Listen to this discussion: BBC Interview – Discussion of Musee Des Beaux Arts by W.H. Auden
Literary Commentaries
Power, Borders, and Boundaries
Johanna Shapiro, PhD
We include three apparently very different poems in this issue. One is a paean to the patient’s family doctor; another references a dying cancer patient whose doctor does not want to let him go; and the third differentiates the living narrator from a group of deceased mental patients. Yet at some level, all three poems are about power, borders, and boundaries. Foucault taught us that power is not the exclusive property of any one group or individual.
Hospitalized at Christmas and Long-Distance Grandma
Johanna Shapiro, PhD
In my reading, these two poems, one by a (then) 3rd year medical student, the other by a distinguished family medicine behavioral scientist, are about two things: the contextualized nature of human life and the miracles necessary when we lose that context. Human beings are particularistic creatures emerging from and anchored by history, family, relationships, culture, faith, place, and life experience. Plucked from these orienting details, we become unbelievable, pathetic, and two dimensional. Brian McMichael writes movingly of his “long-distance” grandma, whom he knew only in one way — “brow-beaten lost and pathetic” when she visited him in California, separated from the context, roots, and place in the world that defined her. Yet in her home environment, hard-scrabble and in decline as it was, full of tough rather than romantic memories, she is strong, “lucid and vibrant.” The details of her life, demanding and sometimes ugly, shimmer with authenticity. He discovers in his grandma a stranger to be proud of.
Hospice and Catching Comprehension
Johanna Shapiro
The two poems in this issue are contributed by medical students, at the time of writing in their third year of training. They both describe clinical situations of great vulnerability—a patient dying of metastatic lung cancer and a non-English speaking woman undergoing a pelvic exam. In both poems, the patients are limited by lack of control. In both, the students are similarly limited by what they can and cannot do — the student in “Hospice” cannot save her patient; the student in “Comprehension” cannot communicate with her patient. Both take refuge in the tangible body of the patient, the chest, uterus, an ankle — but the answers they long for are not forthcoming.
Putting a Broken Doll Back Together Again
Johanna Shapiro
Like Humpty-Dumpty, some patients arrive in their physicians’ exam rooms shattered on many levels because of complex multiple illnesses, severe emotional traumas, or both . Sometimes, like the king’s men , physicians despair of ever putting these patients back together. It is a daunting task and one that requires great courage and great humility. Jo Marie Reilly uses the metaphor of a broken doll to describe the devastation of intimate partner violence and the parallel metaphor of “the doll defender/tender/mender” to characterize the physician who must try to repair her patient.
Commentary: Accountability and Praise
Johanna Shapiro
The juxtaposition of these two poems, “In Praise of the Birthing Vacuum” by Martina Nicholson and “Account, Accountable” by Arlene Katz, although random (like much in life) should give us pause. They describe two momentous alterations in life (one usually eagerly anticipated and the other dreaded) – the point at which a couple becomes a family and the moment at which the American dream of home ownership disintegrates. They also describe the promise and potentiality of what might be in this world as well as the despair and injustice of so much of what is. They beg the question, which view is right?
Innovations in Medical Education Using the Humanities and Arts: Developing Physician Reflective Capacity and “Happiness”
Johanna Shapiro, PhD
The authors contributing to this issue’s Medical Humanities section, Van Winkle et al. and Winter, tackle a persistent challenge in medical education: how to translate the abstract humanistic values and ideals that undergird clinical medicine into concrete contexts that can inform and inspire medical learners’ attitudes and practice. A subset of medical educators has maintained a longstanding interest in using literature and the arts to examine such difficult-to-teach issues in medicine (Charon, 2000; Shapiro, 2003; Halperin, 2010). Following others in the field (Wald, 2010), Van Winkle believes that developing reflective capacity (Wald, 2010) in medical students is an essential piece of this puzzle. Robyn Winter, himself an academic family physician, starts from the assumption that, essentially, happy doctors make for happy (in the sense of better satisfied and better cared for) patients. Each of their papers presents innovative ideas for integrating the arts and humanities to further their educational goals.
Breaking Bad News
Johanna Shapiro, PhD
Although bad news is often devastating for the patient to hear, it is also difficult for the physician to say. Doctors like to fix things. They like to fix broken bones, strep throats, malfunctioning hearts. They do not like things that cannot be fixed. That may be why in medical education we talk about “breaking” bad news because so much ends up broken for the patient, the patient’s family, and the physician.
Doc in a Box
Johanna Shapiro, PhD, Desiree Lie, MD, MSEd
Doc in a Box, a novel by San Francisco Bay neurologist Robert A. Burton, is a redemptive tale of a physician, Dr. Webb Smith, who loses his way mightily, both personally and professionally, only to discover what matters most about life and doctoring. The title, in addition to summoning up dreadful images of Jack in the Box managed care models, also alludes to the good doctor’s sense of entrapment, of being “boxed in” so to speak, by his interpersonal relationships, money worries, and work.
Protect Yourself From This
Johanna Shapiro, PhD
One of the central issues in medical education is how to respond to the suffering of others. Idealistic medical students think they will always respond with an altruistic approach impulse, in which they will naturally draw closer to the suffering other, feel empathy toward this other, and be moved to put the interests of the other above their own interests. Yet they may find that, more often than not, they exhibit an opposite, but equally strong, impulse to detach and separate from the contamination of others’ suffering.