The Me in Medicine: Reviving the Lost Art of Healing by Patrick Roth, MD

For more information about the book, go to   The Me in Medicine: Reviving the Lost Art of Healing.

For more information about the book, go to The Me in Medicine: Reviving the Lost Art of Healing.

What follows is a typical visit to the physician for back pain in the United States: A person hurts his or her back and sees a doctor for a complete workup. The clinician, careful not to miss anything, orders an MRI that is subsequently read by a distant radiologist. The report is sent back to the physician who, depending on the results, calls for a follow-up appointment to discuss outcomes. It is likely that the patient is sent to a physical therapist, who provides a therapy regimen based on the radiology imaging and his or her own experience without need for the physician’s specific prescription. While much can and has been written about this typical medical experience, from its inefficiency to its reliance on medicalization and overdiagnosis, it is the fragmentation and lack of contextualization that Dr. Patrick Roth has highlighted in his latest work, The Me in Medicine: Reviving the Lost Art of Healing.

With an increasing reliance on technology and the expansion of artificial intelligence in medicine, Dr. Roth paradoxically calls on physicians to embrace their philosophical faculties. He proposes that narratives, developed through introspection, as well as teaching, mentoring, and writing, are the missing components in our medical system today. The onus is on both patients and physicians to develop individual and, when they come together for a clinical encounter, shared narratives on health, disease, and treatment for better overall care.

For the patient, narratives mean coming to understand how he or she views health and disease. As Jerome Groopman explains in his book, Your Medical Mind, and Dr. Roth highlights in his, people have a spectrum of temperaments with regards to intervention: Some believe strongly in the human body’s regenerative capacity (naturalist) and others believe strongly in science, technology, and medicine (technologist). These proclivities are important for the patient to consider when making medical decisions, but only represent one piece of the puzzle.

Patients must also consider unconscious cognitive biases they have when making their decision for treatment. Common cognitive biases include the availability heuristic, a mental shortcut in which a person makes decisions based on readily available examples, and hyperbolic discounting, in which a person discounts future reward because of the time delay between the decision and the reward. For instance, using the availability heuristic, a patient may be hesitant to undergo a procedure because a friend had a similar procedure that did not end well, whereas using hyperbolic discounting, a patient may prefer a procedure because they perceive the reward as immediate as compared with the longer treatment course of physical therapy. While highlighting the patient’s decision-making heuristic is certainly not easy, it serves to both increase patient autonomy and satisfaction with outcomes.

The complexities of these medical decisions is the space where physicians, equipped with their own medical narratives, help the patient decide what is best. The physician has the ability to provide the context necessary for the patient’s choice. For this reason, it is incumbent on the physician to become a good storyteller. It is not enough to lay out all the options with statistics or paternalistically make the decision. Rather, believes Dr. Roth, the physician most effectively communicates through anecdotes and analogies for understanding disease ontology and treatment decisions.

There are a number of tools at the disposal of physicians and patients to accomplish these lofty, yet achievable goals. With honed doctoring skills, the physician can extract the patient’s motivations and contextualize them to reach a sustainable and satisfactory outcome. Further, the physician can foster self-efficacy and promote a deep education about disease. The patient, on the other hand, possesses knowledge that the physician is not privy to, i.e., the phenomenology of the disease. By joining support groups and forming online communities, patients empower themselves and shape the narrative of their needs for the medical community. Engaging in these exercises shapes not only the character of the patient and physician, but the disease process too, as it reforms a patient’s reality through changes in their thoughts and perceptions.

Medical science and technology naturally lend themselves to a reductive materialism with an approach that parses apart reality into molecular cascades and biotargets on which intervention is possible. Analogously, medicine, as a distinctly human endeavor, naturally lends itself to storytelling—the currency of effective communication and change. As such, Dr. Roth makes a formidable case for narratives as a staple of holistic medical practice. Narratives reform environmental context, which in turn shapes us and our health. With technology and specialization playing an ever-expanding role in our healthcare system, it will remain paramount to scrutinize our narratives and ensure they are always in service of our patients. — John Paul Mikhaiel


JP_Mikhaiel.jpg

JP Mikhaiel is a medical student at Georgetown University School of Medicine. After earning his BS in neurobiology and philosophy at Georgetown University, he spent two years at the NIH researching brain-related disorders. He is currently a member of the Literature and Medicine track at Georgetown University, and serves on the management board for the coaching program, A Whole New Doctor. His work has been published in Scope, Georgetown’s literary journal. Mikhaiel plans to pursue a career in neurology.

The Serpent's Secret: Kiranmala and the Kingdom Beyond by Sayantani DasGupta

"The Serpent's Secret" is the first book in the Kiranmala and the Kingdom Beyond Series; Scholastic publishes the book on February 27, 2018.

"The Serpent's Secret" is the first book in the Kiranmala and the Kingdom Beyond Series; Scholastic publishes the book on February 27, 2018.

 “Stories are the way we human beings shape our worlds,” writes Sayantani DasGupta, MD MPH, in the article “Stories Matter: Narrative, Health and Social Justice.” In the piece, the author, educator and Intima contributor (Spring 2016 issue), elaborates on the ways that narrative is shaped by many factors, from the personal to the political. Narrative, she posits, can be life-changing: “In the face of illness or adversity, injustice or trauma, stories help bridge what theorist Arthur Frank has called ‘narrative wreckage’—the point at which one’s old life’s plot is no longer valid, and one needs a new plot with which to continue life’s journey.”

These words have a particular resonance right now in light of the #metoo movement, where long-silenced voices are being heard in narratives that support finding ways to balance sexual inequality.  Curiously enough, the words are equally significant as a way to read “The Serpent’s Secret,” a remarkable and delightful new work of children’s fiction by Dr. DasGupta, just published by Scholastic as Book 1 of the new series Kiranmala and The Kingdom Beyond. How refreshing to find an electrifying social theorist like Dr. DasGupta who is also an entertaining prose stylist able to deliver an empowering novel for tweens. It’s a book that is multi-generational in the way the Harry Potter and Hunger Games series were—"The Serpent's Secret" also speaks to readers who finished middle school many red moons ago.

The book begins on the morning of New Jersey kid Kiranmala’s birthday, who in her own sassy voice introduces her story about a day when everything in her world radically changes:

The day my parents got swallowed by a rakkhosh and whisked away to another galactic dimension was a pretty crap-tastic day. The fact that it was actually my twelfth birthday made it all that much worse. Instead of cake or presents or a party, I spent the day kicking demon butt, traveling through time and space looking for my family, and basically saving New Jersey, our entire world, and everything beyond it. But I’m getting ahead of myself. I’ll tell you that part soon. First, let me back up a little.

As readers we are engaged by this smart, empowered narrator, who is alone, newly orphaned, yet tough—she already sounds like Ripley of Alien, one of the original female butt kickers in 1979 when the sci-fi thriller came out. We’re intrigued by words we do not know (what the heck is a ‘rakkhosh’?) and are drawn in by the promise of time travel and life-challenging adventures in other galaxies. In her own knowing way, young Kiranmala has given us the big-picture plot in the first paragraph, enticing us to come along with her to see what transpires.

Like many of the best books in children’s fiction, parents are dispensed with from the get go, here swallowed by a rakkosh—a “carnivorous, snot-trailing demon” who populates many of the Bengali folktales Dr. DasGupta was told as a child. In the first chapters, Kiranmala’s childhood home is also trashed by the demon with a black tongue who she calls “halitosis head.” That’s the overall dynamic and tone the author sets up: sword fighting amid the silliness, cleverness cancelling out the fearful chaos.

“The Serpent’s Secret” is aimed at young people who are at an age where childhood and adulthood begin to overlap, where the power of parents is displaced by the power of peers. Dr. DasGupta, a pediatrician and a mother, knows only too well the rough road of this developmental stage, when the plot of childhood branches off into new paths toward adulthood, and as a skillful writer, she’s able to bring to life the joys, confusion, real terror and pure happiness that emotional journey often takes in intriguing and amusing—not heavy-handed—ways. We are inside the young narrator’s head, seeing and judging events from her no-nonsense point of view. Her voice is compelling.

In Kiranmala’s quest to save her parents, she meets up with a cast of eccentric characters as amusing, complex and memorable as the flying monkeys, the Scarecrow, Tin Man, Good Witch and Bad Witch that Dorothy encounters in “The Wizard of Oz.” There’s Lal and Neel, two brother princes on winged horses who battle zombies and escort Kiranmala from Parsippany to the Kingdom Beyond Seven Oceans and Thirteen Rivers in search of her parents. There’s the magical pun-loving bird, Tuntani, whose corny jokes provide lighthearted moments and reflect the goofiness (“How do chickens get strong? Egg-ersize!”) tweens and teens love. There’s the intimidating green-eyed Sesha, the Serpent King, “guardian of the primordial ocean of divine nectar, keeper of time” and many others, each one an encounter for Kiranmala to confront and conquer to get to her goal.

Throughout the story, Kiranmala discovers dramatic truths about her origins as well as several revelations about life. There is the conflict between dark and light, a familiar theme in children’s and YA fiction from Grimms’ Fairy Tales to “A Series of Unfortunate Events” and “Twilight.” In “The Serpent’s Secret,” Kiranmala learns the difference between dark energy and dark matter, passes through tides of rubies in a peacock barge that reroutes her to the Demon Land (aka "The Blood-Thirsty State,") and battles a room of pythons to steal a jewel needed to read a shape-shifting map that will guide her to her parents. Those are just a few of the startling and original moments that keep the narrative taut and surprising throughout the novel’s 338 fast-paced pages.

Sayantani DasGupta, the daughter of Indian immigrants, wanted to share her love of books with her own kids but was saddened by the lack of heroes that looked like her family and neighbors. She decided to write her own stories, returning to the folktales she heard on childhood trips to India.  Originally trained in pediatrics and public health, Dr. DasGupta is also the author, co-author or co-editor of several books, including a book of Bengali folktales,  The Demon Slayers and Other Stories  (Interlink 1995), and the recent  Principles and Practice of Narrative Medicine  (Oxford 2016). She teaches in the  Master's Program in Narrative Medicine , the  Center for the Study of Ethnicity and Race,  and the  Institute of Comparative Literature and Society  at Columbia University.

Sayantani DasGupta, the daughter of Indian immigrants, wanted to share her love of books with her own kids but was saddened by the lack of heroes that looked like her family and neighbors. She decided to write her own stories, returning to the folktales she heard on childhood trips to India.

Originally trained in pediatrics and public health, Dr. DasGupta is also the author, co-author or co-editor of several books, including a book of Bengali folktales, The Demon Slayers and Other Stories (Interlink 1995), and the recent Principles and Practice of Narrative Medicine (Oxford 2016). She teaches in the Master's Program in Narrative Medicine, the Center for the Study of Ethnicity and Race, and the Institute of Comparative Literature and Society at Columbia University.

In the Author’s Note at the end of the book, Dr. DasGupta goes into detail about the Bengali folktales that inspired many of the characters in “The Serpent’s Secret.” It’s a short and welcome postscript that underscores one of the reasons the author decided to write children’s fiction. As the daughter of Indian immigrants, she wanted to share her love of books with her own kids but was surprised by the lack of diversity in the books available. She decided to write her own stories, returning to the folktales filled with bloodthirsty demons and enchanted animals that she heard on childhood trips to India.  Cue applause for that decision: In the first book in the Kiranmala and The Kingdom Beyond series, Sayantani DasGupta has created lovable characters, a rollicking narrative and meaningful themes that have a broad appeal for many young (and not-so-young) readers, setting up a thirst for what's up next for the appealing young heroine.

New fans of Princess Kiranmala will undoubtedly be clamoring and drooling like rakkhoshs for Books 2 and 3.—Donna Bulseco


DONNA BULSECO, MA, MS, is a graduate of the Narrative Medicine program at Columbia University. After getting her BA at UCLA in creative writing and American poetry, the L.A. native studied English literature at Brown University for a Master's degree, then moved to New York City. She has been an editor and journalist for the past 25 years at publications such as the Wall Street Journal, Women's Wear Daily, W, Self, and InStyle, and has written articles for Health, More and The New York Times. She is Managing Editor of Intima: A Journal of Narrative Medicine.

Narrative in Social Work Practice: The Power and Possibility of Story. Edited by Ann Burack-Weiss, Lynn Sara Lawrence and Lynne Bamat-Mijangos. Foreword by Rita Charon

Narrative in Social Work Practice: The Power and Possibility of Story   by Ann Burack-Weiss, Lynn Sara Lawrence and Lynne Bamat Mijangos.

Narrative in Social Work Practice: The Power and Possibility of Story by Ann Burack-Weiss, Lynn Sara Lawrence and Lynne Bamat Mijangos.

She is 7. She is small…yet she fills the entire room…this child…has been raped... But she is still sturdy, she still smiles…this child of 7 is a giant, a superhero." —Social worker Kristen Slesar, writing about a young client

 “My mother and I are on our way to the store. A gnome, dressed in curly-toed shoes, striped stockings, and pointy cap, waits on the sidewalk. He tries to pinch me. My mother cannot see the gnome. I try to hide, wrapping myself in her skirt…” Social worker Lynne Mijangos, describing a dream she had                   

In a wonderful  new book, Narrative in Social Work Practice: The Power and Possibility of Story (Columbia University Press, 2017), editors Ann Burack-Weiss, Lynn Sara Lawrence and Lynne Bamat Mijangos have gathered intimate, first-person accounts by social workers who have found creative ways to integrate narrative techniques into their work.

In some chapters, the social workers describe how they have developed and used narrative interventions with a wide range of individuals, families, and groups facing a variety of life challenges. In others, they share how they have turned their narrative skills inward and used them to deepen their self-understanding. In each instance, they use the tools of narrative training—close reading, attentive listening, reflective writing, and bearing witness to suffering —to help themselves and others confront and overcome external and internal barriers.

In one chapter, social worker Lauren Taylor uses psychotherapy and oral history to help clients find deeper meaning in their lives. Taylor describes her work with Marvlous, an African American woman who is depressed and in pain. As they talk, Taylor realizes that this sharp 95-year-old is a living historical archive. Working together, Taylor helps Marvlous, who at first thinks she has nothing much to say, recount and preserve the story she and her ancestors played in African American history. Taylor also describes her work with Joe, a 68-year-old man who is contemplating suicide. In the course of their work, Joe, who always dreamed of becoming an actor, writes and performs in a triumphant one-man show about his life.

Demonstrating the cross-border potential of narrative medicine, Benaifer Bhada talks about the narrative work she did with HIV-infected truck drivers in Kenya, and how participation in the group helped the men overcome feelings of shame and isolation, enabling them to seek appropriate treatment.

What do these stories have in common? In eloquent fashion, they all demonstrate how sharing our stories can help us break out of isolation and find our voices and our communities—at every stage of life —even as our bodies and cognitive abilities begin to deteriorate. Working with adults with dementia, Mary Hume uses poetry, co-constructed by the group, to express themselves, affirm their own value and continue to participate in their community:

“I like the smell of lilacs in May time;

 For me that’s the best playtime

I like to bake crullers that are bestsellers

I like to throw confetti when they’re serving spaghetti…”

—Social worker Mary Hume, co-creating poetry with clients in dementia care

Some readers will want to dip in and out of these stories, which will give them a sense of the benefits of narrative practice in social work. But once one starts reading the stories, it's hard to skip around and instead read straight through. Each story is rich in its unique details and emotional truthfulness, making the book hard to put down.—Nelly Edmondson


NELLY EDMONDSON is a graduate of the Narrative Medicine Master's program at Columbia University. She also is an award-winning editor and writer with extensive experience covering medical topics for print and online outlets. In addition to serving as a staff editor at publications such as Weight Watchers Magazine and Ladies’ Home Journal, she has written articles for the The New York Times, Parents, MAMM Magazine, as well as medical-school websites and publications such as Einstein Magazine and The Chironian. http://www.nellyedmondson.com

Blessings and Sudden Intimacies by Greg Stidham, MD

Blessings and Sudden Intimacies by Greg Stidham MD.png

Blessings and Sudden Intimacies: Musings of a Pediatric Intensivist, a 2016 memoir by Greg Stidham, MD, begins with a “sudden intimacy,” an encounter with a parent whose son has just died.  The boy’s mother, after asking Dr. Stidham's permission, takes hold of and strokes his beard, an emblem of his sense of self.   

It's that kind of startling detail, one remembered and deeply felt, that stands out in this medical memoir. In many ways, the author followed the normal trajectory of a clinician's path: After growing  up in Cleveland, and excelling in school, Dr. Stidham attended Notre Dame and the Medical College of Ohio.  In the 1970s, he was a fellow at Johns Hopkins, which had one of five Pediatric Critical Care training programs in the country.  What starts to emerge in the narrative is Dr. Stidham's heightened sense of purpose: He went on to establish a pediatric palliative care program, the first in the region, at LeBonheur Children’s Medical Center hospital in Memphis, where he spent twenty-eight years of his career.

Encounters with critically ill and dying children and their parents present the poignant “sudden intimacies” of the book.  The “blessings” of the title refer to the young patients, families and healthcare personnel who touch him.  But they are also more broadly defined, as when Dr. Stidham writes about his early career, that “without that training and the opportunity to gain [pediatric critical care] expertise I would not have had the adventures that blessed the rest of my life.”  The book is just as much about his personal as his professional life, and he says the two are “inextricably intertwined.”  This is reflected in the structure of the book, which moves around in time and ranges wide geographically.  We are taken on hiking trips to Colorado, camping trips in Arkansas, to Nicaragua where he helped set up a pediatric cardiac surgery program, and to Kingston, Ontario where he moved late in his career.

Dr. Stidham frankly relates his own marital and health problems, numerous enough to raise the question of how much his personal life suffered from the professional toll of long hours, nights on-call, and the emotional strain of dealing with dying children and their families, a potential conflict he doesn’t address directly.  Instead he conveys his belief that life is extraordinary, and that he has done unusual and extraordinary things with his.  He maintains an optimistic world view, a mindset that gives him the empathy and strength needed to sustain a long medical career.

Dr. Greg Stidham

Dr. Greg Stidham

Blessings and Sudden Intimacies makes you think about what you’ve done with your life, yet somehow Dr. Stidham leaves you feeling that whatever you’ve done, it’s enough.  He writes with disarming charm:  “Every life is rich in its own unique way, and deserves commemoration.  Perhaps it is, in part, for those others that I write, for their rich, but otherwise uncommemorated lives.”  He certainly conveys the richness of his own.—Priscilla Mainardi


PRISCILLA MAINARDI, a registered nurse, attended the University of Pennsylvania and earned her MFA degree in creative writing from Rutgers University.  Her work appears in numerous journals, most recently The Examined Life Journal and Prick of the Spindle.  She teaches English Composition at Rutgers in Newark, New Jersey.  Her short story “Pretending Not to Know” appeared in the Spring 2014 Intima.  She joined the editorial board of the Intima in 2015.

Anatomies: A Cultural History of the Human Body by Hugh Aldersey-Williams

Anatomies Book Cover.jpg

In Hugh Aldersey-Williams' Anatomies:  A Cultural History of the Human Body (W. W. Norton & Company, 2013), he poses a quasi-cultural, and intentionally un-anatomical, rationale for his constant middle of the night urination troubles: he’s getting old. The book does not offer a detailed glimpse into any specific disease, nor does it follow any individual navigating through a disease process. However, Anatomies allows the reader, regardless of training or background, to enjoy humorous anecdotes that explain how our cultural interpretations of our bodies, and what disease can do to them, have been shaped for centuries.  

Aldersey-Williams makes known his disdain for doctors’ predilection to use overly obtuse medical definitions for body parts, like saying coxa for hip.  He flexes his wit and knowledge on some of the most complex of organs while seamlessly jumping from micro to macro levels of anatomical and cultural understanding.

While tackling the larger questions that researchers continue to disagree upon, such as what constitutes an organ, the author also poses questions mystifying and ridiculous in equal parts, asking how we join many other species in the act of grooming yet we are unique in our development of hairstyles. He allows you to draw from the experiences he has accumulated as a field researcher as he reports drawing limbs and organs from the formaldehyde confines of an anatomy lab, to sketches of live subjects, and onto the assessment of dancers’, and our own, physical limits. 

The book, much like a textbook sitting on the edge of a cadaver tank in the anatomy lab, is broken up by region and body part. When read through continuously, this layout can prove to be a little disjointed, but the separation of topics allows for a seamless re-entry into the text after prolonged periods of interruption. Anatomies will hardly provide direct insight into any one area, but opens avenues of thought into how we perceive ourselves, each other, and the most famous around us.— Salvatore Aiello 


Salvatore Aiello M.S. is a medical student at Chicago Medical School at Rosalind Franklin University. After graduating from University of Michigan, he found that his minor in writing had the most lasting utility in both his academic and creative pursuits. Salvatore has several scientific articles published in peer-reviewed journals and has contributed to the blog, In-Training. Beyond his coursework and writing, he is described as the Benevolent-Overlord of the Medical Humanities Club where he works with his colleagues to promotes resiliency in physicians and all healthcare professionals.

The Bright Hour: A Memoir about Living and Dying by Nina Riggs

 “Nothing so concentrates experience and clarifies the central conditions of living as serious illness,” wrote Harvard psychiatrist Arthur Kleinman, and nowhere is that idea more evident than in a new memoir entitled, The Bright Hour:  A Memoir of Living and Dying (Simon & Schuster, 2017) by Nina Riggs.

Read More

Barriers and Belongings: Personal Narratives of Disabilities, Edited by Michelle Jarman, Leila Monaghan, and Alison Quaggin Harkin

An Iraq veteran fighting the “quiet conflict” of PTSD, a woman with memory loss who hides her disability as well as her misery, a man whose traumatic brain injury helps him make sense ofhis brother’s disability.  These are a few of the many voices we learn from in Barriers and Belongings.

At first glance, the book is a disabilities studies textbook with an introduction and chapter openings that provide background on social and cultural approaches to disability, as well as useful definitions.  But Barriers and Belongings is much more than a textbook:  it’s an eye-opening collection of lives, told with honesty and moving candor.  The narratives, which are organized into sections around themes such as communication, family and relationships, are engaging and short, allowing room for many different points of view.  Most are written from the perspective of early adulthood, reflecting back on growing up, which gives them an appealing coming-of-age quality.  The writers lead us up to the moment their conception of their disability changes in some way.  The ways are as varied as the disabilities themselves, which range from acquired conditions such as PTSD and chronic pain, to congenital conditions such as cerebral palsy and Down Syndrome, to mental health and cognitive conditions.  Because of these many viewpoints, one writer identifies the need for “people with diverse disabilities [to] recognize our common struggle” in order for the disability movement to reach its “full potential to change society.”

For the book is as much about the larger society as it is about the individual stories.  Most of the writers see disability not as a problem to be solved but as an integral part of themselves, and want to reframe disability from a nonsocial and nonmedical perspective.  As one writer puts it, “I wonder how the world would be if everyone realized that normal didn’t exist, and that trying to achieve normalcy was futile.  What if disability didn’t always need a cure?  What if everyone equated disability with difference, not deficiency?”  Or as another writes:  “Sometimes, abnormal is normal.”


PRISCILLA MAINARDI, a registered nurse, attended the University of Pennsylvania and earned her MFA degree in creative writing from Rutgers University.  Her work appears in numerous journals, most recently The Examined Life Journal and Prick of the Spindle.  She teaches English Composition at Rutgers in Newark, New Jersey.  Her short story “Pretending Not to Know” appeared in the Spring 2014 Intima.