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

clevelandclinicIntroduction

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.

Conclusions

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.

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

 

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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.

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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: www.statesofgracefilm.com

 

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
Oshinsky_Harding_wide
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."

Oshinsky

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.

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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: https://www.youtube.com/watch?v=w-l86fOAsLY&feature=youtu.be.

Oshinsky_Harding_panel

 

The Social Construction of Cancer - Part 2

November 14, 2012 at 3:54 pm

Editor’s Note: This is the second of four installments from guest blogger Dwai Banerjee, a doctoral candidate in NYU's department of social anthropology. Images illustrated by Amy Potter, courtesy of Cansupport.

Part II

However, at this point, Shambu and Rohini's story took a sharp turn. The palliative care team I was visiting with discovered that, partly because of not collectively acknowledging the extent of the disease, Shambu and Rohini had started visiting a new neighborhood private 'ayurvedic hospital.' This hospital claimed to be able to completely cure cancer, provided that the patients pay whatever was the breaking limit of their financial ability. Perfectly aware that it was not her place to recommend or dissuade a line of treatment, the counselor restrained her own opinions. As the family talked, it became clear that to avail this therapy, they were considering risking their son's future as well as their ability to remain in their home. Shambu had been the sole breadwinner in the family, and given the imminent possibility of his passing, such decisions could have catastrophic consequences. The counselor still remained non-committal on the viability of this promise of cure, but skillfully urged Shambu and his wife to talk and think through what they were doing.

Soon, as they talked about their options for the first time, Shambu and Rohini started complaining bitterly about the treatment they had received at this hospital. The self-purported physician had refused to come into contact with the patient, or even take a medical history. Instead, their conversation had revolved around the staff ascertaining what the family could afford. (The counselor was to later tell me that many such 'alternative' hospitals had sprung up around lower-income neighborhoods, and for the urban poor at the margins of an overcrowded public health system, these were unsurprisingly seductive lures.) Soon afterwards, Shambu began to narrate his own life, telling the story of how he had planned his own insurance policies based on an astrological prediction that he would contract cancer, but how that prediction had fallen short by two years and wrecked havoc with his plans.

To my surprise, I began to see how the counselor's decision to listen patiently had allowed the space for these narratives to develop, and how the family now began the slow process of coming to terms with the prognosis. This would certainly not be the last word on the matter, but the team's skilful handling of the sensitive ways in which illness knowledge circulates ensured two vital things. On the one hand, they were careful not to heavy-handedly tear the web of careful ruses that continued to bolster the family and the relations between them and the social worlds around them. But at the same time, they laid the groundwork so that these partial denials would not financially ruin the family in the near future. Thus, the team facilitated the process through which Shambu and Rohini could place the illness within a comprehensible narrative of their lives, while beginning to prepare for what was to come.

Dwaipayan Banerjee is a doctoral candidate at the department of social anthropology at New York University. Prior to his doctoral candidacy at NYU, he graduated with an M.A. and an M.Phil in sociology from the Delhi School of Economics, India. He has recently completed ethnographic work concerning the experience of cancer, pain and end-of-life care in India. His research follows the circulations of these experiences across different registers - language, medicine, law and politics. His broader interests includes working at the intersection of philosophy and anthropology, as well producing and studying ethnographic film and media.

"Give Me A Shot Of Anything: House Calls to the Homeless"

March 9, 2012 at 4:58 pm

Students at the NYU School of Medicine rotate through Bellevue Hospital during their medicine clerkship. Many of the patients they meet come from shelters or the street. Concern about how their patients live outside of the hospital is a topic that is often raised in the weekly humanism seminar I facilitate, so I was particularly interested in screening the recent documentary, Give Me a Shot of Anything: House Calls to the Homeless, to see whether it would be of interest to my students.

The documentary follows a dedicated physician, Dr. Jim O'Connell, as he cares for people living on the streets of Boston. The project began as a short film about the Boston Healthcare for the Homeless Program that runs the house call program, a hospital clinic, and the McGinnis House, a respite center for individuals who need transition care during an illness and have no home to stay during their recuperation. During production of that film, the director, NY based Jeff Schwartz, was so drawn into the lives of the people he met following Dr. O'Connell, that he decided to expand the project into an hour long documentary.

I interviewed Jeff in his New York studio a few days after he screened the film at Harvard School of Medicine. Following are excerpts of our conversation.

As he spent more time out on the street, the people he met began to open up to him on camera.

As we continued our conversation, I became increasingly uncomfortable with the use of the word "homeless" to describe the people who appear in the film. It seemed to me that it would be just as simple to describe people by name or where they were from, or how they had been trained. The word "homeless" had become a defining rather than a descriptive word, not just in this documentary but in the culture.

During the production Jeff became more attuned to the lives of his characters, and the experience changed his life.

To view the trailer please visit:
http://www.givemeashotofanything.com/

-Lucy Bruell, Editor-in-Chief

Painting the Brain

January 26, 2012 at 5:44 pm

Painting the Brain

Rachel Hammer is a third-year medical student and MFA candidate at the Mayo Clinic, and a guest blogger on the Literature, Arts, and Medicine blog.

Medical students are in the process of a professional transformation, and it can be cathartic to express those transformations artistically. One's conceptions of medicine, self, and one's professional identity may cycle through a myriad of forms The Mayo Clinic College of Medicine student interest groups in the humanities and in neurology partnered with the local art museum to host an evening entitled "Paint the Brain" in February 2011. This event consisted of an open invitation to medical students to paint their creative interpretations of the nervous system and the way it creates our human experience. The painting session was preceded by a brief presentation on art theory given by the art center's resident educator, Jason Pearson. Medical student, Lauren Jansons, then spoke on artists whose work has been affected by neurological conditions. Nearly forty paintings were generated.

The majority of the pieces were acrylic on canvas, some were mixed media using fabric, photography, duct tape, or water color. Examples of the artwork include: Andy Warhol-like portrayals of the midbrain, traditional Hmong art as neural gyri, trees of neurons, butterflies emerging from a woman's gut, abstract brains, the landscape of bare calvarium, and one's self portrait in the context of an aura. The paintings were shown on campus for National Brain Awareness Week and at the American Society of Bioethics and Humanities in October 2011. We repeated the painting session in January 2012 with a new topic: global health. Similarly, students were instructed to portray their own representation on the topic. Examples of the artwork from this session included: cervical dysplasia cells as an African mountain range, the earth upheld by many different hands, a closed water bottle hovering in a desert landscape, a woman's portrait overlaid with an anatomical heart, a hospital among gravestones, and a woman looking from a mountain top onto a sea of fog.

Feedback from both sessions was positive. From the first, the neurology student leader reflected, "My painting was inspired by the awe and wonder that filled me as I examined the anatomy of the skull for the first time. The bony cavity that cradles our brains is literally the seat of our conscious human experience and I find the architecture itself very dynamic. The vibrant colors and clear brush-strokes in this painting pay tribute to the constant pulse and flow of vitality through our minds, allowing us to appreciate each new thing."

Another student, a first year, Christine Tran, had this to say: "The painting session allowed me to carve time out of my busy schedule to mindfully focus on something other than the pathophysiology of disease processes or how one cell communicated with another. I didn’t realize it when I signed up to paint but this was a much-needed escape to refresh my mind. I needed to remind myself that… it was possible - and even necessary — to slow down and spend two hours finding just the right shade of beige to paint the contours of a woman’s face, and then to spend another hour giving her hair, highlights, and delicate tendrils. In fact, I enjoyed the exercise so much that when I didn’t complete my painting during the first three allotted hours, I walked back to the museum later in the week in snowy, ten degree weather to spend more time with my painting."

Physicians were invited to both sessions, but very few attended. From the second session, Dr. James Newman commented, "A blank canvas, an unlimited supply of acrylic paint, brushes, and a convivial crew of fellow artists-to-be. The topic was World Health… For me, having painted for many years, but not having touched a brush for too long to contemplate, this was a reawakening. I can't wait for next time."

Shakespeare once penned, "My nature is subdued to what it works in, like the dyer’s hand." So our minds are colored by the mediums we work in. It is refreshing, for a change, to allow color to do what thoughts do.

A Captain of His Ship

January 13, 2012 at 1:15 pm

This week’s guest post is written by Wil Berry, MD, a resident in psychiatry at NYU Langone Medical Center.

My patient, sporting a surprisingly fresh-looking plaid shirt, is sitting at a table in a courtroom on the 19th floor of Bellevue hospital. His hair, in the midst of a transition from sandy brown to silver, falls over his ears but is combed cleanly back to reveal friendly blue eyes. His beard, no longer grimy and tangled, is the color of concrete and full enough to obscure most of his tanned neck. He has been waiting for this moment for most of two weeks, as he has been telling me daily during our fruitless visits, and his posture is stiff with anticipation. I watch him shift his weight form one laces-free sneaker to another, his weathered face showing a softly confident smile, and realize that he looks both profoundly crazy and absolutely not dangerous. And I think, We are definitely going to lose.

The judge comes in, looking at no one, and Mental Health Court is in session. The tone of the regular participants — judge, attorneys, clerk — is flat and uninterested, a contrast to my patient’s jittery energy that makes him seem like a five-year-old at his father’s boring office party. When the clerk tries to swear my patient to tell the truth, he interrupts her to tell her that he can’t swear on a Catholic Bible because he knows the church’s secrets and they are after him. She assures him that he need not swear on any Bible, and he agrees to tell the truth adding "…so help me Christian God, Jewish God, and all gods of the earth."

The attending psychiatrist, my supervisor on the case, speaks first. He says that my patient is psychotic and unable to care for himself, that he has no place to live and has refused to take medication. He says that he is worried that if my patient is released from the hospital in his current state, something bad will happen to him. When he is asked if my patient has been hospitalized before, he replies that our hospital records show thirty-six hospitalizations. In response my patient stands, puts both hands on the table, and says, "Doctor, sir, that is a lie, I have been hospitalized over seventy times!" The judge asks my patient politely to sit down and wait for his turn to speak, and I can see his court-appointed attorney tugging the sleeve at his elbow. He sits, re-composed, saying gently "I’m sorry your honor."

My patient speaks with the unwavering sincerity of a fanatic, his cult composed of his own delusions, his faith reinforced by the doubting psychiatrists who try to diagnose and medicate him. When I first met him, the morning after he had been brought to the emergency room for trying to direct traffic in the center of a busy intersection, I offered him my hand. "Thanks Doc but you don’t want to shake my hand," he said, his voice relaxed and clear. "I just masturbated about twenty minutes ago. My body’s rejecting that chicken they gave us last night." As he stands now, answering questions in that same voice, eye contact warmly fixed on the judge, his demeanor and plaid shirt give him an air of both professionalism and small-town charm.

"Do you intend to hurt yourself?"

"No sir, your honor, absolutely not."

"Do you intend to hurt anyone else?"

"No sir, your honor, absolutely not."

Both parties have fallen into a rhythm, speaking their parts from memory. I wonder if perhaps my patient has spent more time in court than the boyish, court-appointed attorney at his side.

"And what will you do if you are released from this hospital?" Only now does the judge look at him, sliding his glasses down his nose and peering down from the bench.

My patient extends a finger towards the back of the courtroom, the nail long but clean; he is pointing east, to FDR Drive and the water beyond, to the grand and unfulfilled freedom of his future, and the pitch of his voice rises at the thought of it. "I am going to get a boat, your honor. I will be the captain. And I am going to clean up that dirty river."

Afterwards, in a hallway behind the elevator bank, my supervisor asks me why I think we lost. I tell him that I think our patient may have invoked a powerful American archetype, that of the harmless madman, a free-traveling, gray-bearded, hobo-esque schizophrenic who lives by his own code and prizes liberation above all else. I speculate that this symbol is essential to the narrative of our country, of our cities, and of the persistent presence of the seriously mentally ill living among us on our streets. I offer that perhaps it is a symbol which resonated with the court. He tells me that we just got stuck with a bad judge.

While my patient is packing up his room I go and see him to tell him goodbye and wish him well. I offer to see him next week for a follow-up appointment, which I assure him will not take place on the locked ward. He puts the appointment card in the pocket of his wool pants and tells me that he would like to come but doubts he will be available. He smiles at me and tells me that he has enjoyed our conversations. Later that day I sit at my desk, typing up notes and putting in lab orders for the next morning. The window to my right is bolted shut and reinforced with a wire safety guard but if I sit up straight I can see the city stretching southward, lights becoming visible as the sun begins to set. The river is to the east, bridges brimming with evening traffic, the water dark as a shadow between the boroughs, and I watch as a few boats make their way slowly southwards, moving out to sea.


Summer Blog Hiatus

August 4, 2008 at 10:02 am

The Literature, Arts, and Medicine Blog is taking a break until September. We invite you to read some of the more than 20 blog commentaries posted during the past year.

Thanks for your support and attention!

Felice Aull, editor

 

Welcome to the Literature, Arts, and Medicine Blog!

August 2, 2007 at 6:18 am

Purpose: This blog is intended to promote communication and discussion among scholars, educators, and students working in interdisciplinary fields that utilize humanities, social sciences, and the arts to address current issues in medicine and bioscience.

Why do we need this blog?
Many who work in this area of interest are based in small departments or units, or may be the single individual engaged in such scholarship and teaching in their institutions. Aside from attendance at a few annual professional meetings (for which there are limited travel funds), we do not have regular contact with each other or an ongoing forum for discussion. I have learned that there are many individuals and programs in the United States and Canada that are offering courses or have initiated programs that use literature and other humanities, social sciences, and the arts in premedical, medical, postgraduate, and graduate education; many individuals are doing interdisciplinary research in those fields. Yet much of this work may be known to only a small group of colleagues.

You may believe that there are listservs and e-mail that provide interaction among those who wish it, but I have found that listservs function primarily to make announcements or to pose specific questions requiring a quick answer. While listservs are valuable to quickly disseminate information or responses, they do not usually provide a searchable, stable resource for more considered topical discussion. This blog is intended to be such a resource.

Who will contribute?
As a start, the editor will invite individuals to contribute commentaries. We will look for responsive comments from those interested in the posted commentaries; such comments will help to provide an expanded network of contributors. In addition, scholars and students who are interested in submitting commentaries should contact the editor at: medhum@popmail.med.nyu.edu.

What topics will the blog cover?
Categories currently conceived of are: Teaching, Program Development, New Conceptual Frameworks, A Different Take, Regional Events

•Teaching; Program Development-Have you developed syllabi, curricula, or special programs that interdigitate medicine or bioscience with humanities, social sciences, arts in health care settings, undergraduate, graduate, medical, postgraduate, or nursing programs? Why did you think it was important to develop such curricula? Have you evaluated such courses, curricula, programs? How have they been received? What were the difficulties and rewards you’ve encountered in program development? Are there particular books, plays, artwork that you’d like to draw attention to, or caution against using?
•New Conceptual Frameworks— discussion of new interdisciplinary perspectives, for example, Biocultures
•A Different Take -Perhaps you have found reasons why standard texts or art work were not, or are no longer useful in your teaching. Perhaps some of the work you are using has been annotated in the Literature, Arts, and Medicine Database and you have a different "take" on the piece, or additional comments.
•Regional Events — Are there current plays, readings, other productions in your part of the country that would facilitate consideration and discussion of the illness/disability experience, caregiver experience, cross-cultural issues? A commentary would be appropriate, but we also have a sidebar that lists such events, accompanied by a brief description and links if possible. Let us know about such events!