Writing in medicine has gained momentum in recent years as illustrated by the rise of reputable physician–authors and increasing prevalence of medical blogs. This largely stems from the acknowledgment that so much of medicine is about the stories we gather, tell, and become part of. Each story, whether of our patients, colleagues, or hospital staff, unfolds the multitude of human nature.
I initially began writing as an emergency department medical scribe in 2009. For 3 years, I found solace and peace as I reflected upon the tense plots that transpired each day. A college student with no experience of life and death who had never been surrounded by such profound human suffering, I needed a means of release and resolution.
With English as my second language at the age of 14, I never would have imagined that writing would play such a vital role in my adult life. Through writing, I piece together memorable stories I encounter, hoping that, by threading the complicated plots and characters, I can take with me the lessons I learn to future endeavors.
A story carries the potential to stir you in different directions, as each storyline is formulated into words that can be valued in various ways. Writing turns mundane narratives into enlightening life lessons and brings trivial characters alive at pivotal points, all at the tip of a pen.
I still remember the elderly man who suddenly collapsed at home on the day before his 80th birthday and subsequently passed away in the emergency department despite resuscitation and his granddaughter’s cries as she flew toward his body. I remember the overwhelming surge of sorrow and my inability to maintain composure. It was the first time I had witnessed death, and I have never felt so grateful to be alive. Who could forget the petrified expression on the undocumented immigrant worker’s face as he burst through the ambulance door while holding his left arm that has been severed by a chainsaw and was bleeding profusely, and the fury I felt when his boss asked only for towels to clean the blood in his car.
Research conducted in 1999 and 2010 show therapeutic benefits of writing in reducing symptomatology in irritable bowel syndrome (1) and rheumatoid arthritis (2) patients. Although these illnesses have psychological components that benefit from exploration of emotions, every type of illness, even headache and fracture, renders a certain degree of psychological adjustment.
During medical school, amidst the stress of monthly exams and boards, the uncertainty and excitement of advancing in medical education, and the shock and sadness when classmates fell ill with various medical conditions, writing has helped me maintain perspective and focus on the values and goals most important to me.
While journaling in a post overnight shift delirium, I realized that we, as health care providers, should appreciate miracles of life even in the presence of imperfections—a thought triggered by two parents’ joyful embrace welcoming their newborn girl with cleft lips. I obtained closure as I chronicled the 3-week hospital course of a middle-aged woman newly diagnosed with stage IV lung cancer. When she was frustrated at the lack of progress in treatment due to her fever, I explained to her patiently the team’s decisions; sat with her as she tearfully told me that her youngest daughter, who was in college, was not informed of her illness; and encouraged her when she felt defeated as her pulmonary function rapidly deteriorated, limiting her mobility. Writing became a refuge that allowed me to explore and express the complex emotions—sorrow, hope, doubt, and more—from these encounters.
Perhaps it is the same therapeutic effects seen in the studies mentioned previously that also relieve health care providers and medical students of their emotional burdens. Such benefits have been recognized and embraced by many medical institutions in recent years, with curricula that allow medical students, residents, and physicians to share their stories through writing. I had the opportunity to participate in the inaugural Summer Institute in Narrative Medicine in 2014 at Columbia University College of Physicians and Surgeons, led by Dr. Rita Charon. In those short 5 days, medical students from around the country reflected, discovered, and unearthed our inner selves, special moments, and deepest fears. It was therapeutic. We were inspired by the speakers and peers to combine the treatment and care of medicine, listen and tell our patients’ stories, and promote self-care. When do we ever devote such time to humility, in a life filled with obligations and deadlines, all of which consume us and blind us from the beautiful world we live in and the colorful people who surround us?
Qing Meng Zhang
1. Halpert A, Rybin D, Doros G. Expressive writing is a promising therapeutic modality for the management of IBS: a pilot study. Am J Gastroenterol. 2010;105:2440-8. [PMID: 20551938] doi:10.1038/ajg.2010.246
2. Smyth JM, Stone AA, Hurewitz A, Kaell A. Effects of writing about stressful experiences on symptom reduction in patients with asthma or rheumatoid arthritis: a randomized trial. JAMA. 1999;281:1304-9. [PMID: 10208146]