The Me in Medicine: Reviving the Lost Art of Healing by Patrick Roth, MD

For more information about the book, go to The Me in Medicine: Reviving the Lost Art of Healing.

For more information about the book, go to The Me in Medicine: Reviving the Lost Art of Healing.

What follows is a typical visit to the physician for back pain in the United States: A person hurts his or her back and sees a doctor for a complete workup. The clinician, careful not to miss anything, orders an MRI that is subsequently read by a distant radiologist. The report is sent back to the physician who, depending on the results, calls for a follow-up appointment to discuss outcomes. It is likely that the patient is sent to a physical therapist, who provides a therapy regimen based on the radiology imaging and his or her own experience without need for the physician’s specific prescription. While much can and has been written about this typical medical experience, from its inefficiency to its reliance on medicalization and overdiagnosis, it is the fragmentation and lack of contextualization that Dr. Patrick Roth has highlighted in his latest work, The Me in Medicine: Reviving the Lost Art of Healing.

With an increasing reliance on technology and the expansion of artificial intelligence in medicine, Dr. Roth paradoxically calls on physicians to embrace their philosophical faculties. He proposes that narratives, developed through introspection, as well as teaching, mentoring, and writing, are the missing components in our medical system today. The onus is on both patients and physicians to develop individual and, when they come together for a clinical encounter, shared narratives on health, disease, and treatment for better overall care.

For the patient, narratives mean coming to understand how he or she views health and disease. As Jerome Groopman explains in his book, Your Medical Mind, and Dr. Roth highlights in his, people have a spectrum of temperaments with regards to intervention: Some believe strongly in the human body’s regenerative capacity (naturalist) and others believe strongly in science, technology, and medicine (technologist). These proclivities are important for the patient to consider when making medical decisions, but only represent one piece of the puzzle.

Patients must also consider unconscious cognitive biases they have when making their decision for treatment. Common cognitive biases include the availability heuristic, a mental shortcut in which a person makes decisions based on readily available examples, and hyperbolic discounting, in which a person discounts future reward because of the time delay between the decision and the reward. For instance, using the availability heuristic, a patient may be hesitant to undergo a procedure because a friend had a similar procedure that did not end well, whereas using hyperbolic discounting, a patient may prefer a procedure because they perceive the reward as immediate as compared with the longer treatment course of physical therapy. While highlighting the patient’s decision-making heuristic is certainly not easy, it serves to both increase patient autonomy and satisfaction with outcomes.

The complexities of these medical decisions is the space where physicians, equipped with their own medical narratives, help the patient decide what is best. The physician has the ability to provide the context necessary for the patient’s choice. For this reason, it is incumbent on the physician to become a good storyteller. It is not enough to lay out all the options with statistics or paternalistically make the decision. Rather, believes Dr. Roth, the physician most effectively communicates through anecdotes and analogies for understanding disease ontology and treatment decisions.

There are a number of tools at the disposal of physicians and patients to accomplish these lofty, yet achievable goals. With honed doctoring skills, the physician can extract the patient’s motivations and contextualize them to reach a sustainable and satisfactory outcome. Further, the physician can foster self-efficacy and promote a deep education about disease. The patient, on the other hand, possesses knowledge that the physician is not privy to, i.e., the phenomenology of the disease. By joining support groups and forming online communities, patients empower themselves and shape the narrative of their needs for the medical community. Engaging in these exercises shapes not only the character of the patient and physician, but the disease process too, as it reforms a patient’s reality through changes in their thoughts and perceptions.

Medical science and technology naturally lend themselves to a reductive materialism with an approach that parses apart reality into molecular cascades and biotargets on which intervention is possible. Analogously, medicine, as a distinctly human endeavor, naturally lends itself to storytelling—the currency of effective communication and change. As such, Dr. Roth makes a formidable case for narratives as a staple of holistic medical practice. Narratives reform environmental context, which in turn shapes us and our health. With technology and specialization playing an ever-expanding role in our healthcare system, it will remain paramount to scrutinize our narratives and ensure they are always in service of our patients. — John Paul Mikhaiel


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JP Mikhaiel is a medical student at Georgetown University School of Medicine. After earning his BS in neurobiology and philosophy at Georgetown University, he spent two years at the NIH researching brain-related disorders. He is currently a member of the Literature and Medicine track at Georgetown University, and serves on the management board for the coaching program, A Whole New Doctor. His work has been published in Scope, Georgetown’s literary journal. Mikhaiel plans to pursue a career in neurology.

The Serpent's Secret: Kiranmala and the Kingdom Beyond by Sayantani DasGupta

"The Serpent's Secret" is the first book in the Kiranmala and the Kingdom Beyond Series; Scholastic publishes the book on February 27, 2018.

"The Serpent's Secret" is the first book in the Kiranmala and the Kingdom Beyond Series; Scholastic publishes the book on February 27, 2018.

 “Stories are the way we human beings shape our worlds,” writes Sayantani DasGupta, MD MPH, in the article “Stories Matter: Narrative, Health and Social Justice.” In the piece, the author, educator and Intima contributor (Spring 2016 issue), elaborates on the ways that narrative is shaped by many factors, from the personal to the political. Narrative, she posits, can be life-changing: “In the face of illness or adversity, injustice or trauma, stories help bridge what theorist Arthur Frank has called ‘narrative wreckage’—the point at which one’s old life’s plot is no longer valid, and one needs a new plot with which to continue life’s journey.”

These words have a particular resonance right now in light of the #metoo movement, where long-silenced voices are being heard in narratives that support finding ways to balance sexual inequality.  Curiously enough, the words are equally significant as a way to read “The Serpent’s Secret,” a remarkable and delightful new work of children’s fiction by Dr. DasGupta, just published by Scholastic as Book 1 of the new series Kiranmala and The Kingdom Beyond. How refreshing to find an electrifying social theorist like Dr. DasGupta who is also an entertaining prose stylist able to deliver an empowering novel for tweens. It’s a book that is multi-generational in the way the Harry Potter and Hunger Games series were—"The Serpent's Secret" also speaks to readers who finished middle school many red moons ago.

The book begins on the morning of New Jersey kid Kiranmala’s birthday, who in her own sassy voice introduces her story about a day when everything in her world radically changes:

The day my parents got swallowed by a rakkhosh and whisked away to another galactic dimension was a pretty crap-tastic day. The fact that it was actually my twelfth birthday made it all that much worse. Instead of cake or presents or a party, I spent the day kicking demon butt, traveling through time and space looking for my family, and basically saving New Jersey, our entire world, and everything beyond it. But I’m getting ahead of myself. I’ll tell you that part soon. First, let me back up a little.

As readers we are engaged by this smart, empowered narrator, who is alone, newly orphaned, yet tough—she already sounds like Ripley of Alien, one of the original female butt kickers in 1979 when the sci-fi thriller came out. We’re intrigued by words we do not know (what the heck is a ‘rakkhosh’?) and are drawn in by the promise of time travel and life-challenging adventures in other galaxies. In her own knowing way, young Kiranmala has given us the big-picture plot in the first paragraph, enticing us to come along with her to see what transpires.

Like many of the best books in children’s fiction, parents are dispensed with from the get go, here swallowed by a rakkosh—a “carnivorous, snot-trailing demon” who populates many of the Bengali folktales Dr. DasGupta was told as a child. In the first chapters, Kiranmala’s childhood home is also trashed by the demon with a black tongue who she calls “halitosis head.” That’s the overall dynamic and tone the author sets up: sword fighting amid the silliness, cleverness cancelling out the fearful chaos.

“The Serpent’s Secret” is aimed at young people who are at an age where childhood and adulthood begin to overlap, where the power of parents is displaced by the power of peers. Dr. DasGupta, a pediatrician and a mother, knows only too well the rough road of this developmental stage, when the plot of childhood branches off into new paths toward adulthood, and as a skillful writer, she’s able to bring to life the joys, confusion, real terror and pure happiness that emotional journey often takes in intriguing and amusing—not heavy-handed—ways. We are inside the young narrator’s head, seeing and judging events from her no-nonsense point of view. Her voice is compelling.

In Kiranmala’s quest to save her parents, she meets up with a cast of eccentric characters as amusing, complex and memorable as the flying monkeys, the Scarecrow, Tin Man, Good Witch and Bad Witch that Dorothy encounters in “The Wizard of Oz.” There’s Lal and Neel, two brother princes on winged horses who battle zombies and escort Kiranmala from Parsippany to the Kingdom Beyond Seven Oceans and Thirteen Rivers in search of her parents. There’s the magical pun-loving bird, Tuntani, whose corny jokes provide lighthearted moments and reflect the goofiness (“How do chickens get strong? Egg-ersize!”) tweens and teens love. There’s the intimidating green-eyed Sesha, the Serpent King, “guardian of the primordial ocean of divine nectar, keeper of time” and many others, each one an encounter for Kiranmala to confront and conquer to get to her goal.

Throughout the story, Kiranmala discovers dramatic truths about her origins as well as several revelations about life. There is the conflict between dark and light, a familiar theme in children’s and YA fiction from Grimms’ Fairy Tales to “A Series of Unfortunate Events” and “Twilight.” In “The Serpent’s Secret,” Kiranmala learns the difference between dark energy and dark matter, passes through tides of rubies in a peacock barge that reroutes her to the Demon Land (aka "The Blood-Thirsty State,") and battles a room of pythons to steal a jewel needed to read a shape-shifting map that will guide her to her parents. Those are just a few of the startling and original moments that keep the narrative taut and surprising throughout the novel’s 338 fast-paced pages.

Sayantani DasGupta, the daughter of Indian immigrants, wanted to share her love of books with her own kids but was saddened by the lack of heroes that looked like her family and neighbors. She decided to write her own stories, returning to the folkt…

Sayantani DasGupta, the daughter of Indian immigrants, wanted to share her love of books with her own kids but was saddened by the lack of heroes that looked like her family and neighbors. She decided to write her own stories, returning to the folktales she heard on childhood trips to India.

Originally trained in pediatrics and public health, Dr. DasGupta is also the author, co-author or co-editor of several books, including a book of Bengali folktales, The Demon Slayers and Other Stories (Interlink 1995), and the recent Principles and Practice of Narrative Medicine (Oxford 2016). She teaches in the Master's Program in Narrative Medicine, the Center for the Study of Ethnicity and Race, and the Institute of Comparative Literature and Society at Columbia University.

In the Author’s Note at the end of the book, Dr. DasGupta goes into detail about the Bengali folktales that inspired many of the characters in “The Serpent’s Secret.” It’s a short and welcome postscript that underscores one of the reasons the author decided to write children’s fiction. As the daughter of Indian immigrants, she wanted to share her love of books with her own kids but was surprised by the lack of diversity in the books available. She decided to write her own stories, returning to the folktales filled with bloodthirsty demons and enchanted animals that she heard on childhood trips to India.  Cue applause for that decision: In the first book in the Kiranmala and The Kingdom Beyond series, Sayantani DasGupta has created lovable characters, a rollicking narrative and meaningful themes that have a broad appeal for many young (and not-so-young) readers, setting up a thirst for what's up next for the appealing young heroine.

New fans of Princess Kiranmala will undoubtedly be clamoring and drooling like rakkhoshs for Books 2 and 3.—Donna Bulseco


DONNA BULSECO, MA, MS, is a graduate of the Narrative Medicine program at Columbia University. After getting her BA at UCLA in creative writing and American poetry, the L.A. native studied English literature at Brown University for a Master's degree, then moved to New York City. She has been an editor and journalist for the past 25 years at publications such as the Wall Street Journal, Women's Wear Daily, W, Self, and InStyle, and has written articles for Health, More and The New York Times. She is Managing Editor of Intima: A Journal of Narrative Medicine.