Language: English

Do no harm: Stories of life, death and brain surgery.

Very human memoir from a neurosurgeon nearing retirement who tells stories from his experiences of doing (and deciding against) brain surgery. He’s expressive, emotional and even poetic about the beauty and hardship of neurosurgery: p.8 “There is a fine, surgical poetry to (the names of the parts of the brain) which, combined with the beautiful optics of a modern, counterbalanced microscope, makes (pineal gland tumor surgery) one of the most wonderful of neurosurgical operations – if all goes well, that is.” p. 14, observing his first brain surgery: “I had the strange feeling that this was what I had wanted to do all my life … it was love at first sight.” p.25: “I have not yet lost that naive enthusiasm with which I watched that first aneurysm operation 30 years ago. I feel like a medieval knight mounting his horse and setting off in pursuit of a mythical beast.” Marsh also recreates many conversations with patients, giving his own emotional backstory – “His anxiety made me more nervous as I tried to reassure him” “I wasn’t sure she was really taking seriously the risks of the operation, but in the end it was her decision.” He’s brutally honest about his own shortcomings and failures, breaking down the barrier between physicians and patients in healthy and illuminating ways.

Chapters are short and self-contained, making it easy to assign 10-12 pps for a topical reading in many kinds of courses: interpersonal communication, relationships, health communication, medical student life. The particular conditions recede in importance; what matters are the human beings, their relationships, communication and love for medicine. This is well-written enough to be a model for creative writing courses.

Being Mortal: Medicine and What Matters in the End.

A contemplation of the limits of medical care through many specific stories of decision points about when to stop treatment in favor of palliative care. Gawande has been a physician for a long time and an activist/ writer on the side of “know when to say when” – i.e. just because medical technology exists to prolong life doesn’t mean that’s the best thing to do – for almost as long. He makes convincing cases for stopping expensive treatment and “giving life to days” more often than Hail Mary passes that might bring on the 2% chance of a cure.

The book is a readily accessibe read for many audiences and could be assigned in full or excerpted. It was also the subject of a PBS documentory that could be used to supplement class use and bring the text to life.

As a physician, why write?

This is the first post in a new blog on U Mass Med School Medical Humanities Lab, 2019. It is an articulation of why all physicians are storytellers and why most would do well to write them down. This could be beneficial for medical students to reflect upon in order to show the importance of health narratives to new physicians.

The Hidden Dying of Doctors: What the Humanities Can Teach Medicine and Why We All Need Medicine to Learn It

This review of Kalanithi’s “When breath becomes air” focuses most on the opening story of a young colleague who took his own life, the problem of medical student and physician suicide/ depression/burnout, and how humanities education could alleviate the suffering of doctors by connecting them with the human side of medicine, their own and that of patients. This is very useful as a first-week reading in a Foundations of Health Humanities course or as a reference for a talk to aspiring med students

It’s the ‘life’ in end-of-life that matters

Prompted by Atul Gawande’s New Yorker essay (“Letting Go,” which addresses similar themes as his book, Being Mortal), the author reflects on two experiences he had as a resident in the NICU, one in which all possible medical treatment was pursued inappropriately and another in which extra-ordinary measures were not applied so that a family could spend a final day with a fatally ill newborn. The author blames the broader medical system, and says his frustrations with that system led him to his current occupation as a health services researcher.

In contrast to end-of-life stories that involve elderly patients or terminally ill adults, this blog post provides vivid examples of NICU treatment decision-making.

Letting go: What should medicine do when it can’t save your life?

Tells several of the wrenching stories from his book (Being Mortal), making points about medicine’s reluctance to stop treatment and acknowledge the patient is dying, even when the chance of improvement is slim to none. “Modern medicine is good at staving off death with aggressive interventions–and bad at knowing when to focus, instead, on improving the days that terminal patients have left.” 13 pps; suitable for undergrads, professional students, maybe medical students; describes hospice treatments and misconceptions about hospice.

Speaking of Addiction

Dr. Meaghan Ruddy speaks on the importance of the language that health care providers choose to talk about drug addicts, specifically opioid addicts. She shares her story of when she critiqued the label “drug-seekers” in an emergency department that had many such cases. Dr. Ruddy then calls for a focus on destigmatization for drug addiction in future generations of medical professionals. Relevant to pre-med, medical students.

Tourette Syndrome: The biomedical and the literary.

The blog “According to the Arts” is written for the general public. The posts juxtapose a medical description of an illness or disability, in this case Tourette Syndrome, with a novel in which one of the main characters exhibits the condition. The novel captures the signs and symptoms, and describes how Tourette syndrome can affect lives of people living with Tourette and of living with someone who has it. The biomedical text from a neurology journal describes the characteristic tics and behaviors. Comparing the story to the medical account shows the science vs humanities perspectives on illness and could be useful for undergraduate classes in health humanities, especially ones focused on writing. Also useful for health professions students and professionals to emphasize the human factors often missed in clinical encounters.

Intoxicated by My Illness, and Other Writings on Life and Death

The link is a review by J. Russell Teagarden of a book by Anatole Broyard, who died of prostate cancer but used his illness as a way to reflect on literature and illness (and literature and medicine). Teagarden explains that the book is “a collection of writings concerning illness and death, mostly his, and in particular, the metastatic prostate cancer that took [Broyard’s] life at age seventy.” The book is not a chronology of Broyard’s illness but, instead, a collection of his New York Times articles, his notes and early drafts of writings, and a talk he gave at the University of Chicago medical school.

Two subjects in particular might be used in a class. One is an approach to thinking about terminal illness. As Teagarden explains, “The book begins with the first of many counterintuitive notions Broyard offers when he refers to being intoxicated by his illness. With the diagnosis, he ‘is filled with desire—to live, to write, to do everything. Desire itself is a kind of immortality.’ (p. 4) Broyard is not just intoxicated by his illness; ‘I’m infatuated with my cancer.’ He is not doomed as much as he is freed; ‘I can afford now, I said to myself, to draw conclusions.’ (pp. 6-7). Likewise, the idea of meeting death with style is a theme across the book.

The book also addresses the relationship between literature and illness; as Teagarden states, “he considers the literature of illness, the literature for illness, and the literature of death.” The book includes passages in which Broyard tells the story of his illness, and the story of his father’s illness (both died of prostate cancer).

To be a good doctor, study the humanities

The author makes the case for why the study of humanities is necessary for a complete medical education. Humanistic study helps to answer questions that are essential to being a “good” doctor, such as “how best to support a patient who is dying. Do you cry with the patient? Is it acceptable to be detached? Is it OK to resume your life and laugh a few hours later?” Humanistic study also helps physicians appreciate social determinants of health. The article also provides statistics on medical humanities programs, med school acceptance rates for students with humanities background, correlations between humanities background and positive and negative physician attributes, and patterns of residency choices.

The essay could be used as an introductory reading in a medical humanities course.