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.

Frozen, Briefly

The train halts. Beside the platform, a young mother holds her daughter’s hand. The girl is dressed in a red petticoat, the hood flapping carelessly across her back. One leg swings aimlessly – white cotton tights, gripped by a polka-dotted rain boot, greet onlookers with a clumsy hello. People scurry across the platform with brown paper bags, yellow plastic grocery bags, purses clutched against their sides, briefcases swinging purposefully, large duffel bags weighing down a lopsided shoulder.

The little girl hops on to the train. The mother follows absent-mindedly, responding only to the tug of a bright red mitten but not to her daughter’s voice. She grasps a yellow plastic grocery bag, filled to the brim and stretching thin with the weight of its contents. Her face and boots are worn, older than she is, with creases in all the familiar places. Her chapeau is young – slanted blue wool with a dash of feather on the side. Her hands seem to be the most comfortable part of her – calloused, ringless, tightly clutching the bag. A pale blue watch across her wrist – she glances at it but does not react, as if time will not make the difference.

The little girl – bright red bow in a bouncing cascade of blond pony tail. She hums to herself, tilts her head in different directions, almost upside down. A man in one of the nearby seats glances at her with half-interest, eyes almost but not quite lit, considers smiling – but refrains. The lines of his mouth barely curve upwards. The little girl continues on, twisting her head all the way around towards her back, her chin nudging against the edge of her hood.

The mother looks straight ahead, a steady, tired gaze, as pipes and darkness flash by the windows. What is this world made of, after all? She wonders. The measured hesitation of a stranger. One polka-dot rain boot hovering on a platform edge.

More than ever, the bags we heave as the muscles of our arms reach pure exhaustion. As the world flies by, we clutch them tighter.

Thanksgiving in the Hospital

I press on the gas, lean back against the head rest, rest one elbow on the consul, and glide along vacant lanes of highway. Speed, and the absence of traffic, is almost exhilarating at 6AM in the morning, as gold rays pierce through a lattice of cloud cover. One more day in the hospital, in this long string of days. As I walk through the tunnels to the entrance, weary faces pass in the other direction – worn but polished with morning light. Ready to leave. Comforted to be going home, even if only to crash on a pillow. I have a fleeting wish to turn in the other direction, but I suppress it, keep walking, pretend I don’t notice the lump building in my throat. Just another day.

A boy playing in a marketplace with a strutting old gobbler entertains Chichicastenango visitors by doing the son, a dance popular throughout Guatemala. Luis Marden, National Geographic.

Inside the hospital, it is not Thanksgiving. Small, lonely reminders of what is missing – a turkey poster on a wall, the festive sweater of a passerby,  a holiday song playing faintly in the cafeteria – make for a somber backdrop to the day. It would almost be better if there were nothing at all. It is not Thanksgiving inside these walls. It is on the calendar, if one were to look, but in here it is only a shadow, an echo, a memory reverberating through the sterility and the sadness. It is a day to remember – even to long for – all of the better, healthier Thanksgivings before this one. The ones to be thankful for.

The families in the hospital are quiet. Sadder today, if that is possible. One father, rubbing his eyes and rising from a hospital cot as I enter the room, says to me, “I’m with my little girl today. That’s all that matters. That is Thanksgiving.” Another anxious mother raises her eyebrows, “Do you think my son will be able to go home today? It is Thanksgiving, after all.” A grandmother greets me with her new plan, “We are going to reschedule Thanksgiving this year. Thanksgiving will be when my baby comes home. Then we will have a turkey to celebrate. Yes, Lord, we will.” A five-year-old boy begins the day by singing in his room. He ends the day in tears – no one in his family came to visit like they promised.

Holidays in the hospital are some of the saddest times I have experienced. Families, patients, and even nurses and physicians – their yearning for home becomes more poignant. An anxious longing to be elsewhere pervades the building. But we are all resigned. We imagine Thanksgiving beyond the windows. The empty roads are the only sign that something else, something better than this, might be happening in other places. But try not to think of this. Instead, think of it as just another Thursday. Another day in a string of days. The time to celebrate will come, but not today.

Grand Rounds, Volume 7, Number 4: Uplifting Moments in Medicine

Good morning! Thank you for all the submissions which have flooded my inbox over the past week. They kept me going through a stretch of countless overnight shifts in the emergency department, which seemed never-ending and darker than a moonless night. In the midst of stunning fall foliage this October, the vibrant colors of this week’s Grand Rounds reach towards the sky. Take a moment out of the day to live in the present. Listen to the sounds around you, whatever they may be – leaves rustling in the wind, blaring sirens, constant monitors. Sit back, relax, take a long, deep breath and a sip of your favorite morning drink. Take in the flying kites, subtle music, and silver linings of today’s indulgence: Uplifting Moments in Medicine.

Autumn Sugar Maples, by John Eastcott and Yva Momatiuk. Vermont's outstanding array of fall foliage is highlighted by the colorful sugar maple. Broadleaf plants shed their leaves each year in preparation for winter, but variable temperatures and moisture determine how spectacular each annual show will be.

We begin with a story of redemption in Copiapó, Chile: the rescue of 33 miners who had been trapped after the collapse of a mine on August 5. The miners spent 69 days underground. In the first days after the collapse, they set off explosives and burned tires in an effort to communicate with the outside world. Shift boss Luis Urzúa rationed milk, crackers, peaches, and canned tuna for his entire crew over 17 days, before the world knew that the men remained alive 2000 feet underground. When their reserves of bottled water dwindled to only 10 liters, they began drinking water tainted with motor oil from metal drums. By the evening of October 13, all 33 men had been successfully recused and reunited with their families. The spirit which kept them alive through 69 days of darkness is awe-inspiring. The miners worked with each other and with the doctors, scientists, and support groups above ground in order to survive. Gómez, the eldest miner, served as a religious leader and worked with psychologists to support the team’s spiritual health. Yonni Barrios served as the medic for the group; he monitored their health, administered vaccinations, and provided reports for doctors on the surface. Sepúlveda organized the miners’ video journals, and Ticona worked to maintain the underground portion of the telephone and videoconferencing systems. The story highlights the best of medicine, science, and humanity. Watch all 33 rescues online at CNN. Elaine Schattner supplements this with a wonderful post, Copiapó Dreaming – The Copper Miners’ Tale, about the uplifting aspects of their story.

Luis Urzúa, the last miner to be rescued, celebrated with President Sebastián Piñera of Chile.

Along the same theme, we must remember and reflect on the brave men and women who put themselves in danger in the line of duty – fire fighters, police officers, EMTs, and medics. Some even choose this calling without the prospect of compensation. In Michelle Wood’s post, The Volunteer EMS, she recounts the story of her parents who worked as volunteer EMTs in a small town. She mentions a site with poetry dedicated to volunteer EMS personnel.

Moving on to more practical but still uplifting stories, David Harlow interviews Massachusetts State Representative Ruth Balser on the success of Massachusetts health care reform – the state has successfully achieved 97% health care coverage in just a few years. Massachusetts takes the lead again in patient-centered health care with new legislation. On October 1, 2010, it became the first state to require that all hospitals have a Patient Family Advisory Council. Read more at Bedside Manner in the post Leading the Way on Patient Centered Care. On a more personal level, in An Educator by Chance, medical librarian at Laika’s MedLibLog discusses the development and implementation of training modules for medical students and residents who are learning how to navigate the vast world of technology and medical information.

Rescuers applaud the rescue of a firefighter rescued at site of World Trade Center.

And that brings us to the life of the physician. The first Grand Rounds of the year, at Doctor Grumpy in the House, served as a humorous and disgruntled reflection on medicine. Today’s edition serves as a nice juxtaposition to this. Jill of All Trades, MD, writes about the positive aspects of being a physician in Practice Perks. She cites an article by Abigail Beckel in Physicians Practice, Top 10 Reasons to Be Happy You’re a Doctor. For all the physicians, residents, and medical students who are having a difficult time, enjoy these small reminders that our contribution does matter. Despite our endless complaints, grievances, and hardships, remember that the grass is always greener on the other side.

And now we move along to our patients, who are our greatest source of hope. Mattie Stepanek said it best, “While we are living in the present, we must celebrate life everyday, knowing that we are becoming history with every work, every action, every deed.” Bongi, a general surgeon in South Africa, writes about a fulfilling relationship with his patient in the gift. Spice Island Queen, who will be hosting Grand Rounds next week, writes about her experiences at “the best place on earth,” a Camp for Teens with Multiple Sclerosis.

Boy in Mid-Flight, Jodhpur, India in 2007. Photograph by Steve McCurry.

Happiness is not always straightforward. Although countless studies have examined what makes people happy, we have not yet come up with a formula that provides a clean-cut answer. But perhaps there are a few basic principles which can guide us along our path. A psychiatrist at How To Cope With Pain discusses some of these in Are Banana Split Jelly Bellies The Key To Happiness? No – But Here’s What Is (Even Despite Your Pain!). And to end with an uplifting note of laughter – the Happy Hospitalist shares with us a video about a comical interaction between a doctor and a neurologist.

I hope you all leave this morning’s Grand Rounds with a little hop in your step and flutter in your heart. Thank you for stopping by! Please be sure to check out Grand Rounds on Twitter and Facebook.

Grand Rounds: Uplifting Moments in Medicine

I am looking forward to hosting my first Grand Rounds next week! There are many things about medicine and health that are frustrating, angering, and even depressing. I have vented about some of them lately, as I complete a long string of shifts in the emergency department. But for the week of October 19, let’s take the “glass is half full” approach.

The theme: Uplifting Moments in Medicine.

The theme is broad-based, and I encourage all of you to use your imagination and think big. Uplifting moments can include anything about health, hospitals, health care providers, family, friends, dreams, life goals – anything and everything that has given you some sense of hope and enlightenment.

The words of Mattie Stepanek explain it best, in his poem below. Mattie, born with a rare form of muscular dystrophy known as dysautonomic mitcochondrial myopathy, was a writer and an optimist. Mattie began writing poetry at the age of three in order to cope with the death of his older brother. He published six collections of poetry and one collection of peace essays, all of which were New York Times bestsellers. Sadly, he passed away in 2004, three weeks before his 14th birthday. But his legacy – and his love for life – live on in his poems.

On Being a Champion

A Champion is a winner,
A hero…
Someone who never gives up
Even when the going gets rough.
A champion is a member of
A winning team…
Someone who overcomes challenges
Even when it requires creative solutions.
A champion is an optimist,
A hopeful spirit…
Someone who plays the game,
Even when the game is called life.
There can be a champion in each of us,
If we live as a winner,
If we live as a member of the team,
If we live with a hopeful spirit,
For Life.

Search for a hero, a slice of optimism, a diamond in the rough, a silver lining. Or anything else which suits your fancy. When you find it, send it along to idiopathicmedicine at gmail dot com. I look forward to reading your entries!

Abridged Version
Please submit entries for Grand Rounds by Sunday, October 17, at 6PM to idiopathicmedicine at gmail dot com.