Author: cparedes (Page 1 of 2)

1. What is one powerful aspect of Narrative Medicine that you will take away from this course? How do you see yourself using this information in the future?

There has always been a lingering feeling for me that healthcare professionals were not doing the best that they could do. For many, this is still a mystery. However, through this class I understood why doctors typically treat signs and symptoms. They do not let their patients talk enough. Through letting patients talk, you can learn so much about them and their situation that brought them into your office. I will certainly use this in my future as a physician as I want to be the most effective health care professional for my patients. I will strive to find the center of the illness rather than the outer layers of signs and symptoms.

2. What did you learn about healing in general?

Healing in general is a multi-layer approach. There are always the signs and symptoms which are the outermost visible and talked about. Then, when you dig a bit deeper, when talking to the patient, you can determine the reason why they are having these signs or symptoms. Then when you can finally peel that final layer away, the underlying illness or disease is clear. However, you can only peel off these layers with two way communication between physician and patient.

3. What did you learn about yourself (in general or as a future healthcare practitioner)?

I believe I learned that I need to work more on my communication skills. When I began at UNE I was a die hard introvert. Now, I am transitioning into a role of a leader and extrovert. I have learned throughout this class that these are important skills that I need to continue to develop to be able to properly communicate and lead a patient through their illness and into health. I will always carry these skills and ideals with me as I continue down my path as a future physician.

4. How did you grow as a writer, a reader, and/or a critical thinker?

I have honestly grown a lot throughout this course. I have never been someone who thought they could write, little alone write creatively. This is all due to the fact that I have never really had a creative writing class throughout my time in high school or at UNE. I always thought that english was the worse possible class that I would have to take! However, now I understand that English is not something to be dreaded as it does not always included academic essays and point, quote, explanation, 5 paragraph formatting.

5. Explain why you chose the sample essay you included in your ePortfolio. What does it demonstrate about your learning and growth this semester?

I chose this piece to include into my ePortfolio because I thought it was my first piece that I have ever written that I felt proud to share with others. I believe many of the ideas that I present resonate with the things we learned in class. This includes that emotionally wellbeing plays a lot into a person’s symptoms and diagnosis. It also includes the patient doctor communication, or lack thereof. I feel my story could be universally felt and it needed to be shared.

Stress

Laying on the cardiologists table was something that was not new for me. I knew all too well the turquoise blue plastic table. The kind of table that makes you feel so detached from everything around you. In each room was a different childs theme. I was a 17 year old, lying down in a Winnie the Pooh room. When I was younger, this would have been my comfort, but as a young woman I felt even more uncomfortable with where I was. I knew the doctor could sense that I was over the childish aesthetic of the room and just kept cracking jokes as she placed her cold hands and those cold electrodes all over my body.

My cardiologist was in my educated opinion around 100 years old and 4 feet tall. She had on pants up to her neck and rings that were about the size of the curlers I imagine she used at night. Her hands were mostly wrinkles and liver spots. I also do not actually remember, but it wouldn’t surprise me if she had on oversized harry potter glasses as well. My cardiologist was a cartoon character made into a real life person.

She looked over my ECG and sat down in a chair near the door. It’s as though she sat there to block my only exit, the only exit I wanted to take at that moment. Not that her tiny frail arms could really stop me, but maybe she banked on the idea that I could barely run a mile anymore.

Her legs crossed one over the other, her hands placed gently together on her lap. Her wrinkles at the top of one hand touching the palm of the other, a seemingly gentle gesture.

“Well, there’s nothing wrong with your heart that we didn’t already know about.”

At about 9 years old I had been diagnosed with a heart murmur, which soon cleared itself up. However, I was also told I had mitral valve prolapse. This is a typical condition where the valve on the left side of your heart, arguably the most crucial side of your heart, let’s blood go in the direction it is not meant. Mitral valve prolapse is actually incredibly common, often symptomless. But what they don’t tell you is that some people have symptoms, and one of those people is me. The symptoms for me include sudden chest pain, a racing heart, shortness of breath, and dizziness. This is mostly during strenuous exercise, but it can act up randomly as well.

The room was a blur around me. No, not due to dizziness, due to my incredible ability to zone out in any situation. I have the attention span of a goldfish. Suddenly I was snapped back into attention by a conversation my mother and the cardiologist were having. The cardiologist seemed to be questioning my mother about her job. Not much of an explanation needed there, unemployed for the past few years due to her plethora of medical reasons. Suddenly the conversation seemed to switch over to me and my life.

“Do you have a boyfriend?”

“No.”

“How many brothers and sisters do you have?”

“Five brothers.”

“Oh wow! Only girl?” She obviously wasn’t looking for an answer, no one ever is with this question. “That’s a lot of brothers! How are they?”

“Ok.” I couldn’t understand why she was questioning me about my life. This is a medical visit is all I could think. I did not want to waste my time when I was looking for answers as to why I could barely run anymore. I was always a great cross country runner, excelling in my sport, and running a minimum of five miles a day. At this time, I was progressing backwards. Suddenly I went from running these five miles at a fast pace, to running a mile with chest pain. The pain was radiating from my chest to below my left breast.

“Are you happy?”

Honestly, this was not something I was thinking about in the past few months.I was under incredible stress and I was crying just about every night. I had so many applications and scholarships to submit. I was taking care of one of my brothers, taking him to and from school, as my mother has always been severly sick. Due to her sickness, my family was under immense pressure. One of my other little brothers was being bullied at school for his mental disabilities to the point of a kids crawling into his bathroom stall and punching him. My youngest brother was in the middle of trying to find out why he was so sick lately, the biggest idea being that he had leukemia. My uncle had just been in a motorcycle accident and had to amputate his leg or else he would not survive. I had just had my first heartbreak. I was not running well.

I had become a pencil. It was as if I was using the pencil furiously and pushing down too hard on the paper. My pencil had become dull. It could still write, but not in the same sharp manner as before. I had become numb to the world around me. I was not necessarily sad, but I also was not happy. I felt almost nothing. I did not respond to her question.

Difficult

To be honest, I am still unsure to as to why my cardiologist referred me to a therapist. I did not tell her anything that would have stood out as someone who needed help. I only did not answer her one question; I had gotten every other question right, I told her exactly what I knew she wanted to hear. I will chalk it up to a motherly intuition.

I have never been one to look for help from others or tell them how I am feeling if it is at all negative. I attribute this to my irish roots. As comedian John Mulaney once said, “The plan with irish people is like, ‘I’ll keep all my emotions right here, and then one day, I’ll die’”. This is how my family has always been. My grandfather actually passed away because he was having such intense stomach pains and not telling anyone; He died of an abdominal aortic aneurysm. My father one time called me from the hospital asking me to pick him up, he had been in the hospital for a week and I had no idea.

I definitely was not one of the easiest children this women had sit across from her. Sigmund-Freud, as she will so comically be called, was a woman in her 40s with no memorable attributes, and consequently my therapist for the hour. I was told to choose any seat I wished, and my only options were fluffy couches where you sink when you sit. I would not let this protective padding trick me into anything. She handed me a box of tissues and sat down again with her pad and pencil in her hand. That is what made me so mad, she was going to write down my life on a sketch pad. My life was not something that was as easy as a few words or sentences on a pad, and yet she sat there thinking she could fix me. She told me,“We do not have to talk until you want to”. So we sat there together, in silence.

I looked around the room and observed a room that would have made any movie director proud. A dimly light room with a brown aura. A big brown mahogany office desk lurked behind Sigmund-Freud, with her many degrees lining the wall. Little model brains illuminated the idea, for me, that this is not where I was suppose to be. I was concerned with my heart, not my brain.

“Well, If we do not talk, your mother will be spending her money on something that did not matter.”

I already knew that this was wasting her money. I allowed Sigmund-Freud to ask me her cookie cutter questions to learn more about pathetic childs lives. She asked me question after question and I was honest, but very monotone and straight faced.

“Wow, you’ve got a lot on your plate.”

She pompously sat there and thought she knew so much about me and my situation from the ten minutes we talked to each other. I hadn’t even told her the most of it. Sigmund-Freud had no idea who I was or why I was there with her. When my time was up, I threw those unused tissues onto the couch and walked out.

Resolve?

For a year, I did not get better. Even with my lack of ability, I did not return back to my cardiologist. The trust was just not there. I even had a scheduled appointment with her, to check in, and I called and cancelled it. Eventually, when I went into my first year of college, that pain went away and I was able to start my training again. I always feared my ability of a runner, and I did not even join the cross country team in a fear that I would be in pain again, or not live up to my all.

Sitting in my boring Exercise Evaluation and Prescription class, none of the information really ever jumps off the page to me. I was scrolling through my phone, just through the apps. Basically, trying to find something to look at except  for the symptoms of cardiovascular disease information being presented to me.

I do not care too much about finance, but I wonder what the stocks today look like. The stock market is rising, as always, unlike my attention span in this class. My eyes dart to the professor who is about to look this way. I do not want to seem rude, so I lock my phone and tuck it under my leg. I keep snoozing when presented with cardiac rehabilitation program criteria.

“Notice that if you have clinical depression you cannot be considered for this type of cardiac rehabilitation program.”

The least invasive program, the program where you work out on your own. If you have depression, you cannot work out without supervision if you are a heart attack survivor. I finally understood it all. My professor did not realize he was saying something anyone actually cared about. Speaking about my secret outloud to everyone to hear. I could not run because I was not happy.

There really is no amount of time to put everything in your life into perspective. Like most things, a thought is not black and white, and neither is a feeling. My cardiologist could have been attempting the help me emotionally, however, there was no understanding that she gave me. She needed to have gave me an idea as to what she was attempting to do to me, no matter how hard or uncomfortable that may have been for her. I do not blame her, she was wise in her age and this new way of being a doctor is beyond her time. I only hope that physicians in the future will attempt to explain their actions to their patients, so that they feel comfort and understanding in the situation in which they have been placed.

For the therapist, I feel pity for her. I think she wanted to be this perfect mold of her job description. However, the people who step into her office everyday are not perfect. Perfect is just a word and not a truth. Her care was not perfect and I would have never expected it to be. It was too far from perfect, an exact opposition to everything that she had worked for so steadfully.

There is not much that I can do about the past; All I can do is hold a sharpener in my hand, trying to keep my life unblunted for the furious notes I must take.  I do not doubt that this sort of pain and tragedy will cause the same issues in my life again. The manifestation of bad thoughts spreading into my heart like a disease.

Implementing Narrative Medicine. Yes, we should do it. Yes, it’s going to be difficult to change the healthcare system. No, It won’t be hard to make some small improvements over time.

Ideas are okay. Ideologies are better. Make the ideology of the doctor to listen to the patients. How would we do that? Well. Good question. We could, have more medical classes implemented into the curriculum that have to do with story listening. This has been said a lot of time by classmates, think deeper. We could have story classes embedded in our culture. How would we do that? Bring back the family and community dynamics. How would we do that? Interventions. What type of interventions? This is hard to think of on the fly. Intervention: name a few crazy ones at least, get the juices flowing: We could tell police to become more ingrained as the good guys, we could understand which crimes are serious and which crimes are not, we could stop having a bias in our society. This is too big of a scale, not going to happen for a while. Think of little interventions to help the family and community dynamic. Siesta, like in Spain, but instead an hour of time for family. This could be a valuable idea. But how do you get a whole country to do this. Give med students more down time to spend with family. Give them an hour where they go and have lunch with fellow students, a mutual lunch time. Give them time to eat with their professors, get life advice from them. That would be simple, easy to do. Get life advice about medicine from one on one interactions with professors. Only have professors who are very very practical and understand the idea that I am getting at. We need to focus on getting a general idea in society back to caring about one another.

Dear Martha Hall,

I wish I could have talked to you in person. I suppose, one day I will be able to. I found your books to be beautiful. I found the hardest part to be I expected to write you a letter at the end. I want to tell you about how my class watched your film, read your books alongside you, and were able to share in your pain. The books you wrote gave insight into how you felt in your adventure through healthcare. The books are needed for physicians, the black and white physicians. Words matter; not only in writing but in the voice of the doctor, of the patient, of the individual.

I love how you sat down the doctor and told him he had to finally read your book. He had to sit close with you. He had to explain himself while you were able to explain yourself. This black and white doctor, acknowledging how he acted compared to how you felt. Although, not all physicians may have this wake up call in life, they can try to connect with their patients and understand their actions. Physicians are in charge of a life, not only physically, but also emotionally.

I’m sorry. I’m Sorry. I’m sorry. I’m sorry. I’m sorry, that I was not around to talk to you in your life. Recognition always seems to happen after death for all the great writers. I wonder if you know, what an impact you have had.

Sincerely,

Caitlin Paredes

thought this paper was much more enjoyable to read than Frank’s. I enjoyed the support from research, which adds a validity to the writing which Frank’s was lacking. The most important line I felt in this essay was:

“… good narratives can be beneficial in making our complex experiences simpler and more understandable but, at the same time, they distort our recollection of them”(Pennebaker 13).

I find this similar to Frank’s idea that by telling our stories, we are creating the memory. Although, this may not be exactly what he was imagining. By creating our own story, we may not be completely factual. While telling and creating the story may help us, it is only relevant to our point of view and how we would like to see the situation went. I could argue that we are created the story to be one way. It is either black or white in our minds. Although, life is not always black and white. By not dealing the the spectrum of color, we may not heal in the way that we need to. But by creating a color at all out of nothing is a start to healing.

Although this is a difficult read, as it is more scholarly rather than conversational, it is an important read for future health care providers. It wraps up a lot of what is suppose to be learnt in this class, Narrative Writing and Medicine. What I understood as the overlying heart of this is that people need to tell their stories to understand where they stand with themselves. It was interesting to hear Arthur Franks voice in the podcast, as he sounded far different than the “self” that he had written in. I also find it interesting to know he had written this piece using little notes, knowing that the truth in this piece was his own voice, opinion, and knowledge. Perhaps this piece is also a way of him dealing with his own illness, as he does speak of his cancer quite a bit throughout this essay, which is supposed to be generalized.

I also thought it was great the use of different authors that he had incorporated into his writing. It added validity to his ideas. Also, tying them together, is far more important than anything else. Showing that there is a universal thought about how healthcare and storytelling and their dual effort in treatment is revolutional. Such a scholarly article really adds a language that doctors will understand and feel they are worthy to read. So this discussion has more of a permissive feature to it with this essay added into the mix.  

Healthcare is coming along nicely. I mean, swerve, to that bad health care. You know what I mean? Yea, probably not because you aren’t as cool as me. Honestly, I do not get how people could ever give me bad healthcare. Especially a women doctor. She needs to care more about her job! I do not just want to be pushed off due to my weight. I work out all the time, I work hard to keep my body healthy, just sometimes I need help.

That woman doctor needs to hush. She should ask me more relevant questions. I hate when they just push me off. I need a place that feels warm and welcoming, not those boring old medical tables. Skeet off that if you know what I mean. Doctors sometimes act like they know my body more than me, hello, I am black and beautiful, of course I know my body more than them.

It was interesting to read two pieces at the same time that were so counteracting. In one case with Notes From a Difficult Case by Ruthann Robson, we peer into the life of a patient who has been failed by the healthcare workers around her. In the other case in Healing The Wounds by David Hilfiker, we can see a doctor looking back at his mistakes he has made. Although I say the experiences are counteracting, in reality, they tell the same story.

These stories paint a picture of healthcare mistakes. The patient, expecting their lives to be fixed by the physician, and the physician trying to balance all of their knowledge while helping multiple patients a day. “I am a healer, yet sometimes I do more harm than good” (Hilfiker). Not all doctors can be completely and utterly engrossed in every patients case, which is where healthcare struggles. Some patients will always take obvious precedence over others. If a mistake is made once, it should also be expected to happen again with another doctor. Noone is perfect, but there is also chunks of healthcare which have an obvious imperfection. We need to really find those imperfections so that we can give accurate diagnoses and perform the correct procedures.

She was crying in the middle of the street. The street that had become a source of joy to a form of deception. The girl that had become a source of joy to a form of deception. I watched her as she dry heaved into an alleyway.

“Our ride’s here!” the seniors screeched from a few feet away.

“She’s not ready.” my boyfriend said as they picked her up as though she was a wounded soldier. His opinion did not matter as he did not know them or this girl.

They placed her in the front seat as the sober driver drove the clown car back to our homes. I was forced to sit on someone’s lap as we had packed the car beyond its capacity.

“I expected this to be you…” the girl on my team said to me in an obvious hint that it was my twentyfirst. I readjusted my position to get a better look at my friend. She was crying, fresh puke lining her mouth and cheek. The side of the car was splattered, and from the obvious smell lingering in the air, the car interior needed to be washed.

My friend had seen her ex, and after that there was no coming back from the downward spiral. She had become hypnotized by the pain and regret of leaving someone she loved, and the constant drinks coming her way helped her to forget. However, forgetting was not possible. Sometimes love cannot be forgotten but intensified by numbing your brain and body. I knew this all too well from my last break up, nothing can change your feelings but time.

Wind hitting her face, it would seem like she was asleep if not for the whimpering and the gags. I could feel the wind picking up some of the contents of her stomach and hitting me in the face. Somehow, I was unbothered and grateful to be hit in the face with someone else’s misfortune rather than my own.

The main thing that jumped out to me in this piece, and probably the main topic of discussion is communication. The communication of the health care provider, both spoken and unspoken, seemed to be lackluster and unconsoling. Most of the time, it left this already frantic mother, even more anxious about her child. From the “you don’t know until it is in the bucket”, to the inexperienced medical student, to the doctor who wanted her to sign his book, it all felt unreal. The facade of healthcare ripped off in a moment, the professionalism swept away.

The professionalism in this piece also was shown to have a common structure. “Valerie is a saint, but her voice is the standard hospital saint voice: an infuriating, pharmaceutical calm.” Just like in any situation, a pre-scripted, fake response can easily be seen through. People in pain often want the actual human interaction that is unknown to the conscious watch of our ego. The second we give a sympathetic look or an ideal that nothing is abnormal, is the time we go beyond human and become a robot. The biggest struggle I believe for a healthcare worker, is not to become a modeled version of who you should be. Healthcare workers should go with tools they knew were important before all the anatomy classes and empathy tests with paid actors. Do not let what you should be outshine what you know you are.