Narrative Medicine

Narrative Medicine Monday: Jefferson’s Children

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We get a glimpse into both the patient and the physician’s perspective of a manic presentation in Maureen Hirthler’s “Jefferson’s Children“. Her dramatic opening (“If you don’t do something right now, I’m going to hurt my children.”) inserts the reader into the mindset of the patient, desperately asking for help to make sense of her racing and disturbing thoughts. As the emergency physician enters the scene, the narrative shifts and the reader becomes the provider, trying to make a definitive diagnosis and determine an appropriate treatment plan. 

The physician feels the patient should be admitted for psychiatric evaluation and treatment but is unable to find a bed for her and meets resistance from both the patient and her superior. Can you feel her frustration? Have you ever been in a similar situation?

The lack of appropriate, affordable and available psychiatric treatment has been discussed and debated much in recent years. What are the barriers you’ve noted to getting yourself, your loved ones or your patients the mental health care they need? If you could create the ideal mental health system, what would that look like?
Writing Prompt: Try writing from the first person perspective of a manic patient first arriving at the hospital or clinic. What about a severely depressed patient? A very anxious patient? Now write the same scene from the perspective of the medical provider (physician or therapist). How does the scene change?

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Any Common Desolation

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Because of the holiday, I’m taking a hiatus this week from Free Write Friday. Instead enjoy Ellen Bass’s “Any Common Desolation“. Poets.org’s Poem-a-Day arrives in my inbox each morning and, I’m hoping, will make a poetry connoisseur out of me yet. On weekdays they feature new and previously unpublished poems by contemporary poets. Bass’s image-rich “Any Common Desolation” is one of my favorites from the last few weeks.

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Narrative Medicine

Narrative Medicine Monday: E.R.: Port-au-Prince 

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H. Lee Kagan reflects on one memorable night working in a Haitian Emergency Room in “E.R.: Port-au-Prince“. What is Kagan expecting of his experience? When I’ve worked overseas, often in a wholly different medical system and in a resource limited environment, I’ve had similar anxieties, drenched in insecurity. Usually I come to realize I was worrying about all the wrong things. Kagan finds himself unsure how to respond when a patient who was raped arrives in the E.R. He questions himself after this encounter. Do you think he should have done something differently? What did Kagan learn about himself?

Writing Prompt: Have you experienced working or living across cultures or in a different system than the one you’re used to? What was different? Did you learn something about yourself or about medicine? Consider re-writing this piece from the point of view of the patient, the nurse who steps in or the volunteer nurse who can’t sleep. Does this give you new insight? 

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Ramblings

Free Write Friday: Homework

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In high school I used to work backwards. The answers to the odd questions were always in the back of the book. If I was stuck I’d flip to the last pages of my paper covered textbook, look up the answer and work my way back to how it came to be. Usually this helped me figure out the way forward on the even problems, the assigned homework. Sometimes I’d have to get help from my parents; my mom I went to for social studies or English, my dad for geometry or chemistry. But usually I’d keep it to myself, struggle through concepts I didn’t quite grasp. Maybe it was grit. Or maybe it was shame; the beginnings of an imposter syndrome already taking hold in my adolescent self.

 ***

I remember sitting at our dining room table, the brown protective cover shielding the glossy wood beneath. On Sundays I’d trudge through my Chinese homework worksheets, everything was right to left instead of left to right. My characters were lopsided, like a kindergartener’s first words spelled out, the letters mirror images of their true selves, looking as if about to topple over, bent in the wrong place. Repetition, repetition. My hand cramped with the recurrent motion of my pencil. I remember sitting in Saturday school class in the dusty church basement, surrounded by black haired children who knew what they were saying, understood what the teacher asked of us. I stared down at my pencil case, chosen carefully from Uwajimaya, the local Japanese superstore. My classmates were comfortable in this parallel universe, the weekend school environment. They played together loudly, boisterous and free, hanging from the monkey bars at the truncated recess. I couldn’t understand. I was the outsider, unfamiliar with the language, with the culture, like I’d been transplanted as an immigrant into a foreign land just for that sliver of a weekend morning.

***

It was my favorite class, the teacher who lived on an island and woke at 4 a.m. to take the ferry and drive 45 minutes to teach middle school English. I always did the extra credit homework, not because I wanted the points but because I loved the work: creative writing, poetry, reading novels about complicated characters making their way through a simpler time. I labored over a book of poetry and prose all year, the culmination of a year’s diligence of writing and art. That teacher gave us grades, no one else did in middle school. I think she got in trouble for this. She thought highly of us. Maybe it was considered too much to expect greatness out of such awkwardness. The writing assignments gave me a thrill, a satisfaction I hadn’t yet experienced. I should’ve known then, recognized a calling, but I foolishly was lured by so many other distractions. Writing was the work that wasn’t work; it reflected backward, propelled me forward, it whispered to me an understanding of self and of the world that I’m still learning to claim. 

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Narrative Medicine

Narrative Medicine Monday: How to Tell a Mother Her Child Is Dead

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Naomi Rosenberg, an emergency room physician, writes a gripping essay in the New York Times entitled “How to Tell a Mother Her Child Is Dead”. She writes her detailed and heart-rending instruction in second person. Is her use of second person effective? Can you see yourself in this situation, having to deliver the most terrible news? Those of us in medicine have had to deliver bad news, often frequently: a cancer diagnosis, a chronic debilitating illness diagnosis, a loved ones imminent or unexpected death. Rosenberg brings the reader into her situation and hints at the lessons she’s learned on how and how not to approach such a grueling task.

Writing prompt: Have you ever had to deliver bad news? If you’ve had to do this many times what lessons have you learned? If you’ve received bad news, how was it delivered? How do people respond differently to difficult news?

 

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Ramblings

Free Write Friday: Hospital

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1997

She’s volunteering, decided what she wants to do. She catches the bus to the hospital from campus, heavy backpack weighing down her slight shoulders. She has a badge, a short powder blue jacket. She works in the playroom: coloring, washing toys, light streaming through the wall of windows as she stoops to read aloud a picture book or set up a seasonal craft on the low plastic tables. The children come in wheelchairs, heads bald or misshapen or shaved with intention. Tubes may be in their nares or arms. All of it is foreign and she doesn’t know how to act naturally so she smiles a lot, maybe too much. Sometimes she delivers a toy to a child confined to their own room: in isolation. Before entering she puts on a crinkly gown and a mask and latex free gloves, just as she was trained to do. She plays with the child, chats with the teen, tries to connect, but her own awkwardness and all the barriers for protection get in the way.

2003

She’s in medical school, deciding what she wants to do. She rotates through the hospital, a shadow of a doctor in a short white coat, tagging along after her resident. Her pockets are weighed down with too much: laminated cards on how to run a pediatric code, a clipboard with preprinted index cards to keep track of each patient’s labs and history, black ball point pens to record chart notes, gum. She learns she always needs to have gum on hand. She walks the halls, familiar but transformed now she’s armed with some knowledge. She gets to know the palpable quiet of the hospital in the middle of the night. The ceilings here are low; everything is miniaturized to make children feel more comfortable, in this place where discomfort distinctively reigns.

2007

She’s in residency, an MD after her name. She doesn’t wear a coat, but instead a black fleece vest with zippered pockets. Sometimes she’s mistaken for a nurse, but she still doesn’t wear the long white coat; it’s just not the way things are done. She monitors her patients and her medical students. She presents each case to the attending each morning at rounds. She knows what she wants to order in the cafeteria when it opens at 2 a.m. for all the providers who are there overnight on call. She’d rather sleep than eat, but that’s not the way things are done here. Residents review the progress of patients with the medical students, with each other, over the mid-night meal. The lights are turned down low and the children are in cribs and in isolation rooms and can’t breathe well or can’t eat well and most certainly won’t sleep well. The nurses page her and talk in quiet voices. Many patients get better and she discharges them. Some are known by all the staff and roam the halls with their IV poles like tiny emperors, because this place, this hospital, too, is their home.

2016

She brings her infant, the youngest of her three, in to see the specialist. She parks in the newish garage built in the same place she used to catch the bus up the hill. She wheels her baby in the stroller. She waits in line to check in, gets an adhesive visitor’s badge with her picture and her child’s name. There’s a Starbucks downstairs now, in this new wing, but she doesn’t have time to stop for a latte. Her child is crying and she’s late. She wears a red raincoat, her pockets filled with the random items of a mother: a used tissue, a miniature toy construction truck, a purple hair clip, a binky, her smartphone. She’s anxious about seeing the specialist, about the prognosis and treatment plan. She has already texted her friend, the pediatrician, who made helpful recommendations, gave expert advice. She now has the luxury of giving and getting medical opinions in an instant, a byproduct of years of training and now experience as a practicing physician. She waits in the waiting room with other families. Some children read, some run, some sit in laps, some in motorized wheelchairs. Her child’s name is called and her baby is weighed, measured. She sees the physician. Her baby is prescribed medication, which she gets from the pharmacy. A girl waiting in line behind her talks animatedly about a book she wants to read. When she turns to check on her baby she can see the girl’s shaved head, the scar from surgery. So many children here so ill, so resilient. As a mother, she always feels grateful, feels guilty, in this place.

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Narrative Medicine

Narrative Medicine Monday: An Enlarged Heart

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Cynthia Zarin writes a detailed account of a time her daughter fell ill in “An Enlarged Heart”. She explores her own realization that her daughter was significantly sick and also documents her encounters with the medical system on the path to diagnosis and treatment. 

Writing prompt: Write about a time when you were caring for a loved one with an unexpected illness. How did you respond? What were the challenges you encountered with the health care system? What, if anything, did you struggle with yourself?

 

 

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Ramblings

Free Write Friday: Rain

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I remember the winter it rained for ninety days straight. It was some sort of record. Some days it was just a drizzle, grey clouds menacing, threatening but only producing a trickle of condensation. The dampening effect was lasting though. I was forlorn, a college coed struggling with my own gloomy tendencies. The constant rain seemed to confirm my dramatic melancholy.

I had a yellow rain coat, slick and bright, rubber and durable. I don’t know why I chose the bright yellow, sunshiny and pure. It wasn’t a trendy choice; my fashion sense was not yet refined enough to choose statement pieces. An umbrella was seen as taboo for any true northwesterner, a weather crutch not to be used for its actual purpose. This fact was clear: use of an umbrella would border on blasphemy. So daily I trudged across campus, damp with a constant drizzled sheen, ground ebony and bare; the glory of the autumn colors long decayed to brown and dissipated into the soil, reclaimed to become fodder for the following spring’s renewal.

But that winter the grey reigned, the gloom maintained through the dreary days, weeks, extending into months until even the air seemed to weep. Light and brightness forgotten, buried somewhere deep below, hidden high above.

I remember walking across the center of campus, careful steps on the slick bricks, rumored to have been designed specifically to be slippery, easier to hose down and dispose of protesters should a group of young idealists take to the arena with picket signs and voices raised high. That day, though, it was just ordinary students making their way to lecture halls and labs, the library and the dorms. I stopped midway, and gazed at the sky, willing it to show me a break, a glimmer of respite. Instead, the drops fell large and solitary, coalescing on my upturned face.

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