Seminar: Clinical Humanities & the Healing Arts

Dr. Marin GillisProfessor, Medicine, Family Medicine & Community Health

Chief, Division of Ethics, Humanities & the ArtsHerbert Wertheim College of Medicine

Florida International UniversityMiami, Fl

Narrative Medicine

a way of educating physicians, nurses and other providers that uses storytelling (and active listening) to emphasize the humanity of patient and provider, which, according to narrative medicine pioneer Rita Charon, will enable physician to practice medicine with empathy, reflection, professionalism, and trustworthiness.

Three Components of Narrative Medicine

ATTENTION. Giving the patient your entire attention; attending to the patient; learning to be a better listener to patient stories. REPRESENTATION. Narrative Medicine encourages doctors and patients to write to make meaning of their experience. Writing leads to empathy and investment, the work of understanding. (Other forms of reflection, such as visual art or conversation with a friend or mentor, can accomplish the same task.)

AFFILIATION. The tasks of attention and representation lead to a deeper connection a) to one’s own experience and b) to the other person in the caregiving relationship. Physicians become more invested in their patients’ welfare and more willing to advocate for them

Good Stories

-incorporate both sensory details and descriptions of the teller’s feelings--what specific details in this person’s story were transformative for them, and why?--how did behavior or beliefs change and how will this experience shape future behavior?

Isaac was 14, the only child of older parents. At 12, he was diagnosed with an aggressive form of cancer that was wrapped around his spine at the base of his brain. After a year of chemotherapy and radiation treatments, which left Isaac weak and sick, the cancer was not diminished in any way.

At 13, surgery was performed to remove as much of the tumor as possible, which now was wrapped so tightly around his spine that it was affecting his limbs and causing great pain. The surgeons were unable to remove all of the tumor. Within a few months, the tumor grew so much that Isaac lost the use of his left arm and could no longer walk unassisted. Oncologists at his hospital told Isaac’s parents that, medically, there was nothing more to do; they said Isaac had, at best, a few months to live. The parents refused to share this information with Isaac. A palliative care team was brought in to assist the family.

Isaac asked the palliative care physician if he could see the most recent CT scans of his tumor. His mother adamantly insisted he shouldn’t see them. Nonetheless, the palliative care physician arranged for him to see the scans and the palliative care team arranged for his beloved friend and neighbor and her also beloved dog to be with Isaac as he viewed the scans.

With the dog on his lap, the neighbor at his side, and his parents and the palliative care team present, in a private conference room at his hospital, Isaac listened intently as the palliative care physician carefully showed and explained the CT scans to Isaac. Isaac asked if more chemotherapy or radiation would help.The doctor explained that these treatments had been unable to stop the tumor’s growth. Isaac asked If more surgery could be done to remove it. The physician explained that the tumor was too deeply connected to the spine to be removed. For a few minutes, Isaac sat quietly with an inward gaze. Then he asked, “So what do we do now?”

The physician answered that now Isaac should spend time deciding what he most wanted to do in his life and find ways to do them. Within the next few days, Isaac decided he wanted to go home, to spend time with his neighbor and her dog, to eat a favorite meal, to finish a poem he’d been writing before this hospitalization, and to tell a girl in his class that he loved her. He wondered if she would kiss him just once. He wondered what beer tasted like and asked his Dad if he could try one when he got home.

Within two days of going home, Isaac was convinced by his parents to go to another children’s hospital where they begged for treatment for him. He was enrolled in a toxicity study, a drug trial designed to test dosage limits for an experimental treatment. He died in hospital two weeks later.

Poetry and Medicine

• Poetry is communication concentrated• A few words speak volumes.• Concise communication is also a key part of

medical practice• Patients often bring their pains concealed in

metaphor and allusion too

Poetry and Medicine• Doctor Poets• Poems about medicine• Poems about health• Poems about disease• Poetry competitions e.g. UCL/Yale annual prize• Poetry societies e.g. Hippocrates Initiative for

Poetry and Medicine • Poetry as therapy • Anthologies for medics, e.g. Tools of the Trade• Poetry in bioethics education

After the arc of ECTand the blunt concussion of pills, they gave him lithium to cling to- the psychiatrist's stone.A metal that floats on water, must be kept in kerosene,can be drawn into a wire.(He who had jumped into the harbour,burnt his hair off,been caught hanging from the light)He'd heard it was once usedto make hydrogen bombs,but now was a coolant for nuclear reactors,so he broke out of hospital barefootand walked ten miles to meet me in the snow.

Lithium by Robin Robertson