The Art of Memory: A Performance of Poetry and Prose from the Bellevue Literary Review

October 6, 2016 at 8:26 pm

The Division of Medical Humanities presents:

The Art of Memory: A Performance of Poetry and Prose from the Bellevue Literary Review
Wednesday, October 19, 2016 | 6pm

NYU Langone Medical Center, Alumni Hall B Auditorium
More information: | 212-263-3973 |

The BLR is a journal of humanity and human experience published by the Department of Medicine at NYU Langone Medical Center.
Explore the fall issue here.


Learning Empathy through Chekhov

July 26, 2016 at 3:26 pm

Guy Glass, MD, MFA, Clinical Assistant Professor
Center for Medical Humanities, Compassionate Care and Bioethics
Stony Brook School of Medicine

I am a psychiatrist who writes plays and has several professional productions and published plays to my credit. Having recently earned an MFA in theater from Stony Brook University, I am now affiliated with the Center for Medical Humanities, Compassionate Care and Bioethics at Stony Brook University School of Medicine. At both Stony Brook, and starting this fall at Drexel, I teach an elective entitled "Theater and the Experience of Illness" in which medical students both read plays and write their own dramatic monologues.

I dedicated my master's thesis to finding ways that plays might be used in medical education. This involved creating dramatic adaptations of two of Chekhov's "doctor" short stories, including "A Doctor's Visit." In April 2016, I was invited to bring "A Doctor's Visit" to the Arts and Health Humanities Conference in Cleveland. There, I was fortunate to have the opportunity to create a piece of theater with five medical students who happen to be very fine actors and who contributed the blog post below. I'm delighted to see that the exercise gave the students insight into what the arts can contribute to medical training. Moving forward, I hope to find other institutions that will allow me to bring this program to their students.

Reflections on the Importance of Dramatic Arts in Medical School Curricula

Alicia Stallings, DaShawn Hickman, and Nick Szoko


As a part of the Medical Humanities conference held at the Cleveland Clinic on April 9th, 2016, we were asked to perform a dramatic reading of an adapted short story by Anton Chekhov entitled, "A Doctor's Visit." The piece, thoughtfully developed by Guy Glass, MD, MFA, takes place in a factory town outside of Moscow in the 1890s. It features a diverse group of characters: Dr. Korolyov, a middle-aged physician working to jumpstart his struggling practice; Boris, his eager apprentice; Christina Dmitryevna, a caricaturized spinster; Liza, a seemingly spoiled heiress; and Madame Lyalikov, Liza's frenetic and overbearing mother. The story centers on the encounter between Dr. Korolyov/Boris and the inhabitants of the Lyalikov mansion. Dr. Korolyov is called upon to tend to the needs of Liza. Motivated by the prospect of compensation, Dr. Korolyov and Boris make their way to a gritty industrial town outside of Moscow where the gaudy mansion is situated. They arrive to find a hysterical young woman, Liza, nearly bed-bound for no apparent reason. Initially, Dr. Korolyov operates in a detached, business-like manner when examining and interacting with Liza. He is eager to perform his duties and exit, having excluded any true disease process; however, when Madame Lyalikov invites Korolyov and Boris to spend the night at the mansion, Dr. Korolyov achieves a moment of profound insight when he stands in the property's garden and gazes at the glowing factory lights beyond. In this setting, Korolyov recognizes his lack of compassion and revisits Liza in her room, finally able to connect with the young woman and "cure" her by acknowledging and validating her unique narrative. In reading, rehearsing, and performing this work, we extracted three important themes: empathy, justice, and professionalism.


hickmanJustice, as told from the perspective of Boris (DaShawn)
Case Western Reserve University School of Medicine

At the start of the play, Boris attempts to wake the doctor, but we quickly learn that Korolyov would rather the student learn more of the basic science and medicine on his own. He is told to "memorize all the books on my bookshelf, dissect all the rats and frogs you can find. And come back at noon." As outrageous as this sounds coming from the doctor, many schools have taken to this self-directed learning style. Students are spending more time reading and learning on their own or in groups than with professors during their first two years of medical school. The play also makes it abundantly clear that although students need patients to learn from, patients are not always as willing to allow students to learn from them. One of the characters in the play, Christina Dmitryevna, bans Boris from seeing the patient with his teacher. She expresses how she is displeased to be "running a medical school." Being able to act in this role allowed me appreciate all the time I am able to spend with patients during my formative years as a student doctor.

Although the doctor doesn't appear interested in directly teaching Boris basic sciences, he does take the time to teach him about communication skills, history, and society, all topics that will have an impact on the quality of doctor that Boris will become. A theme that emerges from interactions between Dr. Korolyov and Boris is justice. As the doctor and Boris travel away from Moscow to the industrial town, the socioeconomic disparities become more pronounced. The doctor teaches Boris how poor and hard-working the factory workers are. He tells Boris that even though they are poor like the factory workers, because they are doctors, and thus in a higher social class, "[the factory workers] will always hate us."

The town is covered in soot from the factory, and so many people have health problems, including the limited life expectancy of 35. Despite this, the doctor lectures, "it is a pampered rich girl we have been asked to care for." Dr. Martin Luther King, Jr. summed up his teachings nicely when he stated "Of all the forms of inequality, injustice in health care is the most shocking and inhumane." The doctor not only points these injustices out to the student but challenges them in front of the student. He asks about the well-being of the factory workers and implies that it is subpar to the wealthy he has come to visit. These are bold actions that not only teach Boris to recognize injustices but to confront and work to dismantle them.

Without future doctors being taught these lessons the injustices that exist today will continue to permeate our healthcare system, stifling advancements in this realm for the betterment of mankind overall.


Professionalism, as told from the perspective of Madame Lyalikov (Alicia)
Cleveland Clinic Lerner College of Medicine

In the reading, I portrayed Madame Lyalikov, the mother of the patient in the play. In this role, I found that many principles of professionalism were highlighted during the preparation and enactment of the dramatic reading. One component that stands out was the principle of responsibility to colleagues. During my preparation for the role, it gradually became clear to me how different I was from the character. I could not relate to her in her stage of life (I am not a mother), nor her walk of life (I am not wealthy), nor her personality/disposition (I am neither of the anxious variety nor passive). Yet, despite my lack of similarity to this character, for the sake of the audience, to learn from the play, and for the sake of my fellow student-actors, so that they could also portray their characters well, I needed to work to understand this characteraher perspective and her mindsetato meet my responsibility to the group.

Principles of professionalism specific to the practice of medicine were also highlighted in the play. Most notably, the issue of bias was an important theme, which was illustrated by Dr. Korolyov's negative comments to the student about the patient and her mother. In my role as Madame Lyalkiov, I had an interesting vantage point, being both privy to Dr. Korolyov's bias, as an actor, as well as the object of his prejudice, as the character. In this unique position, I found myself reflecting: is Korolyov aware of his prejudice towards her and her daughter? Can she feel how he feels about them? Does she feel that his prejudice is impacting his care of her daughter? Is his prejudice hurtful to her? It was very interesting to reflect on these questions from the vantage point of a future healthcare professional. One likes to think that her attitude towards others can be isolated from how she treats them, and that one can even hide their prejudice, so that the other party is not aware. However, is this true? Are we as medical professionals, and as people in society at large, able to separate how we feel about others from how we treat them? And perhaps more importantly, if how we feel about them is based in prejudice (as in the case of Dr. Korolyov), is it acceptable to continue to harbor these biases, even if we think we can separate them from how we treat patients? These are important questions for students to consider as move forward in their development as medical professionals. My role as Madame Lyalikov brought these questions to the forefront, and gave me much to reflect on with regards to professionalism in interacting with and caring for patients.


Empathy, as told from the perspective of Dr. Korolyov (Nick)
Cleveland Clinic Lerner College of Medicine

"You will learn, if you are to be a doctor, you do not always have to do a thing." As Dr. Korolyov prepares to depart from his visit at the lavish Lyalikov mansion, he offers these reflections to his young assistant, Boris. As medical students, the words of Dr. Korolyov surely resonate with us. We embrace ignorance, thrive in discomfort, and accept inaction. We feel dually limited and protected by our positions as trainees. We are told that the greatest gifts we can give our patients are not medical expertise or surgical acumen, but rather our time, humility, and empathy. So what happens when these fail?

It is no secret that the ability of medical professionals to empathize declines over time. We are cautioned from the first day of medical school regarding this well-cited trend. When we examine Korolyov, we see the familiar vices of the burned out physician. His initial motivation to visit the Lyalikovs is financial. He forms a prejudgement of his patient based on socioeconomic class and lets this guide his diagnostics. There is an unspoken aroma of efficiency and industriousness that hovers over the encounter. As medical students, we face a similar climate. Our attitude towards learning and career choice is tinted by the haze of student debt. We train in tertiary care centers that venerate evidence-based medicine and cost-conscious care. We aim for concision and efficiency in our interviews and presentations. Amidst this, we strive to temper our own arrogance so as not to become hardened to the pain of those around us. With each day we spend on the wards, we are tempted to limit our vulnerability and minimize our emotional presence so as not to compound physical exhaustion with psychological. We ask ourselves, "Am I becoming a professional?" or, "Am I losing my humanity?" We become less of Boris and more of Korolyov.

For Korolyov, it takes a revelation, an "Aha!" moment to arrive at the proper diagnosis. Indeed, it is not until his liminal experience in the garden that Korolyov finally overcomes his psychological barriers to connect with his patient, recognize his biases, and act as a healer. Romanticizing such transformative moments is not unfamiliar in our profession. Our attendings often recall patient encounters that made them stop, reflect, and even reform. As medical students, we remember our first patient death, the first child we delivered, or our first "thank you." These moments, though rare, do more than just provide subtext for television dramas or ignition for research funding campaigns. In some ways, these instances and the act of recounting them eternally bind us to the humanism of our craft while allowing us to mature in our profession. Storytelling, whether it by play, article, or interview, remains powerful, not only for those who listen, but also for those who share. In reliving these experiences, we evoke our emotional self, and this is often done from a place of greater experience and wisdom. The value of this exercise cannot be understated, because beyond connecting us to the ethereal concept of "emotion," it allows us to reflect, critically and honestly, about how this experience and others like it have shaped our practice today. By participating in a dramatic reading of "A Doctor's Visit," I told a story that, over time, became my own. This opportunity offered a space for vulnerability and introspection, and I am thankful that I could engage in this dialogue alongside my colleagues.


For many students entering medical school, it has likely been years since they have taken part in a traditional stage play. Although many may have participated in variety shows or other short dramatic works in college, these dramatic engagements are notably different from traditional plays. The content of variety shows is written by the students themselves, and therefore generally presents contemporary issues from contemporary lens using contemporary language (most of which are shared by and native to the students). Other works of drama present the opportunity to explore diverse settings, subject matter, and perspectives. Utilization of selected plays and short scripts as teaching tools for individual students as well as groups of students has great potential. Indeed, for many medical students, there is great power in silencing our own voice to fully walk in the shoes of another and experiencing the world from their eyes. Script readings can offer students an opportunity to do so again, while providing a reminder why it is important to do so in life as well.

Other members include:
Anne Runkle and Megan Morisada, Cleveland Clinic Lerner College of Medicine.

Richard Selzer and Ten Terrific Tales

July 20, 2016 at 9:23 am

Richard Selzer and Ten Terrific Tales
by Tony Miksanek, MD
Family Physician and Author, Raining Stethoscopes

If there were a Medical Humanities Hall of Fame, physician-writer Richard Selzer (1928-2016) would be a first-ballot selection. And likely by a unanimous vote. The diminutive doctor had a very large presence in the field. He energized the medical humanities movement in the 1970's and 1980's with his lectures, readings, writing workshops, commencement addresses, correspondence, personality, and kindness. But it was his writing - earthy and elegant, whimsical and wise - that masterfully mingled the world of medicine with the world of the arts and highlighted the necessity of humanity in health care.
His literary output includes more than 125 published short stories and essays, a work of nonfiction (Raising the Dead), an autobiography (Down from Troy), a novella (Knife Song Korea), and a diary (Diary). Many of his stories reflect an interest (even an infatuation) in decay and death, the beauty of the body, how illness beatifies the sick individual, the power and fallibility of doctors, and the great panacea/contagion - love.
"Writing came to me late, like a wisdom tooth," Selzer proclaimed. Indeed, he was 40 years old when he began writing seriously. His early efforts at crafting stories dutifully occurred between the hours of 1:00 and 3:00 AM. His initial focus was creating horror stories because it was an "easy" genre to handle. That fondness for the macabre and otherworldly never dissipated as he continued to utilize horror (and humor) in many tales. The majority of Selzer's stories involve doctor-patient relationships, surgery, and suffering. Some of his literary work is weird ("Pipistrel"), experimental ("A Worm from My Notebook"), and an exercise in reimagining ("The Black Swan Revisited").
Surprisingly for an MD, he seemed a bit unconcerned about facts in his writing. Rather, he was deeply interested in creating impressions. For Selzer, facts weren't necessarily equivalent to truth. After all, facts change but impressions endure. Still, Selzer stubbornly searched for truth (and love) in his stories. He was enticed by language and the sound of words. From time to time, he manufactured his own words. He disliked gerunds but appreciated onomatopoeia. His favorite doctor-writers were John Keats and Anton Chekhov both of whom died from tuberculosis - Keats at age 25 and Chekhov at age 44.
I don't know which story Richard Selzer considered his best or most beloved, but I suspect that "Diary of an Infidel: Notes from a Monastery" was at or near the top of his list. The rest of us, however, definitely have our favorite Selzer stories. And while there are so many wonderful tales to choose from, I recommend the following 10 not-to-be-missed selections. My list is divided into two sections. Part 1 includes personal favorites and stories that don't get nearly the attention they deserve. Part 2 is comprised of stories and an essay that I find very useful in teaching.
Part 1: Five Fabulous Favorites:
1. "Tom and Lily"
2. "Luis"
3. "The Consultation"
4. "Toenails"
5. "Fetishes"
Part 2: Five Fixtures for Teaching:
1. "Brute"
2. "Imelda"
3. "Sarcophagus"
4. "Wither Thou Goest"
5. "The Surgeon as Priest"
So there you have it. The two greatest stories by Richard Selzer are "Brute" and "Tom and Lily." Of course, that's just my opinion. How do you see it? You are invited to post to the blog with your favorites. (I have a hunch that "Imelda" is going to vie with "Brute" for the top spot.) In the meantime, The Doctor Stories by Richard Selzer is a perfect place for readers to roost - either as an introduction to his work or an opportunity to reacquaint with some notable tales.

Rx: Literature | A Reading to Celebrate Bellevue Literary Review's 30th Issue

May 5, 2016 at 11:27 am

PLEASE JOIN US Monday, May 16th | 6pm
Bellevue Hospital, 462 First Avenue at 28th St. - Chapel Hall

BLR spring reading 2016

Our readers:

Sonni Aun had the great fortune of growing up all over the world and is now a painter and writer in New York City. She holds a BA in Biochemistry and Art from Rice University and is currently studying writing with the poet Philip Schultz at the Writers Studio.

Katy Lederer is the author of the poetry collections Winter Sex (Verse Press) and The Heaven-Sent Leaf (BOA Editions), as well as of the memoir Poker Face: A Girlhood Among Gamblers. She is currently at work on a collection of essays around apocalyptic themes and a book of poetry about autoimmunity, deformity, and motherhood titled The Engineers.

Susanna Nguy is from Brooklyn, New York. She graduated from the City College of New York in 2013 where she developed a passion for oncology research. She is completing her medical degree and will be doing her residency in Radiation Oncology at NYU. "The Lump," from this issue of BLR, is her first published story.

Adam Young was born and raised in Providence, Rhode Island, where he attended Classical High School. He is currently studying English Literature and Creative Writing at New York University and he is volunteering at Writopia Lab, a creative writing organization offering workshops for kids and teens. His work has appeared in the Zine Play(ed) Boy: Volume II and he hopes to continue to participate in the creative writing community.

States of Grace: From Doctor to Patient and Back Again

April 5, 2016 at 3:39 pm

Katie Grogan, DMH, MA and Tamara Prevatt, MA,
Master Scholars Program in Humanistic Medicine, NYU School of Medicine


Before the accident, Dr. Grace Dammann was a caregiver through and through, in every aspect of her life. A pioneering AIDS specialist, she co-founded one of the first HIV/AIDS clinics for socioeconomically disadvantaged patients in San Francisco at Laguna Honda Hospital. She was honored by the Dalai Lama with an Unsung Heroes of Compassion Award for her service and devotion to this population. Grace was also the primary breadwinner and parent in her family with partner Nancy "Fu" Schroeder and adopted daughter Sabrina, who was born with cerebral palsy and HIV. She lived and worked in such close proximity to illness, death, and disability, but nothing could have prepared her for the devastating injuries she sustained when a driver veered across the divide on the Golden Gate Bridge, crashing head on into her car.

Grace spent seven weeks in a coma, hovering on the precipice between life and death, like so many of her own patients. Ultimately, she awoke with her cognitive abilities miraculously intact, but her body was irreversibly impaired, leaving her wheelchair-bound and dependent on others for simple daily tasks. States of Grace, a documentary film about her profound transformation, picks up Grace's story when she is discharged following a thirteen-month stay in rehabilitative hospitals. Members of NYU Langone Medical Center, including medical and nursing students as well as faculty and staff across all disciplines, were invited to attend a screening of the film and talkback with Dr. Grace Dammann and the filmmakers, Mark Lipman and Helen S. Cohen of Open Studio Productions.

States of Grace captures the expansive and rippling effects of the accident, how it left every corner of Grace's life radically altered-personal, professional, psychological, spiritual, and economic. The family dynamic is turned on its head. Fu becomes the primary caregiver to both Grace and Sabrina, and as Grace says, "Sabrina's position in the family was radically upgraded by the accident. She is so much more able-bodied than I am." Fu struggles with the enormity of the role she has signed up for. Grace wrestles with her gratitude for having survived and the frustrations of her new life: "I feel like I've lost a best friend-my body . . . When I first woke up, I was just glad to be alive, plain and simple. Now I'm just annoyed-annoyed at the limitations. I'm bored." In one scene we see Grace argue with Fu about her right to die if she continues to be so impaired.


Grace grieves for her old life, for how effortless things were. We watch as her fierce resilience pulls her through to acceptance. She credits her Zen Buddhist practice for her ability to keep moving forward: "Nothing lasts forever, even great pain and sorrow." Though some of her ultimate goals-to walk again, to dance again, to surf again-remain unattainable at the film's conclusion, Grace sets, meets, and exceeds new ones. Acknowledging that she only felt completely whole when practicing medicine, she "comes out" as a disabled person to the medical community, returning to Laguna Honda Hospital as its first wheelchair-bound physician, where she is appointed Medical Director of the Pain Clinic. She resumes the caregiver role, but with an intimate knowledge of the lived experience of pain, suffering, and disability. In the talkback Grace remarked, "Once you disrupt the integrity of the body, you're disrupting the integrity of the psyche, and I don't think any of us think about that. I certainly didn't as a physician. I hate to admit how many times I discharged people without even getting them up to see that they could walk." She also brings her Buddhist training to the clinic, where she promotes wellness among the staff and patients by teaching meditation.

As the talkback ended, attendees lingered, eager to chat with the filmmakers and shake hands with Grace, awestruck by her story of triumph, adaptability, service, and the lessons learned on both sides of the doctor-patient divide.

Sabrina will graduate this May with her Bachelor's degree. Grace partnered with the driver who hit her to advocate for a median barrier on the Golden Gate Bridge to prevent similar accidents from happening in the future. The barrier was installed in January 2015.

This screening was co-sponsored by the Master Scholars Program in Humanistic Medicine, the Office of Medical Education, and the Department of Physical Medicine and Rehabilitation. Special thanks to Drs. Pamela Rosenthal and Marianne Sommerville for bringing the film to NYULMC. For more information on States of Grace and to arrange a screening, go to:


NYU Center for Humanities Event Imagining Illness: Pulitzer Prize Winners on Truth and Fact in Narrative David Oshinsky and Paul Harding

March 29, 2016 at 1:30 pm

By J. Russell Teagarden
On a recent winter's evening, Pulitzer Prize winners David Oshinsky and Paul Harding appeared together at the NYU Center for Humanities in an event cosponsored by the NYU Division of Medical Humanities and the Bellevue Literary Press. Erika Goldman, the publisher and editorial director of the Bellevue Literary Press, moderated the session. Jane Tylus, faculty director of the NYU Center for Humanities, provided opening and closing remarks. The evening also had support from the Pulitzer Prize Campfire Initiative.

David Oshinsky's book, Polio: An American History (Oxford University Press) won the 2006 Pulitzer Prize in History, as well as the Hoover Presidential Book Award in 2005. It became the basis for a 2009 PBS documentary on polio. In 2010, Paul Harding's book, Tinkers (Bellevue Literary Press) won the Pulitzer Prize in Fiction and a PEN/Robert W. Bingham Prize. Drawing from their respective genres in the humanities, the authors shed light on how chronic illnesses can affect individuals and their families, in the case of Harding's novel, and on how epidemics can affect populations and national responses in the case of Oshinsky's history of polio.

In her annotation of Oshinsky's book in the NYU Literature Art and Medicine Database, Dr. Janice Willms notes that the narrative was written in a way that readers were easily able to grasp how it was "real people fighting a battle that swept from certain success to likely failure and back again many times, often almost overnight." Dr. Tony Miksanek, in his annotation of Harding's book, focuses on how the "story presents some exquisite impressions of seizures along with the aura that precedes them," and how it "masterfully represents how we measure life."


Both authors spoke of creating narratives that convey a truth, yet their sources for truth are antipodal in nature. As an historian and documentarian, Oshinsky goes to archives and other sources of objective facts and occurrences to build his narrative. He told the audience that in creating his narratives, "not only am I telling a story, but I am fitting into a larger mosaic of other stories." He read a section from his book about a particular polio victim, Fred Snite, that interweaves both the personal suffering and social responses his plight generated.

He had lost the ability to cough so his throat had to be regularly suctioned. He had to be fed in rhythm with the respirator which caused his chest to rise and fall every four seconds, 21,600 times a day. But that was only part of the story, the lesser part. What kept Snite in the public eye was his determination to lead "an otherwise normal life." He became a tournament-tough bridge player, reading the cards in a rearview mirror placed above his head. He traveled to race tracks and to college football games in a trailer equipped with a spare iron lung. "His arrival at Notre Dame Stadium was one of the events of the afternoon," a friend recalled, "Enter the visiting team, polite cheers, enter the home team, loud cheers, enter Frederick, pandemonium." (p. 63)

Oshinsky lamented that as an historian he can't take the liberties availed to novelists, but Harding noted, in referring to this passage, that he is actually "deploying the same tactic as a fiction writer." Harding was allowing that the historian must work from facts and documents, but like the fiction writer, must create compelling narratives if the goal is to reach the general public.


As a novelist, Harding builds his narratives from what he calls "imaginative truth." He starts by "imagining my way into the lives of people…whose lives might otherwise pass by unremarked. The value of their lives would not be witness to." In Tinkers, he imagines his way into the life of a person with severe epilepsy and what it must be like to experience a seizure. He gives witness to the experience in the section he read (or "tone poem" as he called it):

The aura, the sparkle and tingle of an oncoming fit, was not the lightningait was the cooked air that the lightning pushed in front of itself. The actual seizure was when the bolt touched flesh, and in an instant so atomic, so nearly immaterial, nearly incorporeal, that there was almost no before and after, no cause A that led to effect B, but instead simply A, simply B, with no then in between, and Howard became pure, unconscious energy. It was like the opposite of death, or a bit of the same thing death was, but from a different direction: Instead of being emptied or extinguished to the point of unselfness, Howard was over-filled, overwhelmed to the same state. If death was to fall below some human boundary, so his seizures were to be rocketed beyond it. (pp. 47-48)

Harding said he assiduously avoided doing any research about epilepsy, and had only some family mythology and his own close call with electrocution to inform his writing. But, although the seizure experience he describes was mostly mined from his imagination, it covers basically the same scope as a traditional biomedical description of seizures that can be found in Harrison's Principles of Internal Medicine-minus the literary splendor:

Some patients describe vague premonitory symptoms in the hours leading up to the seizure…The initial phase of the seizure is usually tonic contraction of muscles throughout the body, accounting for a number of the classic features of the event. Tonic contraction of the muscles of expiration and the larynx at the onset will produce a loud moan or "ictal cry." Respirations are impaired, secretions pool in the oropharynx, and cyanosis develops. Contraction of the jaw muscles may cause biting of the tongue. A marked enhancement of sympathetic tone leads to increases in heart rate, blood pressure, and pupillary size. After 10-20 seconds, the tonic phase of the seizure typically evolves into the clonic phase, produced by the superimposition of periods of muscle relaxation on the tonic muscle contraction.

Thus, Oshinsky and Harding compose compelling narratives about illness experiences originating from different places and evolving from different forms. In her forward to Humanity in Healthcare: The Heart and Soul of Medicine, Iona Heath captures the essence of what the varied approaches Oshinsky and Harding use when she states, "skilled writers help us to see the world and our own place within it in a new light-a light that falls from a slightly different direction revealing subtly different detail." (p. iv)
These are just a few of the many insights the authors provided during the session.
A video of the entire program is available at:



Cortney Davis - When the Nurse Becomes a Patient: A Story in Words and Images

March 23, 2016 at 1:17 pm


NYU Langone Medical Center welcomed author/painter Cortney Davis to the Smilow gallery for the opening of "When the Nurse Becomes a Patient." Laura Ferguson's interview with Ms. Davis appears here.

Exhibition presented at the NYU Langone Medical Center Art Gallery by the Art Program and Collection.
Photo: Art Program and Collection.


The Patient Experience Book Club at NYU Langone Medical Center

March 2, 2016 at 1:41 pm

When an AP reporter called to tell Erika Goldman, publisher of the Bellevue Literary Press, that its novel, Tinkers, by Paul Harding, won the 2010 Pulitzer Prize for fiction, "it was akin to receiving a blow to the head," she said. "It was concussive." For the first time since 1981, a book published by a small press won the award.

Ms. Goldman told this story to the members of the Patient Experience Book Club at NYU Langone Medical Center, a group that includes physicians, nurses, administrators, analysts and social workers among others. On a recent Friday afternoon, the group met to discuss Tinkers.

Tinkers recounts the last days of George Crosby. Lying in a hospital bed in the middle of his living room, surrounded by the members of his extended family, George's thoughts drift between the scene around him and memories of his boyhood. His father, Howard, a peddler of home goods in rural Maine, had epilepsy. Faced with the possibility that he would be committed to a psychiatric hospital Howard Crosby abandons the family leaving George, his mother and siblings to fend for themselves.

Time is a thematic thread running through the novel (George repairs clocks) as the narrative flows between memories of his childhood and his adult life. Harding describes his book as unlineated poetry. Its rich, descriptive language requires readers to settle into the prose, avoid distractions, and allow themselves the space to fully experience the story.

After a brief introduction by Ms. Goldman about how the Pulitzer Prize process works, the group turned to a discussion of the text. Their interpretations were filtered through their individual experiences working with patients and families. A social worker compared some "not so great" deaths she has witnessed to George's death at home with his family. A neurology administrator pointed out that the stigma attached to epilepsy remains a problem for some of the patients she encounters. Tinkers draws attention to the silence surrounding illness, another commented.


The Patient Experience Book Club was started by Dr. Katherine Hochman in 2012. She came up with the idea after attending a conference on patient experience that was organized by the Institute for Healthcare Improvement in Boston: "What I took away from that was in order to have an engaged patient, we need to have an engaged staff." She decided to hold meetings every two months to discuss books that related, even tangentially, to patient care. A small grant funds box lunches and copies of the selections. The books are made available in advance of the meeting. Sessions typically draw from 10-30 people from all areas of the medical center. For many, it's a chance to meet co-workers who they do not interact with in their normal daily routines.

Locksley Dyce, a hospital administrator, loves to read and is a regular attendee: "It affords me the opportunity to meet in a multi-disciplinary group and exchange thoughts with healthcare professionals whom I probably would not meet otherwise."

The Club invites a faculty or staff member with expertise in a particular area to lead the sessions. Dr. Joseph Lowy from the palliative care service led the discussion of Being Mortal by Atul Gawande. David Oshinsky discussed his book Polio. And during the Ebola scare, the novel Blindness prompted a discussion of what it would be like for a whole society to be affected by an illness. During that session, Hochman and the group wore blindfolds to experience blindness for themselves.


Mr. Dyce finds the sessions particularly thought-provoking. "We try to apply the material from the book to healthcare - especially patient care - and the individual roles that we play in it," he said.

As the session on Tinkers drew to a close, and the members prepared to go back to work, ordering tests, analyzing metrics and attending to their patients, they reflect on the issues brought up in the meeting and acknowledge the importance of taking time to connect with their patients.

The group meets next in April to discuss When Breath Becomes Air by Paul Kalanithi.

Drawing the Human Heart

January 29, 2016 at 11:33 am

This video is adapted from a presentation delivered by our Art Editor, Laura Ferguson, at the 2015 conference of the American Society for Bioethics + Humanities.

In the video, Laura talks about her journey as an artist, the many years she spent exploring her own anatomy and finding beauty in a curving spine - and how it brought her to the the Anatomy Lab at NYU’s School of Medicine as Artist in Residence. There, she uses the expressive power of art to help medical students stay engaged in the emotionally complicated task of dissecting a human body.

links to "How To Draw a Human Heart," a short film about Laura and her Art & Anatomy class, directed by Emon Hassan:

The Vaccine Project

November 6, 2015 at 1:25 pm

An interview with Philip Cawkwell, MS4, NYU School of Medicine, Rudin Fellow 2014-15
By: Katie Grogan, DMH, Associate Director, Master Scholars Program in Humanistic Medicine
Assistance from Tamara Prevatt, Intern, Master Scholars Program in Humanistic Medicine

The Rudin Fellowship in Medical Ethics and Humanities supports medical trainees at NYU School of Medicine - including medical students, residents, and clinical fellows - pursuing year-long research projects in medical humanities and medical ethics under the mentorship of senior faculty. It was established in 2014 through a grant from the Louis and Rachel Rudin Foundation, Inc. and is a core component of the Master Scholars Program in Humanistic Medicine.


Philip receiving his fellowship certificate from Drs. David Oshinsky, his Rudin Mentor, and Lynn Buckvar-Keltz, Associate Dean for Student Affairs, at the Rudin Fellowship Project Showcase, July 7, 2015.

How did you become interested in vaccine refusal and why did you decide to pursue this as a project through the Rudin Fellowship?

Vaccine refusal is something I've been interested in for a long time. As a medical student, and someone with a lot of doctors in my family, it was just accepted that you go to the doctor and get your vaccinations. So, growing up in an age where it felt like there was this huge movement of people who weren't vaccinating their kids, was something that I didn't understand very well. The goal behind this project was to dig a little bit deeper and figure out why this was happening. Why weren't kids getting vaccinated? Where were places with better or worse vaccination rates, and why? I also wanted to figure out what pediatricians can do about it. How can they do a better job of talking to parents and talking to kids and improving vaccination rates overall?

Through your research you discovered that the unlikely state of Mississippi, which consistently ranks at the bottom for other health indicators, has the highest vaccine compliance rate in the country. What's going on in Mississippi?

This is pretty shocking to everyone. Here is a state that is one of the most obese, approximately 35 percent of the population smokes, there is no indoor ban on smoking, and it has the highest rate of infant mortality. Yet, if you look at kindergartners in this state, 99.7 percent have gotten the MMR vaccine series, compared to about 95 percent nationally. That's almost every single kid in the state, and it's remarkable. That was something that I chose to focus on for this project because when you have a 99 percent vaccination rate, you're doing something right. The question is, what did Mississippi do to achieve this?

In one way, they're very fortunate because they have a framework that's in place due to a lawsuit, Brown v. Stone, which was brought against the board of education in 1979. Brown sued the school board in Houston, Mississippi to get his six-year-old son into the elementary school by arguing that his religion precluded him from having his child vaccinated. This went all the way up to the state supreme court that eventually ruled, "No you don't, in fact, have the right to a religious exemption because for the good of the public and society as a whole, sometimes you lose a little personal liberty." In their ruling they went further and invoked the Fourteenth Amendment, which is about equal protection under the law. They said that if they allow a way out of this vaccine statute, then it has to apply equally to everyone. If they allow a religious exemption, then they're discriminating against those who don't have that same religious belief. If they allow a philosophical exemption, then they're discriminating against those that don't have that same philosophy. The way they worded this was very important because it not only shot down Brown's case, but it saw into the future and prevented other personal and religious belief cases in the state. It has stood the test of time. However, it's difficult for other states that don't have this historical legal framework working for them.

It was important for me to figure out what else Mississippi does to maintain this high vaccination rate, so I went there and talked to the health department. Only medical exemptions are permitted, and to get one, the parent has to go through the state health department - it is not enough for the pediatrician to sign off on it. The pediatrician writes a letter and the health department reviews it. You only get that exemption if you have a real medical reason for not getting the vaccine. Further, the health department has a state registry of every child enrolled in school with a list of the vaccines required and a check box of whether or not the child received them. This is what the state epidemiologist calls "unit level accountability." So Mississippi's situation is a combination of this nice legal background and having everything centralized within the state department of health. That's what makes them the leader. (Additional information about exemptions can be found at the end of the interview)

As part of your project, you consulted experts in infectious disease, pediatrics, and vaccine education to explore how the rest of the nation can establish and maintain vaccination programs like Mississippi. What did you learn?

I can start with Mississippi, where I talked to Dr. Thomas Dobbs III, who is the state epidemiologist there. He personally oversees the exemptions and told me a lot about the inner workings of the program. One key thing I learned was that it is a lot easier to maintain a program like this than it is to establish one.

I also talked to a lot of pediatricians. At NYU I talked to Dr. Catherine Manno who is the Chair of the Pediatrics Department. She was able to talk about what it was like going through training at a time when we didn't have some of the vaccines that we do now - things like Haemophilus influenza Type b were routinely killing or crippling children. She commented on how it's remarkable that you can be a pediatrician or someone in training now and never have seen some of those diseases.

I spoke with Dr. Paul Offit at the University of Pennsylvania who has published more than anyone on this topic. He's written a number of books trying to dispel the autism-vaccine link and has developed a vaccine himself. We talked a lot about how it's now becoming popular among parents to try and spread out the vaccine series. People are worried about getting too many vaccines. One thing he was telling me that I think is really important to remember is that there are more vaccines now than there were a few decades ago, but if you look at the actual amount of the vaccine that is in each shot, the amount of antigen you are exposing your child to is much smaller than it was even if you combine all of the vaccines. Because Dr. Offit has been doing this for decades, he was able to provide some perspective. I asked him if he felt optimistic even while seeing the anti-vaccination people in the news everyday. He said with this year's measles outbreak at Disneyland people are finally caring and starting to respond. It was a really positive message from him that things might actually be changing and, indeed, we see that they are.


Philip presenting his research at the Rudin Fellowship Project Showcase, July 7, 2015.

As you mentioned, among younger generations, we don't see many of these diseases firsthand so it's easy to mistakenly believe they've been eradicated. Disneyland was a reminder that this not the case. How did the measles outbreak happen? What did vaccine refusal have to do with it, and were there changes to California's exemption policy as a result?

It started in December 2014, and by February the CDC counted about 110 cases of measles that they could say definitely came from Disneyland. The majority of those cases were children who were either unvaccinated or who had unknown vaccination statuses. I think it was part of the national news and the national conversation and was able to ignite some change in California. The state senators in California who took up this call both had experience with public health. Senator Pan is a pediatrician in California and Senator Allen is the son of a polio survivor, so they both knew how important this was from a personal standpoint. They saw what was happening to their state. California used to have both religious and philosophical exemptions and as of June of this year, they have neither. That was a big change. However, it's important that it's not just California. Vermont got rid of philosophical exemptions this year as well. There are also seventeen other states with some form of legislation concerning vaccine exemptions. In some cases it's to get rid of exemptions and some cases it's making it harder to obtain them. But so far it's just Vermont and California that have actually passed legislation.

Vaccination is an issue that really crystallizes the tension between personal freedom and what's good for society as a whole. Do physicians have a moral obligation to help us reconcile this conflict?

Yes, it's very tough to get people to think about the health of society as a concept rather than the health of their child. If you think about it, these parents are not bad people; they are trying to do what's best for their child. They just have a different view than most pediatricians about what that is. They are really missing the societal aspect to it. Vaccinations are important and necessary because some people can't be vaccinated. If one or two people don't get vaccinated the system won't fall apart because the herd can protect everyone. It's actually safer to be unvaccinated living in a group of people who are vaccinated than it is to be vaccinated living in a group of people who are unvaccinated. And the reason is that around five to ten percent of the time, you don't get full immunity from a vaccine. With parents, there can be this diffusion of responsibility where, "my child does not have to be vaccinated as long as everyone else's is." It's hard to convince someone that you need to be part of the 95 percent that is going to take on that responsibility. It's a really quick snowball when you see states like Colorado, which has the lowest childhood MMR vaccination rate - it's about 83 percent - that's when you start to see problems, when everyone starts to take an individualistic approach.

But you have to look at it from two standpoints - from the parent's and the pediatrician's. Talking to pediatricians like Dr. Manno and Dr. Klass at NYU and Dr. Spiesel at Yale, they all came up with the same scenario: You're a pediatrician and you have someone sitting in your waiting room who can't get vaccinated - maybe he's six months old and not ready for his one-year-old shots yet. Then you have another patient in your waiting room that is sick with a vaccine preventable disease. Because you've allowed that child in your waiting room you now have some liability as a doctor to protect that six-month-old. Now you've exposed him to measles or another potentially deadly illness because you allowed someone who wasn't vaccinated into your office. At the same time, if you say, "As a pediatrician I am only going to see kids who are vaccinated," then what happens to the other kids? Where do they get their care and who sees them? That's a problem too. Several of the pediatricians that I spoke to say they just want to avoid that issue. It's much easier to say, "If you aren't vaccinated, there are a lot of pediatricians around here that will see you so go see one of them." They know they have somewhere else to go, and morally they feel better about that situation than potentially exposing their own patients to someone who isn't vaccinated.

Now if you're a parent, it's a whole other issue. It's this idea that "I'm not going to let the government or the doctor or the establishment make a decision for me about the health of my child." Many talk about it in terms of being forced: "You're forcing my child to get a shot," which isn't technically true. At the same time, there is something that has to be said for herd immunity and protecting those that can't get vaccinated and protecting the health of children as a whole. But when you have all of these vaccines that have been tested so well with data showing their safety and efficacy and you have diseases like measles and polio that we can protect against, it's hard for me to see a way for a doctor to feel comfortable without advocating for all of their patients being fully vaccinated.

What can the medical community do to motivate people who are confused or misinformed about vaccines? Would doctors' offices saying "we will only see patients who are vaccine compliant" compel conscientious objectors to rethink their stance?

It's a really good question. There are two groups of people who won't vaccinate their kids - a group who can be convinced and a group who can't. The really staunch anti-vaccination people, they're settled. They've made up their minds, and there isn't a story you tell them or statistics you give them to change their stance. Then there's a group who aren't vaccinating because they're under-informed or they're a little uncertain. That's the group that is really important because they can be convinced. That's the danger of having a blanket policy that you won't see those kids unless they get vaccinated. Maybe the parents could have been convinced and you shoved them aside.

The other part of my project, besides looking at Mississippi, was looking at strategies for convincing parents to vaccinate their kids. Specifically, I looked at strategies that weren't based in statistics. Doctors love statistics - they speak the language of the p-value and talk about randomized controlled trials proving the efficacy and safety, and that doesn't mean a whole lot to most parents. I looked at narrative medicine and the power of storytelling and whether physicians can talk about stories of patients they've had that weren't vaccinated, or even a personal story about how their kids got vaccinated and how well that's worked out for them. But the problem is that this takes time. When 80% of well-child visits in this country are less than twenty minutes long, it's hard to take five minutes to talk about why vaccines are safe. It's a lot easier to say, "You have to get vaccinated. Vaccines are safe. Here's an information sheet." That's a really complex problem where there's not a great solution at this point.

In addition to considering a narrative approach, you also looked to print media, especially political cartoons, to analyze the anatomy of the vaccine wars. Is there one particular image that you came across that captures the essence of this contentious topic?

There's a cartoon is of a blindfolded man labeled "anti-vaccinationist" walking off a cliff labeled "misinformation" into a big lake of smallpox. My favorite part about it is that it's not a current cartoon but from 1930. So it's this reminder that this isn't new; it's maybe new in the pubic consciousness and becoming a big thing in the media. As long as there have been vaccines, there have been people who have fought against compulsory vaccination. It's always been really tough to convince people that they need to do something for society and that they aren't making a big mistake. It's been played out over and over again every single decade since the 1850's.


Anti-vaccination cartoon, from cartoon booklet, "Health in Pictures," 1930

So, it's stories, both in narrative or visual form, that resonate with people more than numbers and scientific studies. Can you elaborate on this in the context of the now-discredited 1998 Wakefield study that first claimed a link between the MMR vaccine and autism? Why has it had such a lasting impact?

The Wakefield study is really important because it shows how scientists and the lay population look at information differently. The original Wakefield study was a case series of twelve patients and was published in The Lancet. The scientific community then did large studies and meta-analyses looking at thousands of kids and completely discredited the original Wakefield paper. As far as the scientific community is concerned, that was great. That's how science works - you have a hypothesis, you run a test, and come up with a conclusion. Someone else can run the test differently and see how thing stack up. That's why the issue is settled in the scientific community. With the population at large, that's not the case. In 2009, 25 percent of people in this country still believed that vaccines cause autism. Over a decade after this study has been completely debunked and it was proven that the researcher was engaging in deliberate fraud, the public hasn't gotten that message. All these studies that all these scientists are running, what do they mean if no one really understands them or accepts them? That's why you have to think about the way scientists convey information. The anti-vaccination people do a really great job at getting their information out through social media, the Internet, by having spokespeople who can get through to someone who doesn't know what a p-value is but knows what autism looks like.

You're planning to train in pediatrics so you'll be navigating this first-hand - conveying scientific information in a way that resonates with parents and children. What do you think your approach will be, and how has this project informed it?

From a personal standpoint, my goal is going to be to get 100 percent vaccination rates. Part of that is going to be reading parents and seeing what appeals to them. For some, statistics will be great and they will want to see the studies. For some it will be telling them, "Hey, I've personally vaccinated all these kids and have seen them develop and do great." It's explaining how autism works and that there is no link to vaccination at all. There is no proven blanket strategy, so I think that individualizing it will be very useful to me.

What do you think is the path forward with vaccinations in our country? Are we going to see changes at the national level?

I think it is unlikely to see the federal government taking on this matter. This has really been a states' rights issue over the years. Unfortunately, it takes outbreaks like the one at Disneyland to spark change. Maybe it will be more outbreaks. Maybe that will wake people up. Maybe the California one will be enough and all the states that are starting taking up this issue will push through. But it's still really difficult in this country where you have such a vocal opposition. It's hard to be more than cautiously optimistic. I've seen things improve just over the last year - but still there are only three states with policies to limit vaccination exemptions. There are still 47 to go and I think that will take some time.

Types of Vaccine Exemptions
Exemptions differ on a state-by-state basis, but it boils down to three different kinds.

  • First, every single state allows for medical exemptions, and there are a lot of reasons why a child might need a medical exemption. For example, if you are receiving chemotherapy and your immune system is weaker, you don't want to get a live virus vaccine.
  • The second kind - and about 47 states have this - are religious exemptions. Again, it varies from state to state as to how much evidence you have to provide that you have a religious belief that is counter to receiving vaccinations.
  • The third kind - and I think seventeen states have these - are philosophical/personal belief or conscientious objector exemptions, and these run the gamut of pretty much anything. These are usually designed by the legislature as a catchall to let parents have a way to opt-out.
    For some states, like Wisconsin, it's just a check box on a form, you check "personal belief," and that's it - nothing else is required. In Georgia has you send in a notarized statement explaining the philosophical exemption, so you have to actually articulate the reason you are philosophically opposed to vaccination. New York has a religious belief exemption, and we also have the medical exemption. There is no philosophical exemption in New York.

*You can read more about Philip's research in his recently published articles "Storytelling in the context of vaccine refusal: a strategy to improve communication and immunization" in Medical Humanities, and "Childhood vaccination requirements: Lessons from history, Mississippi, and the path forward" in Vaccine.