Poetry in medicine: Chapter and verse

In a previously published Musings blog entry, A plea for poetry in medical practice, I wrote:

Poetry (as well as good literature) is capable of stimulating the development of empathy in the reader—in this case, the clinician—and serves to enable him or her to approach the patient with an element of understanding and compassion. Such an approach undergirds the delivery of quality medical care.

In that piece I advocated for the inclusion of poetry in the medical curriculum to cultivate empathy on the part of clinicians toward their patients:

“It isn’t that clinicians are totally thoughtless people,” I opined. “In many instances they just never learned to appreciate what it might be like to stand in the patient’s shoes.”

On the heels of these words how heartened I was to peruse Dr. Pauline Chen’s recent New York Times column The Doctor as Poet, for here Dr. Chen expresses the same sentiment. more»

The Emerging Science of Narrative Medicine

Last week’s Education Life section of the New York Times carried an article outlining a new offering at Columbia’s College of Physicians and Surgeons: a one-year graduate degree program in narrative medicine.

The offering is the brain child of Dr. Rita Charon, clinical professor of medicine at Columbia, and a leading advocate in this “emerging field” that “aims to treat the whole person, not just the illness.”

For the paltry sum of $50,000, participants can pursue courses in “philosophy, literary theory, psychoanalytic theory, and autobiography,” culminating with a “reading of literature that involves experiences of illness.”

This academic year 28 professionals have matriculated in the course.  At $50,000 per student, that’s a whopping $1,400,000 added to Columbia’s coffers per annum.  To me that seems rather outlandish, even if Dr. Charon does possess a Ph.D. in English in addition to her M.D. degree.

The gist of the program is to produce better doctors—those who can relate with a higher degree of empathy to patients—as well as leaders who can set up similar programs in other institutions of higher learning.

Anyone who has spent any time wrestling with literature will recognize the concept of irony, one of the dominant themes in the discipline.  To my humble way of thinking, as one who has spent untold hours delving into the writings of past medical authors and mentors, the concept of a $50,000 graduate degree program to learn the art of narrative medicine is, well, rather ironic in itself.

My father was a teacher.  He spent most of his career in the classroom, teaching students.  (He eventually rose to the rank of department chairman, a position which required more administrative duties in his final work years.)  I remember his words one afternoon in quiet conversation:  “The only ones who know anything about teaching are those who work in the field.” (Lest readers accuse me of nepotism, let me add that I’ve heard the same sentiment echoed by any number of other teachers worth their salt.)

If I read former physicians like William Osler, Francis Peabody, William Carlos Williams and Albert Schweitzer, as well as any number of literary types such as Tolstoy, Chekhov, Cronin, et. al., I find that the “emerging discipline of narrative medicine” has been emerging for quite some time—decades, I’ll warrant, if not centuries; perhaps millennia.

Personally, over a thirty-year career in clinical medicine, I became involved in “narrative medicine” by listening to patients and trying to make some sense of their stories as I melded them with my own.  I frequently visited with mentors (both living and dead) and learned from them as best I could. I started to write for my own edification—to put things into perspective, to learn from my mistakes, to identify what was important in caring for my patients. I published pieces to share what I learned with others, who likewise were searching for fulfillment in their roles as healers.  All of this I did with no expectation of monetary reward—I did it for the love of it, and an amateur I remain.

Now that narrative medicine has become the “in thing,” entrepreneur types are capitalizing on it, generating big bucks through workshops and programs like Dr. Charon’s at Columbia.  Eventually, it will become tainted. (As Mark Twain said, ‘Taint yours and ‘taint mine.)

But for the time being, those of us who work in the field, listening to the stories of our patients every day, can continue to ride the common waves for as long as the surf’s up.

What can we learn from the humanities?

Stanley Fish, dean emeritus of the College of Liberal Arts and Sciences at the University of Illinois at Chicago, has posted a series of thought-provoking pieces on his New York Times blog “Think Again” about the humanities. His specific question has to do with their relative value as an academic pursuit: to wit, what is the justification for the study of the humanities?

Professor Fish goes to some length to rebut the argument that studying the humanities will make us better individuals. He counters those who opine that wrestling to understand the great literature of poetry and prose, philosophy and history serves to make us more moral, more sensitive to the plight of our fellow human beings.

According to Professor Fish, the humanities will not save us. Indeed, a close reading of these pieces leads you to conclude that, apart from enhancing the subjective aesthetic experience of the student, the humanities have little to offer a society at large.

While Professor Fish is heartened to learn that some of his former students report life-changing experiences as a result of their studies, he is certain that the vast majority would report something quite different. He asserts that “mastery of literary and philosophical texts and the acquisition of wisdom are independent variables.” In other words, exposure to the humanities will not necessarily equip you with the wisdom of the sages. He goes on to say that “the value of the humanities cannot be validated by external measures like increased economic productivity, or the fashioning of an informed citizenry, or the sharpening of moral perceptions, or the lessening of prejudice and discrimination.”

It was once felt that the humanities provided a way to develop critical thinking; yet to Professor Fish, all thinking is ultimately critical thinking, else it wouldn’t be thinking at all. (To me this statement is a perfect example of critical thinking.) And he further argues that the humanities do not enjoy a monopoly in this regard.

Over the course of my thirty-year career as a clinician, I have been an advocate for the humanities in medicine. I reasoned that exposure to good literature, good poetry, good music and quality art would ultimately serve to cultivate and enhance empathy and understanding on the part of the clinician toward the patient. This could only lead to more humane medical care. To my way of thinking, the concept of caring is deeply embedded in the delivery of health care and its ultimate object—the healing of the patient.

If I read Professor Fish correctly, all these years I have been merely whistling in the dark.

We are taught compassion at our mother’s knee. We struggle to learn fairness and regard for the feelings of others in the sand box. Robert Fulghum asserts that all we really need to know we learn in kindergarten.

Although it may not be possible to teach empathy, exposure to the humanities could allow students to rediscover it. Some of them just might go on to incorporate it into the way that they relate to their fellow human beings.

Can the humanities save us? Professor Fish would answer a resounding no. And I would have to agree with him in that regard.

It will take more than the humanities to save us. If we are to become a world community, fighting will have to take a back seat to forgiveness. But even forgiveness will not save us. No, it will take something much deeper, more profound, a more radical mystery—or if you prefer, a miracle—to do that.

“Notes from a Healer” — Heartfelt Morning

Morning, a time of transition—from sleep to wakefulness, from dreams to consciousness, from darkness to first light. Although I have a habit of rising early, this particular morning promised to be a poignant one.

The latest installment of Notes from a HealerHeartfelt Morning — is now online, newly published in the Yale Journal for Humanities in Medicine.

The Yale Journal for Humanities in Medicine is an online clearinghouse for manuscripts dealing with the humanities and medicine.

The stories we tell

We all have stories to tell. While some of the tales we spin are about other folks, perhaps the most intimate sagas we know concern ourselves. Many times they are also the most poignant.

In my professional role as a healer, I maintain that, although we are all broken in some way, we do have the capacity to experience substantial healing — both by telling our story and by listening to the stories of others.

In this instance I use the word healing in the Old English sense of the word: becoming whole in body, mind and spirit.

In the words of professional storyteller Carmen Agra Deedy: “Some of our stories are told from the stage. Some are told in a small group, perhaps over a glass of wine in the evening. Some are told to one intimate friend, just once. And some we can only whisper to the Stygian darkness in the middle of the night.”

At the recent caregivers’ seminar at the Mason Hill retreat center in Cheshire, Massachusetts, those that made formal presentations as well as those in attendance all had a story to tell.

When I spoke to the group of caregivers, standing on crutches, it all came together: brokenness, healing; broken bones and casts; an abstract painting of a piece of cloth intricately folded and the line from Naomi Nye’s poem Kindness about following the thread of sorrow until you can see the size of the cloth; hope for healing through service to others.

I like to think that everyone came away enriched in some way. I know I did.

Brokenness and Healing

Recently I returned from a medical conference at McGill University in Montreal, Canada. The title of the conference was “In Osler’s Footsteps.” I had been invited to give an oral presentation entitled “Brokenness and Healing.” For me it was quite an honor to be asked to give a talk in the Osler Library of the History of Medicine, a mere stone’s throw from the resting place of the great physician’s ashes.

During my weekend in Montreal I stayed at a bed and breakfast run by a woman in her mid 50s named Michelle. The morning of my departure, I took a photograph of Michelle seated on the sofa in her parlor. On the wall behind the sofa where she sits there hangs a large abstract painting. Michelle was the artist. Several of her other paintings hang on the walls of her home; some abstract, some more traditional. Michelle studied art history as an undergraduate, and later completed a Master’s equivalency in Fine Arts.

The painting that hangs on the wall above the sofa in her parlor was one of the last paintings Michelle did. That was back in 1985. Michelle no longer paints, because she is blind.

Michelle suffers from a medical condition known as retinitis pigmentosa. This condition is transmitted genetically. If you happen to be the unlucky recipient of this gene, you too will go blind one day. Michelle told me that seventeen members of her extended family have been affected by retinitis pigmentosa. Although never formally diagnosed, her own father was blind when he died. Michelle has two children of her own, a son and a daughter. The son has retinitis pigmentosa. So far her daughter and two grandchildren show no signs of the disease.

When I told Michelle that I had come to Montreal to deliver a presentation on brokenness and healing, she stopped rocking in the chair and sat forward, seemingly intrigued by my words. We are all broken in some way, I told Michelle; yet we do have the capacity within ourselves to experience substantial healing.

Slowly, Michelle nodded her head. “En français on dit la résilience,” she said.

“Oui,” I replied, “la résilience. C’est la même chose.” Resilience—it’s the same in any language.

At one time or another we are all broken individuals, and those of us who are healers become wounded healers. We may not realize this fully at first, yet we can find strength in our woundedness to minister to those suffering individuals who cross our paths every day.