Posts Tagged ‘Medicine’
When’s the last time you read a comic?
As a boy I loved reading The Beano and later, like lots of other adolescent boys, immersed myself in the more violent worlds of Action and 2000AD. As a medical student, I became attracted to the subversive allure of Fat Freddy’s Cat, The Fabulous Furry Freak Brothers and then, in my late 20s, to Viz magazine. Then I stopped. Whatever role comics might have played in my childhood and young adulthood, it was time to move on. So why do I find myself, in my early 50s, back reading comics again?
Because of GP and cartoonist called Ian Williams. Williams is responsible for coining the term ‘Graphic Medicine’ which describes, according to the graphicmedicine.org site that he helps run, “the role that comics can play in study and delivery of healthcare”. Williams has also produced a wonderful new semi-autobiographical graphic novel, entitled The Bad Doctor — “a darkly humorous tale of medicine, cycling, obsessive-compulsive disorder and heavy metal”. The book details the life of the flawed (in his own eyes), yet deeply human, Dr Iwan James. This wonderful meditation on medicine, humanity and healing is a great reason to start reading comics all over again.
As soon as the book starts, we are drawn into Dr Iwan’s world and sympathise with him as he hilariously navigates the daily grind of heartsink patients, difficult colleagues, middle age, baldness and self-doubt. It is particularly touching where it deals with his experience of growing up, trying to maintain relationships and work, all while suffering from OCD.
In a scene depicting his childhood, it describes the early development of an exaggerated sense of responsibility for the health of those around him (something many of us will identify with). He even demonstrates how his unique experience of living with an illness can help him to help his patients. In another touching scene in the book, he breaks the usually unspoken boundaries of the doctor-patient relationship by sharing the details of his own illness with a patient struggling to cope with OCD — and in doing so, helps his patient.
Writing comics, and bearing witness to his own problems may also have had a cathartic effect for its author. Writing in The Independent, Williams describes how comics gave him a means to talk about an area of his life he hadn’t, as a doctor, felt able to share before.
“In fact, I almost never discussed them with anyone before finding my voice through the medium of comics, in which I found a way to articulate my own earlier struggle with mental illness.”
The book also details the attitude of his professional colleagues to his mental health problems. When he confides with his practice partner that he has fantasised, throughout his life, about killing himself (“Wouldn’t act on it, though… don’t worry. It’s only a mental habit. I don’t own a gun or a guillotine”), his partner’s primary concern is that this might invalidate the practice insurance.
I read the book three times in 24 hours (although it runs to just over 200 pages, it can be read in 30-to-40 minutes). There is something unique about the reading experience of being pulled along by the combination of the framed pictures, the text and the gaps in between. Using cartoons, he manages to describe Dr Iwan’s world in a way that would have been impossible in the form of an essay or through fiction.
With great bravery, wit and technical skill, Williams has managed pull off a number of impressive feats simultaneously. By digging under the surface of a doctor’s working life in the context of his day-to-day existence, he gives an insight into how the theory of medicine is so different from its practice. He also demonstrates what it is like to live life with a mental health illness, while simultaneously showing an excellent doctor practising good medicine, despite it. All the while keeping us laughing and entertained.
This funny, sometimes sad and courageous book will, I hope, go some way to help non-medical readers to understand the challenges of practicing medicine and show that doctors, like them, are human and suffer.
It might even help a few doctors to think a little differently about mental illness amongst their own.
This article was originally published in The Medical Independent
“I learned that whatever we say means nothing, what anyone will remember is that we came” (Julia Kasdorf)
The “rituals and practices around death”, poet and Undertaker Thomas Lynch writes in his book ’The Good Funeral’, “are a window into the soul of a culture. A society that is unsure about how to care for the dead and is confused what to do with grief and loss is a society that is also uncertain about life”.
The Irish tend to acknowledge the importance of, and participate in these rituals ; the wake, the paying of respects to the deceased in the family home or funeral parlour, and the funeral itself. In a situation where words are inadequate, these rituals afford us an opportunity to bear witness to the grief of others and acknowledge our shared humanity. The “dead don’t care” Lynch says, – “but they do matter”.
However clear our roles and responsibilities surrounding the death of a friend or relative, things aren’t always so clear when it comes to the death of one of our patients.
Very few of my medical colleagues (rural GP’s excepted) regularly attend the funerals of their patients. Reasons often centre around the logistics of cancelling clinics and operating lists at short notice. Our primary responsibilities, we feel, are to those still above ground and that our care of our patients ends when they do. For some funerals may be too painful a reminder of our fallibility as doctors – and we may even be concerned that we will be blamed for the death at the graveside by angry, grieving relatives.
Dr. Danielle Ofri, writing in the New York Times, suggests that there may be deeper, unacknowledged reasons for not attending; “Now that the medical care chapter has closed we’re not quite sure how we fit into the patient’s life. We were so recently actively directing the medical care — doing something — and now we are the awkward bystanders”.
It also hurts; “It hurts to keep seeing the bodies of your patients — bodies with whom you have been intimately familiar — laid out in stone-cold carriage. It hurts to see the face of someone with whom you’ve had deeply personal conversation, now rigid with that oddly blank expression. It just hurts.”
There are so many practical and psychological hurdles to attending, its not surprising we don’t usually turn up.
And yet medical relationships are not purely professional. Because of the intimate and deeply human nature of our interactions it is not unusual for us to build up strong relationships with our patients over time, to develop mutual affection and even friendship with them and their families. To deny this part of the relationship by not acknowledging its end, is a denial of an important part of ourselves and our patients.
So what should we do? How do we reconcile our human responsibilities and our need to grieve with those of being a doctor?
“Lead with your humanity” says Thomas Lynch (speaking at the recent dotMED conference). “I encourage you to be among the people of the dead when the time comes – as it always does. You will be improved by it.” He urges us to attend, or reach out in some way; “You can do some really good medicine by just being part of that – when you can – to the extent that time allows – a phone call, a bereavement letter, five minutes at the wake, a cameo appearance at the funeral, a handful of dirt over the grave”.
The funeral, he explains is a means of “getting the dead where they need to go and getting the living where they need to be”. As humans, being present at a funeral forces us to look into the abyss it presses us against the ontological and the existential, and makes us ask the important human questions. “Is that all there is? Can this happen to me? Am I all alone? What comes next?”.
He also suggests that for doctors, facing the human realities of a death in one our patients reminds us that not only are we fallible but also that death is an inevitable. “You spend your lives trying to stop the sky falling. But the sky is falling”.
Whereas the attendance of a doctor at a removal, funeral or at the home of one of their patients after they die is not usually expected, sometimes the smallest spark of kindness at the darkest time are the ones that illuminate the most. These kindnesses are the “stuff of good medicine – these ordinary miracles we do for one another”.
It’s comforting to know, that some of our best medicine can come about by just showing up.
Thomas Lynch spoke at the dotMED Conference in December 2014. Next meeting will be in February 12th 2016.
I’m here. This time, as I say goodbye to my wife and kids, I know that it will be for the last time. My mind drifts inevitably to the fatal accident that will take me, the tears of my wife and children as they attempt to identify my charred and mangled remains, and even what selection of music might be played at my funeral. My teenage children look at me strangely as I hug them and tell them how much I love them before I leave. “You’re being weird, dad. We’ll see you next week. Enjoy the conference.”
Of late, I have become rather obsessed with the idea of my own mortality. A previously unnoticed small lymph node in my neck fast-forwards me (despite the firm reassurance of my GP) to the lymphoma and failed bone marrow transplant that will take me away prematurely. Some short-lived palpitations after drinking too much coffee remind me that the differential diagnosis includes a fatal cardiomyopathy.
I have always been one for a bit of drama, but thoughts about my own death are relatively new to me.
In my youth, the idea of dying never really occurred to me. Death was an inevitability, and despite my frequent exposure to it though work, it was always somehow beyond the horizon. Life seemed an endless list of possibilities and the relentless momentum of their pursuit kept me looking forwards.
Longing to grow up, get a job, fall in love, travel, to fulfil my (ever-changing) dreams and aspirations. Always moving, looking forward, never back.
Many older people spend their time looking back — longing to be young vigorous and healthy again, back in the throes of first love, reliving memories of the best parts of their lives
The reverse is true for many in old age. Many older people spend their time looking back — longing to be young vigorous and healthy again, back in the throes of first love, reliving memories of the best parts of their lives and even dwelling on the bad choices they might have made.
A few of my friends have had dalliances with serious illness and it has made my inevitable demise more real. Whereas I’m healthy, I tire more easily, have slowed-up physically and have to work harder to lose weight. I also keep missing bits around my chin when I shave because it is less taut than it used to be (less of a square jaw, more of a hammock). Now that the inevitable, un-ignorable signs of ageing are upon me, I can see things more clearly. And I’m rather enjoying myself.
I’m in the middle. Without the pushing forward of youth or the pulling back of old age, I’m at a point that writer (and undertaker) Thomas Lynch describes as “balanced between infancy and decrepitude”. It’s a point which allows you a good view of what went before, what lies ahead. It allows a balance and perspective that shows you the importance and wonder of how things are now.
I’ve been reading a lot about psychopaths recently. Psychopaths, according to psychologist and author Kevin Dutton, have “a grandiose sense of self-worth, persuasiveness, superficial charm, ruthlessness, lack of remorse and an ability to manipulate others”. Dutton, in his bookThe Wisdom of Psychopaths points out that “unlike their box-office counterparts, not all psychopaths are violent, or even criminal. Psychopaths are fearless, confident, charismatic ruthless and focused – qualities tailor made for success in the 21st Century”.
Now that I know how to spot one, I’ve begun to notice them everywhere and I’m beginning to think that there may even be a few practicing medicine.
Sheridan’s cheesemongers is one of my favourite places to visit on a Saturday morning. It’s a beautiful shop in the market area of Galway city, with an impressive selection from the best cheese makers from Ireland and Europe. In cheese terms, the possibilities of Sheridan’s are almost boundless.
I have been a visitor to the shop on many occasions over the years, and, with Seamus Sheridan’s help, have extended my cheese knowledge beyond the Babybels and Easy Singles of my childhood.
All the same, the feeling of excitement I get on entering the shop is often accompanied by a level of anxiety as I approach the counter. We’re having some people round for dinner and I have to select something for after the meal. What’s the name of the cheese I had the last time? Is it meant to smell like that? Is it ok just to just get some Cheddar? Will I choose that Gubeen cheese or a Milleens from Cork, a Manchego from Spain, an Azeitão from Portugal or one of the many other dozens of cheese on display? It’s hard not to be overwhelmed.
Sometimes, I wish someone would make my mind up for me.
On his evening off a doctor attends his local theatre when, at a particularly dramatic part of the play, a voice shouts loudly from the audience “Is there a doctor in the house?!”. Eager to help, he immediately stands and replies “I’m a doctor.”
“Bloody awful play isn’t it doctor!” comes the reply.
Doctors are like actors really. Every day we get ourselves into character for performance by donning one of a variety of costumes (white coats, scrubs and suits), with the help of props appropriate to the profession (stethoscopes, opthalmoscopes and reflex hammers). Our performances are often supported by a loyal troupe of other actors and actresses (except for those intent on delivering monologues). Many of us enjoy the thrill of performing in front of an audience and may even find it difficult to perform in ordinary life without one.
It can be challenging for any performers’ family to match the sustained adulation of the captive audience of a full clinic of adoring patients. Having one’s request for breakfast in bed ignored will often come as a disappointment for those of us used to getting our way as leading men or ladies in the workplace.
Anyone with even a passing interest in Irish music will be aware of the excitement surrounding new Irish group, The Gloaming. The group is made up of a number of well known Irish traditional musicians (Martin Hayes, Caoimhín Ó Raghallaigh, Iarla Ó Lionaird) and two Americans; Hayes’ long time collaborator, Denis Cahill and the New York based pianist, Thomas Bartlett.
They perform beautiful, ground breaking, unique music which, although heavily steeped in the tradition of Irish tradition, could not have been made without the curiosity and courage necessary to step outside its walls.
The courage to break down the silos seems to have initially come from Denis Hayes – “I had to play music that I knew he couldn’t like,” he says in reference to his father PJ, a well known Irish fiddler. “I had to approach it in ways that some people would find it offensive”. On making music in modern world; “You can’t be self-referential all the time. It has to reference itself against other music. The reality is that we do exist in the wide open world.”
This openness and curiosity put Hayes in touch with Thomas Bartlett, pianist (who has played with artists as diverse as Rufus Wainright, David Byrne, Norah Jones and The National), writer and producer.
Bartlett, in reference to the lines and rules that are so visible to those steeped in tradition say; “Maybe the reason this works so well is that I don’t recognise the lines that they do”. “It is so hard when you are so aware of what is meant to be done. The fact that I have absolutely no idea of what needs to be done makes them disappear”
A number of these quotes rang true for me in the context of an approach that seems essential for anyone trying to forge new ground in an environment that is deeply conservative and closed to outside influence (like medicine).
Unique and unexpected resonances can often occur at the interfaces of seemingly disparate worlds.
Ring the bells
That still can ring
Forget your perfect offering
There is a crack, a crack
That’s how the light gets in.