Talking About the Book with Surgeons (and Others)

I have been grateful to talk to groups about my life, surgery, ambiguity, narrative medicine, and A Fullness of Uncertain Significance: Stories of Surgery, Clarity, & Grace. Recent talks and reflections:

February 18, 2022 - Albert Einstein College of Medicine Department of Otorhinolaryngology

This was a virtual presentation. The residency program director, John Bent, MD, read about the book in ENToday, a national newsletter for the Triological Society (the only national print coverage the book has garnered, by the way). He emailed and asked if I would talk to the department.

It was a wonderful experience! I did some reading and conversation. A surprise was the presence of Marvin Fried, MD, chair emeritus of the department and an early role model of mine from residency.

I had some great email interactions with a couple of the Einstein residents and faculty after the talk.

March 14, 2022 - Johns Hopkins Department of Otolaryngology Head & Neck Surgery

I have known and admired many of the Hopkins faculty over the years and, in preparation for this presenation, discovered that I also had connections with two of the residents, as well. One of the current fellows was an MCW resident. Nick Rowan, MD helped coordiante the session.

The residents had a Book Club the week before my presentation. They found three of the essays most compelling, including "Harbinger," an essay about the excitement of a first medical experience and how it impacted an early moment in a personal relationship. I also read "Ending Your Career with Grace Means Letting Go of the Knife," whic is an essay about retirement. Great conversation.

Thanks to Chris Gourin, MD for being such a wonderful advocate for my book!

March 16, 2022 - Rush University Department of Surgery

I graduated from Rush Medical College in 1980, so this virtual visit was a bit of a homecoming. I found some old pictures and told some stories, warning people to nice to medical students because, you never know who might come back in thirty-five years and talk about you."

I called out the influence of Steven Economou, MD, a general surgeon who was also an accomplished artist. I also mentioned that I had won second place in an essay contest on, "Why the Medical Humanities are Important to Medical Education," my first foray into the topic back in 1977.

Here's a Rush photo of me standing over the shoulder of Ronald Weinstein, MD, the chair of Pathology and later pioneer in telepathology. Preparing the talk was a great opportunity to remember how influential many of the surgeons and other medical school teachers were in shaping my career.

March 22, 2022 - Medical College of Wisconsin Department of Otolaryngology and Communication Sciences

A presentation to the home team crowd. This was a tag-team talk with fellow MCW book author, K. Jane Lee, MD. She talked about the process of writing her amazing book, Catastrophic Rupture: A Memoir of Healing. We had read sections of each other's work as we were moving toward publication, and it was a delight to share a reading, compare notes, and discuss what we had learned along thw way. We talked to our residents and faculty about the process of writing and how helpful it can be to read and reflect.

March 30, 2022 - Medical College of Wisconsin Department of Surgery

I have been fortunate to work with the general surgeons and surgical specialists at MCW for four decades. My session shared some of that admiration both for their work and for many of them, both current and past. The photo shows a Surgical Grand Rounds presentation, likely from the early 1990s with one of the residents being quizzed by Robert Condon, MD the department chair.

My talk focused on the benefit of including the humanities and reflection for students and residents rotating through surgical rotations. One study showed that 90% of third-year medical students on surgical services were "stressed" or "very stressed," and they found that reflective sessions were very helpful.

April 5, 2022 - Theological Ethics in Helathcare - Mount Mary University - Milwaukee

I was invited to spend time in Professor Shawnee Daniels-Sykes' class at Mount Mary University, speaking in conversation with Sister Shawnee and

her undergraduate students about the book. The students had each been assigned one of the essays in the book to read and be able to summarize. They each had to come up with a question to ask me. The questions were wonderful, ranging from wondering about my own faith to what medical school is like to dealing with dying patients.

Also attending the class was Mary Fran Otterson, MD, an MCW colleague, colorectal surgeon, Mount Mary alumna, and friend of Professor Daniels-Sykes. Having her in the class to provide perspective as a woman, an alumna, and a surgeon was wonderful.

Friday, February 8, 2022 - Creighton University Department of Surgery - Omaha, NE

My long-time head & neck colleague and friend, William Lydiatt, MD, invited me to come to Omaha to speak to his colleagues where I was honored to be the Albano Distinguished Visiting Professor. I gave a book reading and talked about Narrative Medicine. In addition, we had a writing workshop with about forty residents, faculty, and medical students, doing close readings of "Girl," by Jamaica Kinkaid and "Midsummer Rain," by Ted Kooser.

The group was very welcoming and the writing experience excellent. The residents appeared to really work at the opportunity to reflect. I was impressed by what they shared.

The afternoon session, the Dan Lydiatt, MD Symposium on Cost-Effective Care in Head and Neck Cancer, was headlined by Chris Holsinger, MD from Stanford University. Below are some photos from the day.

Thanks to all of the groups who have invited me to share my book, my experiences, and my thoughs about the value of reflection and narrative in a surgical life.

Here's looking forward to more conversations.

#AFullnessOfUncertainSignificance #AFoUSBook #NarrativeMedicine #NarrativeSurgery

Narrative Medicine, Reflection, and Patient Care

Jamaica Kincaid’s short story, Girl, is a list of forty-eight instructions and life lessons that the narrator, a Caribbean mother, is passing along to her daughter.

…when buying cotton to make yourself a nice blouse, be sure that it doesn’t have gum in it, because that way it won’t hold up well after a wash; soak salt fish overnight before you cook it; … always eat your food in such a way that it won’t turn someone else’s stomach; on Sundays try to walk like a lady …; this is how you sweep a yard; this is how you smile to someone you don’t like too much; this is how you smile to someone you don’t like at all; …

The list allows the reader glimpses into the spoken and unspoken cultural traditions from a place far away.

Exploring fiction and the arts with students and residents

During a December Zoom-based narrative workshop, I read “Girl” aloud with the entire third-year medical school class. The students had just completed their first six months of clinical rotations, and I knew that the short story would seem to be set a million miles away from their recent lives:

…this is how you grow okra—far from the house, because okra tree harbors red ants; don’t sing benna in Sunday school; you mustn’t speak to wharf-rat boys, not even to give directions …

The students broke into small groups to talk about the story, its structure, the narrator, and outside allusions. I asked them to think about how they themselves might fit into the story, and if they felt any obligations having read the text.

Now, it was time to make it relevant. “Having experienced this story,” I said, “we will write for five minutes in its shadow. Here is your prompt: Create instructions on how to be a medical student.” What they discovered from their writing was remarkable. They made their own lists. They wrote about experiences. They went back and spoke to their pre-medical school selves. The responses were varied and heartfelt.

Earlier this fall, I taught a Narrative Medicine elective course for fourth-year medical students. We watched videos, looked at visual arts, listened to music, shared poetry, and read fiction by writers including Albert Camus, Rafael Campo, Flannery O’Connor, and Richard Selzer. On the surface, many of the pieces seemed entirely divorced from medicine yet, in every case, we found ways to respond to prompts in the shadow of the works, either in writing or other forms of creativity.

This week, I watched Gabriel Osorio Vargas’ Oscar-winning video short, Bear Story, with our otolaryngology residents. The animated film, which is neither medical nor political, is a wordless story-within-a-story about things that are left unspoken. After a conversation about the history of the piece and our initial reactions, I asked the residents to write in its shadow about a time when things might have had more than one ending. As physicians, we could all relate.

The relevance of Narrative Medicine

In each of experience, the students and the residents gamely read fiction or experienced other forms of creative expression. Although some likely viewed it merely as a pleasant distraction from lives that are constantly focused on science, clinical knowledge, and patient care, my goal was to get them to practice “close reading,” a narrative technique centered around the precepts of paying close attention, creating a representation of each story so it can be told to someone else, and being committed to an affiliation with the artist or storyteller. Narrative Medicine (as developed at Columbia University) teaches that enhancing the skills needed to “close read” a piece of literary fiction, a painting, or any other form of creativity, encourages clinicians to build the exact same skills that we exercise when we deeply engage with the stories our patients entrust to us. The more we practice, the better we get.

When I work with students, I routinely ask them whether they value writing, reflective, and narrative exercises in their medical education. The majority believe that these activities are important, yet many believe that their peers view reflective exercises as a waste of time. In other words, “I think this is really great, but I doubt my classmates do.” Our data, as we found here and here, say they significantly overestimate their peers’ negative views. In reality, most can benefit from and appreciate this type of activity.

As we work toward designing medical education for the future, we should find innovative, measurable ways to include narrative opportunities into the curriculum that build skills and encourage wellness. As one of the M3 participants wrote:

At first, I was unsure how I would feel about spending my morning writing and reflecting with students, but I found this extremely useful … I wish we had more of this placed in our curriculum.

When given the opportunity, the students had no difficulty seeing the parallels between the girl in Jamaica Kincaid’s story and their own experiences running into medicine’s “hidden curriculum.” But, until the opportunity to reflect and write arose, the changes remained hidden.

At MCW, we have several narrative- and humanities-literate colleagues whose gifts remain hidden. There are unexplored community-based humanities partnerships and opportunities. It is time to explore how best to employ the medical humanities to foster character, enhance caring, expand patient care skills, and deeply enrich the lives of our students, trainees, staff, and faculty.