In her Field Notes essay “Hand Holding” (Fall 2019 Intima), Dr. Amanda Swain describes the experience of beginning her surgery rotation as a third year medical student. In the early days of the rotation, she feels an intense sense of being out of place within the “intricately choreographed dance” of the operating room. But when the next patient is wheeled in, Dr. Swain is reminded of how a nurse once took her hand before she underwent surgery, the touch conveying an unforgettable message of comfort during a time of deep vulnerability.
Read moreOn Fathers, Love and “Exit Wounds” by psychiatrist and essayist Greg Mahr
I regularly attend a poetry critique group in Ann Arbor, MI called the Crazy Wisdom Poetry Circle, named after the bookstore and tea shop where we used to meet before the pandemic. The experienced poets there have come to accept the sad and overly personal poems and flash pieces I write and help me craft them into something that sometimes almost sounds like real writing. One of them once told me, “You always write from a place of longing. That’s a good place to write from.” I realized he was right. I find it hard to share what I write with the people I love. When I am in a good relationship, I write about bad ones; when I love someone, I write about missing them.
Read moreAuscultating Meaning: Reflections on the Heart of Medicine by Marc Perlman
© Gordian Knot by Elisabeth Preston-Hsu Spring 2020 Intima A Journal of Narrative Medicine
From diaphragm to earpiece, a stethoscope dutifully chaperones a patient’s internal orchestra to a clinician’s ears. This facile acoustic communication not only allows a provider to screen for a wide host of cardiovascular, pulmonary and gastrointestinal anomalies, but it also may be a conduit for moral reflection.
Read moreDoctoring and Disobedience: Speaking an Important Truth, a reflection by Kelly Elterman
Sometimes, the truth can be uncomfortable. It can be difficult to hear and often, even more difficult to say. In her Field Notes piece entitled “Doctoring and Disobedience” (Spring 2020 Intima) Dr. Lisa Jacobs recalls her struggle with being told to hide the truth of a prognosis from an elderly patient with metastatic disease. Despite the instruction of her attending physician, and the decision of the patient’s family and ethics team to not speak of death to the patient, Dr. Jacobs feels compelled to let her cognitively-intact patient learn the truth. So strong is her conviction that she takes on considerable risk to her own career for the sake of bringing the truth to her patient.
Read moreHealing and Trauma: Recontextualizing Suffering by Sundara Raj Sreenath
Suffering due to trauma or illness often brings with it feelings of disconnect from the world as we knew it when we were healthy. The healthcare provider-healer, therefore, has an important opportunity to intervene in this unique setting and respond to the patient’s cry for help by offering a personal, humanistic touch and guiding them through trauma in addition to clinical management.
Read moreReimagining Chaos in Art and Poetry by Selene Frost
Anatomy of the Vogue by Meagan Wu. Fall 2017 Intima: A Journal of Narrative Medicine
I’ve long been fascinated by the way structure informs poetics and the practice (and in this case—reception of medical care). In my piece “Field Notes on Form,” I extol the ways in which linguistic structure has the remarkable ability to organize our thoughts, increase our signal within the noise, and etherealize the mundane. In “Post NICU Villanelle,” Joyelle McSweeney uses language not only to remediate the chaos of loss and of leaving but also to deconstruct both the poetic form and herself.
Read moreThe Cost of Efficiency and the Price of Empathy, a Reflection by Jordana Kritzer MD
After the long hours and intense learning curve of my Emergency Medicine residency, I had become one of those efficient robots who could solve medical puzzles and save lives, but I felt empty, disconnected—the classic symptoms of burn-out. I was once a wide-eyed, empathetic intern constantly criticized for trying to solve their patient’s chronic issues. I remember one attending saying, “Figure out the least amount of things you need to do to rule out an emergency.” I see now that he was trying to teach me efficiency.
Read moreLife in the Gaps: How Illness Transforms Our Sense of Time by Renata Louwers
It was in those gaps, between our lived experience—the crushing uncertainty about how long my husband would live, the daily reality of his intolerable pain, and the abrupt shift from a life of joyful ease to one spent contemplating death—and the oncology profession’s standards of care, first-line treatments, and numeric pain scales that my frustration festered.
Read moreBecoming the Superheroes Our Parents Need: The Journey from Child to Worthy Caretaker by Usman Hameedi
Our parents are often our first examples of superheroes. They make gourmet meals from minimum wage, give hugs that vanquish our demons, and provide limitless love. They are impervious to damage or decay and are always ready to save our days. So, seeing the human in them, the mortality in their breath is unsettling. When they come to need us, we feel so grossly unprepared.
Read moreAnatomy Lesson: See the Face of Those Before You by Rodolfo Villarreal-Calderon, MD
For those with the privilege of having participated in a longitudinal cadaver dissection, the connection you build with the donor’s body is known to be a truly unique experience. That bond is part of what I attempted to capture in my poem “Through Damp Muslin.” Especially reflecting on how to express gratitude to the person who once was—and now who is, or at least whose body is—lying before you.
Lady Psychiatrist Queen: Compassion in Caregiving, a reflection by Eileen Vorbach Collins
Lisa Jacobs, in her nonfiction piece, March Manic (Intima Spring 2019) describes a long shift on a psychiatric unit. She is “beyond exhausted” to the point of having questioned her own grasp on reality.
As a case manager in a Baltimore City hospital, I once spent hours attempting to find placement for a homeless 19-year-old addicted to heroin who needed long term IV antibiotics. When I asked if I might call her mother she replied “I don’t give a fuck” but retracted her permission as I was leaving the room. I pretended not to hear. The next day I was told she had signed out AMA (Against Medical Advice). a colleague said, “Get over it. She was a waste of time and resources.”
Read moreWhat Does ‘Paying Attention’ Mean in a Healthcare Setting? A Reflection by Ewan Bowlby
Ewan Bowlby is a doctoral student at the Institute for Theology, Imagination and the Arts (ITIA) in St Andrews. He is researching ways of using mass-media artworks to design new arts-based interventions providing emotional, psychological and spiritual care for cancer patients. Bowlby’s paper “Talk to me like I was a person you loved”: Including Patients’ Perspectives in Cinemeducation” appears in the Spring 2021 Intima: A Journal of Narrative Medicine.
Narrative Medicine is about creating connections: finding words, ideas or stories that bridge the gap between patients and health professionals. This search for common ground is beautifully rendered in Carol Scott-Conner’s short story “Christmas Rose” (Spring 2017 Intima). Her fictional narrative reveals how mutual understanding can emerge in unexpected places. An encounter between the resolute, inscrutable Mrs. Helversen and her oncologist shows that the relationship between a physician and patient can flourish when the physician pays attention to the intimate, personal details of a patient’s story.
Initially, the clinical encounter in “Christmas Rose” seems unpromising, hampered by reticence and disagreement. Mrs. Helversen, who has a neglected tumor on her breast, has been “strong-armed” into a cancer clinic by her concerned daughter, and she is not receptive to the prospect of treatment. Scott-Conner, a Professor Emeritus of Surgery at the University of Iowa Carver College of Medicine, switches the first-person narrative from Mrs. Helversen to her oncologist, allowing the reader to inhabit two alternative perspectives on the same meeting and reminding us that the same interaction can be interpreted very differently.
When I wrote an academic article that appears in the Spring 2021 Intima proposing that patients’ perspectives should be included in “cinemeducation,” these differences in interpretation were central to my argument. Showing clips from films to encourage medical students to relate to a fictional patient is an excellent idea. Yet listening to how patients respond to these clips can enrich this pedagogical method. As I demonstrate through the qualitative research presented in my article, patients “see things differently.” The same fictional scene featuring a patient-doctor interaction can draw responses from patients that surprise and challenge healthcare professionals. So, why not use such scenes as a space in which different perspectives can be expressed and discussed, bringing patients and providers together through the audio-visual medium?
In “Christmas Rose,” it is a rock that facilitates this meeting of minds. While the oncologist is surprised when Mrs. Helversen describes her tumor as a “rose,” betraying a complex emotional attachment to the growth, she finds a way to react empathetically and imaginatively to Mrs. Helversen’s unusual behavior. Offering the elderly patient a desert rose rock in exchange for her tumorous “rose,” the oncologist persuades Mrs. Helversen to accept treatment. This fictional oncologist shows an adaptability and ingenuity that the health professionals involved in my research also exhibited. In my article, I describe how health professionals engaged constructively with patient’s unique or unexpected responses to imagined patient-doctor interactions in films. Listening to both sides and hearing alternative perspectives on the same encounter can yield important, enlightening insights, whether one is participating in a focus group, watching film clips or doing a close reading of a short story such as “Christmas Rose.”
Ewan Bowlby is a doctoral student at the Institute for Theology, Imagination and the Arts (ITIA) in St Andrews. He is researching ways of using mass-media artworks to design new arts-based interventions providing emotional, psychological and spiritual care for cancer patients. This involves using fictional narratives, characters, and imagery to reflect and reframe patients' experiences of living with cancer, helping them to understand and articulate the effect of cancer on their lives. He is developing the impact of his research through an ongoing collaboration with Maggie Jencks Cancer Care Trust (Maggie's) and Northumberland Cancer Support Group (NCSG). Other interests include theological engagement with popular culture, the relationship between theology and humor and the use of narrative form for theological expression. Bowlby’s paper “Talk to me like I was a person you loved”: Including Patients’ Perspectives in Cinemeducation” appears in the Spring 2021 Intima: A Journal of Narrative Medicine.
Giving: What Real Generosity Looks Like in Healthcare by pediatrician Lane Robson
Giving defines us as individuals. Patients and healthcare professionals are obliged to share time together. Gifts of shared humanity transcend personal and professional obligations. These gifts might be hoped for but are neither expected nor routine.
Thresholds and Transgressions, a reflection on ICU chaos, communitas, liminality and Levinas by Nancy Smith
Nancy Smith is a retired Registered Nurse. Though she moved through the many domains of hospital nursing, most of her work took place in an Intensive Care Unit. Her co-workers noticed that she would place small strips of paper with poems by various authors on her locker from time to time along with the pictures of her family.
Read moreHow to Hold Cold Hands by Laura-Anne White
I have spent my career as a nurse working with adult cancer patients. I, too, have experience with the self-protective tool of ‘numbing.’ Last spring, the COVID-19 pandemic hit New York City at full force, and I was temporarily transferred to an inpatient, COVID-19-positive cancer unit. I saw no one aside from co-workers, patients, and other essential workers.
Read moreSpeaking Truth: The Visual Arts Help Clinical Diagnosis by Virali Shah
As a society, we are driven by visuals. Advertisements. Social media. Logos. Paintings. Pictures. It is a 21st century skill to be “visually literate.” Only recently, however, the role of visual literacy has expanded into modern medical training.
Read more"Who is Black excellence for exactly?" A poem reflects on that question by medical student Michael Arnold
Michael Arnold is a medical student at Ohio State University Heritage College of Osteopathic Medicine. His poem “Chronic Black Excellence” appeared in the Fall 2019 Intima.
Chronic Black Excellence by Michael Arnold
A hundred years ago, Abraham Flexner
Eulogized Black medicine.
The ink in his pen tattooed
A sleeve on the arm of systemic racism.
The idea that screamed off his report
And echoed the loudest throughout history
Was the notion that Black medicine
Was fundamentally inadequate.
For the last century, Black medicine
Has been self-medicating with Black excellence.
A treatment plan that may be just as bad
As the prevailing social illness.
Black excellence is a poisoned apple,
Being eaten by a Trojan Horse.
Side effects may include:
Elitist attitudes, reactionary logic
Burnout, brunch addiction
And respectability politics
The siren song of Black excellence
Has veered us completely off course.
It’s a self-appointed pedestal that
Makes us look down on the
People that we dreamed of healing.
It makes us want to walk away
From the neighborhoods that
Raised us and never look back.
Black excellence is a blade on
The tongue of Horatio Alger’s descendants;
White people who will cut and paste
Your story into anecdotal evidence
That absolves them of their privilege.
Black excellence is a weight that actively
Compresses our humanity,
Erasing the mere possibility
Of us being normal, regular or average.
It erases the relief of mediocrity
That many of our white colleagues
Comfortably enjoy during their careers.
Who is Black excellence for exactly?
What’s the message we are trying to send?
Who are we sending it to?
Are we trying to claim that we are better
Than the Black people who lifted us up
High enough to access the white-dominated
Space called Western medicine?
Are we trying to signal that we
Are one of the “good ones”?
Is it an attempt to exorcise the demons
Of ever-haunting stereotypes?
Or is it just our insecurities
Crying out, wanting desperately
For white people to finally believe
That we are adequate?
Michael Arnold is a medical student at Ohio State University Heritage College of Osteopathic Medicine. His poem “Chronic Black Excellence” appeared in the Fall 2019 Intima.
On Trauma, Hope and Dragonslayers, an essay by hospital-based physical therapist Galen Schram
Can what we know about PTSD in frontline workers who treated the victims of the Boston Marathon bombings help us understand how to care for our COVID-19 frontline workers? What will be done to understand and treat race-based traumatic stress, a term I hadn’t heard until this summer?
Read moreThe Practice of Prolonging Death, a reflection by palliative care physician Chris Schifeling
“Would we rather die too soon or too late?”
The taboo of talking about death combined with a faith in the insomnia of medical technology leads many to err far on the side of dying too late.
Read moreFinding What's Essential in Just Laundry: Painting and Poetry in Dialogue By Alexis Rehrmann
In both the painting and the poem, these particulars are gone but the objects remain and hold an impression of that past life. There’s honor in caring for these objects, in both our daily work and our creative lives.
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