Welcome to our Spring 2019 Issue
INTIMA: A JOURNAL OF NARRATIVE MEDICINE
As editors, we’re often asked if an issue has a theme, a common trope in publishing that makes it easy to categorize what you will encounter when entering the world of words within. But at Intima: A Journal of Narrative Medicine, we’ve resisted that idea, relying instead on a kind of literary open door policy to see what arrives. This time around, in addition to wonderful poetry, compelling non-fiction and thoughtful academic work that came in, we were surprised by a wealth of Field Notes to review. These short essays, often anecdotal in nature, are narrative accounts by clinicians, caregivers and patients that reflect moments of revelation and connection during a medical encounter or practice.
One of them, “We Should All Be Storytellers,” by Giannina Muncey, MD pretty much sums up in its title the theme of every issue we do. In it, she recounts a moment when asked by a colleague to review treatment for a patient whose sons are unhappy with her care. “As I read through the chart, I reflected on what went unsaid: she was dying. And there are only so many ways to accept the point of dying— but I’m not sure I’ve figured out any of them.” In that moment, Dr. Muncey realizes what was needed was a thoughtful conversation, not additional care. How she goes about having that talk is insightful, skillful and inspiring.
Not all of the pieces in this issue resolve so neatly, or involve a dialogue or co-construction of reality. We were struck by one Field Note (“Death’s Other Kingdom: Reflections on Uncertainty in Pathology” by Benjamin Mazer), which reads more like an interior monologue, or ‘notes to self’ entries in a journal than an essay. One editor “found the exploration of ambiguity in pathology to be quite compelling” while another commented “I like that this piece lives in uncertainty, which feels particularly relevant to the work of Narrative Medicine.” In it, Mazer, who is training to be a surgical pathologist, considers the ambiguities inherent in the profession, especially in relation to dying: “Surgical pathologists simultaneously know more and less of death than the forensic pathologist because they look at it very closely. They meticulously examine a tumor in isolation after the surgeon removes it, deriving a story from first principles. Through surgical pathology we are expected to predict demise or ward it off, stage a cancer or dismiss it as benign. Pathologists hold stories of suffering in their heads and the cause in their hands.” These expectations are often the unspoken weight carried around by clinicians. Voicing them allows the dialogue about them to begin.
Fiction, at its imaginary best, offers us fantastical worlds through which we can view our human experience— think “Game of Thrones” or J.R.R. Tolkien novels. In this issue’s fiction, birth and death are wonder enough, told with the creativity and craft of the excellent writers our editors have chosen. In “Country Doctor,” Rory O’Sullivan writes about a doctor treating a dying man, an experience “all at once special and routine,” in which his “reassuring squeeze of the arm” is “a way of piping confidence from body to body.” William French, in his story “Waiting,” brings us the thoughts and feelings inside the mind of a dying woman as she struggles to comprehend the words of her doctors, nurses and family. She approaches death with these comforting words: “There had not been any pain, never any pain. Nor had there been any fear. In the distance, she had seen faces: her mother, her father, her husband, perhaps even her older brother.”
In “The Birth Plan,” Matthew Bucknor describes a couple and their newborn son “held together close under the spell of new life” and the way a mother’s eyes when she first holds her newborn son “recognize every single cell in an instant.” The narrator’s wife urges him to tell her obstetrician that he’s a doctor, “not your typical friendly Negro.”
Narrative medicine reflects society’s concerns and issues, such as the issue of race in “The Birth Plan.” Similar matters are raised in the Field Notes. Supreetha Gubbala explores issues of being a minority and a woman of color in medicine in “Glitterless.” In “Perilous Privilege,” a psychiatrist learns that a patient’s apparent privileged life hides much more. The author, Lisa Jacobs, writes poignantly:“I couldn’t leave her smile behind. Why was she smiling? Why did she want to die when she had access to so many of life’s great gifts – youth, beauty, intelligence, and wealth?”
These and other fine works pose important questions—and offer rich inspiration. We hope you’ll read and enjoy this issue. Connect with us on Twitter @The_Intima and let us know what pieces were particularly powerful. Also, engage with us on our Crossroads blog. Each issue, we ask our contributors to submit reflections on other work they’ve read in our journal, and for the first time, we invite you, our readers, to do the same and submit yours for consideration via email to email@example.com. In it, we ask that you write about one of the works you’ve read and share your reflection about it. As always, we thank you for your support and continuing interest in Intima: A Journal of Narrative Medicine.
—Priscilla Mainardi and Donna Bulseco for the Editorial Board