5 minute read

Writing: An Outlet and a Vessel

Writing: An Outlet and a Vessel

Rebecca Kowaloff, DO

In healthcare we are witnesses to and protagonists in the key elements of drama. Every day we face sorrow, pain, elation, love, anger, and suffering, through and with our patients. Stories unfold with unexpected twists and the constant character in all of it is the sometimes-fickle human physiology. Often, we are the visionaries, fairly certain we know the story, and we must bear the burden of an exclusive knowledge which feels like foresight, unable to author a different ending. We carry the unbelievably precious weight of human lives and wellbeing in our hands, and though we have specialized knowledge and honed skills, we are, after all, only fellow human beings tasked with a superhuman mission. How do we bear this burden, when so many of those with whom we are closest do not understand, and when medicine demands perfection and precision and worships the deity of cure? For some, an outlet lies in narrating these dramas, and in examining our role as a participant in them and our feelings tied to them.

There is a growing wealth of literature on teaching narrative medicine skills and its benefits for healthcare professionals. Writing helps many in healthcare process the daily tragedies and our self-doubts in the face of such an awesome responsibility and allows us to acknowledge our emotional investment and “to midwife the life scrutiny that inevitably accompanies illness” (1). Writing about patient encounters provides an opportunity to sit with an experience, to examine it with a metaphysical lens, and to reflect on the “transcendent truths, exposed in the course of illness, about ordinary human life” (2). I have found that as I have written more about patient encounters, I have begun to notice more of the concrete personal aspects of the experiences, such as items of clothing and mentions of hobbies or careers, that suggest more about the person and inform their experience of illness. This has helped ground me in the moment, reminding me to capture its entirety, surely making me a more attentive and thoughtful doctor. Writing can be both an off-ramp for sadness and feelings of powerlessness, and an on-ramp to a level of emotional engagement with our work that is not encouraged in our training or by the structure of modern healthcare delivery.

Combating burnout is a popular topic in post-pandemic healthcare discussions. Writing and engagement with the arts as a way to comprehend our work and rediscover our purpose can serve as a powerful tool in this mission. The act of switching from left brain to right brain thinking in and of itself can help sustain us through the stresses of a medical career, giving us a break from focusing on minute changes in lab values and piecing symptoms into diagnoses, to appreciating human physiology and the privilege of being entrusted with another’s health and sometimes their deepest fears and secrets. As physician-writer Anton Chekhov wrote about his two “mistresses,” medicine and literature: “when I get tired of one, I spend the night with the other … neither of them loses anything from my infidelity” (3). Storytelling can be a way to acknowledge doubts about our abilities or shame over our mistakes that we couldn’t directly acknowledge to our colleagues or patients. Characters in literature are complete people, rather than the collection of diagnoses or snippets of history they can become in our notes and offices, and writing about our patients is a way to connect back to why so many of us went into a healthcare profession: to help people.

Many medical journals are recognizing the necessary role of the humanities in the practice of medicine and are adding sections for readers’ poetry and prose. I look forward to these pieces as windows into other types of illness and patients that I do not regularly treat, but also as mirrors to my own experience and feelings of wonder, gratitude, frustration, and inadequacy as a physician. Medical schools – as they increasingly envision and put into practice curricula that move beyond Abraham Flexner’s science-centered, four-year course – are more actively recruiting pre-medical students who majored outside of the basic sciences and are building narrative medicine experiences into their coursework. These tools are good training for honing observation and listening skills and help students view patients as whole people from the beginning of their training. Narrative medicine training also helps build the types of clinicians who “can stay with the emotional and personal complexities of illness without retreating into silent detachment or worse, simply avoiding the human aspects of healthcare altogether” (4). Additionally, time spent focusing on the humanities can also be a break from the rigors of medical education and give students skills they can turn to later in their career to process the physician experience.

You may not consider yourself “a writer,” but I encourage you to try to reflect on your practice or to write about something wholly outside of it to explore what it may do for your mental health, your enjoyment of your work, and perhaps for how you show up for your patients. Writers always say, “write what you know,” and as physician-writer Abraham Verghese writes, “illness is a story” (3). +

Rebecca Kowaloff, DO is board certified in palliative medicine and is a member of the inpatient Palliative Team at UMass Memorial Medical Center. She loves to educate lay people and medical providers in palliative care.

References

1. Charon, R. (2006). Narrative medicine: Honoring the stories of illness. Oxford University Press.

2. Charon R, Narrative and Medicine, N Engl J Med 2004; 350:862-864.

3. Beck D (2016, June 1). Cover Story: The Physician-Writer: Good Doctors are Good storytellers; some make it a second career. American College of Cardiology. https://www.acc.org/latest-in-cardiology/ articles/2016/06/10/11/12/cover-story

4. Lewis B. Narrative Medicine and Contemplative Care at the End of Life. J Relig Health. 2016 Feb;55(1):309-324.

This article is from: