Monday, April 20, 2009

Read this Book: Singular Intimacies

There is something about Bellevue hospital.  One of the most famous hospitals in the world, Bellevue shares doctors with NYU Medical Center, (some of whom treated me when I was so sick years ago) and has a certain indelible mystique.  

I have a particularly soft spot for one of Bellevue's physicians, Danielle Ofri.  She's an incredibly talented writer (her books are intimate, ravishing and moving) and she is also the editor of the wonderful Bellevue Literary Review. (I hold the BLR responsible for my upcoming novel.  A short story they published, which went on to win a prize, bloomed into my novel.)

Now in paperback, Singular Intimacies is an astonishing look at what it really means to be both doctor and patient. Publishers Weekly raved that it is a "powerful collection, tied together by the struggle of a clearly gifted physician to master the complexities of healing" and  Jerome Groopman  aptly categorized the book as the place where  "science and soul meet."

Danielle graciously agreed to let me pepper her with questions.

I have had experiences with doctors who steel themselves from caring too much about their patients or getting too involved because they feel they can be more effective that way, and because otherwise, it can be too emotionally challenging. (I've since changed doctors!) Yet, writing is anything but detached and to tell a really important story about a patient requires really knowing the patient and allowing yourself to really open up to your own emotions.  Your chairman began the requirement that all third year internal medicine students write 1,000 word essays about patients, which I think is wonderful.  During the outpatient medical rotation, you ask your students, in lieu of one of their standard patient write-ups to hand in a narrative write-up that simply tells the patient's story in their own words.  Do they initially balk, especially given their workload?  Do you find students are often transformed or surprised by what emerges?

The standard "medical writeup" (also know as "the history and physical")  is a formal document that describes the patient's illness in preset categories.  When students learn how to write these, they learn the particular language of medicine (the patient admits to having chest pain, the patient denies chest pain, etc.) Not only is this language very stilted, it also casts the patient's experience of illness in a very subjective, even suspicious light.  This is contrasted sharply with the "factual" language that is used when the doctor examines the patient or performs diagnostic tests ( a rash was noted, a murmur was appreciated, the EKG showed...).

When I ask my students to do a narrative write-up, I tell them to eschew the structure and language of the standard H&P and to simply tell the patient's story.  Initially, they are quite baffled because the assignment is so open-ended.  They've worked hard to acquire this argot of doctoring and now I'm asking them to simply toss it aside.  But I give the some tips.  For a patient with diabetes, they may simply ask, "What is it like to have diabetes?" This straightforward question can reveal an enormous divide between how we physicians view diabetes ( a pancreatic disorder of insulin regulation that is associated with extensive renal, vascular, cardiac,  retinal and metabolic complications ) and how a patient might view diabetes ( a pain-in-the-neck illness that requires shots or pills that cause diarrhea and impotence, a tasteless diet that means giving up everything I like, my doctor haranguing me to lose weight, etc.).

Almost without fail, the students are amazed at how easy it is to write the patient's story, and how much they learn about their patient--information that they probably never would have had the opportunity to know.  Many students comment that they've gotten to know the subject of their narrative write-up better than an other patient in their entire medical school career. Occasionally, this has important diagnostic and therapeutic implications.  There was a young woman whose asthma was exacerbated by their dog.  But she wouldn't get rid of it because she knew that her boyfriend would be crushed.  For balanced POV, the students interviewed the boyfriend, who felt terrible about the asthma, but commented ruefully that they could ever get rid of the dog because the girlfriend would be crushed.  The medical student was able to bring these two opinions to the forefront and the couple agreed to give the dog to a friend.  The asthma immediately improved.

Your essays about becoming an intern and a doctor are eloquent, intelligent and gorgeous.  What prompted you to begin writing about your experiences through medical training? And when did you (and do you) find time to write?

I didn't start out planning to write a book or even planning to write.  But after a full decade of medical training at Bellevue, I needed some time away. I took on some short-term temporary doctoring jobs around the country, and in between assignments, I'd travel in Latin America for as long as my money would last.  It was during this period that I finally had some time to breathe and to think. I started writing down these stories, these one-of-a-kind experiences.  The act of writing and revising and editing gave me the opportunity to really consider all that had transpired during my medical training. I then started taking some writing courses and worked on these essays that eventually formed the book Singular Intimacies.

As to finding the time to write, this is always a challenge.  When I was first hired by Bellevue as an attending physician, there was an economic crisis, and the only job available was a three-day-per week job.  Working part-time was not something I ever planned to do, but it was the only thing available.  I began to use the other two days for writing. When the full time job became available, I turned it down. To this day, I spend only three days each week in the hospital. I try to keep my other days for writing only, but they now have to encompass editing the Bellevue Literary Review as well as cello lessons.

What I loved about your book was how you humanized the medical profession and gave a gritty, heart-scorching look at what happens in medical training.  Given your experience, do you think the way doctors are made should change, and if so how?

So much of medical training occurs in a maelstrom, and there is very little time for contemplation.  It would help to have a little bit of space to consider the effects of the tectonic transformations that are occurring. This is why I try to hand out a poem at the end of rounds, if possible.  A few minutes to consider a metaphor or a poetic image hopefully allows the mind and the spirit space for a thoughtful sigh.

What are you working on now?
I'm writing a new book entited Medicine in Translation: Journeys with My Patients, to be published by Beacon Press in early 2010 This book focuses on my patients who are immigrants.  Illness itself is a sort of immigration--from the land of the healthy to the land of the sick.  I'm interested in the many types of journeys that my patients have take.

What is the Bellevue Literary Review, and why does a city hospital host a literary magazine?

When we started having medical students write patients' stories, we thought about creating a student journal for these writings  Then we realized that there was a larger audience for creative writing that deals with issues of health, healing, illness and disease. The Bellevue Literary Review was created in 2002 as an outlet for fiction, poetry and nonficton on these themes.  As the nation's oldest public hospital, Bellevue Hospital has been home to early three centuries of stories that run the full gamut of the human experience, and somehow feels like a perfectly natural place for a creative tribute to this history.  Published twice yearly, The BLR hosts an annual literary competition. The biannual readings are free and open to the public. The next reading is Sunday, May 3rd, 2009.


Jeff Lyons said...


Wow... what a great post. What a great woman. I love this stuff.


Caroline said...

Danielle is fabulous and so are her books. (So is Bellevue and NYU Medical Center, by the way.)

Leora Skolkin-Smith said...

inspiring stuff. thanks for this!

Caroline said...

Oh God, I meant so ARE ...not so is.. I must be really tired.