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Medicine and Literature, Stanford News, Surgery

Stanford Medicine magazine opens up the world of surgery

Stanford Medicine magazine opens up the world of surgery

surgeon hands - 560

It used to be “big hole, big surgeon” — but no more, according to Stanford’s chair of surgery, Tom Krummel, MD, who’s one of the surgeons featured in Stanford Medicine magazine’s report on surgery and life in the operating room, “Inside job: Surgeons at work.”

During his career of more than 30 years, Krummel has seen a massive shift from open surgeries to minimally invasive procedures — major surgeries conducted with tools that work through small openings.

“We do the same big operation. We just don’t make a big hole,” he said in the article leading off the report.

In the same issue, CNN’s chief medical correspondent, neurosurgeon Sanjay Gupta, MD, talks about why he’s “doubling down” on his support for medical marijuana.

As the editor, I’m biased — but I think it’s worth a read, along with the rest of the issue, which includes:

The issue also includes a report on research on Alzheimer’s disease, and an excerpt from Surgeon General’s Warning, a new book by Associated Press medical reporter Mike Stobbe on the fall from power of the U.S. surgeon general. The digital edition offers audio interviews with Gupta, Stobbe, Stanford surgeon and humanitarian-aid volunteer Sherry Wren, MD, and photographer Max Aguilera-Hellweg, MD.

Previously: The vanishing U.S. surgeon general: A conversation with AP reporter Mike Stobbe, Mysteries of the heart: Stanford Medicine magazine answers cardiovascular questions, From womb to world: Stanford Medicine Magazine explores new work on having a baby and Factoring in the environment: A report from Stanford Medicine magazine
Photo by Max Aguilera-Hellweg

Behavioral Science, Medicine and Literature, Stanford News

Does the sight of blood make you queasy? You’re not alone

Does the sight of blood make you queasy? You're not alone

drop of blood2

After writing about my blood phobia — and what I did to tame it — in the spring 2013 issue of Stanford Medicine, I was surprised to get a lot of e-mail from readers suffering from the same condition or similar ones, or both. (In the world of mental health, blood phobia is categorized together with injection phobia and injury phobia, and known collectively as BII phobia.) Their responses gave me a welcome sense of solidarity.

Some sought guidance. A reader in the Philadelphia area wrote:

I now realize I have this phobia. And I had no idea there was a treatment for it.

I pass out with needles, blood and sometimes when someone just talks about blood! Your article actually made me queasy reading it. It took me a while to get through it. But I’m glad I did.

So you know of any treatment centers in Philadelphia who specialize in this?

A reader in the Boston area explained:

From a very young age, I have experienced BII anxiety and vasovagal responses to various medical stimuli.  I used to not be able to talk about injections without feeling uncomfortable or faint, and now I am able to get them without being anxious or needing any medical aides (I used to take Valium).

I am getting closer to my clinical rotations in PA [physician assistant] school and am worried about my irrational fears of blood, surgery, etc.

I was wondering if you had any further suggestions for the student going into health care with these types of BII vasovagal responses.  I am certain I want to be a physician assistant, I am just so concerned that I will not be physically able to carry out my surgical rotations!

Others, like this Bay Area reader,  just wanted to share their experiences:

I first fainted when I was 12 watching a vet surgery! I had no idea what happened or the reaction I had, but I knew it didn’t feel good. I’ve had a few episodes thereafter, usually at doctor’s offices drawing blood. In fact, last year I almost fainted getting my finger pricked at an office health thing! I think the fasting didn’t help… I am so excited to read something like this. To know I’m not the only one, but that there is something you can do, a real exercise to practice that helps!

Thank you for writing this. I truly enjoyed it and feel better already.

Previously: Longreads pick: Blood, sweat and fears
Photo by Alden Chadwick

Global Health, Medicine and Literature, Stanford News

Exploring global health through historical literature

Exploring global health through historical literature

deskPhysician-authors, including Abraham Verghese, MD, and efforts such as Stanford’s Arts, Humanities and Medicine Program draw the general public’s attention to issues important to the medical field. They may also elicit reader empathy by discussing real-world problems, even in fictional contexts, while situating literature and the arts in an influential position.

This relationship between medicine and literature is longstanding and complex. A Stanford News article discusses some examples of public health and humanism in historical literature and profiles the work of Alvan Ikoku, MD, PhD, an Andrew W. Mellon Fellow in the Humanities at Stanford.

From the piece:

As a scholar of 19th- and 20-century movements in international literature and health, [Ikoku] studies the place of long narrative forms, especially novels, in the development of tropical medicine and global health.

In his current book project, Forms of Global Health, Ikoku reads not Dickens or Gaskell, but writers such as Joseph Conrad and Andre Gide, who added to a “library of metaphors about the tropics and colonial spaces,” one that was referenced by “the fathers of tropical medicine” – returnees from colonial medical services, particularly malariologists, who wrote and lectured publicly about the need to establish a new medical specialty for the colonies.

Ikoku points out that literature provided an opportunity for readers to not simply feel an emotion, but to also actively help define a medical field and its knowledge base.

The article notes that Ikoku taught a course for Stanford students from many disciplines this spring called “The Literature of Global Health,” examining “how literary and medical writers have used narrative to explore the ethics of care in the developing world.”

Previously: Thoughts on the arts and humanities in shaping a medical careerMedical students and author Khaled Hosseini share their muse with Stanford community and Intersection of arts and medicine a benefit to both, report finds
Photo by Ben Sutherland

Events, Medicine and Literature, Medicine and Society, Stanford News

Inside Abraham Verghese’s bag, a collection of stories

Inside Abraham Verghese's bag, a collection of stories

What’s inside Abraham Verghese’s medical bag? Visit the Smithsonian Institution’s National Museum of Natural History to see. Verghese, MD, vice chair for the theory and practice of medicine and a physician at Stanford, is one of the notable Indian Americans featured in the exhibition “Beyond Bollywood: Indian Americans Shape the Nation,” which runs through August 2015 in D.C. and then will tour the U.S.

An article in The Caravan dives into the diversity and complexity of experiences lived by Indian Americans in the United States and opens this way:

IN JOHNSON CITY, Tennessee, in 1982, an Ethiopia-born, India-trained medical resident named Abraham Verghese coveted Dr Steven Berk’s doctor bag. He saved enough money to purchase one for himself, then rubbed it with neatsfoot oil to approximate the well-worn, talismanic quality of his mentor’s bag. Verghese then filled it with his kit—eye drops, calipers, prescription pads—and his hopes of assimilating into the American medical establishment.

Verghese’s bag, one of the exhibition’s hundreds of objects on display, is coupled with the physician-author’s memories from earlier in his career: “I had to ask someone how to tie my tie with a thinner knot so I could fit in,” the article notes. “And the only way I could eat the bland hospital food was to put Tabasco sauce on everything.”

The piece continues:

Verghese’s words capture the familiar dual imperative of immigrant life: on the one hand, fitting in, with a tie knot of appropriate girth; on the other, maintaining one’s tastes, through the strategic application of chilli-approximating Tabasco. His story reminds us that even blue- and white-collar immigrants have to negotiate resistance to the perceived “Third World invasion” of the United States, whether through neutralising accents or by softening the stiffness of difference with neatsfoot oil.

Previously: Abraham Verghese shares what’s in his lab coatStanford’s Abraham Verghese honored as both author and healer,  Stanford’s Abraham Verghese = “today’s most creative person” and Abraham Verghese’s Cutting for Stone: Two years as a New York Times best seller

Events, Medicine and Literature, Medicine and Society

Intersection of arts and medicine a benefit to both, report finds

Intersection of arts and medicine a benefit to both, report finds

An article today on Cleveland.com notes that, at least in Northeast Ohio, collaboration between medicine and the arts benefits both camps as well as the region’s economic health. A preliminary report from the non-profit Community Partnership for Arts and Culture looks at ways art and medicine enrich one another in Cleveland and provides recommendations for enhancing those partnerships. From the news piece:

The report identifies four principal ways in which the art and medicine intersect productively:

• The use of arts and culture in medical settings;

• Participatory programs that involve patients and communities in activities and therapies that promote positive medical outcomes and general wellness;

• The potential shown by arts and culture to serve as a rallying point from which public health and social equity can be addressed; and

• The enrichment of medical training.

Meanwhile, at Stanford, art and science lovers prepare for this evening’s Medicine and the Muse symposium, featuring author Khaled Hosseini, MD. Stay tuned for a recap on Scope next week.

Previously: Stanford’s Medicine and the Muse symposium features author of “The Kite Runner”, Literature and medicine at life’s end and Thoughts on the arts and humanities in shaping a medical career

Events, Medicine and Literature, Medicine and Society, Stanford News

Stanford’s Medicine and the Muse symposium features author of “The Kite Runner”

Stanford's Medicine and the Muse symposium features author of "The Kite Runner"

Hosseini SmallNext Wednesday, Stanford’s annual Medicine and the Muse symposium will bring together medical student art, music, photography and literature in a series of performances and exhibits. During the event, Khaled Hosseini, MD, bestselling author of The Kite Runner, A Thousand Splendid Suns and And the Mountains Echoed, will join Paul Costello, chief communications officer for the School of Medicine, in conversation. He will also be available for book signing.

This year’s Medicine and the Muse theme is “Renewal,” informed by Hosseini’s writing. The event “is an opportunity for medical students to share their artistic talents, and to hear from a physician who has followed his muse to success in writing,” said Grace Xiong, a member of the medical student committee organizing the event.

Medicine and the Muse takes place April 16, from 5:30-8:30 PM in Berg Hall of the Li Ka Shing Center for Learning and Knowledge on the Stanford campus. The event is free and open to the public, but RSVPs are requested. To RSVP, e-mail mandm2014@lists.stanford.edu, or call 650-725-3448.

Photo by Elena Selbert

Autism, Medicine and Literature, Medicine and Society

“No, I’m not ready yet”: A sister’s translation for her brother with autism

Over on Medium.com, Abby Norman shares experiences from her youth in a family with a brother, Caleb, who has autism and a mother with an eating disorder. Able to observe and interpret Caleb’s ways of communicating, Abby acts as a translator to give him a voice that others will hear and, one hopes, understand.

From the piece:

What calmed him was lying on the bed for hours, motionless, watching the numbers of the digital clock change.

He did not potty train on schedule. Instead, he had somewhat of an intense penchant for smearing feces all over the rug and walls of the house. This was his way of saying, “No, I’m not ready yet.” … His relationship to the toilet had nothing to do with his bodily needs: the toilet was his method of rejecting objects. If he didn’t want something, he’d flush it down the toilet.

He was only aggressive in the sense that, when startled or overwhelmed, he would kick and scream. They started out seeming like normal tantrums; but while most kids could be consoled, Caleb could not be, and he would have to literally wear himself down before he would stop.

The author notes that even in understanding her brother’s differences, she was not necessarily his ideal caretaker. The piece continues:

Once he started school, the nightmare only intensified. I say that not to describe what life was like for us, but for him. School, with its unpredictable nature and constant social interaction, its lack of structure for kids who needed anything other than “normative learning.” The truth was, Caleb wasn’t really special needs. He was extremely intelligent.

At home, his day to day life was more or less consistent. While my experience growing up with a mum with an eating disorder was difficult, for Caleb, the obsessive-compulsive nature of her lifestyle was exactly what he required to stay calm and safe. He and my mother had, and to this day still have, a very symbiotic relationship.

Previously: Inspired by his autistic son, a Stanford researcher works to understand the biochemistry of autismThe Reason I Jump: Insights on autism and communication, A mother’s story on what she learned from her autistic son and Autism therapies: It still comes down to parents

Medicine and Literature, Stanford News

Stanford’s Abraham Verghese honored as both author and healer

Stanford's Abraham Verghese honored as both author and healer

Verghese signing booksSeveral times I’ve heard Stanford physician Abraham Verghese, MD, champion of hands-on medicine and bestselling author, answer the question: Which does he considers himself first – a doctor or an author?

Always, I’ve heard him give the same answer. He is a physician first. For him, medicine is “a ministry with a calling.” The meaning to his life is in his ministry to the patient; how best to fulfill that ministry is his life’s journey. This he tells the entering first-year medical students during orientation, reminding them to always hold onto to the desire that drew them to medicine in the first place. The desire to help people.

But obviously, it’s not that simple. For Verghese, the author of nonfiction and fiction books and numerous articles in both the general and academic press, the two passions are intertwined and feed into each other. For him, writing is a path of discovery to become a better physician.

Now, Verghese’s work of combining the two fields has again been honored, this time with Verghese being named today the recipient of the $250,000 Heinz Award for Arts and Humanities. In a news story I quote Teresa Heinz, chairperson of the Heinz Family Foundation, which administers the annual Heinz Awards in five categories, on the choice:

Dr. Verghese’s widely acclaimed writings touch the heart and inform the soul, giving people of all walks of life a true understanding of what it is to heal the whole person – not just physically, but emotionally.

Verghese, who will be the commencement speaker for the Stanford medical school graduation in June, said he was excited about the award, which he considers “a lovely validation of work that is in that realm of being on the edge of science yet very much about the art.”

He also received another recent honor. His only novel (he’s currently working on his second), Cutting for Stone, has made the list of Amazon.com’s “100 Books to Read in a Lifetime.” It’s an accomplishment, he told me in an e-mail, that he’s indeed proud of. What writer wouldn’t be honored to have their book listed alongside the likes of Hemingway’s The Sun Also Rises and W. Somerset Maugham’s Of Human Bondage?

Hearing of these two honors – along with recently having reread Verghese’s second memoir The Tennis Partner - reminded me of how close the author’s love for both art and medicine are wedded. And it reminded me yet again that for Verghese both art and science – which includes the entire medical establishment – ultimately exist as tools to help heal patients.

Previously: Abraham Verghese’s Cutting for Stone: Two years as a New York Times best seller, How Abraham Verghese writes, How a battle with Napoleon helped Abraham Verghese write his novel, Abraham Verghese at Work: A New York Times profile and Physicians turn to books to better understand patients, selves
Photo by Singer, 2012

Medicine and Literature, Medicine and Society, Patient Care

Literature and medicine at life’s end

Literature and medicine at life’s end

The traditional narrative in American medicine follows a “diagnosis and cure” storyline, with the narrative breaking down or becoming extraordinarily difficult when a cure is no longer possible. Literature can help bridge the gap between medical expertise and patient experience, particularly when preparing for death. This idea was explored in a recent seminar, “Literature and Medicine at Life’s End,” sponsored by the School of Medicine’s Arts, Medicine and Humanities Program.

It’s not only the patients and their family who suffer, but physicians are suffering too.

The discussion was led by Alvan Ikoku, MD, PhD, and Sunita Puri, MD. Puri, a Stanford clinical fellow in palliative medicine, read an account of her personal struggle with one particular end-of-life decision for a patient she called “Mr. Smith.” Mr. Smith’s body was so rattled with cancer that it was “hard to tell where the cancer ended and his body began.” He had been admitted to the ER, unconscious, with a dangerous pulse oxygen rate and a blood clot in his lung. There was no family to consult regarding treatment. Puri wrote about the battle between her “text book voice,” which said to treat the blood clot no matter what, and a “deeper voice,” which asked the question, “To what end?”

As Puri and Ikoku discussed, navigating the myriad end-of-life decisions made possible by today’s advanced medical technology is not something that is taught in all medical schools. Ikoku, a Mellon Fellow at the Stanford Humanities Center who has a PhD in English and Comparative Literature, explained that literature can serve to fill that missing component. Using two short stories by physician writer Richard Selzer, MD, “Mercy” and “A Question of Mercy,” Ikoku illustrated how end-of-life situations can be written and read about by physicians, and physicians in training. But there must be space and time for that type of reflection, and today’s hectic healthcare system is not conducive to such reflection.

“It is not only the patients and their family who suffer, but physicians are suffering too,” said Puri, who shared the story of treating another terminal patient at the request of his family, even though he was near death. After the patient coded and had to be intubated, Puri worried that the additional procedures would cause the patient undue pain and distress.

The audience of more than fifty medical students, clinical residents, physicians, teachers, ethicists, and community members, had read both Selzer short stories before the session, and participated in a thoughtful discussion about the lack of end-of-life conversations in American society. One attendee, a clinical resident from Ireland, noted that American culture doesn’t talk about death in any meaningful way, often until it’s too late. In an interesting comparison of health-care systems, Puri and Ikoku noted that the ICUs in both England and Ireland are much smaller than in the U.S., and decisions are made about the use of health care resources for “the best possible good,” instead of profit. One Palo Alto resident noted that it wasn’t just the physicians who needed training in end of life discussions. “That is a big burden we put on our physicians, to have to make those decisions if we have not made it clear beforehand, or shared it with a family member. As patients we need to take responsibility for our own end-of-life treatment.”

The evening ended on a lighter note when a visitor from England said he didn’t understand why in America people were always surprised when an elderly person died. “What do you THINK is going to happen?” he asked gently.

“Literature and Medicine at Life’s End” was part of a seminar series that explores the intersection between arts, medicine, science, humanities and technology. It’s sponsored by the Stanford Center for Biomedical Ethics, the Stanford Humanities Center, and the Stanford Arts Institute, and is supported by generous benefactors.

Jacqueline Genovese is assistant director of the Arts, Humanities and Medicine Program within the Stanford Center for Biomedical Ethics.

Previously: Thoughts on the arts and humanities in shaping a medical careerCommunicating with terminally ill patients: A physician’s perspectiveAsking the hardest questions: Talking with doctors while terminally ill and A conversation guide for doctors to help facilitate discussions about end-of-life care

Medicine and Literature, Mental Health, Podcasts

A conversation with Scott Stossel, author of My Age of Anxiety

A conversation with Scott Stossel, author of My Age of Anxiety

Stossel bookScott Stossel has written a tome on anxiety. The editor of The Atlantic magazine opens his best-selling memoir with a frightening yet comical scene at his wedding. He’s standing at the altar in a Vermont church, and his angst has ripped open his innards reducing him to a puddle of sweat and embarrassment. Anyone who’s suffered from severe anxiety can fully appreciate the yin and the yang of his moment:

The minister is droning on; I have no idea what he is saying… I am praying for him to hurry up so I can escape this torment… Seeing me – the sheen of flop sweat, the panic in my eyes – he is alarmed. “Are you okay?” he mouths silently. Helplessly, I nod that I am… As the minister resumes his sermon, here are three things I am actively fighting: the shaking of my limbs; the urge to vomit; and unconsciousness.

Anxiety disorders have a terrifying grip on nearly 44 million Americans. In the book, psychologist David Barlow, PhD, said of the affliction, “Anxiety kills relatively few people, but many more would welcome death as an alternative to the paralysis and suffering resulting from anxiety in its severe forms.”

I first came across Stossel’s work as a cover story in The Atlantic. Then, I discovered there was buzz about the book, as friends around the country were talking about it. For a few weeks, Stossel was everywhere – Fresh Air with Terry Gross, The Colbert Report, London’s Sunday Times, personal appearances around the U.S., and in laudatory book reviews in the nation’s top papers. I believed his exploration of  “fear, hope, dread, and the search for peace of mind” was something all anxiety sufferers seek, and I knew I wanted to snag him for a 1:2:1 podcast.

When we spoke, I thought I would open with a question I was very curious about. “You’re in the middle of a book tour,” I said to him. “It’s a New York Times best seller. You’re speaking in public. Flying around the county. Doing things that you really hate. So has the book been good for your anxiety, as your doctor posed it might be?”

Well, as you’ll hear, there have been ups and there have been downs. Unfortunately, there’s no Hollywood ending at this particular moment to his psychological puzzle. Yet Stossel does congratulate himself for finishing the book, a task at times he was doubtful he could or would achieve.

When I asked Stossel to read from the book, he said it was my choice what he read. So I chose a passage that was hopeful. It talks about how his anxiety, though often intolerable and miserable, could have an upside. “But it is also, maybe a gift – or at least the other side of a coin I ought to think twice about before trading in,” he writes.

In the end, I’m struck by the tremendous courage that it took for Stossel to lay himself bare – to expose some of his most idiosyncratic fears that have crippled him since childhood. He’s a brave man. It’s for that reason I think My Age of Anxiety has meaning well beyond the words on the page. It will help de-stigmatize this little dark corner of mental disorders. Through peeling back his own layers of psychic skin almost to the quick, I think he’ll change attitudes and  perceptions.

I especially liked what Elizabeth Gilbert, author of Eat, Pray, Love, said about the book:

It could not have been easy for Stossel to dissect his own anxiety so honestly in this memoir. But he was brave as hell to write it, and I’m glad he did, for he brings to this story depth, intelligence, and perspective that could enlighten untold fellow readers for years to come.

Amen!

Previously: Reframing reactions could reduce symptoms of social anxiety disorder, Stanford study shows and Does more authority translate into a reduction in stress and anxiety?
Image from Random House

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