physicians, stress that “only if funding for research on firearm-violence prevention and public health surveillance is reinstated can we determine the best approach to addressing the public health crisis of firearm violence.”

Writing Prompt: What specific information would be helpful from firearm-violence research to stem the tide of this epidemic? Have you cared for a patient who has suffered from firearm-violence? Write about the experience. What can you do as an individual to join in the “collective power” to address this public health crisis? Write for 10 minutes.

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