Narrative Medicine

Narrative Medicine Monday: Found in translation?

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Prolific writer, physician and narrative medicine pioneer Danielle Ofri writes about the assumptions we make and the significance of a shared common language in “Found in translation?,” an excerpt from her book Medicine in Translation.

Using interpreters for a medical interview is a skill learned in medical school and honed in residency. Medical providers are advised not to use family members as interpreters, as this could cause the patient to censor themselves or omit important details.   Sometimes though, given my monolinguilism, there isn’t much of a choice. I’ve needed many interpreters over the years, both on the phone and in person. There have been times, even with trained interpreters, that I’ve had the sinking suspicion that something significant was lost in translation. It may be because I ask a question, the patient and translator chat back and forth for a few minutes and in the end the interpreter relays a one sentence reply. Or simply because I realize, as Ofri points out in this piece, that the nuances and casual aspect of communication is lost when a third person enters the equation. Ofri notes her conversation with the patient through an interpreter was “polite and business-like. I asked the questions, he supplied the answers.”

Ofri makes certain assumptions about what language skills her Congolese patient might have or lack. The patient, in turn, also is surprised to learn that Ofri, a white American, speaks a language other than English. She notes how the dynamic of the visit changes after they discover they both speak Spanish. Suddenly, without an interpreter between them, they’re able to communicate on a more casual level. They each learn specific details about each other’s personal history; they “chatted happily.” 

Writing Prompt: Think of a time you’ve had to interact, either in medicine or travel, with another person who didn’t speak the same language. Did you feel like you were really communicating, getting to know the other person? What were your assumptions? If you’ve worked with a medical interpreter before, either in person or through the phone, how did this affect the interaction with the patient or physician? Were you worried something important was lost in translation? Write for 10 minutes. 

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Motherhood, Ramblings

Free Write Friday: Pump

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She’s pumped in bathrooms, in locker rooms, in economy class on a six hour flight wedged between the narrow aisle and a couple on their honeymoon. She’s pumped on a Washington State Ferry, in the passenger (and driver’s) seat of a car, at her desk at work over a harried lunch. She’s pumped at writing conferences and medical conferences and her own weekend island retreat just to get 24 hours away. She’s pumped while consulting an orthopedist, a psychiatrist, a radiologist; she paused her pumping before calling a patient with the difficult diagnosis of breast cancer. 

She’s pumped to get colostrum while her newborn was in the Special Care Nursery, to avoid clogged ducts while at a national bioethics conference, to build up a freezer supply of breast milk for the long days she’s at work. She’s pumped while reading books, while eating soup, while watching bad cable TV in a hotel bedroom. She’s pumped through frustration, through ambivalence, through hot desperate tears of new motherhood.

She’s spent the last six years pumping, off and on. She’s pumped for her three children: willful and strong, eager and growing. She’s pumped for herself: time to work, time to write, time to be something other than Mother, an unclipping of the tether, if only for a few hours. She’s hated pumping, championed pumping; she’s become indebted to the contraption. It’s allowed her to be free, to be connected, to be a distributor of sustenance and maintain her vocational and social and creative aspirations. She gives thanks for the pump, pays homage to it, lays it to rest with gratitude and an easy goodbye.

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Narrative Medicine

Narrative Medicine Monday: Falling Fifth

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Anesthesiologist and poet Audrey Schafer aruges that anesthesiology is actually an incredibly intimate medical specialty. In her poem, “Falling Fifth: The Neurosurgery Patient and the Anesthesiologist,” she tells NPR’s Sara Wong that her speciality is incorrectly viewed as more “knob-and-dial oriented than people-oriented.” Her poem outlines a poignant moment between her and a patient, hugging over “wires, bandages, the spaghetti of tubes, the upright side rail” in the sterility of the OR.

I think of the specialties that seemingly don’t interact as much with patients: radiology, pathology. I can see a familiarity that goes beyond even my most personal interactions with patients as a primary care physician. Radiologists see beyond a person’s skin, through their muscles, bones and vital organs. Pathologists meet a patient on a microscopic tissue level. I like how Schafer displays the connectedness between the anesthesiologist and patient: the physician serves as a trusted guide out of and back into consciousness. 

Writing Prompt: Have you ever had anesthesia? What was your experience both going under and coming out of a conscious state? Alternatively, are you in a medical speciality or type of profession that doesn’t traditionally interact much with people? Is there a component of your daily work that’s surprisingly intimate or keeps you connected to others? Write for 10 minutes. 

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Writing

Published: Skinnamarink

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After receiving a particularly disappointing rejection for a writing residency I had high hopes for, I sent out a flurry of submissions and applications a few weeks ago. In the literary world of slow responses and recurrent rejection, I’m always grateful and pleasantly surprised to get an encouraging nod: an acceptance!

I’m excited my essay “Skinnamarink” goes live on Tribe Magazine today. Tribe speaks to all things motherhood and is a vibrant community created by the unstoppable Kristin Helms. I wrote this particular essay last year while taking Kate Hopper‘s wonderful “Motherhood & Words” online writing course. More recently, I took a Creative Nonfiction online course on writing a nonfiction book proposal headed by the superb Waverly Fitzgerald. Before taking the class I had no idea how much was involved in getting a book published. I mean, no idea. It’s a process, people. I have a whole new respect for every published author and look at each book on my shelf in an entirely new light!

As I’ve delved more into the literary and publishing world, I’m understanding the need to both trust in and defend an artistic vision, as well as develop a porous enough thick skin to harness the critique and wisdom of others to hone that art to its full potential.  I intend to keep working on my current manuscript until it can find a home for publication and be worthy to be read by others. It’s important to me that it be a final product I can be proud of, whether it takes many more months, years or even decades to finish. I want it to inspire more work as I’m already developing two more book ideas. And although I’m piling up rejections as any persistent writer will (apparently I crave professions that feed into the imposter syndrome), I’ll savor the acceptances as the jewels they are. 

Many thanks to Tribe for featuring my post today!

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Ramblings

Free Write Friday: Train

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2015

My son likes Thomas the Train but the newer episodes seem strange to me. Narrated by Alec Baldwin, his voice conjures up 30 Rock or Saturday Night Live. His raspy vocalizations seem misplaced on the Island of Sodor. Thomas is so eager to please, so concerned with being useful. We should all be so diligent with our life trajectories, laser-focused on our purpose. What satisfaction he finds with a job well done, what eagerness he displays to please Sir Topham Hatt. 

My son, too, is eager to please, but also wants what he wants in the typical preschooler way. He likes to link all this toy trains together, crowd them all on the winding wooden tracks. He wears his Thomas overalls, sleeps on his Thomas pillow, reads his Thomas books. I crouch to his low table to help assemble the puzzle-piece-like ends of the tracks, create a circuit for the trains to follow. I too like clicking the trains together, end to end, magnets locking. Each train helpfully pulling its neighbor to the desired destination. 

2009

My lids are heavy; we got up early to take the boat from Naxos back to Athens. Walking up the steep stairs from the port to catch the train, I could’ve sworn a rogue hand reached toward my backpack, fumbling for something of worth. Sealed tightly, I snatched my bag away as the arm disappeared into the swarming crowd. The end of our European tour, we’re heading back to an Athens hotel after several weeks of Swiss Alps, French museums, Italian countryside, Austrian opera, German beer. Our worn bag is full of dirty clothes and camping gear, Rick Steves travel books picked apart. 

I keep our small bag with valuables on my lap as we take precious seats on the packed train. My husband dozes next to me. Suddenly someone taps him, then, in broken English: “Is that your bag?” We both turn to see another man struggling to lug our huge green canvas pack out the open double doors. My husband jumps up, pushes his way through and out of the train, not thinking.

They both stand there on the platform, staring at each other; a stand off. Eventually my husband pushes the perpetrator back, away from the bag and heaves the heavy pack as he slides back through the train doors, just as they close. The train speeds on to the next station. I wonder what we’d have done if he’d been caught at the stop, holding our bag, standing by the thief. No cell phones, no contingency plan. We hadn’t even decided where we were staying that night. I would’ve had all the cash, both our passports. I look at our crumpled bag and all I can think of is how disappointed the thief would have been: all that’s in there is our ratty stinky travel clothes. 

2000

I like looking out the window as the world speeds by. Bright earthy fields of Kerala, the train jolts back and forth hypnotically as the greens all blur. I think it allows an introvert like me to observe so much without getting involved; I can participate in the wonder of the world without expending the energy to interact, to please others, to represent myself. 

We have a six bed cabin, fold down the upper berths for the overnight trip. My mom has sewn me a lightweight sleeping mat made from two soft bedsheets, a pillow case sewn in at the end. I unroll the mat onto the thin mattress and climb in. The train’s to and fro is soothing to the weary traveler, but the early morning hour is punctuated with the pre-dawn calls of “Chai! Chai!” throughout the train car as peddlers distribute the milky drink. 

It’s morning, just barely, and tea time is in order. The spicy sweet scent mixes with the intense body odor of too many people who haven’t showered in too long. I look out the window and take in the grey morning light. I can just make out the shadows of the passing landscape, the new Indian day as it takes form. 

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Narrative Medicine

Narrative Medicine Monday: The Evidence-Based Metaphor

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Medical student Brit Trogen argues that metaphor is not only an important tool in doctor-patient communication but that physicians should be trained to use the most effective metaphors to deliver medical information. Her recent article “The Evidence-Based Metaphor,” uses the example of the medical student’s simulated patient encounter, where actors portray patients and then provide feedback to aspiring physicians about their communication skills. All medical students go through rigorous testing to ensure they can manage the science of medicine, but the more nuanced communication skills required to be an effective clinician can be more difficult to both train and test. Trogen wonders what if there were a way to help guide young physicians toward better communication with their patients, thereby improving the health and well-being of those they’re tasked to care for.

Trogen notes that time pressures are evident for physicians in today’s medical system: “With appointment times creeping ever shorter, a physician may have only moments to explain a complicated scientific concept to his or her patient in a way that is both clear and memorable.” I struggle with this every day in my own practice; many of these concepts take years of study to understand fully. How can they best be distilled down so patients can make a truly informed decision?

I appreciate Trogen’s idea to promote “evidence-based communication” just like we adhere to the values of evidence-based medicine. This is the idea that the treatments we prescribe, the screening modalities we suggest, the procedures we perform be based on research-driven facts, substantiated studies that show that this plan is the best course of action for most. Instead of basing medical care on a whim, it’s based on evidence. Research-based evidence could also have a role in how best to convey information to patients effectively in a time limited way. 

Do you agree with Trogen that physicians would be more effective if equipped with better communication tools, rather than just scientific knowledge? What do you think about her statement that “knowledge is important, but not always sufficient?” As a primary care physician, much of my day is spent helping patients brainstorm how they can remember to take their medications, what changes could be made in their lifestyle to add in some exercise or improve their diet, why they should consider a colonoscopy or cutting back on alcohol or get certain screening tests based on family history. I know I’ve honed some of my own communication skills over my years in practice, but I would welcome a way to reach each patient, if possible, in a more effective and proven way. 

Writing Prompt: Do you recall a physician using a metaphor to describe a treatment plan, disease process or other medical process? Was it helpful? Write about the experience. If you’re a medical provider, think of something you often counsel patients about. Try brainstorming metaphors or consider writing a complete fable on this topic. Alternatively, think about a doctor-patient interaction that hinged on very good (or very poor) communication. Describe the encounter and the benefit or consequences. Write for 10 minutes.

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Ramblings

Free Write Friday: Cabin

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They like to take the ferry, run to the front or the back deck as soon as we embark, salty wind whipping their tiny faces. Their small bodies lean up against the kelly green railing, white foam erupting as the boxy boat rips through the murky waters of Puget Sound. We’ll have some Ivar’s clam chowder for lunch, too many saltines or oyster crackers dumped in the compostable bowl. Their dad will douse the fish ‘n’ chips in sour vinegar and the middle child will follow suit. 

Once we arrive to the island we’ll stop for groceries. Just the basics, just the staples of milk and bananas and eggs and coffee, then wind across the narrow strip of land. Leaving pavement, curving down a gravel-lined lane, slender sticks of evergreen trees reach to the pale sky. They look as if they could topple, bend at the whim of a strong gust, but they’re deceptively sturdy, roots diving deep to anchor. Like toothpicks they taper at the top, their branches fanned out, curved upward. Sometimes an eagle will rest on an upturned branch, as we all rush to observe the regal creature before it stretches its wings to take flight.

We unpack, get reacquainted with the comfortable surroundings. Giant windows and a spanning deck overlook the water below. Down a sharply steep path, dozens of stairs treacherously slick in mid-winter mossy dampness lead to the rocky beach. I like to sit above it all, the steely water below is calming; a constant motion that, strangely, evokes stillness. I wonder if the eagle feels the same; looking down from afar details are missed but the larger picture, the grandness of a distant perspective is captured.

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Narrative Medicine

Narrative Medicine Monday: What You Don’t Know

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Today’s Narrative Medicine Monday is a bit different in that I’m posting an excerpt from a radio show rather than a sample of poetry or prose. Stories of medicine, health and illness are found in all types of art, including written form, oral stories, music and visual mediums.

This American Life is a prolific radio show that covers widely varied topics in a heartfelt, honest and often humorous way. Each show has a theme and this past week’s episode was titled “In Defense of Ignorance.” In the first act, “What You Don’t Know,” writer and producer Lulu Wang tells her family story of deciding to keep test results of the most dire news from her grandmother. Her family’s Chinese heritage influences the stance they take in keeping her grandmother in the dark about her terminal diagnosis. Wang, raised mostly in America and very close to her grandmother, doesn’t agree with this position but, at her family’s request, complies. 

Wang’s family story brings up issues of bioethics, cultural norms and how bad news affects health and illness. How might cultural norms influence the very standards of bioethics in a particular case? Do you agree with the family decision to keep the grandmother in the dark about her terminal diagnosis? Why or why not? Do you think her grandmother actually knew all along? Spoiler alert: Do you think not telling Wang’s grandmother contributed to her surviving despite her dire diagnosis? Wang mentions the Chinese belief of the connection between the mind and body. What are your thoughts on this connection?

Writing Prompt: Think about your own family dynamics and cultural norms. How do you think this has shaped your own views on health and illness? Can you think of a time this construct specifically influenced your medical decision making? Alternatively, think about the connection between the mind and body. Do you think one influences the other? How? If you had a terminal diagnosis, would you want to know? Why or why not? Write for ten minutes. 

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Motherhood, Ramblings

Free Write Friday: Treadmill

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Someone just wanted it out of their house, a bargain at $100, less than a month’s membership at the local gym. Her husband had been wary; another contraption in the basement? But she was pregnant with her third baby, knew there would be no escaping once this little one came, no time to leave for exercise or much of anything. With three under five, it would be difficult to even make it around the lake with the jogging stroller anymore. So she took up the space, hoping it would run, it would work, it would fit into her new morning routine. 

It’s old, dusty when she first folds it down. The belt is loud, too loud to hear the TV over the grating whir. She winces, hoping it won’t wake up the children, but down in the basement the sound that rises to the second floor must just be a pleasant buzz, converging with the white noise machines in their bedrooms. 

Nothing fancy, no bells, no whistles, but it runs. She starts slow, a brisk walk, but quickly accelerates to jogging pace; no time to dilly dally. Heavy legs pumping, headphones jammed into her ears. She can just barely make out the words from the morning news, the NPR co-host waxing poetic about immigration, about divisive politics, about the latest breaking headline. It’s turned up too loud, probably not good for her ears, she thinks, but the cardiovascular exercise makes up for the auditory damage, right? 

The baby monitor is perched precariously where the magazine should be set. She never understood this: how could someone read while running? It always seemed foolhardy to turn a magazine page while jogging on a moving floor, always seemed impossible to lean in to decipher the miniscule type while working up an active sweat. 

Sometimes she’ll see the baby stirring on the monitor, she’ll hear a whimper from the floor above, children starting to argue over their morning cereal. So she runs faster, picking up the pace: 6.5 mph, 7.0. Must. Finish. Run. She starts sprinting. Sometimes she makes it, finishes the 3 miles before the children take over the morning. Sometimes her preschooler comes down to watch, cozy blankie and pull-up in hand, eager to get his day going. He might play with his cars for a bit, watch her quizzically, examining the contraption that lets her move so much without going anywhere. “Mama, a pulley!” She smiles, nods. Lately he’s been obsessed with finding pulleys everywhere. 

She misses running outside, rain on her face, dodging puddles, watching the seasons change around the nearby lake’s circumferential path. Fellow runners are motivating and she seems to run so much faster when she’s exercising outside. But this, it gets the job done; it gets the endorphins rising before 6 a.m. She gets her daily exercise, the muscles worked, the healthy fatigue. And, a year later, she thinks: this may be the best $100 I’ve ever spent. 

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Narrative Medicine

Narrative Medicine Monday: Reprieve

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In his poem “Reprieve,” Jeffrey Harrison writes about the several months following a cancerous brain tumor removal. Everyone is able to take a breath while the patient resumes his daily activities. Although it seemed “a miracle almost,” they “all still wondered how long it would last.” The narrator questions if this time period felt like an “afterlife” to the patient. I like how the narrator lists the simple daily tasks the patient was able to resume, giving us a glimpse into his life and what he had been missing because his illness. 

Have you or a loved one had a serious illness that, for a time, seemed resolved? How did you feel when the treatment worked? If the illness recurred, how did you look back on that time period?

Writing prompt: Think about a time when you, a patient or a loved one was well following a serious illness. Were you able to trust in that period of wellness? Were you always wondering if the illness might come back? If so, how did that undercurrent of worry limit you? How did it feel to grow strong again or resume your daily activities? Write for 10 minutes. 

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