Literature and Medicine

I am developing a class for the Medical Scholars at Michigan State University. These are students accepted into medical school at MSU at the same time they were accepted to MSU undergraduate. They are guaranteed a place in the medical school as long as they keep up their GPA and pass all their premed requirements. As part of the program, students from all four years participate in monthly meetings and group and individual projects.

This year, I'm in charge of the yearly theme - the doctor-patient relationship. Over this summer, students will read 10 short stories all from the perspective of the patient. The monthly sessions will begin with discussion of the readings as well as discussion of what the doctor patient relationship is all about. Then, as students start to learn about the doctor side of the relationship, they will be assigned one of the characters from the stories. That character, and the illness or disability they have, is what the student will research over the next few months. The story helps them understand the kinds of psychological and social issues that arise as a result of the illness process. Then, they will role play their patient in practice doctor-patient interactions. At the beginning of the year we'll have them write a little about the kind of patients they think they would dislike the most. At the end of the year they will revisit their writing exercises to see if any of their ideas have changed.

The stories they will be reading include:
Mirrorings, by Lucy Grealy: a nine year old girl has half of her jaw resected because of cancer. She details not only the treatments, but also the way she is treated in school and outside because of her deformity.

Fathering, by Bharati Mukherjee: the American father of a Vietnamese girl deals with her illness, her mistrust of doctors, and her use of traditional remedies as he tries to find care for a child who is wild with fear and the residue of trauma.

We are night time travelers, by Ethan Canin: An elderly man, dissatisfied by the way he and his wife converse over the rows of pill bottles on the kitchen table, and constrained by the effects of age, illness, and habit, tries to rekindle the love in his marriage.

One Last Time, by Lori Russell: A woman struggles with her husband's painful dying from cancer as she tries to give herself permission to envision her own life after he is gone.

He Read to Her, by Anne Brashler: A woman who has just come home from the hospital after having bowel surgery tries, with her husband's help, to come to terms with living with a colostomy.

From "Cotton in my Ears" by Frances Warfield: A little girl tries to explain the strange behavior of the grown ups around her before she is diagnosed with profound hearing loss.

A Problem of Plumbing by James M. Bellarosa: A paraplegic man who is cultured and educated has to deal with the indignity of inaccessible toilets when out on a date with a beautiful woman.

From "My Left Foot" by Christy Brown: This selection is from early in the book, where the narrator recounts what life looks like from inside a body that he cannot control.

Sex, by Irma Wallem: an elderly arthritic woman who lives in a nursing home competes with the other women residents for the affection of a man, any man.

Milk, by Eileen Pollack: a single Anthropologist is in the hospital after giving birth. Her roommate is a raucous, oppositional black woman whose baby is sick. The story explores prejudice in medical care and its repercussions.

There aren't a whole lot of doctors in these stories. It is important, I think, for the students to realize that doctors aren't necessarily central to the lives of their patients. Their treatments may be - like Lucy Grealy's surgery, or the chemotherapy for the husband in "One Last Time." But the day to day living of life for patients happens without their doctors being in charge. It is not always clear if the doctors and their treatments are helping or hurting. And it is not always clear whether the doctors could help more, especially if they knew what their patients' issues really were.

Some of these stories are annotated in the Literature and Medicine Database, with source references, if you are interested. I prefer to use short fiction or essays in my teaching over novels. The shorter pieces allow for multiple perspectives on similar themes in a way that a novel doesn't. I also try to use mostly contemporary works. In that way the students know these issues are current and relevant for them.

Doctor as rescuer

My husband has been pressuring me to take on coverage of a nursing home 60 miles from here for an internist who is pregnant and will soon be on maternity leave. He tells me the nurses are fed up with the doctor's irritability. He seemed awfully disappointed that I said no.

The urgency behind this request puzzles me; after all, he is the one who consults at that nursing home, not me. I don't know any of these people, the internist included. It isn't clear that the doctor even needs a replacement (she has at least one partner), and the doctor's irritability is likely to be temporary. But my husband has responded emotionally to the nurses' emotions in this situation. He wants to bail them out. He imagines the stress the internist may be under. He wants to bail her out, too. He projects his own anxieties about money onto me; he wants to bail me out, too.

Perhaps all doctors need to rescue others. I suppose at first I was that way, too. I quickly learned, though, that adults are rarely helpless victims (aside from acts of random violence or natural disaster), and bailing them out doesn't provide any lasting benefit.

When I first went into practice in a rural community health center, so many patients, young women especially, brought their problems to me. I heard about violent husbands and unruly children and dying parents and bad work environments and illness and symptoms and a whole slew of issues. At first I felt incredibly burdened by these problems. What could I do to fix their marriage or their job? What pill would make their violent husband go away?

Finally, I learned to respond with: "What do you think you need to do about this?" Most of the time the patient had good ideas, and was just looking for someone neutral to talk things over with. I could bolster their problem solving skills and even teach some additional skills, but no longer felt burdened with the job of finding the answers for them. I use that technique for medical problems too, especially stuff like obesity and tobacco use and stress management. "What do you want to work on first?" helps the patient focus on a smaller part of the problem and find goals that are manageable.

So, what is my husband's deal? He wants to rescue the nursing home staff, he wants to rescue the internist attending, and he wants to rescue me. None of us have asked to be rescued. And what does he get out of the rescuing? Well, he gets to be a hero, with grateful, helpless people, especially women, thanking him profusely for making their terrible problems go away.

No doubt rescuing others is the basic motivation for most people in the helping professions. I wonder, though, if the rescuer is the one who deep down needs to be rescued. My husband was the middle child in his family. His independent, self sufficient older brother probably resented him tagging along. And once his younger sister developed medical problems at a young age, the family focus turned to her. I suspect that the helpful, conscientious middle child disappeared off the family radar.

My husband admits that he has always wanted to cure his sister. What he doesn't talk about is how curing her would have turned the family focus onto him; who wouldn't want eternal gratitude? Over and over he tries to rescue people - his sister, his relatives, his first wife, who is an expert at being a victim; patients; me, I suppose. Who else? Then he collapses at the end of the day from all the responsibility that rescuing implies. There is never enough gratitude and admiration to counter all that responsibility.

So what do I do? I dig in my heels and resist his rescuing by proxy urges, and encourage him to get more information before assuming that the parties in question need to be rescued. And then I need to remind myself that his urgency may indicate his own need for appreciation and attention. It may feel like a bottomless well of need for appreciation and attention, but ultimately it is a need we all share.

And then, if my model of working with patients applies, it may be my job to help him refocus, to suggest other ways that the problems can be addressed. As his wife, I do have responsibility to give him attention and appreciation. The trickier part is to figure out where my responsibilities begin and end. It is awfully easy to be the guilty wife, and believe it is my responsibility to prevent him from suffering. The guilty doctor in me feels the same. Thank goodness for that little voice of sanity that helps me see that my own boundaries need protecting, too. Without boundaries, we all turn into victims.