you can't make this stuff up

Don’t let the term “narrative medicine” intimidate you. This is a broad and inclusive writing niche. You don’t have to be a physician or a health care provider to practice it. You don't have to be a nurse, an aide, or a therapist. In fact, you don't need to have direct contact with patients at all.

"Everybody has a story to tell."

~Joe Strummer~

Maybe you work in the hospital laundry, and one day, a half-smoked joint falls out of the pocket of a pair of surgical scrubs you're folding. Which bleary eyed surgeon did that come from? Or, imagine you’re a janitor called to fix a leaky faucet in the middle of the night. When you walk into the room, the patient is breathing quietly. Then you hear a groan and his breathing stops. Tell us about it.

Perhaps you've been a patient. Tell us what went through your mind the day you started having chest pain. What worried you about it? Why didn’t you go to the ER sooner? 

Maybe you can tell us what it was like to wait in the ER for hours before someone came to set your child's broken wrist. What did you see there? An angry drunk in handcuffs escorted by the police? Drops of blood drying on the floor? The surreptitious pinch the doctor gave the receptionist on her behind when he thought no one was looking? You have a story to tell.

What is it we like to say? You can’t make this stuff up.

"Everybody walks past

a thousand story ideas every day.

The good writers are the ones

who see five or six of them.

Most people don't see any."

~Orson Scott Card~

Now, let’s add another plot twist.

What if the surgeon who is scheduled to replace your aortic valve in the morning was up all night because that afternoon his son totaled the car on his way home from school? What about the ICU nurse who found the cigarette burn on the shirt her ten year-old wore to school yesterday? What about the single mother who works in food service with the dull ache in her low back and unpaid bills collecting on her kitchen counter? What do you think their stories are?

What is yours?

"Tell your story with your whole heart."

~Brene Brown~

jan

how to change the way you think

 

The news this past week was discouraging. The fires in Maui, and now in Washington State. The approach of hurricane Hilary. The war in Ukraine. The oppression of women in Afghanistan. The threats posed by climate change. The ongoing political nonsense here in the US. Etc., etc...

If, like me, you sometimes just don't know what to think anymore, it may be time to change the way you think. To question what you have come to believe because of what you were taught, what you have observed, or what you have experienced in your life. To pause for a moment to reconsider your customary or conditioned response to whatever it is you're up against this time. To explore the feelings that emerge unbidden, as if on cue. Anger, hatred, fear, greed, shame. Not a healthy emotion among them. 

"If we could see the miracle of a flower,

our whole life would change."

~Buddha~

If you are looking for a way to push through fear, grief, anger, or shame, this could be your guidebook. It helped me a lot:

The author is a senior teacher in the Shambala Buddhist tradition and founder of the Interdependence Project in NYC.

Ethan Nichtern

This is not a textbook about Buddhist psychology or practice. It is not intended to promote spiritual conversion, or coercion. It is an invitation to consider looking at life from a different perspective. To examine our choices in life. To question our values. To explore our relationships. The author demonstrates how ancient Buddhist teachings can bring equanimity, connection, even peace when the life we know is chaotic, confusing, and often painful. He lives in Manhattan, so he would know.

I decided to re-read this book--this week--because I needed a good healthy dose of wisdom. I learned that a friend I thought was on the road to recovery...actually, is not. His cancer has spread. Another friend starts chemo this week. She lives alone. Another is facing a future of slow memory loss and progressive frailty punctuated by confusion. It was a bit overwhelming to contemplate.

I needed to hear about interdependence again. About loving-kindness and mindfulness. About what is true and what is deceptive. What is real and what is illusory. I needed to re-examine my response to the painful transitions my friends and family are facing...and to think about how I can be helpful to them.

"It may be that when we no longer know 

what to do, we have come to our real work,

and when we no longer know the way to go,

we have begun our real journey."

~Wendell Berry~

If the news is getting you down...if you feel powerless, victimized, or somehow blameworthy, or if the twists and turns that mark your own path through life are confusing and sometimes scary, consider this:

"The simple act of caring

is heroic."

~Edward Albert~

Caring gives you something to reach for. Something to build upon. Something to offer. 

Ask yourself, "What am I called to do in this life?" 

"What difference do I want to make in the world?"

"How will I proceed?"

"People change for two main reasons:

either their minds have been opened or

their hearts have been broken."

~Steve Aitchison~

jan

 

what we all need-to-know

 

Burlington, Vt

If you are curious about the healing power of storytelling but you haven't started writing yet, I understand. I had a hard time getting started, too. I convinced myself I lacked the skills and talent and dedication required to line up words on the page, one after another...and then, to rearrange them, over and over again until they sounded right. Until they made sense. Until they rang true.

"Words are sacred. They deserve respect.
If you get the right ones,
in the right order,
you can nudge the world a little."
~Tom Stoddard~


It's hard to know how to begin, but instead of worrying about spelling, grammar, and punctuation...instead of fretting over literary style...or judging yourself before you even begin, you might start by asking yourself a couple of questions:

What about my story does the reader need to hear?

Why?

   

The reader needs to know he's not alone. It helps to know how someone else felt when the doctor pronounced the word "cancer" for the first time. What went through his mind? How did he cope? Where did he find the courage to go on?

 

Or maybe one of your readers needs to know how you helped your daughter when she suffered a miscarriage...and how you got through it. What did you say to her? What did you do to provide relief, or comfort, or solace to her? Where did you find yours?

 

"Write about what disturbs you, what you fear,

what you have not been willing

to speak about.

Be willing to be split open."

~Natalie Goldberg~



People need to know it's OK to cry. To rage. To rest. To ask for help, and to embrace it when it's offered.

People need to know there's hope, and when hope fails, it helps to know where others turn for comfort, consolation, and support.

Where do you turn? What story can you tell? Someone, somewhere needs to hear it. When will you begin?

"The healing that can grow

out of the simple act of telling our stories

is often quite remarkable."

~Susan Wittig Albert~

jan

 





 



what are you afraid of?

If you are a healthcare provider, a caregiver, or worse, if you are the patient...you're probably all too familiar with the word "fear."

"It is both a blessing and a curse

to feel everything so deeply."

~Noah Weiss~

Patients probably bear the brunt of it. When they have to wait for the test results they know will determine their fate. When they face a painful or risky procedure. When the phone rings in the middle of the night, and it's the ER calling. They bolt out of bed and they are on their way. Fear can alert you to danger. It can deliver a jolt of adrenaline. It can be a great energizer, a motivating force. 

Fear is also fertile soil for avoidance and denial. For procrastination. For the imagination. Take the case of the middle-aged man who presents to your office with chest discomfort he describes as "indigestion"...because he's afraid to admit it could be his heart. So he fails to mention that the pain gets worse when he walks uphill. That it radiates into his neck when he lifts something heavy. That antacids haven't helped. He's afraid, all right.

Imagine the fear a parent feels when his child is rushed to the hospital because of an illness, injury, or overdose. 

What is it like for a woman in labor if she lost her last newborn because of a heart condition or some other unforeseen complication? What could be scarier?

"Be brave my heart.

Have courage my soul."

~attribution unknown~

As ordinary human beings trying to orchestrate our personal lives outside of the office or hospital, healthcare providers are prone to some of the same fears. I take good care of myself so I don't worry unnecessarily about my health. But I will admit to a twinge of anxiety when I was asked to return for additional views on my mammogram this year. 

I wasn't worried when my PCP picked up a few irregular heart beats on my physical and ordered an echocardiogram. I drink a lot of coffee, so what did he expect? I wasn't worried until the tech started spreading the goop all over my chest. Suddenly, I was a bit anxious about what they might find. I had rheumatic fever as a child, by the way.

Once, when I was in medical school and my mother was out of town on business, I called my Dad just to say hello. He picked up the phone and greeted me, clearly pleased to hear my voice. Then the line suddenly went silent and I heard the receiver fall to the floor. Nothing. I knew he was alone and I was a three hour drive away. Panicked, I called a neighbor of his to check on him and to call for help. Fortunately, he'd experienced a simple fainting spell when he stood up to answer the phone. As it turned out, he was fine...but I feared for his life.

There's that...and then there's the fear that stalks us through the work day. Who hasn't felt it on the way to a "code"? Will the patient need to be intubated? Will I remember the dose of bicarb or atropine to give, and when to give it? Will we be able to save this life? Fear is never far away.

"The greatest mistake we make

is living in constant fear that

we will make one."

~John C. Maxwell~

What about the patient who shows up unannounced at the office with a bad laceration? Fear kicks in. Will I get the layers right when I sew it up? Will it look OK when it heals? What if it gets infected? 

Will the delivery go smoothly? Will the baby be okay?

Will the Narcan work in time?

"Do what you can,

with what you have,

where you are."

~Theodore Roosevelt~

Patients would probably be surprised to know how fearful we can be. Deciding which tests to order and how to interpret them. Afraid of making the slightest mistake. Worried we might miss a diagnosis.

Fear is like a shadow on a cloudy day. It follows us through the day, unseen. Patients don't know it's there, but it is. It might reveal itself as frustration, impatience, or disengagement. It can cause headaches, rapid pulse, nausea, sweaty palms, or shakiness. Even in doctors. Like everybody else.

"Great fear is concealed

under daring."

~Lucan~

What are you afraid of? What will you do about it?

jan