Narrative Medicine Monday: Monday Morning

Audrey Shafer, an anesthesiologist and mother, writes of medicine and motherhood in her mesmerizing poem “Monday Morning“. Highlighting two simple moments at home and at work, Shafer explores the contrast and commonalities between motherhood and her work in medicine. No wonder I love this piece!

What do you think of the juxtaposition of the narrator’s young son and the cool sterile environment of the operating room? The OR is a glaringly lit, predictably ordered, pristine place. As a mother, I could picture the incredible contrast of her preschooler son’s soft body clutching his favorite blanket in the dim early morning. A home with young children is often unpredictable, littered and intimate.

Shafer comments that the one who is exposed and vulnerable in this poem is the author herself. Would you agree? What do you learn about her as a person and as a working mother by reading this poem?

Writing Prompt: Think of a moment at work that reminded you of or seemed in direct contrast to a moment at home. How does your personal life inform your work and vice versa? Write for 10 minutes.

 

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Narrative Medicine Monday: Published!


Starting the year off sharing some great news! I recently received in the mail the Fall 2016 Edition of OUHSC’s Blood and Thunder Journal, which includes two of my essays. I’ve had several pieces published in online journals but there is a special kind of excitement that comes from seeing your name in print on a tangible page. I’m humbled that two of my favorite shorts “Expectant” and “Burst” found a home in this narrative medicine collection.

“Expectant” chronicles the very first delivery I witnessed. Obstetrics was a revelation to me as a young medical student, especially never having had children myself. I was in awe of the entire process and this short essay reveals my own insecurities as I was christened into the world of medicine.

“Burst” is about my first continuity delivery in residency training: a pregnancy meant to be followed throughout all nine months to completion. I was a new physician and had much to learn about the unpredictable nature of obstetrics.

One of my writing goals for 2017 is to make significant progress on a book-length collection of narrative medicine essays.  I’m starting the year off taking Creative Nonfiction’s online course “Writing Your Nonfiction Book Proposal”. Finding time to edit and submit my work has been a continual challenge but writing classes provide encouragement and structure to make the time, harness the energy and muster the gumption to keep at it. I’m eager to let go of the draining and perfectionist tendencies of 2016 and write on in 2017. Holding a palpable culmination of my writing efforts is an encouraging way to embark on a new year and I’m grateful.

 

 

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Narrative Medicine Monday: You Will Feel A Pinch

With a title like “You Will Feel A Pinch“, I couldn’t help but read Marylyn Grigas’ poem in the Bellevue Literary Review. Whenever I’m doing an injection with a numbing medication for a procedure, I say exactly this: “You will feel a pinch, then a burn.” This is just how she begins.

There are so many phrases that I use automatically and repetitively with patients on a daily basis. Leaving the room for the patient to change for a physical exam, I inform: “The gown opens in the back, the paper drape unfolds over your legs.” Performing a Pap smear and gynecologic exam, I explain I’m going to “use my other hand to feel your uterus and ovaries and make sure I don’t feel any masses or anything abnormal.” I listen to the lungs on the back and ask the patient to “take deep breaths through your mouth”, then as I move to auscultate the lub-dub of the heart on the chest I ask them to “breathe normally.” I once had a patient laugh and reply, “What does that mean?” These phrases come out of our mouths, rote habit, without thought as to what a patient, who might be hearing those words for the first time, might perceive. 

After much trial and error you discover what tends to work to communicate with patients in a way they can understand. You begin to anticipate the questions they’ll ask, such as if the gown opens in the back or the front, and preempt with answers. But I think over time, over years, it becomes such second nature that the words fall out without pausing to think about the meaning.

Two years ago I had a skin lesion on my back that was bothering me and I asked my doctor to “burn” it off with liquid nitrogen. This type of so-called cryotherapy is a treatment I perform on others regularly. I always warn “this may sting” and have had incredibly varied responses, ranging from people barely flinching to  crying out in pain. When my own turn came I was acutely surprised at how painful it was, much more than just a “sting”, both during the application and for several days after. I developed a new empathy for the recipients of my cryotherapy treatment going forward. I shudder when I think of all the coaching phrases confidently uttered to my patients in labor a decade before I experienced labor pains myself. 

Why do you think Grigas opens her poem with this oft used warning? What does this phrase seem to make her think of? How does her poem evolve and what do you think it’s about?

Writing Prompt: Think about something you say regularly to patients, almost automatically. Unpack the phrase. Imagine yourself in the patient’s position hearing this for the first time and write from their perspective. What other things might come to mind when a patient hears this phrase? If you’re not a medical professional, can you think of sentences you’ve heard from doctors or nurses that were confusing or funny or easily misunderstood? Write about this for 10 minutes. 

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Free Write Friday: Hospital

 

1997

She’s volunteering, decided what she wants to do. She catches the bus to the hospital from campus, heavy backpack weighing down her slight shoulders. She has a badge, a short powder blue jacket. She works in the playroom: coloring, washing toys, light streaming through the wall of windows as she stoops to read aloud a picture book or set up a seasonal craft on the low plastic tables. The children come in wheelchairs, heads bald or misshapen or shaved with intention. Tubes may be in their nares or arms. All of it is foreign and she doesn’t know how to act naturally so she smiles a lot, maybe too much. Sometimes she delivers a toy to a child confined to their own room: in isolation. Before entering she puts on a crinkly gown and a mask and latex free gloves, just as she was trained to do. She plays with the child, chats with the teen, tries to connect, but her own awkwardness and all the barriers for protection get in the way.

2003

She’s in medical school, deciding what she wants to do. She rotates through the hospital, a shadow of a doctor in a short white coat, tagging along after her resident. Her pockets are weighed down with too much: laminated cards on how to run a pediatric code, a clipboard with preprinted index cards to keep track of each patient’s labs and history, black ball point pens to record chart notes, gum. She learns she always needs to have gum on hand. She walks the halls, familiar but transformed now she’s armed with some knowledge. She gets to know the palpable quiet of the hospital in the middle of the night. The ceilings here are low; everything is miniaturized to make children feel more comfortable, in this place where discomfort distinctively reigns.

2007

She’s in residency, an MD after her name. She doesn’t wear a coat, but instead a black fleece vest with zippered pockets. Sometimes she’s mistaken for a nurse, but she still doesn’t wear the long white coat; it’s just not the way things are done. She monitors her patients and her medical students. She presents each case to the attending each morning at rounds. She knows what she wants to order in the cafeteria when it opens at 2 a.m. for all the providers who are there overnight on call. She’d rather sleep than eat, but that’s not the way things are done here. Residents review the progress of patients with the medical students, with each other, over the mid-night meal. The lights are turned down low and the children are in cribs and in isolation rooms and can’t breathe well or can’t eat well and most certainly won’t sleep well. The nurses page her and talk in quiet voices. Many patients get better and she discharges them. Some are known by all the staff and roam the halls with their IV poles like tiny emperors, because this place, this hospital, too, is their home.

2016

She brings her infant, the youngest of her three, in to see the specialist. She parks in the newish garage built in the same place she used to catch the bus up the hill. She wheels her baby in the stroller. She waits in line to check in, gets an adhesive visitor’s badge with her picture and her child’s name. There’s a Starbucks downstairs now, in this new wing, but she doesn’t have time to stop for a latte. Her child is crying and she’s late. She wears a red raincoat, her pockets filled with the random items of a mother: a used tissue, a miniature toy construction truck, a purple hair clip, a binky, her smartphone. She’s anxious about seeing the specialist, about the prognosis and treatment plan. She has already texted her friend, the pediatrician, who made helpful recommendations, gave expert advice. She now has the luxury of giving and getting medical opinions in an instant, a byproduct of years of training and now experience as a practicing physician. She waits in the waiting room with other families. Some children read, some run, some sit in laps, some in motorized wheelchairs. Her child’s name is called and her baby is weighed, measured. She sees the physician. Her baby is prescribed medication, which she gets from the pharmacy. A girl waiting in line behind her talks animatedly about a book she wants to read. When she turns to check on her baby she can see the girl’s shaved head, the scar from surgery. So many children here so ill, so resilient. As a mother, she always feels grateful, feels guilty, in this place.

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Narrative Medicine Monday: What the Nurse Likes

Cortney Davis’ poem “What the Nurse Likes” reveals what it’s like to care for patients. She notes in her commentary about her poem that she realized “it is necessary for caregivers to say shocking things occasionally about the type of work that they do”. This poem has helped me reflect on what I enjoy about my work and consider what may seem interesting or odd to those outside of the medical field.

Writing prompt: What do you like about caring for patients? What do you dislike? What do you like about receiving medical care? What do you dislike? Write for ten minutes. Think about if any of these things may be shocking to others. Did you surprise yourself?

*Cortney Davis’ website has some more excellent prompts to try.

 

 

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