Narrative Medicine

Narrative Medicine Monday: The Art of Translating Science

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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.

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Ramblings

Free Write Friday: Couch

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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.

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Narrative Medicine

Narrative Medicine Monday: Anatomy Lesson

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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.

 

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Ramblings

Free Write Friday: Ski

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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.

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Ramblings

Merry Christmas

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Here’s a holiday poem, compiled by author Kwame Alexander, consisting of contributions from NPR listeners. This community poem is made up of lines about what listeners like most about this time of year. However you celebrate, or ache, on this day, may you find light and hope as a new year dawns. Peace and joy to the world.

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Ramblings

A Day

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Yesterday was one of those days that derailed quickly. One thing after another, nothing major or too traumatic. Just one mishap exacerbating another making for a terrible horrible no good very bad day. So no free write today. Instead, I attempt to regain some composure, some perspective and wish you a wonderful fabulous all great very good day.

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Narrative Medicine

Narrative Medicine Monday: Someone Else’s Pain

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Brenna Working Lemieux’s poem “Someone Else’s Pain” illustrates the struggle to understand what others are feeling, how challenging it can be to fully grasp another’s suffering. The patient experiences “some driven-screw anguish that flares” that they attempt to explain. Lemieux can only “nod or shake [her] head.”

I can relate to Lemieux; medical providers regularly face the challenge to decipher a patient’s explanation of illness or pain. I delivered babies for many years before I had my own children. After I experienced labor for the first time myself, I cringed recalling many of the comments, modeled after other medical providers, I had made to laboring patients prior to experiencing that pain myself. I had been sympathetic to their pain but could not embody empathy in the same way I could after I had gone through a similar experience. I had no reference point to the crushing agony of contractions that I would later understand. Of course, we can’t fully experience everything our patients go through. However, we can become better at listening and responding to the story they are trying to tell.

Lemieux likens listening to the patient describe their pain to the focus she had in art class, “trying in vain to capture” an image of her hand. Her poem illustrates the nuances and importance of narrative to medicine, the need to hone our listening and storytelling skills to improve the relationship between patient and physician and, ultimately, medical care as a whole.

Writing Prompt: What is the biggest challenge in understanding another person’s pain or illness? Have you ever tried to describe such an experience to a friend or healthcare provider? Think of a time you were on the explaining or the listening end of such a conversation. Write for 10 minutes.

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Writing

Till Chapbook

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I didn’t get a free write done this week but did attend the launch party for the 2017 Till Chapbook. This local organization supports writers, builds community and hosts a writing residency at Smoke Farm each summer. Last June I attended the residency and spent several days reading books on craft, floating down the Stillaguamish River, attending workshops by the likes of the Jane Wong and Claudia Castro Luna, ate homemade fare by our fabulous chef and wrote, among other things, my first published poem Instead, which you can find in the 2017 Till Chapbook. I’m grateful for the talented writers I met and enjoyed hearing several of them read their work at the release party this week. Here’s to Till and the writerly community they cultivate.

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Narrative Medicine

Narrative Medicine Monday: Heroin/e

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In Cheryl Strayed’s essay “Heroin/e” she writes about our ways of facing death, dying, grief and the will to live. Strayed loses her mother to cancer and suffers her own descent into addiction. Strayed’s love for her mother is evident and the loss she feels is acute. When her mother first learns of her diagnosis, Strayed recounts them silently entering the restroom, “Each of us locked in separate stalls, weeping. We didn’t say a word.” Strayed describes the numbing of pain and the warping of time for each of them: “The days of my mother’s death, the morphine days, and those that followed, the heroin days, lasted only weeks, months–but each day was an eternity, one stacked up on the other, a cold clarity inside of a deep haze.”

Writing Prompt: What does it feel like, in a physical sense, to suffer from addiction? From grief? Do you think addiction and grief are linked? Why or why not? Think of your own experience or a time you’ve witnessed this in a patient. Write for 10 minutes.

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Ramblings

Free Write Friday: Starbucks

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They line up outside the first storefront: the trim an earthier green, the logo more organic, subtly suggestive, less polished. They take selfies and wait patiently to order grande peppermint mochas. I shuffle by them onto the cobblestone street, eager to reach the Chinese bakery to collect barbecue pork filled humbow, sticky rice wrapped in lotus leaves, buttery almond cookies that leave a residual crumble. I admire the fruit stands: large trays of plump grapes, squat persimmon, rainbow carrots gathered with twine. The flowers and the flying fish are, like the coffee shop, iconic, each wrapped in waxy paper, rubber-banded for the journey home.

***

I spot the familiar logo from across the street. Sweat sticking to my back, a rushing wall of air conditioning bowls me over as I step inside the coffee shop. The decor is the same, artwork familiar, stout brown chairs circle round veneer tables. I step back home, into anytown Starbucks despite being thousands of miles across the Pacific Ocean on a tiny island of an idyllic archipelago. It’s the brand, what people expect, what they want to see. But I bristle at the cookie-cutter likeness, even as it comforts me. I order an iced latte from the awkward Thai barista, clad in the familiar bright green apron with emblazoned mermaid. I grab my cup with my head slightly down, a kind of apology. But I sip the milky caffeine eagerly, my American thirst quenched.

***

In college I would study at the one on the Ave, in medical school at the one in Madison Park. I’d order my drink and settle down at a table, spread my textbooks and notecards out just so, like surgical instruments lined up for an important procedure. I’d highlight and underline: red, green and blue. Star and paraphrase, chart and summarize. After hours of sitting I’d grow stiff, have to stand to stretch my muscles, hinge my joints. One time my strained neck raised to the hum of whispers: Howard Schultz, the owner of the ubiquitous coffee chain had stopped in for his own caffeinated drink. Someone mumbled that he lived in the neighborhood, came into this particular Starbucks from time to time. Tall, with an open confidence, he didn’t linger. I wondered what his drink of choice would be.

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