Medicine and Mothering on the Front Lines of COVID-19

Two weeks ago I picked my kindergartener up from after-school basketball on a routine weekday afternoon. He bounded up to me, backpack in hand and asked, “Mom, do you know about coronavirus?” His teachers had discussed the viral outbreak and the need for good hand-washing skills. My budding epidemiologist went on to explain how the virus spread from bats to another animal to a human to another human to even more humans and so on. I tucked him into bed that night, marveling at his teacher’s skill in stressing hygiene and explaining the novel virus to a group of 6-year-olds.

Of course now coronavirus, or COVID-19, is all anyone is talking about, reading about. Coronavirus has uprooted my personal and professional life. As a family medicine physician working in Seattle, and as a mom to three young children, COVID-19 has consumed my day-to-day activities and workplace. As a primary care clinician and parent at a U.S. epicenter of the outbreak, there is no other word for home or work right now than upheaval.

I am also a writer, a creator of art. But I have struggled to find the time and emotional space to articulate and explore all the layered questions this crisis has presented to me—as a physician, as a mother to young children, as a creative being in this world. Fragments of essays, lines of poems, pour out of me as I wake with anxiety in the middle of the night, as I run around a deserted Seattle park, as my children beg to gather with their friends, as I discharge a clinic patient who pauses as she exits the exam room: “Thank you for being a doctor.”

As a participant of Harvard Medical School’s inaugural Media & Medicine program, I’ve recently been trained in writing Op-Eds for the public, in discerning misinformation and disinformation in the media about healthcare issues, in thinking creatively about how we can use podcasting or plays or poems to tell stories that make a difference to important public health topics. My classmates and I, healthcare professionals from all over the world whose projects focus on varied themes from mental health to vulnerable populations, from physician burnout to cancer awareness, suddenly find ourselves in the middle of a pandemic, sharing stories from our respective locations worldwide.

My work right now, though, is focused here, on my community: the people I hold most dear and the place I grew up in, I trained in, I live. My colleagues and community are at the forefront of this pandemic. I feel the rising sense of fear, the wave of overwhelm, the steady thrum of kindness.

For now, I offer this. Anyone who attended medical school with me knows I like to make lists. I approach a seemingly insurmountable task by compiling, organizing, and splitting it up into manageable components. Over the last two weeks, as local healthcare systems faced rapidly changing recommendations, confusion about suggested protocols, differing messages on testing capability, questions about adequate protection and supplies, as schools closed and family schedules were upended, I gathered information. Here is my contribution, my list of reliable resources and information for the worried, weary, and hopeful among you.

Despite my own swirling anxieties, I’m grateful for the work I’m trained to do, in medicine and in the humanities. I’m thankful for my colleagues—every aspect of the health care team—who are committed to serving our community’s most vulnerable, and each other, through an uncertain time. I’m bolstered by the parents sharing resources and tips about how best to support our children through unprecedented upheaval. This, I know: we are distilled in a crisis to the best, or the worst, that is in us. May we cling to the best, stand firm in sound science, look to compassion and art that sustains our souls, and encourage others to do the same.

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Media & Medicine

I’m an introvert. I recently took an online Myers-Briggs test a work colleague sent me, and I scored a solid INTJ. This categorization has been stable for me since high school. Though I do enjoy social events and meeting new people, as a true introvert, I find conferences exhausting. Medical or otherwise, the constant introductions, social navigating, and personal storytelling involved can prove daunting.

Last April, I was in Boston at a medical conference and had lunch with a group of women physicians. I struck up a conversation with the woman sitting next to me, trading the standard questions: where we’re from, our medical specialty, our interests. I told her about my passion for writing and narrative medicine and storytelling and physician wellness and bioethics and the humanities and, in turn, heard all about her upcoming book and the wonderful work she was doing in Boston.

A month later she emailed me, saying she had just attended a narrative writing event at her hospital, run by Dr. Suzanne Koven, and that what Dr. Koven was doing seemed very much aligned with my interests and the work I hoped to do in Seattle. Would I like a virtual introduction?

And that, as they say, is history. At least for my work and life. I spent over an hour speaking with Suzanne, learning about her path in both medicine and writing, and how she formed the Literature & Medicine program that has been running for over a decade. I knew I’d like Suzanne immediately when her first words to me were, “Well, let’s discuss our mutual favorite topic: narrative medicine.”

Under Suzanne’s guidance, I went on to establish a Literature & Medicine program at my own institution in Seattle, and she has since become Massachusetts General Hospital’s first Writer-in-Residence.

So when I heard that she and Neal Baer were starting a Media & Medicine course at Harvard, looking at how we can use storytelling to address pressing public health issues, I knew I wanted to be involved.

This past week, the inaugural Media & Medicine class met together in Boston for five days of lectures and networking, community and conversation. With a cohort of 50 people from all over the world, there was rich discussion and consideration of how we can use journalism and podcasting, op-eds and plays to address issues in healthcare.

I was impressed with the many innovative ideas, including implementing design thinking to tackle complex healthcare problems, weaving public health education into television and plays, and using solutions journalism to show that “better is possible” to enact change. Keynote speaker Dr. Leana Wen urged us to start with our authentic selves and stick with the voice we know. We collectively wrote op-ed pitches, practiced playback theater techniques, critiqued podcasts, and turned partner stories into playdough and pipe cleaner art.

I met an impressive group of healthcare professionals from all over the world, eager to expand on work in public health, mental health, health disparities, physician wellness, and chronic disease. We learned from each other, advised each other, helped with networking solutions and built our own community of advocates for storytelling and listening, which we’ll continue to grow over the next six months as we work on specific public health projects.

I had so many rich conversations, and heard from experts in media and storytelling. I’m leaving Boston invigorated and exhausted. I can’t wait to work on my own project, focusing on mental illness, and support and champion the work of my fellow colleagues. Although taxing for introverts like me, I’m so glad I had that conversation, shared my story with the women physicians I met at that conference back in 2018. It speaks to the power of personal connection, of telling our stories with vulnerability and hope, and this, I think, is what the Media & Medicine program is all about.

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AWP 2019 Recap

My first AWP conference was everything I thought it would be: overwhelming, inspiring, and engaging. At times I felt like hiding in a small dark room by myself, at others I was torn by all the panels and gatherings happening simultaneously, wishing I could somehow replicate myself so I could be in all places at once. I met and interacted with admired authors, poets, editors and other emerging writers. I left Portland exhausted and elated.

As an emerging writer who hasn’t had formal training, I didn’t have the same MFA reunion or tribe that other writer friends enjoyed, but I did benefit from a new cohort I now belong to: the AWP Writer to Writer Program. Diane Zinna runs this mentorship program, now in its tenth session, with contagious enthusiasm. I was able to meet Diane and my mentor in person at AWP, as well as other Writer to Writer alumni.

The panels I attended were varied and largely helpful. I learned about writing and teaching flash nonfiction, the perils and pitfalls of writing about real people, writing through trauma, managing parenthood and the writing life, and so much more. I was able to hear Cheryl Strayed and Colson Whitehead speak about the writing life and their craft and hear my own mentor Emily Maloney and writing friends Anne Liu Kellor and Natalie Singer share their work.

I applied for a Tin House intensive workshop on writing the very short essay with Melissa Febos, and and was thrilled to be accepted. An afternoon writing offsite with courageous and creative women was a highlight.

photo credit: India Downes-Le Guin

One of the biggest joys, and hurdles for me, of the week was sharing my own work at a paired reading. I read an essay that has not been shared publicly before and holds particular emotional weight. It was freeing to release this work out into the world and I’m grateful it was well received.

Writers are, by and large, a forgiving and authentic crowd. Though many, like me, are introverts, I was impressed that the feeling of holding space for each other infused the conference. I moved out of my own comfortable cocoon of anonymity by walking the book fair, approaching editors of presses and journals I admire, striking up a conversation with unsuspecting poet Jane Wong as I was walked by the Hedgebrook table (hopefully in a decidedly uncreepy way), and doing a public reading myself.

I tweeted some favorite quotes from the event, but wanted to share these pearls here as well:

“Be willing to dig through the layers of artifice to get to the deeper truth.” – Cheryl Strayed

“What is the purpose of art? To suggest potential realities or states of mind that would not otherwise suggest themselves.” -Richard Froude (a fellow physician!)

Jessica Wilbanks shares she learned “to trust my subconscious more than my intellect” during her writing process.

“Trust that isn’t absolute isn’t trust at all.” – Alison Kinney

“Living a trauma is living a trauma. Writing a trauma is a reconsideration, an attempt to capture yourself in the reconsideration.” – Alison Kinney

“The purpose of art is to lay bare the questions that have been hidden by the answers.” – James Baldwin

“I’ve learned that writing a book will not make you whole.” – Colson Whitehead

“It is a joy to be hidden and disaster not to be found.” – D.W. Winnicott

“Telling this story was worth more than my comfort.” – Melissa Febos

“Real people are more than the worst or best things they’ve done. Craft requires we honor a person’s complexity.” – Lacy M. Johnson

“Be rigorous ethically and in craft before you put your work out in the world. [When writing about real people] scrutinize your own intentions.” – Melissa Febos

So much of writing feels like a solitary pursuit, laced with overwhelming rejection. But, like I’ve experienced in medicine and motherhood and many other aspects of my life, finding a tribe, a cohort of passionate individuals to help support each other and share in community, is invaluable. Thanks, AWP 2019, for providing that space.

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Narrative Medicine Monday: Burnout in Healthcare

I’ve wanted to attend Columbia’s Narrative Medicine workshops for years. Life finally aligned to make that possible this past weekend as I joined professionals from different disciplines gathered to address “Burnout in Health Care: The Need for Narrative.” As a wellness champion for my physician group, this year’s topic was particularly pertinent to my work and practice.

The conference consisted of lectures from leaders in the field of narrative medicine alternating with small group breakout sessions. I was fortunate enough to have Dr. Rita Charon, who inaugurated the field of narrative medicine, facilitate two of my group’s sessions, which consisted of close reading and reflective writing and sharing. This format allows for in depth discussion with medical and humanities professionals, as well as time for introspection about how best to expand on learned concepts and practices when we return home.

Several takeaways for me:

Narrative can be used to address many issues in healthcare, burnout among them. I’ve been facilitating a Literature & Medicine program for my own physician group, and have taught narrative medicine small group sessions to resident physicians, but am inspired to do more of this work to expand the reach to medical professionals and patients. Dr. Charon encouraged us to disseminate the skills deepened through the humanities, that these are what’s missing from a health care system that has become depersonalized. Skills learned through narrative medicine can improve team cohesion, address moral injury and bias.

Writer Nellie Herman offered Viktor Frankel’s words: the primary force of an individual is to find meaning in life. Herman showed us how writing can help us find that meaning, giving shape to our experiences, our memories. Harnessing creativity can be particularly important for those of us who experience moral injury because “when we write, we externalize what is inside us.” Through writing and sharing, we’re making a commitment to something, a raw, less mediated version of events. Through this vulnerability we connect to others; though difficult, that’s what makes it valuable.

Dr. Kelley Skeff approaches burnout and narrative from a physician educator’s perspective. It is not lost on anyone who has been a medical resident or trained them that “we have trained people to take care of patients, even if it kills them. We have trained people to keep quiet.” Skeff offers us this quote from Richard Gunderman: “Professional burnout is the sum total of hundreds and thousands of tiny betrayals of purpose, each one so minute that it hardly attracts notice.” He implores us to combat the code of silence and ask ourselves and each other: What’s distressing you?

Maura Spiegel contends that “narrative language can proliferate meaning.” Spiegel used film clips to show how we can gain access to our own experience. In watching a film, we’re not called upon to respond, but we are often running our own parallel stories along with the movie. Spiegel showed clips from the movies “Moonlight,” “Ikiru,” and “Philadelphia,” and the documentary “The Waiting Room.” In that final clip we saw a young doctor run a code in the Emergency Room where a teenage boy dies. He then is tasked with telling the family the devastating news. He seeks out support from his colleagues on how to do this. Spiegel notes a quote from Jonathan Shay: “Recovery happens only in community.”

I was bolstered to hear about he the work of Craig Irvine and Dr. Deepu Gowda, who discussed how to create a culture for narrative work, both in academic institutions and in clinics. Dr. Gowda explored using narrative medicine sessions with the entire medical team (including nursing staff, administrators, physicians) and found improved teamwork, collaboration, and communication. Both suggested building a team of people interested in narrative work, be they art historians, philosophers, writers, physicians, or psychologists.

More than anything, this workshop churned up ideas and inspired methods that could be used at my own workplace to use narrative work to address burnout. I came away encouraged and connected to colleagues who are interested in the same questions and in addressing the daunting problem we face in our current health care system. Ultimately, we want to “allow voices to be heard, and address suffering, not only of patients but also of medical providers.” This work is challenging, but necessary. As Tavis Apramian noted in the final lecture of the conference, “the meaning that we draw from other people is the reason to keep going.” That it is. I hope to continue learning about this important work and am grateful for the faculty at Columbia who inspire tributaries (or rhizomes!) of narrative and creativity throughout the medical world.

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Narrative Medicine Monday: Narrative Gatherings

The first Medical Humanities Twitter Chat, or #medhumchat, happened January 2nd and was curated by Dr. Colleen Farrell, an internal medicine resident. Although I wasn’t able to fully participate (bath time for my three kids, as often is the case, was not a well-controlled event that offered much down time for a Twitter chat), I was able to go back and read the lively conversation.

Farrell notes in this follow up post the role the humanities play in helping “make sense of the seemingly senseless suffering and heartbreak I witness daily as a doctor.” This seems a common sentiment among medical providers today, as varied opportunities in narrative medicine expand.

Farrell’s blog post lists the Medical Humanities Chat readings and questions, along with a few responses from participants. It’s an interesting format to interact with medical professionals and patients from all over the world.

The next Medical Humanities Chat will be this Wednesday, January 16th at 9pm EST, on the topic of Racism & Medicine. I’m hoping, bath time willing, to be able to participate in this important discussion.

Locally, I recently attended the Northwest Narrative Medicine Collaborative‘s inaugural Seattle event, a medical moth with the theme of “My First Time.” The event sold out in just a few weeks and the stories told were varied, often humorous, and resonant with the crowd of both medical providers and the general public.

The next Seattle NW Narrative Medicine Collaborative event is yet to be announced, but I know is already in the works.

The popularity of these opportunities to share our stories, consider a narrative, process the intimate and at times wrenching role we as medical providers play in health and illness, highlights the thirst for such contemplation and conversation among increasingly burnt out physicians and frustrated patients. I find myself, ten years into my own career in primary care, seeking out such community, eager to help cultivate ways to gather and share.

I hope, wherever you are, you can find or foster similar opportunities to share your story, consider your patients’ narratives, and use the humanities as a tool for further introspection and connection.

Writing Prompt: Consider reading the pieces Dr. Farrell selected for the first #medhumchat and answer the questions posed in written form. Were your answers similar to the ones posted during the live chat? Did you gain a different perspective after reading through the conversation? Did any of your answers or reactions to the readings surprise you? Write for 10 minutes.

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Till Chapbook

I didn’t get a free write done this week but did attend the launch party for the 2017 Till Chapbook. This local organization supports writers, builds community and hosts a writing residency at Smoke Farm each summer. Last June I attended the residency and spent several days reading books on craft, floating down the Stillaguamish River, attending workshops by the likes of the Jane Wong and Claudia Castro Luna, ate homemade fare by our fabulous chef and wrote, among other things, my first published poem Instead, which you can find in the 2017 Till Chapbook. I’m grateful for the talented writers I met and enjoyed hearing several of them read their work at the release party this week. Here’s to Till and the writerly community they cultivate.

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Mothers in Medicine

I’ve long been a fan of Mothers in Medicine, a collaborative blog of supportive mama docs. Many of the contributors are still in medical training and the community is made up of various different specialities. I’m delighted to come onboard as a regular contributor to MiM. You can find my posts under “MP.” I’m so grateful for this community of mama docs who get it. If you’re a mom or momma-to-be and at any point in your medical training or career, I recommend checking out Mothers in Medicine as the candid posts are honest and instructive about the challenges of holding these two important roles. 

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Free Write Friday: Cafe


The glass door swings open awkwardly; it easily gets stuck. It’s slow today, rainy outside and indoors is a refuge. Roasted coffee grounds suffuse the air, I breathe deep for the caffeinated aroma to wake me. Glass display case houses delectables. I like the cinnamon roll scones, butter and spice infused pastry crumbles at the touch. 

They know me here. “The usual?” One barista dark haired, glasses, someone I might be friends with if we were contemporaries in college. She usually has her hair pulled back, a ready smile. She inquires about my kids, about my weekend. The other is more quiet, still friendly but I find a kinship in her introversion. They trade off working the espresso machine, making the savory crepes and manning the register. They work well together.

Music is varied, dependent on the day. Today it is soft, vibratory melodies, barely perceptible. The other day it was David Gray, flashbacks to the 90’s and early 2000’s. I liked the melancholy music; it triggered memories of a transitioning millennium, a time of before and after, when we were all ushered into a dark and divided new norm. 

They remodeled the coffee shop recently, adding wood panels, copper lighting. The concrete floor rings cold and is polished roughly. Anywhere else it would chill me, this floor, but here the soft bare light bulbs overhead, the steam rising from the espresso machine, the friendly conversation between neighbors, the head down seclusion of the newspaper reader: it warms me.

I like the quiet, the bursts of gentle laughter, the sound of sipping coffee, of cups resting on square tables, of tip-tap typing, of a clanking of dirty dishes as we each take a morning pause, collective and caffeinating into the new day.

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