As I read Sarah Gundle’s essay “I Can’t Remember His Name” (Intima, Spring 2023), I recognized a young and eager clinician who felt both moved by someone’s story and inept at affecting change, a dissonance that can reverberate throughout decades of practice. I, too, remembered my earliest encounters, when my own therapeutic skin was most supple and soft, vulnerable to the bruising weights of trauma, addiction and injustice. I recognized the writer’s spontaneous tears – and the impulse to minimize and dismiss them in accordance with the guidelines of rational detachment and therapeutic rapport.
In my non-fiction essay "House of Pain" essay (Fall 2024 Intima), I discuss the problematic MS Hug metaphor, used for unpredictable and distressing chest spasms that can make breathing feel impossible. Hugs are a form of affection, except this one is not. I remember being caught off guard by the intensity of the pain. Words in Logan Shannon’s non-fiction essay “The Gold Standard” (Fall 2019 Intima) resonate profoundly: “It’s the pain that comes from nowhere, the surprise, that throws me.”
There is a tendency in times of upheaval to overestimate the agency of certain individuals. Anxieties engender a cast of heroes and villains making games of global events. But the kernels of truth in these conceptions obscure the relatively small influence such figures exert on our daily lives. Still, there is comfort in the notion that somebody, somewhere, is in charge; perhaps because it suggests that we, ourselves, possess more agency than we perceive and are not, as so often seems, simply adrift on the currents of fate.
In both the literary world and in the clinical world, metaphors take hold of our relationship to illness and health.
“Giving Up the Fight,” by Rebeca Stanfel (Spring 2023 Intima) is a first-person account of her struggle with sarcoidosis and the metaphors that complicated her ability to deal with it. Well-meaning friends and family assailed her with encouragement that depicted chronic illness as a battle to be won or lost.
Jen Baker-Porazinski's story “Dying at Home” (Spring 2024 Intima) drew a vivid picture of a patient and her family, and the rhythm of her last few weeks. The love and dedication of her husband was especially moving.
I was also struck by the narration of Baker-Porazinski’s journey, as a doctor. Reflexively, at each visit, she listened to her patient's heart and took her blood pressure. Baker-Porazinski felt this showed that she hadn’t given up on her patient .
Big moments are surrounded by little moments. That’s what I was trying to pull out in my story “There’s a Special On Car Washes,” published in the latest issue of Intima. That bewildering sensation, common in life and especially in healthcare, that extraordinary things happen but that time marches on without sentimentality. You win the big game but when you get home you still have to take out the garbage. You receive a life-changing diagnosis and then you have to figure out the machine to get out of the hospital parking lot.
Grief walks in many forms, and its footsteps are padded and quiet, imperceptible even, except to those who lay awake at night, counting its tip taps on the upper floor.
I have been practicing medicine since completing my residency in June 2000. It baffles me that to this day I still hear comments from patients, families and loved ones that we physicians often cannot relate to their concerns, their health struggles and their ailments because we are doctors, because we harbor medical knowledge, because “we are not human.”
Every now and then, at the end of a call shift, I leave the hospital with aching feet and heavy eyelids. And then I remember: I am the lucky one. I am the one who gets to go home. My patients – the grandfather whose kidneys are failing, the ten-year-old with meningitis – are not so lucky. They will not go home tonight. They may never go home again.
In my professional role as a medical illustrator, I'm often drawn to a good metaphor. As a patient, the allure of metaphor can be dangerous.