“OLD CARTS” is an acronym we’re taught in medical school to guide us on questions to ask to elicit a history of the patient’s illness: Onset, Location, Duration, Characteristics, Aggravating or Alleviating factors, Radiation (of pain), Treatment, and Significance. Although OLD CARTS is a helpful checklist initially, over time it begins to feel perfunctory, done to check off a requirement on the rubric. We ask many questions, and I am keenly aware I’m asking because I want something from the patient—I want telltale signs, any clues on the diagnosis, any information that the care team can act upon and use— I feel greedy.
Read moreOut of Time? A reflection about illness and its toll on our past, present and future by Sophia Wilson
In her observant poem “Brain as Timepiece (Administering the Clock-Drawing Test to My Patient With Dementia)” (Intima, Fall 2018), Jennifer Wolkin describes the disordered clockface drawn by a patient with dementia: each number stands outside its perimeter like lost digits. The patient’s subsequent drawing of an ‘X’ over the wayward numbers suggests an erasure, not only of cognitive function, but of time itself. Time’s toll equates to a ‘crossing out’ of past, present and future as the ‘disease devours …organ tissue’.
Read moreRooms and Wombs and Writing: A Reflection on Stories Highlighting Life’s Impermanence by Patrick Connolly
I’ve come back to Hemingway’s “Hills Like White Elephants” so many times. He uses third person objective point of view to create a chill in a scene that could otherwise be exuberant and exotic. A train station, central Spain, a hot afternoon, people talking about their lives together, an unspoken baby on the way – and that is a problem.
Read moreConnecting with the World of Our Patients: A Reflection by Savita Rani
In her poem “Internet Dating for Centenarians” (Intima, Fall 2021), Sarah Smith paints an animated picture of her cheeky and cheerful elderly patient. Smith, a board-certified family physician and author of The Doctor Will Be Late, describes her dilemma about which topic to discuss with her patient—lipids or love.
Read moreInside Voices: Learning When to Listen, When to Control by writer Marleen Pasch
In my short story “Rocks and River,” ( Fall 2021 Intima) a young woman named Tran Huong Giang stands on the MacMillan University Bridge and looks into the ravine below. She knows—as does writer Meredith O’Brien in her essay “Another Game Day”(Fall 2021 Intima)—what it’s like to hear two voices.
Read moreLauds: A solitary prayer at the scrub sink by pediatric surgeon Kristen A. Zeller
In the hospital, routines carry us through our days and lend a semblance of structure to the chaos of lives disrupted by illness. Some routines happen on a large scale—weekly gatherings of departments for Grand Rounds, hospital leadership meetings for safety huddles, the hustle of getting a cadre of operating rooms started nearly simultaneously in the predawn. Other routines are more intimate—the sequenced process of doing a sterile central line dressing change, the donning and doffing of PPE outside a patient’s room, the one-one-one nursing handoff at shift change.
Read moreWhen Medical Professionals Care for Their Own: A Response to “Of Prematurity and Parental Leave,” by Mason Vierra
“Of Prematurity and Parental Leave” (Intima, Fall 2021) describes the harrowing experience of giving birth to a premature baby during residency. It’s written by doctors married to each other —Dr. Campagnaro and Dr. Woodside—who co-construct a narrative by telling it from their own perspective.
Read moreStill We Dream: How We Face the Unpredictable World by Mary Anne Moisan
Humans can create a world through perception, imagine a potential life, whether it be the life of a relationship or the life of a baby. We fill in the unknown details to make a whole that is pleasing and good. It’s as if we willfully ignore that so much of life is unpredictable.
Read moreA Simple Ritual: Reflecting on the Moments Before Surgery by poet and orthopedic surgeon Photine Liakos
Surgeons are well-known for precision and protocols. There is often a ritual nature to our actions when preparing for surgical interventions, an orderliness and discipline: checklists, time-outs, pauses, consensus.
Read moreThe Shit Poems: A Reflection by Drea Burbank
I am interested in the juxtaposition between my use of poetry to shed traumatic experiences and memories from medicine, and the description of William Carlos Williams by Britta Gustavson (“Re-embodying Medicine: William Carlos Williams and the Ethics of Attention,” Spring 2020 Intima).
Read moreThe Limits of Love: A Reflection by Carmela McIntire about Anorexia, Overeating and Fulfillment
Disordered eating occupies a spectrum—anorexia nervosa at one end, morbid obesity at the other. Attempting rigid control of the body and its appetites, anorexics are unable to see themselves and their bodies accurately. Compulsive overeaters—often obese—similarly might not see themselves accurately. In both disorders, controlling food is the aim, a genuine addiction, a strategy through which addicts deal with the world and their own circumstances—a necessary coping skill, even though it is risky to health in both cases.
Read moreMothers and Daughters: A Reflection on Cancer, Caring and Seeing the Whole Picture by poet Kathryn Paul
—After ‘Macroscopic” by Adela Wu (Spring 2021 Intima)
My mother and I were not close. I knew she wanted us to be, but I couldn’t do it her way. For most of my adult life, I kept my distance, emotionally and physically. We lived on opposite sides of the continent. In her 80’s, the creeping dementia my mother never discussed was overtaken by a cruel and much more terrifying diagnosis: Stage IV ovarian cancer.
Aided by her cancer-free twin sister, Mom endured multiple surgeries and two lengthy and debilitating rounds of chemo. Each time, her cancer came roaring back within weeks. Her surgeon suggested an experimental Round Three. Mercifully, her oncologist suggested hospice at home instead.
During the first year of Mom’s illness, I was trapped by my own cancer treatment, unable to participate in her care. I called daily, spoke with her, spoke with my aunt, asked about her pain, her “tummy trouble,” her ascites, and her white count. I took notes and dictated the questions to ask at her next appointment.
As soon as my doctors cleared me to visit her, I did. I was always on the verge of moving in with her, but never quite needed to do so. I flew back and forth. The more debilitated she became—by her cancer and her dementia—the more often I visited.
Adela Wu’s Studio Art piece “Macroscopic” simply and eloquently captures the changes in how I experienced my mother during those last months and weeks. The simplest things gave her joy: A small dish of ice cream. A pain-free nap on the down-stuffed cushions of her couch. Cuddles with her cats. A bird visiting the feeder outside her window.
Even as her disease spread through her body, even as she faded, my mom seemed to crystallize. She became, ultimately, the Essence of herself. And—just at the end—I finally saw her.
Kathryn Paul
Photo by Andrew Givhan
Kathryn Paul (Kathy) is a survivor of many things, including cancer and downsizing. Her poems have appeared in Rogue Agent, Hospital Drive, The Ekphrastic Review, Lunch Ticket, Stirring: A Literary Collection, Pictures of Poets and Poets Unite! The LiTFUSE @10 Anthology. Her poem “Dementia Waltz” appears in the Spring 2021 Intima.
Shakespeare, Stanzas and How We Think About Death by Albert Howard Carter, III, PhD
When my sonnet “All Tuned Up” appeared (Spring 2021 Intima), I was asked to write about another piece published in the journal. I chose “I Picture You Here, But You’re There” (Spring 2020 Intima) by Delilah Leibowitz. Her poem and mine both explore how we think and feel about death.
Read moreHow Touch Affects Healing, a reflection by Wendy Tong
In her Field Notes essay “Hand Holding” (Fall 2019 Intima), Dr. Amanda Swain describes the experience of beginning her surgery rotation as a third year medical student. In the early days of the rotation, she feels an intense sense of being out of place within the “intricately choreographed dance” of the operating room. But when the next patient is wheeled in, Dr. Swain is reminded of how a nurse once took her hand before she underwent surgery, the touch conveying an unforgettable message of comfort during a time of deep vulnerability.
Read moreOn Fathers, Love and “Exit Wounds” by psychiatrist and essayist Greg Mahr
I regularly attend a poetry critique group in Ann Arbor, MI called the Crazy Wisdom Poetry Circle, named after the bookstore and tea shop where we used to meet before the pandemic. The experienced poets there have come to accept the sad and overly personal poems and flash pieces I write and help me craft them into something that sometimes almost sounds like real writing. One of them once told me, “You always write from a place of longing. That’s a good place to write from.” I realized he was right. I find it hard to share what I write with the people I love. When I am in a good relationship, I write about bad ones; when I love someone, I write about missing them.
Read moreAuscultating Meaning: Reflections on the Heart of Medicine by Marc Perlman
© Gordian Knot by Elisabeth Preston-Hsu Spring 2020 Intima A Journal of Narrative Medicine
From diaphragm to earpiece, a stethoscope dutifully chaperones a patient’s internal orchestra to a clinician’s ears. This facile acoustic communication not only allows a provider to screen for a wide host of cardiovascular, pulmonary and gastrointestinal anomalies, but it also may be a conduit for moral reflection.
Read moreDoctoring and Disobedience: Speaking an Important Truth, a reflection by Kelly Elterman
Sometimes, the truth can be uncomfortable. It can be difficult to hear and often, even more difficult to say. In her Field Notes piece entitled “Doctoring and Disobedience” (Spring 2020 Intima) Dr. Lisa Jacobs recalls her struggle with being told to hide the truth of a prognosis from an elderly patient with metastatic disease. Despite the instruction of her attending physician, and the decision of the patient’s family and ethics team to not speak of death to the patient, Dr. Jacobs feels compelled to let her cognitively-intact patient learn the truth. So strong is her conviction that she takes on considerable risk to her own career for the sake of bringing the truth to her patient.
Read moreHealing and Trauma: Recontextualizing Suffering by Sundara Raj Sreenath
Suffering due to trauma or illness often brings with it feelings of disconnect from the world as we knew it when we were healthy. The healthcare provider-healer, therefore, has an important opportunity to intervene in this unique setting and respond to the patient’s cry for help by offering a personal, humanistic touch and guiding them through trauma in addition to clinical management.
Read moreReimagining Chaos in Art and Poetry by Selene Frost
Anatomy of the Vogue by Meagan Wu. Fall 2017 Intima: A Journal of Narrative Medicine
I’ve long been fascinated by the way structure informs poetics and the practice (and in this case—reception of medical care). In my piece “Field Notes on Form,” I extol the ways in which linguistic structure has the remarkable ability to organize our thoughts, increase our signal within the noise, and etherealize the mundane. In “Post NICU Villanelle,” Joyelle McSweeney uses language not only to remediate the chaos of loss and of leaving but also to deconstruct both the poetic form and herself.
Read moreThe Cost of Efficiency and the Price of Empathy, a Reflection by Jordana Kritzer MD
After the long hours and intense learning curve of my Emergency Medicine residency, I had become one of those efficient robots who could solve medical puzzles and save lives, but I felt empty, disconnected—the classic symptoms of burn-out. I was once a wide-eyed, empathetic intern constantly criticized for trying to solve their patient’s chronic issues. I remember one attending saying, “Figure out the least amount of things you need to do to rule out an emergency.” I see now that he was trying to teach me efficiency.
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