Tin House: On Acceptance, Rejection and Taking My Time

The Tin House Winter Workshops are held on the Oregon Coast, in the small town of Newport. The quirky Sylvia Beach Hotel is an appropriate literary-themed home base, each room named after a famed author and decorated in the style of their particular genre. I applied to the nonfiction workshop at the last minute, feeling dejected from recent rejections and once again questioning my validity as a writer, as a creator of art. When I saw the instructors for this year’s nonfiction workshop though, I knew I needed to apply.

I’ve admired Esmé Weijun Wang‘s work and, in fact, met her briefly at AWP 2019. I asked her to sign my copy of The Collected Schizophrenias after an awkward non-conversation where I blurted out something about being grateful for her essays. (I am not good around celebrated authors or actors, let me just apologize in advance. Or in retrospect. Sorry, Bradley Cooper.)

Attending my first writing workshop with Tin House and with Esmé was a gift I didn’t realize I needed at this stage of my career. My small cohort of incredible women writers were generous in their feedback and kindness. Their critiques were insightful, their encouragement sincere.

Esmé and the other talented instructors, T Kira Madden and Sophia Shalmiyev, each gave lectures and readings (one of which, I surprised myself by crying through.) Other highlights included the book exchange, dive bar karaoke, participant readings, and moonlit morning runs on the compact coastal beach.

One night we talked about our writing goals for the year and I mentioned my participation in #Rejection100, a group whose purpose is to celebrate the act of trying. Sometimes, I feel too uneducated in the literary world, sometimes I feel too old. Sometimes I feel my voice is too privileged or too uninteresting to have anything of significance to add to the conversation.

T Kira’s lecture, and time with these writers, gave me permission to move beyond my own expectations and the world’s requirements of my work. She challenged us to ask questions of ourselves: What are you writing toward? What are you writing about? How do we reframe our ideas of what “no” means? I like the idea that in nonfiction we are “chasing the question, honoring the unknown.”

Esmé asked us on the last day of the workshop what we’re taking away with us, what we are offering to our fellow participants, from this time on the coast. I said I would take away, and offer, permission. Permission to, as T Kira encouraged, lean into my interests, to listen to my mistakes. Permission to write into the paradox, to take my time. I am impatient and this rushed world fuels this tendency. In writing, in creating, in listening to the story that is tumbling within, I’m learning to take my time, allow rejection to serve as a teacher, not a declaration of who I am. I’ll continue to honor the unknown, and give myself permission to chase the question. Even if I don’t know quite where I’m headed.

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Narrative Medicine Monday: Hospital Writing Workshop

Poet and physician Rafael Campo describes the magic that can occur in a “Hospital Writing Workshop.” Campo starts the poem at the end of his clinical workday, “arriving late, my clinic having run / past 6 again.” Campo is teaching a workshop for “students who are patients.” He notes the distinction that “for them, this isn’t academic, it’s / reality.” These are patients with cancer, with HIV, and Campo is guiding them through poetry and writing exercises to search for healing and respond in a unique way to their disease and suffering.

Campo outlines his lesson, asking the students to “describe / an object right in front of them.” Each interprets their own way, to much poignancy. One student “writes about death, / her death, as if by just imagining / the softness of its skin … she might tame it.” In the end, this poem is about the power of poetry and art for both the patient and the medical provider. It’s about how something as simple as a writing workshop can cause us to pause, “take / a good, long breath” and move through suffering to a kind of healing, to a kind of hope.

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Narrative Medicine Monday: Burnout in Healthcare

I’ve wanted to attend Columbia’s Narrative Medicine workshops for years. Life finally aligned to make that possible this past weekend as I joined professionals from different disciplines gathered to address “Burnout in Health Care: The Need for Narrative.” As a wellness champion for my physician group, this year’s topic was particularly pertinent to my work and practice.

The conference consisted of lectures from leaders in the field of narrative medicine alternating with small group breakout sessions. I was fortunate enough to have Dr. Rita Charon, who inaugurated the field of narrative medicine, facilitate two of my group’s sessions, which consisted of close reading and reflective writing and sharing. This format allows for in depth discussion with medical and humanities professionals, as well as time for introspection about how best to expand on learned concepts and practices when we return home.

Several takeaways for me:

Narrative can be used to address many issues in healthcare, burnout among them. I’ve been facilitating a Literature & Medicine program for my own physician group, and have taught narrative medicine small group sessions to resident physicians, but am inspired to do more of this work to expand the reach to medical professionals and patients. Dr. Charon encouraged us to disseminate the skills deepened through the humanities, that these are what’s missing from a health care system that has become depersonalized. Skills learned through narrative medicine can improve team cohesion, address moral injury and bias.

Writer Nellie Herman offered Viktor Frankel’s words: the primary force of an individual is to find meaning in life. Herman showed us how writing can help us find that meaning, giving shape to our experiences, our memories. Harnessing creativity can be particularly important for those of us who experience moral injury because “when we write, we externalize what is inside us.” Through writing and sharing, we’re making a commitment to something, a raw, less mediated version of events. Through this vulnerability we connect to others; though difficult, that’s what makes it valuable.

Dr. Kelley Skeff approaches burnout and narrative from a physician educator’s perspective. It is not lost on anyone who has been a medical resident or trained them that “we have trained people to take care of patients, even if it kills them. We have trained people to keep quiet.” Skeff offers us this quote from Richard Gunderman: “Professional burnout is the sum total of hundreds and thousands of tiny betrayals of purpose, each one so minute that it hardly attracts notice.” He implores us to combat the code of silence and ask ourselves and each other: What’s distressing you?

Maura Spiegel contends that “narrative language can proliferate meaning.” Spiegel used film clips to show how we can gain access to our own experience. In watching a film, we’re not called upon to respond, but we are often running our own parallel stories along with the movie. Spiegel showed clips from the movies “Moonlight,” “Ikiru,” and “Philadelphia,” and the documentary “The Waiting Room.” In that final clip we saw a young doctor run a code in the Emergency Room where a teenage boy dies. He then is tasked with telling the family the devastating news. He seeks out support from his colleagues on how to do this. Spiegel notes a quote from Jonathan Shay: “Recovery happens only in community.”

I was bolstered to hear about he the work of Craig Irvine and Dr. Deepu Gowda, who discussed how to create a culture for narrative work, both in academic institutions and in clinics. Dr. Gowda explored using narrative medicine sessions with the entire medical team (including nursing staff, administrators, physicians) and found improved teamwork, collaboration, and communication. Both suggested building a team of people interested in narrative work, be they art historians, philosophers, writers, physicians, or psychologists.

More than anything, this workshop churned up ideas and inspired methods that could be used at my own workplace to use narrative work to address burnout. I came away encouraged and connected to colleagues who are interested in the same questions and in addressing the daunting problem we face in our current health care system. Ultimately, we want to “allow voices to be heard, and address suffering, not only of patients but also of medical providers.” This work is challenging, but necessary. As Tavis Apramian noted in the final lecture of the conference, “the meaning that we draw from other people is the reason to keep going.” That it is. I hope to continue learning about this important work and am grateful for the faculty at Columbia who inspire tributaries (or rhizomes!) of narrative and creativity throughout the medical world.

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