Narrative Medicine

Narrative Medicine Monday: Still Not Convinced You Need a Flu Shot?

No Comments

Aaron E. Carroll provides a straightforward explanation as to why getting the flu shot is imperative to a healthy community. In his New York Times article “Still Not Convinced You Need a Flu Shot?” he notes we may be passing on the virus without realizing it, to people much more vulnerable than ourselves: “You can infect others a day before you show any symptoms, and up to a week after becoming sick. Children can pass along the virus for even longer than that.”

Carroll points out our lack of concern about the flu virus, so familiar every winter, is illogical: “Because the flu is so common, we tend to minimize its importance. Consider the contrast with how the United States responded to Ebola a few years ago. We had a handful of infections, almost none of them contracted here. One person died. Yet some states considered travel bans, and others started quarantining people.” He argues that we should be much more concerned about the flu, noting that influenza is the “only cause of death in the top 10 that could be significantly reduced by a vaccine. Lowering risks of heart disease, cancer or Alzheimer’s are much, much harder to do.” We have a way to decrease the morbidity and mortality from a common illness yet we choose not to harness that opportunity.

By looking at the history of the varicella vaccination, Carroll illustrates the benefit we gain through herd immunity and the ethical consideration of getting immunized even if you yourself are not at high risk. He notes that babies were dying from chicken pox prior to implementation of the vaccine, but “as rates of vaccination rose, the rates of death from varicella were low…. But more significant, from 2004 through 2007, not one child younger than 1 year old died in the United States from chickenpox. What was amazing about this finding was that we don’t vaccinate children that young for chickenpox — therefore, those babies’ deaths were not prevented because they were vaccinated. Their deaths were prevented because we vaccinated their older siblings.”

In a previous Narrative Medicine Monday post, I highlighted a New York Times article written by Dr. Danielle Ofri that I’ve used when teaching narrative medicine courses to medical professionals. It illustrates the challenge of communication between physicians and patients and why there often is a disconnect. How can we improve the dialogue to better inform the public and, ultimately, save lives?

Writing Prompt: Do you get your flu shot every year? Why or why not? Do you feel that you understand the reasoning for immunizations? What information might help you better understand? If you’re a medical provider, have you struggled to convey such information to patients? Think of such a time and write for 10 minutes.

Continue Reading

Narrative Medicine

Narrative Medicine Monday: Order

No Comments

Writer and nurse Catherine Klatzer organizes it all in her poem “Order.” I like that it is written in second person, puts the reader in the space of the patient who is “so civilized / so well-behaved.” I can relate to the narrator, finding comfort in gathering forms and ensuring everything is in order, even in documenting the pain. I can sense the absurd tension in deciding if the papers should be sequenced in chronological or reverse chronological order. The poem hints that there is a kind of respite, however ill-conceived, in controlling what we can control even when there exists an “an impossible rupture.”

Writing Prompt: Have you ever felt that “something is tearing, ripping open” yet you moved forward with assembling order to your life, to your medical records? How is ordering what is tangible helpful when we are bombarded by the chaos of illness? Alternatively, consider medical records. If you’re a provider, what is different about working with electronic records versus paper charts? As a patient, how do you compile your medical records? Are they neat and organized? Is there a sense of confusion or comfort when you read them? Write for 10 minutes.

 

 

 

Continue Reading

Ramblings

Free Write Friday: Dressing

No Comments

He brings his stack of neatly folded clothes, procured the night before, into the master bathroom. He likes to dress with Mama in the morning, inky sky evolving outside the frosted windows.

He puts his socks on first, insists they match. So I bought him twelve pairs of athletic socks, all white, identical. He can pull them up and over his calves, a satisfiable stretch.

Next is the underwear, logoed with superhero emblems, bright elastic trim. They too come in plastic wrapping, in neat sets of six or eight or ten. I never understood the “days of the week” underwear until I had children: it’s exhausting for them, for me to watch, to choose what to wear each day, even undergarments.

Next is the t-shirt; can’t be too tight on the neck, on the arms, must hang just so. He likes orange, bright colors. Pixelated hamburgers, paper airplanes, whimsical animals dance on the silk screened front. He pulls them overhead, sometimes his mousy head gets stuck, needing a tug from Mom to help his straining face emerge.

Last, the pants. He likes elastic bands: comfortable, practical. He pulls one leg through, then the other. Doesn’t bother to regard himself in the mirror; instead he rushes off to gather other treasures and accessories from his room.

He shuffles back in, rainbow suspenders in hand, clip-on tie already attached to the front of his waffle t-shirt. “Can you help me, Mama?” His legs shuffle back and forth impatiently; he wants his outfit completed. I clip on the suspenders, straighten his orange necktie. He smiles broadly, proud as he sashays into his day.

Continue Reading

Narrative Medicine

Narrative Medicine Monday: The Art of Translating Science

No Comments

Lise Saffran emphasizes the importance of meaning in public health communication in “The Art of Translating Science.” This conversation is imperative amidst a culture where many important topics become highly polarized and politicized. Saffran argues that it is important for scientists to not just speak more plainly, but emphasize understanding of a concept. She notes that this is more challenging today because “when it comes to politicized topics, our ability to understand is often overwhelmed by our inability to hear.”

As a primary care physician, much of what I do in my daily practice is translational work: explaining a diagnosis, a lab test result, the need for a certain medication, the risks and benefits involved in preventive screening. The goal is to ensure the patient understands the meaning of the medicine, not just the facts. As Saffran notes, “a single word may change the meaning of the whole story.” A physician is also interpreting the patient’s story, taking the narrative they provide about their illness and using this information to determine best next steps toward diagnosis and improving their health. A scientist communicating about public health issues needs to convey concepts on a much broader scale. Our ability to translate effectively will dictate our health as individuals and as a society going forward.

Writing Prompt: Think of a time when you didn’t fully understand what a physician was saying to you. Perhaps it involved a specific diagnosis or importance of a new medication prescribed or test ordered. Did you get the facts but miss the meaning? If you’re a medical provider, think about a time that you missed a significant part of a patient’s narrative. Did that lack of understanding affect their diagnosis or treatment plan? Alternatively, consider a time you read an article on a public health topic such as climate change or vaccinations. Did you understand the underlying purpose of the piece? Have you had a conversation with someone who disagrees with your viewpoint on such topics? What might have increased your ability to understand each other? Write for 10 minutes.

Continue Reading

Ramblings

Free Write Friday: Couch

No Comments

He cried when they took the old couch away. It sat on the front lawn unceremoniously as they carried in the new one: grey heathered tweed, low back, firm cushions, stylish, contemporary.

The old couch looked bulky, awkward in comparison. Beige and bought on a whim over a decade before, soon after we were married. We needed a new couch and had money to spare. Two professionals, no children. We stopped at a furniture store on the way to my brother’s house one day and chose it quickly, unresearched. Unusual for a measured, calculated shopper like me. I was anxious to make our new house a home; real furniture seemed imperative and urgent at the time.

But it served us well through two homes, three children. Substantial back cushions held their form all those years. Good building blocks for fashioning forts. The length just right to stretch out for naps, our toes barely brushing the armrest. We’d pull a hand woven blanket over us, cocooning for a winter hibernation or a spring siesta in the waning afternoon sunlight.

I brought my babies home to that couch, Boppy pillow on my lap, tiny infant swaddled in my arms. The cushions held me through the uncertainty, the exhaustion, the stinging pain of an aching postpartum body nursing all hours of the night and day.

We let the kids jump on it; by the time they came around it was already worn, no need to keep up appearances or needlessly coddle the not fragile.

We’d greet friends, old and new. Birthday gatherings, movie nights, holidays with family, interviews with potential nannies. All of them sat, back upright, feet sturdy on the floor or reclined, elbow cocked back, plate full of potluck fare tidbits in hand.

He cried when they took the old couch away. I felt it too, the tug, the wrenching. So much contained in that substance of wood and fabric.

Continue Reading

Narrative Medicine

Narrative Medicine Monday: Anatomy Lesson

No Comments

Poet Nellie Hill illuminates the process of learning anatomy in her Bellevue Literary Review poem, “Anatomy Lesson.” She notes that to “understand the heart you’ve got to memorize…” I remember searching for ways to memorize, as one professor put it, the “firehose” of information required as a new medical student. Anatomy is especially daunting, with all the blood vessels, nerves, muscle origins and insertions. Dissecting cadavers in anatomy lab is a rite of passage for every medical student, but we also drew pictures, color-coded organ systems, made up songs and stories to help us remember the essential information that is the human body. Hill starts with memorization, but takes the reader on a journey down the “snake path” of the body “to where thoughts become memories or dreams.” I like the imagery of “anatomy stacked like a ladder from your toes” and how Hill hints that the functional organ itself may also hold an intangible purpose.

Writing Prompt: Think about when you first learned anatomy. Even if you’re not in the healthcare field and never took a more intensive course in the subject, we all learn about basic bones and organs as children. Did learning about anatomy help you to see the body, and your own body, differently? When was the last time you thought about anatomy? What are your thoughts on how the physical body or certain organs might be connected to a greater or hidden purpose (acupressure points, the mind-body connection)? Write for ten minutes.

 

Continue Reading

Ramblings

Free Write Friday: Ski

No Comments

She looked up the mountain, the hill she learned on. Remembering the rope tow, gripping tight with mittened hands, chapped cheeks from chill winds. She wore a patterned hat, pulled it down over her ears, lobes pink. Her toes and fingers instantly numb to the freezing temperatures.

***

Her grandfather took her to buy new skis when she was in high school. She had never had new equipment before, always hand-me-downs from older relatives. It felt luxurious, the shiny new blades strapped to matching boots, electric blue with neon yellow accents. She sat compact on a wooden bench in the family owned ski shop, the only acceptable place in the well-to-do suburb to buy skis. The employees fit her feet to the restrictive boots. They felt tight, compressing, oppressive. Everyone assured her the fit was right but her long toes would burn with every run for decades to come.

She never took lessons, only her father giving instruction same as when he taught her to ride a bike or tie her shoes or scramble an egg with rice and just the right amount of soy sauce. He was matter of fact, detachedly patient, waiting for her to overcome her fear. She remembers the swelling of anxiety, looking down the sloping hill, the enormity of getting to the bottom an overwhelming task welling in her chest.

***

The beginner lift slows to a crawl, allowing novices to sit their layered bottoms down onto the cushioned seat, warily grip the arm rest, avoid looking down as they are lifted skyward, skis dangling, boots weighty, gravity pulling like a string taut to the ground.

Looking down, through ski tips, there’s nothing to keep one from slipping: a wayward glove, an aberrant pole, dangling then falling, floating, to the silent impact of snow drifts below. The silence, the stillness of the buffering snow soothes while coasting upward past white coated evergreens, tiny skiers like miniature figurines expertly weaving curves this way and that far below. There’s calm in the severity of the landscape, a numbing peace inherent in the crushing steepness and chill.

Continue Reading