Latest / Flourishing in Medicine: From Surviving to Thriving / Flourishing in Medicine: From Surviving to Thriving Episode 15 Activism and Empathy in Medicine: Dr. Rita Charon on Narrative Competency

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Flourishing in Medicine: From Surviving to Thriving Episode 15 Activism and Empathy in Medicine: Dr. Rita Charon on Narrative Competency · Flourishing in Medicine: From Surviving to Thriving

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What do you think about the work?
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I don't think that's a question I can answer because you gotta fit what you bring to a
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group.
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And I can say go read Wings of the Dove, it's only 600 pages of a Henry James novel.
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But I can quote you the line from that novel that hooked me into doing this work.
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Alright?
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It's a young sick woman sitting in her doctor's office for the very first time.
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And the doctor only has 10 minutes for her visit through some situation in his scheduling.
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Only 10 minutes had he to put at her disposal.
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And then the patient reports and here's the sentence, so crystal clean the great empty
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cup of attention that he placed between us on the table.
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Welcome to flourishing in medicine from surviving to thriving.
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I am your host, Dr. Mick Krasner and this podcast is produced by EmPRO, a medical liability
1:24
insurance carrier in New York State.
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EmPRO is committed through its peer support offerings to supporting the physicians they
1:31
protect.
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The title of today's podcast is Activism and Empathy in Medicine, Dr. Rita Charon on
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Narrative Competency.
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Dr. Charon is a general internist and literary scholar and one of the founders of the field
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of narrative medicine.
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She completed her MD at Harvard Medical School and a PhD in English at Columbia University.
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She's the Bernard Schoenberg Professor of Social Medicine, Professor of Medicine and
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the founding chair of the Department of Medical Humanities and Ethics at Columbia University
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College of Physicians and Surgeons.
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Her research in narrative medicine has been supported by the NIH, the NEH and many private
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foundations and she's authored, co-authored and co-edited four books on narrative medicine.
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She lectures, teaches internationally and publishes extensively.
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She's considered the expert on narrative medicine.
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And this conversation was exciting and so alive.
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She discusses her early experiences with her father's medical practice that inspired her
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to pursue a career in medicine, as well as the impact of her love of literature that
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led to her deep dive into that field, her heartfelt and enthralling journey into literature
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enriched her medical practice by enhancing her listening skills and her ability to unearth
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deeper meaning in patient interactions.
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She emphasizes the close reading of non-medical texts as one way in which health professionals
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can recognize and address structural inequalities within the healthcare system.
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Having had the pleasure, joy and transformative experience of attending one of her narrative
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medicine intensives on the topic of race, this conversation led me back to the written
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word in books as not only an activity for pleasure and deepening meaning in my life,
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but for understanding the fleeting nature of our time as health professionals, as human
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beings, as living things.
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Why not then in our patient interactions be hooked as she was by the words she shared
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with us of Henry James, quote,
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So crystal clear the great empty cup of attention.
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A delightful, engaging, affirming and hopeful discussion.
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I hope you enjoy this conversation with Dr. Rita Charon.
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Welcome to Flourishing in Medicine.
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I am so happy to have Dr. Rita Charon with us today.
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Hello, Rita.
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Hello, Mick.
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I'm so happy to see you again because over the decades we have interacted a lot.
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Yes, it is great.
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I wish I was there in person, but it's the next best thing one could say or at least
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one can kind of think about that possibly.
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So what I'd like to start with, Rita, is have you share with us a bit of origins around
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your interest in medicine?
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Why did you choose all the things you could do with your life as you started out in your
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education?
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You must have fairly early on maybe focused on getting into medical school and then going
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to medical school.
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What was it?
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What were some of the progenitors to that?
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What were some of the things that you experienced or things that happened to you or your own
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you that led you to that?
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Kind of your origin story, we could call it.
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Well it starts when I was a kid, like eight years old, ten years old.
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My father is a GP, was a GP.
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He was from French-Canadian ancestry.
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His practice was in Providence, Rhode Island where I grew up.
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And he would see mostly the French-Canadian immigrants in the office.
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And my sisters and I would routinely go into his office, sit in the back room, put away
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the mail, you know, put the syringes in the boiling water to sterilize them like that.
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So we were the support staff for my father.
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And we got to understand how sacrosanct that office was.
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Now we also went on house calls with him.
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This was, I was in high school like in the very early 60s.
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We would go on house calls with him.
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Several of the house calls were in what is still called South Providence, which is the
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segregated black neighborhood of Providence, Rhode Island.
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I believe it's still that way.
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And we would sometimes, or I would sometimes, go with him to make a house call.
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And it was shocking to me that I, as a kid growing up in this city, for by then like
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14, 15 years, had never been in the home or even in the social presence of a black person.
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So my father expected me to be the doctor.
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I was the one of five sisters who like did well in school or I don't know what, but I
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was somehow elected by him.
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And that felt fine to me.
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And then I went to college.
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I came to New York to college and got involved.
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This was the late 60s by then.
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I was involved in the peace movement and the draft resistance and stopping the war in Vietnam.
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So for a period of years, I didn't want to be adopted.
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I didn't want to be a white professional.
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I didn't want to be separate from the struggles.
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And then after years of teaching school, driving a school bus, things like that, I realized
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he had had a very good idea for me.
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So I applied, got into medical school and never regretted it.
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Well, that's a wonderful story.
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And also interesting that, you know, if you were sort of the support staff in the office,
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one could have had an opposite reaction.
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I'm done with this.
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I'm done with cleaning syringes and doing that.
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I don't want to have anything to do with medicine.
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I was curious about a word you used, sacrosanct.
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And I want to come back to that in a moment because words I think are really interesting.
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And I want to see if it ties in at all with the second half of that answer, which had
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to do with house calls and visiting, especially the segregated area and contacting kinds of
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people one could say that you had no idea of how they lived their lives and in any contact.
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And then this connection with struggles.
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Can you say something about, and then it was shocking what you found.
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Was there something sacrosanct about that experience?
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And then maybe help us define what you mean by sacrosanct.
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So my father had on the office wall a painting, but it was a pastel reproduction of Sir Luke
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Field's The Doctor.
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I'm sure you know that painting very well.
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It was on his office wall the entire time I was growing up.
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And it was only when he died that I took possession of the painting.
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So listeners may know this painting, but it is a physician appearing man sitting at the
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bedside of a very ill appearing young girl with the parents in the background suffering
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terribly.
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So we get the sense that this is a serious, maybe terminal illness.
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And we look at the physician figure who seems not to know what to do except to sit there.
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And that's the witness and that's the sacrosanct's room.
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It's a room of illness.
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It's a room of pain.
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It's a room of sorrow.
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It's a room of loss.
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And the physician figure, although he didn't seem to have much to do, was admitted into
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this sacred space.
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Was the apartment in South Providence sacrosanct?
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I wouldn't have used that word.
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It was rather more telling of the divisions between white providence and black providence
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between people who are comfortable and people who are not comfortable.
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So it was much more a call to action.
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Yes, I can see how that would be a call to action.
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I can also see that as you define sacrosanct, you use the word witness and I filled in the
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word presence also.
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And there was something about you showing up with your father on a house call in a neighborhood
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in South Providence that also was a witnessing and being present to that condition.
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Exactly.
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Exactly right.
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Thank you.
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I know we're going to be bouncing a little bit ahead chronologically, but could you also
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share with us the origin story, if you will, on years later, 10, 20, I don't know how many
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years later, going to graduate school and getting your PhD in literature?
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Yeah.
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Well, the thing on my own without my father's prompting I would have done is study literature.
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I mean, I devoured books as a kid.
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I started writing the stories and that was my pleasure and passion.
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And then the idea of going to medical school was a alternative to that.
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And it wasn't till I was already through residency, through fellowship in general medicine, working
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at Columbia, and I had already started doing some work in the kind of literature and medicine
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movement.
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And I said to my at that time boss, who you probably knew, David Rothman, who is the ethicist
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stranger at the bedside, I said, David, I'm going to take a course in English.
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Like that was a major relief.
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And he goes, Rita, don't take a course.
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Take a master's.
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And sure enough, I already knew some of the people in the English department.
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They said, sure, that would be great.
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We'd love to do that.
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You know, here, fill out this form.
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And I got accepted into the masters.
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And right away, Nick, it made a difference in my practice.
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Like right away, I started learning some narrative theory.
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I started learning, you know, what close reading is about.
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How you can unearth meaning from words.
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And I started listening differently to my patients.
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I started writing down what I heard them say.
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I would give back to them what I had heard.
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I would ask them, what did you hear?
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So the whole practice kind of shifted around to a not a literary practice, but a language
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practice.
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And then when they wrote to me and said, how would you like to stick around for the PhD?
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I said to them, really?
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And it was pure joy.
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I don't know how else to put it.
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Well, that's amazing and joy and luck.
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And it was fortuitous in a sense.
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Right?
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Yeah.
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And I'm thinking you said right away, you saw a difference in your practice that you're
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referring, I'm sure, to your clinical practice, your work in medicine.
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And I'm reading about you.
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I know that your PhD had focused on narratology and the work of Henry James.
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And one thing I read as I was preparing for this was another author had written about
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Henry James that he knew of no stranger work than that of Henry James.
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So I was really curious.
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What's so strange about it?
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So my question then is, if you can divine for our listeners, what is narratology and
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what can Henry James teach students of medicine?
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And what I mean by students of medicine is not just medical students, anyone who's practicing
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in the health professions who's doing clinical work, who are lifelong students in medicine.
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What is narratology and what can Henry James' work teach us?
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Yeah.
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Narratology is simply the study of narrative.
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It's the study of how stories work, how stories are built, how stories enter into one's life.
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Mind and life, what they do to us once they're there.
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This is all, and it's pretty well developed by now.
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It's like centuries worth of real serious scholarly production about what goes on between
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the writer and the reader.
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And of course, that applies to what goes on between the teller and the listener.
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And that was my avenue toward grabbing at how do I listen better?
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How can I listen between the lines?
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How can I listen for the unsaid, for all the stuff besides the data?
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You know, doctors are real good at getting the information.
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But what besides that?
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James attracted me from the beginning because he is still the one who most can capture the
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complexity, not only of what a character might say, but what goes on between the characters
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in the story.
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That intersubjective space between Millie Thiel and Sir Luke Strep, who's her doctor,
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and also what goes on between that flesh and blood author, James, and me, the reader.
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Now, he's long dead, but that doesn't matter at all.
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He's in my life.
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And by now, I mean, that was my PhD dissertation, but by now he's been amply accompanied by
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many, many other authors who, I mean, I just, I could go on.
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But the reading and the voraciousness of, you know, I'll read whole shelves of James
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Joyce, whole shelves of Toni Morrison, like that, like engulfing myself in a writer's
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way of writing and vision.
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You know, what you're reminding me is that, and it's pretty amazing, that each of us brings
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all of ourselves to this science and art of medicine.
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And for you, you know, I'm thinking of the painting by Luke Fills, and I'm thinking of
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Tate, who commissioned the painting and the gallery and art world itself, and I'm thinking
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of Henry James and literature and all this, and that this all becomes living within you,
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whether you're working teaching literature and close reading or whether you're working
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with patients.
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This podcast, Rita, is called Flourishing in Medicine from Surviving to Thriving, and
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it focuses on challenges for physicians and other health professionals and the opportunities
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and ways to flourish professionally and personally.
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And I'd like to read a quote to you and then ask you to comment on it.
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This quote is from Tina Runyon.
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She's a health psychologist.
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We interviewed her a few months ago, and we posted her podcast, my interview of her podcast
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recently.
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She was recently rebroadcast on an On Being podcast just a week or two ago.
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She's kind of an expert on stress as well.
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And let me read this to you because I want to take us into the pandemic a little bit
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and think about your work.
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She wrote, no amount of sophisticated technology can do what health professionals have done
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in these past few months.
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This is early on in the pandemic.
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Offered care with uncertain evidence, sat with dying, comforted family members from
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afar, held one another in fear and grief, celebrated unexpected recoveries, and simply
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showed up.
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Yes.
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We've asked and expected clinicians to show up in ways they were never trained to do.
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No one has been trained in how to emotionally manage months of mass casualties.
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No one has been trained in how to keep showing up despite feeling feckless on the job.
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No one has been trained how to keep regular life afloat at home and anxiety at bay while
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working day after day with little known biohazard.
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Yes.
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So I'd like you to, can you share some thoughts about what narrative medicine literature can
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offer us as health professionals who face this, continue to face challenges all our
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larger in our daily work life, and no doubt will face future physicians, will face large
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dilemmas such as this pandemic that we are still reeling from.
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And the climate crisis that we're in the middle of and the nuclear threats from now
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North Korea and Russia.
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I mean, there's a lot of potential threats on their way.
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It was horrible.
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It was horrible in New York in those times.
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I by then had closed my clinic, but I was still very involved in the, in the medical
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center work.
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You know, you'd walk down the street with, with your mask on and gloves at hand.
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And if anyone came toward you, you move to the middle of the street because you couldn't
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take the chance of being in the presence of the virus.
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And there was even a terrible kind of screening.
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The older the person, the fatter the person, the more debilitated the person, you would
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walk out into the middle of the street.
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Do you see that kind of judgment that they forced us into?
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Yeah, forced us into profiling basically.
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Exactly.
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Exactly.
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And I'm sure it was terribly unfair, but, but that was the extent.
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And then what we did in narrative medicine is start doing narrative medicine training
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for people in the middle of it.
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And we were asked to go up to an affiliated hospital in Westchester to, to Columbia.
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And starting in April or May, we were working with the cancer center with their doctors,
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social workers, patient support staff, chaplains, because they didn't know where they, they
20:41
couldn't figure out how to get to the end of the day.
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And the work that we were able to do with them led to team support, team cohesion, individual
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awareness of their situation.
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They were so grateful that they had, I have creative skills, I can read, I can write.
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It was a gift to them.
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And this was in like small groups and it was once a week for six weeks.
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And it made a difference.
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We're now writing it up.
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We're writing it because we had a decent assessment plan.
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So it's not been published yet, but it's on its way because it was in the thick of COVID.
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And it made a difference for these oncology clinicians.
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And that was repeated.
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I mean, there was, there was work at the primary care clinic and other things.
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So it was really a good emergency reaction to carve out a space that was not work and
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to put them simply in the company of others with whom they worked.
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You know, people would say, I've been working with him for 10 years.
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I never knew that.
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I mean, you see that in your work too, right?
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So it's those connections and they endured, but that doesn't take away the horror of the
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whole thing.
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You know, those terrible supermarkets with nothing on the shelves.
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I mean, it was terrible.
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And even remember the seven o'clock everybody clapped.
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We even got very angry at that.
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We said, we're not the heroes.
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Give me a break.
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Don't clap for me.
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Not for the subway driver, the cash register at the A&P, you know?
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But it was horrible.
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And if only we knew more besides let Pfizer make the next virus vaccine.
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I really wish we knew more about what more we could have done.
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So it sounds like what you were called to do and what you did gave the people who participated
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in that kind of a little taste of the same experience you had that you said right away
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it made a difference in my life.
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So right away doing this made a difference for them.
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That's wonderful.
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I'm wondering if you can then help us connect ideas regarding narrative competency, let's
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say the love of literature and the power of listening to not only professional wellbeing,
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but also quality of care.
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Maybe you can kind of connect the dots there.
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Well the quality of care, I think we were just saying this a few minutes ago, there's
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quality of care for the individual patient.
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There's quality of care for a family.
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There's quality of care for a neighborhood, for a culture, for a society, et cetera.
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We have been working initially on the increasing quality of care one by one by working with
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individual learners.
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I think you've been doing the same.
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Individual learners will come to us and say, I need help in focusing.
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I need help in being humble as I'm listening to a patient.
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I need help in, Gadamer has a wonderful phrase for it, fusing the horizons.
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Between myself and a patient.
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That I'm not replacing my horizon with the patient's, we're fusing them, we're merging
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them so that we can both accept and comprehend where our perspective is.
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But I'm getting impatient with that approach because the one by one is not something that
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equals the challenges we're under.
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So we do have to pay attention beyond the one to one.
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And also we have been doing work mostly with the clinicians.
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I want us to start doing work with patients.
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Some people call it storytelling, others call it diaries or journals.
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But we ought to be giving patients the voice that right now they're not able to harness.
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We're working with a group of young kids with severe mental illness situations.
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And our partner in that project helps the kids write their own songs.
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And they've got composers, they've got musicians, and they've got lyricists.
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And the kids, and some of them are very, very disabled, are able to put into words and or
25:52
music what they're going through.
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So I think this is a wider way to do it.
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It's giving voice to people who have yet to find their own source of agency.
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And in addition to taking care of the physicians and nurses, I think we should be doing that
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too.
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Well, I think it's not separate from it, truly.
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In some ways, doing that will feed back and help the well-being.
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Certainly, you're probably familiar with the work of Colin McCann and Narrative Four and
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the kind of work they do.
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So I think that's also an inspiring approach to giving marginalized or even just groups
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of people that need to have a voice in participating in that.
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Interestingly, that you're talking about the application to groups in larger numbers, you've
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also spoken about the difference in the scientific paradigm about the N of 10,000 and in the
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humanities about the N of one.
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So there's also that piece.
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And I guess working with groups can still give each of the individual participant a sense
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of that uniqueness, that singularity that you write and talk about, that value of life.
27:09
Maybe you can connect that again with health professional flourishing as well.
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So your question helps me know how deeply you've been thinking about what happens as a story
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is told or heard.
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And you have to pay attention to who the listener is.
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I've been working with a group in Nigeria.
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Even the storytelling that goes on among the teenagers who are in danger of HIV or they
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have another group of substance use disorder teenagers.
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And they realize that the storytelling of the kids is what unlocks their capacity to
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really reflect on and get out of their own system, that which they're going through.
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And my question is always who's listening?
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And there's like a spate of story slams.
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Now I take part in some of this.
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Story slams.
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Rita, will you come host our story slam?
28:17
I say, sure.
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But I have like a concern about why would a person talk about something very private
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and potentially vulnerable if they don't know who's listening?
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Who's in the audience?
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What are they hoping to get in return?
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Is it recognition?
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Is it therapeutic help?
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Is it celebrity?
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And I think those are important questions which speak to the complexity of the narratives
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themselves.
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It ain't just written out and published.
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It comes from the depth of a teller.
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And that teller is having to trust or entrust her story to whoever happens to be in the
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audience.
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What do you think?
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Does that make a problem for some of your work?
29:23
No, but it underscores the importance of actually addressing psychological safety and really
29:29
understanding some of the risks.
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There are of course inherent risks.
29:35
As you were speaking, especially early on in this last exchange, talking about the power
29:39
of both the narrative, speaking it and the power of the listening.
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I'll paraphrase it and you could correct me, I'm sure.
29:49
Emily Dickinson, she wrote something like, a word is dead when it is said.
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Some say, I say it just begins to live that day.
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So the words continue to have power even after they're written, spoken, shared.
30:04
And I think we should all, in some ways you're reminding me, we need to take caution and
30:09
at least create circles of safety, psychological safety.
30:13
That's right.
30:14
Yeah.
30:15
She also says though, somewhere else, tell it, but tell it slant.
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So the slant is beware.
30:23
Interesting.
30:24
I never heard that, but I'm taking that slant to mean you can kind of code it a little bit
30:31
so that there is some protection there for you.
30:34
Is that right?
30:35
Am I getting that?
30:36
Yeah.
30:37
And also just in a literary sense, you don't have to come out and say, the apple was red.
30:45
So the slant could be a kind of invitation to metaphorical thinking or indirect telling.
30:54
But when I read that line, I also think about exactly what you said, the vulnerability and
31:01
the need for some kind of guardrails.
31:05
And you know, among our colleagues and in the culture of medicine, this is a fraught
31:10
area.
31:11
Yes.
31:12
And I think that's the safety in our teams, especially as medicine is more and more collaborative.
31:17
It always has been, but more and more compared to say how your father had structured his
31:24
professional life.
31:25
Yeah.
31:26
Right.
31:27
Right.
31:28
He just had his daughters behind him.
31:29
But say more about the risks because you get...so my neurosurgeons are going to get together
31:35
and we're going to help them find a way to process what they go through if a neurosurgery
31:41
goes badly.
31:42
And we may not start there at all.
31:44
We may start much more slantedly.
31:47
We may simply start with reading paragraphs out of fiction.
31:53
I may start simply with showing them images that have little to do with the brain to let
32:01
them examine their own creative thought patterns, see what happens.
32:08
You must go slowly so as not to, as you're alluding to, violate some of your own lines.
32:25
This is not confession.
32:28
This is not finding absolution.
32:29
Totally agree with you.
32:31
Totally agree with you.
32:33
There's a lot to say about this.
32:35
And we did interview a wonderful foregut surgeon from UC San Francisco, a woman who has developed
32:43
a training program for her residents in surgery that is mindfulness-based to help them to
32:49
begin to address the culture of medicine.
32:51
She doesn't even call it mindfulness, but it's really a way of creating some guardrails
32:58
around their reflective experiences, reflecting upon their experiences in training to better
33:05
training.
33:06
So I think it's creating reflective moments, reflective communities.
33:11
Unfortunately, I think, and you probably know a lot about this, that the next generation
33:16
of medical people coming in, Gen Zers, we could say, are experiencing real challenges
33:24
around their own self-identity as reflected back to them in social media.
33:30
Johnson and Haight has this book out about the anxious generation, and this is really
33:35
affecting young people so much so that the Surgeon General just the other day came out
33:40
and suggested...
33:42
It was not well received.
33:44
No, no, but we have a whole incredible tech industry that, of course, would not want to
33:51
receive that very...
33:52
Well, that's right.
33:53
And that, I think, is a thorny issue to raise.
33:57
I'm glad you raised it.
34:00
In addition to equipping the clinicians and the trainees with means to keep their equilibrium,
34:10
I as the old activist I am, am looking for ways to address the reasons that we are in
34:24
situations where, for example, well-resourced white people get expert neurology care and
34:31
black persons on Medicaid have to go to the resident clinic.
34:35
Well, we've taken that in hand at Columbia, and it took many years.
34:41
It took working with the CEO individually and the chief of neurology and a senior black
34:49
neurologist who's now our vice dean for community health.
34:55
It took them years to craft a solution to that segregated care.
35:02
But we have done it, and the hospital put up the funding to replace the revenue that
35:09
would have come to the private physicians if they were to accept Medicaid patients.
35:15
Now, that's a big, big workaround, isn't it?
35:20
And what would happen if we were able to address this more directly with the insurance companies,
35:30
with pharma who keep putting out more and more expensive medicines that nobody can afford?
35:37
I think there's activism that needs to be done to counter what it is that's being done
35:43
to us.
35:45
The hapless pediatrician who has to bring her documentation home to do it after dinner,
35:52
and the kid says, Ma, I guess you're not coming to my little league game.
35:58
So how do we address these structural situations within a medicine that is making people feel
36:08
less and less empowered?
36:10
Well, that's a great question.
36:12
I'm wondering if the, let's say, called practice of narrative medicine, or at least reading
36:19
texts, close reading can point the health professional into discovering for themselves
36:25
some of these structural and systemic inequities that they are part of and beginning to...
36:32
One of the things I really appreciate about the work you do, and when I attended the workshop
36:36
at Columbia, and it focused on race, and it's so true that the things that we read in the
36:44
breakout groups, they were not medical stories.
36:48
And I think that's really important because once we start to bring in our own ideas about
36:53
what's going on, because it's a medical story, we know that, or at least we know a little
36:57
bit of it, it takes us away from that beginner's mind of actually being able to see this and
37:02
learning something completely new.
37:05
And I think it's going to take something like that, something that kind of in some way shocks
37:11
us but subversively.
37:12
You know what I'm saying?
37:15
Yeah.
37:16
And we know that there are counter goals.
37:22
We know that there are incentives for insurance groups, pharma groups, device manufacturing
37:31
groups, tech supplier groups that are more for market revenue purposes than decent care.
37:43
And I don't...
37:44
I mean, we have a lot of activists at Columbia.
37:49
Maybe I imagine Rochester is the same, but the kind of stand up to this shift away from
38:00
patient centeredness toward bottom line centeredness.
38:08
How do we do that?
38:09
Well, I think it's really part of our Hippocratic oath in a sense is that we need to be activists
38:19
and we need to be able to do that.
38:22
And I think that's part of the job description.
38:25
And I don't think that's transmitted to our learners very clearly, nor are there very
38:30
many examples of like, what does this look like?
38:33
What are the choices, the ways in which I can do that?
38:36
It's interesting.
38:37
I'm working on a documentary film called The Healer's Journey and we watched four medical
38:42
students from their first day of medical school.
38:44
They just graduated a couple of weeks ago.
38:46
And so we're done with the filming part.
38:47
I'm contrasting that with an article that Lisa Rosenbaum wrote for the New England
38:51
Journal a couple of months ago about calling, calling into question, is medicine a calling
38:55
or is that just a way of using people's calling to weaponize it, to make it so that they'll
39:02
work harder and accept less and be abused.
39:05
And I found that these students, at least this is so early in their professional development,
39:12
that they are very much open to activism if there were models of how, what it could look
39:19
like.
39:20
And I think we have to provide that.
39:22
Yeah, but now go talk to a couple of PGY3s.
39:27
And those physicians who just leave, I don't want to do this anymore.
39:34
And the nurses who leave, we're desperate for nurses.
39:38
We're stealing all the nurses from the Philippines and Ireland.
39:44
So that bears attention.
39:50
And so in addition to the individual shush-shush, the individual caring for these clinicians,
40:03
we need to at least do our best to fix the nest a little bit.
40:08
100 percent.
40:09
I agree with you.
40:10
You've said that the rigorous study of literary texts improves the capacity of clinicians
40:15
to stick with medicine.
40:17
Yeah, if it gives them a sense that they have agency, they have voice, they are not alone
40:26
in realizing that, wait a minute, when the lady from Billing calls me and says, can't
40:32
you up code that renal function diagnosis so that we can build more, you say, whoa, is
40:40
this what I signed up for?
40:43
So we've got to protect them from that kind of stuff.
40:46
And I think you're right that they want to do the best that can be done.
40:54
And I think your work is trying to protect them from the decay, right?
41:00
We're trying to give them a sense, just like you are, that there is creative ways of working
41:06
that can relieve that emotional exhaustion.
41:08
Once you're emotionally exhausted, you're going to take the path of least resistance.
41:12
Right.
41:13
Yeah.
41:14
OK, go ahead and up code.
41:15
Right.
41:16
But I want to go back to the question you've asked me several times that I maybe haven't
41:18
answered altogether, which is why the literary part?
41:22
What happens when somebody actually goes deep into a Wallace Stevens poem and comes out
41:28
two hours later with a realization for their own life?
41:33
And I'm not an English teacher.
41:35
My duty is not to equip my learners with abstruse reception, reading theory ideas.
41:46
It's rather to enable them to experience it.
41:50
It's to allow them to experience these complex, contradictory, ambiguous situations that are
42:01
hiding all kinds of things.
42:02
What's being hidden in their sentence?
42:04
You know, that's the kind of reading I want them to do because that's the kind of listening
42:10
they'll be able to do.
42:12
Wonderful.
42:13
You've answered it.
42:14
You know, Rita, as we're winding down this time together, this is going to be a challenging
42:19
question.
42:20
Maybe not.
42:21
Maybe you've had this question before.
42:22
But if you could imagine one piece of literature, writing, essay, story that you'd recommend
42:28
to every student of medicine, kind of universally, remember, not just medical students, but
42:32
students of medicine, as just an entrée, a beginning for a journey into this connection
42:38
between professionalism, meaning, well-being.
42:41
What would that be and why?
42:44
I don't think that's a question I can answer because you've got to fit what you bring to
42:52
a group.
42:53
And I can say, go read Wings of the Dove.
42:56
It's only 600 pages of a Henry James novel.
42:58
But I can quote you the line from that novel that hooked me into doing this work.
43:07
All right?
43:08
It's a young, sick woman sitting in her doctor's office for the very first time.
43:15
And the doctor only has 10 minutes for her visit through some situation in his scheduling.
43:24
Only 10 minutes had he to put at her disposal.
43:30
And then the patient reports, and here's the sentence.
43:36
So crystal clean the great empty cup of attention that he placed between us on the table.
43:46
You know, being a student of Zen, I can feel that in my bones, actually.
43:52
Right?
43:53
Okay.
43:54
I leave you with that line.
43:58
That's wonderful.
44:00
I just finished a multi-day silent retreat where the focus was on something called the Heart Sutra.
44:08
You may not know anything about the Heart Sutra, but it is a discourse about emptiness, basically.
44:14
The insubstantiality, the impermanence of everything.
44:19
It's a wonderful, wonderful place.
44:22
I'm getting a little emotional about this and that experience of the retreat and these words from Henry James.
44:29
So thank you very much for that.
44:31
Okay.
44:32
As we finish up, just one last question.
44:34
What else do you do for fun besides reading?
44:37
I concoct things.
44:40
I'm a great concoctor.
44:43
And other people might say, well, yeah, right, Rita, you're writing grant proposals.
44:49
Well, it's not exactly that.
44:51
It's, ooh, how are we going to get the humanities scholars and the clinicians together
44:57
so they're learning together about all this?
45:00
I consider that great fun because it's puzzle.
45:03
Not only is it solving puzzles, but it's reaching out to people I love to say, Paula, come on in.
45:11
Help me think about this.
45:13
She happens to run the Modern Language Association.
45:15
You get the right people together, and it is pure discovery, pure creation.
45:21
I don't speed skate.
45:24
I play the piano.
45:26
See my piano?
45:28
I'm playing my way through Bach's Art of the Fugue, which is very hard, right?
45:35
Art of the Fugue.
45:36
I'm already up to Contra Punta 6.
45:39
And so every, it can't be every day, but every few, couple days, I sit down and just play a prelude.
45:46
So that's my restitution.
45:50
That's wonderful.
45:51
Thank you.
45:52
And I, concocting, I, to me also, there's a flavor of activism there and a flavor of subversion there.
46:00
Yes.
46:00
So I think it's got all of that.
46:02
Exactly right.
46:03
Good.
46:04
All right, Rita, this has been most wonderful.
46:06
Thank you again so much.
46:09
Thank you for listening.
46:10
We'll include a summary of today's podcast and links about Dr. Charon and other references that we discussed in the show notes.
46:17
And I'd like to conclude again by sharing another exercise that I think could help you flourish.
46:22
What I'd like to do is a little different here.
46:24
I'd like to read Emily Dickinson's brief poem, Tell All the Truth, But Tell It Slant.
46:30
I'm going to read it three times.
46:32
So let's start with the first reading.
46:34
Simply listen and noticing the yearning to understand the sensations in the body, the emotional reaction, and the thought stream introduced by listening to this for the perhaps first time.
46:44
Here we go.
46:45
Tell all the truth, but tell it slant.
46:49
Success in circuit lies too bright for our infirm delight.
46:54
The truth's superb surprise as lightning to the children eased with explanation kind.
47:02
The truth must dazzle gradually, or every man be blind.
47:13
I'm now going to read it a second time.
47:15
But before I do, consider how sometimes we cannot take everything in all at once.
47:20
We learn, experience, consider, investigate in increments with only that bandwidth that's available to us at that moment.
47:29
Notice surprise or the shock of lightning.
47:32
Notice our need for kind explanation.
47:34
Notice looking furtively, kind of a slant at a thing, not to overwhelm ourselves.
47:41
Here we go.
47:43
Tell all the truth, but tell it slant.
47:47
Success in circuit lies too bright for our infirm delight.
47:52
The truth's superb surprise as lightning to the children eased with explanation kind.
47:59
The truth must dazzle gradually, or every man be blind.
48:07
Now, finally this time, the third time.
48:09
Before I read this, I'd like you to just think about how we must in some ways relate to our patients, communicate with them.
48:15
We want to be successful.
48:17
We don't want to blind them.
48:18
We hope to be kind.
48:20
We know they will be surprised and even frightened at times.
48:24
We calibrate ourselves out of empathy and compassion.
48:31
Here's the third reading.
48:35
Tell the truth, tell all the truth, but tell it slant.
48:40
Success in circuit lies too bright for our infirm delight.
48:44
The truth's superb surprise as lightning to the children eased with explanation kind.
48:51
The truth must dazzle gradually, or every man be blind.
49:02
Consider listening to this, repeating this practice from time to time.
49:06
See it as a practice in kind of self-regulation, empathy, and compassion.
49:12
I hope you found this podcast and this simple exercise useful to you and look forward to having you join us for the next episode of flourishing in medicine from surviving to thriving.
49:22
To learn more about EmPRO, visit www.myEmPRO.com.
49:27
Their peer support programs can be found at www.myEmPRO.com forward slash peer dash support.
49:35
If you're a physician or medical student in need of urgent support, consider calling the physician support line at 1-888-409-0141 or visit www.physiciansupportline.com.
49:48
And to read more about my work and activities I'm involved in, you may visit www.MickKrasnermd.com or www.mindfulpracticeinmedicine.com.
50:02
Until next time.