While evidence-based medicine and the double-blind study is certainly a valid lens through which to view illness and health... the marginalization of intangibles or unquantifiables such as the patient experience and physician-patient rapport is an unfortunate side effect.
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As I ruminated over my experience of learning to play the violin, playing collaboratively, and then using those skills to heal myself and others, I found Erica Fletcher’s “Viola Strings and Other Troubles: Mentoring a Medical Student’s Artistic Endeavors” (Intima Spring 2014) a source of inspiration. Ms. Fletcher reminded me that tuning a violin or a viola string, or engaging in an artistic endeavor generally, can temper the ebb and flow of a journey of recovery through a mental illness.
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Yesterday, in the hall of the outpatient clinic where I practice as a psychiatric nurse practitioner, my patient politely took my extended hand at the end of our session and then quickly hit the button on the wall sanitizer. The wall sanitizer had been my first impulse as well, but I refrained, worried as to the message I might give if I immediately cleansed my hand after we touched.
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One’s identity is unarguably a product of one's history and life experience. We are also the product of our parents, grandparents, and the distant branches of our family tree. Beyond the obvious genetics—thank you for the 6’2’’ genes Grandpa Frank and not-so-much-thank-you for male pattern-baldness Grandpa Tudrus—our elders serve as our role models for adulthood, parenthood, career aspirations, and everything else one could possibly think of.
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I was born and raised in a Catholic family. This revealed itself in the landscape of my childhood in subtle ways: stray rosaries in the the silverware drawer, conversations in which saints were talked about like old neighbors (“Have you seen the rake?” “Hmm, have you talked to St. Anthony lately?”), and the occasional mass in my family’s living room, presided over by my Jesuit uncle. As a fledgling Catholic, I was also exposed to a lot of talk about dignity.
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Eyes closed, lips pressed in a determined smile or grimace, back hunched to brace against the forlorn landscape, the central figure in Renua Giwa-Amu’s piece “Elmer” reminds me of my own medical journey. A fourth-year student on the verge of graduation, I reflect on how my entire education thus far has been dependent on the pain and illness of countless patients I have read about or cared for.
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As someone who works with words some days and in medicine on others, I have always enjoyed the names of the human blood group systems. While most of us are familiar with A, B, and O nomenclature, there are over thirty other systems, mostly describing “rare blood types”—those that could dangerously react to a transfusion
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In both the fictional "Absolution" and the nonfiction "What We See When We See Each Other" we are reminded of our shared humanity, and of how much we don’t see when we see each other.
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The first time I spoke of the encounter depicted in “E.B.” was during an interview for pediatric residency. The interviewer, a steely-eyed child abuse specialist, asked – not gently, but keenly – about my most difficult experience in medical school. I was surprised that what came to mind was not the drama of bullet holes and blood in the ED, interviewing a woman my own age chained to the wall of the psychiatric ED, or playing tic-tac-toe with a child with leukemia who seemed well but was expected to die from fungal disease – the kinds of gut-wrenching experiences that we swapped like war stories over beers at the end of a rotation.
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“Hospitals tend to have an extraterrestrial air. Shiny structures filled with yawning expanses of slick, sterile floors, strange beeping machines, and masked creatures with gloves cutting open sleeping bodies.”
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The experience of sitting at the bedside of a loved one as s/he comes to the end of life is utterly one-of-a-kind: unique to the people involved and the circumstances of those final days, hours, and seconds. But there are also so many common—if not universal—elements to it as well.
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It feels like I’m always talking about infertility these days. Is infertility just more common because women are waiting longer to have children? We wait longer so we have more problems? Not necessarily.
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“A Mother’s Life” is part of a linked short story collection I’m working on. The collection involves how we often lose our true selves but always come back to our essential essence in the end and how often we hide parts of ourselves from those people closest to us.
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The only thing worse than a little knowledge may be a lot of knowledge. We clinicians rue the arrival of web-based medical “information” and advice which gives patients and their families the feeling they know as much—or more—than their care providers.
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One of my most talented, passionate teachers in medical school, a professor of histology, frequently challenged us to “see God in man,” the divine manifest in the smallest cells and in the largest organs. Regardless of how one interprets “God” based upon personal religious or spiritual beliefs, my professor’s charge speaks to the very human need to search for a greater purpose in nature and in our own physical realities.
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The healing nature of personal connection is evident in “Caretaking.” In my short story “Numb,” I also see the salutary effects of the simplest kinds of human contact. In “Numb,” it is only by listening to the frustrations of another person with a spinal cord injury that the protagonist is able to attain an acceptance of her own losses.
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It is difficult to bear witness, to allow in the present moment, to grasp the full extent of suffering, memories, and loss. However, doing so can also be a source of healing for both the giver and receiver, a means to close old wounds, to offer hope, and to conceive life anew.
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Patients want caregivers to be professional and competent. At the same time, patients expect a level of compassion and empathy from medical professionals. These two impulses can be contradictory.
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I was taught 80 percent of diagnosis comes from history (which is why we have to listen), 15 percent from our exam, and the multitude of tests we over-order helps with only 5 percent. However, the physical exam and a simple handshake do more than contribute to a diagnosis. It is how we bond and offer healing.
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Scholars have begun encouraging doctors to gain more insight from their patients through narrative writing, especially poetry. According to Dr. Rita Charon, director of the Program in Narrative Medicine at Columbia University and co-editor of Literature and Medicine, “With narrative competence, physicians can reach and join their patients in illness, recognize their own personal journeys through medicine, acknowledge kinship with and duties toward other health care professionals, and inaugurate consequential discourse with the public about health care” (as cited in Encke, 2011).
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