Feedback from Belmont University students

I literally loved the presentation.

It was truly amazing.

I was moved by it …

Belmont University student

I recently gave a presentation to public health & nursing students from Belmont University (Nashville, Tennessee) who were on a study abroad trip to learn about other healthcare systems in action.

Belmont University Study Abroad Students in TCD’s Old Anatomy Lecture Theatre

The title of my lecture was ‘Creating & (not?) Meeting Expectations: new thinking needed on nursing & midwifery in Ireland’. I briefly discussed how our ideas of nursing have been established historically (e.g. Florence Nightingale & Walt Whitman) & culturally (e.g. Leanne O’Sullivan – ‘Leaving Early’ & Eleanor Hooker – ‘The Man in Bed Eight’), and then – applying principles of close reading as taken from study of literature – used transcripts of some calls made to RTÉ’s Liveline during the extensive coverage of maternity experiences, to examine how those ideas & ideals are not sustainable, and what we might do to adjust our healthcare systems to modern healthcare expectations.

I’m pleased to say it was well received, as summarised here by the Director of Public Health Program at the College of Health Sciences & Nursing:

Thank you again for speaking to our public health and nursing students.  All of my students commented on how impactful it was to hear the patient testimonies you shared and thoroughly enjoyed the link between humanities and medicine that you so aptly illustrated.  

Director of Public Health Program, Belmont Univeristy
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A GP troubled by an autopsy report

So that the local surgery can close my son’s file, I take the translated autopsy report to a young GP, who sits with his head in his hands, saying, ‘I wasn’t trained to deal with this. We didn’t get to read autopsies. This is absolutely horrendous.’ Perhaps he doesn’t have his own children. Or he does. I do my best to reassure him that it’s usual to search out each detail [as a parent], to try to know. To keep your child company in its death.

Denise Riley, from Time Lived, Without Its Flow

Session #5: Looking Back (at institutions that failed us)

These notes on the fifth session are written by one of the participants, summarising our discussions of Celia de Fréine’s Blood Debts & Hanna Greally’s Birds’ Nest Soup.

I was … very affected by the texts we looked at this week: the narrative accounts from a patient’s point-of-view really spurred my inner empathist, and, by the end of ‘Blood Debts’, I personally viewed the doctors and medical professionals as incompetent or even villainous. I believe strongly that this is what Medical Humanities really brings to our medical education. TV shows often paint this idea of doctors who, despite their smarm and snark, only need critical thought, smarts and perhaps a tiny little bit of luck to end up as the celebrated hero (or anti-hero) of their respective narratives (think House M.D.,Grey’s Anatomy, or The Good Doctor). Outside of perfectly wrapped 45-minute storylines, however, other narratives exist: those of the long-suffering, patient patients, mistreated by medical professionals, ever-wary, ever doubtful. How can we be alienating the very people we have sworn to help? It certainly becomes impossible to ignore this incongruity when stories and poems force us to consider their perspective.

Blood Debts by Celia de Fréine

> This week we looked at Blood Debts by Celia de Fréine, a translation of Fiacha Fola, a sequence of [Irish language] poems by de Fréine describing her experience of being one of 1600 Irish citizen infected with contaminated blood products in the 1970s.

> We began, however, without any knowledge of the context as we went into the first poem: ‘chalice of my blood’. This was a reflective poem acknowledging there seemed to something congenitally wrong with the poet (suggested to literally be her blood), and lamenting on what what she she could have done differently should she had known. She concludes that she would have not done anything differently. She invokes religious (Greek/Roman) imagery that elevates the concept of marriage to mythic proportions and seems to celebrate her right to have the partner and children that she wants.

> In the second poem, ‘miracle play’, heavy dream-like imagery is used, with references to religion and that of plague as she watches a biblical play. There is imagery suggesting the concept of something sinister hiding within something pure, and the concept of dramatic irony as a literary technique—originally used in Greek tragedy, by which the significance of a character’s actions is clear to the audience although unknown to the character—is introduced in her understanding of the spread of disease, unbeknownst to the biblical characters, and harks back to the preceding poem to the concept of the poet’s present self looking at her past choices in retrospect.

> The next poem, ‘september – month of birthdays’ recounts the birth of her second child and the administration of Anti-D (Rho(D) immunoglobulin (RhIG)). There is references to complications in her child’s birth, with his birth being breech instead of head, and references to her child not crying. There is also a sense of misplaced trust in the hospital/medical practitioners, with some subtle doubt being suggested as to whether they are acting in her best interests. Particular emphasis is put on her injection of Anti-D.

> The next few poems describe how she believes she is getting sick and jaundiced. She is placed in a situation where her doctor does not believe her symptoms and self-diagnosis and is dismissed by the doctor as ‘run-down’. This continues on with various accounts of the paternalistic attitude of doctors, from obstetricians to specialists who seem indifferent to her worsening illness. Eventually she is informed of the Anti-D scandal on the media, but despite her efforts to find out more, her concerns are continually sidestepped by upper management. Her initial doubt surrounding healthcare professionals evolves very much into anger and blame and they are painted as clear antagonists in her narrative.

> What Blood Debts does excellently is highlight the communication breakdown between medical practitioners and patients, especially when there is a mistake make by the practitioners. From the dismissiveness of first-line primary healthcare practitioners to the evasiveness of upper management, the medical field is depicted as having a toxic attitude of evasion and paternalism that [reflects] a lack of respect and dignity for its patients. Although occurring in 1977, the Anti-D scandal only became public in 1994—almost 20 years after it occurred, and de Fréine’s account is one of 1600 Irish citizens who were affected.
>

Hanna Greally’s Birds’ Nest Soup

> We ended by taking a look at an introductory excerpt from Bird’s Nest Soup by Hanna Greally, explained subsequently by a podcast we listened to as an autobiographical account of her institutionalisation in a mental hospital against her will, without the legal capacity to have herself discharged. To bring together all the sources we looked at in the tutorial, we considered the concept of institutionalisation: not only as a synonym for ‘incarceration’, but in its sociological meaning—the process of establishing something as a norm in an organisation or culture. We considered the idea of the institutionalisation of medicine and the possible implications that that has on the our future role as doctors-to-be; how the hallmarks of institutions—such as hierarchal systems of bureaucratic management, strict systems of conduct, and depersonalisation—can have a detrimental impact on the doctor-patient relationship.

> I have included some articles for anyone who is interested in further reading around the texts. The first explains the details of the 2018 CervicalCheck scandal, which we noted bares shocking similarity to the Anti-D scandal, the second is a blog post by a recently qualified doctor from the US about the concept of institutionalisation and the reality of real world practice in corporate medicine, and the final article is on paternalism and the doctor-patient relationship.

> CervicalCheck scandal: What is it all about? (The Irish Times, 2018)
https://www.irishtimes.com/news/health/cervicalcheck-scandal-what-is-it-all-about-1.3480699

> How the Institutionalization of Medicine Has Destroyed the Doctor-Patient Relationship (Shlifer, 2016)
http://in-training.org/institutionalization-medicine-destroyed-doctor-patient-relationship-11491

> From Paternalism to Partnership (The Irish Times, 2001)
https://www.irishtimes.com/news/health/from-paternalism-to-partnership-1.316916

#4 Living (while bleeding)

These notes on our fourth session are brought to us courtesy of one of the group, Diane Doran.

‘While Bleeding’ by Doireann Ní Ghriofa

The poem has many layers, hinting at: –
1. Social status (too expensive/vintage shop)
2. expectations on women to be/look a certain way (blusher on cheeks/lipstick on tissues)
3. Shame many women carry about what are normal is a normal bodily function
4. The poet uses red to sum up the female experience – red an emotionally intense colour.

After the poem we discussed how Viagra was once discovered to be effective or period pain however due to apparent side effects was shut down – It was agreed that we should look further into this – does it draw parallels between the papacy and the pill debate recently?

Conversations with Friends by Sally Rooney

Conversation with Friends brought up some discussion on: –

Silence in pain – why are women expected to put up with pain?

What is stopping women from asserting themselves and breaking out of the patriarchy?

We touched on the theme of rich v’s poor – wealthy people are more resourceful due to money and as such will always find a way to get ahead – an inequitable system is leading to an even bigger divide amongst people and this divide becomes more apparent when we consider different races & genders in society.

The importance of consent – twice the consent of the patient in the text wasn’t sought

We talked about the importance of considering the perspective of the patient – in the text she stated both she and the doctor hated each other – What are the elements that will potentially lead a person to feel this way about their caregivers, to have no trust established between them?

The doctor in the text seems oblivious to the patients pain – where do doctors need to draw the line with respect comforting patients

Discussed the importance of giving patients information about what it is that is happening to them.

Discussed the societal expectation to keep your emotions locked up until appropriate time – what is causing this disability when it comes to expressing ourselves? – leads to repressing our true history when in a hospital setting – again comes back to putting up with pain & silencing ourselves.

Some elements of shame expressed – unprotected sex/sex outside of marriage – the girl felt embarrassed to disclose the full details of her sexual experience to the doctor.

Talked about women’s paraphernalia for periods and how men need to be more open and receptive to what women’s body’s are capable of and not add to the shame by keeping it a secret.

‘Notes on Bleeding’ by Emilie Pine, from Notes to Self

Again the theme is around the shame of having a period – hiding it from others – the idea that it is dirty and somehow women/girls are somehow stained.
Focuses on the expectation of women to look & act a particular way (shave/apply foundation)

From my perspective – i found it ironic that we read a redacted text – why is it embarrassing for us to sit and read/listen to the full no holds barred text? – as medical professionals I feel the ability to not get embarrassed by the things we hear will be a very important skill.

Best description of an anxiety attack

This description of an anxiety attack in Sally Rooney’s Normal People is particularly accurate for a specific sort of anxiety and, especially as it proceeds, becomes exceptionally detailed and therefore very helpful to anyone trying to understand what a sufferer of such an attack goes through.

His anxiety, which was previously chronic and low-level, serving as a kind of all-purpose inhibiting impulse, has become severe. His hands start tingling when he has to perform minor interactions like ordering coffee or answering a question in class. Once or twice he’s had major panic attacks: hyperventilation, chest pain, pins and needles all over his body. A feeling of dissociation from his senses, an inability to think straight or interpret what he sees and hears. Things begin to look and sound different, slower, artificial, unreal. The first time it happened he thought he was losing his mind, that the whole cognitive framework by which he made sense of the world had disintegrated for good, and everything from then on would just be undifferentiated sound and colour. Then within a couple of minutes it passed, and left him lying on his mattress coated in sweat.

Sally Rooney, Normal People (Faber & Faber, 2018), p. 206.

Session #3: paediatric/childhood texts

As a preface, we looked at this floor plan of part of a hospital and I asked the group to see if they could spot any issues with it.

http://www.ltmgh.com/Images/Planning&Expansion_of_Hospital_Building.pdf

And in fairness, the unfairness of men having three urinals and two cubicles while women only have two cubicles was identified by one of the fellas. I then read and we discussed an extract about toilet design from this extract from Caroline Criado-Perez’s book Invisible Women: Exposing Data Bias in a World Designed for Men

But even if male and female toilets had an equal number of stalls, the issue wouldn’t be resolved, because women take up to 2.3 times as long as men to use the toilet.

~

I then read & we discussed a poem I had chanced upon in a journal called Alt. It’s called ‘Delivery Room in December’ by Maria Finch. It’s powerful.

My heart latched to you as they wheeled you away
Leaving this husk of lost luggage behind
A cavernous ravenous vessel
That expelled life and then inhaled fear
As eyes locked mine and named me as your own.

~

We then read and discussed as we went Lucy Caldwell’s brilliant story, ‘Multitudes’:

~

Finally, I read them and we interpreted Julia Donaldson’s The Magic Paintbrush, about the ultra assertive, Shen, as a metaphor for medical training.