Patients


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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.)

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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.

The Guardian:

From Friday, doctors working in the 10 GP surgeries on the islands will be authorised by the archipelago’s health board, NHS Shetland, to issue “nature prescriptions” to patients to help treat mental illness, diabetes, heart disease, stress and other conditions.

full story >>>

For Savita Halappanavar

The procedure complete, I wake alone.

The hospital sleeps…

http://www.irishexaminer.com/lifestyle/artsfilmtv/news/the-tuesday-poem-242567.html

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

Heather came to Brooklyn after high school, when she was nineteen, more than thirty years ago. She had planned to go to college to study English literature and become a teacher—she loved poetry, she loved T. S. Eliot, she loved C. S. Lewis—but when she prayed about this she got a sense that God was telling her to go into nursing instead. She was reading the Bible, 1 Thessalonians, and came across the verse “But we were gentle among you, even as a nurse cherisheth her children.” She said to God, Nursing? Lord, I never really thought of nursing. But she discovered that it suited her. Normally, a graduating nurse went into medical-surgical work—that was where the prestige, the difficulty, and the excitement were—but she went instead into home care. She wanted to care for her patients in a personal way, rather than racing from one task to another, one limb to the next—inserting an I.V. here, drawing blood there, scarcely noticing whose vein she was puncturing or whose arm she was holding…

People react differently to a death. Some cry, some are calm. Some are frightened to be left alone with a body. Some fear that the body may come back to life. Wives sometimes throw themselves on the body, weeping and grasping it, especially when the couple have been married forty, fifty, sixty years. “The Bible says, And two shall become one,” Heather says. “It’s a wrenching that happens, a tearing, like a garment that’s being pulled apart.” But fairly often a former spouse is taking care of the patient, because there is no one else to do it, and that person may not feel too much.

When the time seems right, Heather begins the postmortem rituals. She shines a flashlight into the patient’s eyes to see that the pupils no longer constrict, and, if they do not, she closes the eyelids. She checks the pulse at the wrist and neck. She listens to the chest, and looks at the hands to see if they have changed color. She asks the family if there are people they need to call—other relatives, a priest, the funeral home—and if they aren’t ready to do it she offers to do it for them. She phones the hospice doctor to confirm the time of death, and the doctor writes up the death certificate. It is illegal to transfer medications from one patient to another, so she goes to the patient’s fridge and retrieves any leftover drugs and destroys them, with bleach, or coffee, or dirt.

From the New Yorker >>>

Yet despite the obvious layers of artifice, there is something insistent and revealing in these scenes [Corinne May Botz’s photographs of medical actors,the hired professionals who act out illnesses in order to train medical students in caring for patients]. In her 2014 essay “The Empathy Exams,” the writer Leslie Jamison explored her own experience working as a medical actor, and the complex negotiation and performance involved in expressing one’s own pain and in learning to respond to the pain of others.

Full article in the New Yorker >>>

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