Ron Lands recently retired from UT Medical Center, Knoxville, Tennessee as a hematologist.
COVID came and carried with it many reasons to reflect: the fear of a new virus unleashed on a vulnerable world, the death and disability it left churning in its wake. It also gave us Rebecca Grossman-Kahn’s essay “Confined” (Intima, Spring 2020), the product of a prescient writing prompt, the response written in the context of living in the time of COVID. Quarantine, hospitalization, isolation, and social distancing forced us to learn to love family and friends by being apart. Masks complicated our clinical work by hiding the patient’s facial cues of fear, anger, and understanding as well as the caregiver’s expressions of sympathy, empathy, and concern. Communication became another casualty of COVID.
Grossman-Kahn illustrates aspects of confinement in physical and mental illness. She dissects the complex restrictions of physical illness in an 11-year-old girl with cerebral palsy with her “legs like straws,” “strappy physical therapy equipment,” and by pain, causing her to be “tethered to her fluids and morphine.” She illustrates the ripple effect of confinement to her grandfather. The girl needs admission to a rehab facility. He must decide whether to stay with her or leave. Because of COVID, if he leaves, he cannot come back. Another example is a boy in the hospital, “trapped there by his own mind playing tricks on him,” a “video loop on replay of his fears, his worries, his anxieties.” He is further confined by the “pills to contain his thoughts.”
“Mea Culpa” (Intima, Spring 2023) is an illustration of health illiteracy in an elderly black man with poor reading skills that was initially unrecognized. He misses appointments. He wanders in the hospital, surrounded by directions he cannot read. This—another form of confinement—results in delays in his work-up, diagnosis, and treatment.
Health literacy is defined as the degree to which an individual has the ability to understand medical information and use it to inform their decisions. Health illiteracy is more likely in the poor, elderly, less educated, and minorities, characteristics common to most medical practices.
Identifying health illiteracy requires setting aside assumptions. We cannot presume that patients understand just because they nod, smile, and accept educational material. Mitigating health illiteracy requires a willingness to communicate and then confirm understanding. Doing less, in Grossman-Kahn’s words, becomes “a tangled fishing line; the harder we pull in one direction, the tighter the knot becomes” and leads to poor healthcare, dissatisfied patients, and bad outcomes.
Ron Lands recently retired from UT Medical Center, Knoxville, Tennessee as a hematologist. He is an MFA alumnus of Queens University of Charlotte. He practiced medicine for many years in East Tennessee where he grew up. He was privileged to treat strangers, lifelong friends and a few relatives. His writing is about those experiences. Find more of his work at For Lands Sake.