Sunday, June 21, 2009

Saying Goodbye

Today was the last day of the Narrative Medicine workshop. I woke up nice and early, but still rushed out the door to get to the conference on time. There was a birthday party here yesterday for Larry and Laura's daughter Nicola, who's ten today; the party activities included building geodesic domes out of toothpicks and mini-marshmallows. Very cool! But the family also has a no-shoe rule in the house, so as I came downstairs this morning, I stepped on a bent, upward-sticking toothpick. It pierced the sole of my foot, resulting in a fair amount of bleeding. So I had to hobble back up to the second floor, where Laura and the kids were, to get a bandaid.

My foot's fine now, and several doctors at the workshop told me that while it's probably a good idea to get a tetanus booster, I can wait until I get back to Reno; I don't need a $1,000 ER tetanus shot.

We did a lot of great stuff today. The morning started with a terrific lecture about Narrative Humility, the willingness to have your own perceptions twisted upside-down by a stranger's story or observation. Then we broke into small groups and did an interviewing exercise. We paired up with a partner. For five minutes, Person A told Person B whatever story felt most pressing to tell at that moment. For the next five minutes, A wrote how it had felt to tell the story, and B wrote "what you heard." This could be a verbatim transcription, observations about how A told the story, B's responses to the story, or -- most commonly -- some mixture of the three. Then, for yet another five minutes, B told a story to which A listened, after which B wrote about the telling and A about the listening.

It was a very productive session. We heard fascinating stories, equally provocative responses to them, and then engaged in thoughtful (and thought-provoking) analysis.

After lunch, though, I started to fade. The afternoon plenary was about the process of witnessing in medicine. The speaker was very funny and told wonderful stories, but I kept looking for some overarching argument and not finding it (completely my fault, I'm sure). Then we went back to our small groups for the last time, this time without a faculty facilitator, unless we requested one; we were also given an activity, although it was optional.

My group was already down several people who'd had to leave early. When I got to the room, three of the other members were having a long discussion about saying good-bye: when it's comfortable, when it's not, good and bad ways to handle it in a group setting, etc.

Ordinarily I'd have enjoyed the conversation, but today it reminded me too much of Dad. The last time I saw him, before I left the nursing home to go back to the house for dinner, he said "good-bye," very distinctly and forcefully, twice. I didn't let myself know or think about what that meant; I missed my final chance to say farewell to him, to tell him I loved him. I don't have many regrets, but that moment of denial on my part is definitely one of them, and the conversation was like salt in a wound.

As a result, I was a bit cross and snappish during the group activity, through which we took shortcuts. For instance, we'd been given a writing exercise, but we didn't write -- just talked through the exercise -- because someone in the room was tired of writing. I think everyone had hit a wall, and a few people were impatient to leave. There wasn't the sense of focused attention there'd been for the rest of the weekend; everyone, at least to me, seemed distracted.

It was still a great weekend, though. The faculty and other students were amazing, and I feel privileged to have met them and worked with them.

Oh, I have to share a story someone told me during a break, and which I have his permission to post here. He's an addiction doctor, and we talked about how stigmatized addicts are, and he said that their medical caregivers are often stigmatized by other medical professionals, too: "Why would you want to do that? I said that my family experience has taught me never to give up on anyone, and told him my mother's story. In return, he shared a story from his own practice.

A family contacted him and asked him to admit an 83-year-old man, an alcoholic, into a detox unit. The doctor's colleagues, even the other addiction specialists, were very skeptical. "He's been drinking for so long that detoxing will probably kill him." The patient had reluctantly agreed, though, and his daughters desperately wanted him to have the treatment, so the doctor agreed. The patient was admitted for a standard seven-day stay, and discharged to home and AA meetings.

A year later, the patient's daughters called to tell the doctor that their father had just died. He'd been sober since his hospitalization, though, and they wanted to thank the doctor for what he'd done. They'd finally gotten to know their father without alcohol in his system, with that barrier removed. They'd had a year of relationship with their dad, learning who he really was for the first time, and that was priceless to them.

This is why we need doctors who aren't burned out and embittered, who are willing to see patients as people instead of stereotypes. Go, addiction medicine!

And the adventure continues. Tomorrow: Amtrak to Amherst!

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