Instruction as Narrative: A Reflection on Rachel Kowalsky's "Your First Pediatric Intubation"

Adam Conner currently lives in New Jersey with his wife and daughter.

In the medical world (as in the writing world), instruction is everywhere. Take this, don’t take that. Do this, don’t do that. Study diagrams of bones and muscles, diagrams of how a sentence should read. Bodies are made up of cells, words made up of letters. Maybe that’s why medicine and narrative blend so easily.

A writer once told me the editor of a journal she read for had to reject so many cancer stories not because they weren’t well written, but because they all sounded similar. At its most basic level, most narratives on health follow this pattern: you weren’t sick, you got sick, you either survive, or don’t. To find something that breaks that model is truly wonderful.

How lucky was I then to stumble upon Rachel Kowalsky’s piece “Your First Pediatric Intubation” (Intima, Fall 2022). Similar to how my short piece “How to Write About Your Cancer” (Intima, Fall 2022) is structured, Kowalsky’s is an instruction manual in how to intubate a pediatric patient. She gives the reader concrete steps on how to dress, where to position yourself around the operating table, and how to conduct yourself in front of the patient’s family. While the first few steps read as if they were taken straight out of a medical book, Rachel pivots and delves into interior, emotional instruction. Here is where we, the reader, get the guidance we really need.

In a striking image, Kowalsky introduces the “dragons” to us, these “minstrels of your obstinate self-doubt.” While they hang out in the corner of the room, their giant size can’t be ignored, but we mustn’t look. Ghosts from patients past stand beside you, and now this crowded room feels claustrophobic, but not to worry. Like the pediatric patient who breathes new life, you too begin to focus and relax, remembering what you’ve been taught throughout your academic career and, most importantly, your life. We are taken out of the trauma bay off to the next steps of care, and again, receive instruction: “Choose another beginning….” What follows, we don’t yet know, but thankfully, we’ve been taught well.


Adam Conner currently lives in New Jersey with his wife and daughter.