Ramblings

Free Write Friday: Goodnight Moon

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Her sister loved the book, requested it every night. Her brother, not so much. He wouldn’t sit still to listen to any board book; made me worried about his attention and future schooling prospects. The words rush back to me now with this littlest one, memorized at some point years ago with the repetition I endured. Every night: “In the great green room…” I rock the baby and read. 

She tries to eat the thick pages, colored with orange-red, yellow, kelly green. She too takes to the silly story of bidding goodnight to the bears, to the mittens, to the bowl full of mush. I discover I now find comfort in the rhythmic cadence, the sentences fall out of my mouth sing-song, lyrical and pleasing. 

Maybe that’s why she listens quietly, transported to the simplicity of a warm room, a rocking old rabbit, a nightly ritual of farewell to all the little things that surround us – the comb, the brush, the little toy house, and all the big things too vast for us to comprehend – the stars, the air, nobody, the moon. Goodnight to it all. Goodnight to the immediate and the immense. Maybe this still appeals at a time when everything seems virtual, intangible, rushing by. It’s nice to stop and acknowledge, step into the present space and recognize the greater cosmos above. 

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Ramblings

White

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Due to the holiday week, I’m taking a break from Narrative Medicine Monday and sharing a favorite: River Teeth’s Beautiful Things. This narrative nonfiction journal posts a short piece of prose each Monday, highlighting a different “beautiful thing”. Today’s piece by Jennifer Bowen Hicks, entitled “White” captures a moment between her and her son as she walks him to school on a cold winter morning. I encourage you to check out River Teeth’s complete series; these short pieces never fail to inspire.

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Ramblings

Free Write Friday: Ornaments

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The plastic boxes pulled down from the attic, thin film of dust, debris from the particles upset overhead. I begin to pull out, sort through. Shiny, shimmery reds, glittering silver, deep forest greens. I rediscover: Santa photos from years past, wide eyed children frozen in shock and concern, not wanting to flee from the bearded stranger lest it mean no presents; ornaments from childhood, a styrofoam princess with a billowing egg crate gown lined with purple glitter, angelic cherry red dot of lips, blank coal eyes, snowy tuft of hair; items bought on deep discount sale the year prior, appealing to my inability to resist a bargain, accumulating that which isn’t really needed. Candles, too many candles, shaped as evergreen trees, lined with sparkles that shed unceremoniously; I’m hesitant to light them and deplete the wick, thereby defeating the purpose of having said candle, year after year. 

I turn on the Christmas playlist, honed over the years to specific tunes that conjure up Norman Rockwellesque memories that may have happened, or that I wish had happened, in holidays past. We don’t have enough lights, depleted over the years by broken bulbs, but I’m hesitant to start anew with the energy saving LED lights; their glow just isn’t the same, less desirable to sit and stare at the sterile pale light rather than bask in the yellowed soft glow of traditional bulbs no longer available at the drugstore. 

I trim the tree; this year two of my children old enough to participate, take over with their careful placement too distal on the needled branches, causing them to sag, sad with the weight of the gibbous bulbs. Their eyes brighten as they behold each trinket, eager to cluster them at eye’s level. My kindergartener realizes some balance is needed, grabs the step stool, reaching high with her arms to give the wooden snowmen, the tiny wreaths, the fabric angels full view of the living room. She examines each ornament closely before placing it strategically, then steps back, admiring her work as the baby coos as if approving, down below.

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Narrative Medicine

Narrative Medicine Monday: Thanksgiving Dinner

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Allie Gips’ striking poem “Thanksgiving Dinner” profiles her grandparents as they suffer from dementia and recurrent cancer. Gips writes that there is “there is a forgetting that is wrenching and then there is a forgetting that must seem like some kind of forgiveness”. Gips expresses sadness watching her grandfather relive the disappointment at finding the sparkling cider bottle empty again and again. This simple act of recurrent forgetting serves as a rending reminder of the cost of his illness to family gathered at the Thanksgiving dinner table. 

Writing Prompt: Have you witnessed someone suffer the effects of dementia? Think of a particular incident, like Gips’ empty bottle, that struck a chord with you, illustrating the defecits. Write for 10 minutes. 

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Ramblings

Free Write Friday: Mail

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My mom used to send me magazine clippings in the mail. She’d come across an article about medicine or my old high school or our family summer vacation locale and she’d clip it and staple it and send it off in a nondescript white envelope. I’d receive the envelope, neat looped handwriting instantly recognizable, and I’d open it right away. The newspaper clipping or torn magazine sheets usually went into a pile meant to be read later. 

But I was in college, trying to keep up with a rigorous load of textbooks and essays and journal articles. Or I was in medical school, busy with anatomy lab and pathology and pharmacology, drowning in index cards and color coded diagrams meant to aid memorization of muscle insertion and organ innervation. Or I was in residency, distracted with an eighty hour work week and a new husband and new home and new reality of responsibility for very sick patients. Or I was traveling, studying abroad or working internationally, sorting through the complexities of the injustices and richness and suffering and beauty I encountered in the greater world and trying to determine my place in it all. So into a pile they went.

Sometimes I’d come across one much later, still folded neatly, pale yellow post-it with mom’s personal commentary attached: “Thought you’d be interested in this! Love, Mom” Sometimes I’d read it or toss it, but usually it went back in the pile. I felt guilty throwing them away; the effort she put in. 

After I got married my husband started receiving the articles too: about bamboo, education, triathlons. He came to recognize the plain white envelopes, the practical script. He started a pile of his own.

I don’t get clippings anymore in my mailbox. She still sends articles, but they’re attached to an email, they’re posted on Facebook. I usually put them in my mental pile of “to read”, same guilt setting in. I realize, though, I miss the paper piles, the tangible envelope pulled from a mailbox. I miss it in the sentimental way old people miss a diner or their favorite hand lotion or Reader’s Digest. The tangible sleekness of magazine pages, the coarse newspaper marking my fingers. My mom’s distinct cursive signaling the envelope, the article, indicating she thought of me, she thinks of me, and wanted me to know.

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Narrative Medicine

Narrative Medicine Monday: Close Encounter

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Abraham Verghese writes about his experience treating victims of hurricane Katrina in his essay “Close Encounter“. The experience reminds him of working overseas in India and Ethiopia, where “the careful listening, the thorough exam, the laying of hands was the therapy.” Have you ever been in a situation providing medical care when this type of personal touch was the primary treatment? What does taking away many of the medical resources that we take for granted reveal about the other important aspects of medicine? 
Verghese goes on to describe a dignified man in his 70’s who has a chilling tale of survival. Verghese reflects on what it means to say and to hear “I’m so sorry.” What do you think it means to this man to hear those words? 

Writing Prompt: Verghese begins and ends his piece mentioning the “armor” providers strap on for challenging work shifts. Have you tried to wear such armor in your practice? What was the result? As a patient have you been cared for by medical professionals who seem to wear this armor? How did they come across? Have you ever been “wounded” by a patient interaction? Do you agree with Verghese  that the willingness to be wounded may be all we have to offer as providers? 

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Motherhood, Ramblings

Free Write Friday: Monitor

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Grainy pixels coalesce into view with the push of a button. Static and then there she is: a babe in a cushioned box. She’s still, motionless, but I can’t stop watching. I peer closer, hoping to perceive the rise and fall of her chest under the sleep sack, a substitute for the blankets now outlawed due to associated risks. Today’s crib is a barren landscape of one fitted crib sheet. That’s all. No stuffed animals, no crocheted blankets. No binkies, no dolls. We even sacrificed introducing a lovey, modern parents that we are, saturated by the tragic news of the information age, too paranoid about accidental asphyxiation. 

I am entranced, can’t take my eyes away. Sometimes she moves, rolls this way, then that. I glance up, glance back to find her lying perpendicular to where she was before. One side of the crib, then the other. When her eyes open they glow neon with night vision, bright discs punctuating the darkness, signaling wakefulness. Sometimes there’s a pause before she erupts in cries that echo out her bedroom, through the house, through the monitor, ringing in my ears, ricocheting through my head. 

It’s easy to get obsessed with voyeurism. I can watch her every move, scrutinize her intentions. I want to predict: Will she wake now? How long will she sleep? And I wonder: Is she comfortable? Is she breathing? Is she dreaming? What about? I peer into the pixels, as into a crystal ball, willing the future to take form. Who will she be, this rolling, round-faced, murmuring babe?

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Narrative Medicine

Narrative Medicine Monday: You Will Feel A Pinch

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With a title like “You Will Feel A Pinch“, I couldn’t help but read Marylyn Grigas’ poem in the Bellevue Literary Review. Whenever I’m doing an injection with a numbing medication for a procedure, I say exactly this: “You will feel a pinch, then a burn.” This is just how she begins.

There are so many phrases that I use automatically and repetitively with patients on a daily basis. Leaving the room for the patient to change for a physical exam, I inform: “The gown opens in the back, the paper drape unfolds over your legs.” Performing a Pap smear and gynecologic exam, I explain I’m going to “use my other hand to feel your uterus and ovaries and make sure I don’t feel any masses or anything abnormal.” I listen to the lungs on the back and ask the patient to “take deep breaths through your mouth”, then as I move to auscultate the lub-dub of the heart on the chest I ask them to “breathe normally.” I once had a patient laugh and reply, “What does that mean?” These phrases come out of our mouths, rote habit, without thought as to what a patient, who might be hearing those words for the first time, might perceive. 

After much trial and error you discover what tends to work to communicate with patients in a way they can understand. You begin to anticipate the questions they’ll ask, such as if the gown opens in the back or the front, and preempt with answers. But I think over time, over years, it becomes such second nature that the words fall out without pausing to think about the meaning.

Two years ago I had a skin lesion on my back that was bothering me and I asked my doctor to “burn” it off with liquid nitrogen. This type of so-called cryotherapy is a treatment I perform on others regularly. I always warn “this may sting” and have had incredibly varied responses, ranging from people barely flinching to  crying out in pain. When my own turn came I was acutely surprised at how painful it was, much more than just a “sting”, both during the application and for several days after. I developed a new empathy for the recipients of my cryotherapy treatment going forward. I shudder when I think of all the coaching phrases confidently uttered to my patients in labor a decade before I experienced labor pains myself. 

Why do you think Grigas opens her poem with this oft used warning? What does this phrase seem to make her think of? How does her poem evolve and what do you think it’s about?

Writing Prompt: Think about something you say regularly to patients, almost automatically. Unpack the phrase. Imagine yourself in the patient’s position hearing this for the first time and write from their perspective. What other things might come to mind when a patient hears this phrase? If you’re not a medical professional, can you think of sentences you’ve heard from doctors or nurses that were confusing or funny or easily misunderstood? Write about this for 10 minutes. 

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Ramblings

Free Write Friday: Book Club

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I imagine we meet monthly, in the evenings, after dusk. People trickle in, peeling off their Frye boots and stylish rain coats, scattered with droplets from the evening drizzle. They hold tea cups with three fingers, china inherited from a grandmother, delicate gold rims. Or maybe wine glasses without stems, cupped securely in hand. A cheese plate laid out with warm Brie and rosemary crackers, plump purple grapes on the vine. The lighting is dimmed just barely, warm glow overhead illuminating the minglers.

Maybe it’s just women: friends from a church group or a baby group or a local elementary school; tethered by shared stage of offspring and the need to get out of the house for adult conversation. Or maybe it’s a neighborhood group: gathered from one street, connected by locale but varying in age and marital status and recreational interest. 

I imagine some have read the book, a few all the way to the end. Most have found time to make it only part way through, returning it to the library a week after the due date, resigning themselves to the fact that they won’t actually finish it and accumulating a small fine is not going to push the cause further. 

We take our seats, glass in hand, fruit tart on plate. Circling round, small talk continues in twos and threes. We’re friendly and interested. The host begins, we each rate the book on a scale of 1 to 10. I never choose 10, no matter how much I like the book. Extremes make me wary; there’s always room for improvement. Someone’s off on a tangent, dissecting the weather or their sister or the last movie they saw. 

Most like the book, a few dissent. We all wrote book reports in high school and college, but this is less analytical, more a social interaction, a question of how much one succumbs to group think. I imagine the conversation weaves through topics as they relate to our children, our jobs, our neighborhood. There’s a pause, pregnant with silence, and someone checks the time. I imagine we’re all a little hesitant to leave. Eventually we scatter, back to our homes and our bedside stack of novels and manuals on child rearing in the modern age. 

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Narrative Medicine

Narrative Medicine Monday: Jefferson’s Children

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We get a glimpse into both the patient and the physician’s perspective of a manic presentation in Maureen Hirthler’s “Jefferson’s Children“. Her dramatic opening (“If you don’t do something right now, I’m going to hurt my children.”) inserts the reader into the mindset of the patient, desperately asking for help to make sense of her racing and disturbing thoughts. As the emergency physician enters the scene, the narrative shifts and the reader becomes the provider, trying to make a definitive diagnosis and determine an appropriate treatment plan. 

The physician feels the patient should be admitted for psychiatric evaluation and treatment but is unable to find a bed for her and meets resistance from both the patient and her superior. Can you feel her frustration? Have you ever been in a similar situation?

The lack of appropriate, affordable and available psychiatric treatment has been discussed and debated much in recent years. What are the barriers you’ve noted to getting yourself, your loved ones or your patients the mental health care they need? If you could create the ideal mental health system, what would that look like?
Writing Prompt: Try writing from the first person perspective of a manic patient first arriving at the hospital or clinic. What about a severely depressed patient? A very anxious patient? Now write the same scene from the perspective of the medical provider (physician or therapist). How does the scene change?

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