(Re)Published: Dust

“…where are the moments of joy, of beauty, of grace within this doomsday path humans are on? From where or how do we come up with reasons that make it worthwhile to continue living? To rush out of our beds to greet the day? To smile? To laugh? Well, for me, these moments would occur through the positive interactions made possible by love and respect for other people, creatures and the environment…” – Eileen R. Tabios

Thrilled to announce that my collection of vignettes about my work in Kenya, Dust, will be part of an anthology published by Paloma Press this summer. Dust originally appeared in the Spring 2016 issue of Intima. The Paloma Press editor contacted me to inquire about including it in their upcoming book, Humanity. I’m honored to be among professors, poets, ethnographers and others who have contributed to this important work. More to come when the anthology launches this summer!

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Narrative Medicine Monday: GUTS

I previously featured author Janet Buttenwieser’s essay, “The Colostomy Diaries,” on a Narrative Medicine Monday post. Today, I’m pleased to highlight her similarly humorous and heartfelt memoir, GUTS.

Buttenwieser writes with a comfortable familiarity, weaving candor into her story of misdiagnosis, treatment and loss. I felt like I was reading the words of a dear friend; Buttenwieser is authentic and relatable. She navigates the foreign and often perplexing world of medicine as a young patient, stricken with a debilitating illness. She finds herself getting regular CT scans and under the care of a surgical resident, contemplating operative measures: “I decided right then that I liked the resident better than my regular doctor. In my growing survey of medical professionals, I’d begun to notice a trend. The younger the doctor, the more he or she listened to me. They asked questions …”

I was particularly struck by a passage where Buttenwieser describes her overhearing a paramedic relay her emergency case to the hospital where the ambulance is transporting her to. He uses the common medical term “chief complaint.” She bristles at the phrasing, stating “I feel angry at the way we patients are portrayed by the medical establishment as whiny toddlers who need a nap. Patient complains of gunshot wound to the head. Patient complains of missing limb following leg amputation.” There is phrasing that becomes commonplace during medical training, traditional wording that is passed down in the name of congruity. To an outsider, though, I can appreciate how unfeeling much of this must seem. Medical-ese leaves much to be desired in the realm of patient-centeredness.

I was privileged to meet the local author briefly at a book signing and will attend a book club this week where she will also be in attendance. I admire her writing skills as well as her contribution to an important perspective – that of a young patient. GUTS has solidified its place among my favorite narrative medicine memoirs, including In Shock, When Breath Becomes Airand On Call.

Writing Prompt: Have you encountered a certain trend among medical professionals, as did Buttenwieser? Do you agree that younger medical providers are better listeners? As a self-proclaimed rule follower, Buttenwieser finds it difficult, especially early in her bout with disease, to advocate for herself or question her initial physician’s diagnosis and treatment plan. Have you faced a similar challenge in the medical world? Write for 10 minutes.

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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: The Colostomy Diaries

With humor and candor, Janet Buttenwieser writes in “The Colostomy Diaries” about awaiting her gastrointestinal surgery and the aftermath that leaves her with a colostomy. 

I like Buttenwieser’s use of visual details, putting the reader in the room with her, receiving this disappointing news: “‘You’ll have to have your entire rectum and anus removed,’ my surgeon told me over the phone as I sat in my living room, an unread newspaper on the table, cherry blossoms blooming on the tree outside my window.” 

Buttenwieser faces difficulty getting the trash can she needs to dispose of her colostomy bags at work. The humiliating barriers she encounters illustrate the ridiculousness of much “beurocratic red tape.” After her surgery, she struggles with how many details to disclose about her sensitive change in physical status, even to friends. 

Buttenwieser’s candid anecdotes of everyday challenges post-surgery, such as shopping for clothes and dealing with an emergency malfunction of the colostomy bag while out with her small children, show why her new book Guts, set to be released in 2018 by Vine Leaves Press, is likely to be an entertaining and enlightening read. 

Writing Prompt: Think of a time you’ve dealt with “beurocratic red tape” in relation to a medical condition or the medical field. List all of the obstacles you encountered. Can you infuse some humor into the piece, despite the frustrating experience? Write for 10 minutes.

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Narrative Medicine Monday: The Sink

Author Kate Ristau writes about her son’s heart surgery in “The Sink.” She starts the essay remembering her mother’s farmhouse sink, then describes the simple motions she went through at her own kitchen sink the morning of her son’s surgery.

I like how Ristau uses a common utilitarian object as a focal point in this piece. She describes in detail washing her hands at the sink in the hospital waiting room. She implies that these actions grounded her – loading her dishwasher, washing her hands – during this tumultuous life event. Ristau relays the telltale sign that her son, when well at home, has actually brushed his teeth: “That’s how I know he brushed them–the splash of color sliding down the porcelain.”

The reader is thrust into the narrator’s experience waiting for her son to wake up from anesthesia. When he does, the details she provides allow the reader to enter into her experience as the mother of the young patient: “…we used words like valves, clots, stitches, glue and morphine. Complications, IVs, shots, and applesauce, along with fluid in his chest cavity and so many possible futures balanced on the edge of his hospital bed.” Ristau reflects on how her son eventually asks for something quite surprising, out of his usual character, when he is finally able to get up and out of bed. The reader gets the sense that, on the other side of this surgery, he is changed, as is Ristau.

Writing Prompt: Think of an object in your home or workplace that is also found in a doctor’s office or hospital. Consider a plate of food, a chair, a computer, a bed. Describe the experience of that object when at home versus when you or a loved one were ill. Write for 10 minutes.

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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: Dinosaurs

Ophthalmologist Maria Basile writes of the evolution of surgery in “Dinosaurs“, part of the Poetry and Medicine column in JAMA. Her poem reflects on innovations in how surgery is performed and is a commentary on the constant churn of medical reinvention. 

Have you or a loved one personally benefited from a recent medical innovation? Can you think of something important that might have been lost through adopting a medical advancement? Also consider the challenges posed by some new medical procedures and breakthroughs. When kidney dialysis first emerged as an option for treatment of kidney failure and there was very limited availability. Decisions needed to be made about who would receive this treatment. Sometimes a medical innovation raises unforeseen and difficult ethical challenges. 

Writing Prompt: Think back to when you first started medical training. How has medicine changed since that time? What were considered the greatest innovations or bioethics questions of that time? What are they now? Alternatively, think about what was considered a medical marvel when you were a child. How is that innovation viewed today? Write for 10 minutes. 

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Narrative Medicine Monday: Line of Beauty

Arlene Weiner writes of her post-surgical incision in “Line of Beauty,” a poem featured in the online narrative medicine journal Intima. The narrator’s physicians describe her incision site as “beautiful.” She notes the young surgeon admired her incision site “with feeling” but then left her undressed. The reader gets the impression he is appreciating his handiwork but forgetting about the patient it belongs to. Have you ever felt that way about an interaction with a medical provider?

I like how Weiner contrasts this surgery, an “insertion,” with her previous ones, including “a chunk of back punished for harboring promiscuous cells.”

Writing prompt: Think about the different words we use to describe medical procedures or ailments. How might a patient’s description differ from that of a medical provider? Does it matter what words are used? Have you ever had a doctor use a word that surprised you? Write for 10 minutes.

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