Literature, Arts and Medicine Blog

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.

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

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.

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.

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

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!