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

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.

Continue Reading

Paris

Bonjour! I’ve been remiss with posting lately due to travels. I went to Paris in early June for both work and pleasure. It had been a decade since I’d visited the City of Lights, and, despite several stressful setbacks (beware that Airbnb, even if reserved months in advance, can cancel within days of your scheduled arrival!), Paris did not disappoint.

I have a special affinity for the city, as it was the first place I traveled internationally. I took French in high school and went there as an exchange student, living with a host family for just a couple of weeks. It was the first time I’d been anywhere predominantly non-English speaking and my host family was attentive, warm and forgiving. My time in Paris was a gentle nudge out of my American suburban bubble. More drastic shifts in my world perspective would come later, but I always think of Paris fondly as my start to a love of travel. And, of course, it’s Paris! The richness of art, architecture, food, parks, history…. I’ve been back to Paris once each decade since and this, by far, was my favorite trip.

I had initially planned to attend a writing retreat right before my medical conference, but as the retreat was canceled, I instead had several days completely to myself in Paris before my husband arrived and my conference started. As a working mom with three little ones, solitary time in this magical city was bliss. I strolled the narrow streets, stepped into cafes and hidden parks. I hit my favorite Musée d’Orsay and Rodin and sat in quirky bookshops sipping espresso and writing in my notebook. I even had a chance to read a poem during a multilingual open mic night.

The summer institute I attended was also exceptional, an annual meeting of the minds hosted by the CHCI Health and Medical Humanities Network. This organization is a “hub for health and medical humanities research and collaboration” and this year’s theme, “Health Beyond Borders,” brought together experts in both narrative medicine and global health, each particular interests of mine.

Several talks I particularly enjoyed were:

A keynote by Ghada Hatem-Gantzer about her incredible work with women and girls who have suffered violence.

I connected with Shana Feibel on #somedocs prior to the summer institute when I stumbled across her post about presenting in Paris. Dr. Feibel spoke about a topic that resonates with me: “Bridging the borders between Psychiatry and other Medical Specialities: A Case for the Medical Humanities.” I hope to continue to learn from her work in this area.

Sneha Mantri from Duke is a neurologist with her Master’s in Narrative Medicine and gave a fascinating presentation about border crossing and modern medicine as it relates to Mohsin Hamid’s novel Exit West. I also learned Dr. Mantri was in the same narrative medicine class at Columbia as Stephanie Cooper, who I’ve gotten to know well through the Seattle chapter of the Northwest Narrative Medicine Collaborative. It’s a small, connected world!

Columbia’s Danielle Spencer presented innovative work on the idea of lived retrospective diagnosis, or metagnosis. I’m looking forward to her book on this topic, forthcoming in 2020.

Emergency Medicine physician Craig Spencer gave a moving keynote presentation about his work with Medecins Sans Frontieres and specifically the migrant crisis in the Mediterranean.

I returned from Paris rejuvenated and energized on many fronts. C’est magnifique.

Continue Reading

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.

Continue Reading