Narrative Medicine

Narrative Medicine Monday: Going Blind

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German poet Rainer Maria Rilke writes of a nearly-blind woman at a party in “Going Blind.” The poem provides an observation of this woman, as if we were in the room with her. At first she looks “just like the others.” As someone who works in healthcare, usually it is obvious when a patient is sick. But more often than I think we acknowledge, we can’t always tell when a person is suffering or ill. There are many diseases or ailments that might not be readily apparent at first glance.

The narrator does soon note subtle differences in the woman: “she seemed to hold her cup / a little differently as she picked it up.” Rilke focuses on the woman, as the rest of the party moves away: “I saw her. She was moving far behind”. He notices her eyes, “radiant with joy, / light played as on the surface of a pool.”

There is a turn in the poem here, where the narrator moves from seeing her smile as “almost painful” to realizing that once “some obstacle” is “overcome, / she would be beyond all walking, and would fly.” It ends on this hopeful note, the idea that this woman will persevere, and in so doing, move beyond all others and the world’s norms.

Interestingly, here is another version of Rilke’s poem, translated by Margarete Munsterberg in 1912. Reading various English translations of poetry always makes me wonder at what might be missing when we don’t read a piece in the author’s native tongue. Did you get a different sense of the themes or of the woman from reading these translations?

Writing Prompt: Think of a time when one of your senses was limited. What did it feel like to be restricted in this way? Did you note other senses altering in response? Have you observed a patient or a loved one losing their hearing, their sight, their ability to taste food? What did you notice? Alternatively, consider writing from the perspective of the woman going blind. Imagine what she sees, what she feels. Write for 10 minutes.

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Narrative Medicine

Narrative Medicine Monday : What Can Odd, Interesting Medical Case Studies Teach Us?

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Physician author Siddhartha Mukherjee writes in the New York Times about coming across an unusual case study recorded by the late Oliver Sacks. Sacks describes the case of a woman who had a “lifelong history of seeing people’s faces change into dragonlike faces.” Though not a neurologist, like Sacks, Mukherjee is fascinated by the case. A thorough evaluation, including neurological examination, M.R.I. scan and experimental treatments revealed no answer or resolution.

Mukherjee is puzzled by the inclusion in a prominent medical journal. He ponders: “There was no revelatory flourish of diagnostic wizardry….. It was as if Sacks lobbed the puzzle into the future for someone else to solve: In some distant time, he seemed to imply, another neurologist would read this story and find resonances with another case involving another patient and complete the circle of explanation.”

Mukherjee notes that Hippocrates, the father of medicine, himself outlined case histories that remained a mystery without a clear diagnosis. Mukherjee recognizes that medicine has changed: “But over the years, as the discipline of medicine moved concertedly from descriptive to mechanistic, from observational to explanatory and from anecdotal to statistical, the case study fell out of favor. As doctors, we began to prioritize modes of learning that depended on experiments and objectivity.”

Mukherjee seems almost melancholy about the demise of the case study and what this omission means to medicine: “I miss the acuity of the observations, the scatter plots of symptoms that cannot be put into neat boxes, the vividness of description…. I worry that unknown unknowns will go unwritten — that buried within such cases, there might have been a cosmos of inexplicable observations that might, in turn, have inspired new ways of thinking about human pathology.” What role might narrative medicine play in honing the observational and descriptive skills of medical professionals that Mukherjee notes is lacking in today’s medical world?

Writing prompt: Do you agree with Mukherjee that something is lost in devaluing the case study? If so, what is lost? Think of a patient or family member whose illness was unique and perhaps undiagnosed. Write their case study, a detailed accounting of their history of illness. Write for 10 minutes.

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Ramblings

Free Write Friday: Campo San Polo

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Young children scamper across the square chasing balls, bold pigeons and unsuspecting tourists. I sit on a lacquered red bench under a low leafy tree, oblong salmon colored berries just beginning to sprout from its branches. The cover from the high afternoon sun is welcome.

Tourists stroll past with their Burano lace fans, their high-end shopping bags. A man with a walker all dressed in white leans forward as if about to fall over, as if about to kneel in prayer. A child sleeps in his mother’s arms as she reclines on the steps, a yellow bike leaning against the stone structure.

I should move on, get going. But it’s pleasant here, if a bit too noisy. I hear Italian and Russian dialects, I think. The occasional English words from a British or American tourist are too distracting but a foreign language doesn’t have the same effect; the musicality of their native tongues almost a background nicety.

Grey stones of irregular shapes make for uneven ground. The two boys jostling for a soccer ball, bouncing it against the sepia brick buildings, don’t seem to mind.

An elderly man shuffles across the square wearing cushioned sandals, a sky blue plaid cap. He turns, just barely, and shakes his head at something, I don’t know what. Maybe the crying child, maybe the rushed tourists. Maybe his own arthritic knees that are clearly causing him pain. He pauses for a moment as he looks over his shoulder, as if he’s taking it all in, as if he’s remembering something. Then he straightens, and hunches, and realizes it’s time to move on.

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