Narrative Medicine

Narrative Medicine Monday: Line of Beauty

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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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Ramblings

Free Write Friday: Santiago

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I have had a week where much as been out of my control, where the bigger questions of life are asked and the daily answer is in the mundane tasks of doing the laundry, reading stories at bedtime and making sure there’s enough milk in the fridge for breakfast.

Perhaps because of this, I started cleaning out my desk at work with vigor, a task I could complete with a level of control and subsequent satisfaction, sorting through papers sitting dormant for months, maybe years. I came across a clipping of a poem, David Whyte’s “Santiago”. I don’t remember where it came from, if it was given to me by a patient or by a now-retired colleague who used to share poetry with me on Fridays when we both needed it most or if I clipped it myself at some point. Whatever the origin, it spoke to me this week, thinking about the road seen and not seen, the way forward and finding a way, and my own reflection, wondering at the “clear revelation beneath the face looking back”. Let it speak to you this week and may you always be more marvelous in your simple wish to find a way.

 

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Narrative Medicine

Narrative Medicine Monday: Going Solo

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Nurse and writer Amanda Anderson describes the final moments of caring for a patient in the ICU in “Going Solo“.

Anderson opens the piece noting that she decides to scrub the patient’s teeth clean. Why do you think she’s determined to complete this simple act?

The author comments that this passing feels different than others because she doesn’t also have the patient’s family to nurse through the process. Her actions are per protocol, “governed only by a set of instructions:
1.  Administer pain dose once, prior to extubation.
2.  Extubate patient.
3.  Administer pain dose every three minutes for respiratory rate greater than twenty,
or obvious signs of pain, as needed.
4.  Notify house staff at time of asystole.”

How do you feel when you read through the protocol that Anderson follows? How do you think she feels and how does she convey that through her writing?

I appreciate Anderson’s candidness in immersing us in her thought process. She plays jazz for him, then realizes, what if he hates jazz? As medical providers, we only get a snippet of a patient’s life. If you’re a medical provider, have you ever wondered about a specific patient’s life outside of the hospital? How could that information inform their care? As a patient, what do you wish your medical providers knew about who you are?

Writing prompt: As a medical provider, think about a protocol you follow, a procedure or list of instructions you adhere to in a certain situation to provide care. List the steps. Now consider an unwritten protocol, such as a nurse in caring for family members throughout their loved one’s death in an ICU. List the steps. How do they compare? Alternatively, think about an encounter you’ve had in the medical world: a ten minute doctor’s office visit, visiting a friend who is hospitalized, getting or giving an immunization. Imagine the broader life of the person who was giving or getting that medical care. Consider their life narrative. Write for 10 minutes.

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KevinMD

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Excited to share my post on the importance of narrative was published on KevinMD.com this week. KevinMD is a widely read blog that shares “the stories and insight of the many who intersect with our health care system, but are rarely heard from.” Grateful for the work done by KevinMD to give voice to those who work within and are cared for by the health care system, as well as serve as a platform for discussing important current issues. 

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Free Write Friday: Snow Day

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The kids gather their sleds, dusty in attics or basement corners, and head for the hill. An inch, maybe two, come each year, mid fall or late winter. Mismatched snow gear, the pants too small, the jacket gaping, the hat a hand-me-down from big sister, older cousin. 

Usually there’s a predawn session, heading out after a truncated breakfast, too excited to eat much, empty tummies rumbling in anticipation of the snowy day. Pink noses, rouged cheeks, they tread carefully in awkward snow boots. The silence is deafening after a bustling rainy day in the city. Neighbors smile at one another; everyone is off and out. 

The hill is just a slope, barely an incline. Even-earlier risers have already gotten some runs in, adults pulling their toddlers on plastic discs. The green betrays the locale, grass peeking through, causing a bumpy ride. Still, their faces alight with the novel sleekness, skidding down the street, slipping on familiar ground, sliding at the park. 

And after, hot chocolate warms tiny chapped hands, miniature marshmallows bobbing between the wisps of rising steam. It’s a little bit of true winter in the evergreen land. Northwesterners, unabashedly afraid of sleek ice, happily trade in their routine despite being ridiculed for closures. The freeze brings a warmth and the forced slowing in snowfall a welcome calm.

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Narrative Medicine

Narrative Medicine Monday: The Heroism of Incremental Care

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As a primary care physician myself, I found Atul Gawande’s new article “The Heroism of Incremental Care” encouraging and empowering. The New Yorker piece highlights the importance of longitudinal care between a patient and their primary care provider.

When Gawande visits a headache clinic in Massachusetts, the physician there tells him she starts by listening to the patient: “You ask them to tell the story of their headache and then you stay very quiet for a long time.” What have you found is the most important component of a physician-patient encounter? If you are a provider, do you feel you’re always able to listen to the patient’s full story? If you’re a patient, do you feel listened to when you see your doctor?

When Gawande visits the primary care clinic in Boston, he’s told the reason primary care is important to bettering patient health is due to the “relationship”. Do you agree? Have you had a relationship with a primary care provider that has invariably improved your health over the years? If you are a primary care provider, has this been your experience with patients?

Writing Prompt: Gawande writes of the clinic he visits: “At any given moment, someone there might be suturing a laceration, lancing an abscess, aspirating a gouty joint, biopsying a suspicious skin lesion, managing a bipolar-disorder crisis, assessing a geriatric patient who had taken a fall, placing an intrauterine contraceptive device, or stabilizing a patient who’d had an asthma attack.” Think about the last time you saw your primary care provider. Write about that visit in the present tense, then project a decade or two into the future. Imagine how that visit, and many others like it, might have made a difference to your health decades from now. Write for 10 minutes.

 

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Free Write Friday: Feed

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She feels bound, normal routine punctuated by the dread of each day, a scrolling feed of ominous news. Her three-year-old collapses in a tantrum, a heap of hot tears as he pounds his fists on the front door; he wants out. She wants out too, of the surreal reality of this reality show. She doesn’t want to contribute to over dramatization but this present darkness needs no assistance; the prognosis is dire.

So she gets up in the dark, shuffles into her day. Some days it takes effort to exercise, to chat with the barista, to get the kids into the car and off to school, to carry others’ burdens of illness throughout the day. She does it all, simultaneously avoiding while craving the news, the next shocking headline of the day.

She needs to write but struggles to find the words. She reads articles from The Atlantic, The New York Times, The Guardian. She listens to NPR and watches PBS. She streams The Daily Show and Saturday Night Live but finds it hard to laugh. The jokes are funny, but also so not. She follows the ACLU and World Relief on Twitter and avoids Facebook. The bombardment of outraged posts inevitably clog her feed. She feels like she needs to be fed, but slowly, so she can consider, in moderate, sustaining bites. But instead she is gorged on the glut of it all.

She wonders: this must be what it feels like to live during one of those eras, the kind she read about in school textbooks. Protests erupt, world powers align and misalign, everyone feels on edge. She looks at her chubby baby, not even a year old, and wonders what the textbooks will record of this time, how the era will be remembered, deconstructed. What will she tell her infant daughter about this nagging sensation of creeping dread, like struggling to find the surface as your lungs begin to burn underwater, knowing you need to break free and gulp the air.

So she writes anyway and moves about her day. She resolves to be resolute and find the ways a young mother can contribute. She gathers her people and marches with the crowd. She donates to persecuted causes and writes letters to her representatives. She mutes the static on her feed, will not tolerate xenophobia or the lies of alternative facts. She worries about the isolation of her liberal northwest bubble, she worries about her children’s distant future. She’ll read books and write more. She’ll feed herself with knowledge, with the lessons of history; she’ll feed her children and her tribe the same. She hopes this will sustain her and free her, or at least nourish her with a steady diet of discernment and tempered hope.

 

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