Narrative Medicine

Narrative Medicine Monday: The Train

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I featured one of Dr. Thomas Gibbs’ other essays on my very first Narrative Medicine Monday post in 2016. Today’s piece, found in the excellent flash essay journal Brevity, highlights another experience altogether. Dr. Gibbs is an obstetrician and therefore encounters dramatic medical emergencies that can put two lives at risk simultaneously. This was the case in “The Train,” when Gibbs is paged in the early morning hours about a bleeding pregnant patient who works in his office. Gibbs tells her husband to drive the patient himself to the hospital as he knows the urgency of the situation and that the local EMTs would take longer to get her there. He treats the patient as she arrives and disaster is averted. When he goes to inform the patient’s husband in the waiting room, he finds the husband shaken. In just getting to the hospital, all of them were in danger.

This piece made me think of all the advice we give patients, all the instructions we get from well-meaning physicians. Sometimes this advice has unintended consequences, either because patients misinterpret what was said or the instructions weren’t communicated effectively or because of events entirely out of anyone’s control. When you read the final lines of this essay, what were your first thoughts about the situation?

Writing Prompt: Have you given or gotten advice from a physician that, when followed, caused unforeseen consequences? Consider what happened or imagine what could have happened. As a physician, how did this change your medical practice or, as a patient, your relationship with that physician? Write for 10 minutes.

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Ramblings

Free Write Friday: Office Plants

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She’s cleaning out her office, sorting through papers accumulated at Tuesday provider meetings: handouts on how to order intravenous iron, avoid high risk medications in the elderly, updates on the latest USPSTF recommendations.

Her office plants, bought in between Child #1 and Child #2, have suffered. Although assured these were the hardiest of greenery when she chose them from the local nursery, they couldn’t survive two long maternity leaves, an owner who returned to work sleep deprived, plant care at the bottom of a very long list of responsibilities. The soil dried out, even the succulents wilted.

Her youngest now well into toddlerhood, spring emerging from the dark hibernation of winter, she begins to replant, regrow, cultivate, cull.

Ten years into practice, she tosses lecture notes from a decade prior. She updates the snapshots lining the wall behind her desk: her eldest in a tutu, her son being tossed into the air, the baby’s cherub smile gleaming on a sandy beach.

She purchases new plants, still hardy but more hopeful for a prolonged existence. She re-pots them on her back deck, digging into the dry soil with her bare hands, gently shaking the roots. She nestles them into ceramic pots, settles the loose dirt around coarse stems.

It feels satisfying, grime under her nails, handling the earth, cultivating vegetation. She’ll take them back to her desk, restock her favorite tea, keep purging her loose papers, her files. One decade into her career, she’s ready to grow.

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Narrative Medicine

Narrative Medicine Monday: Creating a Clearing

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In “Creating a Clearing,” storyteller Lance Weiler interviews the originator of Narrative Medicine, Columbia University’s Rita Charon. Charon describes how she ended up in medicine and primary care and the origins of the field of Narrative Medicine. She felt she was missing something as a physician from her formal medical training at Harvard. So instead she sought out the English Department: “I figured they were the ones on campus who knew something about listening to stories…” Her time there led to a PhD and, in her words, it taught her “how to be a doctor.”

Charon points out that we are all patients. What do you think of her idea that “we do not have to divide ourselves into mind on one side and body on the other or body on one side and self or personhood on the other, but instead we are all mortals inextricably bound to our bodies, our health, our frailties, our eventual mortality. This is how it is within that element that we don’t become ourselves, but [we] are ourselves”? Do you feel that the medical system tends to separate our bodies from our minds, from our personhood?

Charon explains how Narrative Medicine has grown over the years and now attracts all kinds of people in fields of health care, art, history and beyond. She states that the field of Narrative Medicine has “created a clearing,” a safe space for patients and clinicians and artists to “show people how to listen with great attention and respect.”

Charon describes how we’re traditionally trained as physicians to address a patient’s problem. Western Medicine is a disease model, focused on diagnosing, preventing or treating a problem. Charon takes a different approach. She first listens, focusing on what is important to the patient. I like how Charon begins: “I will be your doctor. I need to know a lot about your body, your health, your life. Tell me what you think I should know about your situation.”

She notes that both sides suffer from the typical patient-physician encounter: “[patients] come in armed with their list of questions that they’ve written down so as not to forget any in their precious twelve minutes, which is all they’re allotted. The clinician, on his or her side, is already looking at the wristwatch aware that there’s another three people in the waiting room waiting for what’s going to amount to the same brusk, impersonal, divided attention. So nobody’s getting what they want or need or desire or can benefit from.” Does this sound familiar to you? Are you hopeful, as is Charon, that if patients and clinicians lead on medical reform we can find a better way? What would that look like?

Writing Prompt: What skills do you find most helpful to listen to another person’s story? What would it be like as a patient to have a doctor ask you: “Tell me what you think I should know about your situation”? How would that question change the conversation? Think about what aspect of your training was most pivotal to teaching you how to be a doctor/nurse/physical therapist, etc. Are you surprised that for Charon it was her studies in English? Write for 10 minutes.

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Motherhood, Writing

Published: Back to Work

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I’m moving into a different stage of motherhood. My youngest will be two years old in June and she’s well into toddlerhood: talking and walking and feeding herself. She’s even expressed some interest in potty training and dressing herself, likely the byproduct of having two active older siblings.

It’s therefore bittersweet to read old essays I wrote while in the throes of new babyhood, that foggy state of sleep deprived motherhood, body and emotions still recovering from the ravages of pregnancy. I’m thrilled to have one such piece published in this year’s issue of Mom Egg Review, focused on play and work in motherhood. My piece, “Back to Work,” is a snapshot in time, returning to work after my last maternity leave. Everything feels uncomfortable in that transition: leaving your children at home, putting on ill-fitting work clothes, pumping at work, waking at night to hold your restless babies.

You can find the Play & Work Issue of Mom Egg Review, full of literary poetry and prose, here. You can order this, or other insightful MER issues, online.

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Narrative Medicine

Narrative Medicine Monday: What I Would Give

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Physician and poet Rafael Campo has published several collections of poetry and prose. In his poem “What I Would Give,” Campo outlines the “usual prescription” given by physician to patient: “reassurance that their lungs sound fine” or “that the mole they’ve noticed change is not a melanoma…” He instead would like to offer them “my astonishment at sudden rainfall like the whole world weeping” and “the joy I felt while staring in your eyes as you learned epidemiology.”

Campo’s poem makes me think about all that we give to patients with each interaction, each hospitalization, over decades of caring for a patient and their family. Should we reorient the standard prescription for cure? As a patient, do you get reassurance from your medical provider? Comfort? What would be the best prescription?

Writing Prompt: If you could give anything to your patients, what would you give? As a patient, what do you expect to receive from your physician? What gives you comfort? Write for 10 minutes.

You can read more about Rafael Campo and his thoughts on the intersection of poetry and medicine in this interview with Cortney Davis, whose work I’ve featured on a previous Narrative Medicine Monday.

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Ramblings

Free Write Friday: Theater

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We’re both reminded of the Vienna Opera House. A decade ago we backpacked through Europe, before Instagram, before kids, before middle age trappings. The filigree, the chandeliers sparkling high above recall the memory for both of us, hippocampi aligned.

Glossy programs stacked high at the entrance relay the actor’s faces, serious and serene. There is no curtain for this show, only one set with minimal props. The music explodes into the air as the house lights dim. The voices, angelic, trumpet as I melt away into the narrative.

Honeycombed notes ring up through the rafters, beats play out on stage as they reverberate throughout the hall. I am in awe of the cast, of the the crew, of the writers. To bring such a story to vivid musicality, to delight the creative and intellectual senses: it is a feat.

The chorus is stunning to the ears but solos make me pause in wonder. To stand on stage with a spotlight aimed at you like a cannon. Absorb, and then deflect, all that energy from the sea of unseen bodies in the darkened audience. To project such a voice, such a singular act into the void of voyeurs. Talent doesn’t seem a sufficient word for the accomplishment.

I suppose it is a gift, to elicit wonder from a crowd of so many. The applause erupts as the finale decrescendos. We step out into normalcy, soundstruck.

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Narrative Medicine

Narrative Medicine Monday: Out of the Straightjacket

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In recent years the importance of physician burnout, depression and the high suicide rate among physicians has become more visible. The New York Times article “Taking Care of the Physician” notes that physicians are “approximately twice the relative risk of suicide compared to people in other professions” and aren’t adequately trained to deal with many of the stressors that being a medical provider entail: “how to deal with conflict, how to deal with negotiation, how to deal with the distress of patients”. We learn the science of medicine but don’t receive enough instruction on the skills that can lead to resiliency in an emotionally grueling profession.

Dr. Michael Weinstein bravely shares his own story of severe depression, subsequent treatment and the struggle he experienced as a surgeon who desperately needed help regarding his mental illness. Weinstein’s essay “Out of the Straitjacket” in the New England Journal of Medicine reveals how he became “profoundly depressed, delirious, and hopeless. He’d lost faith in treatment and in reasons to live.” He describes the brutal hours and culture of residency training and how he went on to become a trauma surgeon, shouldering the emotional toll that intense work can take: “We often make decisions in the face of uncertainty that deeply affect our patients’ lives. When things went wrong, I frequently blamed myself.” Weinstein illustrates the failure in the medical culture to address the frequency of burnout and depression in our profession: “I didn’t know how to talk to my coresidents or faculty about medical mistakes and the accompanying self-flagellation.” He “felt trapped in [his] work and worried that [he] would expose [his] shortcomings if [he] sought a leave or disclosed [his] feelings.” How can we change the stigma associated with such a prevalent scourge on our profession, on so many who suffer from mental illness in this world?

Recent studies on physician wellness point to the fact that “it’s more effective to make changes at the level of the institution, rather than just telling the doctors to shape up in the wellness department.” So many physicians “enter medical school deeply committed to the field, they come with the desire to be empathic and compassionate, if we just create a system that nurtures what they come with then we will have less burnout and higher quality care.” How can we best change our institutions, our culture, to promote wellness in those who care for our health?

Writing Prompt: Do you or a colleague suffer from burnout or depression? How has your institution helped address this issue? How has it failed in addressing this issue? As a patient, what are your thoughts about Dr. McClafferty’s statement in the New York Times article: “If you’re my physician, I want you to be in good shape mentally, physically and emotionally, so you can be really successful at helping me”? If you’ve personally suffered from depression, what stigma did you experience? What was most helpful, from individuals or from your workplace, for recovery? Write for 10 minutes.

If you are suffering from depression or burnout, there is help:

For Physicians: AMA’s Steps Forward

For Patients and Physicians: National Suicide Prevention Lifeline

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Ramblings

Free Write Friday: Cross Country Ski

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The stillness is deafening. I startle to someone coming up behind me until I realize the swishing is from my own skis, legs scissoring across the powder, cutting into the silence-laden air. My quadriceps, my calves burn under layers of cotton, of smart wool. My nose ignites with the chill of exposed skin, nares dripping with shock. I pull my hood tighter, cocooning my half moon ears.

We come to a pond, sheets of ice overlay sections, tempting the foolhardy. A carved wooden sign marks it a “swimming hole.” I try to imagine a sticky summer day when a jump in those waters would be desirable, a welcome cooling. But all I can think about are my fingertips, numb and double-gloved, constantly flexing interphalangeals, willing the circulation to return.

I hear the river’s rush before we see it, the waters churn over smooth rocks, under the precarious bridge. The sound floats on the air, over the snow, down the trail, amplified as if running parallel, overhead, all around, rushing through us as we ski closer to the river’s edge.

The trail forks, we turn right, enter a grove of birch trees, slender white bark complementing the elegance of the silent snow. There’s a muffling to the drifts, an insulation and paradoxical amplification of sound. I like the set grooves in the trail, a designated place to put my slim skis, a comfortable path to follow. They keep me focused, respectable, out of harm’s way.

Today though, it’s too cold – single digit temperatures jolt this moderate-weather gal. We’re unable to enjoy the journey, frozen extremities too distracting. We hurry back to the warming hut, thermosed hot chocolate and a rush of heat greet us.

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