A day in the life of a GP: Jennifer O’Connell spends the day with GPs

From the Irish Times >>>

Overworked, under-resourced and burning out, or overpaid, understretched and privileged?

“What I find unhelpful about those perceptions [about GPs] is that most of what we do is not measurable. We don’t know how many suicides we might have prevented by breathing exercises or just by listening. We don’t know how many heart attacks or strokes we’ve avoided by checking someone’s blood pressure or getting them to stop smoking. We don’t know how many crisis pregnancies we’ve prevented. That’s the stuff you can’t measure.”

Read the rest >>>

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Truthsaying: The need for honesty from patients & doctors: session # 5

With themes of truth & hope underpinning the session, it being International Men’s Day, we read texts mostly by women about pregnancy, labour, babies and girls!

We started, though, with a run through Yeats’ ‘Paudeen’. They’re getting there. We had a recap on last week, and a summary of Maeve Binchy’s ‘Anna’s Abortion’.

From that we read and analysed an extract from Emilie Pine‘s ‘From the Baby Years’ section of Notes to Self. The extract dealt with the loss of her one and only pregnancy. We discussed how particularly invested Pine was in the pregnancy (“I see that I’m shaking”) and how that comes through in her hope & wishful thinking in the face of contrary information/evidence > “Maybe I am wrong. / Maybe the date is wrong.”

We discussed how despite our ideals of professionalism and standardisation, we nonetheless often sense and operate by other, more human realities >

“I have a moment of hoping this coincidence [of going to the same university as the doctor] will make her well-disposed towards me”.

We mentioned how bizarre it is how we often act contrary to our truths, pretending because of not wanting to reveal our uncertainties or to risk appearing not in control > “I pretend like I’ve done this before”.

I emphasised how honestly Pine was recounting all of this now as the narrator. We discussed the contrast between how Pine is aware of the constraints on the staff when it comes to pronouncing the still growing foetus dead, and her actual anger >

“I am furious. At the situation and, specifically, at them. I am a woman, in grief, and these women will not look me in the eye as a fellow woman and tell me that I’m not going to be a mother.”

We discussed the possibility that shame felt by the midwives was behind their failure here. We discussed the blunt honesty of Pine’s admission of how she felt observing the pregnant women outside the National Maternity Hospital > “I would be a better mother. I deserve it more.”

I emphasised how honest a writer she is in her retrospective analysis of her actions and thoughts >

“I am so deep into this that I don’t even see the problem with comparing not being pregnant to a serious illness.” And I therefore suggested she was a welcome/useful voice to hear in the context of how complex the doctor-patient relationship can get, with two flawed “entities” contributing to it. (It is too often presented over-simplistically as rude doctor failing innocent patient.)

~

We moved on to Maggie O Farrell‘s I Am, I Am, I Am, specifically an extract from the chapter called ‘Abdomen 2003’ that recounts the birth-plan for and delivery of her child. (I used the adapted version published by Time magazine.) We discussed how incredibly rude (almost literally: not credible) the consultant, Mr C, was. I paused on and parsed the sentence: “I wish now I’d left there and then, but at the time I was so astonished I complied.” I asked whether or not O Farrell was being as retrospectively honest as Pine here. Was it just astonishment?

[I diverted for a moment to read this important passage from Pine’s last chapter:

The stinging irony, of course, was that my entire talk was about ways that women are intimidated into silence. And here I was, with a platform to speak [having just given a lecture on the silencing of women about rape], finding myself with the same difficulty. The Faculty Chair’s comment [“I find it hard to reconcile how you look and your manner with your subject matter. I mean you look … I don’t want to use the word ‘cute’ but …”] implied that I shouldn’t be talking about rape. It is more than just tedious, this women-should-be-seen-but-not-heard attitude. It is a way of telling women to back to where they belong, back to being silent. I am gobsmacked that I still encounter this attitude in the university. And I am, most of all, weary of having to come up with something in response. I should have called him on his misogyny. But in the moment that he said it, I did not even allow myself to think about the implications of his comment. I wanted to look professional. I wanted to seem strong. I wanted to move on. As so I side-stepped. Which is, of course, a kind of silence.

I suggested Pine’s analysis was possibly true for the O Farrell situation too.]

The reappearance later in the episode of Mr C as O Farrell’s “saviour” was useful in setting up the idea that sometimes the rude doctor is all we’ve got, and maybe we just have to learn as patients how to deal with it, how to communicate with them to protect ourselves.

We contrasted, as O Farrell clearly intends, Mr C with the stranger in beige scrubs who comes to her emotional rescue while “a room full of people … are frantically working to save [her] life.” > “He stepped towards me, away from his wall, and took my raised hand. He enfolded it in both of his. I gazed up at him mutely. His touch was infinitely gentle but firm and sure. He stayed with me while they stitched and stapled me together again; he took the weight of my head and shoulders as they lifted me from the operating table onto a gurney.” [Italics added.]

~

We then read & analysed a story written by a man, Yay! (albeit a Michael Longley type of man > “I’m finely attuned … to the feminine side of the men I like. I really don’t like men who are pumped full of testosterone. I like my men to have a large dose of the feminine virtues.”) ‘The Girl with a Pimply Face’ by William Carlos Williams is one of my favourite texts to discuss with medical students because at first the male doctor’s sexualised descriptions of the teenager he meets on a house visit (“She had breasts you
knew would be like small stones to the hand”) make him seem just “creepy” (as was said today). We analysed the story in considerable detail and discussed too many things to summarise here, but with similar themes as above, of honesty, truth telling, self-awareness … and the sources of hope amidst all the negativity and human failure.

The girl with acne acts like Pine & O Farrell wish, with hindsight or in the very moment, they had acted.

The Williams story is set in a poor, immigrant neighbourhood where people from socially disadvantaged situations do what they have to and can to survive. The doctor too. He (like Sassall in Berger’s A Fortunate Man) in the identifies more with them than he does his colleagues, and he sees in the teenager a sign of something that offers hope. (“She was just a child but nobody was putting anything over on her if she knew it, yet the real thing about her was the complete lack of the rotten smell of a liar.”)

~

To emphasise the socioeconomic angle of this (and of the Berger text from last week), I read the only poem of the week, Julia Donaldson’s brilliant version ofThe Magic Paintbrush (with equally brilliant and clever illustrations by Joel Stewart, which I showed them as I read):

"He slips the brush into her hand
And tells her to be sure
Never to paint for wealthy folk
But only for the poor."

I say straight up to them, emulating as best I can the girl with pimples: what if the paintbrush is your medical qualification and what if we told you only to treat poor people. That stirs things up a good bit. I tell them class is over.

From Maggie O Farrell’s I Am, I Am, I Am

This extract from Maggie O Farrell’s brilliant I Am, I Am, I Am – Seventeen Brushes With Death, was published in Time magazine, ‘adapted’ from the ‘Abdomen 2003’ chapter of the book:

“Get up,” were his first words to me. “Let me see you walk.”

I wish now I’d left there and then, but at the time I was so astonished I complied.

“There is nothing wrong with you,” he pronounced, after he’d seen me take two steps. “You will have a normal delivery.”

I started to ask for clarification but the consultant — we’ll call him Mr. C — talked over me. Caesareans were a cult, he said, a fashion. I had been reading too many gossip magazines. I assured him this was not the case but he shouted me down again: Did I realize that Caesareans constituted major surgery? Why had I allowed myself to be swayed by celebrities? Did I doubt his medical expertise? What was wrong with me, that I was so afraid of a bit of pain?

The rest of the extract can be read here >>>

http://time.com/5113186/maggie-ofarrell-childbirth/

Promises to keep: Doctor-patient interactions

Screen Shot 2018-11-12 at 22.39.17

Forgetting Emilie Pine’s Notes to Self and Maggie O Farrell’s I Am. I Am. I Am. by mistake on the hall table at home, I had to adjust the plan for this class on my way in to Trinity.

We started, as planned, with the opening scene from the film adaptation of Carlo Levi’s non-fiction Christ stopped at Eboli which shows the Levi figure, aged, (“closed off from this world”) contemplating his portrait paintings of the peasants he treated and knew when he was banished to southern Italy for criticising Mussolini’s government. In the clip, we see close ups of the painted faces and hear the voiceover saying “I’ve been unable to keep the promise I made to those peasants upon leaving: that I’d return to them.”

Moving to another poor community in a rural location, namely, Gloucestershire – I then told them about John Berger’s A Fortunate Man, and showed them some of Jean Mohr’s photographs, pointing out that the commission that led to Fionn McCann’s ‘General Practice’ photographs, which hang in the halls around the Biosciences building, was inspired by A Fortunate Man. We read together the short scene early in the book in which a young woman visits the doctor, John Sassall, complaining about nothing in particular (‘You just feel weepy?’). The episode is mostly dialogue, but we discussed Berger’s observation of the patient: that ‘She is nubile in everything except her education and her chances.’ We compared that to Levi’s painterly observations of the peasants of southern Italy. We also analysed the particularly personal level of care that was shown in the consultation, how it reached into the patient’s circumstances, going way beyond physical and even narrowly defined mental health concerns.

We discussed at some length the last few lines of the vignette, another authorial intervention: “After she had turned the corner, he [Sassall] continued to stare at the stone walls on either side of the lane. Once they were dry walls. Now their stones were cemented together.” We identified the poetic nature of it and the possible metaphorical comment it represents in relation to the lives of the local people becoming more restricted.

To stand in for the more negative experiences of doctors that are a feature of some of the encounters in Pine’s Notes and O Farrell’s I Am.., I simply showed them & read from the front page of the Irish Times from 13 September 2018 when the Scally Report was published.

Irish Times frontcover doctor quotes

We then read Kim Caldwell’s personal essay, ‘Life Lessons’ (from CUP’s ‘Palliative & Supportive Care’), about her recollections of dealing with various patients close to or at the time of their death. We discussed why she might have chosen to address those people in the second person singular; and some other aspects of the style of writing, the structuring of the pieces, and the literary nature of some of the writing. We noted how much detail she was able to recall about the lives of these patients, details which she had picked up from spending time with them and consciously listening to them, details which she still recalls and which she consciously shares with the reader, as if challenging the reader to sit with the patient as well and get to know them. We discussed her reasons for going into so much detail, and for wanting to share the accounts with others. (Prompted by one possible reading and the occasional ‘commodification’ of doctors’ experiences that one encounters, we discussed the possibility of there being an element of flexing or trumpeting about such accounts, but the majority of the class felt that this would be an unfair reading to the author in this case whose genuine nature came across very clearly in how much she obviously cared about these people, wanted to remember them as people – not just patients, and how she pointed to her shortcomings and the system’s pressures that prevented this kind of interaction being the norm.) We discussed the pressures on medics to concern themselves with much more than just the science of health, the symptoms, the diagnoses, the treatments. It was pointed out how helpful it was to get this perspective on the patient-doctor relationship.

I gave them – “to go” – a 1977 Irish Times piece written by Maeve Binchy (whose portrait by Maeve McCarthy was one of the paintings chosen to “go with” a poem during our visit last week to the National Gallery), called ‘Anna’s Abortion’, and one of the ‘In Her Shoes’ personal accounts that had some parallels > https://www.facebook.com/InHerIrishShoes/photos/a.142348133106279/239426283398463/

(Note: It was our first poetry-free and fiction-free day.)

Scoping inquiry into the CervicalCheck screening programme: Dr Gabriel Scally

Irish Times frontcover doctor quotes

From the Irish Times, 13 September 2018:

“The report includes scathing criticism of the medical profession, with male dominance in the healthcare sector coming in for scrutiny as the affected women pointed out that most of the doctors behind the failures to disclose information to female patients were men.

“The point was made that many of the major controversies about maltreatment of patients or denial of reproductive rights in the Irish healthcare system have involved women being damaged,” says the report.

“Why does it always happen to women?” one woman said to the scoping inquiry. “I think there is a history of looking at women’s health services as being secondary,” said another.

>>> https://www.irishtimes.com/news/health/scally-scathing-of-whole-system-failure-in-cervical-screening-1.3627389

Connecting words and images at the National Gallery

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After a break for midterm & a reading week, we were back and as arranged met in the foyer of the National Gallery.

Usually when I bring a group to the Gallery, it’s for a creative writing exercise whereby I get them to choose a portrait from the collection and imagine it’s of a patient. I ask them to write a response of some sort to that particular patient’s situation. However, this module is about (creative!) reading, so I had a different plan in mind.

First, though, I had to do the weekly ‘Paudeen’ reading. I guided them through the various sections of the gallery to Yeats’ ‘The Singing Horseman’ and sparing them the embarrassment of having to recite aloud in public, I read the poem once through for them. Possibly just as embarrassing, actually. (Will have to get them to read it on their own next week.) I mentioned that I associated the ‘Singing Horseman’ painting with ‘Paudeen’ – hinting at what was to come.

Next, I brought them to the Zurich Portrait Prize exhibition, mentioning for later reference that here they’d find the only really contemporary work that’s in the Gallery at the moment. Specifically, in order to connect with our previous module and with medicine, I showed them Fionn McCann’s ‘Cézanne’s Apple’, a photograph of artist Brian O’Doherty. (Fionn’s medic mother, Brenda, did her art history doctorate on Brian’s work. Fionn’s medic dad, Seán, was our coordinator for the medical humanities module up until a few years ago. Fionn’s portraits of general practitioners at work hang in the halls of the TCD Biosciences building where these students spend most of their days these days.)

Next we convened in the amazing courtyard between by Joseph Walsh’s ‘Magnus Modus’ and ‘Finding Power’ by Joe Caslin (Wow!) for a briefing. I explained we were in the Gallery to explore the relationship between word & image. By way of example, I showed them Paul Durcan’s ‘Crazy About Women’ book, and read his poetic response to Jack Yeats’ ‘In the Tram’ painting.

I explained that I had reservations about the concept of the ‘Crazy’ project when it happened (so long ago … before they were born?) and it prompted me to organise a very different exploration of the relationship between word & image.

The Bridges & Crossroads project involved getting a group of four living Irish poets – Katie Donovan, Brendan Kennelly, Catherine Phil MacCarthy, Micheal O’Siadhail  – to make a selection of poems from the Irish canon (that is, by dead poets) and read the selection to a group of living Irish artists who were then asked to respond to one of the poems in a visual work. (I wanted to deconstruct Durcan’s divilment! In the end, my divilment was further deconstructed by Alice Maher’s contribution to the exhibtion, wherein she refused to respond to someone else’s words as if art was only capable of illustrating the great literary works, and instead chose to, well, paint a poem.)

I explained that I didn’t expect them to either write a poem or make an image, but instead to take a poem each from the batch I had with me and go find an image that they felt resonated with the poem in some way. I gave them a poem each – with medical connections – by among others, Katie Donovan (‘Marked’), Brendan Kennelly (from ‘The Man Made of Rain’), Angela T. Carr (‘CAT Scan’), Karen J. McDonnell (‘A Bad Dose’), Philip Brady (‘Diagnosis’ & ‘Respiratory Failure’), Leanne O’Sullivan (‘Tracheotomy’) and some fella called Micheal D. Higgins (‘The Crossing’).

I suggested they read and reflect a little on the poem they got, and then just wander about the Gallery checking out the art and seeing if anything jumped out at them as connecting with their poem, and to come back when they were ready, to tell us all how they got on, read their poem, talk about their choice, and show us a snap of the painting they had chosen. (No one chose a three dimensional piece.)

They did just that.

As anticipated, we discussed – arising from the connections – different aspects and themes of the poems than we might otherwise have done – especially visual elements; but we also ended up discussing how different aesthetic styles are picked up in both art and writing (the more abstract the poem, the more abstract the art chosen in some cases).

We heard how some people found very obvious and quite literal representations of their poems, while others struggled to find anything, and still others were too spoiled for choice and changed a few times.

One students’s initial reading of Katie Donovan’s ‘Marked’ brought her to one painting (the portrait of Maeve Binchy and her husband in the Zurich exhibition?), but as she walked on she saw another painting (involving an infant) that completely changed her reading of the poem and so she opted for that painting and reading instead.

For two of the more dense poems, I actually gave them to two different people each, and it was interesting to see the similarities and differences between the choices made for the same poem by different readers. One student thought of a song first as they read the ‘CAT scan’ poem by Angela T Carr, Massive Attack’s ‘Voodoo in My Blood’, and that influenced their choice of painting.

With the Brendan Kennelly poem I had the excuse to play them a clip from Ailís Ní Ríain’s musical setting of extracts of the poem. (And mention impressionism & abstraction in music briefly.)

 

https://player.vimeo.com/api/player.js The Man Made of Rain (extract) – Ailís Ní Ríain from Ailís Ní Ríain on Vimeo.