Writing

Students balance medical school with creative writing – mySanAntonio.com

In situations of life and death or pain and suffering, it can be cathartic to put those feelings and emotions down on paper.

For doctors, it is their job to make life-and-death decisions and face the pain and suffering of their patients.

Narrative Medicine, the practice of combining health care and literature, has gained popularity in medical circles as a way for physicians to process their own feelings, clarify values and come to grips with often unconscious emotions in an emotionally volatile profession.

“Narrative medicine is about the story of the patient as well as the story of the doctor, as he or she struggles with the very challenging and yet very beautiful and rewarding career path,” said Dr. Renate Rosenthal, assistant dean of Behavioral Science Integration at the University of Tennessee Health Science Center.

The UTHSC College of Medicine has a long tradition of a student-run “Cadaver Ceremony,” in which first-year students pay homage and respect to the people who donated their bodies to be used for Anatomy Lab instruction.

For the ceremony, each Anatomy Lab group writes a narrative about their experience.

“These narratives often take the shape of a poem, story, a fantasy of who this person may have been, or an account of the challenges before a student can confidently cut into a human body,” Rosenthal said. “The narratives are often very touching, creative and revealing of considerable literary talent, but they were never collected or published.”

About eight years ago, a group of medical students formed a literary interest group to change that.

They called it Janus, in honor of the two-faced Roman god of transitions and beginnings, and in reference to the fact that so much of medical care deals with transitions — from health into illness, from birth to death, from conception to new life, Rosenthal said.

In addition, medical education is a journey, characterized by many transitions as well.

As medical students enter their third year, they transition from the classroom to the clinic.

Students received the sixth edition of Janus Thursday, May 2, during a ceremony recognizing students’ move from simulation and labs to accompanying a trained physician to see their first patients.

The bound 21-page journal contains detailed accounts of medical students’ most difficult days in the clinic and the classroom.

“For medical students and physicians in training, training is rigorous and hard and very tiring,” Rosenthal said, who also serves as the faculty mentor for Janus. “Many students don’t come to medical school prepared for it because they’ve always been the cream of the crop. They’ve always been the ones who know everything, who do everything right, that everyone admires, the strong ones in the family, who took care of the family. Now, all of a sudden they are here and it’s more than they expected.”

That’s where the spring 2019 title “Drinking from the Firehose” comes in.

Janus editor-in-chief Max Rippe remembers feeling completely overwhelmed when he joined Janus his first semester. He wrote a poem for the publication titled “What Does it Mean Now?”

“It was on ‘what does it mean now that I’ve been accepted to medical school,'” Rippe said. “The world sees me as a success and I can’t help but feel like I’m struggling or failing.”

Seeing his work in black and white gave Rippe something to be proud of at a time when he was feeling low. Later this month, he will graduate and work in emergency medicine at Jackson Memorial Hospital in Miami.

“It’s so valuable to me to see that other people have moments of doubt, and has made me feel so much less alone during medical school,” Rippe said.

Janus associate editor Mel Justo comes from a family of clinicians. Her dad is an internist and her aunt an anesthesiologist, so she’s always had an interest in medicine, but her passion is writing.

She finished her pre-meds in undergrad as a poetry major.

In clinical skills courses, students are graded on empathy. One of the metrics is asking the right questions to make sure the future doctors can resonate with what a patient is going through.

“The difference between a doctor and a very good doctor is how they can interact with their patients — not knowing every pathology or prescription,” Justo said. “The biggest difference is to be able to talk to a patient and come to them as a stranger, but leave knowing the most intimate details of their life.”

Justo’s path to developing empathy comes through reading. She rarely reads a book about medicine, but likes the classics. She recently finished “Lolita.”

“The way in which they write, I can put myself in someone else’s shoes and see from their perspective,” Justo said. “Practicing looking through someone else’s eyes is just as important as looking through an ophthalmascope.”

Understanding the true history of a patient requires being interested in the patient’s story — not just the symptoms, disease and cure, but who the person is, Rosenthal said.

“Nowadays, many physicians don’t value the patient’s story,” she said. “How can you make a good decision about what the patient needs if you don’t know who they are?”

Rosenthal stresses how doctors cannot just assume a patient has the ability to follow the care they prescribe.

“Physicians write prescriptions and don’t ask if the patient has insurance or the money to pay for them or even transportation to the pharmacy,” she said.

While medicine has come a long way in accepting and respecting the social determinants of health, patient stories can help doctors better understand those social determinants by giving them context.

“You all have your own stories and I’m encouraging you to pay attention to who you are, where you came from, the prisms through which you see the world, and if you are in the mood, you might want to commit some of this to paper,” Rosenthal said during Thursday’s ceremony.

This summer, the student staff will begin taking submissions for next year’s edition at the end of the fall semester.

Students are encouraged to write about their experiences and reflections in real time.

“There is great value in stories and expressing yourself in stories,” Rosenthal said. “There is great value in writing diaries. There is value in journaling. There is value in talking about yourself — that’s what psychotherapy is all about — but you don’t have to go to a professional counselor. A lot of times you can write out your own stuff and look at it and say, ‘Hmm, I didn’t know that’s how I felt.'”

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