writing prompt – Page 3

Narrative Medicine Monday: Hospital Writing Workshop

May 27, 2019 No Comments

Poet and physician Rafael Campo describes the magic that can occur in a “Hospital Writing Workshop.” Campo starts the poem at the end of his clinical workday, “arriving late, my clinic having run / past 6 again.” Campo is teaching a workshop for “students who are patients.” He notes the distinction that “for them, this isn’t academic, it’s / reality.” These are patients with cancer, with HIV, and Campo is guiding them through poetry and writing exercises to search for healing and respond in a unique way to their disease and suffering.

Campo outlines his lesson, asking the students to “describe / an object right in front of them.” Each interprets their own way, to much poignancy. One student “writes about death, / her death, as if by just imagining / the softness of its skin … she might tame it.” In the end, this poem is about the power of poetry and art for both the patient and the medical provider. It’s about how something as simple as a writing workshop can cause us to pause, “take / a good, long breath” and move through suffering to a kind of healing, to a kind of hope.

Narrative Medicine

Narrative Medicine Monday: My One, My Only

May 20, 2019 No Comments

In the latest issue of Brevity, writer Michaella Thornton explains how she answers strangers about “My One, My Only.” At the grocery store with her toddler daughter, someone will invariably ask, “Is she your only child?” Thornton understands there are things that “give us away,” like “the way I narrate our grocery trip.”

When “someone asks the ‘only child’ question” at checkout, Thornton recalls the years of infertility treatments she endured: “Instead of conceiving a baby by a glacier-fed lake, we pray at the altar of reproductive medicine and lost causes.” Thornton wonders at it all, noting that the “human egg is a redwood among the rest of our sapling-sized cells. Think of the size of a period at the end of this sentence—that is the size of a human egg.”

She relays the grueling aspects of her experience with infertility treatments, the “pin-pricked stomach,” the “loneliness together” she endures with her husband. In the end, though, “as the doctors put my organs back into my body, as I throw up into a kidney-shaped pan” she is “crying over and over again to my newborn daughter, ‘I love you. I love you so much.'”

In this flash essay Thornton uses a moment with a stranger, an intrusive question many feel compelled to ask, to convey her experience with infertility, with IVF treatments, with the miracle that is her one and only child. She notes the “inadequacy of the question” strangers pose, and, in this short piece, takes us with her through “sublime sadness and joy.”

Writing Prompt: Have you had a stranger comment on the number of children you do, or don’t, have? How did you feel, what thoughts did it trigger when you received this question? Have you or someone you know struggled with infertility or are you a physician who treats this? What is it like for a patient to go through this treatment? Write for 10 minutes.

Narrative Medicine

Narrative Medicine Monday: History Taking in the Anatomy Lab

May 13, 2019 No Comments

Bethany Kette writes about “History Taking in the Anatomy Lab” in the latest issue of JAMA. Kette describes how in medicine we almost always start with the history of the patient, then move on to the physical exam. Kette notes though that “there is one time in our medical careers when we are instructed to perform the most thorough physical examination possible without learning so much as the patient’s name:” that of dissecting a cadaver in anatomy lab.

Now, fifteen years removed from that anatomy lab and ten years into my primary care medical practice, I can attest to the value of history-taking in a relationship developed over time: “It is a closeness and privilege that can provide purpose and meaning to routine acts of medical care.” Yet as medical students learning anatomy through the very intimate process of dissection, we receive very little information about our donors, only their age and cause of death.

In order to better understand the life of the woman who donated her body, Kette created the Obituary Writing Program at Georgetown. Kette developed the program with input from the Literature and Medicine Track director (how great that this is a track in a medical school!) and an obituary writer for the Washington Post. The result allows interested medical students to craft a real narrative about their donors, discover stories “that reveal a life.”

Kette interviews her donor’s son and learns that the woman was a “small-town farm girl” who graduated from Georgetown University School of Medicine: “She had literally stood in my footsteps in the same formaldehyde-scented labs in which I had spent the past year with her as my teacher.” The woman eventually retired from medicine to become a painter and was a “devout Catholic;” her faith informed her drive to help others. The medical students who participated in Kette’s program read the obituaries they had written during a ceremony at the end of the year, part of expressing gratitude to the donors themselves and to their loved ones for the gift of the donor’s bodies.

Kette’s program puts “history in its rightful place before the physical— students now interview the families of their donors before making the first cut in anatomy lab.” It also serves as a reminder to those of us well into medical practice that a person’s rich history, their life lived outside the hospital bed or exam room, is what we’re striving in medicine to help them return to, and what matters regarding their health, in the end.

Narrative Medicine

Narrative Medicine Monday: My Grandmother’s Body

May 6, 2019 1 Comment

Author Anna Leahy writes about “My Grandmother’s Body” in Sweet, an online literary journal. Leahy describes the funeral director, who arrives when called, wearing “his funeral-director suit.” The professional Leahy witnesses is experienced, noting “the stairs’ ninety-degree turn / without changing pace.” The director asks “if he might / lift her himself to carry her downstairs” and Leahy finds a kind of comfort in this. She thinks, “What a relief / to think of her last moment at home, cradled / in the man’s arms.”

Leahy’s poem is a snapshot of a moment and a man, revealing the funeral director’s practicality and reverence for his work and the relief this provides for those who love the deceased. We often reflect on the last moments right before a person dies, but Leahy’s poem, like Lisa Knopp’s “Leaving the Body,” focuses instead on those just after: the weighty finality, the people who interact with the body and the importance this holds for those still living.

Writing Prompt: Have you been near a dead body, either of a loved one or of a patient? What was the experience like? How was the body retrieved, and to where? How did you feel about how this was accomplished? Alternatively, think about your impressions of the funeral director as described by Leahy. Consider writing the scene from his point of view. Write for 10 minutes.

Narrative Medicine

Narrative Medicine Monday: Going Blind

April 22, 2019 No Comments

German poet Rainer Maria Rilke writes of a nearly-blind woman at a party in “Going Blind.” The poem provides an observation of this woman, as if we were in the room with her. At first she looks “just like the others.” As someone who works in healthcare, usually it is obvious when a patient is sick. But more often than I think we acknowledge, we can’t always tell when a person is suffering or ill. There are many diseases or ailments that might not be readily apparent at first glance.

The narrator does soon note subtle differences in the woman: “she seemed to hold her cup / a little differently as she picked it up.” Rilke focuses on the woman, as the rest of the party moves away: “I saw her. She was moving far behind”. He notices her eyes, “radiant with joy, / light played as on the surface of a pool.”

There is a turn in the poem here, where the narrator moves from seeing her smile as “almost painful” to realizing that once “some obstacle” is “overcome, / she would be beyond all walking, and would fly.” It ends on this hopeful note, the idea that this woman will persevere, and in so doing, move beyond all others and the world’s norms.

Interestingly, here is another version of Rilke’s poem, translated by Margarete Munsterberg in 1912. Reading various English translations of poetry always makes me wonder at what might be missing when we don’t read a piece in the author’s native tongue. Did you get a different sense of the themes or of the woman from reading these translations?

Writing Prompt: Think of a time when one of your senses was limited. What did it feel like to be restricted in this way? Did you note other senses altering in response? Have you observed a patient or a loved one losing their hearing, their sight, their ability to taste food? What did you notice? Alternatively, consider writing from the perspective of the woman going blind. Imagine what she sees, what she feels. Write for 10 minutes.

Narrative Medicine

Narrative Medicine Monday: Introduction to Asthma

April 15, 2019 No Comments

Poet Susan Eisenberg gives an “Introduction to Asthma” for the parent and practitioner. Her son suffers an acute asthma exacerbation, the “Cacophony rising in his lungs, / oxygen level falling”. Eisenberg lets us know that her young son “believes / he will die” but also exposes the reality that “Anyone who wants to kill me he says / would have to kill my Mom / first.” She will follow her son anywhere, even Heaven or Hell. The reader’s own breath catches on this truth, as Eisenberg hugs “his eyes in mine / and breathe for both our lives.”

Writing Prompt: Try reading Eisenberg’s poem out loud. What do you notice about her choice of words, line breaks and white space? Think of a time you or a child or friend or patient experienced an acute and sudden medical emergency, such as an asthma exacerbation. Describe what you hear, what you see. Write for 10 minutes.

Narrative Medicine

Narrative Medicine Monday: Perchance to Think

April 8, 2019 No Comments

A couple of years ago I was driving to work when I pulled up behind a car that had a red bumper sticker with white block lettering: “THINKING IS WORK.” When I arrived at my desk that day I wrote this statement on a Post-it note in my barely legible handwriting and moved on with my busy primary care clinic day.

Since then, I’ve had little time to ponder this idea, but it’s always been there, in the back of my mind, the Post-it still pinned to my desk bulletin board. We live in an accelerated world, saturated with information at our disposal. Though I’ve noticed, in my life and in medicine, there is less and less time to access this information, to research, or just think.

Dr. Danielle Ofri’s latest piece in the New England Journal of Medicine highlights this issue. In “Perchance to Think” Ofri outlines a common problem among primary care (and I’m sure all speciality) practices – there isn’t time allotted to actually think about a case. Ofri gives the example of a patient with slightly abnormal lab tests ordered by another physician. As the primary provider, Ofri is then tasked with sorting out whether this patient has adrenal insufficiency or rheumatoid arthritis while also addressing his six known chronic conditions. Ofri notes that, for primary care physicians, “adrenal insufficiency resides in the wobbliest, farthest-flung cortical gurus I possess.” Ofri quickly realized, as her “patient stacked his 15 medications on my desk – all of which needed refills, and all of which could interfere with adrenal function” that what she really needed to give this patient the best care possible was “time to think.”

In medical school we have time to study, to think deeply as we learn the intricacies of the human body and how to treat illness when things go wrong.

Once out in practice, though, there isn’t the luxury of that time to ponder. More and more demands are put on the physician, be it “last week’s labs to review, student notes to correct, patient calls to return, meds to renew, forms and papers spilling out of my mailbox.” Ofri eventually gives up, gives in to the time constraints of the system, and refers the patient to endocrinology to sort out the adrenal insufficiency issue.

As a primary care physician myself, this is an all too familiar dilemma. Ofri recognizes that this situation is untenable to all involved: the patient, the primary care provider, and the specialist. “In the pressurized world of contemporary outpatient medicine, there is simply no time to think. With every patient, we race to cover the bare minimum, sprinting in subsistence-level intellectual mode because that’s all that’s sustainable.”

Ofri eventually takes the time to listen to a podcast on adrenal insufficiency, addend her note and contact the patient with a more cogent plan until he’s able to see endocrinology. But this was time that isn’t usually allotted or even available in a normal physician’s busy life: “many of our patients’ conditions require — time to think, consider, revisit, reanalyze.”

Ofri laments there’s no way to code for contemplation, but asserts that giving physicians the time to think could improve efficiency. “We would save money by reducing unnecessary tests and cop-out referrals. We’d make fewer diagnostic errors and avert harms from overtesting. And allowing doctors to practice medicine at the upper end of our professional standard would make a substantial dent in the demoralization of physicians today.”

Here’s to considering a more wholistic way of practicing medicine, one that includes the intellectual rigor that attracted most physicians to medicine in the first place. After all, thinking is work.

Writing Prompt: Do you think giving physicians time to think would make a difference in efficiency? Have you experienced a case similar to Ofri’s, where if you had a little more time to research, you could manage the case yourself? As a patient, do you notice the time pressures on your physician? Describe what it’s like to experience this as a patient, as a provider. Write for 10 minutes.

Writing

Narrative Medicine Monday: Poof

March 25, 2019 No Comments

This elegy by poet Amy Gerstler was selected by this month’s Poem-a-Day curator, Maggie Smith. I wrote about how Smith’s poem “Good Bones” hangs on a nondescript bulletin board in our clinic, though I never did figure out who posted it there. Each morning this month, I’ve been eager to see what poem Smith selects.

It’s no surprise that I think poetry provides much needed perspective to the world of medicine, and Gerstler’s “Poof” is no exception. Gerstler begins with a small bag of ashes on her lap, a gift from her late friend’s family. She recalls the service, the details of “staring at rows of docked boats” and the woman’s “impossibly handsome son.”

Gerstler speaks directly to her old friend, remembering that “You were the pretty one. / In middle school I lived on Diet Coke and / your sexual reconnaissance reports.” She imagines an alternative storyline where “your father never hits / you or calls you a whore.” Through Gerstler’s memories, both real and imagined, we get a glimpse of their bond, of the woman she, and this world, lost, even though we never learn her name, her vocation. (Why is it that these are the first things we ask? Always: What’s your name? What do you do?)

Gerstler gives us a remembrance that is more: a cinematic illumination of who this woman was: “You still / reveal the esoteric mysteries of tampons. You / still learn Farsi and French from boyfriends / as your life ignites.”

I like that Gerstler considers alternate storylines of their history together. Our formative years can be like this, wondering what different versions of us might transpire. I imagine (and, reaching middle age myself, have already succumbed to such reveries) our later years might also be prone to wondering what other tributaries of life paths might exist in the universe.

Ultimately, we learn that their lifelong relationship remains much as it is was in their adolescence: “I’m still lagging behind, barking up all / the wrong trees, whipping out my scimitar far / in advance of what the occasion demands.” Gerstler’s tender flashes of moments between the two is a tribute not only to her late friend, but also for all of us who are lucky enough to have kept company with cherished friends over the decades.

Writing Prompt: Think of a person (or patient, if you’re a medical provider) important to you who was suddenly gone. Write them an elegy in second person, or, alternatively, a letter. What are the memories, the moments, that stand out to you? Did this person vanish, as they did for Gerstler, with a “poof,” or would you use a different way of describing their absence from your life? Alternatively, consider writing an elegy or a letter to a long-time friend or patient who is still alive. Write for 10 minutes.

Narrative Medicine, Writing

Narrative Medicine Monday: The Fall of Icarus & Musee des Beaux Arts

March 18, 2019 No Comments

I’m just finishing up a wonderful poetry course taught by Michelle Penaloza, and recently explored ekphrastic poetry. These are poems written in response to a piece of art. She had us read two different poems written about Brueghel’s “Landscape with the Fall of Icarus.”

I found the poem by W.H. Auden relates to medicine and illness in a way, a commentary on how suffering exists in the world while the rest of life goes on. Auden observes how well the “old Masters” understood suffering, “how it takes place / While someone else is eating or opening a window or just walking dully along.” For people who are struggling with illness, especially chronic illness, this normalcy and indifference of the rest of the world can seem almost as an affront. When dealing with a difficult diagnosis, it can be painful to see the world advance as it always has, even though it must. In Icarus’ case, Auden notes that “the expensive delicate ship that must have seen / Something amazing … / Had somewhere to get to and sailed calmly on.”

Writing Prompt: Consider writing your own ekphrastic poem or free write in response to Breughel’s “The Fall of Icarus.” What do you notice about the painting and how might you expand on its meaning? If you’re a medical provider, have you seen others suffering but, for whatever reason, had to move “calmly on?” Do you think medical training or the medical system contributes to this type of response? If so, how? As a patient, have you experienced an illness or suffering while the rest of the world goes on, unaware? How did that make you feel? Write for 10 minutes.

Narrative Medicine

Narrative Medicine Monday: Ikiru

March 4, 2019 No Comments

Today’s Narrative Medicine post highlights a first: a movie. As part of preparation for this week’s Columbia Narrative Medicine Workshop, I watched a 1952 Japanese film, Ikiru. This movie, directed by Akira Kurosawa, outlines the life and death of a man with end stage cancer.

I happen to also be facilitating a Literature & Medicine gathering this week, where the topic is “Confronting Mortality.” In it, we are reading Tolstoy’s novella “The Death of Ivan Ilyich,” which similarly shows a man facing a terminal illness and wrestling with the meaning of his life and the nature of his painful death.

In Ikiru the protagonist, Mr. Watanabe, has not missed a day of work in 30 years at the same tedious government job. The narrator notes that “he’s only killing time, he’s never actually lived.”

I’m certainly not a movie critic, but several things stood out to me, looking at this film through a narrative medicine lens. First, his physicians insist on withholding the terminal nature of Mr. Watanabe’s illness, stating it’s a “mild ulcer” only, even when Watanabe begs them for the truth. This scene reminded me of a panel on cultural issues in bioethics I attended many years ago. On the panel was a bioethicist from Japan, and he explained the cultural influence of withholding the true prognosis or even diagnosis of an illness from a loved one; that a physician might deliver a terminal diagnosis to a patient’s family member rather than to the patient themself.

We get flashbacks in the movie to understand the central character more. His wife died when his son was young and he never remarried. Although they live together still, Watanabe and his son have a difficult relationship; they struggle to really communicate and Watanabe in fact is never able, despite several efforts, to actually confide his diagnosis and angst to his son.

Mr. Watanabe comes across a stranger who he asks to show him “how to live” and they gamble and dance and drink, but ultimately he finds little lasting pleasure in these endeavors.

The central character then turns to an old colleague, a young woman, trying to decipher her vitality, her zest for living. Through this interaction, he resolves to get a park built for the community. In the end he succeeds, battling the bureaucracy he was a part of himself for decades. It seems the completion of the park gives the dying man some semblance of peace, a legacy solidified, which produces the meaning he was struggling to find.

Writing Prompt: At one point in the film, Watanabe tells a colleague “I can’t afford to hate people. I haven’t got that kind of time.” What are the different ways you’ve seen patients who are terminally ill react to facing their limited time? Did they give up hate? Or something else? In Mark Doty’s poem “Brilliance” the patient initially gives up investing in anything he can’t finish. Why do you think Watanabe decided that the playground would be his last project, his last investment in what little energy and time remained? Write for 10 minutes.

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