Welcome to the Fall 2024 Intima: A Journal of Narrative Medicine

 As we launch our Fall 2024 issue on the Day of the Dead, we recognize the significance of the timing: Many of our contributors wrote about mortality and the deaths that have lingered and affected them. Poet-physician Joan Roger recalls a time of profound grief as a medical trainee during the 9/11 tragedy in her poem, “Dear Rescue Worker.” In “Death Certificate,” internal medicine resident Ramya Sampath likens the time of death to the moment a river merges with its delta—both difficult to pinpoint. Her powerful poem begins:“The dying don’t always go gently,” echoing Welsh poet Dylan Thomas’s villanelle “Do Not Go Gentle Into That Good Night.” Questions about life and death engender reflection—at home, at work, in war and in peace. The essential questions get asked in the work in this issue, questions such as: How can a clinician know what happens once a patient passes over? That’s what fourth-year medical student Maesha Elm Elahi ponders beautifully in her poem “Where Did She Go? ((I Don’t Know, I Don’t Know, I Don’t Know)).” 

The repetition of “I don’t know” sometimes becomes a mantra when facing mortality. In the Field Notes essay “Invisible,” Joanne Wilkinson writes about a dying patient not much older than her, and Wilkinson, an Associate Professor of Family Medicine at Brown University, questions whether she’s doing more than just being “on the sidelines of other people’s tragedies.” In the heartbreakingly self-aware essay “A Promise of Rest,” retired hematologist and poet Ronald Lands shares the difficulty in allowing a longtime patient to end her slow suffering and die. His evocative piece lets us come to our own conclusion: Perhaps presence and empathy are the only things required of stewards of the dying.

Dealing with the heavy toll of medicine leads our contributors to process through art and literature the essence of Narrative Medicine. Inspired by Michelangelo’s Sistine Chapel, illustrator and hospitalist Ankit Mehta drew and penned a graphic narrative call to action for a systemic end to clinician burnout in “The Last Judgment” (read the first panel above). Tajwar Taher, or “Doctor Dad,” thinks of what he’s sacrificed in spending time with family for a “spot on the raft on the river of medicine.” Fellow doctor-parent Hanna Saltzman knows it’s not normal to witness children dying and feels that burden in her body in her essay “Up.” Another pediatrician mother Steffi Gauget transforms intrusive thoughts about her child’s mortality into gratitude for their life together in “What Cutting My Baby Boy’s Christmas PJ Tags Taught Me About Distorted Worries.” 

Finding a meaningful balance between life and work is not easy for our contributors—but we value when they share how they stay on track. In “The First Patient,” a meditative dance video created and performed by Tessa Palisoc and Andrew Murdock, both MD candidates at Drexel University College of Medicine, we witness them exploring the “complex relationship” that medical students experience with a donor body in anatomy class. The dance “uses contact improvisation, a technique featuring weight sharing, touch and movement awareness” to bring the ideas home.

Viewing the peaceful swirl of the snail’s shell in Anna Hostal’s visual art piece “Harmonic Helix” (shown below) reminds one to move more slowly and intentionally. With that in mind, doctor Zoran Naumovski surprises himself on a much-needed family vacation shortly after the COVID-19 pandemic, when the act of saving a drowning man alleviates his burnout in the funny, passionate and blunt essay “Rekindling a Physician’s Soul.” Similarly, psychiatric nurse Jennifer Anderson finds her ability to emotionally detach herself from her young patients waning in her Field Notes essay “Managed Care.” She expertly weaves psychiatric theories to frame her burgeoning burnout, as life imitates art. 

Deep empathy for patients’ struggles carry a lot of weight in this issue’s stories. In “Splitting Wood,” public health physician Emily Groot offers a gripping and compassionate story of those living with schizophrenia. We hear the voices one man hears, feel his fear and share in his struggle to defeat not just the voices, but a real threat from the outside world. Some stories moved editors to tears. Physician and professor of medicine Gaetan Sgro brings us “The Folded Flag,” a poignant short story of a hospitalized young man told through dialogue with his elderly roommate. In the intimate details of a patient’s experience and through the eyes of others whose lives briefly touch his, Sgro reminds us in this fictional narrative that the pandemic is far from over; its capacity to reveal our divergent beliefs showing us—as one fiction editor put it—“the tension between trust in authority and individual autonomy.”

On the brink of a new U.S. presidential term with global implications for health, our contributors brought timely pieces on the evolution of clinical care. Medical student Angela Tang-Tan shares the quiet, yet unforgettable moment of mutual recognition she shared with a patient after gender-affirming surgery in her Field Notes piece “Top Surgery.” In “String of Pearls,” chaplain Elizabeth Ryder holds the duality of likely never having children with gratitude for long-acting reversible contraception, pondering whether birth control will even exist in eight years. It is stories like these that will inform the future practice of medicine.

As editors and readers, we are grateful for the deep reflection and hard work all of our contributors have put into creating original narratives that share a common desire for connection and humanity in a challenging and complex universe. Our Fall 2024 issue holds the nuances of both practicing and receiving healthcare with a caring dignity and attention. And while we cannot see into the future, we can pause and look up at the sky with its constellation of stars and natural wonders, as surgeon Carol Scott-Conner shows us in her exquisite essay “How to Find a Comet.” Reach high, reach out and let us know your thoughts.
—Angelica Recierdo for the Editors of Intima: A Journal of Narrative Medicine