Painted Nails and Personal Narratives - Thompson Writing Program

54
The idea behind
this essay actually
surfaced in
my neuroscience
FOCUS program
during a discussion
with Profes -
sor Julie Tetel.
She explained
that society imagines
a conflict between the sciences
and humanities, one that pits rationalism
against emotion, hard truth against
personal interpretation. The dichotomy,
she said, was a false one—the
subjectivity of human knowledge means
that science and art may be one and
the same.
Her thoughts led me to question
Duke’s pre-med culture, which often
treats medicine as a strict science and
emphasizes orgo grades while ignoring
the humanity of healing. I wanted my
final Writing 20 project to address this
dilemma. Though at that point we had
written only personal narratives, this
assignment presented a new challenge:
to incorporate creative nonfiction elements
into a research paper.
All good writing is personal. Infor -
ma tion is seen through and processed
by an author’s unique lens, and the
es say or report or journalistic article
Only when writing her story
did I began to see her as not
some surgery survivor, but as a
person with a perspective and
a past and penchant for feisty
nail polish.
�
Painted Nails and Personal
Narratives: An Exploration of
Creative Nonfiction in Medicine
Jocelyn Streid
Writing 20 (Spring 2010): Writing the Self
Professor Bridget Cooper
Her nails were always red. Blood-red, devil-red, Marilyn-Monroe-ain’tgot-nothing-on-me
red. They rested on top of graying sheets, a stark
contrast to the overwhelmingly institutional hospital room, the shapeless
medical gown, the wrinkled skin and tired eyes of the elderly
woman whose fingers blazed with polish. I don’t remember her name
or where she was from or what surgery she had just endured, but I remember her
nails. And the awkwardness — I remember that, too. I was a volunteer at Barnes-
Jewish Hospital, roped into the position by a mother who wanted me to do something
medical with the summer after my sophomore year of high school. If anything,
though, I emerged more disinclined towards medicine than ever before. Overly efficient
doctors with clip boards and clipped voices strode past me; too-white walls left
me gasping for air. Floundering
amongst surgeries and suffering,
I couldn’t even seem to connect
with the patients I was supposed
to be helping. I sat with the
elderly woman for hours over
that summer, trying not to look
at the peeling bandages around
her neck while reading aloud
Better Homes and Gardens magazines
so that I wouldn’t have to
think of something to say. She
was old; I was young. She was
sick; I was not. There was a
chasm between us that I could
not begin to bridge.
I pushed her out of my memory
when I turned in my hospital
badge, convinced that volunteering
in healthcare, let alone working
in it, was not for me. Years
later, though, while composing
an essay on volunteerism, she
somehow made it onto the page.
As my writing unleashed memo-

ies of her, something strange began to happen.
I wondered if her sheets were scratchy. I
imagined what she was like when she was
younger. I asked myself if she felt awkward,
too. I look back now on what I wrote — “she
preserved her dignity by painting her nails”—
and realize that only when writing her story
did I began to see her as not some surgery survivor,
but as a person with a perspective and a
past and penchant for feisty nail polish. My
words examined my response to raw emotion;
through them, I learned to articulate my
empathy.
I wonder what would have changed if the
physicians I saw—the ones more interested in
sodium-potassium pumps and phospholipid
bilayers than the patients themselves — took
the time to write something other than a medical
report. The literary arts offer an understanding
of human experience that nothing
else can; they aren’t, after all, called the
humanities for nothing. At the same time, the
practice of healing holds its own unique
insights into human life and human death.
That’s why the moment after I told my college
advisor that I wanted to be a doctor, I told her
that I also wanted to be an English major. I’m
convinced that there’s a relationship between
great literature and great medicine, and that
the most important type of literature a doctor
can read lies at the bottom of the literary hierarchy.
Creative nonfiction — sometimes condemned
as inartistic and even self-aggrandizing—cultivates
exactly the kind of awareness
of the self and of others that the healthcare
system now lacks. As I plunge into this exploration
of arts both literary and medical, I’ll
examine how reading the stories of others
and, in turn, telling our own, promotes selfreflection,
increases our capacity for em pathy,
and teaches us to listen to others in a radically
different way. Then, I’ll show how this precious
connection between creative nonfiction
and medicine is being challenged when we
need it now more than ever before.
The link between the humble personal essay
and the towering healthcare system seems
ambitious at best, delusional at worst. Yet
creative nonfiction does for doctors what traditional
medical training seems to miss — it
gives them permission to accept their emotions.
Recognizing the pull and push of our
fluctuating feelings seems simple enough, but
the natural mode of human beings as emotion-laden
creatures grates against the ideal
exalted by the medical community. Physicians
are supposed to be cool, calm, collected.
There’s a reason we eat up the attitude of television’s
Dr. House; he exhibits exactly the sort
of composure in chaos that we crave in the
doctor-stoic. Yet this ethos of professionalism
has morphed into an imperative of impassivity;
a doctor who cries when a patient receives
a heartbreaking prognosis somehow isn’t
doing their job. Dr. Suzanne Poirier of the
University of Illinois explains that physicians
often consider emotional distress “a weakness”
and consequently “hide feelings of grief, selfdoubt,
and isolation” (Shapiro 142). It’s no
wonder, then, that doctors suffer depression,
alcoholism, and suicide at staggeringly high
rates. When a cancerous concentration of bottled-up
emotions metastasizes, a physician’s
mental health lies ravaged in its wake (Bar -
clay 1 and Siegel 593).
A possible prescription? Writing creative
nonfiction. It requires doctors to reflect upon
rather than repress the reality of their own
struggles; when pouring their stories onto
paper, they cultivate a sort of emotional
awareness that forces them out of their stoic
shell. The pen peels away their protective covering
and there they are on the page — their
selves laid bare. Those brave enough to exercise
this all-encompassing honesty reap the
rewards, for studies have found that physicians
who practice personal writing for a mere
five weeks feel less insecure and more able to
cope with the immense responsibility of medicine
(Nevalainen 220). It’s no large leap, then,
to say that personal writing makes for a more
competent physician. I don’t need a medical
degree to know that better mental health
leads to better performance.
Writing creative nonfiction, however, functions
as far more than a physician’s emotional
release. Unlike pushing data in a lab or studying
respiration in a class, crafting personal
essays cultivates an all-too elusive quality no
doctor can do without: empathy. In the medical
field, the word “empathy” is a bit like
“diversity”— it sounds good on paper and
looks great in mission statements, but nobody
really knows what it means or how to get it.
Confusion is understandable; true empathy is
not nearly as easy as, say, pity. As Dr. Roy
Schafer explains, to empathize is to “feel yourself
into the subjective experience of another”
and “identi[fy] with the other” (qtd. in Das -
Gupta 452). Anyone can feel sorry for a disease
victim, but it takes emotional imagination
to take “aspects of the other into the
self” until the “boundaries of self and other
are…blurred” (Ibid). Let’s be honest; all this
that emerges serves as a reflection
of the writer, no matter
how subtly. To merge creative
nonfiction and researched argumentation,
I needed to display
this personal element without
compromising academic credibility.
It’s easier said than
done, of course, and I constantly
caught myself either
cramming in statistic after statistic
or telling anecdote after
anecdote. Revising was equally
confusing. One paragraph
would appear too meandering
and unsupported, while the
next would strike me as information-dense
and textbookdry.
Yet while combining the
worlds of research paper and
nonfiction narrative sometimes
seemed an unnecessary hassle,
I ultimately realized that this
was the only way the essay
could be written; I could best
argue for the synthesis of personal
and academic approaches
to medicine by exhibiting the
same fusion in my paper. In
short, I needed to argue for
the importance of an individual’s
story by telling a narrative
of my own.
There’s a relationship
between great literature and
great medicine.
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56
might sound like psychoanalyst tripe irrelevant to
the practice of medicine. Is it really necessary for a
doctor to “blur the boundaries” between herself and
her patient? The answer, according to a 2002 study,
is a re sounding yes; physicians with higher levels of
empathy actually have higher clinical competence
during their first year after medical school (Hojat et
al. 524). Another study seven years later found that a
physician’s empathy can actually boost a patient’s
immune system, speeding his recovery over ailments
as un treatable as the common cold (Study: Doc tor’s
Empathy May Help). Explanations are uncertain,
but it’s all too clear that doctors need more than a
brilliant MCAT score if they truly wish to serve.
Empathy, however,
does not come naturally
to everyone, and even
those gifted with oodles
of it may find their abil -
ity to empathize worn
down in the emotional
hotbed of a hospital,
where stoicism provides
for self-preservation in
the face of human tragedy.
Sterile hospital halls
and sterile doctor’s in -
struments encourage a
sterility of emotions; con -
stant exposure to death
and disease practically
necessitates it. Physi -
cians often cope with the
terror of responsibility
and the inevitability of
failure through “de per -
sonalization of the pa -
tient” (Shapiro 142). Yet
a doctor who distances
herself from the person
she’s supposed to heal is
soon dulled to the reality
of human suffering; if
she does not constantly
renew her em pathy, she
risks roboticism.
Writing creative nonfiction
may offer a solution.
Doctors who write about where they work
inevi tably write about whom they treat. Once they
commit the patient’s story to paper, they gain a perspective
that no medical briefing sheet could afford
them. Crafting a narrative, Dr. Geoffrey Hartman of
Yale explains, requires a “distinctly engaged rather
than detached” writer. The doctor’s meditative lens
“shield[s] the patient from being considered a passive
medical object” (343). This writerly perspective
A doctor who distances herself from the
person she’s supposed to heal is soon
dulled to the reality of human suffering;
if she does not constantly renew her
empathy, she risks roboticism.
A doctor who writes automatically
humanizes whom she heals—a character
in a story is not a sick case but rather an
individual who happens to be sick.
completely transforms the way physicians approach
their patients. As one young doctor tells us, writing
means that instead of simply looking for “material to
do a patient write-up,” she searches “for material
that move[s] [her] and ma[kes] [her] wonder”
(Reichert et al. 260). The physician thus steps into
the role of compassionate observer rather than
detached scientist. In incorporating a patient’s narrative
into her own, a doctor automatically humanizes
whom she heals—a character in a story is not a sick
case but rather an individual who happens to be sick.
Writ ing, then, awakens a physician to an individual’s
existence as not just a patient, but also a person.
Furthermore, reading creative nonfiction holds
a place in the medical
field every bit as crucial
as writing it. Those who
want to develop compassion
for the patient
might as well crack open
a book as well as pick
up a pen. Recent studies
have found that reading
narratives actually stimulates
areas of the brain
associated with empathy;
subjects scored hig h -
er on various tests for
compassion if they read
a story rather than a dry
text (Haley). To read a
narrative, after all, is to
put oneself in the position
of another and ex -
perience their lives on
page after page after
page—this sort of imag -
inative unity is the very
basis of empathy.
Yet even if novels and
short stories fuel the de -
velopment of a physician’s
empathy, creative
nonfiction supercharges
it. The difference lies in
the personal narrative’s
claim to truth. We find
ourselves drawn to reality
television and Hollywood exposés because there
is something strangely and uniquely magnetic about
real people and real events. In fact, research has
revealed that the brain processes information it perceives
as true in a way fundamentally different from
information perceived as fiction. When reading or
listening to someone’s actual story, neurological re -
gions associated with both the recollection of personal
experiences and self-referential thought pro cesses

ecome automatically activated (Abraham 4).
Simply put, the individual in the story seems
real because she reminds one of oneself. If this
merging of the self-and-other sounds distinctly
like Dr. Schafer’s definition of empathy —
that of “feel[ing] yourself into the subjective
experience of another” — that’s because it is;
hearing about real people causes us to see
them as more relevant to ourselves. Their ex -
periences bring to mind our experiences, and
together, identities intertwine. Thus, reading
creative nonfiction allows a physician to practice
relating foreign experiences to personal
ones; it nurtures a habit of seeing the world
through another’s eyes and encourages exactly
the sort of empathy hospital wards need.
The ability to empathize, however, is not
the only otherwise elusive skill that creative
nonfiction nurtures. Reading personal writing
also teaches aspiring doctors what we all
failed to learn in kindergarten: how to listen.
According to Dr. J. Vannatta of the University
of Oklahoma, doctors can find about eighty
to eighty-five percent of the information necessary
for diagnosis in patient narratives (qtd.
in Smith 55). Yet the medical interview often
acts as an interrogation; the doctor fires off a
list of questions about cough frequency, sleep
fluctuations and the intensity of a running
nose on a scale from one to ten. Although
such rapid-fire run-downs may diagnose common
conditions, Dr. Rita Charon argues that
more complicated conditions require a patient
to tell his story in full. As Charon listens, she
must “identify metaphors or images, tolerate
ambiguity and uncertainty…identify the
unspoken subtexts, and hear one story in light
of others told by [the] teller” (Charon 4). The
doctor must remain sensitive to nuances of
the patient’s story that no check-mark list can
capture. This sort of intense attention may
sound superhuman, but quite frankly, it
isn’t — English professors have taught it for
years. The art of interpretation lies in the
domain of literary scholars, but such exclusivity
need not be the case. Charon argues that
such “narrative knowledge” finds apt application
in healthcare, for doctors exposed to the
literary arts cultivate skills of careful reading
that translate into skills of careful listening
(10). Readers cannot interrupt an author in
the midst of her essay, and a doctor cannot
interject to ask if the pain was mild, moderate,
or intense. Instead, the listener, like the
reader, must wait, collect evidence, and un -
derstand the patient’s story from the patient’s
viewpoint, not her own.
What does this sort of interaction look
like? It’s not a specialized set of knowledge or
a radically new mode of treatment—it’s a subtle
kind of attention to detail that we already
practice when we open a book. The difference,
though, is that instead of reading an essay,
we’re reading a patient. Dr. Charon tells us
the story of a man who came into her office
complaining of crippling abdominal cramps.
Charon, however, looked beyond the textbook
list of ailments. She noted the pressured way
her patient spoke, saw the tension with which
he gripped the examination table, and remembered
his words when he said that he had
endured the pain for a decade or so without
once stepping into a hospital. These small
signs signaled to Charon that her pa tient harbored
a long-standing fear of the medical
Hearing about real
people causes us to see
them as more relevant
to ourselves.
establishment—one that had compromised his
health for years. With this knowledge in mind,
she treated him with extra gentleness to ensure
that her examination was “not an assault but
an effort to help” (Charon 12). This is what listening
to the patient means; by absorbing the
man as a person with a past rather than as a
hodgepodge of symptoms, she cared for his
health—not only as it pertained to his immediate
condition, but also as it related to his relationship
with medicine as a whole.
Careful listening, however, requires even
more than picking up details and piecing
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together plotlines, which again explains why
creative nonfiction offers more to a physician
than novels. Here too the key lies in creative
nonfiction’s relationship to reality. An individual’s
story is an account of subjective emotions
and experiences, not a list of facts. The
teller of the story lays a narrative framework
over an ever-shifting collage of impressions
An illness narrative, just
like any narrative, cannot be
objectively “True.” Those who
read personal essays must sift
through a complex portrayal of
reality and understand the author
not through just what she says,
but also how she says it.
and ideas; there are a thousand ways to communicate
the same events, the same symptoms,
and each one gives a slightly different
picture. By its very nature, then, an illness
narrative, just like any narrative, cannot be
objectively “True.” Those who read personal
essays must sift through a complex portrayal
of reality and understand the author not
through just what she says, but also how she
says it. Reading creative nonfiction therefore
uniquely equips doctors to deal with the everuncertain
nature of truth in patient narratives.
Both the essayist and patient present an
understanding of their experiences subject to
re-interpretation and revision; there is as
much meaning in what they don’t mention as
there is in what they do.
Falsehoods and half-truths remain just as
frustrating in the medical realm as they do in
the literary one; a fair share of James Freys
step into our hospitals. Yet the teenager who
refuses to disclose his sexual history, the
woman who lies about her alcohol usage, and
the man who exaggerates his symptoms to get
a bottle of pills can’t be dealt with as easily as
A Million Little Pieces. We can’t move their
narratives from the Autobiography to the
Fiction section of the bookstore and be done
with them, for no matter how misleading
their stories, they still need care.
How, then, can a doctor provide treatment
when the truth of a patient’s condition
remains shifting and uncertain? Reading creative
nonfiction gives otherwise floundering
doctors the skills to make sense of intensely
layered information, for the stories both
essayists and patients tell are in themselves
telling, no matter the veracity of their claims.
As oral historian Alessandro Portelli puts it,
the “psychological truth” may indeed be just
as important as the factual truth (qtd. in
DasGupta 450). Take, for example, medical
student Yo-El Ju, whose patient lied about his
symptoms and downplayed his ailments.
Tests revealed prostate cancer, but when Ju
confronted her patient with the diagnosis, he
stormed out of the hospital denying it. Had Ju
considered the psychological implications of
the patient’s deception, she might have sensed
that fear of disease fueled his defensive denial
and may have broken the news with more tact
(Smith 56). Yet she had not practiced such
nuanced interpretation, and a cancer victim
left the hospital untreated.
Ability to understand a patient’s story —
his whole story, including what he leaves
unsaid—thus carries real weight in medicine.
When it comes to deciphering the meaning
of an illness narrative, doctors exposed to
personal essays will have an advantage over
those who have read only charts and spread
sheets, which are understood to be purely factual,
and even over those who have read only
novels, which are understood to be purely fictional.
So, creative nonfiction’s inherent blending
of truth and artistic liberty mirrors the
nature of the patient’s story.
From more honest self-reflection to more
genuine compassion to more nuanced listening,
those in medicine stand to gain a great
deal from the study and creation of personal
essays. As a pre-med English major, it’s not
hard to imagine why I want to argue this
point—linking writing and reading to healing

justifies my undergraduate education. But before
you cast me as some overly defensive bookworm, I’d
like to clarify: the purpose of this essay isn’t to rationalize
my choice in majors (though it’s certainly an
added bonus)—it’s to change the mentality of those
who assume that a doctor’s worth is measured solely
in her MCAT scores and stethoscope skills.
This assumption is an increasingly common
one—biology and chemistry rank as the most popular
majors for medical school applicants. Such an
overt bias towards the sciences was not always the
case; a medical school address delivered a century
ago encouraged physicians-in-training to pursue
studies in not only English, but also French and
German literature (Williams 1067). Although re -
search reveals that humanities majors make just as
competent — and often, as one Journal of Medical
Education study found, even more competent —
physicians later in their lives, the myth prevails: science
people are tougher, smarter, and ultimately better
doctors (Yens 434). I stepped into a pre-medical
advising meeting a few months ago and found
myself met with surprise. When one friend ex -
claimed “But I thought you were an English major!”
I slipped into my seat, ego bruised. My medical aspirations
served as a secret identity; underneath the
façade of the mild-mannered bookworm lay a purpose-driven
pre-med. Like a Clark Kent caught
changing in a telephone booth, I felt exposed whenever
my two sides showed.
Yet I’m not the first to draw a link between literature
and medicine. Several physicians have thrived
both in the ward and at the writer’s desk, including
literary giants like Chekov, William Carlos Williams,
Sir Arthur Conan Doyle, and even Jurassic-Park-creator
Michael Crichton (Fanning 1 and Howard 82).
Even so, when the number of college students studying
humanities has declined by over fifty percent in
four decades, it’s clear that the doctor-writer tradition,
along with the study of literature itself, is in
danger (Cohen). The wailings of English professors
and Literature majors alike may sound familiar —
bemoaning the state of one’s subject is as clichéd a
part of the humanities tradition as quoting Shakes -
peare or wearing sports coats with elbow patches.
Yet as one professor points out, “people in the hu -
manities…have never felt quite as much of a panic
that their field is becoming irrelevant” as they do
today (qtd. in Cohen).
Irrelevance. Ay, there’s the rub. No one who wants
to function at cocktail parties will accuse the works
of Dostoevsky of worthlessness, but in an increasingly
digitized, economized, and supersized world,
it’s far too easy to see them as irrelevant. I hesitate
when telling people I’m an English major — the
phrase “cardboard box,” and, more specifically, the
image of me living in it, springs far too easily to
mind. No wonder, then, that those with doctoring
dreams often see reading and writing as frivolous,
even self-indulgent. The understanding is this: the
mushy-gushy of literature is all very well and good,
but when a surgeon hovers above your tumor,
scalpel in hand, it doesn’t matter what books she
reads. If my examination of creative nonfiction in
medicine has accomplished anything, though, it
proves that it does.
And while many doctors may scoff at the idea
that literature could improve their medical practice,
learning how to read narratives might help their bottom
lines. Eighty percent of those who file for malpractice
point to problems caused by superficial or
insufficient communication between their physicians
and themselves (Hojat 522). If doctors were to
adopt the perspectives of those they care for, they
would leave their patients — not to mention their
pocketbooks—in a far happier state.
Nevertheless, in the face of ever more crippling
malpractice insurance, the once-sacred and nowstrained
relationship between doctor and patient has
begun to crumble. Medical students without narrative
empathy become doctors without narrative
empathy, and their focus is on “curing, not caring”
(De Moor 212). The “good doctor” is one who analyzes
the symptoms, makes the biological connections,
and defeats the disease; in the face of all this
hard science, patients necessarily become numbers,
subjects, goals. The public, then, accuses their doctors
of being too distant, and doctors accuse the
public of being too demanding. There is no easy
solution; goodness knows that even the most powerful
of personal essays will not fix the fact that scores
of Americans receive subpar treatment, if they re -
ceive it at all. A society’s healthcare — scientifically
overwhelming, economically burdensome, and forever
and ever evolving — may always remain a perpetually
— and perhaps necessarily — frustrating
beast. Still, improving medicine begins with the cultivation
of a new philosophy of healing, one that
sees the patient as an individual with a history, a
heart, and most importantly, a story. Creative nonfiction
will not solve all of our problems, but it certainly
gives us a tool with which to start.
This essay, then, is not simply a grand justification
of my classes, my major, or my nerdy libraryleech
tendencies. It’s my own desperate attempt to
awaken the medical (and, for that matter, pre-medical)
community to the ability of the personal narrative
to heal some of the rifts in modern medicine and
in turn provide for better care. Repairing the
increasingly strained relationship between doctors
and their patients does not begin with more innovative
treatment techniques or more extensive medical
research. After all, critics of physicians rarely claim
that they have too little medical knowledge. Instead,
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60
Medical students with-
out narrative empathy
become doctors without
narrative empathy, and
their focus is on “curing,
not caring.”
those who distrust their doctors do so because
the white coat in front of them doesn’t seem
to understand what it means to be a patient.
In short, we don’t need more science in medicine—we
need more humanity. This is where
reading and writing creative nonfiction comes
in. After all, doctors understand individual
bodies, but readers and writers understand
individual consciousnesses, the souls that
make us more than bags of bones and blood.
Recognizing the stories of other people—real
people, with painted nails and an insatiable
Better Homes and Gardens obsession —
encourages physicians to reflect, empathize,
and listen in a way that nothing else can. I
know that’s what it did for me. �
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