Narrative Medicine

Media & Medicine

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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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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: How Virginia Woolf Taught Me to Mourn

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Katharine Smyth explains “How Virginia Woolf Taught Me to Mourn” in her recent essay on Literary Hub. Smyth outlines how Woolf described the mourning period surrounding her mother’s death, and how that “spring of 1895 in London… may as well have been the winter of 2007 in Boston” when she was grieving her own father.

Smyth and her mother illustrate how people can react to grief differently. Her mother “saw the ringing doorbell as an interruption,” while Smyth “liked hearing from the outside world: grief is rapacious, and cards and flowers functioned as its fuel. As long as they continued to proliferate, the experience of loss was active, almost diverting. It was only when their numbers dwindled, then ceased altogether, that a kind of dullish hunger set in.” I think the same can be said of those who experience trauma. Often, others surround you during and immediately after the event, but as time progresses and active support dwindles, a loneliness takes its place.

One of Smyth’s friends “invited me to her parents’ apartment for a kind of mini sitting shiva. For several hours she and her mother listened as I talked about my father’s life; I loved that neither was cowed by death’s awkwardness.” This gift to Smyth seemed an unexpected balm. Do you think most of us succumb to death’s awkwardness? Why do you think this is a cultural norm?

Smyth notes that when the distractions end, “Above all, I disliked the passing of time, disliked the thought that every minute carried me further from my father.” She can relate to Woolf’s surreal experience in the wake of a parent’s death: “The tragedy of her mother’s death, she said, ‘was not that it made one, now and then and very intensely, unhappy. It was that it made her unreal; and us solemn, and self-conscious. We were made to act parts that we did not feel; to fumble for words that we did not know. . . . It made one hypocritical and immeshed in the conventions of sorrow.'”

Smyth identifies with Lily in Woolf’s To the Lighthouse: “her frustrations are those of the grown writer who must confront grief’s fogginess, its unreliability. ‘Why repeat this over and over again?’ she thinks angrily of her attempts to register the fact of Mrs. Ramsay’s passing.” Smyth, too, finds herself repeating, “My father is dead, I continued to say, my father is dead.”

In To the Lighthouse, Smyth discovers that Woolf conveys “her understanding that we all need some structure by which to contain and grapple with our dead.”

Writing Prompt: Although not religious, Smyth finds the act of sitting shiva cathartic, finds herself “longing for ritual, for structure, for some organizing principle by which to counter the awful shapelessness of loss.” Think of your own experience of grief or loss. Can you relate to the healing benefits of structure? Write for 10 minutes.

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Narrative Medicine

Narrative Medicine Monday: Why Doctors Should Read Fiction

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Sam Kean’s article in The Atlantic, “Why Doctors Should Read Fiction,” highlights what many medical schools, residencies and medical groups are realizing: medical providers and patients alike benefit from physicians taking an interest in literature. Kean asks, “if studying medicine is good training for literature, could studying literature also be good training for medicine?”

Kean’s article outlines a study in Literature and Medicine, “Showing That Medical Ethics Cases Can Miss the Point.” The study found that “certain literary exercises…can expand doctors’ worldviews and make them more attuned to the dilemmas real patients face.”

Students rewrite and dissect short stories that expose an ethical case study, such as physician-writer Richard Seltzer’s “Fetishes.” The study’s author, Woods Nash, argues that “short stories are far more effective means of teaching students and health-care professionals to wrestle with the mess, to pay attention to narrative perspective and detail, and to become more comfortable with ambiguity.”

Writing Prompt: Have you read a piece of fiction that outlined a certain bioethical dilemma? Do you agree with Kean’s assertion that doctors should read fiction? How might the practice prove beneficial to a medical provider? Read Seltzer’s “Fetishes” and rewrite the story in short form, as a poem or case study. What new insight do you gain from this exercise? Write for 10 minutes.

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