Auscultation

Description:

An immersive viewing of The Broken Column by Frida Kahlo reflection on serious illness, chronic pain, medical gaze and resilience.

Artwork:

The Broken Column: https://en.wikipedia.org/wiki/The_Broken_Column

References:

Herrera, Hayden. Frida Kahlo: The Paintings. Harper Perennial. 2002.

Kahlo, Frida. The Diary of Frida Kahlo: an Intimate Self-Portrait. Abrams. 2005.

Vickers AJ, Cronin AM, Maschino AC, et al. Acupuncture for Chronic Pain: Individual Patient Data Meta-analysis. Arch Intern Med. 2012;172(19):1444–1453.

Budrys V. Neurological deficits in the life and works of Frida Kahlo. Eur Neurol. 2006;55(1):4-10.

Description:

An immersive reading ‘O could my wandering breeze-pinioned mind’ by Henry Derozio with reflection on anxiety and therapy

Poem:

O! could my wandering, breeze-pinioned mind
True brotherhood in earthborn spirit find.
One that might ever on unflagging wings
Companion me in my imaginings,
One that from earth could take its earthliness.
And robe it with the mind’s own light — ’twould bless
The wheeling of existence — we should rise
Like wild twin comets hurrying through the skies,
Or swift as starshoots dart into the chasms
Of earlier planets. These enthusiasms
Which ceaseless glow in my volcanic brain.
Because unshared, have ever brought me pain,
And left my mind in dark, despairing mood
To feel, and think upon its solitude. —

References

Henry Derozio: https://en.wikipedia.org/wiki/Henry_Louis_Vivian_Derozio

Sonnet: https://scalar.lehigh.edu/derozio/sonnet-o-could-my-wandering-breeze-pinioned-mind?path=fakeer-of-jungheera-a-metrical-tale-and-other-poems-1828

Grech T, Marks A. Existential Suffering Part 1: Definition and Diagnosis. Fast Facts. https://www.mypcnow.org/fast-fact/existential-suffering-part-1-definition-and-diagnosis/

Ma X, Yue ZQ, Gong ZQ, Zhang H, Duan NY, Shi YT, Wei GX, Li YF. The Effect of Diaphragmatic Breathing on Attention, Negative Affect and Stress in Healthy Adults. Front Psychol. 2017 Jun 6;8:874.

Coombs NC, Meriwether WE, Caringi J, Newcomer SR. Barriers to healthcare access among U.S. adults with mental health challenges: A population-based study. SSM Popul Health. 2021;15:100847.

Description:

An immersive reading of excerpts from ‘Aurora Leigh’ by Elizabeth Barrett Browning with reflection on the benefits of illness, social determinants of health and discharging people experiencing homelessness.

Work
She stirred;—the place seemed new and strange as death.
The white strait bed, with others strait and white,
Like graves dug side by side, at measured lengths,
And quiet people walking in and out
With wonderful low voices and soft steps,
And apparitional equal care for each,
Astonished her with order, silence, law:
And when a gentle hand held out a cup,
She took it, as you do at sacrament,
[…]
I think it frets the saints in heaven to see
How many desolate creatures on the earth
Have learnt the simple dues of fellowship
And social comfort, in a hospital,
As Marian did. She lay there, stunned, half tranced,
And wished, at intervals of growing sense,
She might be sicker yet, if sickness made
The world so marvellous kind, the air so hushed,
And all her wake-time quiet as a sleep;
[…]
She lay and seethed in fever many weeks,
But youth was strong and overcame the test;
Revolted soul and flesh were reconciled
And fetched back to the necessary day
And daylight duties. She could creep about
The long bare rooms, and stare out drearily
From any narrow window on the street,
Till some one, who had nursed her as a friend,
Said coldly to her, as an enemy,
‘She had leave to go next week, being well enough,’
While only her heart ached. ‘Go next week,’ thought she,
‘Next week! how would it be with her next week,
Let out into that terrible street alone
Among the pushing people, ... to go ... where?’

References

Aurora Leigh: https://www.gutenberg.org/files/56621/56621-h/56621-h.htm

Elizabeth Barret Browning: https://www.poetryfoundation.org/poets/elizabeth-barrett-browning

Fitzpatrick-Lewis D, Ganann R, Krishnaratne S, Ciliska D, Kouyoumdjian F, Hwang SW. Effectiveness of interventions to improve the health and housing status of homeless people: a rapid systematic review. BMC Public Health. 2011;11:638.

An immersive reading of excerpts from ‘The South’ by Jorge Louis Borges with reflection on the experience of critical illness, iatrogenesis and communication.

Work:

Fever wasted him and the pictures in The Thousand and One Nights served to illustrate nightmares. Friends and relatives paid him visits and, with exaggerated smiles, assured him that they thought he looked fine. Dahlmann listened to them with a kind of feeble stupor and he marveled at their not knowing that he was in hell. A week, eight days passed, and they were like eight centuries. One afternoon, the usual doctor appeared, accompanied by a new doctor, and they carried him off to a sanitarium on the Calle Ecuador, for it was necessary to Xray him. […] When he arrived at his destination, they undressed him, shaved his head, bound him with metal fastenings to a stretcher; they shone bright lights on him until he was blind and dizzy, auscultated him, and a masked man stuck a needle into his arm. He awoke with a feeling of nausea, covered with a bandage, in a cell with something of a well about it; in the days and nights which followed the operation he came to realize that he had merely been, up until then, in a suburb of hell. Ice in his mouth did not leave the least trace of freshness. During these days Dahlmann hated himself in minute detail: he hated his identity, his bodily necessities, his humiliation, the beard which bristled up on his face. He stoically endured the curative measures, which were painful, but when the surgeon told him he had been on the point of death from septicemia, Dahlmann dissolved in tears of self-pity for his fate. Physical wretchedness and the incessant anticipation of horrible nights had not allowed him time to think of anything so abstract as death.

References

The South: https://www.medina502.com/classes/ml260_2017/readings/Borges-The_South.pdf

Jorge Luis Borges: https://www.poetryfoundation.org/poets/jorge-luis-borges

An Autobiographical Essay: Newyorker https://www.gwern.net/docs/borges/1971-borges-anautobiographicalessay.pdf

Campbell C, Scott K, Skovdal M, Madanhire C, Nyamukapa C, Gregson S. A good patient? How notions of 'a good patient' affect patient-nurse relationships and ART adherence in Zimbabwe. BMC Infect Dis. 2015;15:404.

Stollings JL, Kotfis K, Chanques G, Pun BT, Pandharipande PP, Ely EW. Delirium in critical illness: clinical manifestations, outcomes, and management. Intensive Care Med. 2021;47(10):1089-1103.

Cutler LR, Hayter M, Ryan T. A critical review and synthesis of qualitative research on patient experiences of critical illness. Intensive Crit Care Nurs. 2013;29(3):147-157.

Description:

An immersive reading of excerpts from ‘Three Thoughts’ by Alice Moore Dunbar-Nelson with reflection on marginalization, the call to healthcare, courage and facing dragons.

Work:

experts from Three Thoughts’ by Alice Moore Dunbar-Nelson

"Who dares stand forth?" the monarch cried,
"Amid the throng, and dare to give
Their aid, and bid this wretch to live?
I pledge my faith and crown beside,
A woeful plight, a sorry sight,
This outcast from all God-given grace.

What, ho! in all, no friendly face,
No helping hand to stay his plight?
St. Peter's name be pledged for aye,
The man's accursed, that is true;
But ho, he suffers. None of you
Will mercy show, or pity sigh?"

Strong men drew back, and lordly train
Did slowly file from monarch's look,
Whose lips curled scorn. But from a nook
A voice cried out, "Though he has slain
That which I loved the best on earth,
Yet will I tend him till he dies,
I can be brave." A woman's eyes
Gazed fearlessly into his own.

References

Violets and Other Tales: https://www.gutenberg.org/files/18713/18713-h/18713-h.htm#LEGEND_OF_THE_NEWSPAPER

Alice Moore Dunbar-Nelson: https://www.poetryfoundation.org/poets/alice-moore-dunbar-nelson

https://www.aafp.org/about/policies/all/incarceration.html

https://journalofethics.ama-assn.org/article/why-prisoners-deserve-health-care/2008-02#:~:text=The%20vast%20majority%20of%20inmates,becoming%20a%20burden%20to%20all

Rainer Maria Rilke, Letters to a Young Poet: https://kbachuntitled.files.wordpress.com/2013/04/rainer-maria-rilke-letters-to-a-young-poet.pdf

An immersive reading of excerpts from ‘The Botanic Garden Part II: The Loves of Plants’ by Erasmus Darwin with reflection on dropsy, digitalis, heart failure and medical myths.

Excerpts

415 Bolster'd with down, amid a thousand wants,

Pale Dropsy rears his bloated form, and pants;

"Quench me, ye cool pellucid rills!" he cries,

Wets his parch'd tongue, and rolls his hollow eyes.

So bends tormented TANTALUS to drink,

420 While from his lips the refluent waters shrink;

Again the rising stream his bosom laves,

And Thirst consumes him 'mid circumfluent waves.

—Divine HYGEIA, from the bending sky

Descending, listens to his piercing cry;

425 Assumes bright DIGITALIS' dress and air,

Her ruby cheek, white neck, and raven hair;

Four youths protect her from the circling throng,

And like the Nymph the Goddess steps along.—

—O'er Him She waves her serpent-wreathed wand,

430 Cheers with her voice, and raises with her hand,

Warms with rekindling bloom his visage wan,

And charms the shapeless monster into man.

Reference

https://www.gutenberg.org/ebooks/10671 (Lines 415-432) Accessed 1.15.22

Thibodeau JT, Turer AT, Gualano SK, et al. Characterization of a novel symptom of advanced heart failure: bendopnea. JACC Heart Fail. 2014;2(1):24-31.

Falk RH. "Bendopnea" or "kamptopnea?": Some thoughts on terminology and mechanisms. JACC Heart Fail. 2014 Aug;2(4):425.

Littler WA. Withering, Darwin and digitalis. QJM. 2019 Dec 1;112(12):887-890.

Littler WA. William Withering digitalis and the pulse. QJM. 2019 Aug 1;112(8):565-566

Smulyan H. The Beat Goes On: The Story of Five Ageless Cardiac Drugs. Am J Med Sci. 2018 Nov;356(5):441-450.

Krikler DM. Withering and the foxglove: the making of a myth. Br Heart J. 1985;54(3):256-257. doi:10.1136/hrt.54.3.256

Wilcox RA , Whitham EM. The symbol of modern medicine: why one snake is more than two. Ann Intern Med. 2003;138:673–677.

Rogers, Kara. "Guinea Worm Disease". Encyclopedia Britannica, 3 Jul. 2018, https://www.britannica.com/science/guinea-worm-disease. Accessed 21 February 2022.

An immersive reading of excerpts from the short story ‘Iron Routine’ by Zitkála-Šá with reflection on healthcare disparities, authority and antagonists.

Excerpts
‘Iron Routine’ by Zitkála-Šá

A paleface woman, with a yellow-covered roll book open on her arm and a gnawed pencil in her hand, appeared at the door. Her small, tired face was coldly lighted with a pair of large gray eyes.

She stood still in a halo of authority, while over the rim of her spectacles her eyes pried nervously about the room. Having glanced at her long list of names and called out the first one, she tossed up her chin and peered through the crystals of her spectacles to make sure of the answer "Here."

Relentlessly her pencil black-marked our daily records if we were not present to respond to our names, and no chum of ours had done it successfully for us. No matter if a dull headache or the painful cough of slow consumption had delayed the absentee, there was only time enough to mark the tardiness. It was next to impossible to leave the iron routine after the civilizing machine had once begun its day's buzzing; and as it was inbred in me to suffer in silence rather than to appeal to the ears of one whose open eyes could not see my pain, I have many times trudged in the day's harness heavy-footed, like a dumb sick brute.

Once I lost a dear classmate. I remember well how she used to mope along at my side, until one morning she could not raise her head from her pillow. At her deathbed I stood weeping, as the paleface woman sat near her moistening the dry lips. Among the folds of the bedclothes I saw the open pages of the white man's Bible. The dying Indian girl talked disconnectedly of Jesus the Christ and the paleface who was cooling her swollen hands and feet.

I grew bitter, and censured the woman for cruel neglect of our physical ills. I despised the pencils that moved automatically, and the one teaspoon which dealt out, from a large bottle, healing to a row of variously ailing Indian children. I blamed the hard-working, well-meaning, ignorant woman who was inculcating in our hearts her superstitious ideas.

Reference

American Indian Stories: https://www.gutenberg.org/ebooks/10376

Thierry J, Brenneman G, Rhoades E, Chilton L. History, law, and policy as a foundation for health care delivery for American Indian and Alaska native children. Pediatr Clin North Am. 2009 Dec;56(6):1539-59.

Rhoades ER, Rhoades DA. The public health foundation of health services for American Indians & Alaska Natives. Am J Public Health. 2014 Jun;104 Suppl 3(Suppl 3):S278-85. doi: 10.2105/AJPH.2013.301767. Epub 2014 Apr 23.

https://www.ihs.gov/newsroom/factsheets/disparities/ Accessed 1.17.22

Kovich H. Rural Matters - Coronavirus and the Navajo Nation. N Engl J Med. 2020 Jul 9;383(2):105-107. doi: 10.1056/NEJMp2012114. Epub 2020 Apr 24.

Description:

An immersive reading of the poem ‘On Pain’ by Kahlil Gibran reflecting on total pain and spirituality in healthcare.

Poem

On Pain by Kahlil Gibran

And a woman spoke, saying, Tell us of Pain.
And he said:
Your pain is the breaking of the shell that encloses your understanding.
Even as the stone of the fruit must break, that its heart may stand in the sun, so must you know pain.
And could you keep your heart in wonder at the daily miracles of your life your pain would not seem less wondrous than your joy;
And you would accept the seasons of your heart, even as you have always accepted the seasons that pass over your fields.
And you would watch with serenity through the winters of your grief.

Much of your pain is self-chosen.
It is the bitter potion by which the physician within you heals your sick self.
Therefore trust the physician, and drink his remedy in silence and tranquility:
For his hand, though heavy and hard, is guided by the tender hand of the Unseen,
And the cup he brings, though it burn your lips, has been fashioned of the clay which the Potter has moistened with His own sacred tears.

References

The Prophet: https://www.gutenberg.org/ebooks/58585

Zuskin E, Lipozencić J, Pucarin-Cvetković J, Mustajbegović J, Schachter N, Mucić-Pucić B, Neralić-Meniga I. Ancient medicine--a review. Acta Dermatovenerol Croat. 2008;16(3):149-57.

Shinall MC Jr, Stahl D, Bibler TM. Addressing a Patient's Hope for a Miracle. J Pain Symptom Manage. 2018 Feb;55(2):535-539.

Puchalski CM. The role of spirituality in health care. Proc (Bayl Univ Med Cent). 2001;14(4):352-357.

https://www.mypcnow.org/fast-fact/total-pain/ Accessed 12.24.21

https://poets.org/poet/kahlil-gibran Accessed 12.25.21

https://www.health.harvard.edu/healthbeat/giving-thanks-can-make-you-happier Accessed 12.31.21

An immersive reading of the poem ‘A Visit to the Asylum’ by Edna St. Vincent Millay reflecting on mental institutions and windows.

Poem:
A Visit to the Asylum
Edna St. Vincent Millay

Once from a big, big building,
When I was small, small,
The queer folk in the windows
Would smile at me and call.
And in the hard wee gardens
Such pleasant men would hoe:
“Sir, may we touch the little girl’s hair!”—
It was so red, you know.
They cut me coloured asters
With shears so sharp and neat,
They brought me grapes and plums and pears
And pretty cakes to eat.
And out of all the windows,
No matter where we went,
The merriest eyes would follow me
And make me compliment.
There were a thousand windows,
All latticed up and down.
And up to all the windows,
When we went back to town,
The queer folk put their faces,
As gentle as could be;
“Come again, little girl!” they called, and I
Called back, “You come see me!”

References:

Pérez-Fernández F, López-Muñoz F. The Kirkbride buildings in contemporary culture (1850-2015): from 'moral management' to horror films. Hist Psychiatry. 2019 Sep;30(3):336-351.

https://www.washingtonpost.com/outlook/2019/10/31/scary-asylums-are-halloween-classic-its-time-retire-trope/ Accessed 11/4/2021

An immersive reading of excerpts from the novel Never Let Me Go by Kazuo Ishiguro with reflection on professional caregivers, burnout and scapegoats.

Excerpts

It means a lot to me, being able to do my work well, especially that bit about my donors staying “calm.” I’ve developed a kind of instinct around donors. I know when to hang around and comfort them, when to leave them to themselves; when to listen to everything they have to say, and when just to shrug and tell them to snap out of it. […] I know carers, working now, who are just as good and don’t get half the credit. If you’re one of them, I can understand how you might get resentful. […] Carers aren’t machines. You try and do your best for every donor, but in the end, it wears you down. You don’t have unlimited patience and energy. (P3-4) […] And sooner or later a donor doesn’t make it even though, say, it’s only the second donation and no one anticipated complications. When a donor completes like that, out of the blue, it doesn’t make much difference what the nurses say to you afterwards […] For a while at least, you’re demoralised. Some of us learn pretty quick how to deal with it. But others [...] they never do. […] A lot of them, you can tell, are just going through the motions, waiting for the day they’re told they can stop […] They don’t know what to say to the whitecoats, they can’t make themselves speak up on behalf of their donor. No wonder they end up feeling frustrated and blaming themselves when things go wrong. I try not to make a nuisance of myself, but I’ve figured out how to get my voice heard when I have to. And when things go badly, of course I’m upset, but at least I can feel I’ve done all I could and keep things in perspective. (p207- 208)

References

Kazuo Ishiguro, Never let me go, Vintage Books. NY 2005.

Travers JL, Teitelman AM, Jenkins KA, Castle NG. Exploring social-based discrimination among nursing home certified nursing assistants. Nurs Inq. 2020 Jan;27(1):e12315.

Emily Paulin. COVID-19 Deaths in Nursing Homes Plummet, Staff and PPE Shortages Persist. AARP. https://www.aarp.org/caregiving/health/info-2021/nursing-home-covid-deaths-down-shortages-continue.html Published 3/11/2021. Accessed 10/17/2021.

Kandelman N, Mazars T, Levy A. Risk factors for burnout among caregivers working in nursing homes. J Clin Nurs. 2018 Jan;27(1-2):e147-e153.

Brene Brown. Daring Greatly. Gotham Books. 2012.

https://www.nytimes.com/2021/10/20/health/nursing-homes-covid-vaccine-mandate.html Accessed 10/21/21.

https://www.aapacn.org/article/covid-19-staff-vaccination-rates-tips-from-facilities-that-achieved-90-100-percent/ Accessed 10/31/21.