‘The Other Side of the Fence’ by Michael Corbo

Medical student Michael Corbo reflects on what he’s learnt from being a patient.
I am sitting on a green chair in the waiting room. I have been sitting here for hours, but it feels like it has been days. I keep looking at the clock on the wall beside me. The room is filled with people, but all I can hear is the resounding ‘tick tock’ coming from my right side. A thousand beads of sweat start to develop on my forehead, one for every thought racing through my mind.
“Michael Corbo!” My heart stops. “The doctor is ready for you now.”
I follow the nurse’s lead to the end of the hall where we stop at Operating Room (OR) #7.
The air in the OR is cold and crisp. I get on the table and lie down with my face towards the ceiling. Cold sweat begins to drip down my forehead. It is clear that I am apprehensive and yet, none of the healthcare providers have addressed how I am feeling. My hand nervously shakes as a line is inserted into one of my veins. I take one more gasp of air before my eyes gently close and will not open again for at least thirty minutes.
This is an experience that I have been through many times. However, it is the first time that I am the patient. After such an event, it has become clear to me that no matter how minor the procedure, the thought of surgical intervention and going under general anaesthesia is enough to generate a great deal of worry.
As a patient who was evidently nervous going into surgery, the question “why didn’t any of the healthcare providers address my feelings?” was still on my mind hours after the operation. I kept trying to tell myself that this question was irrelevant since the surgery was a success. However, as time passed and perspective was gained, I realized that my concern was a legitimate one. In a profession where another human being completely places their trust in you, how can the physician provide the best care without truly understanding what the patient is experiencing?
Understandably, the thought of entering into an emotional relationship with patients can be a scary notion. However, all medical specialties should have a keen focus on developing these skills and recognizing the most appropriate time to utilize them. To only treat a patient’s physical needs is inadequate; a Holistic approach in which emotional, mental, and physical aspects are all addressed would lead to increased patient satisfaction and care. This is not a skill that comes naturally, but must be practiced and perfected.
As a future physician, I sincerely hope that more resources can be invested into teaching medical students and residents how to treat the patient like a person, instead of just an interesting case. At the end of the day, the majority of people will not remember how well you performed at your job, but rather the level of communication and hospitality that they received while they were under your care.
michael.corbo@medportal.ca

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’21st Century Medicine, Aristotle And The Church’ by Dr. Andrew R. J. Tillyard

I recently attended the funeral of the local parish priest and this led me to consider many of the similarities between what I do in medicine and the role of the ‘Parish Priest’ as well as the ‘misrepresentation’ of 21^st medicine. I work in intensive care, a setting of immense emotional stress for patients and relatives, and not infrequently for staff as well. Intensive care can appear more like the cockpit of an aeroplane – full of machines that bleep and flash as they keep patients alive. This, however, can belie the true meaning of what we do. There is an evolving mis-interpretation of what medicine is: that good medicine in the 21^st century is skill based technical wizardry, where ‘good’ doctors are people, who can diagnose, treat and cure using magnetic resonance imaging (MRI’s), gene therapy, or laser guided scalpels and the like.
I believe that what a patient wants first and foremost is a physician who is compassionate, honest and committed to their cause. Without these under-pinning attributes, their drive to find the best treatment for each of their patients will be diminished. William Osler said in 1907 that “You (physicians) are in this profession as a calling, not as a business, as a calling which exacts from you at every turn self-sacrifice, devotion, love and tenderness to your fellow-men. Once you get down to a purely business level, your influence is gone”.[1] And for ‘business level’ one could insert ‘disease or diagnosis’. The patient is just one part of the whole person just as the successful treatment is just one part of an illness journey (al-be-it a vital part). Knowing the physician is compassionate, committed and honest forms the foundation upon which the scientific wizardry starts to work. It also has a very real beneficial treatment effect (placebo). And this is where Aristotle returns to the fray of modern medicine.
Aristotle’s  Nichomachean  Ethics sets out the three stages of virtue ethics: arête (knowledge), phronesis (practical wisdom) and eudaimonia (flourishing – performing as an expert).[2] Part of knowledge is an understanding of what personal attributes (dispositions such-as compassion, humility, justice and courage which Aristotle called ‘virtues’) are required to ‘flourish’. As doctors (and I assume clergy) become more knowledgeable and experienced, the good virtues (dispositions) that make them strive to do the best for patients becomes in-grained in how one performs as a physician. Put generally, we professionals, sailors, gardeners, mothers, etc have a duty to do what we do with good intentions. And the more we do this, the better our abilities will be. Comte-Sponville has said that to flourish is an individual’s accountable task; virtue and especially that of compassion are pre-requisites and to be without them is to be ‘inhumane.’ [3] Virtue is ‘a force that has or can have an effect’: it gives the person their distinctive excellence. It is this acting well that makes a person ‘more humane’.  In Immanuel Kant’s terms, it is one of the individuals duty’s to others. [4]
An Aristotilean ‘good doctor’ or ‘good priest’ will not always make a good decision. Indeed, there is a circular argument here: it could be considered morally presumptuous to assume a consultant physician is a virtuous, or good doctor just on the basis of training or level of seniority, and therefore will always make good decisions. But, this in-part misses the point. It is the underlying virtues of a doctor that will make them reflect and study, coupled with experience and a desire to determine what is in the patients best interests, that will lead to good decisions. Put more simply, it is the underlying virtue to help that is necessary to start being of help.
As our lives become ever more technological (internet, texting and tweeting), there is a risk to three necessary elements of living well: communication, listening and understanding. There is a cliché – time heals all wounds, but I would argue based on my experience with patients and their loved ones that, providing them with understanding and a chance to voice their views, will heal those wounds more quickly. Thankfully, as technological advances allow us to preserve the heart beat of patients ever longer, the Department of Health is also starting to recognise the importance of understanding the person as a whole, as evidenced by the drive to allow patients to say what they would ideally like or not like when they come to the end of their lives (the “Preferred Priorities of Care” and “Advance Decisions” (living wills) documents that people can complete). This is first and foremost though, a role of family, friends and professionals.
References
1: Osler W. The reserves of life. St Marys Hospital Gazette. 1907; 13:95-8
2: The ethics of Aristotle: the Nichomachean ethics. (translated JAK Thompson, revised Hugh Tredennick). London, Penguin Books, 1976
3: Compte-Sponville A. A short treatise on the great virtues. London: Vintage, 2003
4: Ameriks K. ‘Immanuel Kant’ in The Cambridge Dictionary of Philosophy. Ed. R. Audi. Cambridge: Cambridge University Press 1999
Dr. Andrew R. J. Tillyard
Clinical Academic Lead for Medical Ethics and Law, Peninsula Medical School
Consultant in Intensive Care Medicine, Derriford Hospital
andrew.tillyard@pms.ac.uk

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‘Comics & Medicine: The Sequential Art of Illness’: Conference, Chicago, 9-11 June 2011

This second international interdisciplinary conference* aims explore the past, present, and possible future of comics in the context of the healthcare experience.  Programs in medical humanities have long touted the benefits of reading literature and studying visual art in the medical setting, but the use of comics in healthcare practice and education is relatively new.  The melding of text and image has much to offer all members of the healthcare team, including patients and families.  As such, a subgenre of graphic narrative known as graphic medicine is emerging as a field of interest to both scholars and creators of comics.
We are pleased to confirm two important keynote speakers: David Small, author of ‘Stitches’ and Phoebe Gloeckner, author of ‘A Child’s Life’
We invite proposals for scholarly papers (15 minutes), poster presentations, and panel discussions (60 minutes), focused on medicine and comics in any form (e.g., graphic novels, comic strips, graphic pathographies, manga, and/or web comics) on the following—and related—topics:

• graphic pathographies of illness and disability
• the use of comics in medical education
• the use of comics in patient care
• the interface of graphic medicine and other visual arts in popular
• culture
• ethical implications for using comics to educate the public
• ethical implications of patient representation in comics by
• healthcare providers
• trends in international use of comics in healthcare settings
• the role of comics in provider/patient communication
• comics as a virtual support group for patients and caregivers
• the use of comics in bioethics discussions and education

We also welcome workshops (120 minutes) by creators of comics on the process, rationale, methods, and general theories behind the use of comics to explore medical themes. These are intended to be “hands-on” interactive workshops for participants who wish to obtain particular skills with regard to the creation or teaching about comics in the medical context.
We envision this gathering as a collaboration among humanities scholars, comics scholars, comics creators, healthcare professionals, and comics enthusiasts.
300 word proposals should be submitted by Friday, 28 February 2011 to submissions@graphicmedicine.org. Proposals may be in Word, WordPerfect, or RTF formats with the following information and in this order: author(s), affiliation, email address, title of abstract, body of abstract.  Please identify your presentation preference: 1) oral presentation; 2) poster presentation; 3) panel discussion; or 4) workshop. While we cannot guarantee that presenters will receive their first choice, we will attempt to honor people’s preferences, and will acknowledge the receipt of all proposals submitted. Abstracts will be peer-reviewed by an interdisciplinary selection committee. Notification of acceptance or rejection will be completed by 14 March 2011.
This event is co-sponsored by the Medical Humanities and Bioethics Program at Northwestern University Feinberg School of Medicine, the Department of Humanities at Penn State College of Medicine, and the Science, Technology and Society Program of Penn State University, and is supported by a grant from the Charles Schulz Foundation.
*Information about the 2010 conference, “Comics and Medicine: Medical
Narrative in Graphic Novels,” in London, England can be found at
www.graphicmedicine.org.
Dr Ian Williams

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“Newspeak (PART TWO): British Art Now is doubleplusgood!” by Dr Jane R Moore

A few weeks ago I visited the new exhibition at the Saatchi Gallery with my group of 4^th year King’s College Medical Students. Visits to galleries, museums and art installations are an integral part of the ‘The Good Doctor’ Special Study Module but I hadn’t included the Saatchi Gallery before.  Modern conceptual art is challenging and I was uncertain how this visit would help in our exploration of medical matters. I need not have worried; our visit was enjoyable, reassuringly accessible and it was easy to make links to the theme of goodness in contemporary medical practice.
Newspeak Two on display in the large bright rooms at the Saatchi Gallery, King’s Road, London continues the showcase of contemporary British Art started in June 2010 with Newspeak One.  All the original exhibits, including the widely advertised Pink Cher by Scott King, have been replaced and the new collection opened at the end of October.  Charles Saatchi’s Sensation! exhibition (Royal Academy 1997) had – sensationally -  brought late 20th century British Art to public notice. This was the outing of Damian Hirst’s shark, Tracey Emin’s unmade bed, Mark Quinn’s blood sculptures, Chris Ofili’s ingenious uses of elephant dung and the Chapman Brothers doing what they do best – shocking us into a reaction.  So what would we make of Newspeak?
George Orwell coined the term newspeak in his dystopian classic Nineteen Eighty-Four[i].  This was the deliberately duplicitous politicians’  language which removed all shades of meaning from words.  For example, “think” used as both noun and verb makes the word thought superfluous so it can be abolished;  if pleasure / pain becomes  ”goodthink” any negative connotations can be dismissed.  In this way the total dominance of the State was reinforced leaving the population passive and malleable.  By calling this collection Newspeak is Saatchi mocking contemporary art?  Or is he referring to present-day “artspeak”, an artificial, pretentious, hollow and at times unintelligible discourse?  For our group this was our first link to contemporary medicine as we considered the role of  “medicspeak”.
Our guide, a postgrad art student, showed us some of her favourite pieces and gave brief descriptions.    We appreciated this guidance which allowed us to move on to our own interpretations and make links to contemporary medicine and society. On our own I think we would have been at a bit of a loss. Though a description of all we saw would not be practical here are some highlights.
Gallery 3 contained three massive, detailed and beautifully painted canvasses of men and machines by Jonathan Wateridge.  We liked Space Program 2008, a group of men posed in front of a spaceship under construction.  However on close scrutiny you could see the spaceship was a milk bottle, the launch control panel a mobile phone key pad, and the astronauts ‘spacesuits’ ordinary workmen’s overalls decorated with bits of household tat. Yet the men, in reality the artist’s friends, give the appearance of authority and confidence. We were reminded of Luke Fildes’ iconic picture The Doctor (1887).  This picture, painted at a time of increasing mistrust in the science of medicine, managed to suggest that medicine and the establishment as a whole, had the power to confront the difficulties encountered by society[ii].  In the same way we are lead to think that Wateridge’s unlikely astronauts’ competence and skill will surely lead to a successful expedition to further man’s mastery of outer space and so all is well with the modern world.
http://www.saatchi-gallery.co.uk/artists/artpages/jonathan_wateridge_space_group.htm
Anne Hardy (Gallery 5) has a series of four photomontages of ‘depopulated rooms that suggest surreal fictions’ according to the exhibition catalogue[iii]. What we saw were detailed photographs of the same space, some frames showing a clutter of carefully arranged seemingly miscellaneous objects:
http://www.saatchi-gallery.co.uk/artists/artpages/anne_hardy_cell.htm
Other frames showed an empty space with the outside crowding in;
http://www.saatchi-gallery.co.uk/artists/artpages/anne_hardy_drift.htm
We found these images claustrophobic but compelling; reminding us of both the workings of the human body with tortuous nerves and blood vessels, and of the machinery of modern medicine which cuts us off from normal communication with our patients.
In Gallery 10 The Followers, Ximena Garrido-Lecca has produced a huge reproduction of a Peruvian burial wall. Each niche containing photos, mementoes, plates of food or a bottle of beer by which the deceased were remembered by their grieving ‘followers’.  This is a beautiful exhibit, but after a short time as observers we became uncomfortable; we felt that we were intruding or showing a prurient misplaced interest in intimate details of people who had had no choice in the display and what it revealed. It was easy to make parallels to the role of the medical practitioner and our patients’ narratives.
http://www.saatchi-gallery.co.uk/artists/artpages/ximena_garrido_followers5.htm
So how do I justify this visit to the Saatchi Gallery to look at contemporary British art?  How can such activity be a valid and relevant and relevant contribution to undergraduate medical education?
Artists observe, capture and record visual images; when patients describe events, feeling, concerns, they set scenes using their own imagery; in turn, doctors listening to patients’ stories and descriptions form pictures in their own minds.  Looking at paintings and any art installations increases our observational skills and allows us an opportunity to practice the interpretation of visual images.  By engaging with the story behind the picture we try to discover our own reactions and in group discussion we have the opportunity to explore these feelings further.
Our visit to the Newspeak exhibition stimulated important discussion about important aspects of contemporary medicine which may not be encountered elsewhere in the medical curriculum. We may not have been able to understand it all the exhibits but certainly some of the pieces we looked at in the Newspeak exhibition were wonderful. We came away feeling we had risen to the challenge that modern art had presented and as a result expanded our horizons.

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Oncologist Sam Guglani wonders what medical care really means

Care infuses medicine. Well, the word ‘care’ infuses the language of medicine – Healthcare, Intensive Care, Palliative Care, Standard care, Standard of care, Best supportive care, Care Quality Commission. But what actually is medical care?Good medical care perhaps primarily describes the quality delivery of evidence-based therapeutic interventions, for example drugs, operations, scans, anaesthetics, and the organisation of services to permit these. It must also necessarily refer to the judgments around such interventions, that is to say the ethical consideration towards appropriate medicine. A skilfully performed pneumonectomy may not reflect good medical care in a patient dying from advanced lung cancer, for example. It seems reasonable then, to suggest that good medical care demands quality clinical medicine and ethical judgment. That the former requires rational thought may not come as a surprise, but the latter? In fact, contemporary ethics and moral philosophy place reason and rational thought at the core of what it is to make moral judgments and act ethically.
However, schools of ethical thought don’t always agree on what it is that constitutes the basis for moral action in medicine. For example, lying to patients may be considered to be bad because lying is bad in principle, or good if the lying perpetuates good outcomes such as hope, or bad again if the consequences, despite the good outcome of hope, generalise towards the negative, such as an erosion of trust.  Further to disagreeing on the basis for moral arbitration, the centrality of ‘reason’ may be questioned. ‘Care ethics’ gives weight, beyond rational thought, to the place of sympathy, emotional understanding and relationships in informing ethical judgments (Beauchamp and Childress 2001, p. 369)
Jonah Lehrer, in his book ‘The Decisive Moment’, describes the place of emotional understanding in morality:  ‘At its core, moral decision-making is about sympathy. We abhor violence because we know violence hurts. We treat others fairly because we know what it feels like to be treated unfairly. We reject suffering because we can imagine what it’s like to suffer.’ (Lehrer 2009, p 174) He goes on to elaborate on the evidence for emotion having a central role in ethical judgment and paints a very interesting picture in aligning often very rational thinking with clear acts of immorality. Even so, what about this, the idea of sympathetic and compassionate care in medicine?
Well, firstly, it seems as though, unlike the parameters of clinical/ technical care in medicine, compassionate care is harder to measure. Technical care is relatively easily measured and to a certain extent such data form the basis of the new outcomes framework for the NHS.  Healthcare staff in general and doctors in particular recognise this and to a certain extent aspire towards it. For patients and relatives, these data may be more opaque, unless significantly removed from the mean. As such, responsibility for judging, monitoring and delivering technically good care may be readily handed over to the profession.
Compassionate and empathetic care is harder to measure and in many respects therefore it just isn’t. Where currently is the section in our appraisal folders entitled compassion?  Doctors seem to value it much less and indeed we almost feel uncomfortable when discussing it.  Patients and families though, recognise this much more readily and indeed are generally very sensitive barometers of it.  Their assessment is probably more reliable, consistent and reproducible than any parametric measure we might use.  We all know (and can recognise ourselves when we become patients) the health worker who cares.
Such care can be a simple and empirical prompt towards good medicine, through sympathetic imagination: how would we want our family or indeed ourselves to be managed in such a situation? Of course this isn’t enough and is potentially open to abuse. But so is a version of medicine informed simply by good technical skills or good ethical judgment.
Compassionate and sympathetic care is arguably a primary prompt and governing steer for the entirety of good medical care. And it is the platform for engaging patients at times of often profound vulnerability. It might motivate finding the bed, asserting the need, chasing the results, over-booking the clinic, calling the family, developing the service, asking for opinions, clarifying all the evidence, seeking consensus, admitting the uncertainty and withdrawing the treatment. It is antithetical to hubris and necessarily connected to a proper medical professionalism, one founded upon a duty to patients rather than the rights of a privileged set.
How do we teach and foster this care? By recognising its importance – now more than ever in a resource -constrained, exponentially more technical NHS with increasing demand and possibility. By selecting students, training doctors and consultant appointments with this in mind. And, perhaps most challenging, but also most pressing, by decanting it through professional example.

References
Beauchamp, T. and Childress, J. (2001) Principles of Biomedical Ethics, Oxford, Oxford University Press
Lehrer, J. (2009) The Decisive Moment, Edinburgh, Canongate

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Off Sick; Narratives of Illness Past and Present

Scholars from the universities of Glamorgan and Cardiff are currently breaking new ground in the Medical Humanities with the Off Sick project, writes Dr Richard Marsden. This research initiative, led by Dr Martin Willis and Dr Keir Waddington, puts a new twist on the well-known concept of the ‘illness narrative’. It focuses not on the people who actually suffer from illness, but instead on those who support and care for them. In this vein the project team is currently gathering stories from carers across the South Wales area.
This is very much an interdisciplinary project, which aims to explore not only how carers construct and define their experiences through stories in the present day, but also how they did so in previous decades and centuries. Moreover, Off Sick also brings in comparative material from the literary sphere, including fictional accounts, life-writing and poetry.
The peg on which this work is hung is the encounter with ‘medical institutions’. Indeed, the very idea of the illness narrative arose partly in response to a tendency for clinicians to neglect the experiences of the patient, seeing them instead in de-personalized terms as biological problems to be solved with science. Illness narratives are often perceived as a means of reversing this trend and re-empowering the patient.
For that reason, the stories that Off Sick is particularly interested in deal with visits to hospitals and other clinical settings. However, it is the ways in which carers and family members turn their experiences of such encounters into narratives that is the real crux of this research. This emphasis on the stories of those around illness, together with its holistic and comparative approach to contemporary, historical and literary materials, is what makes Off Sick so innovative.
The project’s findings will be showcased through academic presentations and publications, and also through an exhibition (scheduled for June 2011) which is aimed not at academics but at individuals and groups whose lives have been affected by illness and who have their own stories to tell about it. In addition, Off Sick runs a lively, varied and ongoing programme of events and public talks drawing on the expertise of literary scholars, historians, social scientists and medical practitioners.
For more information on the project you can visit the Off Sick website (http://literatureandscience.research.glam.ac.uk/cissmi/offsick/), join the Off Sick Facebook group (http://www.facebook.com/pages/Off-Sick/133055340078848) or follow Off Sick on Twitter (http://twitter.com/OffSick). Alternatively please contact the project’s Research Assistant, Dr Richard Marsden, on rmarsden@glam.ac.uk.

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Medicine Unboxed 2011: Medicine and Values, Cheltenham UK 15 October 2011

Good medicine is more than a set of technical decisions and interventions involving
drugs, operations or tests. It demands more of the practitioner - professionalism,
empathetic care, moral consideration, insight, an understanding of human suffering
and necessarily, wisdom. These attributes are not always prioritised in selecting
for or training healthcare professionals, and there is little time or attention
given to their authentic development within busy working environments. Further,
there is a widening hiatus of trust, understanding and expectation between medicine
and society around what constitutes good medicine. This pressingly requires real
engagement around medicine’s role and society’s values. A purely scientific answer
will never prove sufficient here.

Medicine Unboxed is a unique project and conference programme that engages both the
public and front-line NHS staff with a view of medicine that is infused and
elaborated by the humanities. Contributors include artists, writers, the clergy,
poets, philosophers, lawyers, linguists, musicians, theatre, ethicists, academics
and doctors. The results are thought-provoking, inspiring, sometimes funny and often
moving.

Our theme this year is Medicine and Values.

We think of medicine as simply fact-based, efficient and scientifically robust.
These arbiters can become the measures of good medicine. However, medicine is
infused with judgments of value - individually for doctors and patients but also in
medical science, for society, for policy-makers and health economists. Ethics, law
and religion inform duties and rights in medicine, through principles and values.
The values that define good medicine are not always apparent or agreed upon and
there remains the potential for tension between them.

We'd like to invite you to come along to Medicine Unboxed 2011 and join us in
uncovering the values that pertain to medical care and debating the ambivalences
around the arbiters of good medicine. Our speakers this year include the Rev. John
Bell, John Carey, Lionel Shriver, Jo Shapcott, Ray Tallis, Paul Bailey, Michael
Arditti and Havi Carel.

Come to the debate - be inspired.

Sam Guglani, Consultant Clinical Oncologist.
http://medicineunboxed.us2.list-manage.com/track/click?u=040c885489432f9ea79fbd23b&id=f00835b9f4&e=1767bdcee5

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Dr Arati Bhatia describes her own humbling experience with cancer and chemotherapy

The drainage tube and the negative pressure bag were my constant companions for sixteen days. I was not always respectful of them, even bouncing them around occasionally. I had an intense sense of relief when we were finally parted. They had served their function well. The wound had healed, and there was no collection or infection. Cosmetically, it was a job well done.
Post-mastectomy the strangest sensation was the lack of it. My elbow was numb. I had been unaware of the importance of my elbow to my wellbeing. Now I am reminded every day of what has happened. The operated arm must enter the shirtsleeve or blouse before the normal one. Earlier I had never given much thought to this. Suddenly you are more aware of your own body and its vulnerability.
I had always been proud both of my physique and looks, even though I had contributed little towards then. My tailor affirmed my arrogance. In his years of tailoring experience, I was the only woman whose size had remained so constant for the better part of thirty years.
I am blessed with thick, glossy, low maintenance hair. A shampoo and a brush is all they ever needed to spring into place. Sleep or gusty winds couldn’t disturb them. Suddenly I was terrified of touching my hair, leave alone combing them. Each hair hurt, yelling its impending doom. I procured a wig made from someone else’s hair. But I hesitated to run my comb through it. It was not my hair; however, this made-to-order wig was my only escape from chemotherapy-induced baldness.
I joined work after the winter break. Medical leave for the next round of chemotherapy had to be routed through the department office, forcing me to disclose my health status to my colleagues. My friends in the department already knew I had breast cancer, and were fighting their own battle, a bit like my family. The reactions I observed in the department got me thinking.
Many of my colleagues were about the same age as my self, give or take two to three years. Also, a department dominated by women is emotional! Crying is a common phenomenon. Disclosure to two senior colleagues was accompanied by weeping and hugging, an emotion I had never encountered in the department before. Were the tears for me or for themselves — a realization of their own susceptibility? I think the latter. As the news spread, many headed for the radiology department.
There were those who stood silently, some with tears in their eyes. Others reassuringly gave me the latest outcome for this type of cancer from the literature. They had done their homework well; these were mainly postgraduate students.
A third lot – the vast majority – failed to make eye contact. Either they could not handle it, or for them I had already passed on. Strangely, one person who had fallen out with me some years ago came to make amends. This was difficult to handle. It left me confused. He is highly religious and I felt he was looking for redemption, ensuring that I did not interfere with his karma.
Although it has been two years now, and I have moved on, coping with the immediate effects of chemotherapy had a permanent humbling effect.
Dr Arati Bhatia
Professor of Pathology
University College of Medical Sciences
Delhi-95
India
aratibhatia@yahoo.co.in

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2011 International Symposium on Poetry and Medicine

I recently attended the 2nd Annual Hippocrates Poetry and Medicine Symposium, which was held at Warwick Medical School and hosted by Professor Donald Singer and Associate Professor Michael Hulse. During the day, a group of researchers and clinicians from a variety of backgrounds gathered to explore the role of poetry in the discourse of medicine, including renowned poets, Marilyn Hacker and Gwyneth Lewis.
Themes included: 
history of interactions between medicine, health and poetry; impact of health and disease on the writings of the professional poet; poetry as therapy; the nature of the body, and anatomy; the history, evolution, current and future state of medical science; the nature and experience of tests; use of poetry in health professional training, the experience of doctors, nurses and other staff in hospitals and in the community; the experience of patients, families, friends and carers in these situations; the experiences of acute and long-term illness and dying, of birth, of cure and convalescence; the patient journey; the nature and experience of treatment with herbs, chemicals and devices used in medicine.
The diversity of both the themes and the backgrounds of the presenters, and attendees, signify a very important movement in contemporary medical practice; namely, to address the experience of practicing medicine, and the humanistic elements of the doctor and patient interaction.
Our contemporary clinical settings are surrounded by an array of machines, sterility, and the attempt to reach purity through the annihilation of disease and illness. During this battle, it is all too easy to lose the identity of who we are and who we are fighting for amongst the technology and techniques we can enact to engage with pathology. Yet, when the body is inflamed, and inflicted, with the wars between health and illness, and life and death, the nature of poetry reveals itself to be fundamental to our experience of being human. And this awareness was achieved throughout the symposium, with speakers such as Professor Femi Oyebode declaring the “same skills you need to write are the same skills you need to be a good doctor”.
In parallel to descriptions of symptoms and diagnoses, poetry describes the inner states of a person, the territory immune from any form of empirical probing. A poem is, in itself, a “machine made of words” (William Carlos Williams). The words one writes have a function; they are not just ethereal images and metaphors, or, as another of the presenters, Dr Sandy Goldbeck-Wood said, “poetry embodies the indescribable – poetry has a physical element; it encodes suffering”.
Such communication is vital for Medicine’s endeavor; to heal, the wound must be identified.
The identification of wounds in individuals and communities are both bodies of symptoms, exuberating into the environment which contains our living presence. This was illustrated most poignantly by the work of Dr Sorcha Gunne, who has analysed women’s poetry about HIV/Aids in South Africa.
Through a person’s narrative, a discourse forms, and in medicine it is one that serves the doctor and patient relationship.
Fiona Hamilton, from the writing organization, LAPIDUS, describes narratives as tools that “allow for confrontation between doctors and patients without jeopardizing the emotional disassociation required”. Poetry was also demonstrated to be an indiscriminate force; physical boundaries and limitations are transcended. Age, gender, culture, ethnicity, are irrelevant. Speakers Dr Simon Opher and Karen Hayes presented an exceptional project, working with elderly patients affected by dementia to reconstruct memory through metaphor – one of the last language functions to deteriorate in Alzheimer’s disease – and return to them their stories, because “stories are the architecture of who we are”.
On the other side of the spectrum – and world – Dr Renee Liang of New Zealand, showed the success of community initiatives that encourage under-privileged young people to release their frustrations and anger – as well as pride and joy – through poetry, and the positive impact that this has on their health.
The poem, though, is also for the healer. Nurse, Sue Spencer, described techniques for teaching nurses in medical education the value of words for the “(he)art of nursing”.
It also became apparent that medicine’s healing hands write in arenas other than the surgery, the hospital, the care home. Reflection on our human condition; its fragility and its robustness is part of the world we embody, and Rogan Wolf’s presentation “Poems in Public on the Frontier” personified this notion.
Finally, towards the end of a day characterized by moments of epiphany and realization of connections between the body and the mind, medicine and the human condition, there was a very special announcement. The symposium also marked the occasion to announce the winners of the annual International Hippocrates Poetry prize:
The winners of the open international awards were: ▪ 1st Prize: Michael Henry (Cheltenham, England) – The Patella Hammer. ▪ 2nd Prize: Cheryl Moskowitz (London, England) – Correspondence with the Care Home. ▪ 3rd Prize: Johanna Emeney (Albany, New Zealand) – Radiologist’s Report.
The winners of the NHS category awards were: ▪ 1st Prize: Paula Cunningham (Belfast, N Ireland) – The Chief Radiographer Considers. ▪ 2nd Prize: Wendy French (London, England) – The Doctor’s Wife. 3rd Prize: Dr Sandy Goldbeck-Wood (Cambridge, England) – Inappropriate ADH.

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Singing for the Motherland, Singing Medicine’s Cure.

A recent evening attending a live Greek music ensemble revealed some important characteristics about human nature; and significances for medicinal practices about the interconnectedness of our human condition with the Land on which we are born, live, love, suffer, and die.
The words of the song bore no meaning until my friend kindly whispered its translation, and then, suddenly I could understand the deep, lonely sentiments conveyed by the singer’s gaze and harmonies.
The song spoke of the distress of having to migrate from Greece during the 1960’s, forging his adoration to the land from where he was borne with the endearing reference of “Mother-land”.
For so much of medical practice, the gaze is on the life as it is now. We often, carelessly, forget that the origins of where we once were endured the beginning of our story, and carved the paths within our bodies towards both our health and our illness.
Our Land, whether it be contained within the crevices of a mountain valley, a village, or the open sprawl of urban streets, the rolling sands in the deserts or a land instilled in the echoes of the ocean, is the physical birth of our life and nurtures us in such ways akin to Motherhood.
To hear the longing for one’s “Motherland” is simply a cry; a loss of our foundations. The psychoanalyst, Sigmund Freud, argued that we are always in a state of dialectic turmoil and change because we are trying to return to the mother-child illusion; a state of unification between our internal and external worlds, of peace.
Modern medicine focuses on achieving unification by neutralizing the disparity between health and illness. But, what if our balance for peace reaches much deeper states, in the sense that our internal, physiological dispositions are fundamentally connected to our first sight of the world? What can this say for those who are displaced from their lands? After all, the word “diaspora” originates from the Greek word διασπορά; meaning, to scatter or disperse from one’s ancestral homeland.
How can medicine accompany the person by the bedside in a manner of compassion and relation that resonates the land they long to feel? On reflection to this question, I recalled Lévinas’s conception of compassion in “Useless Suffering” (1982). Lévinas argues for compassion in an empathetic sense: you cannot suffer in my place, yet you can suffer together with me by directing your sympathy into my position and so my suffering can gain a meaning that is new and rescued from the depths of one’s tunnelling despair.
This transformation in suffering is the fortification for the role of the humanities in medicine; creating an expression between the empirical and the existential.
The Greek who sang for their “Motherland” illustrated that medicine crosses boundaries that are sometimes tangible and sometimes invisible.
At times, medical insight can locate the crossover between health and an illness, whilst at other times, pain is suffering without symptoms, without origins. This means that life and death are not only processes in the clinical setting and whilst medicine explores with scrutiny the origin of pain, pain can also result from a loss of origin. When a person experiences the death of origin, it negates the possibility of recreating the idealism of their birth, nurtured by their “Motherland”.
Such loss of the meaning of one’s own birth through this way is an alienation from immortality; a person must recognise that it is their death that will become actual instead.
In a sense, we may all experience alienation in the advent of states of disease, taking us away from the life we once knew. Thus, alienation can be encountered both when one leaves the boundaries of their land, and also boundaries within their body. Patients are, in effect, diasporas; lost, and astray amid uncertainty and discomfort away from their health.
Finding ways to recreate our familiarity – our famil(y)-ity – is an important and integral part of practicing medicine.
A song for our “Motherland”, the heart’s embrace to its original cradle, is also the song of medicine, seeking the cure to resurrect the vitality of the heart’s original beat.

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The Drama of Medicine-All the Ward’s a Stage: 8th Annual AMH Conference, 11-13 July 2011, University of Leicester,UK

Plans for the 8th annual conference of the Association for Medical Humanities are now well underway, with an exciting line up of papers, workshops and plenary speakers. Celebrated poet and doctor Dannie Abse will be running a session entitled Poet in a White Coat; Jed Mercurio, author of Bodies and creator of the TV series Cardiac Arrest, will speak on the Doctor as Antihero;  Professor Laurie Maguire, from Magdalen College Oxford, will explore Shakespeare’s guide to health and illness; and Matthew Alexander from North Carolina, a leading authority on the use of cinema in medical education, will begin the conference with a workshop and plenary address on this subject.
Other workshops cover medicine in comics, architecture in health and photography, and a video of experiences in a heart and lung transplant unit.  There are nearly 50 short papers exploring the conference themes of Dramatis personae (people), Plays and Plots (stories), and The Stage (settings and environments).
Delegates are attending from throughout the UK ,as well as from the Republic of Ireland, Canada, the USA and Sri Lanka.  Sign up soon to join them!
To book either a full residential package or a day delegate spot, go on-line at www.shop.le.ac.uk For any queries contact the conference team at amhconf@le.ac.uk
Whether you’re a seasoned AMH member, or simply someone who wants to find out more about medical humanities, this is sure to be an enjoyable and thought provoking way to spend a couple of days.

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Who needs their hands? Reflections on being a patient

I have a confession to make: up until a month ago I was a surgical virgin, never having experienced anything more intrusive than the extraction of four unwanted wisdom teeth. Which meant that when I signed up to have operations on both my hands I didn’t have a clue what was in store, but comforted myself with what I’d always told patients: that it was just a small operation, done under local anaesthetic and over in less than twenty minutes, so there was nothing very much to be concerned about.
What I didn’t know was quite how frustrating it is to have your hands out of action. There are irritating things, like not being able to cut up your own food; logistically challenging things, like getting out of a bath; and downright undignified things, of which I’ll say no more, other than acknowledging that access to a bidet can come in handy.
None of these things will, thankfully, last too long in my case, but this minor foray into the post-operative world has at least got me thinking. Thinking about what it must be like to be old, when the problems I’ve encountered, oh so briefly, are a constant given, and thinking too about how easily and thoughtlessly doctors, nurses, and other health professionals use the word just in everyday conversation with patients. As in ‘you  just need a scan /some blood tests/ to see a specialist, and it’ll just hurt a little/ take a couple of weeks/ be a matter of time’. As if patients were somehow too stupid to realise that tests are ordered and referrals made precisely because something rather worrying might be going on, and as if coping with all but the most minor of illnesses were ever anything other than hard, and sometimes even life changing, work.
Well just to let you know I’m doing fine now. Thanks to an excellent surgeon, the judicious use of a few painkillers, and the fact that unlike many of the people for whom cutting up their food, getting out of the bath, and wiping their own bottom simply isn’t an option, I’ve had more than my fair share of helpers, plus access to all the necessary bathroom fixtures and fittings. It’s not a lot of operating room experience I’ll admit, more of a first date really. But enough to make me appreciate just how fortunate I am, and to make me determined never to use the word just again, or at least not in vain.

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