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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

Medical Education, Medicine and Literature

Thoughts on the arts and humanities in shaping a medical career

We’ve written before about art’s intersections with medicine. For example, Audry Shafer, MD, director of Stanford’s Program on Arts, Humanities, and Medicine, explains how art in the medical setting can help patients and caregivers communicate an experience. A multidisciplinary undergraduate course helps students understand the structures of human viruses through sculptural renderings. And physician-author Abraham Verghese, MD, professor of medicine, advocates for attention to bedside manner through literature as well as policy.

Over on The Arnold P. Gold Foundation’s blog, Johanna Shapiro, PhD, a professor at UC Irvine School of Medicine, makes another case for letting your pre-med son or daughter major in philosophy (or sociology or art history). She writes:

To me, the most important meta-questions a future physician can engage with (preferably every day of her life) are fundamentally moral ones:

  • What kind of doctor do I want to be?
  • Who am I and who can I become within the practice of medicine?
  • How do dominant discourses in medicine and society influence me, my patients, and our community in negative or positive ways?
  • What is my commitment/responsibility/ to my patients and my community and how can I best serve them?

Arts and the humanities serve not to make you a better person, Shapiro writes, but to encourage you to continually examine and evaluate your actions – a useful course of study in any profession.

Previously: Stanford humanities course helps counteract the “powerlessness and shame” of addictionMore than medicine: Stanford medical students embrace their artistic passions through unique program and Live tweeting journalist Sheri Fink at Medicine and the Muse Symposium 

Medicine and Literature, Stanford News

Stanford Medicine magazine’s big reads of 2013

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The 10 most-read Stanford Medicine magazine stories published this year (as determined by pageviews on our website):

Almost without hope – Seeking a path to health on the Rosebud Indian Reservation: Tracie White’s report on life in one of the hardest places in America to stay healthy — the Rosebud reservation in South Dakota.

Labor day – The C-section comes under review: An article by Julie Greicius explaining the rise of C-sections and why a decrease in how often the procedure is performed should be around the corner.

Microbe computers – Built from the stuff of life: A feature by Andrew Myers on the creation of a computer made of biological molecules that can run inside our cells.

Blood, sweat and fears – A common phobia’s odd pathophysiology: John Sanford’s story about conquering blood phobia.

Against the flow – What’s behind the decline in blood transfusions?: Sara Williams explains the drop in transfusions — and why it’s good news for health.

Leo and Frida – The doctor and the artist: A feature by Catherine Reef on the friendship between artist Frida Kahlo and Stanford surgeon Leo Eloesser, MD.

Too deeply attached – The rise of placenta accreta: Erin Digitale describes the epidemic of placenta accreta and how this potentially fatal condition affected one family.

Roll up your sleeve – There’s still no substitute for blood: Jessica Shugart on why blood donation remains crucial.

In his blood – A doctor driven by hemophilia: Krista Conger profiles Holbrook Kohrt, MD, a physician who grew up with hemophilia and is dedicating his life to finding cures for life-threatening disease.

Priming the pumps – Debugging Dhaka’s water: Ruthann Richter tells how a trip to the slums of Dhaka, Bangladesh led to a radical solution for contaminated drinking water.

Previously: Stanford Medicine magazine’s big reads of 2012 and Stanford Medicine magazine’s big reads of 2011
Illustration (the cover of our special report “Blood at work”) by Renphoto

Media, Medicine and Literature, Technology

More reasons for doctors and researchers to take the social-media plunge

More reasons for doctors and researchers to take the social-media plunge

I’ve come across so many helpful and insightful articles on medical and science professionals’ use of social media lately that I’m compelled to share a few. Last week on Wing of Zock, Cynthia Floyd Manley, associate director of public affairs and marketing at Vanderbilt University, shared nuggets from a recent conference on digital professionalism and reminded readers why maintaining a digital presence is so important for doctors. (She quoted Bryan Vartabedian, MD: “Physicians have two choices, really. They can participate in the discussion that is happening online and frame the story, or they can let someone else frame the story for them.”)

Earlier in the month, the PLOS blog Mind The Brain published a Q&A with a young scientist who uses Twitter to connect with other researchers and learn more about what’s happening in her field. She provided concrete tips for those scientists who want to dip their toes in the Twitter waters and also shared how the platform connects her with other academics:

I feel that with Twitter, my academic world expanded to include many colleagues I wouldn’t otherwise meet. I am now able to keep my finger on the academic pulse better. The information shared on Twitter is so much more current than you would find on journals or conferences. For instance, academics I follow post their latest articles on Twitter that would otherwise probably take me months to learn about. I can then ask questions of the authors themselves and chat with them. I think we all love to talk about our work!

And just today, MedCrunch featured a piece singing the praises of Twitter (which prolific blogger and social-media expert Kevin Pho, MD, calls here “the most powerful application for listening and for keeping informed about what’s happening in the science and medical communities”) and encouraging physicians to – at a minimum – create and maintain professional profiles on LinkedIn. As Susan Williams writes in her post, “defining your reputation by illustrating your credentials and your authority in your field affects two of the most important patient-doctor relationship traits: respect and trust.”

Previously: How should doctors respond to negative reviews?, A reminder to young physicians that when it comes to social media, “it’s no longer about you”, How using Twitter can benefit researchers, Advice for physicians when interacting with patients online and How can physicians manage their online persona? KevinMD offers guidance

Medicine and Literature

When death comes rapping at the chamber door: Writers inspired by crises and medical emergencies

looking to heavenHave you ever had a near-death experience? I haven’t, so I can only imagine how much more creative I could be right now. At least that’s the leap I chose to make after reading a blog post on The Airship that featured eight famous writers who experienced medical emergencies or sidestepped an untimely death and went on to produce now-canonical works of literature. These are suffering artists not in the heartbroken sense, but on a physiological level.

Russian novelist Fyodor Dostoyevsky, the piece notes, endured seizures all his life. When he was arrested at age 28 and sentenced to death, and then unexpectedly freed by order of the Tsar and sentenced to hard labor in Siberia instead, things started looking up. From the piece:

This incident is said to have increased the frequency and severity of Dostoevsky’s epileptic fits, but the young writer also channeled the experience into his work, evident from this passage in The Idiot:

He said that those five minutes seemed to him to be a most interminable period, an enormous wealth of time; he seemed to be living, in these minutes, so many lives that there was no need as yet to think of that last moment, so that he made several arrangements, dividing up the time into portions — one for saying farewell to his companions, two minutes for that; then a couple more for thinking over his own life and career and all about himself; and another minute for a last look around…

Then there’s Stephen King, who, during an uncharacteristic bout of writer’s block, took a walk to clear his head when working on “On Writing”:

A passing driver, distracted by his dog moving around, plowed into the unsuspecting writer. King flew into a ditch, where he suffered a collapsed lung, severe fractures to his leg that nearly required amputation and a broken hip.

Despite undergoing several subsequent surgeries, King kept working on the book, for which this new experience formed an integral part. In addition, upon his return home from the hospital, King was able to see his studio as it would have been had he died in the accident. That image provided the inspiration for his subsequent novel, Lisey’s Story.

The other authors’ stories include similar cliffhangers and injury recoveries.

Via @randomhouse
Photo by kevin dooley

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