Narrative Medicine Monday: Lithium and the Absence of Desire

Virginia Chase Sutton’s wrenching poem “Lithium and the Absence of Desire” warns of what may be lost in taking a necessary medication. She deftly describes the world before starting lithium and the reader is entranced along with her, “dozing in light and soaked color.” Despite side effects causing a graying of her world, the author dutifully takes “the medication as prescribed.” Written in second person, the reader is drawn into her longing for what she has lost and together we collectively struggle in vain: “Strain all you will but you have given desire away.”

Writing Prompt: This poem describes a negative, even devastating, side effect of a medication, yet the writer recognizes there was “No choice since you must take the pills.” Have you experienced a minor or life-altering side effect from a medication? Describe life before and after starting the medication. Did you keep taking the medication as prescribed, or did you search for a different treatment? Write for 10 minutes.

 

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Free Write Friday: Hair Accessories 

I used to play beauty parlor with my best friend. She didn’t like the game of coiffing, but I enjoyed the tugging on hair, taming her strawberry blond curls, selecting and applying the ribbon or hair clip just so. I would stand back and admire my handiwork, wisps and strands situated as I commanded. They succumbed to my coercion and I was satisfied. 

*

My hair was cut too short in fourth grade and I never got over it. It was a “boy” cut, not the cute Dorothy Hamill kind made popular by the 1980’s figure skater. Instead of a bobbing bowl cut, it’s as if the hairdresser took clippers to the back, the sides, the whole mass of thick dark tresses. It was too short for any hair clips and headbands gave me a throbbing ache at my temples. I wore a blue and red and white knit button up sweater in my school picture that year. I liked the sweater, the fanciful snowman perched near the hip pocket. My smile though was strained as if I knew the aberrant hairstyle would haunt my year. 

I went skiing once that winter with my brother and as the attendant was helping us onto the chair lift, toes frozen in clumpy boots, I heard a distinct, “There you go, boys!” He was being friendly but I was mortified, this mistaken identity at a time when all begins to hinge on your perception of what others think about you, molding what you come to think of yourself. 

*

My son gets upset that I can’t braid his hair like I do for his big sister. I pull out accessories: clips and bows and headbands in an attempt to give him alternate adornment. He seems placated, a thin line of a smile as I pull back a strand of his bangs with the royal blue polka dot clip. He steps back, but doesn’t scurry away to admire himself in the mirror as my daughter would. No, it’s the participation that matters to him. He rushes downstairs to show off his fancifulness. 

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Narrative Medicine Monday: Erasure

Student and poet Thomas Nguyen writes of memories and loss in “Erasure.” In his poem Nguyen is instructional, warning how time affects our connection to those we’ve lost: “Accept that time makes things distant, that his absence doesn’t bleed into your memories as much as it used to.” There are only a few significant people in my life who have died, but I can identify with Nguyen who needs to try “harder and harder to remember the last time” he saw his mentor.

Nguyen notes that the patient speaks of his melaonmas as if they were part of his garden: “My dermatologist taught me how to care for them.” Nguyen goes on to contrast this with the green moss on the windows of his home. Do you agree with Nguyen that “life always adds?” Do you find this contention comforting or suffocating, or both?

Writing Prompt: Have you spent time with a loved one or patient who was nearing death? If time has passed, how have your memories of this person been affected? Recall the last time you saw them. Outline the details, like Nguyen’s memory of “neatly-pressed khakis.” Write for 10 minutes.

 

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Free Write Friday: Purge


You have the sudden urge to purge. You spend a long holiday weekend sorting through all of your children’s clothes; the Space Bags stuffed beneath twin beds and dressers, the lost items at the back of their closets. You match socks, discard pliable hand-me-down infant shoes. You sort through stained sleepers used by three, maybe four children. You organize clothes too small, too big for your three children. You find dusty discarded tights hiding behind a dresser. 

Then you move on to your own closet. Haphazard piles of clothes in four different sizes, maternity pants with stretchy elastic waistbands, nursing shirts with openings for nipples to peek through. Some are worn and gigantic, others are new with tags, bought on sale on a whim early postpartum when you were self-conscious about the extra chub, in need of pants that actually fastened but didn’t accentuate an after-baby muffin top. 

You try things on, everything that is “regular” now that you’re not pregnant or nursing. You’re done with that phase, toss those clothes into donation piles enthusiastically. You revel in your body back, no longer a receptacle for another’s development, no longer a conduit for sustenance. You kneel on the closet rug, toss items out the door into organized heaps. You slip one leg into old jeans, boot cut, out of style. You still have a hard time getting rid of things that fit but don’t provide true comfort. Each spared item should elicit the thrill that comes from a piece that feels just right on your skin, in your bones. You’re a goldilocks who holds on to the chair that is just a little too small, a little too big; if only you had the strength to keep only that which is just right.

After folding and organizing all shirts, all slacks, all dresses, all jackets, you sit back and admire. It’s a thing of beauty, a sigh of release to have it all there, visible, organized. That momentary satisfaction is enough to propel you downstairs into the next project. 

You tackle the junk room, meant to be a playroom. It became a dumping ground in the last 12 months, initially out of necessity, then out of sheer exhaustion. There were too many urgent demons swirling to even acknowledge this minor chaos existed. But now you have a window: the strength, the energy to sort, to discard, to organize. Bags of ski gear, gift wrapping, party decorations weigh down the child’s train table, buried under clutter. Boxes of camping gear, partially deflated sports balls, missing pieces of random toys are unearthed as you dig, excavate further into the room. 

This takes longer, more endurance, more muscle. You lift heavy items, find you’re missing ski gloves and appropriate boxes for storing camping gear. It takes more emotional energy to decide what toys to keep for your youngest child, to gauge which winter hats will still fit your oldest two. It doesn’t end with the same satisfaction, the playroom purge. Piles of equipment, of clothes, still line the hallway, boxes of trash and donations in the mud room. But the door can open, the children can play. You set up the train tracks on the squat table, lay out two trains heading in different directions. You can’t explain it, but it felt necessary to get this all done, right now. You were desperate for an ordered respite; seemed the antidote to a season of chaos devoid of calm. 

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Narrative Medicine Monday: The Permanent

In “The Permanent,” Amy Burke Valeras takes us back to the 1980s when perming your hair was a thing. In the first half of the poem, Valeras opens up about her struggle with her hair; I could relate. I similarly begged for an ill-advised perm the same year, the same age as the author. I like how Valeras makes her hair a central character of the poem. We battle along with her preteen self as she tries to tame the “frizzy poof.” We can understand when, two decades later, she is told she has cancer but all she can think of is: “My hair!”

Writing Prompt: Think of an every day aspect of your life, of your body, that you took for granted or had a different relationship with until you became ill. Consider level of energy during a bout with the flu, walking with a sprained ankle; maybe you have lost your hair to chemotherapy or a breast to invasive cancer. Write about your relationship with this aspect of your body before you became ill and after. How did things change? Write for 10 minutes. 

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Narrative Medicine Monday: A View from the Edge

Dr. Rana Awdish is a critical care physician turned advocate for training in compassionate care following her incredible near death experience in her own hospital. Her essay “A View from the Edge” in the New England Journal of Medicine provides an overview of her 2008 experience as a critically ill patient cared for by her colleagues.

In her book “In Shock,” out this October by St. Martin’s Press, she outlines her harrowing near-death illness and recovery. I’m eager to read Awdish’s book and hear more about how her experience led to advocacy for “compassionate, coordinated care.” In her NEJM essay she describes how “small things would gut me. Receiving a bill for the attempted resuscitation of the baby, for example…. A trivial oversight, by a department ostensibly not involved in patient care, had the potential to bring me to my knees.” After recovering, Awdish channels her grueling patient experience into a drive to transform the way we receive and provide medical care. She contends “we need to reflect on times when our care has deviated from what we intended — when we haven’t been who we hoped to be. We have to be transparent and allow the failure to reshape us, to help us reset our intention and mold our future selves.”

Writing Prompt: Have you noted an erosion of empathy among medical providers? If so, think of a specific example and write about how you felt as the patient. If you’re a medical provider, have you ever been cared for by colleagues at your own hospital? What was it like to be on the “other side,” as a patient? Did you come away from the experience with new knowledge and empathy that you then incorporated into your own practice? Write for 10 minutes. 

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Free Write Friday: Candy


Her favorites were just candy canes, really, root beer and cherry, ribbon of contrasting color twirled around the candy stick. She liked how they were organized by flavor into sturdy glass jars, fanned out, as if leaning, calling to a child’s eager hand. She’d struggle with the wrapper, ask a parent for help. She was the type of child to keep the wrapper on, roll it down slowly, avoid sticky fingers and prolong the treat by keeping it intact. She never bit into a Tootsie Pop until the last minute, resisting the final satisfaction of the chocolatey core. 

She liked Smarties, similar to Sweet Tarts. Smooth discs of sugar cradled on her tongue, easy to savor incognito. She could keep a roll in her pocket, swing across the monkey bars and pop another in her mouth. Portable and practical. Anything gummy was appealing too: severing bear’s heads with her tiny teeth, the novelty of a cola flavor in chewy candy form. 

On Halloween she’d sort her sweet lot, save the best for last. Some years she waited too long, and the prized candy bar would be lost or forgotten. She was good at self-discipline, sometimes to a painful fault. Her best friend’s mother rationed their Halloween candy, doling out one treat a week. It lasted her well into the other holidays, Thanksgiving and Christmas peppered with the distant memory of a costumed past. 

She never liked Snickers, any nutty interruption to the palate seemed intrusive, unwelcome when enjoying a sweet. Instead, she preferred caramel, coconut. Almond Joy and Mounds, 100 Grand and Three Musketeers. She knew this wasn’t a popular opinion, that she should prefer Snickers like all the rest. 

She watched Willy Wonka & The Chocolate Factory in awe, wanted to float via Fizzy Lifting Drinks with Grandpa Joe, savor an Everlasting Gobstopper, dance with the Oompa Loompas, search for a golden ticket with the rest of the world. Years later, she’d visit Harrods’ shiny Candy Store in downtown London, stroll through the sleek abundance of Disneyland’s Main Street Candy Palace. Even as an adult, she’d savor the innocence in indulgence of pure sweetness, find comfort in an overwhelm of treats in a world that often runs sour. 

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Free Write Friday: Camping


We move by the light of the skies. Time untethered to seconds, minutes, hours. 

Shadows cast onto nylon tents, faded grays and greens meant to blend into earthy surroundings. Toothpicks of trees stretch heavenward, branches and bark punctuating a pale sky. Bikes laid flat on their sides, like fallen dominoes, line the campsite. Brightly colored helmets are scattered asunder. 

They grab their bikes and pump legs up the hill to the playground nestled in the trees. They twirl and slide, climb and spin, dust rising underfoot. Teeth bared, faces upturned with glee, taut with playful exertion.

They return to home base, tumble in the dust, twist in the hammock, balance on the yellow slack line situated between two sturdy tree trunks. Footprints of sneakers and toddler Crocs pepper the campsite. Dirty feet, caked with dust, the reminder of an earth long forgotten by more bourgeois days spent indoors: at school, at work, at homes walled off from such grime. Here, we can’t get our feet clean, no matter a 3 minute token shower, no matter a towel wiping down, no matter a dip in the cold ringing canal, uneven stones and oyster shells underfoot. Still the dark mark of filth between toes marks us. 

Down at the water they zig-zag across the rocky beach, search for colorful stones, treasures of abandoned sea creature skeletons, slimy seaweed. Our backs align straight in the kayak as we glide through the seafoam green toward the hazy hills beyond. A little one dips an appendage or two in the water, leaning from the front unexpectedly as I struggle to stay balanced and centered on the stand up paddle board. 

A burn ban has a dampening effect; we gather around the citronella candle as the skylight fades, skin graying to ashen. Headlamps alight, artificial and glaring. Canvas camp chairs unfold around the would-be campfire. It’s too dark and we succumb to the arc of the heavenly bodies, one seceding as the other takes reign in the sky. 

Camping is a children’s glory: timetable discarded, dirt embraced, leisure activities and food prevail unencumbered. They chase each other through the brambles, swing gleeful in the hammock, unearth large stones to discover tiny crabs frittering sideways, eager to find a new hiding place. Grime accumulates under their fingernails like dust clinging to the mantle at home. It marks them unconcerned, free from the shackles of the modern urban childhood of after school activities and rationed screen time. 

We wake to birds rustling, charcoal light reversing gray to green to sky. I arise despite myself, soak in the soreness of my bones. The light, the earthen air call me to get up, get out, move myself into the surroundings I was meant to inhabit.

We move by the light of the skies. Time untethered to seconds, minutes, hours. 

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Free Write Friday: Jewelry Box


On her tiptoes, she sneaks, carefully slides open the tiny drawers of her mother’s bedroom armoire one by one. A musty wave rushes toward her tiny nostrils, itching at excitement of fanciful objects just within reach. Each item considered carefully, she knows her favorites. 

She likes the amber shine of a pendant necklace, smooth oval jewel in her tiny hand, silver links slipped over her neck. The scarves slide through her fingers, smooth as the silken tofu her father slurps with his morning miso soup. A similar disjointed juxtaposition, her own squat neck against the designer scarves, printed floral, geometric navy and regal red. The clip-on earrings hang heavy on her tiny lobes, faux jewels shine just as bright as the real thing to her undiscerning eye. She is suddenly transformed: bejeweled, an empress, a queen. 

She wonders why her mother never adorns herself, with all these treasures at her disposal. If it were her (it will be her) she’d drape herself in accoutrements, dazzle with accessories daily.

Years later though, despite an endless array of accessory options, she wears minimal makeup, stud earrings, her wedding ring only most days. She inherits her mother’s designer scarves, her grandmother’s antique beaded purses. But, like her own mother, she learns to cultivate other treasures, she finds different priorities in her daily routine. 

She looks at her own young daughter and wonders: why the obsession with adornment, with makeup, with appearance? Her daughter watches in amazement as she puts on mascara, mimics her intently as she applies blush, begs to wear a shiny statement necklace around the house, strutting in her plastic high heels. 

Maybe we all want to appear to be more than we are sometimes, live into our imaginations. Maybe it’s okay, even necessary, to try on different, more glamorous selves. Maybe that’s part of growing into, and revealing, who we really are.

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Free Write Friday: Lockers

You have nightmares about lockers. Narrow gray sheets of metal from ceiling to floor, endless rows line the halls. You circle the maze of corridors. You’re turned around, pressured, panicked, late. You can’t find it at first, the one that belongs to you. You pause at one, then the other: all wrong, all empty. 

Others watch you, they laugh. Or, worse yet, they ignore you. You’re insignificant. If you finally find what you’re looking for, it’s shut, impenetrable. You spin the lock to the right, to the left, to the right again. The white notches of the knob blur and you realize your numbers are wrong, it’s all wrong. 

Something’s off, you can’t remember. You missed whole assignments, entire courses, a full year of your life passed by all wrong; you forgot to pay attention. You rush for help, but it’s no use. You can’t recall time and now it’s too late. You won’t resign yourself to fate, so instead you struggle. You keep spinning the lock back and forth, back and forth until it clicks open. But it doesn’t matter now. Instead of relief you feel grave, an ominous weight when you unlock what you’re looking for. The moment, the urgency, the purpose, it’s passed you by. 

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