Notes from the Green Couch

Jack Truten

Word.Doc and narrative medicine.

Monday, February 19, 2007

Notes from the Green Couch

Working in medicine is like a disease in itself. The cause is implicit in the job - dealing with the sick and suffering, losing the battle to save someone from death, let alone unbearable physical or mental anguish, one too many times. The symptoms all branch from perpetual trauma - compassion fatigue and burnout; exhaustion and stress. Treatment is troubling as traumatic experiences are notoriously difficult to recover from the subconscious - let alone treat. Insular reasoning is often frustrating and unproductive; talking is more therapeutic, yet often construed as complaining by listeners. Writing, prescribes Truten, is the optimal medicine.

Touting a PhD in English and Folklore, Truten praises writing as giving "shape to the shapeless, form to the formless... a really efficient, incisive method to reaching the difficult stuff" - providing a person with something tangible to look at, share, experience, and interpret. In the biweekly meetings headed by Truten, the pediatric clinicians he deals with have the opportunity to exchange then discuss personal workplace stories (written before or at the beginning of each session) in an effort to "develop the antidote to compassion fatigue and burnout."

While the act of writing about trauma is rarely therapeutic in itself, the story can help the writer begin to come to terms with an experience and his or her feelings surrounding it. As the discussion facilitator, Truten uses his literary background to identify and interpret techniques employed by the writer. Like an English teacher, Truten implores his group to observe structure, themes, style, and most importantly, voice. An author's voice indicates how connected the doctor feels with the patient; the personal "I" shows some distance, while "we" shows a strong association with the suffering.

Some doctors have the capacity to become calloused. In the case of those affected - where the daily intimate interaction with suffering and death debilitates the doctor - Truten hopes to use narrative medicine as a coping mechanism and keep clinicians working effectively. Success is hard to measure overall, but individuals have already responded favorably. One registered nurse had a baby die unexpectedly and nearly quit on the spot. Through the seminar, however, she gained understanding and clarity of mind; rejuvenated and supported, she remained at the hospital.

Truten cited other stories over the course of his presentation, one of them his own. Some time ago, Truten worked as a staff nurse in a psychiatric unit. One patient, dubbed Jane for the purposes of the story, had been admitted and released multiple times over the course of a year, earning Truten's admiration and friendship over that time. Aging about forty years, Jane was pretty, lovely, and self-mutilating.

One day, Jane's hemoglobin levels dropped dangerously low and Truten personally escorted her to the hospital. In the car, she removed an old one-blade razor hidden in her hair. Both doctor and patient were cut in the ensuing struggle. Feeling like a failure - incapable of saving the patient he had invested the most care and emotion into - Truten abandoned the harsh realities of medicine and returned to school to study the fantastical fictional worlds of English.

Ironically, had narrative medicine existed thirty years ago, Truten might be a doctor in the discussion and not the seminar's facilitator.