Narrative Medicine

Narrative Medicine Monday: Jamaica Kincaid’s “Girl” and the Challenge of Growing Up in Medical Training

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I first read Jamaica Kincaid’s “Girl” as part of a generative writing workshop during a summer writing residency. Our small group gathered folding chairs around long tables set up in an old barn near the Stillaguamish River in rural Washington. I was taken with each of the readings poets Jane Wong and Claudia Castro Luna had us read, but “Girl” struck me most, with its unusual punctuation, jarring directness, and call to re-examine the lessons we receive.

Emergency physician and writer Dr. Naomi Rosenberg explains in a recent JAMA article how Jamaica Kincaid’s “Girl” resonates in a very different environment–with new physicians in a narrative medicine workshop.

Rosenberg comments on the unexpected “striking similarity” these physicians have to Kincaid’s young girl, joining “a system that demands they quickly learn the skills of their craft, the rules of survival, and the values they will fight for all while navigating their instinctive psychological responses to illness, injury, healing, injustice, and grief.”

Rosenberg and the “burgeoning narrative medicine department” at her urban hospital have used “Girl” in the residency didactic curriculum, medical school electives, and writing workshops for all health care system employees with a goal to “constantly explore ways to help physicians, nurses, staff, and students ‘develop attention.'”

She describes how when they ask the residents to read “Girl,” intially they are met with resistance. How could this lyrical prose about coming of age in an island culture relate to healthcare professionals who “treat gunshot and stab wounds, deliver babies, diagnose cancer, unclog dying hearts for a living?” And yet, the new physicians quickly make the connection: “‘It reminds me of residency,’ one obstetrics-gynecology resident tells us, ‘a million instructions and things to do. It’s all over the place, and rapid fire.'”

At the end of the session a simple writing prompt is given, “metabolizing their own experiences and taking a moment to string words together—something young physicians today rarely, if ever, get a chance to do.” The result is surprising: “an exploration of hierarchy, medical education, and the silent curriculum of growing up.”

I wrote about my own experience at Columbia’s Narrative Medicine workshop, where we did a similar exercise and I again encountered Kincaid’s “Girl.” I love Rosenberg’s use of this piece to help new physicians still finishing their training grapple with the accelerated nature of a medical residency, the growth and expectations that come with modern medicine. It also was interesting to learn that Rosenberg herself used “Girl” as inspiration for her own wrenching New York Times essay, “How to Tell a Mother Her Child Is Dead” which I wrote about here and is one of my own favorite pieces to use for reflection and discussion among healthcare professionals.

As Rosenberg recognizes, literature has a way of “again and again, deepen[ing] our inspection and understanding of the internal and external worlds.”

Writing Prompt: Take a cue from Rosenberg’s exercise and respond to “Girl” by writing instructions on how to be a healthcare professional (nurse, physician, pharmacist, etc.) Alternatively, write instructions on how to be a patient, or a patient’s parent or partner or child. Write for 10 minutes.

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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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Ramblings

Free Write Friday: Ski

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She looked up the mountain, the hill she learned on. Remembering the rope tow, gripping tight with mittened hands, chapped cheeks from chill winds. She wore a patterned hat, pulled it down over her ears, lobes pink. Her toes and fingers instantly numb to the freezing temperatures.

***

Her grandfather took her to buy new skis when she was in high school. She had never had new equipment before, always hand-me-downs from older relatives. It felt luxurious, the shiny new blades strapped to matching boots, electric blue with neon yellow accents. She sat compact on a wooden bench in the family owned ski shop, the only acceptable place in the well-to-do suburb to buy skis. The employees fit her feet to the restrictive boots. They felt tight, compressing, oppressive. Everyone assured her the fit was right but her long toes would burn with every run for decades to come.

She never took lessons, only her father giving instruction same as when he taught her to ride a bike or tie her shoes or scramble an egg with rice and just the right amount of soy sauce. He was matter of fact, detachedly patient, waiting for her to overcome her fear. She remembers the swelling of anxiety, looking down the sloping hill, the enormity of getting to the bottom an overwhelming task welling in her chest.

***

The beginner lift slows to a crawl, allowing novices to sit their layered bottoms down onto the cushioned seat, warily grip the arm rest, avoid looking down as they are lifted skyward, skis dangling, boots weighty, gravity pulling like a string taut to the ground.

Looking down, through ski tips, there’s nothing to keep one from slipping: a wayward glove, an aberrant pole, dangling then falling, floating, to the silent impact of snow drifts below. The silence, the stillness of the buffering snow soothes while coasting upward past white coated evergreens, tiny skiers like miniature figurines expertly weaving curves this way and that far below. There’s calm in the severity of the landscape, a numbing peace inherent in the crushing steepness and chill.

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Ramblings

Free Write Friday: Pool

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2017

I hold her squirming, slippery toddler thighs, evasive like slick eels. She clomps her feet down, uneasy steps in the little pool, even with the extra buoyancy of the chlorinated water. She likes to open her mouth, like a great whale, letting the pool seep in, then out through her widely spaced teeth, two on top, two on bottom. She, surprisingly, exults in going under, seems to fall purposely: Oops! Silly me! Throwing her head back, eyes squeezed tight shut as she leads with her upturned chin, mouth open, nostrils flared, beckoning the water toward her until she is fully immersed, sinking, trusting that I’ll catch her, lift her upright to breathe clear air. As she emerges, a look of unadulterated glee followed by just the faintest hint of melancholy. A mermaid she wishes she could be.

1990

She is so thin and graceful, wearing an electric blue bikini, mousy hair. I’m surprised when she approaches me poolside. Overweight and awkward, I wear my pudginess like armor; it keeps me humble, it keeps me introverted. I long to be charming, liked. Don’t we all at this preteen age? (At every age.) I can’t believe it: friends with me? She’s inquisitive, chatty, polished. I feel more elegant just being near her. It is revealed eventually, this is the truth: I am just a means to her end, a conduit for connection to my tall, older brother. He has reached the golden age: past gangliness, past acne, post-braces. I’m in awe of him too. 

1983

I’m learning to swim in the side pool, previously a hot tub but converted to what we call “the baby pool.” A bridge of dark brown tiles, just an inch under the surface, divides the tiny pool from the larger. Like a stumpy appendage, a bleb of an outgrowth, the small pool protrudes. The older kids like to coast back and forth on their tummies, sliding like monk seals. I can barely touch the bottom, on my tippy toes I bounce along, suspended for just a moment, like a moonwalking astronaut. A perimeter ledge for seating, I leap from side to side arms outstretched with orange inflated “muscles,” skinny legs flailing behind me. Sometimes I sink under with the effort, sour liquid up my nostrils, eyes stinging from chlorine. I grab the a handhold of smooth tile, turn, and try again.

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