My daughter is not a case

In our rush to practice sound scientific medicine, it’s easy to lose sight of the fact that we are treating human beings, who are most likely vulnerable, apprehensive and in need of moral support in their darkest hours. more»

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Literary medical weblogs

Dear J.B.,

Your comment on my blog posting The stories we tell came in just as I was re-reading the first chapter of James Joyce’s Ulysses on the front porch.  Previously, I hadn’t run across the Joyce line you quoted about all novelists having only one story, which they tell again and again; but it certainly rings true.  Hemingway said that in crafting a piece of writing he could “cut the scrollwork or ornament out and throw it away and start with the first true simple declarative sentence” he had written. In my book, anyone who takes writing seriously has to start with a desire for truth and the stamina to pursue it, no matter where it might lead.

You also mentioned Dr. Robert Coles.  I too was fortunate to hear Dr. Coles speak two decades ago at a conference on medicine and the humanities.  I recently read Handing One Another Along, a collection of lectures from an undergraduate course which Coles taught at Harvard on literature and social reflection. (The title of the book comes from a line in Walker Percy’s The Moviegoer, one of Coles’ favorites.) Dr. Coles, of course, is an excellent resource for many good works on medicine and literature as well.

Decades ago I got interested in the idea of using story as a vehicle to explore the doctor-patient relationship.  Throughout my medical training (I am a practicing physician assistant) I was appalled at the insensitivity which many clinicians demonstrated in dealing with patients in their time of suffering.  I struggled to understand the source of this coarseness in bedside manner.  Had these clinicians always acted this way, or through years of training had their medical education squelched whatever empathy they might have once had?  Was this perhaps a defense mechanism they had developed over time to shield themselves from the suffering that they witnessed daily in practice?  If so, what could be done about it?  (It certainly wasn’t helping the patient to heal.)  Could empathy be taught, or was it an innate trait possessed by only a minority of individuals who opted for a career in medicine?

As I began to craft narratives of patient encounters, I discovered that the act of writing itself enhanced the way I related to patients.  Somehow writing the story down served to hone an empathetic response.  It also served to help me deal with my own emotions, guilt and grief which I experienced in encounters with patients.  As my perspective developed, I was fortunate to find several like-minded souls in the social ether along the way.  Over the years I worked with other colleagues to create several online sites which continue to function as forums for clinicians and patients alike, Cell2Soul and Dermanities among them.  After reviewing my book Patients Are a Virtue, Dr. Howard Spiro asked me to consider submitting a monthly piece—“Notes from a Healer”— for the Yale Journal for Humanities in Medicine; and I was also invited to write a bimonthly Humane Medicine column for the Journal of the American Academy of Physician Assistants.  I established this weblog to serve as a repository for my writings.

My hope has always been that with ongoing exposure to these sorts of narratives, more and more medical colleagues might come round to recognizing just how intimate and profound the doctor-patient relationship truly is, and come to an understanding that there is much more to the art of healing than just closing a surgical incision, dressing a wound or writing a prescription.  Medical practice is after all the stuff of life; and because literature historically has been an attempt to capture the essence of what it means to be alive, it is small wonder that the two complement each other so beautifully.  As you so aptly put it, medicine and storytelling go hand in hand.

None of us can be all things to all men; but we can certainly make some fumbling attempts to alleviate suffering in the world and bear one another’s burdens as best we can.  As Rilke so aptly put it, perhaps if we learn to love the questions themselves, we can one day live on into the answers.