Narrative Medicine Monday: Primum Non Nocere:

Emma Barnard is a visual artist and researcher focusing on fine art and medicine. Her latest installment, “Primum Non Nocere,” reflects the patient experience. Barnard’s work is influenced by her own interactions with the medical world as a patient and her research into this arena, including Michel Foucault’s term ‘medical gaze,’ used to “denote the dehumanizing medical separation of the patient’s body from the patient’s person or identity.”

I’m interested in Barnard’s method of creating art, where she follows a patient into the exam room and questions them right after, producing a drawing based on their response. She notes that many of the physicians are surprised at the resulting artwork: “During the consultation process patients show little emotion; it’s quite difficult to read how they really feel about the impact of the words spoken during the clinical encounter.”

Barnard also incorporates the physician and surgeon perspectives. Could you relate to her images of a physician’s experience in a busy clinic practice?  I could certainly identify with the depiction of others superseding the “self” and various demands of work and home life feeling compartmentalized. Do you agree with the neurosurgeons’ statement that as physicians we view a division between us and patients and that we have to understand this alienation “if we are to find ways to soothe it and become connected to our patients and to the essence of medicine?”

Writing Prompt: As a patient, have you ever experienced Foucault’s ‘medical gaze,’ where you perceived a provider as seeing you only as a body, rather than recognizing your personhood? What did that feel like? As a medical provider, have you ever caught yourself interacting this way with a patient? How can we work to overcome this tendency? Write for 10 minutes.

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Free Write Friday: Hair Accessories 

I used to play beauty parlor with my best friend. She didn’t like the game of coiffing, but I enjoyed the tugging on hair, taming her strawberry blond curls, selecting and applying the ribbon or hair clip just so. I would stand back and admire my handiwork, wisps and strands situated as I commanded. They succumbed to my coercion and I was satisfied. 

*

My hair was cut too short in fourth grade and I never got over it. It was a “boy” cut, not the cute Dorothy Hamill kind made popular by the 1980’s figure skater. Instead of a bobbing bowl cut, it’s as if the hairdresser took clippers to the back, the sides, the whole mass of thick dark tresses. It was too short for any hair clips and headbands gave me a throbbing ache at my temples. I wore a blue and red and white knit button up sweater in my school picture that year. I liked the sweater, the fanciful snowman perched near the hip pocket. My smile though was strained as if I knew the aberrant hairstyle would haunt my year. 

I went skiing once that winter with my brother and as the attendant was helping us onto the chair lift, toes frozen in clumpy boots, I heard a distinct, “There you go, boys!” He was being friendly but I was mortified, this mistaken identity at a time when all begins to hinge on your perception of what others think about you, molding what you come to think of yourself. 

*

My son gets upset that I can’t braid his hair like I do for his big sister. I pull out accessories: clips and bows and headbands in an attempt to give him alternate adornment. He seems placated, a thin line of a smile as I pull back a strand of his bangs with the royal blue polka dot clip. He steps back, but doesn’t scurry away to admire himself in the mirror as my daughter would. No, it’s the participation that matters to him. He rushes downstairs to show off his fancifulness. 

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Narrative Medicine Monday: Erasure

Student and poet Thomas Nguyen writes of memories and loss in “Erasure.” In his poem Nguyen is instructional, warning how time affects our connection to those we’ve lost: “Accept that time makes things distant, that his absence doesn’t bleed into your memories as much as it used to.” There are only a few significant people in my life who have died, but I can identify with Nguyen who needs to try “harder and harder to remember the last time” he saw his mentor.

Nguyen notes that the patient speaks of his melaonmas as if they were part of his garden: “My dermatologist taught me how to care for them.” Nguyen goes on to contrast this with the green moss on the windows of his home. Do you agree with Nguyen that “life always adds?” Do you find this contention comforting or suffocating, or both?

Writing Prompt: Have you spent time with a loved one or patient who was nearing death? If time has passed, how have your memories of this person been affected? Recall the last time you saw them. Outline the details, like Nguyen’s memory of “neatly-pressed khakis.” Write for 10 minutes.

 

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Free Write Friday: Purge


You have the sudden urge to purge. You spend a long holiday weekend sorting through all of your children’s clothes; the Space Bags stuffed beneath twin beds and dressers, the lost items at the back of their closets. You match socks, discard pliable hand-me-down infant shoes. You sort through stained sleepers used by three, maybe four children. You organize clothes too small, too big for your three children. You find dusty discarded tights hiding behind a dresser. 

Then you move on to your own closet. Haphazard piles of clothes in four different sizes, maternity pants with stretchy elastic waistbands, nursing shirts with openings for nipples to peek through. Some are worn and gigantic, others are new with tags, bought on sale on a whim early postpartum when you were self-conscious about the extra chub, in need of pants that actually fastened but didn’t accentuate an after-baby muffin top. 

You try things on, everything that is “regular” now that you’re not pregnant or nursing. You’re done with that phase, toss those clothes into donation piles enthusiastically. You revel in your body back, no longer a receptacle for another’s development, no longer a conduit for sustenance. You kneel on the closet rug, toss items out the door into organized heaps. You slip one leg into old jeans, boot cut, out of style. You still have a hard time getting rid of things that fit but don’t provide true comfort. Each spared item should elicit the thrill that comes from a piece that feels just right on your skin, in your bones. You’re a goldilocks who holds on to the chair that is just a little too small, a little too big; if only you had the strength to keep only that which is just right.

After folding and organizing all shirts, all slacks, all dresses, all jackets, you sit back and admire. It’s a thing of beauty, a sigh of release to have it all there, visible, organized. That momentary satisfaction is enough to propel you downstairs into the next project. 

You tackle the junk room, meant to be a playroom. It became a dumping ground in the last 12 months, initially out of necessity, then out of sheer exhaustion. There were too many urgent demons swirling to even acknowledge this minor chaos existed. But now you have a window: the strength, the energy to sort, to discard, to organize. Bags of ski gear, gift wrapping, party decorations weigh down the child’s train table, buried under clutter. Boxes of camping gear, partially deflated sports balls, missing pieces of random toys are unearthed as you dig, excavate further into the room. 

This takes longer, more endurance, more muscle. You lift heavy items, find you’re missing ski gloves and appropriate boxes for storing camping gear. It takes more emotional energy to decide what toys to keep for your youngest child, to gauge which winter hats will still fit your oldest two. It doesn’t end with the same satisfaction, the playroom purge. Piles of equipment, of clothes, still line the hallway, boxes of trash and donations in the mud room. But the door can open, the children can play. You set up the train tracks on the squat table, lay out two trains heading in different directions. You can’t explain it, but it felt necessary to get this all done, right now. You were desperate for an ordered respite; seemed the antidote to a season of chaos devoid of calm. 

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Narrative Medicine Monday: Disaster Relief

Today’s Narrative Medicine Monday is a bit different. In light of recent catastrophic hurricanes in the U.S., there have been many stories about disaster relief and people stepping up to help in ways they’re not used to. One such person is Dr. Jennifer McQuade. This NPR story describes how McQuade, a melanoma oncologist, dropped off basic supplies to a shelter following hurricane Harvey and discovered the medical aid there severely lacking. She then found herself in charge of a medical shelter, enlisting the help of other physicians and medical providers via a physician moms social media group. Often in such situations we’re called upon to help each other in ways we might not imagine possible. As Texan Claudia Solis notes in the story, “There’s a kindness…. They’re your neighbor, and you have to help, and it’s beautiful.”

Writing Prompt: Have you ever found yourself in a situation where you had to provide medical care beyond your normal area of expertise? Have you ever been the recipient of such care? Describe the situation and how you felt. How did it bring you closer to the people around you? Write for 10 minutes. 

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Free Write Friday: Eggs

We used to have chickens. We housed them in our backyard, in several iterations of a homemade chicken coop. We got three chickens at once, learned it was better for them to not be alone. Our neighbor girls had raised chicks in their classroom, they were looking for takers to adopt the fuzzy creatures. We were childless, homesteading was en vogue. Why not?

They came to us with names already; I can’t remember them all. I do remember Becky. White feathers, she was unassuming, not the leader, not the most endearing; a ready follower. 

Raccoons roamed our city neighborhood like a carnivorous gang, looking for trouble. Sometimes I’d turn on the back porch Iight to catch a glimpse of their panda-like fur, eyes glinting in the sudden illumination. They didn’t seem to scatter like other animals, held their own. They were arrogant, behaved as if they belonged there and wouldn’t be deterred by a human intrusion.

One night we woke to horrible screeching. At first it sounded like a child, a dramatically tortured innocent. I realized it was the chickens, our chickens, crying into the night air, desperate for escape. They were trapped by our carefully placed chicken wire, the sturdy boards of our coop.

My husband went into the backyard to witness the carnage, chase away the culprits, recover plume and innards strewn across the lawn. I would discover feathers weeks later, flown to corners of our yard unnoticed that first night, that next day. I don’t know all the details of what he found, couldn’t stomach the specifics. 

The next morning I heard a familiar noise, distinctly bird-like. Over on the neighbor’s roof was Becky, injured leg, hobbling and whimpering but alive. Becky was a survivor. How she escaped the raccoon’s rampage is a mystery. Quiet and unassuming, still, she had the grit to somehow endure. We took her to the bird vet and spent weeks painstakingly feeding her antibiotics for her wound infection. 

We adopted other chickens over the years, nine in total. Some were lost to faulty gendering (roosters out themselves quickly with their incessant crowing), others succumbed to subsequent raccoon attacks. Becky survived to the end. When she finally surrendered we decided to close up shop on chicken rearing. We enjoyed some very expensive eggs and learned a justified wariness toward savage raccoons. 

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Narrative Medicine Monday: The Permanent

In “The Permanent,” Amy Burke Valeras takes us back to the 1980s when perming your hair was a thing. In the first half of the poem, Valeras opens up about her struggle with her hair; I could relate. I similarly begged for an ill-advised perm the same year, the same age as the author. I like how Valeras makes her hair a central character of the poem. We battle along with her preteen self as she tries to tame the “frizzy poof.” We can understand when, two decades later, she is told she has cancer but all she can think of is: “My hair!”

Writing Prompt: Think of an every day aspect of your life, of your body, that you took for granted or had a different relationship with until you became ill. Consider level of energy during a bout with the flu, walking with a sprained ankle; maybe you have lost your hair to chemotherapy or a breast to invasive cancer. Write about your relationship with this aspect of your body before you became ill and after. How did things change? Write for 10 minutes. 

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Free Write Friday: Eclipse


1991

I remember standing in a small field on Kauai, thick kelly green blades of grass underfoot. The square glasses, opaque cellophane-like lenses didn’t seem to do much at all. I was told to look up, face skyward. My older teenage brother had built a box, a contraption that revealed a projection of the eclipse. It was all underwhelming, the tiny crescent in the sky, projected on the cardboard. I remember thinking, ungraciously: This is it? I don’t remember it getting cold or dark or being moved in any significant way. After the novelty of the moment wore off, I wanted to get on with it, proceed with our vacation day. Head to the pool, play at the beach. I had only a vague concept of what I was looking at, looking for. 

2017

He starts to cry as the temperature drops. I want to take it all in, but he’s a heap on the wet grass, weeping beneath his paper solar eclipse glasses stapled to the back of a child’s tiger face mask. Why does the sun have to disappear? Why does it have to happen only today? He wants to ride his bike around the perimeter of the park but Dad says let’s wait until after 10:20 a.m., the point of maximal partial eclipse, 92% in these parts. He collapses into the whimpering mess of a typical three-year-old: unpredictable, unintelligible wailing. 

We begin to feel a chill, our friends put on sweatshirts. I’m unprepared and goosebumps emerge on my bare arms. There’s a festive feel, the large field peppered with strangers in lawn chairs, blankets splayed out with picnic foods, cardboard contraptions and eclipse glasses at the ready. My son is hugging his knees, sitting on the gravel path. His wails drown out the crowd, focused skyward, as they start cheering. 

I’m anxious about my one year old, afraid she’ll gaze directly at the sun. All faces turned upward, leering at the spectacle. She’ll follow suit. But I have to attend to my three-year-old, whimpering about the sun, the moon, a desperation in misunderstanding. I think about the historic panic about such an event: the sun disappearing momentarily. Of course it would feel like an omen, a harbinger of doom. He’s channeling that historic angst, knowing that the sky darkening midmorning is unnatural, feels off. 

I crouch beside him, rubbing his back, trying to convince him it’s all right. I can’t tell if he’s upset because the sun is disappearing or because I can’t keep the eclipse from remaining for another day so he can see it tomorrow. It doesn’t matter. It’s the illogic of a three-year-old tantrum. 

The air seems filtered, a hazy Instagram “Nashville” tainting the late summer morning. Time speeds up and suspends, as if the eclipse causes a filtering of moments, a sifting of time. As if heavenly bodies aligning requires all to pause ceremoniously, a recognition of our minisculeness. And yet nothing waits for the three-year-old angst. He rocks in my arms until the typical light returns and all is as it should be again. 

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Fluidity

I was camping last week in the glorious San Juan Islands and realized I wouldn’t be able to finish my regular Free Write Friday post since I was, blessedly, without any WiFi connection or phone reception for several days. Our family returned late Sunday night and, after four days of swimming, kayaking, exploring and sitting around the campfire, I also realized that mountains of laundry and back-to-school prep would take precedence over my usual Narrative Medicine Monday post. So I’m letting these goals lapse, like my hope to read any of my book club book (The Glass Castle, in case you were wondering) this past weekend. 

I’m approaching a year of blogging and initially chose a biweekly schedule of narrative medicine and free write posts somewhat arbitrarily, knowing that it would keep me accountable to have a set schedule. It’s been good for my writing and my overall well-being to write regularly and press publish even when my work isn’t completely polished. At this juncture, I’m giving myself a pass to forego a post here and there when on vacation or at a conference or finishing another piece of work. 

This fall I’ve signed up to take a poetry course and I’m actively pursuing a home for my nonfiction book. Blogging has been a salve, a selfish pursuit of craft and vulnerability. I’m not looking to give it up, but I am ready to give it more fluidity. 

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Narrative Medicine Monday: A View from the Edge

Dr. Rana Awdish is a critical care physician turned advocate for training in compassionate care following her incredible near death experience in her own hospital. Her essay “A View from the Edge” in the New England Journal of Medicine provides an overview of her 2008 experience as a critically ill patient cared for by her colleagues.

In her book “In Shock,” out this October by St. Martin’s Press, she outlines her harrowing near-death illness and recovery. I’m eager to read Awdish’s book and hear more about how her experience led to advocacy for “compassionate, coordinated care.” In her NEJM essay she describes how “small things would gut me. Receiving a bill for the attempted resuscitation of the baby, for example…. A trivial oversight, by a department ostensibly not involved in patient care, had the potential to bring me to my knees.” After recovering, Awdish channels her grueling patient experience into a drive to transform the way we receive and provide medical care. She contends “we need to reflect on times when our care has deviated from what we intended — when we haven’t been who we hoped to be. We have to be transparent and allow the failure to reshape us, to help us reset our intention and mold our future selves.”

Writing Prompt: Have you noted an erosion of empathy among medical providers? If so, think of a specific example and write about how you felt as the patient. If you’re a medical provider, have you ever been cared for by colleagues at your own hospital? What was it like to be on the “other side,” as a patient? Did you come away from the experience with new knowledge and empathy that you then incorporated into your own practice? Write for 10 minutes. 

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