Narrative Medicine

Narrative Medicine Monday: The Second Floor

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Poet Rachel Hadas describes how those near the end of life grow distant before they pass in “The Second Floor.” She begins with a dream, consisting of “a harried pilgrim to a shrine.” She states that “[a]s quickly on their short legs toddlers move, / tall parents lumbering in slow pursuit, / so they speed onwards, people whom we love.” I like the unexpected juxtaposition of the unsteady toddler at the beginning of life to the dying loved one at the end. She paints an image of Sam and his daughter cradled together in “[s]leep and love, the quick, the nearly dead.”

Writing Prompt: Do you agree with Hadas’ assertion that the terminally ill are “somehow out of reach well before the grave?” Why or why not? What role do dreams play in our processing of ill or dying loved ones? Have you experienced such a dream? Write for 10 minutes.

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Ramblings

Free Write Friday: Trains

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We ride the monorail to the city center, food court and live music on stage, families milling around on a holiday weekend, heading to the children’s museum or playground or bringing tourists to the iconic needle in the sky. Their dad is hungry, so he peels off to peruse the menu of greasy gourmet burgers, poutine doused in thick sauce, a grilled cheese dripping in butter for the kids. I veer the little ones to the centerpiece, the electric train. Every winter it’s set up in the center house, a pretend village sprinkled with snow and Christmas cheer. I never noticed the details before. My children now old enough to pause, stand still in wonder long enough for me to explore. Tiny figurines placed carefully, carrying wrapped boxes, firewood, bundled babies in their arms. My four year old’s excitement builds as the train speeds toward his face pressed against the plexiglass. It’s a wistful display of a bygone time but, modern boy though he is, the old fashioned train still holds charm.

***

My older brother had a train table growing up: handmade, wood, painted a mossy green. Tracks laid down across the entire span, chin level to my 8-year-old peering eyes. I remember a tunnel, trains traversing through a plastic snow topped mountain pass. The contraption took up most of his large bedroom, meant to be a downstairs family room or den. There was an opening in the middle. We’d climb under and pop up in the center as if underground moles. He conducted the whole display, detailed greenery sprouting on the landscape. I’d watch in wonder as the trains sped by.

***

My grandfather had a train computer game he liked to play. When we’d visit his tidy rambler in a well-to-do suburb in the early 2000’s we’d sit in his den, this octogenarian navigating down the pixelated tracks on his desktop monitor, clicking keys to make the trains whistle and stop. It wasn’t the most entertaining way to spend our time with this beloved elder of the family, but we indulged him and his enthusiasm for the simple program. He took computer lessons in his last decade of life, he traveled the world, he went sky diving when he turned 80, showing up on my parents’ front porch proudly wearing a t-shirt and holding a VHS tape record of the tandem free fall as proof. He must’ve always loved trains too. I like to picture him as a little boy, nose pressed to the glass at Christmastime, as a teen piecing together the intricate parts of a model train, placing the finished product triumphantly on winding tracks.

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Narrative Medicine

Narrative Medicine Monday: The Quiet Room

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Trauma surgeons Drs. Masiakos and Griggs outline the public health crisis that is gun violence and the need for further research and action to combat this persistent threat. In “The Quiet Room,” they achingly describe delivering the devastating news to a mother that her child has died. They note that “we tell ourselves that this senseless dying must end. But it doesn’t end. Another child is shot, and another mother is heartbroken.” They go on to outline the epidemic of gun violence, asserting that “whether on the streets of Chicago or in the churches of Charleston and Sutherland Springs, [it] is a national health emergency.” These trauma surgeons, along with many other physicians, stress that “only if funding for research on firearm-violence prevention and public health surveillance is reinstated can we determine the best approach to addressing the public health crisis of firearm violence.”

Writing Prompt: What specific information would be helpful from firearm-violence research to stem the tide of this epidemic? Have you cared for a patient who has suffered from firearm-violence? Write about the experience. What can you do as an individual to join in the “collective power” to address this public health crisis? Write for 10 minutes.

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Ramblings

The Pumpkin

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I’m enjoying a second Thanksgiving feast with family today so will forego the usual Free Write Friday post. Instead, in honor of the pumpkin pies my three children enthusiastically helped me bake this year, enjoy this poem by John Greenleaf Whittier, “The Pumpkin.” May you and yours enjoy good food, conversation and connection this holiday weekend.

The Pumpkin

John Greenleaf Whittier, 1807 – 1892

Oh, greenly and fair in the lands of the sun, 
The vines of the gourd and the rich melon run, 
And the rock and the tree and the cottage enfold, 
With broad leaves all greenness and blossoms all gold, 
Like that which o’er Nineveh’s prophet once grew, 
While he waited to know that his warning was true, 
And longed for the storm-cloud, and listened in vain 
For the rush of the whirlwind and red fire-rain. 

On the banks of the Xenil the dark Spanish maiden 
Comes up with the fruit of the tangled vine laden; 
And the Creole of Cuba laughs out to behold 
Through orange-leaves shining the broad spheres of gold; 
Yet with dearer delight from his home in the North, 
On the fields of his harvest the Yankee looks forth, 
Where crook-necks are coiling and yellow fruit shines, 
And the sun of September melts down on his vines. 

Ah! on Thanksgiving day, when from East and from West, 
From North and from South comes the pilgrim and guest; 
When the gray-haired New Englander sees round his board 
The old broken links of affection restored, 
When the care-wearied man seeks his mother once more, 
And the worn matron smiles where the girl smiled before, 
What moistens the lip and what brightens the eye? 
What calls back the past, like the rich Pumpkin pie? 

Oh, fruit loved of boyhood! the old days recalling, 
When wood-grapes were purpling and brown nuts were falling! 
When wild, ugly faces we carved in its skin, 
Glaring out through the dark with a candle within! 
When we laughed round the corn-heap, with hearts all in tune, 
Our chair a broad pumpkin,—our lantern the moon, 
Telling tales of the fairy who travelled like steam 
In a pumpkin-shell coach, with two rats for her team! 

Then thanks for thy present! none sweeter or better 
E’er smoked from an oven or circled a platter! 
Fairer hands never wrought at a pastry more fine, 
Brighter eyes never watched o’er its baking, than thine! 
And the prayer, which my mouth is too full to express, 
Swells my heart that thy shadow may never be less, 
That the days of thy lot may be lengthened below, 
And the fame of thy worth like a pumpkin-vine grow, 
And thy life be as sweet, and its last sunset sky 
Golden-tinted and fair as thy own Pumpkin pie!
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Narrative Medicine

Narrative Medicine Monday: To Seize, To Grasp

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Writer Heather Kirn Lanier describes her daughter’s seizures in “To Seize, To Grasp.” Lanier begins the flash essay outlining her infant daughter’s first seizure: “not the worst one, although it brought the biggest shock.” Lanier relays what it’s like to be thrust into the medical world and terminology of a new diagnosis: “New traumas gift new glossaries. Words become boxes into which you can pack the pain.” She achingly describes the pain of watching her child seize, unable to do anything but wait: “But of course he could only do what I could do, which was inject medicine and wait.” Lanier closes the piece with her daughter’s worst seizure, which was not the longest. What was it that made this last one so frightening for Lanier? Can you relate to grasping onto that which can be lost at any second?

Writing Prompt: Have you been suddenly thrust into the medical world because of your own illness or a loved one’s diagnosis? What was it like to learn a new vocabulary and way of interacting with the medical system? What did you find most challenging or surprising? Write for 10 minutes.

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Ramblings

Free Write Friday: Beach

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She walked down the hill to the beach, bundled in a down coat, fingerless gloves and a white knit hat. Sneakers on pavement gave way to fine sand spilling over her laces as each step took more effort. Closer to the shoreline the sand was more compact, sturdier beneath her. Here she could stroll along the rocky ground, now pounded by the November waves, wind whipping them into a fury.

She imagined a storm, how it would rage in years past, toss fishing boats as they struggled to avoid the lighthouse signaling at the point. She thought of the contrast, just yesterday sun warming her face as she ate lunch, read, wrote on a picnic table perched on the beach, watching couples meander along the shore with their dog. She could linger.

The wind beat fiercely as she climbed a small hill to circle back. But as she found herself among the golden reeds, atop a mound just set back from the rocky beach, she felt suspended, wind pounding from all directions. She paused, the intermission comforting, demanding reverence.

Pressure on all sides, she remained. It was as if liquid, not air, compressed her. As if warmth, an unexpected peace held her in the midst of the chill November day.

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Narrative Medicine

Narrative Medicine Monday: In Shock

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Although I’ve never met her, author and critical care physician Rana Awdish on some level feels familiar. Not only are we both part of a supportive online group of physician-writers, but I just finished reading her wrenching memoir, “In Shock: My Journey from Death to Recovery and the Redemptive Power of Hope.” Awdish’s gripping account of her near-death experience, subsequent hospitalization in her own ICU and revelations about the shortcomings in both support for and education of medical providers in the realm of empathy are illuminating. Her book is infused with challenge and hope and a call to transform the way we train physicians and care for patients.

Awdish is thrust from the world of providing medicine into that of receiving it – a patient under her own colleagues’ care. The contrast of these positions of power and vulnerability are striking and Awdish describes the jarring experience and her own enlightenment as she pivots between these two roles. She shares with the reader her revelations regarding how we provide medical care to those in crisis and inspires us to find a better way.

I was particularly convicted by Awdish’s insight into how medical training encourages physicians to suppress many of our emotions. She traces this ideal back to the father of modern medicine, Sir William Osler, who encouraged “‘aequanimitas.’ Osler regarded this trait as the premier quality of a physician. It represented an imperturbability that was described as manifesting in ‘coolness and presence of mind under all circumstances, calmness amid storm, clearness of judgment in moments of grave peril.'”

Awdish asserts that as physicians “we aren’t trained to see our patients. We are trained to see pathology. We are taught to forage with scalpels and forceps for an elusive diagnosis buried within obfuscating tissues. We excavate alongside our mentors in delicate, deliberate layers, test by test, attempting to unearth disease. The true relationship is forged between the doctor and the disease.” Do you agree with Awdish’s assessment? Why or why not?

If you’re a physician, if you’re a patient: read this book. Discuss it with your colleagues, mull over it with your book club. The questions Awdish raises, the challenges she poses are vital to improving the way we care for each other in our most acute times of need.

Writing Prompt: If you’re a physician, did you learn to develop “aequanimitas” through your training? Did you feel this trait was a requirement, overtly stated or otherwise, to be a “good physician?” Have you yourself ever been a patient feeling, like Awdish, “powerless in a way that is impossible to imagine, from a privileged position of wholeness and well-being?” Awdish lists biting phrases that were directly said to her or that she overheard when she was a patient. Have you experienced similarly painful words from a medical provider? Have you said such words to a patient before? Try writing from both the patient and the medical provider’s perspectives. Write for 10 minutes.

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Ramblings

Free Write Friday: Retreat

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You plan months ahead to make it work. Line up sitters, meal plan for the following week, organize an overnight weekend at Grandma’s house. It feels luxurious, the silence and the resting in words. “Thinking is work.” You read it on a bumper sticker weeks ago and it remained with you, rolling over in your mind. You wrote it on a post-it and stuck it to your computer. Thinking is work but it’s not valued, not reimbursed in our quantifiable, time card, excel spreadsheet world. 

So you plan. You prepare excessively just so you can have the time, the space to think. You kiss your babies goodbye, leave them with Costco lasagnas and Daddy’s breakfast-for-dinner. You drive to the ferry terminal, eat clam chowder, thick with cream, chewy and loaded with immersed oyster crackers punctuating each bite. You cross to the peninsula, familiar from childhood jaunts with your family: damp woods to explore, saline air stinging nostrils, small town diners with stiff grilled cheese hugging cups of tomato soup. 

In the dark it’s a struggle. You find the communal house on the old military fort, now converted into housing for writing retreats, community events. Odd to think these dusty buildings used to be barracks. You came here for your medical school orientation weekend, sleeping bags tucked under arms, eyeing strangers with anticipatory reluctance, a peculiar Junior High start to the four years of forming physicians into being. You also came here for medical residency retreats. Each spring you’d all gather, let loose in the way a group working 36 hour days, 100 hour weeks, caring for the critically ill must. 

The drafty house smells familiar, like ghosts of orientations past reside. Here are strangers, unbonded to you, a writerly community. All introverts, you’re bound by the thinking, the thinking is work. You write and you read. You walk and you sit. The seaside air suffuses your mottled skin, still tensile but hinting at fine lines and transition into middle age. You can think here. You can create. It’s work, but it’s inspired. And those other selves, those other lifetimes, those other beings of retreats past dance on the floorboards, float through the drafty air, haunt the tap-tapping as letters form into words creating sentences giving meaning to the empty page. 

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Narrative Medicine

Narrative Medicine Monday: Baptism by Fire

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Pediatric Intensivist Gwen Erkonen’s fast-paced essay “Baptism by Fire” was recently highlighted in one of my favorite online creative nonfiction journals, Hippocampus Magazine. The piece begins with Erkonen sitting in Grand Rounds, a newly minted attending physician. Erkonen deftly describes the apprehension and weight of responsibility all physicians experience when, after a decade of training, they are finally in charge: “Four years of medical school, three years of pediatric residency, and three more years as a pediatric critical care fellow. My time as a medical apprentice is done. I no longer have an attending physician to help me with my decision-making. I am solely responsible for my patients.”

Erkonen’s pager calls her to an excruciating emergency: a toddler with extensive life-threatening burns. The reader is thrust into the dire situation with her as she assumes care of the critical patient, running the resuscitation efforts of the medical team and communicating with the young girl’s mother in the waiting room.

Erkonen not only relays her own inner turmoil during this first challenge of her new career, she also conveys her keen observations of the other participants. The surgery resident she first meets in the trauma bay “looks cool and in control with his hands folded across his chest and a broad-based stance, but I can tell from his shaking voice he’s not sure what to do.” Erkonen’s details describing the patient’s devastated young mother gives us insight that the family’s narrative is multi-layered and tragic even before this catastrophic event: “She starts to sob, and buries her head in the older lady’s chest. Then I notice that she has a disposable Bic lighter in her hand. She keeps flicking it so that flames jump from the spark wheel…. I notice that her hands are dirty. Not from the fire but because she hasn’t showered in several days.”

Most any physician can empathize with Erkonen’s inner dialogue. Years of training doesn’t negate the adrenaline-infused uncertainty when you first encounter the incredible weight of trying to save another’s life: “Feeling like an idiot, I nonetheless plow forward.” Erkonen is unflinchingly honest in her description of the events and her vivid details leave the reader breathless, exhausted and empathetic, as if we were watching them unfold on a medical drama, yet responsible along with her.

Writing Prompt: Think of a time when you were in a new position that held intense responsibility. Maybe it was your first week as an attending physician or a new job managing a large part of your workplace. Maybe it was your first hours as a new parent. Describe your own inner dialogue and your perception of others you interacted with during that time. Alternatively, try re-writing Erkonen’s essay from the point of view of the surgical resident, the burn nurse, the patient’s mother, the priest, the trauma surgeon. Write for 10 minutes.

 

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Ramblings

Free Write Friday: Leaves

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She walks with a wide gait, toddling down the sidewalk. Pausing at a crunch underfoot, she bends to pick up a dried leaf, yellowed and brittle. She examines it, hands it to you as if a treasure you should keep. It crumbles at your touch, leaving only the spine between your fingers, frail leafy remnants rain down onto the concrete below.

She’s enthralled by it all, gesturing her chubby finger, exclaiming with a noise that captures the essence of “leaf” without sounding anything like the word. As you walk home she squeals for you to stop at every tree, at every fallen branch. She reaches out to the Japanese maple in your front yard, afire this time of year. It was the one tree you asked the contractor to salvage when your house was remodeled half a decade ago. He looked at you sideways at the time: Why bother? But you knew. This tree would color your fall joyous.

Her pupils constrict as she touches the feathery crimson tip of a maple leaf, five points splayed out in reverence. Her lips curl as she considers the velvet color. “Leaf. Leaf. Leaf.” You repeat it to her as a mantra, as if a reminder to yourself. Each year it all changes – summer warmth to fall crisp, winter hibernation to spring sprout – but the words remain constant. You want her to learn so it will steady her, a foothold to rely on in this revolving world. You know the cycle, the recurrent pattern that must proceed. This too, the brilliant chorus of colors dancing, will tumble. But its glory today, blazing in the late October sun, is enough for you both.

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