Posts tagged narrative medicine

Embrace

The echoes of my steps resonated within the expanse of the hospital garage. As I made my way to the end of the aisle to my stall, a couple caught my eye.

A tall man, his hair only beginning to turn grey, faced a woman of similar age, dressed in a beautiful white summer dress. Next to them a car, its trunk agape, half packed with a box of personal belongings and a white plastic bag full of clothes sat waiting. Still, they stood, pausing, ruminating.

They stared longingly into each other’s eyes, a deep seeded pain overwhelming them as tears trickled down their delicate features. A warm embrace as they held each other tightly and wept.

I wondered what terrible tragedy had befell them. Did a loved one’s health take a turn for the worst? Did a loved one just pass away? Did their mother, father, daughter, or son, just perish from this earth? I could not help but wonder.

But it was not my place to ask.

I watched helplessly as they buried their heads in each other’s shoulders and comforted one other.

I continued walking.

My friend, old and passing, said,
“There is more to life than staying alive.
Don’t rescue me too much.”
On his farm, twelve miles out
by rough gravel roads, he is done
with plowing, spraying, harvesting.
But he is not done watching the sun
sink below the windbreak or listening
to the nighthawks above his fields.
Don’t make him move to town.
There is more to tragedy
than dying.

A Note to His Doctor by Kevin Hadduck.

Poetry and Medicine, JAMA July 2, 2014, Vol 312, No. 1

Today, I saved a life.

A narrative piece by docedace.

And I wish I could tell you a story about fancy heroics - about an exploratory laparatomy, a chest thoracostomy, or a patient that coded and I was the last person to perform the chest compressions that brought them back to life.  But I can’t.  But I can tell you that I saved a life.

The Day I Started Lying to Ruth

A cancer doctor on losing his wife to cancer.

A year ago, after a busy night on call, I received a phone call from my mother. Instead of her usual self, she sounded anxious, with an urgency in her voice I seldom hear. I would learn that a close friend of hers had just been diagnosed with cancer.

"Do you know anything about it?"

As one of the mandatory components to our curriculum  I certainly knew it in broad strokes. It was this education that allowed me to deduce based on some of my mother’s description of her friend’s results and symptoms, that the prognosis was poor.

"Yes, I do."

I wrestled with myself over the phone. How much should I say? How little? Was it my place to say anything at all? But my mother was worried for her friend. Having lost my father to cancer only years ago, she wanted at least some reassurance.

Even despite my limited experiences as a student though, I knew I could not offer any. I hesitated.

Instead, I put on my suit of armour that was my white coat and spoke objectively about what the results were, what the symptoms meant, and what the doctors may offer her in the coming weeks.

"But I do not have the full picture." I cautioned. "Her doctors are there evaluating her and this is obviously their specialty." 

In a way, I was trying to wash my hands of the responsibility. I did not want the burden of knowledge that I now possessed that my mother desperately wanted. I answered her questions as best as I could. Intent not be optimistic or pessimistic.

But people always hear what they want to hear. She felt that there was still a possibility of a reversal. A recovery. A new lease on life. She just was not ready to go through everything with my father all over again. I could not muster up the strength to say anything in return.

When my father was diagnosed with cancer at the end of his days, I knew nothing about it. I was the ignorant and oblivious observer. I could still hope. I could still maintain optimism.

But now, armed with a wealth of knowledge, I fear the day when I must confront a similar situation again. When I can understand the disease, interpret results, and foresee the future. It is both a power and a curse.

Some day in the distant future, when all of my family members turn to me for guidance in those dark hours asking those questions that nobody ever wants to ask or answer - “How is he doing? Will he get better? What can we do?” - I hope I have the courage to say what is right.

The Struggle

For weeks, a patient had been ambivalent, struggling with the decision between full medical care or comfort care only. It was only a matter of time between the disease would make that choice for her.

Everything we could do to prolong her life had been done. There was no process left to reverse. The disease was reaching its ultimate conclusion. With great reluctance, the patient agreed to comfort care.

It pained me to see her struggle because I knew how much it chewed her up inside, to leave behind her family and friends, to be confronted with the threshold of death. It was obvious she loved dearly and was dearly beloved.

I saw her briefly again today after finishing my rounds, passing through our hospice. After seeing her struggle for so many weeks with this decision, I was relieved to find her smiling, having finally found peace in these last hours, surrounded by friends and family. As they gathered to look at old photo albums and share stories under the warm winter glow, her eyes flickered with joy as she laughed with her grandchildren.

For a moment, our eyes met as she caught a glimpse of me by the nursing station. Quietly, we acknowledged each other.

When I was waiting for test results I tried to make up a description in my mind of the consequences of a bad outcome; for myself and then for my wife and my children. For myself it maybe is not too bad - straight to the grave - which is where we all go; even if we think it is too early whenever it comes to that. It is awful, it is difficult to get used to that thought - if you ever are able to…it would be worst for my wife…she is the one who has to take the blow.

When I heard of going to the cancer clinic, I began shivering all over my body. As soon as I opened the door here I felt the smell of the house of death. I can still feel this smell. The word cancer is loaded with fear, I think, and I know some persons who have died of cancer. A tumor is a tumor; uncontrolled cell division, something growing and attacking inner organs.

I react severely to the cytotoxic drugs. I feel so sick, and although I get other drugs to subdue the vomiting, the sick feeling is there, rocking my body all the way. I feel as if I am being run over by a steamroller - my whole body is reacting.

I remember when I woke up from the operation the surgeon told me they had found “islands of outgrowths” in the peritoneum, which was negative news. Something strange happened to me; all anaesthetics and all drugs disappeared from my body, my brain become crystal- clear and I thought: “How can I tell this to my wife?

An excerpt from Expressive Metaphors in Cancer Narratives by Carola Skott, PhD RN.

The Bleed

"Unhook me from these machines. I am going home now and not a moment later."

More than an hour before, I stood by the bedside and watched as the team worked furiously to resuscitate him. Esophageal varices, a cluster of severely dilated and pressurized veins, had been slowly brewing within him over his many years of alcoholism. With the tension of its walls reaching the breaking point, the time bomb had exploded in a torrential gush of blood.

More time than we could handle.
The other day, something very unusual happened: we had more free time on our hands than available work. The day was already off to an atypical start when the patient list fit onto a single page as opposed to the usual two. While rounding, it soon became clear that many of them would be discharged, leaving little in terms of in-house management.
"Perfect!" said my preceptor. “We will go to the hospice then and review our patients there." And so we went, having finished early. A typical morning seldom included the hospice round because of time constraints. This day we were lucky. 
We arrived on site to find: only one patient issue. Total time of management: ten minutes. Yet again, we were stuck. My preceptor scratched his head as he sifted through his planner. There was nothing to do for another two hours.
In a career where there never seems to be enough time, we suddenly found ourselves with more time than we could handle.
"Well this is awkward," he commented almost disappointingly. “Shall we go for coffee then?"
And so we sat in a Starbucks and caught up on life, the universe, and everything. There was an otherworldly feel to the morning, an uncomfortable ease as we tried to relax into our seats. Threaded through the eye of the medical storm, we tried to enjoy a moment of downtime but could not, knowing there was more work to be done, more work waiting for us, helpless to the time that separated us from it.
Sitting there, I wondered if we were truly lucky to have had time to sit and talk. I wondered if medicine suddenly found itself with more moments like this, would it drive doctors mad? 
How wonderfully odd creatures we are to thrive on the fast track life of our work.

More time than we could handle.

The other day, something very unusual happened: we had more free time on our hands than available work. The day was already off to an atypical start when the patient list fit onto a single page as opposed to the usual two. While rounding, it soon became clear that many of them would be discharged, leaving little in terms of in-house management.

"Perfect!" said my preceptor. “We will go to the hospice then and review our patients there." And so we went, having finished early. A typical morning seldom included the hospice round because of time constraints. This day we were lucky. 

We arrived on site to find: only one patient issue. Total time of management: ten minutes. Yet again, we were stuck. My preceptor scratched his head as he sifted through his planner. There was nothing to do for another two hours.

In a career where there never seems to be enough time, we suddenly found ourselves with more time than we could handle.

"Well this is awkward," he commented almost disappointingly. “Shall we go for coffee then?"

And so we sat in a Starbucks and caught up on life, the universe, and everything. There was an otherworldly feel to the morning, an uncomfortable ease as we tried to relax into our seats. Threaded through the eye of the medical storm, we tried to enjoy a moment of downtime but could not, knowing there was more work to be done, more work waiting for us, helpless to the time that separated us from it.

Sitting there, I wondered if we were truly lucky to have had time to sit and talk. I wondered if medicine suddenly found itself with more moments like this, would it drive doctors mad? 

How wonderfully odd creatures we are to thrive on the fast track life of our work.

Words Never Spoken

A man struggled with severe depression and suicidal ideations for many years. No amount of counselling, medication, and therapy could lift him from the bleak depths of his own personal hell.

He had been involved in the loss of a life. On a dark and rainy night in the summer of yesteryear in a far and remote place, a car barrelled through a stop sign into his own. He was hurt, but she was gravely wounded. Without phone reception and without a soul in sight, he carried this stranger with him on that lonely road hoping to find help, to find anyone. In that darkness, the stranger died.

Racked with guilt and a sense of helplessness, he spiralled into depression with a burden of having not saved this person from their fate. Every night, the nightmares came; every night, he failed to save her. It was agony. 

One day, the doctor tried something new. “I want to you take control of your dreams. Think of new endings to that moment. Let your thoughts carry themselves into your dreams. Change what happens.” The man was puzzled. “Perhaps imagine yourself to be Superman. Fly her to the nearest hospital. Maybe dream up an ambulance.” The man was hesitant to try, but decided with everything else they already did, what was the harm in trying? 

"You do not recognize me, do you?" A stranger said to the doctor one day at a coffee shop. He looked up perplexed but suddenly recognized the man he had seen those many months before. It surprised him. The man was smiling, well kept, and spirited. The difference was night and day.

"What happened?" 

"It worked, doctor. Your dream therapy worked for me. Thank you."

"Did you save her in your dreams? Was that what it took?"

"No. I was never able to save her. But one day some months later in my dream, carrying her as I always did down that lonely road, I heard words she never spoke, but words that helped to give me closure."

"What did she say to you?"

"Thank you for not letting me die alone."

Breast Cancer Survivors Find the Michelangelo of Nipple Tattoos

In the waiting room of Little Vinnie’s Tattoos, bikers and punks sit side by side with church-going grandmas and soccer moms. Customers fly in from as far as Saudi Arabia, Spain, and Brazil, to an unassuming strip mall just outside of Baltimore complete with tanning salon, liquor store, and adult DVDs. Anxiously, they enter Vinnie Myers’ shop, the final destination for many breast cancer survivors attempting to recover what mastectomies have stolen away.

For all of medicine’s advances, the best option for areola reconstruction is tattooing, and in the field of cosmetic tattooing, Vinnie’s trompe-l’oeil “areola portraits,” as he calls them, are widely regarded as the best that money can buy.

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