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Thursday September 21 2017

The Story of Disease: Humanities in Medical Education

Medical humanities has become a burgeoning educational tool to develop empathy and compassion in would-be doctors. While some have cried that literature in medicine heralds the resurgence of ancient empiricism, many residence programs have found success in implementing tools like narrative medicine which allow doctors to account their personal relationships to patients.

Some nights I find myself drinking tea with people long since dead. I’m tucked into my bed with my knees budging dangerously close to my chin and my hands neatly unraveling the cold ends of my bedspread. The stiff cadavers of human flesh sit next to me, their cold extremities immune to the warmth of my sheets. As I sit there under the glint of a dim light searching hungrily into the night, the departed bode me on, their spindly fingers worn and shaky as they tell me to laugh when they did or cry when there is no other choice.

They are authors, and together, though they can never know me and I can never know them, they help me discover late at night that I am not isolated or lonely or anything really. I belong, and so did they, and here we are, an aggregate of people before and after me, connected by the time and space between words.

This sense of belonging is the soul of narration. Literature, at its very core, is not a simple description of the world but instead a vivid, breathing part of it. It is a scrutiny of everyday, of the chaotic lifestyles we busy ourselves with, of the significant and the grand, of the unique and the mundane. It allows a perception into another world that is not unlike ours, and in doing so, readers can directly enter into the lives of characters with such exactness that they feel their own pulse coursing through the pages.

Proponents of the humanities have often claimed that such vicarious experiences can lead to empathy in individuals, especially in the medicinal field. Dr. Edmund Pellegrino, a Dean at State University of New York, argues as much. “We can become so infatuated with progress in knowledge and control,” he says in an essay entitled Flexner: 75 Years Later, “that we lose our perspective, lose our historic sense, lose a philosophic outlook, lose sight of relative cultural value.”

While the sciences offer the necessary technical wherewithal, it is the humanities, he suggests, that allows for competence in social perception, emotional receptivity, and cultural sensitivity. Due to the imagination latent in literary fiction and the study of it – the need to nitpick at various word choices, the quest to figure out what an author meant in a given sentence, and the humanizing aspect of stories – Pellegrino thinks that doctors can glean better ways to deal and respond to the complexity of a patient’s sickness through literature.

Pellegrino is not alone in this thought. Many medical schools across Canada and America have recently incorporated such humanistic ideals into their curricula in the hopes of improving physician and patient relationships. Exercises such as narrative medicine or parallel charts (both forwarded by Dr. Rita Charon, a literary scholar and practicing clinician), which allow doctors to describe their personal encounters and relationships with patients, have become common practice in residency programs as a way to gauge a doctor’s ability to perform effective, complete care.

Obvious limitations present themselves between time, intellectual capacity, and a person’s ability to penetrate into the gravity of someone’s suffering. No matter the amount of reading and textual analysis, there is only so much empathy and compassion one can show. More urgent is that the resurgence of humanities in medicine cannot be at the expense of scientific expediency. Those dark ages have since passed. Yet the reverse should not be a choice either. Scientific prowess cannot, and should not, overshadow compassion.

It is a difficult balance, and many medical schools are attempting to tightrope this awareness by offering these wide-ranging literature-based programs. Without a doubt, it is a necessary equilibrium to reach. Patients are the stories of a lifetime bound in flesh. Carved into their cheekbones is the best day of their life and in their smile weighs the saddest night. Their knees shake because they spent much of their life praying and their lips crack because they have lived by the sea, a sea that has battered their hair into a sandy gray and etched canyons for wrinkles into their forehead. They have the greenest-blue-hazel eyes you have ever seen. They are a brother, a friend, a lover, a sinner, a saint, a teacher, a student, the bravest person and a coward all at the same. They move. They shake. They do, laugh, and feel. They wear hand-knitted sweaters.

They are a narrative only they know – a summation of experiences, actions, and feelings up to that point – and physicians are but a small character captured in between the blinks of an eye.

For this reason, sickness does not simply injure a person’s physicality and rejuvenation is not just a bodily concern. Illness and healing alike involve the whole being of an individual. Both involve the unwinding of that patient’s story; there is an assault on the entirety of a person. From a free individual to an anxious, dependent, often bed-ridden patient, they become an iota of what they were and what they saw themselves to be.

The Anatomy Lesson of Dr. Nicolaes Tulp by Rembrandt encapsulates a period of heightened enlightenment in both the arts and sciences.  The Anatomy Lesson of Dr. Nicolaes Tulp by Rembrandt encapsulates a period of heightened enlightenment in both the arts and sciences.

But they are not just the sum of their sickness. In between the coughs and blood and diagnosis are those same stories; their pages are just curling in a moment of bad weather.

It is empathy, the ability to transcend the bodily limitations and try to understand the feelings of a patient, that is vital in the healing process, and the movement of medical humanities works to encapsulate this connection inherent in literature. When done correctly, medical humanities is the idea that patients are not just looking for a cure, a salve, or a panacea. They are looking for healing entirely through a shared experience between the doctor and the patient that transcends cultural, compassionate, and religious boundaries.

While I am just an undergrad mulling around like everyone else and I may know very little about very little, at the very least I know that when I read at night I am alone in my bed but at the same time I’m not. Patients want to feel the same thing. They, like me, want to know that they are connected by virtue of being alive, by reading the words in front of them, and by seeing the experiences, the worlds, the lifetimes of a patient, a doctor, and an author, in between the bare spaces of the words.

By Kacper Niburski

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References:

1. Comer-Kidd D, Castano E. Reading Literary Fiction Improves Theory of Mind. Science. 2013 October.

2. Pellegrino D. Flexner 75 Years Later: A Current Commentary on Medical Education. University Press of America. 1987.

3. Chen P. Stories in the Service of Making a Better Doctor. The New York Times. 2008 October.

4. Meakin R. The Humanities in Medicine – Distancing and the Distance Between Us. Medical Humanities. 2005.

5. Albert D. Ten Important Reasons to Include the Humanities in Your Preparation for a Scientific Career. Science Careers. 2011 May.

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The Meducator is McMaster University’s undergraduate Health Sciences Journal. It publishes pieces that critically address current issues with a high degree of scientific rigor, but in a way that is accessible to a broad audience.

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