Narrative Medicine

Narrative Medicine Monday: The Name of the Dog

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In The New England Journal of Medicine essay “The Name of the Dog,” physician Taimur Safder remembers a lesson learned early in residency. Safder is stumped when, “as a freshly minted doctor,” he presents “a patient who was admitted for chest pain after walking his dog” and his attending asks a curious question: “‘What was the name of his dog?'” Safder is initially perplexed as to why this question even matters, but when the attending physician takes the group to the patient’s bedside to inquire, he realizes that very question “led to a transformation I did not fully appreciate at the time: there was an actual person behind that hospital-issued gown.”

This lesson proves valuable to Safder’s medical training. Through it, he forms similar connections with patients that allow him to “have difficult discussions about [the patient’s] immigration status and what it meant for his treatment plan,” and sign a “treaty under which [Safder] would read the ‘studies’ [the patient] brought in about black cherry and milk thistle and she would start taking one new medication every 2 months.” In learning about a person beyond their identity simply as a patient, trust develops and the patient-physician relationship can grow.

While caring for a patient who eventually ends up in hospice, Safder comes to another realization: “the question that I’d been carrying around since my first day of residency could work another type of transformation: it helped my patients see the person behind the white coat.”

Writing Prompt: Has there been a question you’ve asked a patient that revealed essential information about them as a person? Have you, as a patient, been asked a question by a medical provider that may not have seemed directly medically relevant but was important to them understanding you as a person? What was the question? What did it reveal? Write for 10 minutes.

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Narrative Medicine

Narrative Medicine Monday: What Insomniacs Do in Bed

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Donna Steiner lets us know “What Insomniacs Do in Bed” in her poem in The Healing Muse. Steiner touches on those heightened moments in the middle of the night, when the rest of the world seems muted. She admires much, including “the under-valued texture of flannel sheets” and “the capacity of our aging lungs.” She notices the absence of all sorts of things, including “of rain, of drizzle, of shower…” Steiner wonders about “germs and mites and viruses, and whether they multiply right now,” a vivid recognition of what those of us up at ungodly hours imagine.

Over the past two decades I’ve often been awake in the middle of the night, occasionally due to insomnia but more frequently because of medical work or motherhood, nursing my own babe or delivering a new life into the world in the pale hours of almost-morning. Steiner issues a call to accept the gift of repetition, that it is a “form of education.” Perhaps the most significant to the insomniac is the “merciful repetition of daybreak.”

Writing Prompt: Have you suffered from insomnia? Does Steiner’s poem resonate with you? What do you do when you’re up at night and no one else is? If you’ve been up in the middle of the night for another reason (residency, parenting), what did you notice about being awake when the rest of the world is sleeping? Write for 10 minutes.

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Narrative Medicine

Narrative Medicine Monday: Disease’s Gifts

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In “Disease’s Gifts,” poet Joy Ladin muses on fear and life and death in the face of illness. Ladin outlines the paradoxes of disease: “That you can be fearless / when fear is all you have” and that “you aren’t alone in loneliness.” This poem is an encouragement, a call to overcome and accept and succeed, even though “fear inverts / the meaning of success.” Ladin’s poem resonates because it offers words of hope while acknowledging the incongruity of illness. Disease can feel like “the end of the world,” and yet, Ladin contends, we all want to believe “you will survive it.”

Writing Prompt: What gifts, if any, have you experienced through illness? What role do you think fear plays in disease? Review Ladin’s list in the second to last stanza; what do you need to live? Write for 10 minutes.

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Ramblings

Free Write Friday: Low Tide

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We wait until morning, sip percolated coffee, nibble day-old donuts bought at the new gourmet shop adjacent to the ferry terminal. A friend saunters up from an adjacent campsite to let us know they’re heading down to the beach. “It’s low tide, right now!” Kids circle their way back to the campsite, wheels turning. They discard their helmets as we stroll to the rocky cliff.

A woman stands by a sign outlining the local sea life, pulls up her scuba gear, ready to search for urchins, float among the kelp.

We clamber down a few concrete steps, then cling to the rock face littered with barnacles, making our way to a sandy cove. A parent points out footprints: a second grader’s sneakers, a crab’s pointed tracks, the imprints of a dog’s paws padding across the compact sand.

A rock island is exposed, tide pools revealed. Green anemones open with neon fronds, swaying gently until startled into retreat. Bouquets of mussels jut out in clusters among mossy kelp. Limpets cling to the black rock, suction secured. We stop, we bend down to observe.

Two moms well versed in marine life point out the chitons, armed with a hardy shell of armor they remind me of turtles, of shields. There are always eight plates, predictable. One child shouts out, “Mom, come over here, it’s the biggest chiton in the world!” We moms give each other a knowing look: could be, but more likely a 7-year-old’s exaggeration. Instead, we find what she describes: a chiton as big as our hand but without a shell. “Maybe someone took its plates.” The thought makes us sad, a thief of the worst kind. We look it up later and, in fact, the creature is just as it was meant to be: the giant pacific gumboot chiton is without a hard exterior. An aberrancy of its kind in size and structure.

A few more from the group straggle, venture out to the ends of the fingery point in search of an elusive seal that pops its head momentarily up above the surf before diving back down again. My son has gathered too many mussel shells, iridescent shimmer calling to him like a siren, the abundance too much to contain his enthusiasm. “Here Mom, I found another one!” I convince him to choose a solitary shell to cherish as we make our way carefully among the slippery rocks back to shore.

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Narrative Medicine

Narrative Medicine Monday: The Narrative Messiness of Chronic Illness

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Ellen O’Connell Whittet ponders “The Narrative Messiness of Chronic Illness” in a recent piece in Ploughshares. O’Connell Whittet acknowledges that illness narratives may be challenging to show in scene and that “suffering… doesn’t always have a satisfactory ending.” Yet, she notes that illness memoirs, such as those of Paul Kalanithi, Lucy Grealy, Jean-Dominique Bauby and Porochista Khakpour can be particularly engaging, “turning the story of an ailing body into a work of art.”

Bauby, who suffers from “locked-in syndrome,” tells a grueling story without a tidy ending. O’Connell Whittet grimly concludes one tragedy of his chronic illness narrative is that he “cannot… count on getting well.”

O’Connell Whittet recognizes the importance of defining a diagnosis to Porochista Khakpour in her memoir “Sick.” When Khakpour “laments to her acupuncturist that she is still without a diagnosis, her acupuncturist asks, ‘does it need a name?’ But without a name, Khakpour cannot pinpoint the words she needs to convince us, or herself, of the extent of her suffering.” How important to suffering are the words we use to define illness? Does having a specific diagnosis validate that suffering, to ourselves or to others, in a different way?

O’Connell Whittet recognizes “Khakpour’s refusal to give us order out of illness’s chaos” and eventually determines that “[r]eading accounts of chronic illness allows us to embrace the ambiguity of the body and our experiences within it.”

Writing Prompt: Have you read a chronic illness memoir that turned a “story of an ailing body into a work of art?” Think about a particular part of that book or essay that was most enthralling or enlightening. What did you learn? How did it affect you? Did the structure mimic “illness’s chaos?” Write for 10 minutes.

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Narrative Medicine

Narrative Medicine Monday: In Life’s Last Moments, Open a Window

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British physician and author Rachel Clarke advises in The New York Times that to care best for our terminally ill patients we should, “In Life’s Last Moments, Open a Window.” Dr. Clarke relays the story of a patient dying of cancer who was nonverbal but clearly in anguish. “We tried talking, listening, morphine. His agitation only grew.”

Clarke initially questions if the “sheer vitality of nature might be an affront to patients so close to the end of life — a kind of impudent abundance.” Instead she finds, as in the case of her patient with tongue cancer who merely wanted his door opened wide to the adjacent garden, many patients develop an “intense solace… in the natural world.”

It is the song of a blackbird outside her window that gives one of Clarke’s breast cancer patients perspective that even “[c]ancer is part of nature too, and that is something I have to accept, and learn to live and die with.”

Clarke shuns the idea that end of life care needs to equate to a “dark and dismal place.” Instead, she contends that what should dominate hospice “is not proximity to death but the best bits of living.”

Writing Prompt: Clarke’s patient Diane notes that cancer is a part of nature. What are the implications of this statement for you as a medical provider, as a patient, as a loved one? When you’ve been ill, have you found solace in nature? Write for 10 minutes.

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Narrative Medicine

Narrative Medicine Monday: Vicious

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Tim Cunningham gives us a glimpse of Abdul, a teenage Rohingya refugee he encounters in a Bangladesh camp, in Intima‘s “Vicious.” Cunningham notes that his “belly was swollen like the rice fields” and “[t]hough described by many as non-literate because he had no official access to school, he could read the Quran with ease. His recitation of its Surahs was exquisite.”

When Cunningham meets Abdul in clinic, his pain is “everywhere,” as if “[h]is genocide had shifted internally, an annihilation of his once-healthy cells.” Abdul had lost his appetite entirely, did not “miss dahl and rice, mangos and bananas, though he knew that he should. ”

Cunningham imagines where he might transfer Abdul, had he the resources: “They would have diagnostics for his hepatomegaly and cachexia. They would have 24-hour staff, teams of nurses and physicians to treat and listen his life-story. The providers would all speak Rohingya. These thoughts were but daydreams. For extraordinary diseases, with extraordinary measures and extraordinary means, there are ways to treat illness.  If you are Rohingya, there is nothing.”

Cunningham’s prose elicits a visceral response to his patient’s physical and emotional trials, but it is Abdul’s word of response to a difficult intravenous stick that give both Cunningham and the reader pause: “Vicious.”

Writing Prompt: If you’re a medical provider, are there certain assumptions you make about a group of patients you see? How did you feel when Abdul repeatedly says “vicious?” What do you think that word might mean to him? What does it mean to you? Have you worked in a resource-poor setting or with a marginalized group of patients before? Recall an encounter with a patient. Write for 10 minutes.

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Ramblings

Free Write Friday: Soccer

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Her cleats are neon pink, a black swoop to give them credence. She hustles onto the field, tackling her girlfriends in a playful gesture. They run drills, found on the internet by the volunteer coach. Games to teach them teamwork, footwork, skills for basic play.

We bring our camp chairs, a bag of snacks, two water bottles to quench their thirst. The littles run on the perimeter, beeline to the playground where they can swing and slide and dig in the sand for a temporary distraction.

I see the girls from afar, their ponytails wagging as they scrimmage, green jerseys tangled up in the fray. They take turns kicking into the net, ball shanked to the left, to the right. Their legs scissor across the grass, some controlled, some gangly, some running to the goal with intention, comfortable in their bodies, aware of where thye’re going and who they want to be.

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Narrative Medicine

Narrative Medicine Monday: Preparation

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Abigail Lin’s poem “Preparation” in the Journal of the American Medical Association begins with a heartbeat as the focus of a medical student’s studies. She notes “we studied valves as if they were pipes: / what makes them rust, or clog.” There’s a note of bravado as the student starts their journey in medicine: they “marveled… as if we had built it ourselves.”

The humility comes later, realizing the fallacy in believing that “we could learn the architecture of grief / simply by examining blueprints.”

I remember marveling at the intricacies of design in my college introductory biology courses. I had in mind that I wanted to be a physician, but one of my most surprising revelations was learning about botany. I was amazed by the specificity of design in plants, the complex workings of how they grow, receive nourishment from the sun, from the rain; how they give back to the earth.

Lin’s poem is a caution to new medical providers. Much of our learning is in the machinery of the patient, the inner workings of the body. So much more is involved in treating the patient, not merely the disease.

Writing Prompt: If you are a medical provider, recall when you first started studying medicine. Were you naive, as Lin’s poem asserts? Is there something you’ve studied that you’ve marveled at? Did you learn a more nuanced appreciation as you progressed in your career? Recall an instance that contributed to that maturity. Write for 10 minutes.

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Ramblings

Free Write Friday: Girl Scouts

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We met in a Methodist church on a weekday afternoon. Recite the pledge, munch a snack, craft a project. We’d earn badges through field trips, skills, lessons. I was snack helper, clean up helper. We’d rotate through, sit in a circle on the beige carpet. Make new friends, but keep the old; one is silver and the other gold.

We took our sleeping bags to overnight camp, sang songs around the campfire. Kumbaya. I didn’t like the bugs, the forest air was foreign to my sheltered suburban self. I liked the novelty of it though.

I never was good at selling cookies. My dad retired young, couldn’t take them to work like the others. Too many other Girl Scouts in my neighborhood, we had to ration out the doors to knock on. Most people were nice enough to the awkward girl in the green vest but I wasn’t animated enough to make more than a pity sale. My mom, like me, an introvert and not wanting to be too pushy, didn’t help my failing cause. I wanted to be forward, learn the marketing skills, but I never did muster the ability to sell.

I remember traveling with my troop to the Peace Arch on the northern U.S. border, admiring a stylish girl with long braids and a green beret, souvenir pins stuck to her vest. What travels she’s made, what friends she’s met! I started collecting pins that day, not to trade but to keep: document the family road trip to Disneyland, the annual summers in Hawaii, the study abroad in France, the Mekong Delta, the crowded dusty streets of India and beyond.

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