Friday, July 25, 2008
Score One for Narrative Medicine!
I recently got some nice news from my friend Marin Gillis, who's the Director of Medical Ethics and Humanities at our medical school, and who's been a steadfast champion both of narrative medicine and of my work with it. She was the person who asked me to teach a class on narrative medicine as part of the third-year Clinical Reasoning in Medicine course.
Some of the medical students are more than a little skeptical about this, for obvious reasons. They have gobs of hard science to learn, and they aren't getting enough sleep, and many of them are scientists by inclination as well as training. In this setting, narrative medicine, and other work in the humanities, often feels fluffy and extraneous. Although the students have always been polite to me and done the work I asked of them -- often very well -- there's also been some unspoken resistance. I could often sense the "this is bs" current in the room, although no one ever said it aloud. (I should add that this mindset isn't limited to medical students, and is often much stronger in freshman comp classes, where students can be much less polite about it!) But as a med school faculty member told me, "They'll get in five years, you know? When they're in actual practice, something's going to happen in a patient interaction, and they'll look back and say, 'Ooooh! That's why she wanted us to learn this!'"
For at least one student, it didn't take five years.
When I saw Marin last week, she told me that one of the medical students who'd been in the CRIM class told her a story about another student in the class, who'd been very resistant to the material. I'd given them a published case about a fourteen year old boy dying of cancer; I had the students write a letter from one of the people described in the case (the boy, one of his parents, one of his doctors, his beloved neighbor, the beloved neighbor's beloved dog, the girl in his class he wanted to kiss) to someone else on the list of characters. The students paired up and swapped letters; each then wrote a response to the other's letter. So if one student wrote from the boy to his doctor, the second wrote from the doctor to the boy.
This one student, evidently, thought the whole exercise was complete and utter hooey. Why were they spending time on this garbage? How was this ever going to be useful?
Two weeks later, he told his friend, something happened at the hospital, and he suddenly understood why it was important. He had the aha moment. "Ooooh! That's why she wanted us to learn this!"
I don't know what happened, although I'd love to know. Marin's trying to get the student to write me a note about it, but apparently he's too embarrassed. (Dear med student: If you're reading this, you don't need to be embarrassed. Believe me, I know the material can seem irrelevant at first! I'm just glad it didn't take you five years to change your mind.)
In any event, this is an invaluable affirmation of the work I've been doing. Marin and other med school faculty have been very positive all along, but the opinions that matter the most are those of the students.
In other medical-humanities news, we'll be starting up the Literature & Medicine program in August, and Marin recently met with the staff of a care facility where there's strong interest in a writing and healing group. So I may be doing that work sooner than I expected. And we also have our first student in a narrative-medicine elective, and she may be able to get me invited to teach a narrative medicine or reflective writing session at the HEART elective in Santa Cruz next April.