Ramblings

Free Write Friday: Ski

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She looked up the mountain, the hill she learned on. Remembering the rope tow, gripping tight with mittened hands, chapped cheeks from chill winds. She wore a patterned hat, pulled it down over her ears, lobes pink. Her toes and fingers instantly numb to the freezing temperatures.

***

Her grandfather took her to buy new skis when she was in high school. She had never had new equipment before, always hand-me-downs from older relatives. It felt luxurious, the shiny new blades strapped to matching boots, electric blue with neon yellow accents. She sat compact on a wooden bench in the family owned ski shop, the only acceptable place in the well-to-do suburb to buy skis. The employees fit her feet to the restrictive boots. They felt tight, compressing, oppressive. Everyone assured her the fit was right but her long toes would burn with every run for decades to come.

She never took lessons, only her father giving instruction same as when he taught her to ride a bike or tie her shoes or scramble an egg with rice and just the right amount of soy sauce. He was matter of fact, detachedly patient, waiting for her to overcome her fear. She remembers the swelling of anxiety, looking down the sloping hill, the enormity of getting to the bottom an overwhelming task welling in her chest.

***

The beginner lift slows to a crawl, allowing novices to sit their layered bottoms down onto the cushioned seat, warily grip the arm rest, avoid looking down as they are lifted skyward, skis dangling, boots weighty, gravity pulling like a string taut to the ground.

Looking down, through ski tips, there’s nothing to keep one from slipping: a wayward glove, an aberrant pole, dangling then falling, floating, to the silent impact of snow drifts below. The silence, the stillness of the buffering snow soothes while coasting upward past white coated evergreens, tiny skiers like miniature figurines expertly weaving curves this way and that far below. There’s calm in the severity of the landscape, a numbing peace inherent in the crushing steepness and chill.

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Narrative Medicine

Narrative Medicine Monday: Someone Else’s Pain

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Brenna Working Lemieux’s poem “Someone Else’s Pain” illustrates the struggle to understand what others are feeling, how challenging it can be to fully grasp another’s suffering. The patient experiences “some driven-screw anguish that flares” that they attempt to explain. Lemieux can only “nod or shake [her] head.”

I can relate to Lemieux; medical providers regularly face the challenge to decipher a patient’s explanation of illness or pain. I delivered babies for many years before I had my own children. After I experienced labor for the first time myself, I cringed recalling many of the comments, modeled after other medical providers, I had made to laboring patients prior to experiencing that pain myself. I had been sympathetic to their pain but could not embody empathy in the same way I could after I had gone through a similar experience. I had no reference point to the crushing agony of contractions that I would later understand. Of course, we can’t fully experience everything our patients go through. However, we can become better at listening and responding to the story they are trying to tell.

Lemieux likens listening to the patient describe their pain to the focus she had in art class, “trying in vain to capture” an image of her hand. Her poem illustrates the nuances and importance of narrative to medicine, the need to hone our listening and storytelling skills to improve the relationship between patient and physician and, ultimately, medical care as a whole.

Writing Prompt: What is the biggest challenge in understanding another person’s pain or illness? Have you ever tried to describe such an experience to a friend or healthcare provider? Think of a time you were on the explaining or the listening end of such a conversation. Write for 10 minutes.

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Narrative Medicine

Narrative Medicine Monday: Heroin/e

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In Cheryl Strayed’s essay “Heroin/e” she writes about our ways of facing death, dying, grief and the will to live. Strayed loses her mother to cancer and suffers her own descent into addiction. Strayed’s love for her mother is evident and the loss she feels is acute. When her mother first learns of her diagnosis, Strayed recounts them silently entering the restroom, “Each of us locked in separate stalls, weeping. We didn’t say a word.” Strayed describes the numbing of pain and the warping of time for each of them: “The days of my mother’s death, the morphine days, and those that followed, the heroin days, lasted only weeks, months–but each day was an eternity, one stacked up on the other, a cold clarity inside of a deep haze.”

Writing Prompt: What does it feel like, in a physical sense, to suffer from addiction? From grief? Do you think addiction and grief are linked? Why or why not? Think of your own experience or a time you’ve witnessed this in a patient. Write for 10 minutes.

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Ramblings

Free Write Friday: Starbucks

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They line up outside the first storefront: the trim an earthier green, the logo more organic, subtly suggestive, less polished. They take selfies and wait patiently to order grande peppermint mochas. I shuffle by them onto the cobblestone street, eager to reach the Chinese bakery to collect barbecue pork filled humbow, sticky rice wrapped in lotus leaves, buttery almond cookies that leave a residual crumble. I admire the fruit stands: large trays of plump grapes, squat persimmon, rainbow carrots gathered with twine. The flowers and the flying fish are, like the coffee shop, iconic, each wrapped in waxy paper, rubber-banded for the journey home.

***

I spot the familiar logo from across the street. Sweat sticking to my back, a rushing wall of air conditioning bowls me over as I step inside the coffee shop. The decor is the same, artwork familiar, stout brown chairs circle round veneer tables. I step back home, into anytown Starbucks despite being thousands of miles across the Pacific Ocean on a tiny island of an idyllic archipelago. It’s the brand, what people expect, what they want to see. But I bristle at the cookie-cutter likeness, even as it comforts me. I order an iced latte from the awkward Thai barista, clad in the familiar bright green apron with emblazoned mermaid. I grab my cup with my head slightly down, a kind of apology. But I sip the milky caffeine eagerly, my American thirst quenched.

***

In college I would study at the one on the Ave, in medical school at the one in Madison Park. I’d order my drink and settle down at a table, spread my textbooks and notecards out just so, like surgical instruments lined up for an important procedure. I’d highlight and underline: red, green and blue. Star and paraphrase, chart and summarize. After hours of sitting I’d grow stiff, have to stand to stretch my muscles, hinge my joints. One time my strained neck raised to the hum of whispers: Howard Schultz, the owner of the ubiquitous coffee chain had stopped in for his own caffeinated drink. Someone mumbled that he lived in the neighborhood, came into this particular Starbucks from time to time. Tall, with an open confidence, he didn’t linger. I wondered what his drink of choice would be.

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Narrative Medicine

Narrative Medicine Monday: The Second Floor

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Poet Rachel Hadas describes how those near the end of life grow distant before they pass in “The Second Floor.” She begins with a dream, consisting of “a harried pilgrim to a shrine.” She states that “[a]s quickly on their short legs toddlers move, / tall parents lumbering in slow pursuit, / so they speed onwards, people whom we love.” I like the unexpected juxtaposition of the unsteady toddler at the beginning of life to the dying loved one at the end. She paints an image of Sam and his daughter cradled together in “[s]leep and love, the quick, the nearly dead.”

Writing Prompt: Do you agree with Hadas’ assertion that the terminally ill are “somehow out of reach well before the grave?” Why or why not? What role do dreams play in our processing of ill or dying loved ones? Have you experienced such a dream? Write for 10 minutes.

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Ramblings

Free Write Friday: Trains

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We ride the monorail to the city center, food court and live music on stage, families milling around on a holiday weekend, heading to the children’s museum or playground or bringing tourists to the iconic needle in the sky. Their dad is hungry, so he peels off to peruse the menu of greasy gourmet burgers, poutine doused in thick sauce, a grilled cheese dripping in butter for the kids. I veer the little ones to the centerpiece, the electric train. Every winter it’s set up in the center house, a pretend village sprinkled with snow and Christmas cheer. I never noticed the details before. My children now old enough to pause, stand still in wonder long enough for me to explore. Tiny figurines placed carefully, carrying wrapped boxes, firewood, bundled babies in their arms. My four year old’s excitement builds as the train speeds toward his face pressed against the plexiglass. It’s a wistful display of a bygone time but, modern boy though he is, the old fashioned train still holds charm.

***

My older brother had a train table growing up: handmade, wood, painted a mossy green. Tracks laid down across the entire span, chin level to my 8-year-old peering eyes. I remember a tunnel, trains traversing through a plastic snow topped mountain pass. The contraption took up most of his large bedroom, meant to be a downstairs family room or den. There was an opening in the middle. We’d climb under and pop up in the center as if underground moles. He conducted the whole display, detailed greenery sprouting on the landscape. I’d watch in wonder as the trains sped by.

***

My grandfather had a train computer game he liked to play. When we’d visit his tidy rambler in a well-to-do suburb in the early 2000’s we’d sit in his den, this octogenarian navigating down the pixelated tracks on his desktop monitor, clicking keys to make the trains whistle and stop. It wasn’t the most entertaining way to spend our time with this beloved elder of the family, but we indulged him and his enthusiasm for the simple program. He took computer lessons in his last decade of life, he traveled the world, he went sky diving when he turned 80, showing up on my parents’ front porch proudly wearing a t-shirt and holding a VHS tape record of the tandem free fall as proof. He must’ve always loved trains too. I like to picture him as a little boy, nose pressed to the glass at Christmastime, as a teen piecing together the intricate parts of a model train, placing the finished product triumphantly on winding tracks.

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Narrative Medicine

Narrative Medicine Monday: The Quiet Room

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Trauma surgeons Drs. Masiakos and Griggs outline the public health crisis that is gun violence and the need for further research and action to combat this persistent threat. In “The Quiet Room,” they achingly describe delivering the devastating news to a mother that her child has died. They note that “we tell ourselves that this senseless dying must end. But it doesn’t end. Another child is shot, and another mother is heartbroken.” They go on to outline the epidemic of gun violence, asserting that “whether on the streets of Chicago or in the churches of Charleston and Sutherland Springs, [it] is a national health emergency.” These trauma surgeons, along with many other physicians, stress that “only if funding for research on firearm-violence prevention and public health surveillance is reinstated can we determine the best approach to addressing the public health crisis of firearm violence.”

Writing Prompt: What specific information would be helpful from firearm-violence research to stem the tide of this epidemic? Have you cared for a patient who has suffered from firearm-violence? Write about the experience. What can you do as an individual to join in the “collective power” to address this public health crisis? Write for 10 minutes.

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Narrative Medicine

Narrative Medicine Monday: To Seize, To Grasp

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Writer Heather Kirn Lanier describes her daughter’s seizures in “To Seize, To Grasp.” Lanier begins the flash essay outlining her infant daughter’s first seizure: “not the worst one, although it brought the biggest shock.” Lanier relays what it’s like to be thrust into the medical world and terminology of a new diagnosis: “New traumas gift new glossaries. Words become boxes into which you can pack the pain.” She achingly describes the pain of watching her child seize, unable to do anything but wait: “But of course he could only do what I could do, which was inject medicine and wait.” Lanier closes the piece with her daughter’s worst seizure, which was not the longest. What was it that made this last one so frightening for Lanier? Can you relate to grasping onto that which can be lost at any second?

Writing Prompt: Have you been suddenly thrust into the medical world because of your own illness or a loved one’s diagnosis? What was it like to learn a new vocabulary and way of interacting with the medical system? What did you find most challenging or surprising? Write for 10 minutes.

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Ramblings

Free Write Friday: Beach

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She walked down the hill to the beach, bundled in a down coat, fingerless gloves and a white knit hat. Sneakers on pavement gave way to fine sand spilling over her laces as each step took more effort. Closer to the shoreline the sand was more compact, sturdier beneath her. Here she could stroll along the rocky ground, now pounded by the November waves, wind whipping them into a fury.

She imagined a storm, how it would rage in years past, toss fishing boats as they struggled to avoid the lighthouse signaling at the point. She thought of the contrast, just yesterday sun warming her face as she ate lunch, read, wrote on a picnic table perched on the beach, watching couples meander along the shore with their dog. She could linger.

The wind beat fiercely as she climbed a small hill to circle back. But as she found herself among the golden reeds, atop a mound just set back from the rocky beach, she felt suspended, wind pounding from all directions. She paused, the intermission comforting, demanding reverence.

Pressure on all sides, she remained. It was as if liquid, not air, compressed her. As if warmth, an unexpected peace held her in the midst of the chill November day.

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Narrative Medicine

Narrative Medicine Monday: In Shock

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Although I’ve never met her, author and critical care physician Rana Awdish on some level feels familiar. Not only are we both part of a supportive online group of physician-writers, but I just finished reading her wrenching memoir, “In Shock: My Journey from Death to Recovery and the Redemptive Power of Hope.” Awdish’s gripping account of her near-death experience, subsequent hospitalization in her own ICU and revelations about the shortcomings in both support for and education of medical providers in the realm of empathy are illuminating. Her book is infused with challenge and hope and a call to transform the way we train physicians and care for patients.

Awdish is thrust from the world of providing medicine into that of receiving it – a patient under her own colleagues’ care. The contrast of these positions of power and vulnerability are striking and Awdish describes the jarring experience and her own enlightenment as she pivots between these two roles. She shares with the reader her revelations regarding how we provide medical care to those in crisis and inspires us to find a better way.

I was particularly convicted by Awdish’s insight into how medical training encourages physicians to suppress many of our emotions. She traces this ideal back to the father of modern medicine, Sir William Osler, who encouraged “‘aequanimitas.’ Osler regarded this trait as the premier quality of a physician. It represented an imperturbability that was described as manifesting in ‘coolness and presence of mind under all circumstances, calmness amid storm, clearness of judgment in moments of grave peril.'”

Awdish asserts that as physicians “we aren’t trained to see our patients. We are trained to see pathology. We are taught to forage with scalpels and forceps for an elusive diagnosis buried within obfuscating tissues. We excavate alongside our mentors in delicate, deliberate layers, test by test, attempting to unearth disease. The true relationship is forged between the doctor and the disease.” Do you agree with Awdish’s assessment? Why or why not?

If you’re a physician, if you’re a patient: read this book. Discuss it with your colleagues, mull over it with your book club. The questions Awdish raises, the challenges she poses are vital to improving the way we care for each other in our most acute times of need.

Writing Prompt: If you’re a physician, did you learn to develop “aequanimitas” through your training? Did you feel this trait was a requirement, overtly stated or otherwise, to be a “good physician?” Have you yourself ever been a patient feeling, like Awdish, “powerless in a way that is impossible to imagine, from a privileged position of wholeness and well-being?” Awdish lists biting phrases that were directly said to her or that she overheard when she was a patient. Have you experienced similarly painful words from a medical provider? Have you said such words to a patient before? Try writing from both the patient and the medical provider’s perspectives. Write for 10 minutes.

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