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The Reading Room: A review of ‘The Development of Narrative Practices in Medicine c.1960-2000’

1 Apr, 15 | by cquigley

 

The Development of Narrative Practices in Medicine c.1960-2000

Jones E M, Tansey E M. (eds) (2015) Wellcome Witnesses to Contemporary Medicine, vol. 52. London: Queen Mary University of London.

 

Reviewed by Ben Chisnall, Medical Student, King’s College London, UK

 

“Narrative medicine” is a term used to refer to a number of analytical and interpretative approaches towards medical practice and interactions between patients and doctors. Its remit is broad, and encompassed within its boundaries are examinations of the personal and professional stories of doctors and patients, the sense-making processes of medical discourse, literary representations of medicine and its practitioners, and the scrutiny of medical forms of writing. Yet it remains a nebulous term, and this book – a transcript of the Wellcome Witness Seminar held at Queen Mary, University of London in June 2013 – brings together many of the individuals who have driven the development of narrative medicine studies in the UK, USA and Europe to provide insight into the scholarly currents which have shaped the field as it stands today.

The book takes the form of a discussion in which a series of narrative accounts are provided by academics and clinicians, many of whom can be regarded as protagonists of the narrative medicine movement. These narratives chart the chronological development of narrative medical studies and the reasons behind its integration into universities and medical schools. What comes across as a major concern of those involved is the desire to better hear the voice of the patient, and to incorporate the patient’s perspective into the thought processes of doctors.

The discussion begins in the 1960s and 1970s, with the introduction of humanities academics into US medical schools. The two main reasons for this, the book suggests, were the desire to provide a more balanced education for medical students, and – as Professor Kathryn Montgomery explains – to “keep [students] interested in patients as they went through the great grinder.”

What is hinted at but not answered in the discussion is whether the interest in what is now referred to as “patient-centred care” within the medical profession prompted a reaching out towards the humanities, or whether the development of narrative medicine and medical humanities departments drove the medical interest in understanding the patient’s perspective. One suspects that these explanations are both correct, and that a gradual alignment of interests between clinicians and humanities academics led to a shared interest in narrative practice in medicine.

The book also touches on larger social trends which may have driven and been driven by increasing interest in narrative medicine. The growth in popularity of celebrity illness memoirs – examples given in the text by Professor Arthur Frank include the Newsweek journalist Stewart Alsop’s column about his leukaemia, and the personal accounts of breast cancer by journalist Betty Rollin and First Lady Betty Ford – indicate a growing desire to hear the voice of a patient and their experiences and interpretations of their own disease and interactions with the medical profession. A recent and useful regular addition to the British Medical Journal entitled “What your patient is really thinking” is a good illustration of how patient voices have come to be valued and their experiences seen as enlightening both for doctors and for lay readers and listeners.

Alongside the development of narrative medicine has been the establishment of medical ethics as a field of study in its own right, which the book identifies as a parallel and reinforcing influence on narrative medicine. Literature and narrative can be used to apply ethical concepts in practical situations, and stories can provide the shift in perspective needed to understand complex ethical dilemmas. Yet as Arthur Frank highlights in the discussion, medical ethics as a discipline does not capture the element of suffering inherent in narratives of illness; this is where narrative medicine can act as an influential force on ethics.

Whilst these developments were happening in the English-speaking academy, narrative medicine in mainland Europe – as described here by Professor Jens Brockmeier from the American University of Paris – looked more towards influences from psychiatry, psychoanalysis and Freud. What emerges is the sense of the ideas behind psychoanalysis working their way into the medical academy through the growth of psychiatry as a scientific discipline during the 20th Century. So too is the study of hermeneutics, which runs through much European analytical literature, applied to the process of medical interpretation: of texts, tests and tales of patients.

The discussion in the book is far-ranging in theme and chronology, and contributions are well marshalled by Professor Brian Hurwitz in the chair. It provides valuable and thought-provoking insights into the beginnings of the narrative medicine movement, and the various and geographically diverse voices captured in the text give a heterogenous feel befitting the nature of the subject under consideration. Although narrative medicine is currently a specialised area of study, the topics under discussion in the text are accessible and applicable for those unfamiliar with the field.

Reading the book brought to mind the influence of those principles at the heart of narrative medicine on the reporting of and reactions to two scandals in the NHS which have been in the public consciousness recently – the Francis Report into the standards of care at the Mid Staffordshire NHS Trust, and the revelations of abuse at a number of NHS hospitals by Jimmy Saville in the 1960s and 1970s. Mention is made in the discussion of a “crisis of compassion” in the modern NHS, and the poor standards of care at Mid Staffs were uncovered when patient voices – many of whom were elderly, and therefore less likely to command attention – were listened to and acted upon. Similarly, the rise to prominence of the voice of patients after years of dismissal led to an investigation into Saville’s abuse. These are prime illustrations of not only the impact that narrative can have on modern healthcare, but also on how the ideas behind narrative medicine delineated in this book have become widespread and valued.

Medicine Unboxed: Students 2015 – An Invitation to Participate

24 Mar, 15 | by Deborah Bowman

Medicine Unboxed: Students 2015 – Call for Participation

 

Medicine Unboxed aims to inspire debate and cultural change in healthcare. Medicine today exists at a time of extraordinary scientific knowledge and therapeutic possibility but faces challenging moral, political and social questions. Medicine Unboxed engages the general public and healthcare audiences with a view of medicine that points to human experience, ethical reflection and political debate alongside scientific achievement. We believe the arts can illuminate this perspective, inspire conversation on the values implicit to good medicine and foster a sense of awe and wonder. Our annual events – Unboxed (2009), Stories (2010), Values (2011), Belief (2012), Voice (2013) and Frontiers (2014) – attract audiences of over 300 people, and draw writers, politicians, philosophers, musicians, performers, theologians and artists into dialogue with clinicians and patients. These events are theatrical, moving and challenging. Our event this year, on 21-22 November in Cheltenham, explores Mortality.

 

Now in its third year, the Medicine Unboxed: Students event brings students of the arts, health and medicine together to share, explore and converse, drawing on the unique perspective and experience of being a student or in the early stages of a profession. Medicine Unboxed: Students 2015 takes place on the afternoon of Friday 20th November and we are seeking proposals for participation in this event and to be interns for Mortality.

 

Medicine Unboxed thrives on diversity and inclusivity. We are particularly keen to welcome students (undergraduate or postgraduate) from all backgrounds, including (but not limited to) art, drama, music, medicine, literary studies, philosophy and allied health subjects. You can submit a proposal in one of four broad categories:

 

  1. Provocations and Debates– proposals are likely to focus on a contested aspect of health, illness and its treatment and/or to explicitly engage with multiple points of view;
  2. Exhibitions and Performance– submissions in this category are likely to be creative e.g. poetry readings, monologues, excerpts from plays, creative writing, musical performances, stand-up comedy, art exhibits, short films etc.
  3. Workshops and Interaction– proposals may include experiential activities such as drawing, creative writing, singing and voice activities, improvisation etc or an interactive approach to a question or concept.
  4. Conversations– submissions in this category are likely to take the form of short papers or prompt material presented to, and discussed with, the audience.

 

Proposals may be from individuals or groups. They should be no longer than 500 words and include the i) title, ii) format, iii) names and affiliations of the people involved and iv) a summary of the contribution proposed. You should also indicate in which category you would like your proposal to be considered.

 

Please email your proposal by 6 July 2015 to Dr. Sam Guglani (sam@medicineunboxed.org). All proposals will be reviewed by the advisory group for Medicine Unboxed: Students and decisions will be communicated by 20 July 2015. 8 winning entries will be selected to present at Medicine Unboxed: Students (20th November 2015) and to act as interns for Mortality (21-22 November 2015) with travel and accommodation for the weekend included as part of the award.

 

 

Follow:             @medicineunboxed and @MUstudents

Explore:           http://mustudents.wordpress.com/ and http://medicineunboxed.org

Join:                 https://www.facebook.com/groups/175072369272118/?fref=ts

Mail list:          https://www.facebook.com/medicineunboxed/app_100265896690345

 

 

ePatients: The Medical, Ethical and Legal Repercussions of Blogging and Micro-Blogging Experiences of Illness and Disease – Call for Papers and Conference Details

22 Mar, 15 | by Deborah Bowman

Queen’s University Belfast, 11-12 September 2015 Call for Papers

Referring to the growth of online patient-initiated resources, including medical blogs, the BMJ noted in a 2004 editorial that we were witnessing ‘the most important technocultural medical revolution of the past century’. Ten years later, the controversy caused by Bill Keller’s opinion piece in the New York Times (‘Heroic Measures’, January 2014) and a blogpost on the Guardian US website criticising Lisa Bonchek Adams’s decision to tweet her experience of breast cancer, remind us of the ongoing sensitivities surrounding online patient narratives and the complex relationship between the world of medicine and social media. Emma Keller, the freelance journalist (and wife of Bill Keller) who questioned Adams’s use of twitter to discuss terminal illness, wrote the following: ‘Should there be boundaries in this kind of experience? Is there such a thing as TMI? Are her tweets a grim equivalent of deathbed selfies? Why am I so obsessed?’ Adams, in emails to the Guardian, said that the column was ‘callous’ in its treatment of her and noted that the blogpost was riddled with inaccuracies and quoted a private direct message without permission.

As debates on the ethics, dynamics and even legal repercussions of online patient narratives become more prevalent, an international, interdisciplinary conference at Queen’s University Belfast, hosted by the Health Humanities Project Research Group at the Institute for Collaborative Research in the Humanities, will focus on how those with life-threatening or incurable illness use social media, as well as the medical, ethical and potential legal consequences of online accounts of pain, suffering and the clinical experience. We welcome paper proposals dealing with ePatient accounts from a variety of countries and cultures which address the following questions:

  •   What does the rise in social media (“web 2.0”) participation by patients tell us about the ways in which the growing influence of e-patients is challenging the power structures of traditional healthcare and, as a result, proving contentious?
  •   In what ways might social media narratives of illness be seen as a useful source of information for medics? What, conversely, are their limitations?
  •   How do patients influence their online followers, and vice-versa?
  •   What are the ethical issues involved in documenting ‘the public deathbed’?
  •   What are the potential legal consequences of publicly chronicling the clinical experience?

250-word proposals for 20-minute papers (or three-paper panels), in English, should be sent to Dr Steven Wilson by email attachment at the following address: steven.wilson@qub.ac.uk. The deadline for receipt of proposals is Friday 3 April 2015.

Art in Arthritis by Nancy Merridew

22 Mar, 15 | by BMJ

 

 

I called Marco from the waiting room.

 

Everyone looked waxen under the fluorescent lights of Rheumatology Clinic. His olive skin looked grey. He rose like a grapevine on the trellis – thickset but gnarled through the seasons.

 

Marco helped his wife with her handbag and they walked together. Her gait was robust; his was antalgic and unhurried, though slower than he’d have liked.

 

In the consulting room we shared our introductions. I explained that I was aware of his medical history and asked “what are your biggest joint troubles today?”

 

Marco’s molten voice was rounded with a beautiful Italian accent and 80 years of life.

 

Apologising in fluent English Marco said that he didn’t speak English well and that it’s important to “talk the talk” of the doctors.

 

He looked down, reached into a shopping bag, and handed me three sheets of drawings.

 

I was stunned by beauty, utility, and clarity.

 

Brown ink outlined each picture, backfilled with camel watercolour. One image revealed the face of a younger man and the muscular shoulders of youth – his mind’s eye self-portrait.

 

Marco nodded to confirm that he had drawn them all.

 

Each drawing was anatomically correct and swelled from the parchment like parts of an amputee ghost. In some, his bones were bare. In others Marco had blended superficial features of skin with deeper structures of the appendicular skeleton.

 

A left hand floated on one page, like Adam’s in his Creation on the Sistine Chapel ceiling. Words – “Pain here” and “Here too” – were anchored by lines drawn to the hand, portraying metacarpophalangeal and proximal interphalangeal pain.

 

Figure.1_Hand.Shoulder_BMJ

Figure 1. Annotated drawings of right shoulder, face, and left hand:

  • “Pain here” [SHOULDER]
  • “Pain here” [5th METACARPOPHALANGEAL JOINT]
  • “Here too” [2nd METACARPOPHALANGEAL JOINT]
  • “Pain here” [FINGER]

 

Six weeks earlier a rheumatologist had diagnosed Marco with recurrence of polymyalgia rheumatica, with shoulder and small joint features, and with a possible component of new onset rheumatoid arthritis. Recurrent carpal tunnel syndrome was diagnosed in his right hand.

 

On the other pages Marco had drawn his hips, knees, and feet, and annotated their aches with cursive writing.

 

These bones it seems that they are coming apart. When I walk for about ¾ of an hour then it start to give pain. Swells up and gets quite hot. The knee.

 

Figure.2_Knee.Foot_BMJ

Figure 2. Annotated drawings of foot and knee:

  • “Pain here especially at night.” [KNEE]
  • “These bones it seems that they are comming (sic) apart. When I walk for about ¾ of an hour then it start (sic) to give pain. Swells up and gets quite hot. The knee.” [KNEE; TIBIOFIBULAR JOINT]
  • “Pain here last for days on both feet. Not all the time” [TALUS]

 

Marco was seen in the hospital’s Orthopaedic Clinic for severe osteoarthritis of his knees.

 

A carpenter, who still bent those knees to work, Marco explained that he once did a Fine Arts degree to support his business. Beyond that expertise, his careful handling of the autographed pictures revealed an artist.

 

The edge of one page cut through the word “foot” at “foo” which perhaps reflected Marco’s life.

 

Born during the Great Depression he was of the frugal generation – practical, resourceful, industrious. I wondered if Marco had ever rationed paper as a luxury, each sheet precious and saved for handsome cabinet designs.

 

Perhaps as an artist, unwilling to share flaws, he had cropped a larger page of sketches.

 

Figure.3_Hip.Foot_BMJ

Figure 3. Annotated drawings of right foot, pelvis and right lower limb:

  • “Both feet hurt at times” [FOOT]
  • “Pain in here sometimes not all the time” [HIP JOINTS BILATERALLY]
  • “Right leg. Pain here” [FEMORAL HEAD, TIBIAL PLATEAU]

 

I was enthralled.

 

Marco’s eyes danced like bubbles from the surface of Prosecco – the muted pleasure of artistic pride.

 

Already he had offered his pictures to me three times as a gift.

 

Yet I had declined as it seemed too generous. I thanked Marco and encouraged him to keep bringing the drawings to appointments given their clinical value.

 

I completed the history.

 

Marco’s main concerns were steroid-related weight gain, although his arthralgia had improved.

 

As he talked I noticed subdued hand gestures. Given his Italian heritage, perhaps Marco suffered a cultural version of locked-in syndrome from the pain that restricted his upper limbs.

 

After completing the physical examination, I liaised with my registrar about Marco’s clinical plan. In a makeshift gallery behind the consulting suites I showed his artworks to the rheumatologists.

 

They advised that I could keep the pictures, and to take photocopies for the medical record. I made an extra copy either for me or for his art portfolio.

 

I returned to the clinic room. Marco’s wife, who had been silent, was keen to hear the consultants’ opinions of his drawings.

 

She beamed on learning that they were unanimously said to be “the most beautiful ever seen in clinic”, and particularly enjoyed by the Head Professor of Rheumatology.

 

Again Marco offered his pictures and this time I accepted with delight.

 

Smiling, he received his own copies as I explained his treatment changes and follow-up plan. We shook hands. Those aching hands created beauty and conveyed exceptional insights.

 

I watched as he left with his wife and wondered about their lives, leaving Italy to bring their charisma to Melbourne.

 

Two days later I framed the drawings – an exquisite medical document and gift. They hang in my home and evoke Marco’s grace, eloquence, and vitality.

 

* * *

 

Acknowledgements and Postscript

 

Marco, a pseudonym, has consented to the release of his artworks for the purposes of this article. See Figures 1, 2, and 3. Sincere thanks to the patient for his generosity and insights.

 

Thanks to Dr Thomas Lawson Haskell BMBS for his excellent photography of the drawings.

 

Correspondence: Dr Nancy Louisa Gwen Merridew BA BSc MBBS DTMH

Basic Physician Trainee, Launceston General Hospital

PO Box 1328, Launceston, Tasmania, Australia 7250

Nancy.Merridew@gmail.com

Tiger Country (Hampstead Theatre): A Review by Aneka Popat

13 Jan, 15 | by Deborah Bowman

 

 

For some, the workplace is synonymous with shiny desks, immaculate windows and a calm open sea of computers, complete with the reassuring hubbub of Monday morning gossip. Yet, for those that work in the capital’s hospitals, the workplace is a jungle where the gleam of a scalpel and the unforgiving glare of ward lighting mark the territory. We are in Tiger Country, a world where instinct stirs and we flirt with fate.

 

Nina Raine’s Tiger Country is a thrilling drama about professionalism, prejudice, romance, ambition and failure in an overburdened health service. It is far from the hyperbolic depictions of television soaps. It is frank and honest, exploring not only the daily challenges of a busy London hospital, but also the impact on the individual of being there both literally and metaphorically.

 

The emotional core of the play is with two ambitious female doctors, at different stages of their training, but each determined to succeed. Emily (Ruth Everett), a junior doctor, represents Tiger Country’s young blood. Though rigorous and thorough in all she does, we see her vulnerabilities as she attempts to juggle her professional identity and her relationship with medic boyfriend James (Luke Thompson). In contrast, Vashti (Indira Verma), the single and driven urology registrar rediscovers the identity that was increasingly obscured behind the surgical mask.

 

Raine seamlessly integrates medic ‘slang’, and inside jokes in her docu-play and avoids caricatures. The 14-strong cast creates a working hospital in all its diversity and detail. The squeaky wheels of hospital beds, the disposable coffee cup beside the computer station and the power walks of staff contribute to a stylistically sensitive set. The audience sits either side of the stage and is immersed in the frantic hospital environment. Fergus O’Hare deserves a special commendation for his sound design with Bollywood numbers sitting alongside the melodies of Nitin Sawhney.

 

Tiger Country is a sharp and quick-witted play about hospital culture. It offers more than a view of hospitals and the NHS. The piece is an intelligent examination of the human cost and achievements of medicine.

 

Tiger Country is at Hampstead Theatre until 17th January: http://www.hampsteadtheatre.com/whats-on/2014/tiger-country/

 

Aneka Popat, 4th Year Medical Student

St George’s, University of London

m1000780@sgul.ac.uk

 

 

Letting go of ourselves; how opening our minds will let us understand our patients by Benjamin Janaway

10 Jan, 15 | by BMJ

 

Empathy is described by Webster’s dictionary as ‘the feeling that you understand and share another person’s experiences and emotions’ 1, the subjective knowledge that you can be inside the mind of another and feel things as they do. I would argue that although this is a beautiful concept, due to the variation of people’s experiences, the stories of their lives and their dreams and aspirations, no one can ever truly empathise before letting go of themselves.

In my work I often hear long stories, sometimes connected, mostly unconnected, with the physical symptoms that a patient displays. It is more often than not, as previously discussed in another of my articles, the change in a patients way of life is their main concern, not the physical problem causing it. It is the subjective perception of an objective physical or mental change that presents the drama within his or her own mind.

Through my extra academic work into philosophy, psychology, neurology and through reading classical literature, I have noted a basic human desire to label and explain the external world with reference to ourselves. This message is conveyed in either parable or direct prose from religious texts, to Stephen Hawking’s ‘A Brief History of Time’, where Hawking quotes;

Humanities deepest desire for knowledge is justification enough for our continuing quest. Our goal is nothing less than a complete description of the universe we live in2.’

Hawking’s grace with words beautifully expresses an underlying psychological process that may at times burden our brains but at the same time paint the canvas of our deepest dreams and questions. We wish to know the universe to know our purpose, to know ourselves, to explain changes in the universe we see to give us some inkling of their significance, and how we our significant.

Happiness, sadness, anger and many more are all primal responses to the complexity of the universe we see, something deep within us, explained through psychology as conditioned responses, through anatomy as limbic activation3 and through literature as the beauty of things. We paint our image of the universe with our own brush, the paint coloured by our own lives.

Those who have read ‘Love in the Time of Cholera’ will know the bitter beauty of a life spent in the shadow of unrequited love, and you may have your own judgements about Florentino Ariza and his choices4. Some may argue that his life spent in waiting represents the purest of human love, the greatest that our minds and words can create, is a life well spent. Others may argue that his life was wasted, opportunities missed in the false deification of a lost summer love. I would argue that you are both right, that your interpretation is based on your own understanding of your universe and your own values. Florentino represents a longing deep in all of us to connect with another, and in a deeper way, to connect with the universe itself.

I would argue that it is the variation in our perspectives that makes for the rich tapestry that humanity will leave hanging in our corner of the universe. Each story told is simply strand intertwined with a million others, and as doctors we have the privilege of becoming part of many. Realising that our thoughts are simply are own, our own opinion and ascribed our own value is a step in the right direction to understanding others, that standing back from your square in the tapestry allows you to see the entire works.

For a patient, a word I abhor and wish to replace with ‘John, Mary, or whoever’, their strand is redirected by illness, however minor or major, and ends leaving a different mark on their universe, a frayed edge or missed thread. For my time in oncology, seeing those facing death with bravery and pride, the last threads of their ebbing strands glowed brighter than ever before as the wonderful healthcare staff helped them tread their own path.

In treating these amazing people I learned to forget about my own views of the world, my own assumptions of the universe, to clear my mind and listen to not just their words, but what they wished to convey with them. To paraphrase a famous spiritualist, words are signposts pointing to something5, and are often taken further than what they actually mean. ­To fully understand the emotional context conveyed in a word one must lose their own assumed reaction and critique their own understanding, their own mind created connection, and see things anew.

Seeing things anew, letting go of your own views and trying to learn and understand those of the patient is the closest I argue that we can come to true empathy. Even suffering the same ailment does not mean you see the disease the same way; it does not paint the same story or change your view in the same way. In the end medicine is not just dealing with disease, it is dealing with the minds and dreams of those, who through forgetting ourselves, and we are simply part of one cosmic consciousness. We are all painters, each with our own brushes and colours, but only by letting go of our own can we pick up another’s.

At the beginning of this article I quoted Webster’s definition of empathy, but I now propose a minor amendment,

‘the process by which letting go of your own view, you may understand and share another person’s experiences and emotions’.

By seeing the universe through the eyes of another, we can see how their story changes and how we can help shape their narrative, guide their thread, or steady their hand, in making the mark they wish to leave on this universe. That, I argue, is our empirical job as doctors, to help people be who they wish to be. So as healthcare professionals, junior or senior, how do we achieve this? Greet each new person with the zest you approach a new novel, without assumption, without preconception and with open arms and mind.

ben.janaway@nhs.net

The opinions above represent those of the author and do not necessarily reflect those of SDHCT or associated NHS affiliates.

 

References

  • http://www.merriam-webster.com First accessed 27/12/14
  • Hawking, S. A Brief History of Time, 1988, Bantam Books, Transworld Publishers, England
  • Peters, S, The Chimp Paradox, 2011, Ebury Publishing, England
  • Marquez, G G, Love in the Time of Cholera, re-published 2008, Penguin, Australia
  • Tolle, E, The Power of now’, 2001, Hodder Publishers, England

Gamal Hassan: “Stoker’s plight: Is Murderous Instinct Nature or Nurture?”

20 Dec, 14 | by Ayesha Ahmad

A review of the film “Stoker” USA 2013 directed by Park Chan-Wook

Mental illness and its impact on individuals and families have inspired film-makers from all around the world. “Stoker” directed by the visionary film maker Park Chan-Wook (of “Old boy” fame, http://en.wikipedia.org/wiki/Oldboy_(2003_film) is a family drama with a different twist.

more…

Khalid Ali: “In the Shadow of Guardians: A Review of ‘Radiator’ and ‘My Old Lady'”

20 Dec, 14 | by Ayesha Ahmad

“Radiator” screened at the London Film Festival October 2014, star rating: 4* directed by Tom Browne, due to be released in 2015

“My old lady” is currently in general release in the UK, star rating: 3*, directed by Israel Horovitz, http://cohenmedia.net/films/my-old-lady

The Oxford dictionary defines the word “guardian” as ” a person who is legally responsible for the care of someone who is unable to manage their own affairs, especially a child whose parents have died”. Two new British films “Radiator” and “My old lady” explore the role reversal of a “guardian” in two families when children take over the caring role for their frail parents.

more…

The Good Surgeon by Shekinah Elmore

19 Dec, 14 | by Deborah Bowman

 
I don’t know what to do with my life. I love surgery and I love people. It is frequently implied to me, without much subtlety, that those values are steeply at odds. “Surgery? I’m surprised! You’re so patient, you take time to explain things, and you don’t seem to get frustrated.” The resident had just met me for the first time, watching me explain the importance of anti-hypertenisve medications to one of my patients at a primary care clinic in a small and underserved town near Boston. I sighed at her comments, and couldn’t help but laugh. Did surgeons have such a bad reputation?
I already knew the answer. When I briefly flirted with pre-medicine as an undergraduate, I loved working in the emergency department. I was drawn to the excitement and adrenaline, but liked equally the time talking with patients, making them feel comfortable in challenging, frightening times. By the time I finally committed to medicine, after working in public health and living abroad, I quickly became hooked on anatomy. I was always the first of my team to lab, having carefully read the planned dissection for the day. I had noticed on the first day of lab that our cadaver had on the brightest, most perfect red toe polish. I often wondered silently about her life as I searched for her nerves and vessels. Anatomy was beautiful, but I enjoyed working with people. I never considered surgery. In a weird twist of fate, our anatomy professor had auctioned off her old copy of Schwartz’s Principle of Surgery, I ended up buying it because I was so drawn to the cover, the weight, or so I tell myself. My professor found out that I’d bought her prized volume, asking with glee “Are you going to be a surgeon?!” I remember mumbling something only slightly more gentle than “absolutely not” and awkwardly backing away from the encounter. Surgery just didn’t make sense.

The stereotypes that we carry about surgeons are densely layered and deeply cultural. We imagine the surgeon as arrogant, technically masterful, controlling, and perhaps even quick to anger. But, he, and it is generally a “he” that stars in our fictions, is this way because it is best for the patient. By taking control and “fixing the problem,” he has obviated the need for bedside manner. For compassion. When we imagine a good surgeon, we do not often imagine a “good” doctor.
When I was diagnosed with breast cancer a few years ago, my first visit was with a surgeon. She was patient. She took the time to explain the treatment options. She did not seem frustrated. I felt comforted and optimistic. And, several weeks later, when she called to give me the news that I’d been dreading, that the PET scan showed an area of uptake in my lung, I could hear the pain in her voice. I was in shock, alone in my apartment, splayed out on the bedroom floor and reeling from the emotional equivalent of vertigo. “We will make it through this” she said with a strength that resonated with a place inside me that I had not yet begun access.
When things got better, in a very relative sense, and the nodule in my lung turned out to be a primary tumor and not a metastasis, I visited a thoracic surgeon. Though imposingly tall and perhaps a little hulking, he was boisterous and smiled easily. He held my hand tightly as I went off to sleep. I remember his voice in the recovery room saying that things had gone well. He was at my beside every morning throughout my hospital stay. His visits were quick, but always meaningful as he perched on the side of my bed and updated me on the plans for that day.
Despite my experiences with these good surgeons, these good doctors, I had still felt the burden of stereotype pulling me away from surgery. As a person concerned with empathy, with the humanities, as a woman, I had been surreptitiously and insidiously taught that surgery would not be the right fit. Now, at the beginning of my fourth year, despite these pervasive generalizations, I know that surgery is a wonderful option for any medical student.
Certainly, the personalities of surgeons likely differ, on average, from the personalities of specialties considered more person-centered. But, empathy, or the ability to imagine the experience of the other, is not out of reach for any physician or surgeon. The dance is delicate. To understand the situation of the other, to take it to heart, but to not be immobilized by it, even to push it to the corner of our minds if it impedes our service to best interests of the patient. But, to connect with a person, and then to participate in his or her operation has never really felt counterintuitive to me, and I would imagine that this is the case for most surgeons.
In fact, the most memorable surgery of my third year was a gastric bypass performed for a patient that I had known through my primary care clinic for the entire year. I squeezed her hand in the preoperative area, telling her that we would take the best care of her. In the operating room, I didn’t wince when incisions were made or closed. I was wrapt with the beauty of the surgery, thinking to myself often that this would finally help her joint pain and hypertension. Help her move again. This was the surgery that she and I had been waiting for all year.
I hope that my caring, my love of people, and my patience will be valuable, regardless of whether or not I choose to spend part of my time in the operating room. I hope that we, as a profession that includes both physician and surgeon, can ensure that the empathetic student is not deterred from surgery. And, moreover, that the empathetic surgeons, of whom there are many, can be recognized as teaching us all what it means to be good doctors.

 

Short Bio:

 

Shekinah Elmore is a fourth year at Harvard Medical School. Her creative work has been published in Third Space, the College Hill Independent, and JAMA. She was awarded first prize in the 10th Annual Michael E. DeBakey Medical Student Poetry Contest for her poem “gnosis,” and an honorable mention in the 2013 Arnold P. Gold Humanism in Medicine Essay Contest for an earlier version of “The Good Surgeon.” She is thankful to the many good surgeons who have been her carers and teachers, and looks forward to working with many more in her career in oncology. Correspondence at shekinah@hms.harvard.edu.

 

CFP: Postgraduate Medical Humanities Conference 2015 (University of Exeter, 20-21 July 2015)

11 Nov, 14 | by Deborah Bowman

CFP: Postgraduate Medical Humanities Conference 2015
University of Exeter, 20-21 July 2015
Confirmed Keynote Speakers:
Professor Stuart Murray, University of Leeds
Dr Roberta Bivins, University of Warwick
Building on the success of last year’s Postgraduate Medical Humanities Conference, this conference aims to bring together researchers from a variety of disciplines in a manner that reflects the broad scope of exciting research being carried out in the field of the medical humanities at present. We therefore welcome abstracts on any aspect of the medical humanities from postgraduates working in all disciplines, including but not restricted to English Literature, History, Film, Classics, and Art History. We also strongly encourage proposals from students training in a medical discipline (including trainee doctors, carers, psychiatrists, and other practitioners) who are interested in the medical humanities.
While this call is open to papers on all topics within the wide medical humanities remit, we would specifically like proposals on themes of contemporary importance within the field, such as the development of medicine and/or the medical humanities in India and China; representations of medicine in graphic novels; and ageing.
The conference will provide a forum for postgraduate scholars to exchange ideas and share their research in a friendly and engaging environment. The event will also allow delegates to discuss their work with senior academics in the field, including keynote speakers and other members of the Exeter Centre for Medical History.
The event will close with a roundtable discussion, featuring our keynote speakers and other esteemed members of the Centre for Medical History. This session will draw together the themes arising from the conference and reflect on future directions of research in the medical humanities.
There will also be a workshop led by Ryan Sweet and Betsy Lewis-Holmes (co-organisers of the forthcoming event Exewhirr) on public engagement.
We invite applicants to submit abstracts of up to 300 words (for 20-minute previously unpublished papers) to pgmedhums@exeter.ac.uk by Friday 19 December 2014 with “PGMH 2015 Conference Abstract” written in the subject line of the email. We also welcome panel and workshop proposals. Such proposals should include 300-word abstracts for up to four speakers in addition to a 500-word overview that explains the aims and rationale for the session.
We hope to be able to offer a small number of travel bursaries, which will be announced closer to the event.

Ryan Sweet

PhD Candidate

University of Exeter

eProfile: http://www.eprofile.ex.ac.uk/ryansweet/Academia.eduexeter.academia.edu/RyanSweet

Twitter: @RyanCSweet

 
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