Wednesday, May 8, 2019

Medical Practice

Image result for icuEnvironmental & Science Education
Edward Hessler

I recently read Intern: A Doctor's Initiation by Sandeep Jauhar which focuses on the first year of medical residency, a year noted for its brutal and inhumane schedule. Jauhar attended medical school directly following the completion of a Ph.D. in theoretical physics, in fact he missed his first day of class, a result of defending his thesis. Upon completion of his third year of medical school he started his internship. 

Jauhar made the career switch for several reasons, one of them was a desire to work in a more humane profession.  During his residency he became a critic/commentator of medicine, at first writing on the nature of internships and then more broadly about the practice of medicine. He continues to write for the New York Times, now as a practicing cardiologist.

A column by an internal medicine resident, Colleen M. Farrell (Washington Post) reminded me Jauher's book which is a wonderful read.  Both Jauhar and Farrell have a deep concern about patient care, especially the  relationship between patient and physician.

Farrell describes her first experience in an Intensive Care Unit (ICU). She was still a medical student, there to learn about lung physiology and lung ventilators. She had never seen a person in this condition. Her first reaction was wondering whether she should pray. Then she was jolted from her thoughts by a basic question from her medical school professor about lung physiology but found she "couldn't reconcile this academic discussion with the existence of the man in the bed." Could I cope "working in an ICU?"

Farrell was assigned to an ICU during her internship and in her essay she describes several wrenching cases. "I stumbled home from those long shifts (27 hours), exhausted to delirium. I would crawl in bed next to my husband, climb under his arm and sob. 'Please don't die,' I'd say...."

After her ICU assignment, Farrell read some poetry by Mary Oliver. One poem, The Rabbit, allowed her to see "my patients: bleeding, moaning, gasping. I pictured what once was, and what was lost. The poem helped me to accept what I didn't want to be true: that death as painful as it is, has its place in nature."

Farrell returned to the ICU, this time as a resident, responsible for a team of medical student interns. By then she had become more interested in the machine. and lung physiology. During one round, "I decided that the ventilator could wait and I would teach them something else. I gave each student a copy of the poem Intensive Care by Jane O. Wayne. ... I asked the students if the poem related at all to their experience in the ICU."  That experience "provided an opening, a permission slip to name the grief we experience vicariously and the helplessness we feel when medicine has reached its limits."

"Bringing poetry to the ICU," Dr. Farrell "discovered, is one way to the heart of things."  

Dr. Farrell, like Dr. Jauhar, is a physician-writer. She has a web page with a biography (she intends to become a pulmonary and critical care physician), a list of published columns, and information about Medical Humanities Chat, a Twitter-based discussion of poetry and prose "with a mission of fostering reflection, and communication in health care."

Of course, poetry and prose have a place in medicine, one that has been practiced for a decade or two. See, for example, the Bellevue Literary Review. The BLR is published by NYU Langone Medical Cener "as part of the Department of Medicine's thriving Division of Medical Humanities." Dr. Farrell is doing her residency at the NYU center.

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