Tag Archives: doctors

Using Patient Stories To Mentally Survive As A COVID-19 Clinician

Dr. Christopher Travis, an intern in obstetrics-gynecology, has cared for patients with COVID-19 and performed surgery on women suspected of having the coronavirus. But the patient who arrived for a routine prenatal visit in two masks and gloves had a problem that wasn’t physiological.

“She told me, ‘I’m terrified I’m going to get this virus that’s spreading all over the world,’” and worried it would hurt her baby, he said of the March encounter.

Travis, who practices at the Los Angeles County + University of Southern California Medical Center, told the woman he knew she was scared and tried to assure her she was safe and could trust him.

Asking many questions and carefully listening to the answers, Travis was exercising the craft of narrative medicine, a discipline in which clinicians use the principles of art and literature to better understand and incorporate patients’ stories into their practices.

“How do we do that really difficult work during the pandemic without it consuming us so we can come out ‘whole’ on the other end?” Travis said. Narrative medicine, which he studied at Columbia University, has helped him be aware of his own feelings, reflect more before reacting, and view challenging situations calmly, he said.

The first graduate program in narrative medicine was created at Columbia University in 2009 by Dr. Rita Charon, and the practice has gained wide influence since, as evidenced by the dozens of narrative medicine essays published in the Journal of the American Medical Association and its sister journals.

Learning to be storytellers also helps clinicians communicate better with non-professionals, said writer and geriatrician Dr. Louise Aronson, who directs the medical humanities program at the University of California-San Francisco. It may be useful to reassure patients — or to motivate them to follow public health recommendations. “Tell them a story about having to intubate a previously healthy 22-year-old who’s going to die and leave behind his first child and new wife, and then you have their attention.”

“At the same time, telling that story can help the health professional process their own trauma and get the support they need to keep going,” she said.

Teaching Storytelling To Doctors

This fall, Keck School of Medicine of USC will offer the country’s second master’s program in narrative medicine, and the subject also will be part of the curriculum in the new Kaiser Permanente Bernard J. Tyson School of Medicine in Pasadena, which opens its doors July 27 with its first class of 48 students. (KHN, which produces California Healthline, is not affiliated with Kaiser Permanente.)

Narrative medicine trains physicians to care about patients’ singular, lived experiences — how illness is really affecting them, said Dr. Deepthiman Gowda, assistant dean for medical education at the new Kaiser Permanente school. The training may entail a close group reading of creative works such as poetry or literature, or watching dance or a film, or listening to music.

He said there’s also “real, intrinsic value” for patients because a doctor isn’t only being trained to care about the body and medications.

“Literature in its nature is a dive into the experience of living — the triumphs, the joys, the suffering, the anxieties, the tragedies, the confusions, the guilt, the ecstasies of being human, of being alive,” Gowda said. “This is the training our students need if they wish to care for persons and not diseases.”

Dr. Andre Lijoi, a geriatrician at WellSpan York Hospital in Pennsylvania, recently led a virtual session for 20 front-line nurse practitioners who work in nursing homes. Two volunteers recited Mary Oliver’s 1986 poem “Wild Geese,” which reads, “Tell me about despair, yours, and I will tell you mine. Meanwhile the world goes on.”

Sharing the poet’s words helped the nurses relieve their pent-up tensions, enabling them to express their feelings about life and work under COVID-19, Lijoi said.

One participant wrote, “As the world goes on around me I mourn seeing my aging parents, planning my daughter’s wedding, and missing my great niece’s baptism. I wonder, when will life be ‘normal’ again?”

Processing Fear To Provide Better Care

Dr. Naomi Rosenberg, an emergency room physician at Temple University Hospital in Philadelphia, studied narrative medicine at Columbia and teaches it at Temple’s Lewis Katz School of Medicine. The discipline helps her “metabolize” what she takes in while caring for COVID-19 patients, including the fear that comes with having to enter patients’ rooms alone in protective gear, she said.

The training helped her counsel a worried woman who couldn’t visit her sister because the hospital, like others around the country, wasn’t allowing relatives to visit COVID-19-infected patients.

“I’d read stories of Baldwin, Hemingway and Steinbeck about what it feels like to be afraid for someone you love, and recalling those helped me communicate with her with more clarity and compassion,” Rosenberg said. (After a four-day crisis, the sister recovered.)

Dr. Pamela Schaff (right) discusses narrative medicine in the Hoyt Gallery at the Keck School of Medicine of the University of Southern California, as Chioma Moneme, a student in the class of 2020, looks on. (Credit: Chris Shinn)

Close readings can also help students understand the various ways metaphor is used in the medical profession, for good or ill, said Dr. Pamela Schaff, who directs the Keck School’s new master’s program in narrative medicine.

Recently, Schaff led third-year medical students through a critical examination of a journal article that described medicine as a battlefield. The analysis helped student Andrew Tran understand that describing physicians as “warriors” could “promote unrealistic expectations and even depersonalization of us as human beings,” he said.

Something similar happens in the militarized language used to describe cancer, he added: “We say, ‘You’ve got to fight,’ which implies that if you die, you’re somehow a failure.”

In the real world, doctors are often focused narrowly, devoting most of their attention to a patient’s chief complaint. They listen to patients on average for only 11 seconds before interrupting them, according to a 2018 study in the Journal of General Internal Medicine. Narrative medicine seeks to change that.

While listening more carefully may add one more item to a physician’s lengthy “to-do” list, it could also save time in the end, Schaff said.

“If we train physicians to listen well, for metaphor, subtext and more, they can absorb and act on their patients’ stories even if they have limited time,” she said. “Also, we physicians must harness our narrative competence to demand changes in the health care system. Health systems should not mandate 10-minute encounters.”

Telling The Patient’s Whole Story

In practice, narrative medicine has diverse applications. Modern electronic health records, with their templates and prefilled sections, can hamper a doctor’s ability to create meaningful notes, Gowda said. But doctors can counter that by writing notes in language that makes the patient’s struggles come alive, he said.

The school’s curriculum will incorporate a different patient story each week to frame students’ learning. “Instead of, ‘This week, you will learn about stomach cancer,’ we say, ‘This week, we want you to meet Mr. Cardenas,’” Gowda said. “We learn about who he is, his family, his situation, his symptoms, his concerns. We want students to connect medical knowledge with the complexity and sometimes messiness of people’s stories and contexts.”

In preparation for the school’s opening, Gowda and a colleague have been running Friday lunchtime mindfulness and narrative medicine sessions for faculty and staff.

The meetings might include a collective, silent examination of a piece of art, followed by a discussion and shared feelings, said Dr. Marla Law Abrolat, a Permanente Medicine pediatrician in San Bernardino, California, and a faculty director at the new school.

“Young people come to medicine with bright eyes and want to help, then a traditional medical education beats that out of them,” Abrolat said. “We want them to remember patients’ stories that will always be a part of who they are when they leave here.”

This story was produced by Kaiser Health News, an editorially independent program of the Kaiser Family Foundation.

We Are as Strong as Our Weakest Link

Coronavirus has overtaken how people are living their lives and is now controlling their psyche – as it should.

Reaction has ranged from indifference to paranoia. On one end of the spectrum, reckless students from University of Austin chartered a plane and flew to Mexico for spring break. 44 of them contracted coronavirus. On the other, fake news circulates, conspiracy theories go viral on WhatsApp, and people self-medicate with chloroquine, leading to paranoia.

What is fact and what is fiction?

Ethnic Media Services video briefing on Coronavirus

Ethnic Media Services held a video briefing last Friday, March 27th, with a panel of medical health professionals and advocates who are on the forefront of coronavirus research, work, and policy. The panelists addressed current information about the virus, safety measures, and effects on marginalized communities.

Dr. Daniel Turner-Lloveras, Harbor UCLA Medical Center, and Dr. Rishi Manchanda, Health Begins, spoke about overlooked populations and how their health will actually determine the efficacy of COVID-19. Turner-Lloveras pressed that we need to ensure access to public health for those that are undocumented or without health insurance. 43% of undocumented immigrants are without health insurance and are high risk populations if they contract the virus. 

Additionally, the pandemic has the potential “to disproportionately affect communities of color and immigrants,” Dr. Manchanda confirmed. He expanded that the reason for this is that these populations are at a “greater risk for exposure, have limited access to testing, and have severe complications.”

Dr. Rishi Manchanda briefing community media outlets

Many frontline staff for essential services belong to such communities and are at a higher risk of exposure because of their contact with the public. People on the frontline are unable to take time off due to the nature of their job and their dependency on the income; many continue to work while sick. Infection can spread from work to home and into these communities due to the density of housing.

Once exposed, vulnerable populations have limited access to testing for a multitude of reasons – fear of the healthcare system, lack of health insurance, inability to communicate their needs, and underlying racism. 

Infection from this virus can cause complications leading to chronic illness. The risk of developing chronic illness is higher for communities of color. Research shows that African American, Latinx, and Asian Americans have an increased probability of having chronic illness, over white populations; “Asian Americans, Native Hawaiians, and Pacific Islanders are at twice the risk of developing diabetes than the population overall.”

The nascence of a pandemic brings with it a pressing need to address the gaps within the structural framework of the public health system in America. If we are unable to effectively help disenfranchised communities, then we are ineffective in controlling the spread of the virus. 

“By caring for others, you’re caring for yourself,” Dr. Turner-Lloveras urges. 

Public health is not an economic drain or a privilege, it is a right. Dialogue around healthcare has long forgotten the systemic racism embedded in it; the wealth gap limits the accessibility to health care or good health care. NAACP studies have found connections between coronavirus and negative impacts on communities of color. 

But racism has moved beyond just health…

Asians and Asian Americans are experiencing racism at higher rates. Manju Kulkarni, Executive Director of Asian Pacific Policy and Planning Council, recounted a story of a child experiencing verbal and physical assault for being of Asian descent at a school in LA. Since then there have been around 100 reported cases a day of hate towards AAPIs on public transit, grocery stores, pharmacies. Kulkarni and her team at A3PCON are doing everything in their power to legislate and educate.

That said, it is our social responsibility to stay informed and updated. “Bad information is deadly,” states Dr. Tung Nguyen, University of California, San Francisco, as he gives quick rundown of what is known about COVID-19 thus far:

  • Currently there is no known vaccine or immunity from COVID-19. 
  • Vaccines are 12-18 months out, if the vaccine was approved for phase 1 testing today.
  • COVID-19 has exponential spread; if there are 200,000 cases this week, there will be 400,00 cases next week, 1 million cases the next week, and 4 million cases by the end of the month.
  • COVID-19 is an infection that leads to sepsis and those with sepsis require ventilators; this has led to a national shortage of ventilators.
  • There is a 1.5% – 4.5% death rate from COVID-19.

Information to keep you safe:

  • Have the healthiest person leave the house to get essentials.
  • Have a room to disinfect in before entering primary areas of the house.
  • COVID-19 is in the air for 3-6 hours, lasts 24 hours on cardboard, and on steel and metal for 72 hours.
  • Clean commonly touched objects – faucets, handles – with disinfectant.

If you are sick, call your hospital or provider in advance. Hospital resources are currently limited and telehealth measures have been put in place to assess patients from a distance. You can find more on the CDC website

Dr. Tung Nguyen and Dr. Daniel Turner-Lloveras, both gave one big takeaway – the best thing one can do during this pandemic is STAY AT HOME

Abide by the shelter in place regulations and continue to keep the dialogue about the pandemic open. The coronavirus pandemic has reminded us of the need for awareness, the importance of early containment, and the accessibility of health care to colored communities/immigrants. 

Srishti Prabha is the current Assistant Editor at India Currents and has worked in low income/affordable housing as an advocate for children, women and people of color. She is passionate about diversifying spaces, preserving culture, and removing barriers to equity.

A Tribute

A Tribute 

Your eyes all tired and red 

for you haven’t slept in days.

You work all hours, day and night

Your cabin now a triage

you have no place to even sit 

and rest your feet a bit.

The scrubs you use are now 

to be reused, for patients

come in dozens by the minute. 

No time to sip coffee, tea, or even water,

you don’t recall when you last ate! 

No momentary pause

you are on call all day.

You leave your children, husband, wife, 

mom, dad, brother, sister,

without a hug or a kiss, 

so they stay safe.

No time to even worry 

if and when you will see them next.

No bathroom breaks, or calls home 

to say, you are safe.

The fears, the tears, and

the choke you hold within 

never shown or shared.

With no classes taught,

or time to prepare, 

no proper equipment, 

or protective gear,

and resources so scarce,

you were just thrown 

in the frontlines 

of this Pandemic,

and expected to do your best

without thinking of your own life 

or that of your family.

******

Thank you seems so small a word, for no amount of gratitude will ever suffice for all the doctors, the nurses, the first responders, the hospital staff, and to all those who are working so selflessly and tirelessly to save lives. How terribly wrong and ungrateful it will be of us to not listen and not cooperate, and to keep expecting more of their selflessness and sacrifice than what they are already giving. The least we can do, is to stay home with our families, so they can come home to theirs! 

Anita R Mohan is a poet and Freelance writer from Fairfax, Virginia.