Narrative Medicine

Narrative Medicine Monday: Standardized Patient

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Artist Kerry Tribe’s latest installment at the San Francisco Museum of Modern Art, Standardized Patient, brought back memories for me of medical school. The article on Tribe’s work by Hyperallergenic describes her as “interested in memory, language and awkward connections.” The relationship between patients and doctors-in-training certainly consists of awkward connections. I remember the standardized patients we worked with to learn how to take a basic medical history, how to perform a physical exam, even how to do pelvic and rectal exams without as much fumbling and hesitation inherent in such a personal exam. All the standardized patients I encountered were professional and helpful, giving valuable feedback and helping us prepare for a new component of the medical licensing exam: that of a standardized patient interaction. For this portion of the exam we flew down to California (the closest location for those of us training in the Pacific Northwest) and stood outside nondescript doors in our short white coats, much like the medical students in the last photo of this piece. I remember feeling terrified at what this patient, this actor, might judge me on. Was I too friendly? Not personable enough? Did I make enough eye contact? Ask the right questions? Perform the right physical exam? Give the correct reassurance and explanation?

Tribe’s installment “captures the atmosphere of a hospital: that draggy kind of feeling, as though everything is tired and washed out, as if you are waiting for something.” She shows the uncertainty of physicians-in-training: “We can see the tentativeness of the prospective doctor, as they question one SP about how her boyfriend has treated her and see how the doctor tries to comfort her.” I like that Tribe captures the nuances of medical training, that “[w]atching this display of effort creates empathy for the doctors as well as the actors. Seeing the feelings of both — impatience, kindness, concern — flash across their faces, you almost forget they’re acting….”

Writing Prompt: If you’re a physician, recall a particular interaction with a standardized patient during your training. What did it feel like? What did you learn? As a patient, were you aware that your physician trained with actors as patients? Does this seem strange or is it encouraging to you? What kind of focused training on communication or empathy might be helpful for your doctor today? Write for 10 minutes.

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Narrative Medicine

Narrative Medicine Monday: Of Mothers and Monkeys

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Caitlin Kuehn’s essay “Of Mothers and Monkeys” draws parallels between her research work with macaque monkeys and her mother receiving treatment for breast cancer in the same hospital. As her mother starts chemotherapy, Kuehn “rotate[s] between the animal ward and the human ward.”

Kuehn wrestles with the ethical ambiguity faced in animal research. Thinking of her own mother’s reaction to chemotherapy, she darts off to her work in the research lab, wondering “what animal first shared with my mother that sudden fear of a throat closing in… I realize that I—as a student, with very little power but a whole lot of responsibility—am complicit in a moral choice I have still not taken the time to make. Some days it is hard to remind myself that medical research has a purpose. Some days it is as clear as cancer. Some days I just do not know.”

When Kuehn’s mother needs injections to help boost her immune system after suffering from a serious sepsis infection, though Kuehn “could do a subcutaneous injection in the dark,” she becomes “shatteringly nervous” whenever she has to give her mother injections; the familiar activity takes on a different tone.

Kuehn’s mother begins to rely on her to answer medical questions, but Kuehn’s scientific expertise is limited to “what I have learned in my undergraduate science classes, or here at the lab. All of it applicable only to non-human mammals, or else too theoretical to be of any use for as intimate a need as this. I have no good answers.” I was struck by the fact that often, even for those of us who have extensive medical knowledge and training, we still lack “good answers” to those questions posed by suffering loved ones.

Kuehn has a strong reaction when her mother declares that she’s fighting her cancer for Kuehn and her sister: “She’s pushed her will to persevere off onto my sister and me. It’s too much pressure to be somebody else’s reason.” Have you ever been somebody else’s reason for fighting for survival? Did you have the same reaction as Kuehn to that kind of pressure?

Writing Prompt: At one point Kuehn responds to Domingo’s convulsions in the same comforting way she does when her own mother’s throat begins to swell during her chemotherapy: You’re going to be okay.  When a patient or loved one has been faced with a particularly challenging moment of illness, is there a mantra you’ve repeated to them? To yourself? Did it help? Write about the situation. Alternatively, reflect on Kuehn’s statement that “death is a condition of life.” Write for 10 minutes.

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Narrative Medicine

Narrative Medicine Monday: What Patients Say, What Doctors Hear

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Dr. Danielle Ofri’s latest book, What Patients Say, What Doctors Hear is a call to re-examine the way doctors and patients communicate with each other. Through fascinating patient examples and directed research, Ofri illuminates the pitfalls in the current medical system that lead to miscommunication and, ultimately, worse heath outcomes.

I was particularly struck by Ofri’s call for physicians to become better listeners, and thus “co-narrators” of a patient’s story. This term was coined by researcher Janet Bavelas, whose study shows that how physicians listen to a patient’s story in fact contributes to the shaping of that narrative. Ofri asserts that “medicine is still fundamentally a human endeavor,” that one of the most significant ways we can advance health care is by improving one of our most basic tools: communication.

I’m thrilled Dr. Ofri will be speaking to my medical group this week and I’ll be able to meet her in person. Dr. Ofri has written many books and essays important to the world of narrative medicine and is the Editor-in-Chief of the Bellevue Literary Review.

Writing Prompt: One chapter in Ofri’s book outlines a “Chief Listening Officer” who was hired by a hospital to listen to patients and translate their needs back to the hospital so they could improve care. Ofri notes the value of this, that “being listened to so attentively is a remarkably energizing experience. It makes you eager to continue engaging.” Have you ever had an interaction with a medical provider who listened to you and your story in this way? How did it make you feel? Did that experience benefit your health in any way? Write for 10 minutes.

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Writing

The Artist’s Way

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At the beginning of the year, I stumbled into a group working through Julia Cameron’s prolific The Artist’s Way. The premise is that we’re all created to be creative, that along the way our artistic self becomes “blocked” and, through a process of exercises and exploration, we can unleash our underlying creativity, transforming our own life in the process. It’s an involved undertaking, which I tackled in characteristic too-fast-out-of-the-blocks fashion.

I had heard of Cameron’s book but didn’t know much of what it was about when I agreed to commit myself to the group and the process. I’ve found the “Morning Pages” Cameron endorses a cathartic free-form journaling that does serve to unearth our core stumbling blocks and greatest desires in life. I’m recalling previous passions and brainstorming ways I could incorporate these childhood joys into my adult life: writing and playing music, performing elaborate plays, detailed needlework, making bracelets, dancing.

I have to admit I was skeptical at first. Despite being a life-long journaler with a history of a strong spiritual faith, I initially found some of her observations and suggestions new-agey and impractical. What modern professional parent has time to write three pages every morning and take their inner artist on a weekly date? I’ve since come around, appreciating the thematic chapters and exercises, the encouragement and confidence instilled that we are all creative beings, most content and most ourselves when we find ways to weave artistry into our lives.

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Narrative Medicine

Narrative Medicine Monday: Today, Magda

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Writer Catherine Harnett presents us with Magda in her opening paragraphs, a woman who wears “scarlet velvet shoes with bows, so ladylike” and “sends thank you notes to hostesses the next day.” Magda takes a cab to visit her husband, Conrad, who “cannot place her, though she seems familiar.” Magda notes that with this persona “she can talk with ease about The War, how hard it is to live without silk and chocolate.” Magda and Conrad have tea together and as she leaves she recalls the other roles she’s played. There is a melancholy sweetness to Magda’s character play. She has found a way to have satisfying interactions with her husband despite his progressive and painful memory loss. Her husband has, in fact, disappeared and Magda fills the void with her elaborate personas.

Writing Prompt: What do you think of Magda’s approach to meeting with her husband, who no longer remembers her? Is she taking on the different personas more for his benefit or for hers? Have you had a loved one who has forgotten who you were? How did it feel? If not, imagine someone close to you suddenly didn’t remember your life together. Write for 10 minutes.

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Ramblings

Free Write Friday: California

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The light wanes as we step out of the hotel conference room, eyes blurry from hours of lectures, Powerpoint slides flashing, acronyms swirling, EKGs dancing. The sun has set but the purple light of dusk hovers in the sky. The moon is rising over the palm trees lining the street, thin stems with bushy tops, as if each were adorned with floppy wigs or jester’s caps. The air is cool but not cold in way the sky is shaded but not dark.

We make our way to the cove after dinner, can just discern the rough waves crashing onto the rock face. We want to feel the fine granules of sand between our toes, stow them home in our carry-on bags tucked away in our shoe soles and jean pockets.

We hear the seals before we see them, sharp intonations directed upward, all around. They squeal and shriek their protestation to our presence. We are intruders and suppliers, they must love and hate us. One seal beaches several yards away. We point and exclaim like paparazzi, eager to elevate the novel to a venerated plane.

***

The sand on the soles of my feet, the sudden coolness of the water washing over my toes, the Pacific wild in its winter norm, tame by the time it reaches the California shore.

People-watching is paramount along the walkway that winds parallel to the strip of sand. Surfers haul their boards under their arms as if the equipment is another appendage, wetsuits peeled to their waists, hair dripping to their shoulders. Rented bikes with fat tires and curved handlebars in candy coated colors weave in and out of pedestrian traffic. Tourists unsteady as they cycle, unsure on their winter legs in the foreign sunlight.

Twenty-something revelers pack the margarita bars, sipping slushy neon drinks in oversized goblets. They laugh easily, their cheeks crimson they lean into each other suggestively, throw their heads back into the bright sun. A girl in a green vest pulls a wagon filled with Girl Scout cookies, stacked Samoas and Thin Mints, boxes disappear into eager hands.

Umbrellas and beach towels dot the pale sandscape. Sunday afternoon revelers exult, even here, in a warmer than expected day. I close my eyes and see a glow, rouge-hot, yellow afire.

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