reading Richard Westcott’s “Bright is the Ring of Words,” in the Spring 2107 Field Notes was the watering for that seed of idea that encourages us to always listen to the story of a patient or person we are facing.Read More
Chaos stories can be “told” through metaphor, gesture, and image. We need to find ways to expand our capacity to listen to these types of patient (or family member or community) stories.Read More
In Sarah Shirley’s poem ‘Wernicke-Korsakoff’ (Intima, Spring, 2017), she elucidates the dilemma of caring for a patient who is angry, non-compliant, inarticulate, hostile, confused, or otherwise “difficult”. How do we reach across the barriers that such patients present, to find an opening through which we can glean from them the information we need to take care of them, and to establish mutual trust?Read More
This truth became inescapable when I began my nursing career on a cancer and hospice floor. Oncology care is fraught with the observation of suffering. The desire to find meaning in pain converges with the harshness of reality. Why
Life and death, as blatantly simple as they may seem from a purely physiological standpoint, are rather complex phenomena. Healthcare practitioners witness life and death a countless number of times. They are taught the intricacies of the human body: how to optimize its function and how to declare it deceased. Yet, nothing can prepare even the masters of this trade to face their own demise.Read More
Our verbal and written stories tie us together and promote understanding. They help us to work through traumatic experiences, to acknowledge our demons, and to heal.Read More
Illnesses are contagious.
We all know this, but while the frame on the bed grows ever smaller, sometimes the faces of the grieving grow gaunt as well.Read More
I first discovered I had Minimal Change Disease, the mildest form of nephrotic syndrome, when a routine insurance urine examination came back with higher than normal protein. Up until then, I assumed that foamy urine was a by-product of what I’d eaten or had to drink. In Sarah Safford’s poem, “A Cute Kidney Failure” from The Intima Fall 2016 issue, she asks the same question, “Kidneys, shmidneys, who thinks about them.” After my initial diagnosis, I did. A lot.Read More
No one, not even someone you love, can fill the hollowness. Still you cannot walk this alone. You need a witness, an errand goer, a soft presence, a light in the hallway. Someone who brings you tea or clean clothes, whose eyes will look back into yours.
When I looked up from all the waiting rooms, I found a communion of once-strangers waiting to help meRead More
What to do?
In 1927, in his lecture to Harvard medical students, the terminally ill Francis Peabody M.D. provided the answer, “the secret in caring for the patient, is in caring for the patient.”Read More
Togetherness is not artificial–it is not forced into the nooks and crannies between people. It is intrinsic to our existence as humans, no matter how fleeting the collision of our worlds. Moreover, togetherness need not be physical. We can feel connected to
The hierarchy in medicine is impossible to ignore. Medical students shuffle, interns survive, senior residents manage, and staff attendings command. Fortunately, these relationships have evolved over the last few decades and past feelings of authoritarianism have turned into mentorship.Read More
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