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Around Campus

Title

Student Society Encourages Clinical Storytelling

Around Campus

Date
05/30/2018
Article

The David Geffen School of Medicine Gold Humanism Honor Society (GHHS) believes storytelling can help physicians find deeper meaning in medical practice. The group recently hosted a night of storytelling and PostSecret art designed to celebrate the human emotions often stifled by pressing clinical routines and protocols.

View PostSecret Art

"We believe storytelling is central to our jobs as current and future clinicians—we come to see patients through their histories, and recognize narrative competence as being an important clinical skill. But perhaps more importantly, in an era of increasingly formulaic medicine, telling our stories gives us as clinicians the chance to see both ourselves and our patients as deeply human and to connect the narrative richness of our profession," said the GHHS chapter members who led the event.

The UCLA GHHS thanks their chapter for making the event possible, the Nocturnists and Dr. Emily Silverman for inspiration and storytelling guidance, and everyone who shared their deeply personal stories.

Live Storytelling

The storytellers reflected on experiences that altered their ideas of humanistic care and made them question traditional labels of “doctor” and “patient.”  

Damond Ng - Medical Student, Class of 2020

Clinical Storytelling Event

A devastating failed code helped Damond understand the true meaning of resilience in medical practice.

"I know this won't be my last code, but next time, I will be ready. Despite any self-doubt, I am enough."
- Damond Ng

Read more

Hospitals call “codes” when patients require life-saving resuscitation. As a medical student, Damond had never been involved in a code. In fact, most of his code knowledge came from simulations…and episodes of House, Scrubs, and even The Office.

One day, Damond found himself near an operating room that was calling a code blue. Startled and unsure, he answered the call, taking over resuscitation. The necessary electrical shocks made the patient resemble a person about to wake from a nightmare. Unfortunately, the patient would never wake up again.

Soon after the code, Damond woke from his own nightmare. His partner had seen him convulsing and shaken him awake, worried he might be sick. But Damond knew he was fine…physically. He had just been administering chest compressions in his sleep, reliving the code.

Damond’s first code made him realize that quiet confidence doesn’t grow overnight. It comes from scar tissue created by failure and unsaved patients. Damond knew he could build confidence only by working past his fear and insecurity, accepting the responsibility—the honor—of being a doctor.

"I know this won't be my last code, but next time, I will be ready. Despite any self-doubt, I am enough."
- Damond Ng

Shiela Beroukhim - Medical Student, Class of 2018

Clinical Storytelling Event

A special relationship helped Shiela remember that physicians, committed to healing, can sometimes forget how patients have their own paths to travel.

"Patients are their own people; they have their own stories and their own desires."
- Shiela Beroukhim

Read more

Shiela desperately wanted to save her patient.

The patient had been bedridden since she entered the hospital for severe abdominal pain, which turned out to be stage 4 cancer.

Shiela and the patient bonded over their shared language—Farsi. Every morning, the woman woke to tell Shiela stories about her life, her family, and her challenges. Having grown to love the woman like a grandmother, Shiela could not wait to get her started on chemotherapy.

Cancer wasn’t the biggest obstacle Shiela faced in the patient’s care. A few complications created an ethical dilemma.

  • The medical team declared the patient unfit for chemo.
  • The patient did not want chemo.
  • The patient's son, who had suffered many recent losses, insisted the patient move forward with chemo, no matter what.

Not knowing what to do, Shiela focused on getting her patient healthy by bringing her ice cream, knowing one spoonful of the sweet treat might be all the patient would eat. Shiela cared for the patient, making herself available for anything—conversation, support, or simply love.

One night, on the eve of a procedure, the patient gripped Shiela's hand and said, "You are my angel."

The patient passed away before Shiela had the chance to see her again.

Shiela’s patient taught her that medical problems are far from black and white; they sometimes come along with ethical challenges, requiring physicians to walk a heart-wrenching line between the wishes of patients, doctors, and grieving loved ones.

"Patients are their own people; they have their own stories and their own desires."
- Shiela Beroukhim

Shiela learned to respect the patient’s journey and to stop seeing a patient’s death as her own.

Kevin (KJ) Blair, MD - Resident, General Surgery

Clinical Storytelling Event

A powerful experience with a grieving family made KJ promise himself he would always make time to get to know his patients.

"With our schedules, we convince ourselves we don't have time to connect with patients. But when physicians can step forward and have those conversations, it's powerful and important."
- Kevin (KJ) Blair

Read more

When KJ was an intern, a patient arrived with his happy, loving family. The young man had a terminal illness that, due to recent complications, threatened to end his life much sooner than expected. He was looking for just a little more time.

KJ noticed how the family’s steadfast spirituality gave them peace and comfort, and he asked if he could join one of their prayers. The family seemed surprised and delighted that a physician, and a surgeon no less, would want to pray with them, but they invited KJ to join whenever he could.

Before KJ had a chance to pray with the family, the patient moved to the intensive care unit (ICU). Sensing a ticking clock, KJ stayed late after a long, grueling shift to keep his promise of prayer.

During the prayer, the family chose not to resuscitate the patient if his heart stopped. KJ felt their sadness, but also their strength; he felt blessed to witness something so powerful.

The prayer helped KJ experience a new side of his work, something bigger than administering treatments and medications. He knew on a different day, hunger, fatigue, or a busy schedule could have kept him from the family. He promised himself he would never let anything stop him from connecting with his patients.

"With our schedules, we convince ourselves we don't have time to connect with patients. But when physicians can step forward and have those conversations, it's powerful and important."
- Kevin (KJ) Blair

Neveen El-Farra, MD – Internal Medicine

Clinical Storytelling Event

Shared tears helped Neveen learn not to underestimate her influence as a physician. She saw that humanistic care can be as simple as answering a question.

"I did something that was so small, but it meant so much to her."
- Neveen El-Farra

Read more

In early January, a drunk driver hit a car carrying a woman who had come to the United States looking for a better life. After the accident, the woman could barely move. Her jaw had been wired shut. She was caged in a C-spine collar.

Soon after the accident, Neveen found the patient’s mother sitting quietly with her daughter in the hospital room. Neither of the women spoke English. Filled with awe and gratitude, Neveen wondered how, with no connections or leads, the medical team had found the patient’s mother in a distant country.

Using a video translator, the patient’s mother asked Neveen when her daughter would be free of the C-spine collar. Neveen had no answers, but something in the mother’s eyes, and Neveen’s never-ending dedication and commitment to her patients, made her take the extra time to track down the information.

Neveen will never forget what it felt like to deliver the simple, yet precious news: They would remove the patient’s C-spine collar in 10 days. The women, including Neveen, shared tears of joy.

Neveen realized that sometimes, simple answers help patients regain hope. Information, whether positive or negative, heals patients far better than silence. That day, Neveen reaffirmed the importance of never hesitating to find information for her patients, regardless of the effort needed or the request made.

"I did something that was so small, but it meant so much to her."
- Neveen El-Farra

Maya Smolarek, MD - Resident, Psychiatry

Clinical Storytelling Event

Dehumanizing encounters with a patient made Maya reframe her ideas of humanistic care and the doctor-patient relationship.

"I saw myself as a woman, and a doctor who wants to do good for patients, who wants to defend herself, but who also wants to be kind."
- Maya Smolarek

Read more

For Maya, seeing patients as people, and even loving them, had always come easily. One particular patient challenged that in a personal way.

The patient, an older veteran, dehumanized Maya by sexualizing her in his looks, greetings, words, and expecations of her.

Maya recalled the feeling, “It’s subtle, like a drop of water on stone. It’s only a matter of time before it erodes.”

Maya tried to laugh off the man’s advances, remembering her commitment to patient-centered care while simultaneously questioning it. She wondered how much she had to take for the sake of quality care.

Maya blamed herself for the scenario, wondering if she smiled too much or had been too nice. She wondered if she was too sensitive, letting comments that seemed so small to others bother her so much. She started feeling more like a “silly girl” than a doctor, particularly in light of dismissive remarks from a male attending.

By exploring and accepting her own human reactions to being objectified, Maya gave herself permission to stop stifling her feelings in the name of patient-centered care. In a later encounter with this patient, she found herself able to interact with him not only as a human deserving of compassion, but also as someone who hurt her. Maya reimagined her idea of care by acknowledging the two humans in the sacred doctor-patient relationship.

"I saw myself as a woman, and a doctor who wants to do good for patients, who wants to defend herself, but who also wants to be kind."
- Maya Smolarek

Natalie Merchant - Medical Student, Class of 2019

Clinical Storytelling Event

Natalie’s experience revealed how physicians sometimes project their own lives and emotional histories onto patients and can be blinded to their patients’ unique needs.

"Sometimes, when we blind ourselves from situational context, we have the opportunity to meet the patient in a neutral space."
- Natalie Merchant

Read more

Natalie struggled with the idea of personality pathology on her psychiatric clerkship. She was concerned that certain techniques could lead psychiatrists to decide a patient’s clinical fate even before an initial meeting. She wondered if she and her colleagues ever failed to see the whole patient.

Natalie’s concerns manifested when she encountered a pregnant patient suffering from psychosis. Natalie’s colleagues saw a struggling young mom, damaged by her situation—a rough home life, an abusive boyfriend, and many other difficulties.

Seeing a warrior where her colleagues saw weakness, Natalie disagreed with the attending physician about the best course of treatment. She wondered how her kind, understanding colleagues could be so wrong about this patient.

That night, the patient rejected food and medications and even attacked a nurse. Natalie realized that she, and not her colleagues, had been wrong about the patient.

The experience helped Natalie see how easy it can be to project one’s personal history onto a patient. Natalie and the patient shared similar backgrounds, and Natalie realized this made her see what she wanted to see—strength and persistence instead of mental illness.

Natalie suddenly saw the value in the separation cultivated by her colleagues. She learned to be aware of her tendency to see herself in some patients, and she committed to acknowledging the emotional history she brings to clinical interaction and finding the neutrality needed for excellent care.

"Sometimes, when we blind ourselves from situational context, we have the opportunity to meet the patient in a neutral space."
- Natalie Merchant

Lauren Textor - Medical Student, Ph.D Candidate

Clinical Storytelling Event

After seeing a patient’s social history inspire care that was punitive instead of healing, Lauren wondered if candor begets inequality.

"How does deriving pleasure from morphine signify moral failure?"
- Lauren Textor

Read more

Lauren came to medical school with an anthropology background and a passion for supporting health equity, in part by relaying detailed social histories for her patients.

One of Lauren’s patients made a positive first impression that morphed into a negative one through the format of the medical presentation.

First impression: Young, perky, and bright

Presentation:

  • Unmanageable pain from a recent trauma
  • A difficult life of foster care
  • A recent arrest

The arrest aroused the attending physician’s suspicions, and the medical team wondered if the patient was untrustworthy—and if they should believe her reports of severe pain.

Lauren fought to give the patient the benefit of the doubt, questioning the subtext of her colleagues’ judgments. Lauren asked herself, "What does it mean to say that someone might like morphine? How does deriving pleasure from morphine signify moral failure?”

As the medical team tried to taper the patient’s morphine supply, Lauren offered support and conversations to ease the pain. Everything Lauren observed affirmed a vulnerable young woman trying hard to help herself and gain the approval of her medical team.

Lauren realized that, on top of severe pain, the patient had developed an opioid dependence in the hospital, despite the best intentions of everyone involved. However, the patient received no treatment for opioid dependence—partly because the medical team had labeled her "suspicious." She did not return to follow-up appointments with the medical team.

Lauren learned to question her original belief in the merits of detailed social histories. To avoid health inequality in the future, she decided to carefully consider certain factors when reporting, knowing that detailed histories might increase trust for some and increase suspicion for others.

"How does deriving pleasure from morphine signify moral failure?"
- Lauren Textor
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