Ode to Critical Thinking: Intima in the Classroom by Barry Peters

What student wouldn’t be intrigued by being allowed “to wear nothing but hats / to school, take naked that test I won’t ever pass”? It’s a tempting, subversive double-violation of our high school dress code … and a major reason, I’m sure, why my English students often choose to analyze Jen Karetnick’s “Ode to Melatonin” (Spring 2017) at the Raleigh, NC, magnet school for medical science where I teach.

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What Was, What Is and What Will Be: A reflection on the poem “Decision” by Ron Lands by: Tharshika Thangarasa

Tharshika Thangarasa is a daughter, sister, friend and fourth year medical student at the University of Ottawa.  Her artwork    “Stroked”     appears in the Spring 2019 Intima: A Journal of Narrative Medicine.

Tharshika Thangarasa is a daughter, sister, friend and fourth year medical student at the University of Ottawa. Her artwork “Stroked” appears in the Spring 2019 Intima: A Journal of Narrative Medicine.

It is incredible how abruptly and drastically things can change. Nowhere is this more evident than in medicine.

In his beautiful piece “Decisions”, Ron Lands takes the reader through the delicate moments preceding the disclosure of a medical diagnosis to a patient. Holding the weight of the individual’s new reality, hesitant to pass it on… unsure of whether or not the person has the supports necessary to bear it.

The concept of a new reality, seemingly defined by disease is also depicted in my studio artwork entitled “Stroked”. In this image, the intricate cerebral vasculature is depicted as the branches of a tree. They serve as the highway through which nutrients are able to reach the leaf buds, allowing them to blossom. They allow blood to nourish the neurons of our higher level cortical areas, those that form our identities. A stroke, represented by the burning of these branches, is one example of a medical phenomenon that can unexpectedly, and eternally, alter a person’s life.

Yet, the task of disclosing this to the patient is in the hands of the provider. A person, who too can struggle with it’s magnitude. Providers, patients, families… no one is immune to the sometimes devastating consequences of disease.


Tharshika Thangarasa is a daughter, sister, friend and fourth year medical student at the University of Ottawa. She cultivates her own wellness at the intersection of art and medicine, and hopes to continue to embrace the humanities on her journey to becoming a psychiatrist. Her artwork “Stroked” appears in the Spring 2019 Intima: A Journal of Narrative Medicine.


©2019 Intima: A Journal of Narrative Medicine

The Art of Sparing: When the Patient May Not Want to "Hear it Straight" by Xanthia Tucker

In her poem “Overwhelmed” (Spring 2013 Intima), Kendra Peterson shares a terminal diagnosis with her patient. “I told the harsh and ugly truth/ of glioblastoma multiforme,” she writes, “my practiced words unresectable and infiltrating.” In honoring his wish “just to hear it straight,” her words both describe and become his diagnosis. Once spoken, they are “unresectable and infiltrating” his understanding of the rest of his life.

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From T. S. Eliot to Alzheimer’s: Similar Themes Within Separate Illnesses by Laura-Anne White

The final stanza of T.S. Eliot’s “Preludes” has been a favorite of mine since my college English Literature class. My professor had a passion for literature that bordered on fanatical, and all but commanded us to over-analyze “Preludes.” Haunting, perplexing, and illustrative; the words build into a fog of emotion that I have accessed at various intervals since. It feels cataclysmic, desert-like; as if you are observing the experience of another from the sidelines, which consist of nothing but dirt.

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How to Really See a Patient by Nikhil Barot


Nikhil Barot is an Associate Professor of Medicine at David Geffen School of Medicine at UCLA and practices Pulmonary & Critical Medicine and Palliative Care Medicine at Olive View-UCLA Medical Center in Los Angeles. His essay  “Numb”  appears in the current issue of Intima,

Nikhil Barot is an Associate Professor of Medicine at David Geffen School of Medicine at UCLA and practices Pulmonary & Critical Medicine and Palliative Care Medicine at Olive View-UCLA Medical Center in Los Angeles. His essay “Numb” appears in the current issue of Intima,


Nikhil Barot is an Associate Professor of Medicine at David Geffen School of Medicine at UCLA and practices Pulmonary & Critical Medicine and Palliative Care Medicine at Olive View-UCLA Medical Center in Los Angeles. He has written essays and poetry for Nautilus, The Smart Set, Open Letters Monthly, and Medical Humanities. His non-fiction essay “Numb” appears in the Spring 2019 Intima: A Journal of Narrative Medicine.


2019 Intima: A Journal of Narrative Medicine

How to Really See a Patient by Nikhil Barot

There’s certainly a personal bias for me to reveal that the vital sign I most admire is the respiratory rate. The lungs, after all, are a pulmonologist’s favorite organ. Yet the reason for my affection is that the respiratory rate is the one vital sign that can be observed from the doorway of the patient’s room. Before I place my hand on the wrist, before I pull the stethoscope out, before the leads and blood pressure cuff are in place, I can watch the heave of the chest and learn a great deal about my patient in an instant.

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How Carolyn Welch's poem "Relapse" reflects on America's opioid crisis by Angelica Recierdo

Carolyn Welch’s poem “Relapse” from Intima’s Spring 2018 issue speaks deafening volumes of how addiction can be in every corner of mundane family and home life. Especially in the context of America’s current opioid crisis, her poem does the hard work of showing the pain felt by parents in towns all over the country who have to make painful decisions in the hopes of their child’s recovery.

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Caregivers, Grief and Metaphors: Reflecting on Sara Adler's poem “Birds of Prayer” by John Jacobson

Birds of Prayer” is striking to me for the writer’s use of metaphor. I believe that both caregivers and the ill need metaphors. We especially need metaphors from nature. They reconnect us to a wider web of life where we can find some sense of belonging. They also give us distance. They help make sense of the senseless.

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Honoring the Messengers of Grief: Thinking deeply about what haunts us by poet and nurse practitioner Katherine Seluja, ARNP

I’m sorry to admit that during my own healthcare training, I was taught to carefully guard my feelings, to remain composed and “professional.” The thought of hugging a patient was considered too personal, too involved. Now, decades into my career, I have most definitely put that advice aside.

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Thinking about Love, Death and Suicide by Andrea Rosenhaft

When I attempted suicide last year, in March of 2014, I didn’t write a suicide note even though I am a writer. Instead, after I took the overdose, I stumbled back to my bedroom, collapsed into a tangle of blankets and sheets and sobbed as I murmured goodbyes to my cat, Zoe. I closed my eyes and stroked her soft fur with one hand as I waited patiently to die.

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On Bodies: The Transformative Power of Nature by poet Jesse Holth

There is something very special about the poem “Breast Unit” by Konstantina Georganta, published in the Spring 2014 issue of Intima. This poem examines nature, and the human experience, through the lens of undefined moments. It has an almost scrap-like quality, with pieces embedded and skillfully woven throughout the narrative. In a way, it’s the opposite to my poem “Anatomy in Nature”published in the Spring 2018 issue of Intima. These poems are like two sides of a single coin. While mine works to pull the inside out, finding reflections of the human body, its inner workings and organs, in plants and nature imagery, Georganta’s work pulls the outside in – relating nature to us by anthropomorphizing, humanizing.

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Swimming Alone: Thoughts on What It’s Like Being a Medical Student Thrown Into the Proverbial Deep End of the Hospital Wards by Thomas J. Doyle, MD

Thomas J. Doyle MD is an internist who lives in Providence, Rhode Island. His Field Notes essay " To Pronounce " appeared in the Spring 2018  Intima: A Journal of Narrative Medicine.

Thomas J. Doyle MD is an internist who lives in Providence, Rhode Island. His Field Notes essay "To Pronounce" appeared in the Spring 2018 Intima: A Journal of Narrative Medicine.

I can’t recall the first time I performed a death pronouncement. I’m sure I was taught how to diagnose death, but I can’t summon to mind much in the way of specifics. My recollections are vague, often from nights on call as a student or intern tagging along with senior residents as they performed death pronouncements on the wards.

On the other hand I can immediately summon to mind many other experiences from the pressure cooker of medical training. I can visualize the frothy trachea of an enormous man in respiratory failure whom I successfully intubated during a rotation in the ICU. I still cringe recalling ribs cracking under my palms as I performed CPR on a frail elderly man. I pushed rapidly on his sternum and recoiled internally even as I knew my technique was correct, recalling an attending’s advice that “sometimes you need to break some ribs for a good cardiopulmonary massage.”

I feel a personal sense of loss that I didn’t write down the emotional impact of my early experiences in learning to diagnose death. My essay “To Pronounce” is an attempt to make up for that loss.

And it is with that sense of loss in mind that I applaud William Fyfe for his essay “No Time For Tears Today,” published in the Fall 2017 Intima: A Journal of Narrative Medicine under ‘Field Notes.’ In concise, immediate, elegant prose, he captures the essence of what it’s like to be a medical student thrown into the proverbial deep end of the hospital wards. Many of Fyfe’s words resonate with my memories of training: “chaos,” “imposter,” “sheepish,” “drained,” “ashamed,” “unexpected.”

In particular, his essay captures an unspoken lesson students are expected to absorb while keeping their heads above water – that in medicine we are expected to swim because – well, because that’s just what we have to do.

Fyfe’s prose, however, hints at the emotional isolation that can creep into our lives in medicine very early on, and locates the reader squarely in the proverbial moment when we may momentarily “get it together” to confidently function with humanity.

I like to think that Fyfe’s title is intended to convey a touch of irony because, after all, a decent amount of the reason there are so many among us who become numb or burned out is because we can’t, or don’t, let ourselves have time for tears at least once in a while.


Thomas J. Doyle MD is an internist who lives in Providence, Rhode Island. He graduated from The Warren Alpert School of Medicine at Brown University in 2003 and completed training in internal medicine at Rhode Island Hospital. He practices inpatient hospital medicine at Charlton Memorial Hospital in Fall River, MA. His Field Notes essay "To Pronounce" appeared in the Spring 2018 Intima: A Journal of Narrative Medicine

A Death Is Not Closure: How Poems Can Help Bring Clarity to Our Loss by Alida Rol

Alida Rol practiced as an OBGYN physician for many years. She holds an MFA in writing from Pacific University. Her poem " After A Year in Hospitals"  appears in the Spring 2018  Intima.

Alida Rol practiced as an OBGYN physician for many years. She holds an MFA in writing from Pacific University. Her poem "After A Year in Hospitals" appears in the Spring 2018 Intima.

In her poem, “Writing Elegies Like Robert Hass”(Fall 2015 Intima), Jenny Qi wrestles eloquently with the death of her mother. She hooked me with the title, and she does American poet Robert Hass, who served as Poet Laureate of the United States from 1995 to 1997, proud. This is not a sugarcoated remembrance but a wry and thoughtful, grateful and pained elegy. I assume the speaker is Qi herself.

She layers nuanced and conflicted emotions, recalling her mother’s bad habits, like scratching “bug bites until they bled,” being “petulant and stubborn,” or driving “too fast,” but also the traits that made her so endearing: She was “so greedy for living, so hasty with love.” Qi wants to remember her mother’s generous and genuine qualities, but then in the chilling final stanza recounts the burden she still carries over how her mother died. The poem transitions seamlessly between all the unsorted, colliding feelings, before it leaves us with a closing heartbreak.

For years, I tried to write poems about my brother’s death. Over time I found the memories slipped away yet, paradoxically, a clearer picture of him began to emerge. I wrote about discovering who he was in the poem, “After A Year in Hospitals,” aware that we, the living, may perhaps be reinventing the persons who can no longer speak for themselves. Although, in this poem, I did not include my own misgivings over the way my brother died, I relate very strongly to the way Qi vividly describes her torment over her mother’s last moments.

Description alone cannot do her poem justice. It needs to be read in its entirety to experience the impact. Reading Qi’s poem reminds me that poetry has the power to evoke, through concrete images and masterfully chosen words, an empathic emotional state.


Alida Rol practiced as an OBGYN physician for many years. She holds an MFA in writing from Pacific University. Her poems and essays have won several awards and have appeared in Rhino, Passager, The Examined Life, Nasty Women Poets Anthology, and Hektoen International, among others. She lives in Eugene, Oregon. Her poem, "After a Year in Hospitals" appears in the Spring 2018 Intima.

 

 

How We Might Use a ‘Script’ in Navigating a Diagnosis of Breast Cancer by Lori Duin Kelly

Lori Duin Kelly was the founder and longtime chair of the Body and Physical Culture area of the Popular Culture Association. Her paper      "The Scar Project: Visual Language for Telling the Story of Breast Cancer in Women"      appeared in the Spring 2017 Intima: A Journal of Narrative Medicine.

Lori Duin Kelly was the founder and longtime chair of the Body and Physical Culture area of the Popular Culture Association. Her paper "The Scar Project: Visual Language for Telling the Story of Breast Cancer in Women" appeared in the Spring 2017 Intima: A Journal of Narrative Medicine.

In my article "The Scar Project: Visual Language for Telling the Story of Breast Cancer in Women" in the 2017 Spring issue of Intima, I was interested in exploring the notion of scripts women use to navigate a diagnosis of breast cancer, and the extent to which these scripts co-opt and direct a patient's thoughts about that medical experience. In particular, I was contrasting the different approaches employed by Susan Komen's "pink culture" with the stark black and white images of post mastectomy patients in David Jay's S.C.A.R. project.

Joy Liu's short story, "Triumphant," in that same issue adds to that notion of scripts and the role they play in medicine, only here the script is one written by a young researcher who has just completed a research fellowship, and feeling empowered by that experience, is confident in her ability to "blast [the cancer of her patient] into oblivion."

Part of the confidence the young physician is feeling is a consequence of another script, that generated by the company who produced a new drug with great promise in fighting renal cancer. That script of the drug company becomes easily incorporated into the script that directs the physician's performance with her patient, in large part because that script is consistent with the narrative the physician wishes to tell.

The patient, meanwhile, has his own script, and a major conflict in the story arises when these scripts come into conflict. The patient's script, which discloses that the medication causes memory lapses, crippling back pain, as well as acne across his whole body, elicits --perhaps requires-- a response from the physician that having a lot of symptoms "is a sign that the medication is probably working." Such optimism becomes harder to sustain when the next CAT scan appears. The diminished size of some lesions but the generation of new ones show results that are equivocal at best, and certainly not consistent with physician's scripted outcome for this patient, the "applause from my auditoriums of admirers," "the living testament to my mastery of renal cell carcinoma."

In the course of righting her own disappointment, the physician fails to pick up on the story that is playing out in the patient's life. His statement about his unwillingness to "throw away what's left on someone else's rainbow," his tears when his girlfriend leaves him and he is left alone with no one to settle his estate once he dies, are strong lines in the dialogue of his script, but the researcher is so embedded within her own narrative, so caught up in her own frustration over the results of the trial, that she is unable to respond, except to offer another script, one that involves his being transitioned to traditional therapy. Only after her patient takes his life do his words begin to resonate with the deep understanding of how the script of his cancer read for him.

The power of scripts, like diagnosis, is that they give shape to the chaos that is illness. They offer a direction to go, actions to take. The danger of scripts is that their power in directing the narrative can become so dominant that they fail to admit into their account competing story lines that also insist on playing themselves out. "Triumphant" ends on a positive note: the physician produces a paper that explores depression and suicide in cancer patients. But the caveat that "Soft studies don't publish well" suggests an awareness of the complex structures that undergird all narratives, and how the dissemination of some scripts sometimes comes at the peril of the omission of others, equally important and compelling.


Lori Duin Kelly was the founder and longtime chair of the Body and Physical Culture area of the Popular Culture Association. Now retired from fulltime teaching at Carroll University, Professor Kelly continues to publish work exploring the notion of how narratives become constructed around medical events and how and why the different voices within those conversations become subordinate or ascendant in constructing medical understandings. Her work has appeared recently in Sage Open and Journal of Medical Humanities.

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Poetry and String Theory: How Each Brings the Macro and Micro Together to Heal by Ingrid Andersson

Ingrid Andersson is a full-time midwife and poet in Madison, WI. She is completing her first collection of poetry, entitled  Down the Female Ages . Her poem "At The Green Burial Informational Luncheon" appeared in the Spring 2018  Intima: A Journal of Narrative Medicine.

Ingrid Andersson is a full-time midwife and poet in Madison, WI. She is completing her first collection of poetry, entitled Down the Female Ages. Her poem "At The Green Burial Informational Luncheon" appeared in the Spring 2018 Intima: A Journal of Narrative Medicine.

The Irish poet Eamon Grennan said, “I think poets are string theorists in some ways. They are trying to bring the macro and the micro constantly into a single focus.”

Few experiences focus human life and practice more, than advanced illness or the impending death of a family member. Susan Sample's poem "Indigo" (Intima, Spring 2014) succeeds in capturing the weight and span of such an experience. 

It begins in water, on a raft, with a rowed backstroke, the strong pull in the poet's chest alone beneath pale clouds and looming cliffs, cut through with dark swaths / of coal. Then, it moves to the marbled linoleum undercurrent of a hospital floor, worn through / on the threshold of patient rooms, and a dark lung mass on the X-ray of the poet's friend, the iced absence of breast another swath. Onward, in the less silent chemo suite, we're surrounded by everyday tragedies of pic lines, Hickmans and ports, and the poet's father's slow drip, as it clicks like an aperture set for a long exposure: / one sleeve of his favorite fleece rolled up. The cobalt blue of his sleeve colors the poem, as does the weighted blue of the bowl / he ate cereal from as a boy that I found on the shelf / of his apartment this morning.

Amidst the poem's heaviness, a thread runs through it like a hope, pulling and holding together body and earth, deep grief and sunlight, the particular and the universal. It runs dark and inexorable, like water, like veins through rock, like an intravenous line into a loved one. But it also runs like the sky blue yarn joining a hundred tiny squares in a quilt that a nurse pulls for the poet's father from a woven basket.

Like Susan Sample, I too write poems from life looking into the uncharted fathoms of aging parents. How do we, who strive enough every day to help strangers through pain, disintegration and dying, attend to our own ill and aging without drowning, without growing dangerously benumbed or isolated?

Poetry answers this question in its revelation of patterns, of countless connecting threads, in its refusal to disregard the details of every day and its insistence on homing them in whole people, families, culture and nature. Poetry is a healing practice, because it is a homing practice. My poem "At the Green Burial Informational Luncheon" (Intima, Spring 2018) aims to bring home the death of my mother.


Ingrid Andersson is a full-time midwife and poet in Madison, WI. She is completing her first collection of poetry, entitled, Down the Female Ages. Her writing has appeared in The Progressive magazine, About Place journal, Midwest Review and Wisconsin Poets' Calendar. Her poem "At the Green Burial Informational Luncheon" appeared in the Spring 2018 Intima: A Journal of Narrative Medicine.

Be Patient, Listen to your Patient: A Reflection on the Difficulties of Describing a Disease by Suzanne Edison

Suzanne Edison MA, MFA, writes most often about the intersection of illness, healing, medicine and art. She has a child living with Juvenile Myositis. Her chapbook, The Moth Eaten World, was published by Finishing Line Press. Her poem " The Body Lives Its Undoing " appears in the Spring 2018 Intima.

Suzanne Edison MA, MFA, writes most often about the intersection of illness, healing, medicine and art. She has a child living with Juvenile Myositis. Her chapbook, The Moth Eaten World, was published by Finishing Line Press. Her poem "The Body Lives Its Undoing" appears in the Spring 2018 Intima.

In Rachel Betesh’s poem “Admission Assessment” that appeared in the Fall 2014 Intima, the doctor observes a patient, finding the words to describe both his condition and her understanding of his experiences. She listens well, using precise language. Her first observation is visual, she sees his posture, but almost immediately that awareness is paired with hearing his breathing. She says:

 so measured these breaths break: shallow

            like rainwater with nowhere to settle:

            he parcels air; he can’t give it away.

 

Breath as a parcel, a package that can’t be given away. Breath is precious and difficult simultaneously. As a reader I am pulled into a field of empathy; the doctor trying to understand her experience of the man. She listens acutely to his “ragged song of breathing.” and “the natural sweetness of the body / reduced to laboring: an immeasurable effort,…”

The doctor listens to what is being said as well as what is not being said. She hears his breathing and his words. He “cradles” his hand, the size of a grapefruit, and says, “now it’s everyplace, / and the air seeps and sings out, out without measure.”

She thinks his words are the most salient reason for hospitalization and should be in her assessment: “now it’s everyplace.”

The doctor is aware that not everything can be seen, that this hand is the most visible aspect of his cancer; but she knows it is in his kidneys as well.

I am reminded of William Osler’s words of wisdom to his medical students at Johns Hopkins, “Listen to your patient, he is telling you the diagnosis.”

What can’t be seen is often true in autoimmune diseases as well. Listening to a patient describe the experience of his or her body might help a doctor find a diagnosis, but not always.  My poem, “The Body Lives Its Undoing” (Spring 2018), speaks to this experience. Initially I use the words koyaanisqatsi and uggianaqtu from Native people’s languages that speak directly to a “life out of balance,” to the body “behaving strangely.” Then, I try to enact the feelings of the patient through the sounds of words: cawing, cacophony, clattering; hard ‘c’ sounds that cut, which lead to the image of chaos.

How to let others know the internal feeling of an autoimmune disease.  Not only the sounds of feelings, but in images such as “cascading through flames / joints and muscles dragging like a loose muffler on asphalt” that try to portray the feelings of exhaustion and inflammation that come with most autoimmune diseases.

The patient in my poem wants to find balance, knows she is “listing” in a “turbulent sea” with disease, but wants to navigate it with “…my hand      on the tiller.”

Listening with eyes, ears and an open heart and mind is what most patients want and need, even if there is no definitive diagnosis, treatment or cure. Hearing their words and giving attention creates empathy, which goes a long way towards healing and helps the patient deal with the ups and downs of a disease.


Suzanne Edison MA, MFA, writes most often about the intersection of illness, healing, medicine and art. She has a child living with Juvenile Myositis. Her chapbook, The Moth Eaten World, was published by Finishing Line Press. She has been awarded grants from Artist Trust; Seattle City Artists, and 4Culture of King County, Seattle. Poems are forthcoming in About Place Journal; Other poetry can be found in: JAMA; SWWIM; What Rough Beast; Bombay Gin; The Naugatuck River Review; The Ekphrastic Review; and in several anthologies including The Healing Art of Writing, Volume One. She is a board member of the Cure JM Foundation and teaches writing workshops at Seattle Children’s Hospital and Richard Hugo House in Seattle. www.seedison.com. Her poem "The Body Lives Its Undoing" appears in the Spring 2018 Intima.

 

We Need More Stories From Young Patients by Kelley Yuan

Kelley Yuan will begin her studies at Sidney Kimmel Medical College in 2018 as part of the Penn State/SKMC combined BS/MD program. Her paper entitled " Stories from Kids: The Unheard Voices of Pediatric Patients " appears in the Spring 2018 Intima: A Journal of Narrative Medicine.

Kelley Yuan will begin her studies at Sidney Kimmel Medical College in 2018 as part of the Penn State/SKMC combined BS/MD program. Her paper entitled "Stories from Kids: The Unheard Voices of Pediatric Patients" appears in the Spring 2018 Intima: A Journal of Narrative Medicine.

Thousands upon thousands of patient narratives. Remember the one from the eleven year old? Me neither.

We need more stories from young patients. They experience illness and emotions just as exquisitely as adults, if not more so. From their accounts we stand to learn a great deal about pain, hope and resilience. My piece, Stories from Kids: The Unheard Voices of Pediatric Patients, represents a small fraction of the many younger voices that narrative medicine has overlooked.

A great example of seeking youth voices is Ali Grzywna’s work, Anorexia Narratives: Stories of Illness & Healing. The accounts she gathered from anorexic teens and adults reveal how anorexia gave them a sense of control, a coping mechanism for other stressors, or a form of identity. Notably, she featured teen voices and the teen experience.

Based on this understanding of the underlying thought processes, therapy has evolved to treat anorexia. Instead of casting off the anorexic identity, patients learn to reshape the narrative to change their behavior—learning to select the healthy voice over the anorexic voice, instead of muting the anorexic voice altogether. Teen stories spurred progress.

Our current understanding of how children and adolescents interpret illness is dreadfully narrow, especially given the recent rise in juvenile autoimmune diseases and adolescent mental health issues. Without the youth perspective, our search for better treatments remains incomplete. The more we seek their stories, the more we can uncover to help these young minds and bodies heal.


Kelley Yuan will begin her studies at Sidney Kimmel Medical College in 2018 as part of the Penn State/SKMC combined BS/MD program. She studies illustration and fences épée when she should be revising for exams. Her work seeks to capture the rare, light-hearted moments in a field filled with pain, fear, and tough decisions. Her paper entitled "Stories from Kids: The Unheard Voices of Pediatric Patients" appears in the Spring 2018 Intima: A Journal of Narrative Medicine.