Narrative Medicine Monday: Going Blind

German poet Rainer Maria Rilke writes of a nearly-blind woman at a party in “Going Blind.” The poem provides an observation of this woman, as if we were in the room with her. At first she looks “just like the others.” As someone who works in healthcare, usually it is obvious when a patient is sick. But more often than I think we acknowledge, we can’t always tell when a person is suffering or ill. There are many diseases or ailments that might not be readily apparent at first glance.

The narrator does soon note subtle differences in the woman: “she seemed to hold her cup / a little differently as she picked it up.” Rilke focuses on the woman, as the rest of the party moves away: “I saw her. She was moving far behind”. He notices her eyes, “radiant with joy, / light played as on the surface of a pool.”

There is a turn in the poem here, where the narrator moves from seeing her smile as “almost painful” to realizing that once “some obstacle” is “overcome, / she would be beyond all walking, and would fly.” It ends on this hopeful note, the idea that this woman will persevere, and in so doing, move beyond all others and the world’s norms.

Interestingly, here is another version of Rilke’s poem, translated by Margarete Munsterberg in 1912. Reading various English translations of poetry always makes me wonder at what might be missing when we don’t read a piece in the author’s native tongue. Did you get a different sense of the themes or of the woman from reading these translations?

Writing Prompt: Think of a time when one of your senses was limited. What did it feel like to be restricted in this way? Did you note other senses altering in response? Have you observed a patient or a loved one losing their hearing, their sight, their ability to taste food? What did you notice? Alternatively, consider writing from the perspective of the woman going blind. Imagine what she sees, what she feels. Write for 10 minutes.

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Narrative Medicine Monday: Introduction to Asthma

Poet Susan Eisenberg gives an “Introduction to Asthma” for the parent and practitioner. Her son suffers an acute asthma exacerbation, the “Cacophony rising in his lungs, / oxygen level falling”. Eisenberg lets us know that her young son “believes / he will die” but also exposes the reality that “Anyone who wants to kill me he says / would have to kill my Mom / first.” She will follow her son anywhere, even Heaven or Hell. The reader’s own breath catches on this truth, as Eisenberg hugs “his eyes in mine / and breathe for both our lives.”

Writing Prompt: Try reading Eisenberg’s poem out loud. What do you notice about her choice of words, line breaks and white space? Think of a time you or a child or friend or patient experienced an acute and sudden medical emergency, such as an asthma exacerbation. Describe what you hear, what you see. Write for 10 minutes.

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Narrative Medicine Monday: Perchance to Think

A couple of years ago I was driving to work when I pulled up behind a car that had a red bumper sticker with white block lettering: “THINKING IS WORK.” When I arrived at my desk that day I wrote this statement on a Post-it note in my barely legible handwriting and moved on with my busy primary care clinic day.

Since then, I’ve had little time to ponder this idea, but it’s always been there, in the back of my mind, the Post-it still pinned to my desk bulletin board. We live in an accelerated world, saturated with information at our disposal. Though I’ve noticed, in my life and in medicine, there is less and less time to access this information, to research, or just think.

Dr. Danielle Ofri’s latest piece in the New England Journal of Medicine highlights this issue. In “Perchance to Think” Ofri outlines a common problem among primary care (and I’m sure all speciality) practices – there isn’t time allotted to actually think about a case. Ofri gives the example of a patient with slightly abnormal lab tests ordered by another physician. As the primary provider, Ofri is then tasked with sorting out whether this patient has adrenal insufficiency or rheumatoid arthritis while also addressing his six known chronic conditions. Ofri notes that, for primary care physicians, “adrenal insufficiency resides in the wobbliest, farthest-flung cortical gurus I possess.” Ofri quickly realized, as her “patient stacked his 15 medications on my desk – all of which needed refills, and all of which could interfere with adrenal function” that what she really needed to give this patient the best care possible was “time to think.”

In medical school we have time to study, to think deeply as we learn the intricacies of the human body and how to treat illness when things go wrong.

Once out in practice, though, there isn’t the luxury of that time to ponder. More and more demands are put on the physician, be it “last week’s labs to review, student notes to correct, patient calls to return, meds to renew, forms and papers spilling out of my mailbox.” Ofri eventually gives up, gives in to the time constraints of the system, and refers the patient to endocrinology to sort out the adrenal insufficiency issue.

As a primary care physician myself, this is an all too familiar dilemma. Ofri recognizes that this situation is untenable to all involved: the patient, the primary care provider, and the specialist. “In the pressurized world of contemporary outpatient medicine, there is simply no time to think. With every patient, we race to cover the bare minimum, sprinting in subsistence-level intellectual mode because that’s all that’s sustainable.”

Ofri eventually takes the time to listen to a podcast on adrenal insufficiency, addend her note and contact the patient with a more cogent plan until he’s able to see endocrinology. But this was time that isn’t usually allotted or even available in a normal physician’s busy life: “many of our patients’ conditions require — time to think, consider, revisit, reanalyze.”

Ofri laments there’s no way to code for contemplation, but asserts that giving physicians the time to think could improve efficiency. “We would save money by reducing unnecessary tests and cop-out referrals. We’d make fewer diagnostic errors and avert harms from overtesting. And allowing doctors to practice medicine at the upper end of our professional standard would make a substantial dent in the demoralization of physicians today.”

Here’s to considering a more wholistic way of practicing medicine, one that includes the intellectual rigor that attracted most physicians to medicine in the first place. After all, thinking is work.

Writing Prompt: Do you think giving physicians time to think would make a difference in efficiency? Have you experienced a case similar to Ofri’s, where if you had a little more time to research, you could manage the case yourself? As a patient, do you notice the time pressures on your physician? Describe what it’s like to experience this as a patient, as a provider. Write for 10 minutes.

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AWP 2019 Recap

My first AWP conference was everything I thought it would be: overwhelming, inspiring, and engaging. At times I felt like hiding in a small dark room by myself, at others I was torn by all the panels and gatherings happening simultaneously, wishing I could somehow replicate myself so I could be in all places at once. I met and interacted with admired authors, poets, editors and other emerging writers. I left Portland exhausted and elated.

As an emerging writer who hasn’t had formal training, I didn’t have the same MFA reunion or tribe that other writer friends enjoyed, but I did benefit from a new cohort I now belong to: the AWP Writer to Writer Program. Diane Zinna runs this mentorship program, now in its tenth session, with contagious enthusiasm. I was able to meet Diane and my mentor in person at AWP, as well as other Writer to Writer alumni.

The panels I attended were varied and largely helpful. I learned about writing and teaching flash nonfiction, the perils and pitfalls of writing about real people, writing through trauma, managing parenthood and the writing life, and so much more. I was able to hear Cheryl Strayed and Colson Whitehead speak about the writing life and their craft and hear my own mentor Emily Maloney and writing friends Anne Liu Kellor and Natalie Singer share their work.

I applied for a Tin House intensive workshop on writing the very short essay with Melissa Febos, and and was thrilled to be accepted. An afternoon writing offsite with courageous and creative women was a highlight.

photo credit: India Downes-Le Guin

One of the biggest joys, and hurdles for me, of the week was sharing my own work at a paired reading. I read an essay that has not been shared publicly before and holds particular emotional weight. It was freeing to release this work out into the world and I’m grateful it was well received.

Writers are, by and large, a forgiving and authentic crowd. Though many, like me, are introverts, I was impressed that the feeling of holding space for each other infused the conference. I moved out of my own comfortable cocoon of anonymity by walking the book fair, approaching editors of presses and journals I admire, striking up a conversation with unsuspecting poet Jane Wong as I was walked by the Hedgebrook table (hopefully in a decidedly uncreepy way), and doing a public reading myself.

I tweeted some favorite quotes from the event, but wanted to share these pearls here as well:

“Be willing to dig through the layers of artifice to get to the deeper truth.” – Cheryl Strayed

“What is the purpose of art? To suggest potential realities or states of mind that would not otherwise suggest themselves.” -Richard Froude (a fellow physician!)

Jessica Wilbanks shares she learned “to trust my subconscious more than my intellect” during her writing process.

“Trust that isn’t absolute isn’t trust at all.” – Alison Kinney

“Living a trauma is living a trauma. Writing a trauma is a reconsideration, an attempt to capture yourself in the reconsideration.” – Alison Kinney

“The purpose of art is to lay bare the questions that have been hidden by the answers.” – James Baldwin

“I’ve learned that writing a book will not make you whole.” – Colson Whitehead

“It is a joy to be hidden and disaster not to be found.” – D.W. Winnicott

“Telling this story was worth more than my comfort.” – Melissa Febos

“Real people are more than the worst or best things they’ve done. Craft requires we honor a person’s complexity.” – Lacy M. Johnson

“Be rigorous ethically and in craft before you put your work out in the world. [When writing about real people] scrutinize your own intentions.” – Melissa Febos

So much of writing feels like a solitary pursuit, laced with overwhelming rejection. But, like I’ve experienced in medicine and motherhood and many other aspects of my life, finding a tribe, a cohort of passionate individuals to help support each other and share in community, is invaluable. Thanks, AWP 2019, for providing that space.

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