The sociological concept of the “sick role” may absolve patients of responsibility for causing their illness. But it does not protect them from the stigma often associated with illness. Nor does it protect them from their own feelings and thoughts.Read More
When something dramatic, threatening, and life-altering happens, chaos frequently ensues among those affected. While individuals struggle to incorporate the trauma into their lives, the relationships among them are inevitably strained.Read More
In her poem “Letter to a 93-year-old Cadaver Who Died from Multiple Causes,” published in the Spring 2014 Intima, I feel Jennifer Stella perfectly presents the learning curve of a medical student working with their first human patient – a body gifted to them to dismantle.Read More
A life well lived is often considered to be one that has had its share of joy and sorrow. The extent of the joy we are able to experience is measured only by the depth of pain we have endured. The same could be said of a professional life well practiced. Life full of its measures of joy and grief is the subject of Ashley Chapman’s essay, “With Dignity” (Field Notes, Spring 2016).
Chapman describes how moved she was when observing her physician preceptor’s deep and genuine and human response to the news of a long-time patient’s imminent death. A response that included the seasoned preceptor’s tears.
“There is a sacredness in tears. They are not the mark of weakness, but of power. They speak more eloquently than ten thousand tongues. They are the messengers of overwhelming grief, of deep contrition, and of unspeakable love”, wrote Washington Irving. It is this very loving and true response that the Chapman admires in her preceptor.
A different response to the challenges of life is found in “Not Every Homemade Thing” (Spring 2017). This exploration of fear and grief was inspired by my mother’s valiant life with Parkinson’s disease and the consideration of inherited illness. It is a type of “ghost” story and was my response to a request to write about something that “haunts” me. During the process, I found resonance with a quote by C.S.Lewis, “No one ever told me that grief felt so like fear.”
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.
Because it is in those moments of true and human response, that we learn so much about ourselves and those we care for and love. The tears of Ashley Chapman’s preceptor served as a signpost that said: great wisdom and experience walks here. This was not the cool hands-off approach that, sadly, many of us were taught at one time. But a full hearted and deeply involved response of a caring physician.
Certainly the same can be said of examining our responses to our family illnesses. We must honor these messengers of grief and fear as indicators of a life well lived or a professional life well practiced.
Katherine DiBella Seluja, who won the Southwest Writers Poetry award, is a poet and a nurse practitioner. Her work has appeared in American Journal of Nursing, bosque, Connotation Press, Crab Creek Review, Iron Horse Literary Review and Santa Ana River Review, among others. Her first collection of poetry, Gather the Night, is dedicated to her brother and focuses on the impact of mental illness. It is forthcoming from UNM Press in 2018. Katherine works as a pediatric nurse practitioner in Española, NM and as adjunct clinical faculty at the College of Nursing at UNM. She holds degrees in Nursing from Columbia and Yale University. Katherine is currently working on a collaborative poetry project in response to the 2016 presidential election.
© 2017 Intima: A Journal of Narrative Medicine
We, as physicians should go beyond “Why do they do this?” to ask, “Where did trust break down?” and, “How may I make myself a worthy recipient of my patient’s deepest, darkest fears?”Read More
Memory may seem even more mysterious when there’s less of it—why do we remember this and not that? Other times, it seems to make perfect sense, especially with Alzheimer’s patients, who often remember earlier memories and forget later ones.Read More
Transitioning from a cross-cultural neophyte into a culturally competent warrior is a precarious and arduous process in medicine. It is typically a journey accomplished on one’s own with little guidance, training or support. It’s also a journey that requires deep self-reflection and the ability to objectively critique the culture of biomedicine.Read More
Openness vs secrecy. These subjects are familiar to anyone who has ever struggled with a serious health condition.Read More
As I read, I felt with you the fear, the pain, the madness.
The would-be caretakers – police, EMT’s, nurses, doctors – all too human and apathetic. Aren’t we all? I, too, am angry with them – for taking your dignity, and giving nothing in return.Read More
Her first night on call she is assigned the care of a man with AIDS. He is rail thin, on the slow train to death. He was once a person just like her, but now he seems frightening, repulsive, and dangerous, although endlessly pitiful.Read More
This is a blog about Intima and narrative medicine in general and all that we can read and absorb from this excellent online journal. Every issue grabs my attention for the poetry, articles and the blogs that respond to other people’s work.
My poem "Exchange" was written after my son came home from working in the Far East. He brought with him a girlfriend who had also been working with him for the British Council. Poom was Thai. We had never met before and they arrived in the evening. She was exhausted from the long flight. I had prepared a meal and over supper, a nurturing and nourishing time and good time to talk with new and old friends. She told me that her father had died and she was still very sad. We had candles on the table but we lit another one for her father and placed it in an important position near the flowers that seem to symbolize new growth, new seasons.
Then Poom started to tell us that she had had Stevens-Johnson Syndrome, a syndrome I had never heard of. But as she told us her story another narrative emerged, the emotional need to now pass on the story. This for me is what narrative medicine is all about. It’s telling our stories to a health professional who can understand what is going on for us emotionally, intellectually and physically. Poom felt, at this supper in a country she didn’t know, not long after her father’s death and this dreadful illness, that she needed to talk about it and try and rid the experience from her mind in a strange country. This was her narrative being told right now.
I was very struck by the wisdom in Vivian Lam’s Crossroad's essay "This Game We Play Called Dying." Even dying has a narrative for each individual although by the time we are in the clutches of death we may be too ill, too sick, to tell our story to anyone. So it is the people who care for us who have to interpret our story at this stage of our lives. Hence the need, as Vivian Lam says, to be able to know whether or not the dying person wants someone with him/her now or whether she/he’d rather take the final steps alone. Therefore it is the responsibility (and I mean responsibility) of the nearest person to the dying to have found out this part of the narrative while it is possible to do so. This may be the health professional who cares and treats the dying with compassion. Dying is the final and may be the most important part of the narrative.
Wendy French is a poet, whose latest collection of poems is Thinks Itself A Hawk (Hippocrates, 2016). Her collaboration with Jane Kirwan resulted in the book Born in the NHS (Hippocrates, 2013). She won the Hippocrates Poetry and Medicine prize for the NHS section in 2010 and was awarded second prize in 2011. She has worked for the past twenty years in healthcare settings. She was Poet in Residence at the UCH Macmillan Centre from April 2015-2016 and this year will be working with patients/caregivers on writing memoirs. She is one of six poets invited to Bucharest to work with MA students on translations of their novels into English. She currently is writing poems to celebrate Waterloo Bridge.
Rooms can confine us or give us a special place to inhabit. Hallways and corridors can lead us where we want to go or lead us astray. Two works in the Fall 2016 Intima, one fiction and one nonfiction, use these physical spaces to represent the emotional struggles that come with severe or mysterious illness.Read More
The mechanical properties of the heart are well understood. Tricuspid valve calcification may lead to stenosis, resulting in myocardial hypertrophy and decreased cardiac output. On the other end of the spectrum, mitral valve prolapse may lead to eventual mitral regurgitation. Eventually, chronic tendinous injury to the chordae tendineae attaching the valve to the papillary muscles may occur, producing a flail leaflet. It is simple: the heart strings produce the music of harmony.
But what of discord? What of when the harmony fails us?Read More
Medicine is full of the extraordinary every day. And really, how much extraordinary can one person absorb?Read More
We learn in medical school to take full social, family and physical histories with a new patient. We use checkboxes to run down the list of points in each history. We are taught to be thorough and document each answer.
Transitions are equally important in the hospital as day shifts to night and night to day and we hand off patients we may have been taking care of the past 12 to 24 hours. Just as children need time to adjust to a transition, so do our patients as they transition to a new day, new staff, and possibly a new baby.Read More
We are often powerless in the face of death or illness to do much besides watch; we are forced to recognize “the uselessness of love to give her breath.” This feeling of helplessness we experience, both as physicians and as caretakers, forces us to reevaluate the way we understand ourselves and the purpose behind the role we play as a family member or a healthcare provider.Read More
The game of death is quite addictive.
Of course, the stakes are high—it’s the end of all things, the last chance, last glance, last words. All-or-nothing; last-ditch effort. A lifetime of apologies, love, and tenderness condensed into a prognosis of months, days, a few gasping breaths.Read More
As I examined