Narrative Medicine

Narrative Medicine Monday: May Cause

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Writer Elspeth Jensen highlights the many instructions we are confronted with when taking medications in her Bellevue Literary Review prose poem “May Cause.” Jensen’s poem accelerates throughout and hints at the absurdity of all we are told to do, not to do, of all we are advised to avoid, to look out for: “Use care when operating a vehicle, vessel, boat, until you become familiar with blurred vision, symptoms worsening, fear, or sadness.” Jensen repeats “do not” six times in this short poem. The reader, as the patient, feels the anxiety evoked by the many stipulations of being medicated.

Writing Prompt: Think of the last time you read the instructions given to you with your medication. Perhaps you still have one in your medicine cabinet. Take it out and read it in full. How many times are you told “do not?” Is anything confusing? Humorous? Did you adhere to the instructions? Why or why not? Write for ten minutes.

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Ramblings

Free Write Friday: Carving

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She likes pulling the top off at the stem, the way it can be placed right back like a corresponding puzzle piece. She’ll use a scoop but finds more satisfaction in her bare hands, stringy innards gripped with tenacity, pulled at until they give way. She’s the one to sort through the gourd’s flesh, retrieve each slimy seed, spread them on a baking sheet to roast to nutty perfection. The five-year-old shouts a reminder to save a few seeds for his garden; he’s studying plants, learning about spiders at school.

Then, the design. A template or a copy, stolen from a previous October or a Pinterest post. She never was good at coming up with artistic inspiration on her own. A traditional cat, an astonished ghost, a toothy grin with triangular eyes. The children need help with the markings on the convex surface, the wielding of sharp tools.

They place a tealight in the bottom of the hollowed out orb, set the creations on the front porch steps. Barely evening, it’s dark already, light from the jack-o-lanterns wink at those passing by. Children satisfied with the bright orange set against Benjamin Moore’s Newburg Green, they retreat to the warmth of the indoors to sip hot cider. Cinnamon and cloves suffuse the air as they gather roasted seeds to snack.

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Narrative Medicine

Narrative Medicine Monday: On the Eve of My Mother’s Dying

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Writer Peggy Duffy’s flash nonfiction piece in the latest issue of Brevity, “On the Eve of My Mother’s Dying,” is a snapshot of her mother’s last days on hospice.

Duffy opens with the assertion that those who work in hospice “coordinate.” In my experience, both as a physician and as a family member, caring for those at the end of life, this verb rings true. The hospice people coordinate all the details of transport and durable medical equipment and adjustment of medications for comfort and, ultimately, Duffy realizes, “my mother is actively dying, and they strive to coordinate that too.”

Duffy’s father is upset they are not coaxing his wife into eating, despite her being unresponsive. The social worker explains to him “that unless my mother opens her eyes and asks for food, unless she can swallow, she cannot eat.” Duffy understandably struggles with her father’s resistance to accepting why they can’t give her mother water to drink: “Not long after I leave, he calls. Why won’t they give her water? She can’t swallow. What about on a teaspoon? You have to swallow even the tiniest amount of water. How can she survive without water? (Pause) She isn’t going to survive. I remind him she signed an advanced directive years ago when she was still lucid and knew what she was signing.”

Duffy is surprised at the stretching of time in the final days of her mother’s life: “I can’t work, can’t think, can’t sleep. I never knew dying could take so long.” If you’ve cared for a loved one on hospice, did you experience the same distortion of time as Duffy?

The piece ends with a touching, and surprising, kiss from Duffy’s mother: “Something long dormant stirs beneath my chest where my heart lies. I lay my head on her chest where her heart still beats.”

Writing Prompt: Have you had difficulty explaining any aspect of end of life care to a spouse, child or parent of a dying patient? Often loved ones have discussed clear wishes of what they would like done, and not done, when nearing the end of life. When it comes time to actually carry out actions according to these wishes though, this still can remain a painful process. Have you experienced this first hand? Write for 10 minutes.

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Ramblings

Free Write Friday: Tractor

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We arrive late afternoon, after the youngest wakes from her nap. Pumpkins first, the field is littered with families arranging their littles on orange gourds, with teens snapping selfies before disappearing into the corn maze. It’s the weekend, late in October so the pickings are slim. My five-year-old rushes to a perfectly rounded pumpkin, the appropriate size, just to be shattered when he realizes the rotty blemish on the bottom precludes this particular selection. My eldest squints from the harsh sunlight, peels off her fleece jacket as she rushes across the field in search of less picked over options. When sufficiently satisfied with our selections, we wheelbarrow them back to the entrance, pumpkins flanking the littlest for the ride.

Kettle corn is next, oblong bags hung on an apple cart, ready for sticky consumption. I like the crunch, the mingling of the salty with the sweet as remnants of kernels wedge between my teeth. Little fingers joust for a handful of the popular snack.

We meander to the petting zoo, a miniature horse and stench of pig slop greet us near the barn. My son clambers onto the old tractor, rusty and stationary. He turns the wheel this way and that, bares his teeth in glee. He hops down eagerly when I mention the slide.

They climb the hay bales to the top and glide down, side-by-side, each on a burlap sack. Parents wait at the bottom of the slides,cameras at the ready, crane their necks in anticipation of their child’s turn. A few revolutions and mine are ready to move on to the bouncing blog, an inflated rubber pillow of sorts, embedded in the ground. Children hop and skip across, as if weightless on the moon, as if soaring off a trampoline.

The toddler pleads for the tractor ride, a lumbering pull past the corn maze and the play area. The rest of us acquiesce her request, tiny squeals still ringing in our ears. We sit shoulder-to-shoulder, hip-to-hip with other families as they snap pictures, wave to those we pass. My youngest rests her arm on a stranger’s leg to steady herself as the tractor lurches forward. The woman smiles down at her as we make our way back along the dusty lane.

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Narrative Medicine

Narrative Medicine Monday: The Name of the Dog

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In The New England Journal of Medicine essay “The Name of the Dog,” physician Taimur Safder remembers a lesson learned early in residency. Safder is stumped when, “as a freshly minted doctor,” he presents “a patient who was admitted for chest pain after walking his dog” and his attending asks a curious question: “‘What was the name of his dog?'” Safder is initially perplexed as to why this question even matters, but when the attending physician takes the group to the patient’s bedside to inquire, he realizes that very question “led to a transformation I did not fully appreciate at the time: there was an actual person behind that hospital-issued gown.”

This lesson proves valuable to Safder’s medical training. Through it, he forms similar connections with patients that allow him to “have difficult discussions about [the patient’s] immigration status and what it meant for his treatment plan,” and sign a “treaty under which [Safder] would read the ‘studies’ [the patient] brought in about black cherry and milk thistle and she would start taking one new medication every 2 months.” In learning about a person beyond their identity simply as a patient, trust develops and the patient-physician relationship can grow.

While caring for a patient who eventually ends up in hospice, Safder comes to another realization: “the question that I’d been carrying around since my first day of residency could work another type of transformation: it helped my patients see the person behind the white coat.”

Writing Prompt: Has there been a question you’ve asked a patient that revealed essential information about them as a person? Have you, as a patient, been asked a question by a medical provider that may not have seemed directly medically relevant but was important to them understanding you as a person? What was the question? What did it reveal? Write for 10 minutes.

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Narrative Medicine

Narrative Medicine Monday: What Insomniacs Do in Bed

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Donna Steiner lets us know “What Insomniacs Do in Bed” in her poem in The Healing Muse. Steiner touches on those heightened moments in the middle of the night, when the rest of the world seems muted. She admires much, including “the under-valued texture of flannel sheets” and “the capacity of our aging lungs.” She notices the absence of all sorts of things, including “of rain, of drizzle, of shower…” Steiner wonders about “germs and mites and viruses, and whether they multiply right now,” a vivid recognition of what those of us up at ungodly hours imagine.

Over the past two decades I’ve often been awake in the middle of the night, occasionally due to insomnia but more frequently because of medical work or motherhood, nursing my own babe or delivering a new life into the world in the pale hours of almost-morning. Steiner issues a call to accept the gift of repetition, that it is a “form of education.” Perhaps the most significant to the insomniac is the “merciful repetition of daybreak.”

Writing Prompt: Have you suffered from insomnia? Does Steiner’s poem resonate with you? What do you do when you’re up at night and no one else is? If you’ve been up in the middle of the night for another reason (residency, parenting), what did you notice about being awake when the rest of the world is sleeping? Write for 10 minutes.

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Narrative Medicine

Narrative Medicine Monday: Disease’s Gifts

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In “Disease’s Gifts,” poet Joy Ladin muses on fear and life and death in the face of illness. Ladin outlines the paradoxes of disease: “That you can be fearless / when fear is all you have” and that “you aren’t alone in loneliness.” This poem is an encouragement, a call to overcome and accept and succeed, even though “fear inverts / the meaning of success.” Ladin’s poem resonates because it offers words of hope while acknowledging the incongruity of illness. Disease can feel like “the end of the world,” and yet, Ladin contends, we all want to believe “you will survive it.”

Writing Prompt: What gifts, if any, have you experienced through illness? What role do you think fear plays in disease? Review Ladin’s list in the second to last stanza; what do you need to live? Write for 10 minutes.

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Ramblings

Free Write Friday: Low Tide

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We wait until morning, sip percolated coffee, nibble day-old donuts bought at the new gourmet shop adjacent to the ferry terminal. A friend saunters up from an adjacent campsite to let us know they’re heading down to the beach. “It’s low tide, right now!” Kids circle their way back to the campsite, wheels turning. They discard their helmets as we stroll to the rocky cliff.

A woman stands by a sign outlining the local sea life, pulls up her scuba gear, ready to search for urchins, float among the kelp.

We clamber down a few concrete steps, then cling to the rock face littered with barnacles, making our way to a sandy cove. A parent points out footprints: a second grader’s sneakers, a crab’s pointed tracks, the imprints of a dog’s paws padding across the compact sand.

A rock island is exposed, tide pools revealed. Green anemones open with neon fronds, swaying gently until startled into retreat. Bouquets of mussels jut out in clusters among mossy kelp. Limpets cling to the black rock, suction secured. We stop, we bend down to observe.

Two moms well versed in marine life point out the chitons, armed with a hardy shell of armor they remind me of turtles, of shields. There are always eight plates, predictable. One child shouts out, “Mom, come over here, it’s the biggest chiton in the world!” We moms give each other a knowing look: could be, but more likely a 7-year-old’s exaggeration. Instead, we find what she describes: a chiton as big as our hand but without a shell. “Maybe someone took its plates.” The thought makes us sad, a thief of the worst kind. We look it up later and, in fact, the creature is just as it was meant to be: the giant pacific gumboot chiton is without a hard exterior. An aberrancy of its kind in size and structure.

A few more from the group straggle, venture out to the ends of the fingery point in search of an elusive seal that pops its head momentarily up above the surf before diving back down again. My son has gathered too many mussel shells, iridescent shimmer calling to him like a siren, the abundance too much to contain his enthusiasm. “Here Mom, I found another one!” I convince him to choose a solitary shell to cherish as we make our way carefully among the slippery rocks back to shore.

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Narrative Medicine

Narrative Medicine Monday: The Narrative Messiness of Chronic Illness

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Ellen O’Connell Whittet ponders “The Narrative Messiness of Chronic Illness” in a recent piece in Ploughshares. O’Connell Whittet acknowledges that illness narratives may be challenging to show in scene and that “suffering… doesn’t always have a satisfactory ending.” Yet, she notes that illness memoirs, such as those of Paul Kalanithi, Lucy Grealy, Jean-Dominique Bauby and Porochista Khakpour can be particularly engaging, “turning the story of an ailing body into a work of art.”

Bauby, who suffers from “locked-in syndrome,” tells a grueling story without a tidy ending. O’Connell Whittet grimly concludes one tragedy of his chronic illness narrative is that he “cannot… count on getting well.”

O’Connell Whittet recognizes the importance of defining a diagnosis to Porochista Khakpour in her memoir “Sick.” When Khakpour “laments to her acupuncturist that she is still without a diagnosis, her acupuncturist asks, ‘does it need a name?’ But without a name, Khakpour cannot pinpoint the words she needs to convince us, or herself, of the extent of her suffering.” How important to suffering are the words we use to define illness? Does having a specific diagnosis validate that suffering, to ourselves or to others, in a different way?

O’Connell Whittet recognizes “Khakpour’s refusal to give us order out of illness’s chaos” and eventually determines that “[r]eading accounts of chronic illness allows us to embrace the ambiguity of the body and our experiences within it.”

Writing Prompt: Have you read a chronic illness memoir that turned a “story of an ailing body into a work of art?” Think about a particular part of that book or essay that was most enthralling or enlightening. What did you learn? How did it affect you? Did the structure mimic “illness’s chaos?” Write for 10 minutes.

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Narrative Medicine

Narrative Medicine Monday: In Life’s Last Moments, Open a Window

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British physician and author Rachel Clarke advises in The New York Times that to care best for our terminally ill patients we should, “In Life’s Last Moments, Open a Window.” Dr. Clarke relays the story of a patient dying of cancer who was nonverbal but clearly in anguish. “We tried talking, listening, morphine. His agitation only grew.”

Clarke initially questions if the “sheer vitality of nature might be an affront to patients so close to the end of life — a kind of impudent abundance.” Instead she finds, as in the case of her patient with tongue cancer who merely wanted his door opened wide to the adjacent garden, many patients develop an “intense solace… in the natural world.”

It is the song of a blackbird outside her window that gives one of Clarke’s breast cancer patients perspective that even “[c]ancer is part of nature too, and that is something I have to accept, and learn to live and die with.”

Clarke shuns the idea that end of life care needs to equate to a “dark and dismal place.” Instead, she contends that what should dominate hospice “is not proximity to death but the best bits of living.”

Writing Prompt: Clarke’s patient Diane notes that cancer is a part of nature. What are the implications of this statement for you as a medical provider, as a patient, as a loved one? When you’ve been ill, have you found solace in nature? Write for 10 minutes.

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