Narrative Medicine

Narrative Medicine Monday: In Life’s Last Moments, Open a Window

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British physician and author Rachel Clarke advises in The New York Times that to care best for our terminally ill patients we should, “In Life’s Last Moments, Open a Window.” Dr. Clarke relays the story of a patient dying of cancer who was nonverbal but clearly in anguish. “We tried talking, listening, morphine. His agitation only grew.”

Clarke initially questions if the “sheer vitality of nature might be an affront to patients so close to the end of life — a kind of impudent abundance.” Instead she finds, as in the case of her patient with tongue cancer who merely wanted his door opened wide to the adjacent garden, many patients develop an “intense solace… in the natural world.”

It is the song of a blackbird outside her window that gives one of Clarke’s breast cancer patients perspective that even “[c]ancer is part of nature too, and that is something I have to accept, and learn to live and die with.”

Clarke shuns the idea that end of life care needs to equate to a “dark and dismal place.” Instead, she contends that what should dominate hospice “is not proximity to death but the best bits of living.”

Writing Prompt: Clarke’s patient Diane notes that cancer is a part of nature. What are the implications of this statement for you as a medical provider, as a patient, as a loved one? When you’ve been ill, have you found solace in nature? Write for 10 minutes.

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Narrative Medicine

Narrative Medicine Monday: Vicious

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Tim Cunningham gives us a glimpse of Abdul, a teenage Rohingya refugee he encounters in a Bangladesh camp, in Intima‘s “Vicious.” Cunningham notes that his “belly was swollen like the rice fields” and “[t]hough described by many as non-literate because he had no official access to school, he could read the Quran with ease. His recitation of its Surahs was exquisite.”

When Cunningham meets Abdul in clinic, his pain is “everywhere,” as if “[h]is genocide had shifted internally, an annihilation of his once-healthy cells.” Abdul had lost his appetite entirely, did not “miss dahl and rice, mangos and bananas, though he knew that he should. ”

Cunningham imagines where he might transfer Abdul, had he the resources: “They would have diagnostics for his hepatomegaly and cachexia. They would have 24-hour staff, teams of nurses and physicians to treat and listen his life-story. The providers would all speak Rohingya. These thoughts were but daydreams. For extraordinary diseases, with extraordinary measures and extraordinary means, there are ways to treat illness.  If you are Rohingya, there is nothing.”

Cunningham’s prose elicits a visceral response to his patient’s physical and emotional trials, but it is Abdul’s word of response to a difficult intravenous stick that give both Cunningham and the reader pause: “Vicious.”

Writing Prompt: If you’re a medical provider, are there certain assumptions you make about a group of patients you see? How did you feel when Abdul repeatedly says “vicious?” What do you think that word might mean to him? What does it mean to you? Have you worked in a resource-poor setting or with a marginalized group of patients before? Recall an encounter with a patient. Write for 10 minutes.

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Ramblings

Free Write Friday: Soccer

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Her cleats are neon pink, a black swoop to give them credence. She hustles onto the field, tackling her girlfriends in a playful gesture. They run drills, found on the internet by the volunteer coach. Games to teach them teamwork, footwork, skills for basic play.

We bring our camp chairs, a bag of snacks, two water bottles to quench their thirst. The littles run on the perimeter, beeline to the playground where they can swing and slide and dig in the sand for a temporary distraction.

I see the girls from afar, their ponytails wagging as they scrimmage, green jerseys tangled up in the fray. They take turns kicking into the net, ball shanked to the left, to the right. Their legs scissor across the grass, some controlled, some gangly, some running to the goal with intention, comfortable in their bodies, aware of where thye’re going and who they want to be.

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Narrative Medicine

Narrative Medicine Monday: Preparation

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Abigail Lin’s poem “Preparation” in the Journal of the American Medical Association begins with a heartbeat as the focus of a medical student’s studies. She notes “we studied valves as if they were pipes: / what makes them rust, or clog.” There’s a note of bravado as the student starts their journey in medicine: they “marveled… as if we had built it ourselves.”

The humility comes later, realizing the fallacy in believing that “we could learn the architecture of grief / simply by examining blueprints.”

I remember marveling at the intricacies of design in my college introductory biology courses. I had in mind that I wanted to be a physician, but one of my most surprising revelations was learning about botany. I was amazed by the specificity of design in plants, the complex workings of how they grow, receive nourishment from the sun, from the rain; how they give back to the earth.

Lin’s poem is a caution to new medical providers. Much of our learning is in the machinery of the patient, the inner workings of the body. So much more is involved in treating the patient, not merely the disease.

Writing Prompt: If you are a medical provider, recall when you first started studying medicine. Were you naive, as Lin’s poem asserts? Is there something you’ve studied that you’ve marveled at? Did you learn a more nuanced appreciation as you progressed in your career? Recall an instance that contributed to that maturity. Write for 10 minutes.

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Writing

Published: Humanity

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Paloma Press’ “Humanity,” edited by Eileen Tabios is out! You can read more about it here, including options for purchase. In this anthology “we glimpse an overall picture of strength and fragility, of empathy, and myriad hopes.”

I’m proud my essay, “Dust,” originally published in Intima, is part of this diverse anthology.

Paloma Press is supporting migrant and refugee children through UNICEF here if you’d like to contribute to their important work.

If you’re in the San Francisco area, Paloma Press will be hosting a reading of “Humanity” to benefit UNICEF on 9/22/18 at the San Francisco Library, Glen Park Branch at 2 p.m. There will also be various readings throughout the country hosted by contributors, including Sonoma County, Atlanta, Norfolk and New York City.

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Ramblings

Free Write Friday: Girl Scouts

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We met in a Methodist church on a weekday afternoon. Recite the pledge, munch a snack, craft a project. We’d earn badges through field trips, skills, lessons. I was snack helper, clean up helper. We’d rotate through, sit in a circle on the beige carpet. Make new friends, but keep the old; one is silver and the other gold.

We took our sleeping bags to overnight camp, sang songs around the campfire. Kumbaya. I didn’t like the bugs, the forest air was foreign to my sheltered suburban self. I liked the novelty of it though.

I never was good at selling cookies. My dad retired young, couldn’t take them to work like the others. Too many other Girl Scouts in my neighborhood, we had to ration out the doors to knock on. Most people were nice enough to the awkward girl in the green vest but I wasn’t animated enough to make more than a pity sale. My mom, like me, an introvert and not wanting to be too pushy, didn’t help my failing cause. I wanted to be forward, learn the marketing skills, but I never did muster the ability to sell.

I remember traveling with my troop to the Peace Arch on the northern U.S. border, admiring a stylish girl with long braids and a green beret, souvenir pins stuck to her vest. What travels she’s made, what friends she’s met! I started collecting pins that day, not to trade but to keep: document the family road trip to Disneyland, the annual summers in Hawaii, the study abroad in France, the Mekong Delta, the crowded dusty streets of India and beyond.

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