The Nocturnists and the Healing Power of Storytelling in Medicine

A few years ago, I stumbled upon the Moth Stories.  Originally based out of New York, but now in cities around the country, people would come together at a venue to share and listen to personal stories based on a theme for the evening. Ten people, randomly selected one at a time, would go up on the stage and tell their story. I went to one in Chicago a few years ago not quite sure what to expect, but my experience was profound. There is such intensity and intimacy created by sharing such impactful and vulnerable moments to an open and receptive audience. I had the opportunity to share my own Moth Story  (which you can see here) at one of these events. I gained tremendous personal incite preparing my five-minute story. I also realized, telling my story in front of several hundred people without any notes was more stressful than running most ICU codes.

It is no surprise that this format translates so well to the medical world. In 2015 a second-year resident at UCSF, Emily Silverman, after seeing the Moth Stories herself, started The Nocturnists, a similar storytelling event but geared for the medical community. The program has grown over the years in the San Francisco area and there have been shows in Boston and this fall, New York City. Emily just completed the first season of The Nocturnists Podcast, which I finally, over the long weekend, binged on.

Each of the thirty-minute episodes, start with a ten-minute story, recorded live from one of the stage shows. The rest of the podcast is an interview between Emily and the storyteller, further unpacking their themes, taking a deeper dive into a range of topics:  The dehumanizing aspects of residency training and the impact on both doctors and patients, the competing roles physicians face providing hope versus reality, the anxiety of running a code and other procedures for the first time, the loss of autonomy for our sick patients and the impact on the doctor-patient relationship, end of life issues and advanced care planning, EMR’s, the opioid crisis and more.  Each of these vivid and personal narratives, through the voice of the storyteller, contain multiple themes that will feel familiar, formative and universal for almost all  health care professionals. For those whose lives are outside of medicine, the access “behind the scenes”, not just to the story but to the mindset and thoughts of the storyteller themselves, make the listener immediately invested and connected. Almost every story resonated personally; except for the one where the morgue refrigerator broke down one night, challenging the problem-solving ability of an administrator on call. You are going to have listen to episode #8 to learn more about that one.

The medical themes I have been writing about here on my blog; burnout, demands of residency training, dealing with and end of life issues, formative moments in the life of physicians, are all brought to vivid life in these wonderful and powerful stories contained in the podcasts. Just hearing them alone in my car all weekend long, has helped me feel more connected to the medical community at large, which I believe is the most valuable component of the Nocturnists. A lot is being written about “Narrative medicine” and the power of  stories to help our patients and ourselves; injecting some much needed humanism into the medical workplace. When people, with their varied backgrounds, have the opportunity to share their stories with each other out loud, the healing power of connection comes alive. I do not believe it is a coincidence that the growth and success of the Nocturnists comes at a time when physician burnout and frustration is at an all time high.

I invite you all to check out the podcast on Itunes or Stitcher and listen. I look forward to season 2, and hopefully for The Nocturnists to make their way to Chicago sometime soon!

Anyone who has appreciated my writing, will definitely find these podcasts  well worthwhile and thought provoking.  I look forward to the day the Nocturnists come to Chicago!

Balance 2.0?

So, a wannabe author/writer walks in to a writer’s conference…

Sounds like the beginning of a not very funny joke.  But, that was me earlier this month as I attended the Harvard’s Writing, Publishing and Social Media Conference for Healthcare Professionals.  Quite a busy three days. Started at 7AM and  finished after 8PM. A lot to learn and absorb: Improving writing style, understanding the publishing and self-publishing landscape, using social media effectively and with purpose.  During the three days, met some great people that I now know in IRL (in real life).

There were so many take aways but a few things did strike a chord and stand out.

  1. This blog is “static.” Once or twice a month I write something. Probably a little too long and a little too moody (more on that in a minute). Right now, it’s really a one-way communication between myself and you the reader. I would like there to be more engagement and build on what I have started. I would like to provide more content that hopefully YOU the reader find either useful and interesting or entertaining.

 

  1. So I am asking you, the reader, what more you would like to see? How can I  make this more of a two-way conversation? I am looking to post:

 

  • Shorter thoughts and musings on life and themes such as burnout.
  • Write on End of life issues / advance care planning / introduce thought leaders and game changers in this space
  • Timely topics of the day.
  • Interesting book reviews or articles in paper or journals on critical care, end of life care, burnout.
  • Guest bloggers with strong clear voices on interesting and important topics.

 

  1. The last part that threw me for a loop was how morose or weighty my writing must feel to most people. I often dismiss as a joke, when my long-time friends send me a text checking in to make sure I am ok after a typical post. During the conference, it was commented on that IRL I seem different than the “voice” that comes across on the blog (ie: I have a sense of humor, funny/sarcastic and quite social instead of morose, melancholy, moody or morose)

So, to be brief, my BLOG and website is a work in progress (similar to my life in general). But I hope to grow it into something more.  So maybe call it Balance Redux, or Balance 2.0

Come to think of it, lets get this conversation started.  Thoughts on a new name? Anyone….

The pace and path to mindfulness

Fast

I eat. Fast. Often, I consume the food I place on my plate before I even make it to the kitchen table. It’s as if I grew up during times of famine, desperate for each and every morsel. On the rare night my family has dinner together, I am usually finishing just as they are starting, and by doing so, send a not-so-subtle message that I value family time together less than just eating.

I drink. Fast. That first beer stands no chance. After my first “sip”, I look sheepishly at my near empty bottle, while others are still using the bottle opener. The joy and satisfaction of a cold beer on a hot day is made all too brief.

I read. Fast. If I like a book, I will devour it in hours. I will keep turning pages until the first light of day sneaks in under the bedroom blinds, signaling me to stop reading and start getting ready for work. The more gripping the book, the quicker my pace and ironically less time to enjoy my escape.

I see patients. Fast. A necessary skill when the hospital is bursting with influenza, the ICU’s are buzzing with patients on ventilators, and my afternoon office is bustling with overbooked patients. I am relieved when I make it through the day without the weight of unfinished charting and unreturned patient phone calls still to be made. But back home, my escape is not without consequence. I feel a gnawing, growing internal uneasiness at the lack of depth and breadth of my numerous interactions.

Slow

I write. Slowly. Frustratingly so for someone trying to create content and build a platform. But I love to labor over sentence structure and word choice. Although slow, it is not painful. When I am able to put to paper the perfect sentence that captures what I see and feel in my head, it generates a soothing and intoxicating internal harmony.

I listen to music. When I do, time slows, regardless of its fast or slow beat. In my car or at a concert. The chords, notes and riffs are felt more than heard, resonating within. Sometimes I get lost within a space that only exists for a brief moment in time.

I cook. Measured and deliberate. I prefer the feel of certain knives in my hand. Cast iron more than non-stick and the warmth of the oven pre-heating behind me. Whether it’s making homemade pizza dough, baking gluten free muffins or smoking a brisket for the better part of a day, I don’t feel that time has been wasted.

I run. Sometimes for hours. Disconnected and separated from phone and home, my foot cadence becomes my mantra as I let go of the competing forces of work, family and social media. I dive deeper into unresolved thoughts and emotions.

Pace

I first learned about the concept of pacing in high school.  Figuring out a “steady” versus “race” pace was a skill needed to survive swimming thousands of yards day after day. I apply the same concept when training for and competing in Iron-distance triathlons. How fast can I push before burning out too quickly? How do I not leave anything in the tank as I cross the finish line? When I think about the activities and actions that bring me the most meaning and happiness, pace is a dominant factor.

Mindfulness often evokes images of yoga, crystals, incense and oils. But the truth is, when the pace is right, mindfulness comes into play without the need for any new age music in the background. Just as I appreciate the cadence of my breathing on a run or the layering of different tracks on a particular piece of music, mealtime can be transformed from mindless to mindful. Tasting the food and enjoying conversation, while being present and in the moment with my family around the table, becomes so much more than quickly ingesting empty calories.

Applying pacing and mindfulness to an otherwise generic patient encounter opens up opportunities to create a more qualitative interaction. Picking up on verbal and non-verbal cues. Recognizing that what is not being said may be more important than what is. Filling in and clicking on all of the blanks and boxes in the EMR might facilitate an orderly collection of important health data points, but it does not facilitate a natural exchange of information, nor does it create a comfortable space that promotes openness and candor.

We make thousands of conscious decisions every day. What should I eat for breakfast? What shirt will I wear? Do I go for a run or a long bike ride?  What will I write for a new blog post? But we rarely pay explicit attention to the pace of our actions. I have lived most of my adult life moving at a fast clip. Transitioning to part-time gives me the opportunity to slow down and be more cognizant about the pace I choose moving forward. By doing so, I hope to reclaim in my work world the quality that has been absent in some of my recent patient encounters. And when outside the walls of the hospital, I hope to capture more often, that internal harmony or resonance that is waiting for me.  If I can just find the right pace.

How Do You Know When Someone Is Broken?

How do you know when someone is broken? When their spirit is fractured? When their sense of self no longer aligns with what once was. When you feel as if you have woken up in a foreign land, but that sense of displacement is coming from you, not your surroundings.

In television shows and movies, that moment for a doctor is obvious. The scene in which a physician cries in the stairwell, knees bent, head hanging dejectedly. A downward spiral into drugs and alcohol that leads to a near-miss in surgery. Or a final, explosive ranting monologue, that alienates the doctor in front of patients and peers. They have snapped. They have broken. At least until the next scene or episode.

Real life rarely follows a Hollywood script.

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