Writing to Save Oneself

An article published recently in the Los Angeles Times, Test-taking anxiety, indicates that when students write about their anxiety, they tend to perform better. At the University of Chicago, a group of 20 college students were given a math test. In the 10 minutes prior to the exam, one group of students was asked to write down their feelings about the test. The other group sat quietly. As compared to their baseline scores on the test, the group that had written down their feelings improved by 5 percent, while the group that had sat quietly worsened their scores by 12 percent.

The idea that writing is therapeutic, and can even improve performance, is not a new one. It has been utilized effectively in poetry therapy for centuries. The first known poetry therapist was Soranus, a Roman physician who lived in the 1st century A.D. And the same concept is now being implemented in medical schools, as discussed in a recent article in The Wall Street Journal, Poetry, Painting to Earn an M.D..

The process of writing has much to offer all kinds of people – physicians, patients, bloggers, novelists, musicians, engineers. To pick up a pen and express how we feel is a momentous step in the process of self-discovery and personal growth. Perhaps incorporating writing more into the daily life of physicians and patients could be an effective way to improve communication, reduce stress and anxiety, and develop closer relationships in the hospital setting. From a practical standpoint, this becomes difficult when there is simply not enough time to take a step back from things and write. But if a brief amount of time were allotted each day – even 15 minutes – to writing, that might provide a source of relief for weary minds and downtrodden souls.

The concept of narrative medicine has taken hold at some university hospitals, with Columbia University at the forefront of this movement. The idea behind narrative medicine, at least in part, is to hurt and to heal through writing. The process of taking a blank page and beginning to express all of the grief, life, death, pain, hope, and fear that lives and breathes in the walls of the hospital is a formidable one. It is almost overwhelming. There are so many stories to tell, so many plights to share. But this could bring into the world of academic medicine a fresh breath of air – and a new source of healing.

Reflections on residency thus far…

To assume that residency can be explained fully to one who has not experienced it in its entirety is naïve. It is almost a living thing – changeable, ravishing. It is a path forged through jungles which holds mystery even after the turns, trials, and tribulations have been fully exposed. As residents, we take photographs along the way to capture moments of progress, anger, fear, frustration – but only in retrospect, and perhaps not even then, it is possible to understand which moments will become significant. Why are there patients whose brief encounters are vivid to me still, while others have simply faded from my memory? How is it that I can paint with certainty the eyelids, the fingers, and the nose structure of my first cadaver from six years ago, but that I can now say so little about the eyelids, fingers, and noses of my patients? I can remember the face, tanned, broad, with graying eyebrows, of the woman whom I first declared dead. But I cannot remember the faces of any of the others who followed. They blur together – a swarm of people whom I have watched depart from this world. Strangers, patients, bodies in stretchers – but not faces.

Steve McCurry, National Geographic

Surviving residency means learning to look away. Or, more precisely, learning to see through the very elements of life – and death – which used to stop us in our tracks. Writing has revealed to me how muddled – and how out of our control – this process is. I have learned to listen clinically – I have learned to listen to the words that will save me time later, that will clinch the diagnosis, so that I might have a minute to steal five minutes of sleep or a slice of sustenance. And, sadly, I have learned to discard all the other pieces of a patient’s story. The details of their personal lives have become meaningless to me – even troublesome for my primary tasks, efficiency and depersonalization.

Medicine practiced in this manner draws me farther away from my writing faculties – and my sensitivities – than I have realized. The process of depersonalization is far more amenable to cartoon drawing or improv comedy than it is to writing – something light, humorous, distant. My art and writing have become vapid. I can observe, but with strict limitations and great distance. I have skillfully walled off the emotions of my patients. In the last two years, in spite of all the tragedy I have faced, I have not shed a single tear for a patient. I wonder why.

There is an unspoken culture in medicine that it is cowardly to break down on the job. It is cowardly, in fact, to personalize the emotions of our patients enough so that it affects our performance. We are expected to rise “above this,” if you will – to be objective, discerning physicians. And I have done exactly this, with raving reviews from my superiors. But it makes me concerned that there is something missing. Perhaps taking care of such sick patients should not be so easy.

This is why illness close to residents – among ourselves, our friends, and our families – hits us so hard. It is not merely the illness itself, but all the implications that come along with it. In spite of our adept skills, it is far more difficult to depersonalize the illness of a loved one than of a stranger. These situations create a dichotomy in our minds – in order to perform our day-to-day tasks, we almost need to believe we are invincible. But when those around us fall, we must accept – even if briefly – the reality that we are not.

I am not sure what the solution is. With the demanding hours of this training, and the way residency – a living, breathing being – devours our lives, takes from us any ounces of energy which we may have remaining, brings us into the void of the hospital in all its intensity – I am not sure how we can open ourselves up to this, emotionally, and survive it. And so, at least for now, we do not.

I watch my fellow residents. We walk around this hospital like zombies, more absent then present. I can only wonder how we will emerge from this – as alienated as we are now, or will we regain some sense of warped humanity after all of this is over… Only time will tell.

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