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Jack Truten: Word.Doc and narrative medicine. | Monday, February 19, 2007 |
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| Notes from the Green Couch |Kerry Cooperman first learned about narrative medicine in 2004. A phrase invented by Dr. Rita Charon at Columbia University three years earlier, narrative medicine integrates the humanities and sciences, provoking doctors from all fields to write about the traumatic experiences they encounter as part of working in medicine. Intrigued by Charon's revolutionary idea, Cooperman contacted his pre-med peers and moved to found a group through the Writers House. That September, Word.Doc held its first meeting in the Arts Cafe, allowing “undergraduate students, graduate students, faculty and anyone…to discuss and experience the ways in which medicine, narrative, literature and art inform one another in creative and useful ways.” Today, Word.Doc has flourished into one of the largest and most successful Writers House groups, convening the third Thursday of every month, open to anyone interesting in writing and narrative medicine.
Aside from the regular readings and responses, the group will occasionally invite a guest speaker. Dr. Jack Truten - a Penn alumnus - was one of these guests, having recently completed the Anderson Fellowship in Clinical Ethics and Medical Humanities at Allentown's Lehigh Valley Hospital. Shifting his focus to specialist training in narrative medicine, Truten described the purpose, application, and benefits of narrative medicine.
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.
NOTES FROM THE GREEN COUCH. Click on the image above to see all of Eric Karlan's notes from the Green Couch - summaries and analyses of events and projects of the Kelly Writers House. 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.
