Medical Humanities

Gun violence has become a national epidemic. It has indelibly affected our community and is, as Stu Durando argues in Under the Gun, a matter of public health. Here’s a brief blurb for the book:

“In 2007, Dr. Martin Keller cut into a dying teenager’s chest in the emergency room to give him a chance at life and changed the treatment of gun injuries at St. Louis Children’s Hospital dramatically. Keller arrived as director of trauma when the hospital was beginning to see more gunshot wounds than any children’s hospital in the country. Amid the chaos, he and other caregivers were tasked with making improvements to create a smoother running trauma operation. Under the Gun looks inside the emergency and operating rooms as physicians, nurses and surgeons tackle the overload and social workers strive to limit repeat gun injuries. It also examines the lives of victims and families, including a 6-year-old girl critically injured with a shotgun by her brother, a 12-year-old boy shot in the head and killed by a friend with a gun found on a bed, and a high school senior shot in the back while walking to school.”

Come join Mr. Durando (and possibly Dr. Keller) as they talk about the book and its aftermath. The talk will be on Zoom on March 31, 2021 at 5 p.m. eastern time. Please register via Eventbrite. You may purchase the book in a variety of venues.

Dr. Hilton-Buchholz ’04 spoke to students in the Illness Narratives class about her journey into the medical field, “We’re Going to be O.K.” her e-book about COVID-19 aimed at helping children in vulnerable communities stay safe, healthy and optimistic, and racial disparities in medicine.

Zoom Recording Passcode: 2*h#ux!X

This guest blog post was written by Anna Lonon, a new affiliated faculty member of our Medical Humanities Program.  Stay tuned to hear more about our exciting new affiliates!

The recent July 16 webinar, “Medicine, Narrative, Pandemic & Power,” sponsored by the Modern Language Association (MLA) could not have been a more relevant and salient talk. The webinar featured Rita Charon, MD, PhD, founder of the Division of Narrative Medicine at Columbia University, and Professor of Medicine at Columbia University Medical Center, and Aakriti Pandita, fiction writer and

infectious diseases physician who, ironically, was one of the first Covid-19 patients in Rhode Island. Together, Charon and Pandita advocate for the medical  humanities to create better physicians and healthcare providers; ones who are more perceptive and more committed to the ‘radical listening’ necessary to treating patients and pursuing social justice.

The power of the narrative is a central theme of the talk, and is demonstrated beautifully in Pandita’s own illness narrative, followed by Charon’s analysis of it. Pandita’s narrative comes across both relatable and horrifying, as we learn of a highly educated physician being repeatedly misdiagnosed as her symptoms worsen, eventually leaving her like “an infant again.” (She is eventually diagnosed with tuberculosis of the spine, an extremely rare condition, after self-advocating and aggressively seeking a correct diagnosis.) Although traumatic, it is this life changing event that turns Pandita to literature and writing, and, as Charon argues, ultimately makes her a better doctor who really listens to her patients. Charon recounts specific narrative structures present in Pandita’s story (like her temporal restructuring to relay the trauma associated with her illness) giving us front row access to what this type of “radical listening” looks like and how narrative theory and literary criticism can provide more perspective to a patient’s story.

Who wields power is also a central theme of the talk and Charon argues for more balance between those who have the power with those that typically do not. What is both fascinating and troubling is how someone like Pandita, a physician who obviously wields some power, is still failed by the U.S. healthcare system. Just a few years after her initial illness, Pandita again has to self-advocate for a Covid-19 diagnosis after being dismissed by multiple practitioners. A remedy to these failings, both agree, can be found in bringing narrative medicine to those in power. As Charon notes, there is a lot that we needto listen for regarding the factors that make us who we are, including our socioeconomic and cultural backgrounds, and studying the humanities facilitates these necessary skills.

So, how do we use narrative medicine and the humanities to correct the disparities that exist in medicine? Health practitioners must commit to social justice. They must give those without agency the ability and right to be heard, and “radically” listen. Both the Division of Narrative Medicine at Columbia University and the Division of Social Medicine work to promote this. Moreover, what comes from not listening and, therefore, from not committing to social justice? Perhaps the difference between life or death. Charon and Pandita describe liver and kidney transplant recipients overrepresented in whites and underrepresented in the black community; and a much higher incidence of childbirth mortality in black women than whites across classes. Issues like this warrant more questioning, more curiosity and more listening to find the answers and get better outcomes for these patients.

For Charon and Pandita and all of us in the medical humanities, it is at the intersection of literature and medicine, of storytelling and healing, that social justice is found. When we open ourselves up to really listen to everyone’s story, and we actively explore it as we would a plot in a story, we get to the deeper meaning, the full story, and, hopefully, to complete healing.

For access to a recording of the webinar, click Here.

On July 29, I had the honor of attending Dr. Damon Tweedy’s virtual visit with SC AHEC. Two days earlier, The New York Times published his opinion article about medical training and race: an article in which Tweedy argues that “Medicine, like other institutions in society, is now being called to task by its own for the role it has played in perpetuating the longstanding inequities that have led us to this moment.” As a black physician, Tweedy understands how these inequities are visible in medicine and also perpetuated by a medical establishment in which, as of 2016,

half of the medical students and residents surveyed agreed with one or more false statements about biological differences based on race, such as the idea that Black people had thicker skin and less sensitive nerve endings than their white counterparts.

Tweedy’s talk, divided into a lecture and discussion, began with a focus on the idea of race as “biological difference” and “behavioral pathology”; he mentioned, for instance, that many believe that COVID-19 disparities are due, in part, to the fact that Black people “can’t practice health hygiene” or masking. While certain disorders, he continued, tend to happen more in the Black community, these beliefs are products of systemic racism within the healthcare field, an issue examined by recent books like Medical Apartheid, Black and Blue, and Just Medicine. 

Much of this movement, according to Tweedy, has been advanced by the students who enter medicine.  These students have been demanding curricular changes, like the “Anti-Racism” curriculum at Duke University, where Tweedy works and teaches.  Tweedy picked up on a topic we had discussed at our last book club meeting; anti-racism cannot be relegated to one lecture or one (typically minority) faculty member. It needs to be “part of the whole curriculum.”

While these changes are heartening, other statistics tell us we have far to go.  From 1978-2014, the percentage of black men in medical school stayed the same.  The percentage of black women nearly doubled, but black men “have become less common in the medical space.”  Much of this is due to the cultural narrative of “what it means to be a black man”; the intersection of our notions of race and masculinity.  Yet Black patients are more likely to utilize services when they have a Black physician, so this cultural narrative needs to change.

How do we change this?  In our discussion, we covered the usual questions asked on an intake form:  What is your age, race, and gender?  In what way/s does asking about race already impose a variety of stereotypes on a patient?  Perhaps we could include occupation or, as many suggested, get to know patients’ stories first.  This brought us to the idea of narrative medicine (which will be covered in ENGL 290 this fall semester) as a way to understand a patient as more complex than “black” or “white.”  He’s not arguing for colorblindness, but are we doing it in the best way when we reduce it to that?

What would, Tweedy asked, prevent structural racism in healthcare?  Most of the book club participants answered this poll question with “universal health coverage.”  According to one doctor, who conducted a study, states that took ACA/Medicaid money fared better in ters of patient health than states (like our own) that did not.  Others argued about “implicit bias” training, arguing that physicians need to learn to “speak the same language” as their patients.  Often, Black patients’ first engagement was so terrible that they decided they would “rely on God.”  We need, Tweedy argued, to come up with an engagement model that looks at implicit biases.  Often, medical students’ very training perpetuates and reinforces stereotypes: stereotypes often strengthened by the prominence of telemedicine during the COVID-19 pandemic.  While physicians can see patients who might otherwise not get to the lab, these same people cannot get services or pick up medication.  Access, too, illustrates the structural racism that undergirds our society and is reflected and reinforced by healthcare institutions.

Tweedy hopes to work on these structural issues “in a more concrete way” in his second book, coming out soon.

Interested in how the arts and humanities can be applied to mindful practices? Next Wednesday, July 29th, at 6 p.m., MUSC professors Drs. Cindy Dodds and Lisa Kerr will present tools for physical, cognitive, and emotional learning and healing using visual thinking strategies and creative writing exercises in this virtual workshop. These exercises are frequently applied in health care education but can easily be used by individuals to develop observation skills, center thoughts, and explore emotions in a variety of circumstances. Dr. Dodds and Dr. Kerr will lead participants through two examples as they explain the positive effects of the creative arts for us all.

Please see this page for more information and registration details.

CofC history professor, Jacob Steere-Williams is a guest speaker on a webinar hosted by UNESCO. Join us on Thursday, July 23 at 10:30am to learn more about the history of pandemics.

On July 9^th, I joined a group of about 600 people, from medical professionals to interested South Carolinians, and attended a discussion of Dr. Damon Tweedy’s Black Man in a White Coat.  The discussion, sponsored by SC AHEC, focused on the first part of the book; another discussion will follow on Tuesday, July 21^st, and the event culminates with Tweedy’s virtual visit on July 29^th.

As our nation awakens to the realities of systemic racism, the humanities hold an especially important role in highlighting narratives that illustrate individual lived experiences. As racial disparities become more and more evident in health care, it behooves us to listen to Tweedy’s experiences as someone on both sides of the stethoscope.

When polled about what surprised us the most about Tweedy’s book, the answer wasn’t systemic racism or inequalities in medicine.  It was his openness in talking about these things: in admitting that, even as a person of color, Tweedy experienced inherent bias against patients of color. One African-American physician spoke eloquently about how similar Tweedy’s thoughts, feelings, and biases were to his own, and to those of other healthcare providers of color.

Exacerbating the systemic racism at play here is the hierarchical culture of medicine itself. As with many high-pressure careers, this comes with the notion of “imposter syndrome,” especially for someone already considered different. In medical school, many medical students said, one is supposed to be “untouchable,” always “on.” As a person of color, though, one cannot be too aggressive, overconfident, or arrogant, or one earns the dreaded epithet of “angry” or overly “emotional.” This reminded me of Austin Channing Brown’s I’m Still Here: Black Dignity in a White World.  On her first day in a job, Brown’s boss tells her that he is there for her if she has any “concerns,” but, when she shares a concern about a racist incident, she is told that she is too “sensitive.”  It is a catch-22 that characterizes the lives of many professionals, especially in hierarchical settings like that of a medical hospital.

And bias is baked into medical training, too. One medical student perceptively reported that, when he was taught about sexual transmitted infections, most of the genitalia on the slides were dark. When it came to less stigmatized diseases, people of color were not represented. Curious, I did a “Google Search” for images of STD’s. They are too gruesome to post, but they were all, with the exception of one, images of people of color.

We all need to be aware of our implicit biases, of our racism, but health care professionals also have to make quick decisions regarding their patients. How, asked one doctor, do we “combine experience (good, thoughtful, meaningful experience) with an understanding of our own biases?”

The last question was, perhaps, the hardest: do we feel comfortable educating our colleagues, or our friends, about discrimination? It is hard—damn hard—to allow oneself to be “educated,” which reminded me of Robin DiAngelo’s White Fragility.  As one participant said, “we educate (people) about speaking up, but not about listening.” How do we listen, really listen, to our colleagues and friends?  To the people we will serve? How do we do this when we have been accused of bias?

These are really important questions, both in and outside of a healthcare setting. We need to interrogate bias because, as one elderly doctor said, the medical evidence is incontrovertible: bias makes people sick. Bias kills. And it is preventable.

The Post and Courier ran the following article “SC educators say absence of masks, social distancing threatens in-person classes this fall” to highlight the challenges many schools are facing. Senior and Medical Humanities minor Maddie Gies is quoted in the article and shares her concerns:

Gies, who lives in downtown Charleston, said she’s felt discouraged and frustrated by the lack of masks she sees being worn on King Street and other public spaces near the heart of the college’s campus. Based off what she’s seen on social media, many of her friends are continuing to socialize as normal.

“I would love nothing more than to go out right now, but I can’t,” Gies said. “It’s just kind of hurtful because it makes me feel like I’m wasting my time or like you’re not taking it seriously or I’m having to sacrifice and you’re not. It’s just like a slow build of just seeing those things.”

Gies, who is studying special education, also worries that the spread of the virus will impact her ability to get in-person student teaching experience in the classroom this year.

At least two of the five classes she’s registered for in the fall have already been switched to take place solely online, she said, causing her to consider putting her studies on hold for a semester.

“It’s not just my senior year. It’s your kid going to school. It really affects everyone. And I don’t think people are realizing that,” she said.

Pick-up for College of Charleston face mask, hand sanitizer and sanitizer wipes for college offices at the Stern Center on Tuesday, May 26, 2020.

Since the article ran, the College released the Back on the Bricks plan for fall.