When I read “All Tuned Up” by Albert Howard Carter III (Spring 2021 Intima), I remembered a pediatric intensive care unit patient from my own 1980’s residency experience. In Carter’s poem, a medical resident presents a case during mortality and morbidity rounds. The resident is moved to tears as he tells the gathered audience about the death of a patient he knew well. A senior doctor “gently” offers context and says, “Maybe he was just tired.”
Mercifully, I’ve muffled memories from some of the deaths during my residency training in the pediatric intensive care unit. But I remember a slight girl of about sixteen with silky, wavy hair, lying in a metal-frame bed parallel to the wall against the window, in silhouette.
In this reflection, a retired surgeon examines the research findings of evidence-based medicine to uncover whether empathy, in addition to the principles and practice of narrative medicine, can facilitate deeper healing.
Fiction and visual art are a natural pairing, one digging deep through words, the other a profound visual exploration. Both genres allow ways to explore the issue of mental health.
Recently, I read Adam Conner’s short story “How to Write about Your Cancer” (Fall 2022 Intima) with amusement and recognition. And if I transform the rules in it to a scorecard, my poem, “Minds Go Where Bodies Can't” ends in the red.
“I like Beethoven the best!” is a declaration made by a patient of Mitali Chaudhary, as she readies to leave his hospital room. A busy senior medical resident at the University of Toronto, Chaudhary juggles many demanding responsibilities with her desire to get to know this elderly patient. In her Field Notes essay titled “Beethoven’s Symphony No. 5,” published in Intima’s Fall 2023 issue, she recalls how she’d tried to get her patient to respond to questions about symptomatology, all the while aware that twenty-three other patients – along with a group of junior residents and medical students – were awaiting her time and attention. In that moment, she finds herself turning away from an opportunity for a personal interaction with him in order to ensure she manages her tasks appropriately.
One of my most enduring memories of volunteering is of helping with a beauty club for patients with advanced Alzheimer’s Disease. Each week I would be regaled with stories of young women visiting their mothers and planning fun outings with their girlfriends. While I applied makeup and painted fingernails, the smiles and facial expressions were those of young women anticipating a good time.
On the outside these ladies were quite different.
Both Karen George’s poem, and my “Triptych:Oncology Fish,” share an expression of admiration for the resplendent inner strength in our loved ones, emanating despite the foreboding shadows of illness, suffering and loss. The emotions floating around our lived spaces as our loved ones endure and battle disease in the face of difficult circumstances move in many directions including grieving, reflecting, hoping, enduring and celebrating, colors that shift and radiate with the heroically hopeful, illuminating presence of gratitude and love.
While returning to the U.S. on an international flight not long ago, I sat next to a young African woman. As we approached our destination, she sheepishly passed me her passport and a customs form. Since I was in the aisle seat, I assumed she wanted me to pass it along to the flight attendant, until I realized the form was blank. She was asking me to fill it out.
Great books can guide us in every day life, and I found it fitting that Dean Schillinger, MD and I both invoke works of literature to describe the experience of realigning our values with those of our patients. In his essay, “The Quixotic Pursuit of Quality,” (Spring 2015 Intima) Dr. Schillinger compares himself and his patient, Mr. Q, to Quixote and Sancho Panzo from Miguel de Cervantes Saavedra’s Don Quixote. With only misplaced medication lists, no-show appointments, and a stubbornly elevated hemoglobin A1c to show for his repeated efforts to help Mr. Q better manage his many comorbidities, Dr. Schillinger’s frustration melts away when Mr. Q unexpectedly gives him a massage. From then on, “the duel was over.” There would be no more tilting at windmills.
I work at a community clinic with patients who are homeless–there is the stigma of homelessness, and then there is the stigma of looking homeless.
Some patients of mine do not–or do not yet– appear unhoused. It is usually those who still have family that support them, who live in a car, who hold a job—running food for Doordash, picking for Amazon, sitting security—or who have not been homeless for so very long. But many of my patients do appear frankly homeless: a shuffling gait, a blanket draped around their shoulders, belongings pushed in a stroller, blackened teeth, leg wounds.