More New Links

As I mentioned in my last post, I have been adding new links to “My Links List” to highlight medical literary journals that I appreciate.  This week, I was very pleased to have a poem in Pulse—voices from the heart of medicine, which is one of my personal favorites. 

Pulse is an online magazine for sharing stories about illness and healing from the patient and healthcare professional points of view.  It is also a community, where you can meet others interested in the humanistic side of medicine.

You can subscribe to Pulse for free using this link and receive emails when new issues are posted.  You get an email about once a week, so it’s not a burdensome addition to your (probably overflowing) inbox.  And I like having a reminder on a busy Friday to take a moment to pause, gain some insight into someone else’s powerful experience, and think about what my work means.

Here is a link to the poem, which you can also find in my list.  Enjoy!

New Links

I am going to add some links under “My Link List” to literary journals that I like, in case you (my readers) are interested.  I will start with some that have been kind enough to publish my poetry, not because I am shamelessly promoting myself but because you may be curious about that side of my life. 

For me, writing is inextricably connected to the practice of medicine.  We participate in a great deal of story-telling.  We are receivers and interpreters of our patients’ stories.  We add to them with our own explanations, predictions, and meanings.

The sterile and impersonal language of medical records is never quite satisfying to me as a way to express someone’s experience of illness.  A more creative method is called for.

I have added a link to the Yale Journal for Humanities in Medicine, which I particularly enjoy.  I invite you to peruse its deep and fascinating exploration of not only “the humanities” but “humanity” itself, through the lens of illness and medical care.

On October 25, 2011, you will find Mr. H Tells His Doctor about Himself.  This poem is about a patient I encountered in the ER.  After only a few minutes of strictly biomedical history-taking, he offered up an illuminating tale of spiritual healing that he had experienced. 

I must admit that I was not fully prepared to receive it.  I wanted him to supply the answers to the questions on my admission documents (a list of past diagnoses and surgical procedures, allergies, medications, etc) as efficiently as possible.  After all, it was 3 am and I had a lot of work to do. 

Instead, he gave me unexpected insight into what his renal failure meant to him.  I would have liked the chance to talk more about it but had to focus on the immediate problem of the shortness of breath that brought him to the ER.  My unresolved desire to reflect more on his personal experience grew into this poem.

Pre-op

I recently had my post-dental surgery check-up, which prompted me to go back in my notebook and see what I had written prior to the procedure.  Though this is only a minor contribution to the doctor-as-patient trope, it was my first experience of this type.  Some of you may identify with it, so I have decided to share.

I am about to have dental surgery for the first time.  Really, my first time for any surgery.  My first time for sedation.  It’s a very common procedure, which I probably should have done a long time ago.  I am still reluctant, but I can think of this in the context of my relationship with my own patients.  Maybe it will be good for me to be in pain.  I have been blessed with good health, for the most part.  This will be a new experience.  I know that it will not be the same in duration, magnitude, or implication as what many of my patients suffer, but I can still approach it as a chance for learning and empathy.

I rarely deal with the healthcare system from the patient’s side.  I have a major advantage with my level of health literacy, able to navigate this territory and advocate for myself in ways that many patients find inaccessible.  I can only imagine how hard it would be to do all these steps of scheduling, parking, registration, following instructions, asking and answering questions, dealing with insurance and co-pay, completing forms, knowing what problems to look out for during recovery and what to do about them etc, if I did not speak English well, could not read, or had any number of other barriers that routinely burden people seeking care.

I also rarely do informed consent from the patient’s point of view.  I am usually the one explaining procedures and listing the possible complications.  Yes, complications are unlikely, but even something that goes wrong less than one percent of the time happens to somebody.  When I am the one receiving sedation, medications, cutting, and extracting, the risks feel closer to home.  Even in accepting necessary risk, people never imagine that it will actually happen to them. 

I like to be in control.  I would rather be doing than receiving procedures.  It’s hard for me to submit myself to sedation or to the clouded mind of pain medications.  However, just as I need to identify with other people’s pain, I also need to be sensitive to my patients’ vulnerability.  It’s an opportunity to give up control. 

Part of my desire to be in control manifests as a compulsion to be constantly accomplishing something.  I want to be making the most of every moment, moving forward, meeting goals.  Overall, this is good.  I work hard and devote myself to a vocation that helps others.  But sometimes, I have to give myself permission to slow down.  I had to argue with myself that it was okay to take a day off after surgery. 

Ironically, turning this whole experience into a lesson is, in a way, a means to control it.

Guest Post

Check out my guest post on KevinMD!

Reunion

This past weekend, I attended my 5-year medical school reunion.  My class made an impressive showing, considering the complexity of our lives and work.  It was delightful to see everyone who could make it.  We have gone on to a variety of successes: finishing residencies, some pursuing fellowships and some finding jobs.  What made the strongest impact on me, however, was seeing how many of us have children now.  Though I have not yet contributed, the rest of my class has been surprisingly productive.  I don’t have hard statistics on this, just an impression of an unexpected quantity of babies at this event.

It is not easy to be a parent in medicine, especially a mother.  Our prime childbearing years coincide with 80-hour work weeks and very little flexibility or control over our lives.  It is hard for anyone to spend long days and nights with constant mental and physical strain, skipped meals, lack of sleep.  It is even worse to attempt this while pregnant or nursing.  Maternity leave is only 6 weeks, and any desire to take longer is discouraged by the guilt of colleagues covering for you.

We devote so much time and energy taking care of others that we often neglect to take good care of ourselves.  We come to work even when feeling sick or exhausted because the work has to get done, and we are part of a macho culture that does not admit “weakness”. 

With so many factors arguing against children, it is heartening to me that so many women (and men) are overcoming these challenges and having families anyway.  Perhaps the culture of medical training is changing over time, as more women enter medicine.  We bring with us the revolutionary concept that there is more to life than work. 

Our work is vitally important and will always require dedication and sacrifice.  However, part of humanizing medical care for patients entails treating ourselves as people too.

In Summary

I have been struggling with two distinct but complementary tasks of summary: writing a research abstract and a novel synopsis.  In both cases, I must capture the key points of a much longer work.  I must provide the busy reader with the highlights and also stimulate an interest to read more.  Perhaps most difficult of all, I must give away the ending.

The abstract gives a 300 word version of a 3500 word article.  It follows a predetermined structure with the background, methods, results, and conclusions of my research study.  The essence of a work that took two years to complete must be distilled into a form that takes ten minutes to read.  I have to admit that although the details are of great importance to me, they are not necessarily wanted by the reader. 

The synopsis is an even more daunting challenge.  I have more experience reading and writing research abstracts.  I have internalized the expectations and know how to meet them.  I am much less familiar with the literary world.  Synopses are not published with their novels, as abstracts accompany their papers.  They are read primarily by publishers and agents.  I have never played either of these roles and have, at best, a hazy impression of them.

In addition, the synopsis must summarize a 120,000 word book.  It has taken four years to write and has existed in some cognitive form for even longer.  All the subtleties of characterization, sub-plot development, imagery, and texture must be sacrificed in squeezing it down into a few pages.  It is not a pleasant task. 

However, it is necessary.  In order to send my intellectual works (both scholarly and literary) into the world, they must be accompanied by their summaries.  I am sure it is good for me in some way to go through this process, attempting to discern the most important elements and convey them to others with no prior knowledge of their source.  Even so, I will be happier when I am done!        

 

More Difficult Questions

“Doctor, do you believe in God?”

This question comes up more often than I had expected when entering medical training.  I was immersing myself in the world of science.  I anticipated questions from patients and family members about diagnosis, prognosis, or treatment options.  My studies prepared me to address these inquiries.  But science is not the only worldview on patients’ minds.

In general, I plan to avoid discussing religion and politics, since these tend to be divisive topics.  However, both are inextricably linked to the practice of medicine and cannot be ignored.  And I’m sure I am not the only one who has been asked this question in a patient care situation, so it is worth wrestling with it here.  I cannot claim to have a good answer for dealing with this, but I can offer my experience.

The most recent instance was a patient who was struggling with losing his job, in the context of depression, anxiety, and a history of alcohol and drug dependence.  Suddenly, his security, future plans, identity, relationships were all disrupted.  I have also been asked this question by a woman undergoing ovarian cancer treatment, the mother of a comatose patient in the intensive care unit, a man in recovery from a debilitating stroke, and a man dying slowly of congestive heart failure.

I could decline to answer.  There are plenty of questions that I consider outside the scope of our doctor-patient relationship and redirect the conversation away from them (such as questions about whom I plan to vote for).  But questions of faith are, in fact, relevant. 

I want to know my patients’ values and beliefs.  They are important not only in life-and-death decisions but in any condition that could be affected by social support or coping skills.  If it seems helpful to my patients to know my values and beliefs and they directly ask me, I will share.

I usually do not know the agenda behind the question at the time.  My patient and I may have very different backgrounds and perspectives.  The important thing is not that we have the same belief but that we seek to understand each other.  So, I answer honestly.  And I open up the conversation and make it okay for my patients to talk about the spiritual side of their health and illness.

Happy Easter to everyone celebrating, this week and last week.