‘Outside the operating theatre, I burst into tears’: Gabrielle Cummins on experiencing a panic attack during a medical procedure

From the Irish Times >>>

“Will I get your mam?” asked the nurse.

“She’s not here,” I spluttered in between tears, “she had to get back to our shop to work.”

Those lines are from my diary, written when I was 13 years of age. I had just been admitted to hospital with a threatened burst appendix and was about to be operated on to have it removed. My 13-year-old self writes: “When I’m brought to the room outside the operating theatre, I suddenly become very frightened and burst into tears. The nurse tries to console me. I’m given something to calm me down and a short time later, all I remember is being wheeled into the operating theatre where I comment on the great view of the Rock of Cashel out the window and then I fall into a deep sleep. I wake up in the recovery room, calling once again for my mother and, thankfully, this time she’s there.”

Read the rest >>> 

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Final session, in St James’s Hospital

Two things got us off to a bad start for this one:

  1. This was meant to be last week’s session so that all the social & political material of last week would be the climax, but it wasn’t logistically possible.
  2. The transport from Trinity Biosciences Institute was late & some students got lost which meant we were very late getting started & therefore had to cut a few texts that I’d planned to read with them 😦

We met at the entrance to the hospital & I briefed them on a small exercise I wanted them to do: inspired by Danielle Ofri’s idea of literary rounds, I gave them each the text of a different poem/text & asked them to read it to themselves for a few moments. Each poem was set in a hospital. I then asked to make their way at their leisure to the seminar room and on the way to observe as much as they could about the hospital environment connected with, inspired by, or entirely unrelated to the poem they’d just read!

In class, we started with the Yeats poem & tried to recall it without reference to the text. It wasn’t entirely a success, let’s just say.

We then went around the group, with each person reading aloud the poem they had received and then sharing with the group their observations about hospitals/ the hospital we were in / the hospital in the poem. Each contribution led to further discussions & chats & recollections.

The poems were Leanne O’Sullivan’s ‘Tracheotomy’, & ‘Leaving Early’, ‘In the Way’ by Elaine Feeney, ‘Postcards from a Hospital’ by Doireann Ní Ghriofa, ‘Visitors, Kidney Ward’ by Enda Coyle-Greene, ‘Leaving the Ward Behind Me’ by Tommy Lambert & ‘The Chapel Corridor’ by Barry Mitten (both from Climbing Mountains in our Minds, edited by Sylvia Cullen) and Patrick Kavanagh’s ‘The Hospital’.

Bronwen Barrett & Martha Knight of Freshly Ground Theatre

The texts we didn’t get to, but which I distributed nonetheless and which I will be using with a new group next term instead, were Eleanor Hooker’s ‘The Man in Bed Eight’ & the first scene from a new play called the Bold Step by Bronwen Barrett & Martha Knight of Freshly Ground Theatre, which I saw (& was totally bowled over by) at the weekend. (They kindly emailed me the opening scene, which they based on interviews with their mothers about their own births: “M: There was a student midwife sitting beside me, shaking … B: ‘you’ll be grand, you’ll be grand.’ M: I remember turning to this nurse, typical teacher, like, in the middle of the epidural, saying ‘sure, I could be correcting copies”!!!!! 🙂 

I then read a few bits of Danille Ofri’s essay ‘The Poetry Ward’  about introducing poems to the routines of doctors in hospitals. I finished up with a full reading of John Stone’s ‘Gaudeamus Igitur’ & dismissed everyone with best wishes. 🙂 

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/

Career versus motherhood

From an essay, ‘Advice on Motherhood’, by Dominique Cleary, first published in the Dublin Review (#72, Autumn 2018), there’s this interesting scene featuring the obstetrician >>

It took two epidurals to deliver John. My husband asked me whether I had noticed the obstetrician stroking my thigh during labour. I hadn’t, but I knew I had hugged his arm for comfort. When he placed John at my breast he said, ‘No more babies, you have one of each now and you’ve done enough.’ It was strangely reassuring to hear him say that. He restricted my visitors and arranged that I get an extra night’s rest in my overheated hospital room that smelled of rotting grapes and wilting lilies.

The essay, which was reproduced in full by RTÉ Culture (here), is quite the indictment of how our society was/is constructed when it comes to supporting parenthood, particularly pregnancy, labour and early motherhood, and especially in relation to women’s careers. There is a very revealing flashback scene in which the author is confronted by a classmate on her first day as a law student:

‘Look around at all the women,’ he said. ‘For every one of you, there’s a man sitting home right now that didn’t get in. Most of you are going to get married and have children anyway. What a waste.’

Module opener 2018/2019

To begin my twentieth year teaching literature at Trinity College School of Medicine, and as I usually do to bring them rapidly and suddenly out of their more textbook-, fact- and learning- based world, I read a poem.

I first asked them to call to mind someone in particular they don’t like, someone who bothers them intensely, someone they would dread spending a long bus journey sitting beside, and then to give them the name Paudeen.

And I read Yeats’ poem ‘Paudeen’ to them.

Indignant at the fumbling wits, the obscure spite
Of our old Paudeen in his shop, I stumbled blind
Among the stones and thorn-trees, under morning light;
Until a curlew cried and in the luminous wind
A curlew answered; and suddenly thereupon I thought
That on a lonely height where all are in God’s eye,
There cannot be, confusion of our sound forgot,
A single soul that lacks a sweet crystalline cry.

And I read it again.

And I read it again, explaining that when we meet someone for the first time, as they were meeting me, we are often distracted by a variety of observations we make about them from what they are actually saying; I gave them the example of how we often forget someone’s name when they first introduce themselves to us; I said we’d be reading each of the poems we encounter a number of times!

Then I told them I was going to ask them to do something they may never have done before or not done in a very long time: a dictation. I got them to write out the poem word for word as I read it to them again, explaining first that I hoped it would help them become more familiar with how the poem is put together.

Then I told them I was going to ask them to another thing they may never have done before or not done in a very long time: a group reading. I got them to join me in reading the poem aloud all together. And then we did it again, and as we did I freed my vocal presentation even more and injected a bigger dose of emotional charge into it, by way of demonstration, by way of making sonic room for them to do the same, and by way of making them more aware that this was an informal, liberal arts environment!

And I think at least some of them felt the charge, and I discussed the power of art with them a little, comparing what we just did to singing in the shower or dancing in the dark etc. Poetry may be quieter but it can be extremely powerful in its own way, and it finds its place, especially when we open ourselves up to it.

I then went through the poem with them line by line and discussed various aspects of it, by way of illustrating close reading and starting to get them comfortable with personal perspectives and different interpretations. I paused every now and again to invite them to offer their own thoughts, but didn’t put any pressure on them to contribute at this early stage.

I also hinted at why this poem might prove beneficial to them to have in reserve when they eventually become doctors! We’ll recite it every week together.

So, that was all by way of presenting one aspect of the module: literature.

~

To present the other aspect of the module, namely medicine, I turned to non-fiction prose (as close to science as we get!) and read some extracts from a number of columns by a columnist whom I can’t bring myself to mention here but who wrote well and humorously about doctors many years ago, to wit:

Medical students are put through a hell which is the very opposite of education. Far from their minds being opened, being prompted to engage distant and different horizons, far from their time at university being one of mental liberation and personal discovery, medical students find themselves being funnelled into a witless, brain-sterilising marathon of fact-retention.

The very first task of medical school is the conversion of the brain from a vital ratiocinative organ for analytical thought and speculation into a machine for storing facts – in other words, a cerebral shoebox containing a vast anatomical index, in which you can find the name of every nerve-ending and every follicle, and also, in an unswept and unvisited corner, a small, withering organ called common humanity.

This is not the fault of the students. It is almost impossible for the spirit of ordinary sensitivity, of optimistic enquiry, of normal ignorant speculation working its way to enlightened conclusion, to survive the Gradgrindery of medical training. Medical students probably work five or ten times harder than art students; and correspondingly, they discover five or ten times less about human nature. That discovery is made in casual college discourse, in unstructured debate, in wide and varied and undisciplined reading. It is the very purposelessness of the liberal arts which give them purpose.”

This allowed me to ad lib on the perceived differences between the liberal arts and sciences, but in a very balanced way, emphasising that medical students indulged in plenty of casual discourse and arts students spent a lot of time reading dull books. It also allowed me to talk about the overall thinking behind humanities modules for medical students.

~

And so on to the main course:

Lucy Caldwell‘s eponymous story from her short story collection ‘Multitudes‘*. I read out loud this powerful story set in a paediatric ward, line by line, observation by observation, episode by episode; pausing regularly to comment or invite observations – personal and / or interpretative.

The consultant mentioned on the first page allowed me to invite one of the group to pose the well known riddle about the father and son who are in a car accident and rushed to hospital for emergency treatment, but the surgeon announces “I can’t operate on this boy. He is my son”. (Until it’s no longer a riddle, what have we got? _________.**) I even gave the briefest summary of deconstructionism!

(The mention of Susan Sontag’s idea of a kingdom of the well and a kingdom of the sick prompted me to read as an aside Dennis O’Driscoll’s ‘Someone’.)

We also discussed things like how patients & staff experience things very differently; how artificial and therefore challenging the atmosphere in hospitals is for patients (… and staff!); how othering illness is; how the powers of observation/description many writers exhibit (especially Caldwell here, for instance when her narrator is describing her efforts to breast feed / ‘nurse’ her sick child), how the detail of these observations would be expected of the best doctors when it comes to understanding patients and making diagnoses. (Needless to say, they don’t need to put in writing the observations as well as Caldwell does; though I did mention how many doctors were also good/great writers.)

Finally, we discussed how literally we ought to take a narrator of a story, or how believable every detail of a story is; could particular things “actually happen” to the narrator as described, or could they be taking poetic licence or using magic realism techniques to convey a truth other than the observable truth?

“I sing over the noise of the machines and I sing myself into a sort of doze. Sometimes I try to sing alternative endings for the soldiers … Sometimes I try to sing other songs …”

We ran out of time at that stage, which is a good thing, as hopefully they’ll want to go off and read the rest of the story for themselves now.

*Also available in ‘The Long Gaze Back: an anthology of Irish Women Writers’ edited by Sinéad Gleeson.

**I should say that apart from those who knew the riddle already, no one else in the group of ten got it, male or female. This despite the mention of the consultant being the prompt to put the riddle!