Tuesday, March 16, 2010

Dance and Medicine

The mid-point of medical residency is probably the bleakest point in medical training. The daily grind of death and disease wears young doctors down, and the end of residency seems impossibly far off. In the second year of my residency at Bellevue Hospital, I began taking dance class at the Martha Graham studio in Manhattan. It turned out to be an unexpectedly visceral lifesaver for me.

Here is an excerpt from the essay, “Pas de Deux,” which appears in the new anthology from “Becoming a Doctor,” edited by Lee Gutkind. (Norton, 2010.)

“One day, after a long night in the ICU, I rushed straight to dance class, leotards under my scrubs. I had spent the bulk of my last thirty hours with Nilsa, a young woman dying of HIV. Nilsa’s body was ravaged by bacterial, viral and fungal infections. The body cavities that weren’t drowning in their own fluids were hemorrhaging blood. Her temperature never dipped below 103°. The breathing machine provided oxygen in exchange for her tuberculosis-laden breaths. I injected sedatives when she convulsed, her water-logged lungs laboring to absorb more oxygen. The nurse and I arranged icepacks around her burning skin, but they melted rapidly. Her death was slow and brutal. Her mother, two brothers, and aunt sat with her, weeping into their protective respiratory masks.

I limped out of the hospital after signing Nilsa’s death certificate. There were so many infections that I couldn’t decide which one to write for “immediate cause of death.” My sleep-starved body longed for bed, but my aching soul dragged my protesting limbs to East 63rd Street.

We were doing the plié-relevé series, a set of exercises that I have always found particularly beautiful. There is one point, in fifth position, in which the drama builds until the climax occurs with just one simple motion: a 90° twist of the body while lifting into a relevé, one arm scooping an arc into the sky. In one brief, but compelling, moment, the whole class rises into the air as a single being, sweeping its focus from the one corner of the room to the other. Physically subtle, yet emotionally dramatic, almost more so for the understatement of the movement.

…I look back now and realize that it was the continual infusion of the aesthetics of dance that helped keep me alive throughout those draining years. After each daily dose of agony and suffering, I needed not only to witness beauty, but to participate in beauty. I was well aware that I couldn’t possibly approach the feats of the advanced dancers, but that turned out not to matter at all. It was enough just to be a bit player in that world, to be a miniscule stitch in that weave of beauty.”

Reprinted from “Pas de Deux” by Danielle Ofri, from “Becoming a Doctor,” Gutkind, L., ed. ©Norton, 2010.


Danielle Ofri is a writer and practicing internist at New York City’s Bellevue Hospital. She is the editor-in-chief of the Bellevue Literary Review. Her newest book is Medicine in Translation: Journeys with my Patients.

View the YouTube book trailer.

You can follow Danielle on Twitter and Facebook, or visit her homepage.

Her blog, Medicine in Translation, appears on Psychology Today’s website.

Monday, March 15, 2010

Concepts of health and illness conference

Conference announcement and call for papers: Concepts of health and illness
1-3 September 2010, UWE, Bristol, UWE, Bristol and Lancaster University
Conference funded by the AHRC

Keynote Speakers:

Dr Jonathan Andrews (Newcastle, UK), The 'deja la' of madness? Continuities and shifts in the relationship between madness and death

Prof Baroness Ilora Finlay (Cardiff & House of Lords, UK), Fear as a key driver in the assisted suicide debate

Prof KWM Fulford (Oxford & Warwick, UK), Delusion and Spiritual Experience: Facts, Values and Concepts of Disorder in Mental Health

Prof Lennart Nordenfelt (Linköping, Sweden), The Controversy between Naturalistic and Holistic Theories of Health and Illness

Prof Fredrik Svenaeus (Södertörns högskola, Sweden), What is phenomenology of medicine? Embodiment, illness and being-in-the-world

Dr Alex Wood (Manchester, UK), Conceptions of Psychological Well-Being and Illness: Sickness, Optimal Functioning, and Authenticity

Over the past three decades, various accounts of health, illness and disease have been proposed by researchers from history, sociology, law, philosophy, public health and economics. Often, however, proponents of various accounts have been isolated within their own discipline with an apparent unawareness of competing accounts. As a result, while there are now a number of different accounts of health, illness and disease available, there is no consensus about which, if any, of these accounts is ultimately acceptable and what implications each account may have.
This three-day international conference will explore differences and overlaps between these different accounts. The conference aims to bring together researchers from multiple disciplines to create dialogue between them, as well as between researchers and healthcare practitioners, on the concepts of health, illness and disease.

We welcome contributions from any relevant discipline on any topic that falls within the broad remit of the conference title. Each paper will be allotted 20 minutes for presentation, followed by a ten-minute discussion. We aim for the conference to be inclusive and to represent a broad range of views and approaches. We particularly welcome contributions from healthcare practitioners. There will be a number of slots reserved for graduate papers and graduate bursaries will be available.

Contributions are invited for:
· Panel topics
· Individual papers
· Healthcare practitioners contributions
· Graduate papers

NB: please send us your abstract before the deadline if you require an early response. We strongly recommend this option for overseas participants who may need to book flights.
Please send proposals (500 word abstract) via email by Monday 12 April, 2010 to both organisers:Dr Havi Carel havi.carel@uwe.ac.ukDr Rachel Cooper r.v.cooper@lancaster.ac.uk


There is no registration fee and meals and refreshments will be provided during the conference. Participants who may wish to attend the conference without presenting in it are welcome to do so.

Rooms have been block-booked from the UWE Conference Centre and information on how to book accommodation for the duration of the conference will be circulated shortly.
The conference will be held at the UWE Frenchay Campus, in Bristol, UK. For maps and directions: http://www.uwe.ac.uk/aboutUWE/campus/Frenchay.shtml

This conference is part of the AHRC-funded project on the concepts of health, illness and disease.

For the project home page: http://www.uwe.ac.uk/hlss/courses/philosophy/ahrc_chid_network.shtml

Conference organisers:
Dr Havi Carel (UWE, Bristol)

Dr Rachel Cooper (Lancaster)

Tuesday, March 09, 2010

Poetry in Medicine

When I make rounds with my students and interns, I always try to sneak in a poem at the end. I think poetry is important because it helps convey the parts of the medical experience that don’t make it into textbooks. It’s important because it teaches creative thinking—something of immense value to doctors.

It’s important because interpreting metaphors is a critical clinical skill in diagnosis; patients’ symptoms often present in metaphorical manners and we doctors need to know how to interpret our patients’ metaphors. Last but not least, there is a therapeutic value to introducing beauty into a situation that is not commonly associated with aesthetics.

I’ve been giving poetry to my medical team for a few years now, but I’ve always wanted to give poetry to my patients. Unfortunately, English is not the first language for most of the patients in my hospital, so this has been challenging.

But there is one set of patients that seems to consistently speak English—the alcoholics. The Bowery-type alcoholics aren’t necessarily the favorite patients of the interns. These patients are frequent fliers, they are clinically “uninteresting,” they are often malodorous, and their illness is perceived as self-inflicted. But they do speak English.

So one morning on rounds, our team went to examine a new alcohol-withdrawal admission. His condition was standard: alcohol-on-breath, speech slurred, fingers trembling, hair and beard disheveled, body odor a mix of unwashed socks and cheap beer. He was cranky, and impatient with the detailed questions we asked.

As the team was finishing up, I whipped out some papers from my pocket—Jack Coulehan’s poem “I’m Gonna Slap Those Doctors. I gave a copy to the patient and distributed the rest to the resident, interns, and medical students. Asking their forbearance for this slight divergence from medical protocol, I plowed onward and read the poem aloud.

I’m Gonna Slap Those Doctors

Because the rosy condition

makes my nose bumpy and big,

and I give them the crap they deserve,

they write me off as a boozer

and snow me with drugs. Like I’m gonna

go wild and green bugs are gonna

crawl on me and I’m gonna tear out

their goddamn precious IV.

I haven’t had a drink in a year

but those slick bastards cross their arms

and talk about sodium. They come

with their noses crunched up like my room

is purgatory and they’re the

goddamn angels doing a bit

of social work. Listen, I might not

have much of a body left,

but I’ve got good arms -- the polio

left me that -- and the skin on my hands

is about an inch thick. And when I used

to drink I could hit with the best

in Braddock. Listen, one more shot

of the crap that makes my tongue stop

and they’ll have something on their hands

they didn’t know existed. They’ll have time

on their hands. They’ll be spinning around

drunk as skunks, heads screwed on backwards,

and then Doctor Big Nose is gonna smell

their breaths, wrinkle his forehead, and spin

down the hall in his wheelchair

on the way to the goddamn heavenly choir.

(from Medicine Stone, 2002. © Jack Coulehan, reprinted with permission)

As I read the poem, I could feel the atmosphere in the room changing, ever so slightly. The focus shifted from the patient to the poem, and everyone was an equal neophyte with this particular poem.

When I finished reading, some of the medical team looked uncomfortable, but the patient was smiling broadly. “This is great,” he said. “I love it!” With his pronouncements, everyone relaxed a bit.

“You know,” the patient continued, seemingly happy to have an audience, “ I used to read some books, back in the day.” He sat up in bed, more animated now. “I like history stuff—ancient Greeks, ancient Romans. Real characters, those guys.”

We ended up having a conversation about his childhood in small-town New Jersey, how he cut classes in high school to putter around on the beach.

We left the room feeling awkward but also somehow lighter. Suddenly our patient wasn’t just another alcoholic drying out on the ward. He was a real person, someone who stood out in our minds.

The poem certainly didn’t change the course of his devastating disease of alcoholism. It didn’t offer him the epiphany to suddenly quit drinking or to reconnect with his estranged family. His liver enzymes didn’t miraculously normalize. His platelets didn’t bound back to health. But it gave all of us a sense of human connection.

Throughout his four-day stay in the hospital, the patient was much more pleasant to the team. I noticed that the students and interns wandered in more frequently to say hello. We all felt just a bit more connected.

Rx: Take two sonnets and call me in the morning.

If you are interested in poetry and medicine, check out this unique conference at Duke University on May 21-23. Life Lines: Poetry for Our Patients, Our Communities, Ourselves. (I will be giving a presentation there.)

Danielle Ofri is a writer and practicing internist at New York City’s Bellevue Hospital. She is the editor-in-chief of the Bellevue Literary Review. Her newest book is Medicine in Translation: Journeys with my Patients. View the YouTube book trailer.

You can follow Danielle on Twitter and Facebook, or visit her homepage.

Her blog, Medicine in Translation, appears on Psychology Today’s website.