Narrative Medicine

– So we are expecting
12 students today and we’ve got one,
two, three, six? Come on, fill the sides and there’s a seat
waiting here for someone. It’s special, I’m assuming
that somebody here will be… And I think we’re
almost ready to go. One, two, three, four,
five, six, seven. So why don’t we start, if
you’ll just pass that up. My name is Ellen Malomed and my work is with something
called narrative medicine. It’s storytelling about people’s
disease and people’s lives. So that we don’t
separate the two. We’ve expanded it
beyond the narrative in terms of storytelling,
we include all the arts. The daily practice of medicine is connecting to other people. If we have that capacity, even
as a person who admires art, then can we develop
those skills of empathy? A week in a bed as a
patient, what happens? Everything from janitors
coming in and turning lights on when you’re trying to sleep. Getting food that is
absolutely inedible. Having visitors that
you can’t send away because otherwise you’re the
creepy bad patient in room 230. So, being a patient
is really important for a doctor to understand. Empathy is the feeling that
one might have for a patient and compassion is the
action that one uses in order to work
with that patient. So one is more the feeling
and one is more the action which is where we get the
statement, compassionate care. So I guess my next
question to you is, if you grow up in a house where
there’s no expression of it, can you learn how you
can translate feelings of empathy into
compassionate care? We look at medicine
kind of like theater. There is no script,
you’re improvising with each patient
at each session. – I’m glad that you came in and let’s see what we can do
to get to the bottom of that. – It means being present,
it means understanding that empathy can
mean many things. Holding the space for
someone, learning to listen. – No, I think that might be it. – Okay so it’s just — – That’s when I noticed it. – Okay and it hasn’t been… – Being a patient
really is the best way to understand the problems
within our healthcare system. (soft music) I was very healthy,
I was a vegetarian, I was teaching exercise class, I was a certified
Alexandra technic teacher. So I was teaching people
how to deal with pain and then when I
was 52 years old, a lump was in my breast
through a mammogram and I was pretty shocked. At first I like
made a joke of it because it was not
easy to accept. I stopped making a joke
after the first day. It wasn’t funny. I was aware that medical ease, even though I’m very smart, did not make sense
when I was panicked. I felt like doctors
would come into my room and walk out without making
any kind of connection. My nurses during
chemotherapy and radiation and surgery were amazing because people go into nursing if they have a sense of
empathy or compassion. But doctors need to be
trained in that too. Being ill is hard enough. If there are ways that we
can make being ill easier for people, it makes
a real difference. It’s not expressed
in every culture, it’s not expressed
in every family unit. Can you learn it
by absorbing art? And you might think well, you
know, I’m not an art person. I’m a science person, as though the brain is
split in two so clearly that we can’t absorb
both of those concepts. Even if you are a
listener, a watcher, what are your art forms? What do you like? – I like to read. – Aah now to me, reading, I mean talk about absorbing
other cultures, empathy, understanding by looking at
what we call close reading in our work here, how do
you read between the lines? Which is what you gonna be doing
with patients all the time. What do you like? – Country Western Dancing. – Oh great, did you
know that about him? You do now. (laughing) – So when you first
presented this question, I thought of the
food program I run. We take produce
that’s been rejected and we save approximately
30 million pounds of fresh produce and I just… – This is going beyond
traditional training and a lot of seasoned
doctors and faculty members say why reinvent the wheel, we’ve been doing it
like this for years. And my argument there
is we’ve been doing it, but a lot of people have gotten
hurt through this process. Have had illnesses perhaps
that were overlooked or that were caused by
inadequate communication. So, I think this is
absolutely necessary, especially as technology
becomes so much more a part of healthcare, that we
cannot lose the humanity, the humanness in the medicine. – Okay, what if it’s like a
person stroking down into water and it’s just somebody swimming and you can’t even see
their body over here. – Oh. – Yeah. (laughing) – Yes, considering
all images we’ve seen. – This is like a
clock or something. This is the hour hand,
it’s almost back up to 12. It’s the cycle of the day. – I honestly think it’s
just, whatever medium… – Something we look at at
the beginning of session one where we’re focusing
on visual arts. We look at the traits,
characteristics
that are similar, the skills that a
physician needs to know. (crowd chatting) And an actor needs to
know, but also a dancer, or a musician. Can you hear more than
one sound at a time when you’re listening
with a stethoscope? – We were wondering if either it was age
causing the wrinkles or if they had been in the
water for a long time… – Those skills that you
know as appreciators of art are similar to the skills that you will have to learn
as medical practitioners. So, I can throw out one example. A person who sculpts, the shared skill with you
learning to be a physician is that you both
need to know anatomy. It’s made out of
glass and ceramic. It was made by a patient
whose name is John Woos. It’s called “Imperfect
Bone Origin”. – When you really start
looking at the position we notice he’s
kinda like relaxing. He or she, the
skeleton is like — – Could you tell the gender? – I’m sure I’m
supposed to but no. (laughing) – You’ve got three more
years to know this, don’t you worry about it. – He was kinda like reclining. – Okay, so this is his quote, “It is marked with gold and there is deformity
in every location of every fracture
I have ever had. And contains the actual plate that was in my femur
when I was a child. This piece is a tribute
to human abilities, specifically the human ability
to create and overcome…” – You know, the hand looks
sort of like the knuckles are a little thicker and
that makes me think… – So what we’re trying to
teach is how to look quickly and see a lot. – Grasping, grasping
for an object or for something
greater, you know. (laughing) – I want students who have
been told for a very long time that they are perfect,
to get rid of that and to have a little humility
and look at themselves. – Kind of a physician
unveiling that art form and at least for
us we’re thinking about how much training
we’re getting… – This is the time
to know yourself. This is a time for reflection because in medical school
you won’t have that leisure. It’s a hard job and that’s in addition of course to the science that
they need to learn. There have been
studies, over years, looking at how doctors
respond to their experience with medical humanities courses. And most doctors will say, their work is bigger than
just medicine for them, it’s fulfilling in
a different way. They’re happier. Part of learning how
to be a physician that goes home at the
end of a work week and still has something left
is what your boundaries are. There needs to be a knowledge
before you begin this work of what you can give and I think knowing
what you can give and still stay whole
is really important. So, thank you and
I’ll see you again at the end of the semester for a different
kind of workshop. Take advantage of
being here, you know, not just sitting in those
very dark classrooms that you have. (crowd chatting)

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