Narrative Medicine Monday: To Seize, To Grasp

Writer Heather Kirn Lanier describes her daughter’s seizures in “To Seize, To Grasp.” Lanier begins the flash essay outlining her infant daughter’s first seizure: “not the worst one, although it brought the biggest shock.” Lanier relays what it’s like to be thrust into the medical world and terminology of a new diagnosis: “New traumas gift new glossaries. Words become boxes into which you can pack the pain.” She achingly describes the pain of watching her child seize, unable to do anything but wait: “But of course he could only do what I could do, which was inject medicine and wait.” Lanier closes the piece with her daughter’s worst seizure, which was not the longest. What was it that made this last one so frightening for Lanier? Can you relate to grasping onto that which can be lost at any second?

Writing Prompt: Have you been suddenly thrust into the medical world because of your own illness or a loved one’s diagnosis? What was it like to learn a new vocabulary and way of interacting with the medical system? What did you find most challenging or surprising? Write for 10 minutes.

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Free Write Friday: Beach

She walked down the hill to the beach, bundled in a down coat, fingerless gloves and a white knit hat. Sneakers on pavement gave way to fine sand spilling over her laces as each step took more effort. Closer to the shoreline the sand was more compact, sturdier beneath her. Here she could stroll along the rocky ground, now pounded by the November waves, wind whipping them into a fury.

She imagined a storm, how it would rage in years past, toss fishing boats as they struggled to avoid the lighthouse signaling at the point. She thought of the contrast, just yesterday sun warming her face as she ate lunch, read, wrote on a picnic table perched on the beach, watching couples meander along the shore with their dog. She could linger.

The wind beat fiercely as she climbed a small hill to circle back. But as she found herself among the golden reeds, atop a mound just set back from the rocky beach, she felt suspended, wind pounding from all directions. She paused, the intermission comforting, demanding reverence.

Pressure on all sides, she remained. It was as if liquid, not air, compressed her. As if warmth, an unexpected peace held her in the midst of the chill November day.

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Narrative Medicine Monday: In Shock

Although I’ve never met her, author and critical care physician Rana Awdish on some level feels familiar. Not only are we both part of a supportive online group of physician-writers, but I just finished reading her wrenching memoir, “In Shock: My Journey from Death to Recovery and the Redemptive Power of Hope.” Awdish’s gripping account of her near-death experience, subsequent hospitalization in her own ICU and revelations about the shortcomings in both support for and education of medical providers in the realm of empathy are illuminating. Her book is infused with challenge and hope and a call to transform the way we train physicians and care for patients.

Awdish is thrust from the world of providing medicine into that of receiving it – a patient under her own colleagues’ care. The contrast of these positions of power and vulnerability are striking and Awdish describes the jarring experience and her own enlightenment as she pivots between these two roles. She shares with the reader her revelations regarding how we provide medical care to those in crisis and inspires us to find a better way.

I was particularly convicted by Awdish’s insight into how medical training encourages physicians to suppress many of our emotions. She traces this ideal back to the father of modern medicine, Sir William Osler, who encouraged “‘aequanimitas.’ Osler regarded this trait as the premier quality of a physician. It represented an imperturbability that was described as manifesting in ‘coolness and presence of mind under all circumstances, calmness amid storm, clearness of judgment in moments of grave peril.'”

Awdish asserts that as physicians “we aren’t trained to see our patients. We are trained to see pathology. We are taught to forage with scalpels and forceps for an elusive diagnosis buried within obfuscating tissues. We excavate alongside our mentors in delicate, deliberate layers, test by test, attempting to unearth disease. The true relationship is forged between the doctor and the disease.” Do you agree with Awdish’s assessment? Why or why not?

If you’re a physician, if you’re a patient: read this book. Discuss it with your colleagues, mull over it with your book club. The questions Awdish raises, the challenges she poses are vital to improving the way we care for each other in our most acute times of need.

Writing Prompt: If you’re a physician, did you learn to develop “aequanimitas” through your training? Did you feel this trait was a requirement, overtly stated or otherwise, to be a “good physician?” Have you yourself ever been a patient feeling, like Awdish, “powerless in a way that is impossible to imagine, from a privileged position of wholeness and well-being?” Awdish lists biting phrases that were directly said to her or that she overheard when she was a patient. Have you experienced similarly painful words from a medical provider? Have you said such words to a patient before? Try writing from both the patient and the medical provider’s perspectives. Write for 10 minutes.

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Free Write Friday: Retreat

You plan months ahead to make it work. Line up sitters, meal plan for the following week, organize an overnight weekend at Grandma’s house. It feels luxurious, the silence and the resting in words. “Thinking is work.” You read it on a bumper sticker weeks ago and it remained with you, rolling over in your mind. You wrote it on a post-it and stuck it to your computer. Thinking is work but it’s not valued, not reimbursed in our quantifiable, time card, excel spreadsheet world. 

So you plan. You prepare excessively just so you can have the time, the space to think. You kiss your babies goodbye, leave them with Costco lasagnas and Daddy’s breakfast-for-dinner. You drive to the ferry terminal, eat clam chowder, thick with cream, chewy and loaded with immersed oyster crackers punctuating each bite. You cross to the peninsula, familiar from childhood jaunts with your family: damp woods to explore, saline air stinging nostrils, small town diners with stiff grilled cheese hugging cups of tomato soup. 

In the dark it’s a struggle. You find the communal house on the old military fort, now converted into housing for writing retreats, community events. Odd to think these dusty buildings used to be barracks. You came here for your medical school orientation weekend, sleeping bags tucked under arms, eyeing strangers with anticipatory reluctance, a peculiar Junior High start to the four years of forming physicians into being. You also came here for medical residency retreats. Each spring you’d all gather, let loose in the way a group working 36 hour days, 100 hour weeks, caring for the critically ill must. 

The drafty house smells familiar, like ghosts of orientations past reside. Here are strangers, unbonded to you, a writerly community. All introverts, you’re bound by the thinking, the thinking is work. You write and you read. You walk and you sit. The seaside air suffuses your mottled skin, still tensile but hinting at fine lines and transition into middle age. You can think here. You can create. It’s work, but it’s inspired. And those other selves, those other lifetimes, those other beings of retreats past dance on the floorboards, float through the drafty air, haunt the tap-tapping as letters form into words creating sentences giving meaning to the empty page. 

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Narrative Medicine Monday: Baptism by Fire

Pediatric Intensivist Gwen Erkonen’s fast-paced essay “Baptism by Fire” was recently highlighted in one of my favorite online creative nonfiction journals, Hippocampus Magazine. The piece begins with Erkonen sitting in Grand Rounds, a newly minted attending physician. Erkonen deftly describes the apprehension and weight of responsibility all physicians experience when, after a decade of training, they are finally in charge: “Four years of medical school, three years of pediatric residency, and three more years as a pediatric critical care fellow. My time as a medical apprentice is done. I no longer have an attending physician to help me with my decision-making. I am solely responsible for my patients.”

Erkonen’s pager calls her to an excruciating emergency: a toddler with extensive life-threatening burns. The reader is thrust into the dire situation with her as she assumes care of the critical patient, running the resuscitation efforts of the medical team and communicating with the young girl’s mother in the waiting room.

Erkonen not only relays her own inner turmoil during this first challenge of her new career, she also conveys her keen observations of the other participants. The surgery resident she first meets in the trauma bay “looks cool and in control with his hands folded across his chest and a broad-based stance, but I can tell from his shaking voice he’s not sure what to do.” Erkonen’s details describing the patient’s devastated young mother gives us insight that the family’s narrative is multi-layered and tragic even before this catastrophic event: “She starts to sob, and buries her head in the older lady’s chest. Then I notice that she has a disposable Bic lighter in her hand. She keeps flicking it so that flames jump from the spark wheel…. I notice that her hands are dirty. Not from the fire but because she hasn’t showered in several days.”

Most any physician can empathize with Erkonen’s inner dialogue. Years of training doesn’t negate the adrenaline-infused uncertainty when you first encounter the incredible weight of trying to save another’s life: “Feeling like an idiot, I nonetheless plow forward.” Erkonen is unflinchingly honest in her description of the events and her vivid details leave the reader breathless, exhausted and empathetic, as if we were watching them unfold on a medical drama, yet responsible along with her.

Writing Prompt: Think of a time when you were in a new position that held intense responsibility. Maybe it was your first week as an attending physician or a new job managing a large part of your workplace. Maybe it was your first hours as a new parent. Describe your own inner dialogue and your perception of others you interacted with during that time. Alternatively, try re-writing Erkonen’s essay from the point of view of the surgical resident, the burn nurse, the patient’s mother, the priest, the trauma surgeon. Write for 10 minutes.

 

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Free Write Friday: Leaves

She walks with a wide gait, toddling down the sidewalk. Pausing at a crunch underfoot, she bends to pick up a dried leaf, yellowed and brittle. She examines it, hands it to you as if a treasure you should keep. It crumbles at your touch, leaving only the spine between your fingers, frail leafy remnants rain down onto the concrete below.

She’s enthralled by it all, gesturing her chubby finger, exclaiming with a noise that captures the essence of “leaf” without sounding anything like the word. As you walk home she squeals for you to stop at every tree, at every fallen branch. She reaches out to the Japanese maple in your front yard, afire this time of year. It was the one tree you asked the contractor to salvage when your house was remodeled half a decade ago. He looked at you sideways at the time: Why bother? But you knew. This tree would color your fall joyous.

Her pupils constrict as she touches the feathery crimson tip of a maple leaf, five points splayed out in reverence. Her lips curl as she considers the velvet color. “Leaf. Leaf. Leaf.” You repeat it to her as a mantra, as if a reminder to yourself. Each year it all changes – summer warmth to fall crisp, winter hibernation to spring sprout – but the words remain constant. You want her to learn so it will steady her, a foothold to rely on in this revolving world. You know the cycle, the recurrent pattern that must proceed. This too, the brilliant chorus of colors dancing, will tumble. But its glory today, blazing in the late October sun, is enough for you both.

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Narrative Medicine Monday: Air Hunger

The narrator visits her mother in the hospital in “Air Hunger,” a striking short essay found in University of Virginia’s narrative medicine journal Hospital Drive

Two months have passed since she last saw her mother, but in the interim the narrator notes her mother has “become a patient.” The details the writer shares give us a glimpse into how her mother’s illness has changed her over time. Her mother barely touches the lunch tray beside her hospital bed: “She picks at her food, but it’s air that she’s hungry for.” The narrator wants to ask her mom how she feels, but already knows the answer: “I can see what I see, I can hear what I hear.”

Writing Prompt: Have you witnessed a loved one’s deterioration of health over time? What was it like to see them in one light and weeks or months later note a dramatic change? Do you remember a moment when they became, either to themselves, to you or to others, “a patient?” Write for 10 minutes. 

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Free Write Friday: Pumpkins


Pumpkins reign this time of year. Pumpkin spice infuses dense breads, pumpkin syrup sweetens lattes thick with foam, bulbous pumpkin costumes cushion costumed kids, oven roasted pumpkin seeds sprinkled with coarse salt are browned to a satisfying crunch. At the pumpkin patch my son collects them in his wheelbarrow like he’s hoarding for hibernation, rolling the lumpy gourds along the uneven ground, raising the smallest with handled stems above his head triumphantly. He’s working, intent on his task, unaware of the futility; we’ll only need a few of the treasures he amasses. 

We’ll carve them, paint them, light them from the inside. Set them out on the front porch steps. They’ll rot from the bottom up, browning and reeking, black mold creeping up the sides like sinuous coils of vines, a ruinous infestation. The children will dress up, pretend to be, gather their eager plastic tubs, pumpkin shaped with garish black triangles for eyes, nose, teeth. 

They like the flickering glow as jack-o-lanterns wink from neighbors’ homes. Each unique, each decaying from the moment they are chosen. Plucked from the earth, carved and admired for a fleeting celebration, a macabre exultation, as darkness descends into shorter days and longer nights, as the curtaining chill causes retreat into fireside evenings, woolen socks, cups of steaming tea cupped in chapped hands. 

Pumpkins serve a transition: the yellow summer glow into the crimson of the winter season. The jarring contrast tempered by this orange intermediary, tolerated, even embraced, if only for a month or two.

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Narrative Medicine Monday: Feeding Tube

In “Feeding Tube” author Susan Kelly-DeWitt relays a memory of paper birds that a patient’s family hung over the hospital bed “wild tropical birds, macaws and toucans, parrots and cockatoo.” The visual that Kelly-DeWitt provides is vivid. The reader comes away feeling that humanity reigns over the mechanical devices that tend to dominate the hospital landscape.

I remember very little about the physical details of the critical care hospital room where I participated in my first code as a medical student. I do remember sitting by the resident physician as he wrote his note in the patient’s chart at the nurses’ station just after the man had died. I looked across the desk into the patient’s glass-walled room, my eyes fixed on an elaborate dream catcher hung carefully, just over his bed.

Writing Prompt: The hospital can sometimes feel a like a sterile, mechanical place. Think of a moment or an item, like Kelly-DeWitt’s paper birds, that struck you as out of place or particularly telling about a certain patient, their family and their life. Write for 10 minutes.

 

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Free Write Friday: Lists


I’m the kind of person who likes to make lists. Grocery lists, to-do lists, lists for work tasks, home tasks, personal tasks, lists of things I should do today and this week and this year and this lifetime. Yellow post-it notes litter my work desk, stuck to my computer monitor, clogging up the fabric tackboard mounted along one wall. I’ve tried different techniques in the past to manage my lists, but paper is still my preferred method. My purse is peppered with scraps torn from a gardening store mailer or a cafe napkin, reminding me to pick up milk and tampons and cough drops on my way home. We have an app now to keep the convoluted family schedule straight, each of five family members assigned their own contrasting color, but the to-do list blankly staring back from a palm-held screen doesn’t work well for me. I forget to check it, there isn’t the same satisfaction with crossing off, tossing a scrap of paper, purging the item from my mind and my day.

Sometimes I’ll find an old list in a rarely-used purse or backpack. I’ll remember that particular week, the mundane tasks I felt were so urgent, so important at that time. Order cupcakes for my son’s birthday, send that email to my boss, finish editing an essay for the submission deadline looming, now long past. Once I found an old list from my wedding, the endless tasks for that momentous event crossed out carefully. There were a few things still left, that never got done. There always are. 

I’m the kind of person who likes to color code. I’m a splitter, not a lumper. In medical school I had an infamous binder: two inch white with a clear slotted cover, brightly colored tabbed dividers for each course. Red for Histology, green for Pathophysiology, orange for Intro to Clinical Medicine. I had a separate binder for Anatomy; all those organs and nerves and blood vessels, origins and insertions of muscles to memorize: they deserved their own separate filing. Colored pencils used to sketch out each organ, each nerve pathway, the sequence of events mapped out for optimal memorization. 

I’m the kind of person who likes to plan for every contingency. Futile, I know. Futile, I’ve realized. Futile, I still plan meticulously, despite knowing better. Now, I at least have the realism to not expect as much from my planning, know it all may be in vain, know that lists and organization and planning ahead only achieves calm for the now. Eventually chaos ensues and chaos, despite best laid plans, ultimately reigns.

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