Patients


For Savita Halappanavar

The procedure complete, I wake alone.

The hospital sleeps…

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

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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 >>>

Whoever says that the medical profession can’t tell one end of a guitar from the other clearly hasn’t encountered Belfast-based Joe O’Sullivan. By day, he is professor of oncology at Queen’s University, and clinical director of Northern Ireland Cancer Centre. By night, he’s a guitar strummer and songwriter, and the man behind the album, Take a Deep Breath, which, he says, was inspired by his experiences working with prostate cancer patients.

Up until recently, playing music was “nothing too serious”, and while he isn’t about to give up the day job, the transition from performing in cover bands to writing his own material has taken root. “My first few attempts at song writing would have been internalising,” O’Sullivan admits, “and they were about the usual stuff, really. The first song that made an impact on me became the album’s title track. I’d witnessed a wife comforting her husband, who was dying. They were a young couple who I knew really well, and she was holding his hand, asking him to take a deep breath.”

Read full article on Irish Times website >>>

At the launch of a US fundraising push by the Irish Hospice Foundation in New York, Byrne said that the clinical culture and physical surroundings within Irish hospitals often contribute to the trauma felt by dying people and their loved ones.

“I attended the bedside of a friend who was dying in a Dublin hospital. She lived her last hours in a public ward with a television blaring out a football match, all but drowning our final conversation,” he said at the launch of the charity’s Design and Dignity Fund in the United States.

“I looked around this depressing place, with the cheap curtain separating her from other patients, walls painted nondescriptly institutional, the awful food, the ubiquitous smell of disinfectant mixed with human odour, and I began to think about the physical environment in which we might spend our final hours, that space which, as the late Seamus Heaney said, is ‘emptied’ and ‘pure change’ happens,” said Byrne, patron of the foundation. “I have since come to believe that in hospital aesthetics are as important as function, that both are in fact closely linked. And that an aesthetic environment automatically leads to good practice and better care.”

Michael O’Reilly, chairman of the Design and Dignity project, said that when people are beyond cure it becomes a “sacred obligation” to attend to death with care and dignity. (Times) >

We are all mental patients. Few of us enjoy perfect physical health all of the time, and the same is true of our mental health. One in four of us is suffering from mental-health problems — from mild depression to full-on paranoid schizophrenia. It’s all around us, every day. Why supermarket chains, Tesco and Asda, thought it was acceptable to sell ‘mental-patient’ Halloween costumes is baffling — would they sell, say, inflatable wheelchairs, or joke dialysis machines? Not likely — there would be outrage. We don’t mock physical problems, but it’s okay to laugh at mental illness? (Examiner) >

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