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Articles    H2'ed 2/23/12

Medical Writing: the Healing Power of Narrative

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Today begins my 2012 journey to Australia for Culture Camp with the Gippsland and East Gippsland Aboriginal Cooperative.   We continue our mission to assist them to incorporate more of their culture and heritage into their health care.   Particularly, we hope to midwife a process of their discovering their own ways instead of just grafting onto their world the practices of the people from the Northern Territories who never lost their ceremonies and their language.   However, Gippsland and East Gippsland are very different from the North.   They are the farthest Southeast tip of Australia.   Only the island of Tasmania lies any further East.   They are a lake, ocean, and woodland people from a temperate climate where snow occurs in the winter in the high mountains.   They are not people of the tropics.   Their culture and language (Gunnai/Kernai) is different from those of the Northern Territories.   Through a convergence of our delegation of Native Americans and of those from the Northern Territories and of those from Gippsland and East Gippsland, perhaps something magical will occur.

Changes have occurred in our party.   My colleague, Rocky Crocker, is still coming.   He is a family physician who teaches in the Center for Integrative Medicine at the University of Arizona -- Andy Weil's program.   He is also the President of our Board for the Coyote Institute for Studies of Change and Transformation, based in Brattleboro, Vermont.   Rocky is Choctaw from Mississippi and talks like a real Southern gentleman.   We were also going to bring two Lakota colleagues from South Dakota, but the woman had to have surgery and also couldn't come.      Barbara Mainguy, however, could not come.   She has come each year for the past three years.   We are high over the Western New Mexico desert in a United Airlines flight from Albuquerque to Los Angeles.   So Rocky and I will carry on for everyone.

Beneath us are clouds and desert.   No snow.   The land is arid and dry -- so opposite of our home in Vermont.   Melbourne will be in the height of summer, like the latter half of July in the United States.   I've never been there in summer but I'm told that temperatures can top 40 degrees, though still not as hot as Tucson.   My hottest day ever was +53 degrees one summer in Phoenix where we fried eggs on the car hood just because we could and mercifully spent most of the day in the swimming pool.   I can't even remember why I was there anymore, but I was.

We are coming from the Creativity and Madness Conference in Santa Fe, New Mexico.   My talk was physician writers: the healing power of Narrative.   Besides a marvelous Saturday night dinner, we spent most of our time preparing this talk.   Our only other activities consisted of lunch with our friend Marga and her daughter.   Marga is an amazing fitness expert and filmmaker who is currently unemployed thanks to the vicissitudes and foibles of St. Vincent Hospital in Santa Fe.   She had been working there as a patient's complaints manager, but most of her department was "retired".   I wondered with her who the hospital would get to talk the angry patients out of suing, since that had been her primary task.   We wondered if the malpractice insurance premiums were perhaps less expensive than the salaries of people to prevent malpractice actions.   We didn't know.

We saw our friend, Amy Stein, who does a marvelous workshop for physicians and other health practitioners on how to draw a self-portrait.   Amy has published a paper on her work in the Permanente Journal, a medical publication.   It can be accessed at no charge by typing into google's search engine, "Amy Stein Permanente Journal self-portrait".  


In a beautiful place like Santa Fe, it's important to remind them that other places have beauty, also.   We began with a quote from the physician, Anton Chekov, who said, "'Medicine is my lawful wife; literature is my mistress.'' I quipped to the audience, by the time we're done, "I hope you'll agree that Chekov should have said, as Dr. Tom Janisse (Editor of The Permanente Journal) said, "Medicine is storytelling; storytelling is medicine."   Writing about our patients brings out the huge amount that is left unsaid in the encounter between physician and patient and physician and world.   Writing allows us to be more than a clinical voice.   It not only humanizes the patient, but also the physician.   Current availability of media and access to ways of creating text is a revolution in medicine, allowing us now to write our clinical histories (stories) with our patients and allowing patients to edit and re-write those stories so that a rich, life-capturing document can emerge from the clinical encounter.


Writing also allows us to manage the difficulties of medical practice. Writing the case story gives us more perspectives and awareness than we had before.   Helping the patient to write his/her story reveals details and clarity never present before.   It is also therapeutic (aka healing) for the person telling the story.   I mentioned a 1999 study in the Journal of the American Medical Association in which writing about traumatic experiences helped people to make additional improvement over optimal medical management for both asthma and rheumatoid arthritis.   For these people, storytelling is medicine.   Engaging in this storying process also facilitates a more ethical and socially just relationship with patients because of the equalization of power that it entails and the respect the hearing people's stories creates.


Then I made a humorous "black box warning" like the FDA does for drugs.   James Gates Percival, an early 19th-century physician poet from Connecticut wrote:


       "If pleasure meet my ever-weeping eye,
I see a demon lurking 'neath its flow'rs;
The smile of joy but wakes the heavy sigh,
And seems as sad as when the tempest low'rs"


Diane Cox of the New York Times wrote that "Dr. Percival spent most of his life rejecting medicine for writing, then rejecting writing for medicine, all interspersed with nervous breakdowns and suicide attempts."    So apparently writing doesn't work for everyone, though we could make the counter-argument that perhaps Dr. Percival would have succeeded at suicide had he not had poetry as an outlet.


It's all in how you see the road: as leading to the bleak, horrors of winter, or toward the joys of another season's passage.   Writing helps us get clear on that.

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Lewis Mehl-Madrona graduated from Stanford University School of Medicine and completed residencies in family medicine and in psychiatry at the University of Vermont. He is the author of Coyote Medicine, Coyote Healing, Coyote Wisdom, and (more...)
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