Categories
Emotion Empathy General Narrative

Repost: Stories of Suffering

As the MSPress Executive Board transitions, we bring you a post from past! Enjoy the work of one of our emeritus writers, Sara Rendell.

I am a medical student because I love questions. After a blood vessel takes a punch, what causes the platelet pile-up? What makes people blink, gag, cough, or sneeze? Why is cat litter as scary as alcohol for a pregnant woman?

Some medical questions are unanswered. Yet, science promises progress. With enough grant-funded work in labs and clinics, scientists can describe new diseases. Medicine will show where illness happens, researchers will explain how it happens, and epidemiologists will predict who it is more likely to happen to and when it could happen to them. Even with all of this knowledge, there is one question I do not expect my medical training to answer.

While I go to lectures, practice interview skills, and learn how to diagnose and prescribe, people endure pain, distress, and loss, and I can’t explain why. Why do people suffer?

Photo courtesy of drp
Photo courtesy of drp

I can look to people who suffer for answers. It is not hard to find written first-person narratives of suffering. In these narratives, protagonists are often cast in two roles: the suffering fighter and the wise sufferer.

As Kathlyn Conway discusses in her essay, “The Cultural Story of Triumph”, the narrative of a “suffering” fighter dominates over other stories of illness. Illness becomes a journey to physical cure. Where physical cure is not possible, illness is cast as a path to wisdom, a form of moral development. The patient becomes a traveler who should somehow be “uncomplaining, strong, and brave” on this journey (Conway, 2007).

“Illness is a chance to show us your guns and triumph!” the medical culture seems to say.

If society expects sick people to be “fighters” what else do we expect from them? I think of S, a 62-year old woman with osteosarcoma, who put on lipstick while her skin was sinking deeper into the spaces between her bones. “Can’t let this cancer make me ugly honey,” she said as she applied her makeup in the mirror. What does it mean that S’s fight against cancer involved cosmetic routines?

The idea that people grow in strength or wisdom while suffering is familiar to me. As essayist, Pico Iyer describes in “The Value of Suffering”, suffering can be a doorway to compassion, loss can be an invitation to appreciate nuance. Yet, my intestines tangle when I imagine telling a patient who suffers, “What an opportunity to unfurl in wisdom!” Even if I did not say this out loud, I wonder what my expectations might communicate.

Untitled 2 copyLast year, my close friend J died of metastatic breast cancer while 27 weeks pregnant with a boy. During her first trimester, we would lie on my floor and look up at the ceiling when retching woke her in the morning. Over the next few months we went to her prenatal visits and giggled over possible baby names. Then, she stopped eating and her nails turned yellow. Her doctor said, “Hopefully it’s hepatitis.” He didn’t bother to tell us what it hopefully wasn’t. Her yellow vomit and “liver nodules” explained. She was 24 years old when she passed away and left behind her husband and 3-year old son.

That was an inexplicable catastrophe. But J’s husband needed to believe that somehow God had planned this. If he believed that her death was one example of many forces that roll over us the way tires would ants trying to cross a highway, then how could he continue with day-to-day life? How would he keep being his son’s Papa?

Even after I gather years of experience with suffering, I do not expect to be able to explain it. I do know that the stories we tell about suffering can influence how we relate to patients.

My expectations form the questions I ask and the things I attend to.  Imagine me telling a patient, “Fight your cancer, but stay pretty.  Also, grow spiritually so you can teach me through your suffering.”  That feels like a lot of pressure to put on someone who is ill, even if it is unspoken. If I look for a suffering fighter in a patient who cannot cast herself in that role, I risk disrespecting her experience. If I try to learn wisdom from a patient who does not see his illness as a journey to moral development, I might disregard his life story.

Medical school teaches me to synthesize and simplify information.  The more narratives I hear, the more I feel a desire to string them together along a unifying theme.  Cultivating attention to less common stories about suffering and loss reminds me to listen when I long to explain.

Sources:
Conway, Kathlyn. 2007. Beyond Words: Illness and the Limits of Expression. University of New Mexico Press. Albuquerque

Iyer, Pico. 2013. The Value of Suffering. New York Times.
Featured image:
“After a Night Shift” by Stephanie Scott

Categories
General Lifestyle

Medical Humanities

Evaluating me, my attending writes,

Sometimes our strengths can also be
our weaknesses
and in OB-GYN, confidence can be taken as
arrogance.

I eat 32 chips ahoy cookies I find
six months after I first opened them
in the back corner of my kitchen cabinet,
behind cans of beans and tuna.
That same day, my neighbor’s daughter texts me
a photo of red bumps under her pubic hairs.
A bag of trash is the only thing in my refrigerator;
no time to take it out and it would have made
my apartment smell like dead people.

The people who die in hospitals—you see it
in their skin—grey and dry—two days before
it happens. My chief tells me to notify the family
but there was no one who cared, so I write it up.
A new patient sleeps in the dead patient’s old bed.
Just as soon as the morgue people leave
the nurse’s assistant changes the sheets and
mops the floors in bleach.

Doctors skip lunch. I do too
to put off the depression that smacks me
when I stop propelling patients from bed,
to diagnostic test, to operating room and
start propelling white bread and meat-mush
from esophagus to anus.

Featured image:
Bed by Alex

Categories
Narrative Reflection

An Ambulance’s Burden

I step off of Northeast Corridor 7871 and into New Jersey. Sunlight makes the tracks look so warm that I feel cheated when cold wind rushes my face. A man walks toward me. He comes close enough for me to smell the rancid recency of cigarettes before he says, “Excuse me.” I look at him and his eyes dart from my face to the door.

“Do you have a cellphone?” he asks.

“Do you need to make a call?” I ask, annoyed at a flash of thought I catch myself engaging, how do you know he won’t steal it?

“Yeah. The ambulance.” he says, casually.

“9-1-1?” I ask as I dial the numbers on my phone.

“Yeah.” he says, emitting a forceful exhale. I have yet to eat and his breath hurls vomit at my senses. I hand him the phone. I imagine my brother scolding me, “Really, Sara, you can’t just hand your phone to people. At least get insurance.”

He won’t take your phone in a train station where there are policemen. I reason with my fear, still guilty over my first-thoughts.

“Yes, hello. I need an ambulance at Trenton station… Suicidal thoughts. I wanna go to St. Francis. I’ll wait in the parking lot outside… OK… yeah… OK.”

He is silent. I imagine a weary dispatcher typing information into a form.

“Yeah, yeah.. suicidal thoughts… yeah, wanna kill myself. I’ll stand outside the station. Uh….” He looks at me.

“Which side we on?”

“The Newark/New York side.” I say.

“Newark/New York side” he repeats, “Jeans and a grey sweatshirt. My name is . . . “

I stop eavesdropping and start thinking about his call. He hands me my phone.

“Thank you.” He smiles, showing gaps between rusted teeth. “You have a nice day.”

“Take care.” I say, trying to reconcile myself to his smile.

If I could not understand English, I might have imagined his call was a take-out order. He was ready with the prompt they couldn’t refuse. “I wanna kill myself.” He expected the questions in the order the dispatcher asked them. He picked his hospital.

What does it mean that his best option is to call for a ride to the hospital that would cost up to $900 if he could pay?  Waiting for my train, I think about his smile. I wonder at the difference between a usual day for him and usual day for myself. What do I know?  Maybe he did want to kill himself. But what if he just needs a place to stay or needs help with the sweating agitation of withdrawal?

How will EMTs, nurses, and doctors think of him? As a system manipulator? Someone who suffers because of gaps in social insulation? Another case? A person who makes choices?  A recipient of charity?

I think of a patient I interviewed who said he came to the hospital to “Get halodol to chase the voices.” When I pressed for explanation, he replied, “You know, get clean. Get outta everybody’s way, get some… some free sleep, take care of my medicals . . . get outta everybody’s way.”

“What do you mean by get out of everybody’s way?” I had asked.

“You know… I don’t wanna bother nobody…be in their way while they trynna do jobs and work and studyin’ and workin’, you know… like get outta their way to not be sick you know… don’t wanna be a burden.”

After the ambulance leaves for St. Francis with the man who borrowed my phone in tow, I wonder whether an ER doc will tell his resident, “He came to get out of everybody’s way.”

Featured image:
Ready by Matt Carman

Categories
General

Stories of Suffering

I am a medical student because I love questions. After a blood vessel takes a punch, what causes the platelet pile-up? What makes people blink, gag, cough, or sneeze? Why is cat litter as scary as alcohol for a pregnant woman?

Some medical questions are unanswered. Yet, science promises progress. With enough grant-funded work in labs and clinics, scientists can describe new diseases. Medicine will show where illness happens, researchers will explain how it happens, and epidemiologists will predict who it is more likely to happen to and when it could happen to them. Even with all of this knowledge, there is one question I do not expect my medical training to answer.

While I go to lectures, practice interview skills, and learn how to diagnose and prescribe, people endure pain, distress, and loss, and I can’t explain why. Why do people suffer?

Photo courtesy of drp
Photo courtesy of drp

I can look to people who suffer for answers. It is not hard to find written first-person narratives of suffering. In these narratives, protagonists are often cast in two roles: the suffering fighter and the wise sufferer.

As Kathlyn Conway discusses in her essay, “The Cultural Story of Triumph”, the narrative of a “suffering” fighter dominates over other stories of illness. Illness becomes a journey to physical cure. Where physical cure is not possible, illness is cast as a path to wisdom, a form of moral development. The patient becomes a traveler who should somehow be “uncomplaining, strong, and brave” on this journey (Conway, 2007).

“Illness is a chance to show us your guns and triumph!” the medical culture seems to say.

If society expects sick people to be “fighters” what else do we expect from them? I think of S, a 62-year old woman with osteosarcoma, who put on lipstick while her skin was sinking deeper into the spaces between her bones. “Can’t let this cancer make me ugly honey,” she said as she applied her makeup in the mirror. What does it mean that S’s fight against cancer involved cosmetic routines?

The idea that people grow in strength or wisdom while suffering is familiar to me. As essayist, Pico Iyer describes in “The Value of Suffering”, suffering can be a doorway to compassion, loss can be an invitation to appreciate nuance. Yet, my intestines tangle when I imagine telling a patient who suffers, “What an opportunity to unfurl in wisdom!” Even if I did not say this out loud, I wonder what my expectations might communicate.

Untitled 2 copyLast year, my close friend J died of metastatic breast cancer while 27 weeks pregnant with a boy. During her first trimester, we would lie on my floor and look up at the ceiling when retching woke her in the morning. Over the next few months we went to her prenatal visits and giggled over possible baby names. Then, she stopped eating and her nails turned yellow. Her doctor said, “Hopefully it’s hepatitis.” He didn’t bother to tell us what it hopefully wasn’t. Her yellow vomit and “liver nodules” explained. She was 24 years old when she passed away and left behind her husband and 3-year old son.

That was an inexplicable catastrophe. But J’s husband needed to believe that somehow God had planned this. If he believed that her death was one example of many forces that roll over us the way tires would ants trying to cross a highway, then how could he continue with day-to-day life? How would he keep being his son’s Papa?

Even after I gather years of experience with suffering, I do not expect to be able to explain it. I do know that the stories we tell about suffering can influence how we relate to patients.

My expectations form the questions I ask and the things I attend to.  Imagine me telling a patient, “Fight your cancer, but stay pretty.  Also, grow spiritually so you can teach me through your suffering.”  That feels like a lot of pressure to put on someone who is ill, even if it is unspoken. If I look for a suffering fighter in a patient who cannot cast herself in that role, I risk disrespecting her experience. If I try to learn wisdom from a patient who does not see his illness as a journey to moral development, I might disregard his life story.

Medical school teaches me to synthesize and simplify information.  The more narratives I hear, the more I feel a desire to string them together along a unifying theme.  Cultivating attention to less common stories about suffering and loss reminds me to listen when I long to explain.

Sources:
Conway, Kathlyn. 2007. Beyond Words: Illness and the Limits of Expression. University of New Mexico Press. Albuquerque

Iyer, Pico. 2013. The Value of Suffering. New York Times.
Featured image:
“After a Night Shift” by Stephanie Scott