Doctor


ORIGINAL POST IS HERE >>> http://medhum.blogspot.ie/2010/03/poetry-in-medicine.html

Poetry in Medicine

When I make rounds with my students and interns, I always try to sneak in a poem at the end. I think poetry is important because it helps convey the parts of the medical experience that don’t make it into textbooks. It’s important because it teaches creative thinking—something of immense value to doctors.

It’s important because interpreting metaphors is a critical clinical skill in diagnosis; patients’ symptoms often present in metaphorical manners and we doctors need to know how to interpret our patients’ metaphors. Last but not least, there is a therapeutic value to introducing beauty into a situation that is not commonly associated with aesthetics.

I’ve been giving poetry to my medical team for a few years now, but I’ve always wanted to give poetry to my patients. Unfortunately, English is not the first language for most of the patients in my hospital, so this has been challenging.

But there is one set of patients that seems to consistently speak English—the alcoholics. The Bowery-type alcoholics aren’t necessarily the favorite patients of the interns. These patients are frequent fliers, they are clinically “uninteresting,” they are often malodorous, and their illness is perceived as self-inflicted. But they do speak English.

So one morning on rounds, our team went to examine a new alcohol-withdrawal admission. His condition was standard: alcohol-on-breath, speech slurred, fingers trembling, hair and beard disheveled, body odor a mix of unwashed socks and cheap beer. He was cranky, and impatient with the detailed questions we asked.

As the team was finishing up, I whipped out some papers from my pocket—Jack Coulehan’s poem “I’m Gonna Slap Those Doctors. I gave a copy to the patient and distributed the rest to the resident, interns, and medical students. Asking their forbearance for this slight divergence from medical protocol, I plowed onward and read the poem aloud.

I’m Gonna Slap Those Doctors

Because the rosy condition

makes my nose bumpy and big,

and I give them the crap they deserve,

they write me off as a boozer

and snow me with drugs. Like I’m gonna

go wild and green bugs are gonna

crawl on me and I’m gonna tear out

their goddamn precious IV.

I haven’t had a drink in a year

but those slick bastards cross their arms

and talk about sodium. They come

with their noses crunched up like my room

is purgatory and they’re the

goddamn angels doing a bit

of social work. Listen, I might not

have much of a body left,

but I’ve got good arms — the polio

left me that — and the skin on my hands

is about an inch thick. And when I used

to drink I could hit with the best

in Braddock. Listen, one more shot

of the crap that makes my tongue stop

and they’ll have something on their hands

they didn’t know existed. They’ll have time

on their hands. They’ll be spinning around

drunk as skunks, heads screwed on backwards,

and then Doctor Big Nose is gonna smell

their breaths, wrinkle his forehead, and spin

down the hall in his wheelchair

on the way to the goddamn heavenly choir.

(from Medicine Stone, 2002. © Jack Coulehan, reprinted with permission)

As I read the poem, I could feel the atmosphere in the room changing, ever so slightly. The focus shifted from the patient to the poem, and everyone was an equal neophyte with this particular poem.

When I finished reading, some of the medical team looked uncomfortable, but the patient was smiling broadly. “This is great,” he said. “I love it!” With his pronouncements, everyone relaxed a bit.

“You know,” the patient continued, seemingly happy to have an audience, “ I used to read some books, back in the day.” He sat up in bed, more animated now. “I like history stuff—ancient Greeks, ancient Romans. Real characters, those guys.”

We ended up having a conversation about his childhood in small-town New Jersey, how he cut classes in high school to putter around on the beach.

We left the room feeling awkward but also somehow lighter. Suddenly our patient wasn’t just another alcoholic drying out on the ward. He was a real person, someone who stood out in our minds.

The poem certainly didn’t change the course of his devastating disease of alcoholism. It didn’t offer him the epiphany to suddenly quit drinking or to reconnect with his estranged family. His liver enzymes didn’t miraculously normalize. His platelets didn’t bound back to health. But it gave all of us a sense of human connection.

Throughout his four-day stay in the hospital, the patient was much more pleasant to the team. I noticed that the students and interns wandered in more frequently to say hello. We all felt just a bit more connected.

Rx: Take two sonnets and call me in the morning.

If you are interested in poetry and medicine, check out this unique conference at DukeUniversity on May 21-23. Life Lines: Poetry for Our Patients, Our Communities, Ourselves. (I will be giving a presentation there.)

Danielle Ofri is a writer and practicing internist at New York City’s Bellevue Hospital. She is the editor-in-chief of the Bellevue Literary Review. Her newest book is Medicine in Translation: Journeys with my Patients. View the YouTube book trailer.

You can follow Danielle on Twitter and Facebook, or visit her homepage.

Her blog, Medicine in Translation, appears on Psychology Today’s website.

Posted by Danielle Ofri at 14:36

Labels: art, culture, doctor, doctor-patient relationship, medicine, patient, poetry, translation

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“The arthrodesis happens, and after 10 weeks encased in hip spica – I’m my own alabaster statue – a doctor attempts to remove it with a cast saw. Blade meets skin, and I try not to imagine what’s happening beneath the plaster. The pain feels like a scald, of heat spreading. I explain this to the orthopaedic doctor, this man I’ve never met, and he does that thing I’m used to male doctors doing: he tells me I’m over-reacting. A rotating blade is slicing into my flesh, but I need to calm down. When my mother starts to cry he demands that she leave the room. Fifteen minutes later I plead with him to stop, and he finally gives up, annoyed.”

So writes Sinéad Gleeson, about her experience of juvenile arthritis and the orthopaedic interventions and emotional trials she had to go through.

Blue Hills and Chalk Bones

A DEMONSTRATION

Letter by this morning’s post to say I may go home for Xmas if I won’t have a demonstration (do they picture bands?)
– Dr Kathleen Lynn

What might drive me, a doctor,
to jump out of reason and into the fire
of rebellion? Haunted by skulls
that boast through the thin skin of children
who ghost the alleyways, dying
young in silent demonstration,

I raise my own demonstration
against my limits as woman and doctor. (Continue reading rest of poem >>>)

Casualty

They bring us crushed fingers,
mend it, doctor.
They bring burnt-out eyes,
hounded owls of hearts,
they bring a hundred white bodies,
a hundred red bodies,
a hundred black bodies,
mend it, doctor,

 

As reprinted and discussed in the Guardian >>>

Calls flooded in to neighbours, word reached the emigrants abroad via email, Skype and phone. They recited the Rosary in churches and prayed for him and those he left behind.

And there was worry too. How would they cope without him? Who would be their doctor now? No one else knew their medical history. They all believed they had a unique connection with him.

There was a bond.

Irish Independent >>>

Medical Council chief executive Bill Prasifka said he was disappointed that the reported experiences of bullying by trainees was no better this year.

He was also unhappy that many trainee doctors seemed to be receiving little or no feedback and have poor experience of induction.

“I am fully aware that the issue of bullying cannot be dealt with overnight and a cultural shift needs to occur in this instance,” said Mr Prasifka. “However, an improved induction programme, or the simple delivery of feedback, is something that can, in fact, be achieved quickly.

“If trainees working in a clinical environment are feeling underprepared, it is a patient safety issue and that is why we have decided to do all we can do within our regulatory role.” (Irish Examiner >>>)

Dr Janis Burns recently wrote this open letter to David Cameron:

 

Dear Mr Cameron,

On Wednesday morning this week I returned to work at 0800. I worked the weekend in Intensive Care as a junior doctor, for your information I was working from 2000 to 0900 on Friday, Saturday and Sunday i.e. I was part of the team that provided a 24 hour, 7 days a week, 365 days a year service. My consultant started his weekend of work at 1700 on the Friday. He finished at 0800 on Monday morning. He didn’t go home until well after we had started our night shift and he was in before we went home in the morning. We also disturbed him overnight to tell him about our unstable patients. He didn’t grumble once. Our anaesthetic consultant didn’t grumble when we took a patient back to theatre for bleeding in the middle of the night, nor did he grumble when he was anaesthetising an emergency case the following night. The consultant surgeon also didn’t grumble. Your irresponsible colleague Jeremy Hunt seems hell bent on suggesting to the public that there is no 7 day a week service and that consultants do not work weekends. I have submitted a request, via the Freedom of Information Act, to the Department of Health last night to quantify how many consultants currently opt out of weekend working. I look forward to finding out.

In the middle of the night my colleagues (doctors AND nurses AND radiographers AND healthcare assistants) and myself were assessing patients with multi-organ failure being supported with complex devices, these patients are teetering on the brink of death all the time. At the end of my 3 night stint, just when I was at my lowest ebb, a patient got really sick. You try managing that after you’ve been up all night and then tell me the NHS isn’t 24 hours 7 days a week 365 days a year. When you have personal experience of that, I would like you to look me, and every other doctor in the NHS, in the eye and tell us that you genuinely believe that we are being adequately paid for all the responsibility that rests on our shoulders.

Let’s put things in to context. An Assistant Manager in Pret-a-Manger has a salary of £29,500 and a Manager £40,800. In other roles their starting hourly rate is £7.70/hr everywhere except inside London where they pay £7.90/hr. On the current pay system a doctor has to work for a minimum of 9 years after graduating from their 5 year degree course before they have a basic salary higher than a Manager who works in Pret. How much student debt did people working in these roles accrue?

On Monday night I did something Jeremy Hunt has openly chastised. I worked another night shift as a locum in another hospital. Why did I do this? Because I, 34 years old, did not want to have to borrow money, yet again, from my elderly parents. It’s embarrassing but you see I studied medicine as a second degree. I am Scottish but studied in England and therefore was liable for all my tuition fees and did not receive the NHS bursary, unlike my European colleagues. Sadly, during those four years, the student loans did not even cover my rent. I accumulated £20,000 professional studies loan and £7000 of credit card debt. Over £1000/month of my salary is used for debt repayment and I still have 26 more months to pay before I am only left with my student loan repayment. Living in London, my rent is £926/month. How much of my salary do you think I actually get to enjoy? Do you think I will ever be able to afford to buy a one bedroom flat in London? I don’t think it’s unreasonable to want to own the flat I live in, neither do you apparently but yet you seem hell bent on making it impossible for me.

This month I have to pay £325 upfront in cash for a mandatory course as part of my training in anaesthesia. I will get that money back, eventually, but to be honest it will then be used up as I need to sit an exam, again, mandatory for my training. Those exams are tough and I may not pass it on my first attempt. Surprisingly enough, the NHS doesn’t pay for continuing professional development, I will need to study for this in my free time if I want to progress and yet you claim to want a world class service? How do you anticipate that will happen when you and your Health Minister have no idea what life as a doctor is like? I would relish the opportunity to have you shadow us on a night shift, but you won’t.

Has any of the above made you think that it’s not quite such a rosy life being a junior doctor?

Do I have to remind you that in order to get a place to study medicine I had to excel academically? I had to be better than all those other applicants who wanted to study medicine. I studied medicine at the University of Cambridge. In many other professions that would have been my ticket to earning mega bucks. As people frequently and correctly point out medicine is a vocation. I truly love my job and my career but I think you have lost sight of the bigger picture. It’s all very good claiming you want a world class health service but if you continue to act irresponsibly and vilify doctors by suggesting we don’t provide a 7 day a week service you will destroy the NHS.

My basic salary is less than £50,000 after working for almost 4 years since graduation. I studied for 4 years on an accelerated medicine degree while a newly qualified TFL Tube driver earns £49,673. Can you put your hand on your heart and tell me you think this is fair? “Making work pay” is your party’s current slogan. Can you explain to me exactly how all my hard work is being rewarded? My reward isn’t financial is it?. If you pay peanuts you get monkeys. If you want a world class health service you need to ensure that medicine remains an attractive career and a competitive degree course. The more you continue to vilify doctors and bully us financially the more unattractive you make it. It doesn’t take a genius to realise that results in a lower calibre of applicant and a lower calibre of doctor in the long run. Being blunt, to make it through medical school requires an immense capacity for knowledge, problem solving, resilience and good old fashioned intelligence with an enviable work ethic. You and your party have behaved disrespectfully towards my profession and the NHS as a whole. It disgusts me.

Congratulations on your inflation busting pay rise by the way. I believe you think the right thing to do is accept it, despite stating that you think it was the wrong decision to award it. A classic statement from a politician, if ever I heard one.

The sad thing Mr Cameron, when one of your friends or family members or even just someone you pass in the street becomes critically unwell in front of you, you will realise that whether it is the middle of the night or the middle of the day, a massive team will leap into action and that team consists of more than doctors, more than nurses, more than healthcare assistants, more than porters and more than the technicians in the labs running all the tests that we need to manage the patient. That patient will get everything they need. Perhaps then you might actually appreciate all the work we, as a team, do. You might then actually help us become a world class health service instead of working against us.

You need to get real, not doctors. You can’t even pay doctors and nurses and all the allied health professionals an adequate salary for their scheduled hours and you certainly don’t pay us for all the extra hours that we do outside of what we are supposed to. You do realise that Trusts across England actively discourage us from reporting the actual hours we work because they can’t afford for us to breach the European Working Time Directive or actually pay us for the extra hours.

In summary you need to pay doctors, nurses and all the allied health professionals an appropriate salary that reflects the important roles we actually do in providing the 7 day a week service that we currently provide. If you genuinely want to improve patient safety then you just need to provide more staff at every level, patients would be safer if you adopted mandatory minimum safe staffing levels and ensured these were enforced. I realise this simple, yet effective solution, is costly and perhaps that is the reason Jeremy Hunt has chosen to deliberately attack Doctors.

I look forward to your response,

Janis Burns

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