MARY PAN

Narrative Medicine Monday: Locked-in Syndrome

June 19, 2017 No Comments

Pakistani bioethicist Anika Khan reviews Jean-Dominique Bauby’s remarkable story in her essay “Locked-in syndrome: inside the cocoon.” In it, she describes how Bauby, an editor of a prominent magazine who suffered a debilitating stroke, lived out his days entirely paralyzed but with mental clarity completely intact. Bauby’s only method of communication, and how he eventually wrote his 1997 book The Diving Bell and the Butterfly was by blinking with his left eyelid. He used a French alphabet provided by his speech therapist to painstakingly blink his way to communication with the outer world.

Khan relays some of Bauby’s remarkable insights into living in such a state and she also reflects on how medical providers need to take a “more empathetic look at the incapacity and helplessness experienced not only by patients with locked-in syndrome, but by analogy, other patients who have no way of giving voice to their experience of sickness. Often, patients become diseases, numbers and syndromes to healthcare professionals who have repeatedly seen illness and have lost the capacity to relate to the experiences of patients.”

Writing Prompt: Have you as a patient ever felt misunderstood by your medical provider? What were you trying to relay and what was the response that revealed to you the miscommunication? Think about your visceral reaction to this encounter. As providers, what specifically have you done to combat the risk of patients becoming “diseases, numbers and syndromes?” How do you maintain this empathy while still preserving some emotional boundaries? Write for 10 minutes.

Ramblings

Free Write Friday: Pain

June 16, 2017 No Comments

I notice it gradually, while exercising one morning. It’s a familiar routine, but that day bending over to touch the floor, leg lifted behind, I can’t hold the pose and my back gives way. The pain is insidious, then persistent. I go to work, hobbling throughout my day. Coworkers ask: What happened? Do you need something? Then they suggest: Try my chiropractor. Try downward dog. Here’s a hot pack. This is the only thing that helped my sciatica years ago. They’re all trying to be helpful but I can only wince. I can hardly walk. The pain is shocking, debilitating.

As a physician, I see people in pain every day. Pain from overexertion, pain from chronic illness, pain from medication side effects, pain from heartache. But to experience it myself, the slowing of body, the unexpected twitch of muscle with a movement, the limitations imposed by a body that isn’t working as it should, by a body that is a conduit for pain rather than a vessel for function: it’s humbling.

I don’t exercise for a week, then two. It’s hard to explain to others who only see me as able-bodied. They don’t realize. I shuffle as I cross the street; my husband and children walk casually ahead, so far ahead, on the crosswalk. I feel slow, I feel invalid. I get massage therapy, apply heat therapy, ingest ibuprofen religiously. The pain, initially searing in my back, flares unpredictably, shooting through my hip as I rise from sitting, as I twist to respond to a question, as I bend to pick up my baby from her crib.

A week into the flare, I just want to lie in bed, not get up, not go out. Though I am loathe to just lie there. I resent the creeping sluggishness. I want to defeat the lethargy and, simultaneously, be enveloped in it. I can suddenly see how people succumb: to numbing medications, to despair. Pain steals all functionality until the pain is all that’s left. And then it becomes your only companion. It is a cruel tease. One day or moment might feel a bit better, hope rises. Then, cruelly, it dissipates as the pain roars back.

One day I wake and can sit up without wincing, can walk with only a slightly antalgic gait. Everyone asks: How are you feeling? I feel tentative. I feel better. I feel anxious that it might come back, might return to level me again. I’ve learned now, it’s taught me. Pain is a presence, but also a thief.

Motherhood, Narrative Medicine

Narrative Medicine Monday: The Sink

June 12, 2017 No Comments

Author Kate Ristau writes about her son’s heart surgery in “The Sink.” She starts the essay remembering her mother’s farmhouse sink, then describes the simple motions she went through at her own kitchen sink the morning of her son’s surgery.

I like how Ristau uses a common utilitarian object as a focal point in this piece. She describes in detail washing her hands at the sink in the hospital waiting room. She implies that these actions grounded her – loading her dishwasher, washing her hands – during this tumultuous life event. Ristau relays the telltale sign that her son, when well at home, has actually brushed his teeth: “That’s how I know he brushed them–the splash of color sliding down the porcelain.”

The reader is thrust into the narrator’s experience waiting for her son to wake up from anesthesia. When he does, the details she provides allow the reader to enter into her experience as the mother of the young patient: “…we used words like valves, clots, stitches, glue and morphine. Complications, IVs, shots, and applesauce, along with fluid in his chest cavity and so many possible futures balanced on the edge of his hospital bed.” Ristau reflects on how her son eventually asks for something quite surprising, out of his usual character, when he is finally able to get up and out of bed. The reader gets the sense that, on the other side of this surgery, he is changed, as is Ristau.

Writing Prompt: Think of an object in your home or workplace that is also found in a doctor’s office or hospital. Consider a plate of food, a chair, a computer, a bed. Describe the experience of that object when at home versus when you or a loved one were ill. Write for 10 minutes.

Ramblings

Free Write Friday: Bridge

June 9, 2017 No Comments

She likes to sit under the bridge after her appointments, down by the canal. The benches at the corner are a little too breezy, she brings a cardigan when she remembers. It’s right by the trail, the one that weaves through half the city, along the waterfront, through the industrial and suburban outskirts.

She sits facing the water. She likes how the curve of the worn wooden bench feels beneath her. Cyclists whiz behind, along the paved path; she likes the sound of the spokes on the wheels lightly clicking as they pedal by. Sometimes there’s a rollerblader, a scooter. She hears the footfalls of joggers’ shoes, light conversation of two coworkers strolling on a lunch break.

Across the way are small houseboats, some modern, some quaint, some barges. Kayakers and yachts pass under the steel bridge. When the big boats glide by she can hear their engines whirring, working hard to pull them along. A small fishing dingy passes and she thinks about how it’s dwarfed by the steely grandeur of the bridge, rusted sheets of metal bolted in, criss-crossed throughout.

The locks are further down, she hasn’t been for years. She took the kids once, should take them again. It’s a marvel, really: all that water rising up, draining down. Carrying the fish, the seaweed, the boaters along with it. Each year the salmon run brings a viewing crowd to the locks; it’s a destination.

She hears the traffic on the bridge overhead and the next bridge down. Today the birdsong is bright and clear, outshines the highway traffic. It’s not rush hour, but still, it’s perplexing, that nature would reign in this way.

She likes to see the American flags hung on the sail boats; a bolt of red, white and navy set against the creamy hull, the bluebird sky. She likes to see the freeway across the lake, all the cars gleaming in the sunlight and wonder: where are they going, where have they been? She likes to consider the seagulls gliding overhead, hovering on the wind; sometimes they’ll suddenly dive or take off, as if they just remembered someplace they need to be.

Narrative Medicine

Narrative Medicine Monday: New York Lungs

June 5, 2017 No Comments

In her poem, “New York Lungs,” medical student Slavena Salve Nissan writes of the intimacy of knowing a patient “underneath her skin fascia fat.” Nissan notes how her beloved city left a mark on her patient’s lungs. She thinks about the people who loved her patient and how even they didn’t know that the patient looks “like a frida kahlo painting on the inside.”

Place is a central theme in this poem. I like the subtle imagery of the medical student and her patient breathing the same air, from the same city, in and out of their lungs. This commonality, too, connects them.

As a medical provider, we experience intimacies with patients that are both strange and surreal. It is a great privilege that our patients allow us, for the purpose of diagnosis or treatment, to perform these intrusions: cutting into the skin, sampling cells from the cervix, looking into the ears, listening to personal stories, palpating the lymph nodes. Over time this can become routine to the medical practitioner, but I do still wonder, and hope I never lose keen curiosity, about the lives of my patients beyond the exam room.

Writing Prompt: Reflect on the vulnerability between a patient and physician. Is it surprising that we can be so open and trusting with a near stranger? Think about such a time, perhaps a surgical procedure or mental illness or embarassing symptom, when you put your complete trust in your medical provider. What was that like? Write for 10 minutes.

Ramblings

Free Write Friday: Speed Boat

June 1, 2017 No Comments

My three-year-old calls it a speed boat, and it is. Wind whipping our faces, hair swirling behind, strands winding around each other haphazardly. It’s their first time on an inner tube. A long braided rope tethers the inflated donut to the sleek new vessel. The sunny long weekend, barbecue in our bellies, exuberant friends all contribute to the exhilaration.

Even so, I’m surprised at my six-year-old’s enthusiasm, eagerly egging on the captain to go faster, faster, weave serpentine over the murky waters of the strait. She learned to swim, and swim well this year. But the bouncing motion, unpredictable and jolting, makes me cringe, watching her from afar. Any moment she could bounce high, bounce right off, face stinging into the green waters, choking on the unexpected douse. Gripping tight to the inner tube though, her smile is so wide, so unabashed, so gleeful. I can’t help but exult with her.

My skin sun-kissed by salted air and pummeled by the wind, I feel taut, relaxed, satisfied. An early summer glow to the late afternoon, washing away months of rainy Pacific Northwest grey, particularly gnawing and extended this year. I rest into the warming sun, the exuberant children, the rush of air past my ears, pressing into my chest as we speed along, parallel to the rocky shore.

Narrative Medicine

Published: Timeline

May 29, 2017 No Comments

I’ve tried to write a piece like Timeline several times. It’s simply a chronicle of my typical work day, but, in the past, I never was able to get it just right. It didn’t flow sufficiently, wasn’t a clear reflection of the exhaustion I feel at the end of the day.

When I discovered Pulse’s “More Voices” column theme this month was “Stress and Burnout,” I felt compelled to finish this piece for submission. It was initially much longer, but I think the confines of the short word count (less than 400) was helpful in honing it to only the necessities. Previous versions of this essay were written in first person or third person. Second person, I’ve discovered, suits the purpose of the piece. My goal is to place the reader in the shoes of the primary care physician, feel the weight of her day, the exhaustion inherent in the constant churn of a general practitioner’s practice. I hope this piece provides a snapshot of a day-in-the-life of a family physician, and evokes a thoughtful reflection on the state of our health care system and the very real crisis of physician burnout.

I’m grateful to Pulse for publishing Timeline and for their regular promotion of issues relevant to patients and medical providers through narrative medicine poetry and prose.

Writing prompt: When do you feel most stressed at work? When do you feel energized? Have you witnessed signs of burnout in your colleagues or your own medical provider? List your own timeline of a typical workday. How do you feel when you read it back? Write for 10 minutes.

Motherhood, Ramblings

Free Write Friday: Relics

May 26, 2017 No Comments

I’ve pulled them from the attic before, stored them in the basement closet. Now the youngest is standing, feeding herself, almost one. She doesn’t need the propping, the overhead entertainment. She’s outgrown the bedside crib, the Jumperoo, the molded foam seat that kept her back upright.

The equipment is garish or cutesy. It’s plastic and bright. It’s overwhelmed our home, fixtures that fade into the landscape, the background of a cluttered family environment. Still, it’s hard to say goodbye.

I know it all needs to be tossed, given away. After three babies, or more since many were hand-me-downs, the stuff is all worn, outdated. I see the new moms today with sleek strollers that keep the baby situated as if sitting on a dais, the stylish bouncers that blend into a post-modern home. Our items are now obsolete in function and style. One of our old baby-propping cushions has been recalled for safety concerns. There’s no reason to keep these things around.

I remember my oldest baby, now in kindergarten, loving the bouncer, thick legs pumping, broad smile punctuated by a high squeal of delight. Her wispy infant hair swaying with the movement like thick reeds of seaweed undulating with the tide.

I remember my middle baby, he didn’t like to be confined; any seat with openings for his legs was too constricting. Instead he squealed for release, wouldn’t sit down even in his high chair, ate his meals standing on the floor or on our laps.

I remember my youngest baby, how we couldn’t find one leg of the baby swing when we pulled it from the attic, rendering it useless. We borrowed another one whose motion was too gentle to soothe her squeaking cries. Eventually we gave up on the swing altogether. We finally found the missing leg long after she was able to sit up, roll over, stand on her own. We disposed of the swing, no longer needed.

I gather the rest of the items slowly, sequentially, as they expire from their usefulness. I contemplate the memories held within with each passing on. There’s a sentimentality to these baby relics, covered with slobber, patted with the chubby hands of three active babes over the years.

As I sort through, I wonder what the contraptions will be like when my babies have babies; how they’ll differ, how they’ll tap into the enduring infant affinity for jumping and rocking, squeezing and swinging.

Narrative Medicine

Narrative Medicine Monday: The Last Heartbeat

May 22, 2017 No Comments

Cortney Davis’ “The Last Heartbeat” explores her competing identities as daughter and nurse at her dying mother’s bedside. Davis opens the poem as she holds her mother’s hand, counting her last heartbeats, witnessing her last breath. She ends with greater questions of life and soul as she walks with a friend through a cemetery.

Writing Prompt: If you’ve been at the bedside of a loved one as they died, what do you remember most? What have you forgotten? What about at the bedside of a terminal patient? Did this experience prompt greater questions about the soul? Write for 10 minutes.

Ramblings

Free Write Friday: Waiting Room

May 19, 2017 No Comments

It could be a doctor’s office or a therapist’s office or masseuse’s office or dentist’s office. Everyone rushing in, stops suddenly. This place is only meant for halting. It’s a purgatory of sorts. No one makes eye contact. You could be here for a tooth extraction, a horrid cold, a spasming back muscle, a debilitating anxiety that usually keeps you holed up at home. You don’t want to assume why others are here, so you ignore each other.

Looking around, there’s a water cooler, an assortment of tea bags set out on the table: peppermint, earl grey, African red bush. The best flavors are depleted, the black tea bags overflow. It’s silent, save for the buzzing of the fluorescent lights overhead, plastic rectangular panels alternating with popcorn ceiling.

A waning lamp sits on a corner table, the time on the small clock is wrong and it’s aggravating. Shouldn’t a waiting room of all places keep correct time? A laminated wood coffee table is centrally located with magazines stacked too neatly. Who keeps them all so organized, so appealingly kept? Choosing a magazine is like a Rorschach test, wondering if others will judge the decision, if you can live with it yourself. The intellectual rigor of The Economist or the gossipy superficiality of People? The organizational practicality of Real Simple or the envy-inducing travelogues of Condé Nast? Maybe you’ll just scroll, head down on your phone, where you can maintain anonymity.

You sit too straight backed on the worn leather couch, waiting. You should slouch back, relax. It’s increasingly challenging to sit in silence, in stillness, in this incessantly rushing world. You distractedly peek out of the corner of your eye. The wide leaves of the adjacent plant are drooping, yearning for a drink of water, clearly neglected. It makes you wonder at the reliability of this place; shouldn’t plants be tended to just as people are? You guiltily realize, your own office plants are just as wanting.

Someone opens the door, a stocky middle-aged man. You don’t look at him directly but glance up through your lashes just a moment, long enough to take him in. He’s calculating, surveying the room, deciding if he should grab tea, a magazine, where he should sit. He falters, then grabs a Time magazine. You try not to judge, but you do. He must be serious. But when he sits down, he takes out his phone, scrolling through intently, waiting for his turn.

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