Stories Matter

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“Stories matter. Many stories matter,” states author Chimamanda Ngozi Adichie in her powerful TED talk “The Danger of the Single Story.”  Adichie points out that listening and clinging to a single story—about a person, a place, a situation—creates stereotypes, and, in her words, “the problem with stereotypes is not that they are untrue, but that they are incomplete. They make one story become the only story.” She goes on to say, “The consequence of the single story is this: it robs people of dignity; it makes our recognition of our common humanity difficult; it emphasizes how we are different rather than how we are similar.”

I thought about Adichie’s wise words earlier this week as I moderated a hospital-based panel discussion on service provision and community advocacy to end commercial sexual exploitation and sex trafficking. The panel and the day-long training for health care providers included personal stories of survivors of sexual exploitation. None of the survivors remotely resembled Julia Roberts in the “modern Cinderella story” movie Pretty Woman, which reinforces the common stereotype of the high-class and empowered hooker. Instead, the survivors told stories of trauma and violence which both preceded and accompanied sexual exploitation.

In my introductory talk about why this topic matters, I linked to an important storytelling video geared towards healthcare providers on The Life Story website, “Medical Emergency.”  I appreciate how this particular video weaves together the stories of women in their own voices. Advocacy is not about speaking for those less fortunate, less powerful, but of using our own power and privilege to amplify their voices, their stories. Our job as healthcare providers, as compassionate citizens, is to step back and listen respectfully.

Another powerful story came to me today via a colleague who sent me the link to this NYT Op-Docs Season 6 video “We Became Fragments” directed by Luisa Conlon, Hanna Miller, and Lacy Jane Roberts. Through their video, they step back, listen, and then amplify the voice and words of Ibraheem Sarhan, a young Syrian refugee now living in Canada. I love how this short video highlights the importance of competent and compassionate, trauma-informed teachers and healthcare providers. When one of Ibraheem’s teachers gives an in-class assignment to write about their family, the teacher gently points out to Ibraheem that he doesn’t have to write about his family if it is too painful a topic. The teacher must know that a bomb in Syria killed Ibraheem’s mother and siblings and left him with a shattered leg. Ibraheem tells us that when people ask him about his visible leg injury, “they don’t know how much my heart burns when I tell my story.”

Stories matter to the teller and to the listener. What we need more of in this world is for all of us to increase our capacity to listen to a multiplicity of stories and within those stories to recognize our common humanity.

 

 

Worksite Metaphor

IMG_2562This past week I spent time cleaning my office at work, recycling (shredding) the detritus of an academic life: tenure and promotion materials,  teaching evaluations, student papers, and my own papers. I do this periodically to ensure there is never too much of me—of my identity—at work, not from a pathological paranoia, but rather from a desire to maintain healthy boundaries. Or at least that is what I tell myself.

But during the cleaning and sorting I found a hand-written draft of a prose poem that I wrote many years ago during a workshop I taught on narrative medicine. It was in response to a close read and discussion of Jane Kenyon’s poem “The Sick Wife” and her husband Donald Hall’s poem “The Ship Pounding.” As Carol Levine writes in “Two Poets: One Illness,” the poems “…offer a rare view of the same illness from the perspective of the patient (Jane Kenyon) and her husband and caregiver (Donald Hall), both distinguished poets.” (Journal of General Internal Medicine, March 2010, 25(3): 275-275.)

In Hall’s poem he uses the metaphor of a ship to describe his experience in the hospital when his wife was sick. He concludes with describing the hospital as “the huge vessel that heaves water month after month, without leaving port, without moving a knot, without arrival or destination, its great engines pounding.” I used as an accompanying writing prompt for workshop participants to write a description of their own metaphor for their particular work site. What is your metaphor for your own work site? Here is what I wrote (and found while cleaning my office—and have now shredded):

Dusty, moldering storage closet

door with stuff behind

forgotten cast-offs

old files labeled for people and departments and programs that died long ago

textbooks for subjects that are no longer taught

a ceramic statue of Florence Nightingale holding her lamp

beside a bowl of nectaries

people who have retired but won’t leave

people who should retire 

computer parts, old landline phones, stenographic paper

which is what exactly?

My office—bare–no books

A few seashells

I can leave, clear out in a moment

Not closed inside a storage closet.

 

 

 

Poetry: The Art of Observation

IMG_4390Recently, I had the opportunity to take a Saturday environmental writing workshop at the University of Washington’s wonderful Burke Museum. I signed up for it when I found out that our Washington State Poet Laureate Claudia Castro Luna was teaching a session.  Two out of three of the sessions—including Luna’s—were centered around the practice of close observation. We were instructed to go outside the UW Observatory (coolest old building!), stand or sit in one place, observe and write down as many sensory details as possible for ten minutes. It was raining softly so I stood in the shelter of a doorway to conduct my observation. I was reminded of the truism that the art of paying attention comes through the practice of attention and close observation. These are essential skills for many aspects of life, and most definitely for the provision of good human-centered health care.

And yes, included in my observation and note-taking of details, was this sweet, tenacious dandelion stuck between a rock and a hard brick wall, yet managing to thrive and bloom. An apt metaphor for oh so many things. But dandelions were on my mind since I had just run across a historical document on Seattle pioneer Catherine Maynard. Catherine was second wife to our famous Doc Maynard and she was Seattle’s first official nurse. She is credited with introducing dandelions to the Seattle area. Dandelions were (and still are in certain circles) an important medicinal plant used to treat scurvy and other ailments.

After observing this dandelion, I wrote this poem. Happy Earth Day.

An Ode to Dandelions

labeled a weed

noxious, non-native species

scorned, uprooted, exterminated, poisoned

labeled a tonic

food, medicine

harvested leaves, flowers, roots

eaten raw, cooked

steeped in hot water for tea

fermented for wine

elixer of dandiness

—dandilicious

 

What is a weed?

What is a tonic? A label?

Laughing yellow button

turned to whisp of fluff

blow away

fly away

spread your tonic weed seed!

 

Poetry Heals

IMG_4301 “come celebrate/with me that everyday/something has tried to kill me/and has failed.” Lucille Clifton, “won’t you celebrate with me” from Book of Light (Copper Canyon Press, 1993).

Poetry heals. Is it any surprise that at times of crisis, illness, grief—or joy and celebration—we turn to poetry to help express what straight word prose cannot?

I have been reminded of this over the past week while simultaneously holding the joy of a family milestone birthday with the sudden serious illness of a dear friend. I have been thrown into the arms of poetry.

Poetry heals. Our first responders are poets, as are artists of all kinds. Cherish our poets and artists. Their work is essential for our existence, for our survival. Listen up you curmudgeonly naysayers who proclaim that poet laureates of our cities, states, and nations are a waste of taxpayer dollars—that the money would be better spent on sweeping away our human waste, on filling the potholes in our roads. You too—but perhaps too late—will be thrown into the arms of poetry.

“There are times when people have experiences that don’t fit neatly into a storyline, a narrative of what happened. Especially within the context of trauma, suffering, and oppression, our ability to arrange bits together into a coherent narrative is overwhelmed. Yet these experiences, beyond the reach of narrative, can be formulated, conveyed, and communicated through metaphor, poetry, art, photography, and gesture.” (From my essay, “Witness: On Telling” in Intima: A Journal of Narrative Medicine, Fall 2017.)

I end this, as I began, with the words of Lucille Clifton. Here is a powerful video recording of her talking about and then reading her poem, “The Killing of the Trees.” In her opening statement, she says, “There seems to be very little reverence for life. I think there is a thing which bothers me about people not having reverence for life that doesn’t look like themselves. And I think that is a great mistake.” As a gifted poet, Clifton can “see it all with that one good eye.”

Poetry Saves

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“Pause there while the sea lights a candle” Josephine Ensign/2018

“…when people say that poetry is a luxury, or an option, or for the educated middle classes, or that it shouldn’t be read in school because it is irrelevant, or any of the strange and stupid things that are said about poetry and its place in our lives, I suspect that the people doing the saying have had things pretty easy. A tough life needs a tough language—and that is what poetry is. That is what literature offers—a language powerful enough to say how it is. It isn’t a hiding place. It is a finding place.” p.40

This is one of my favorite quotes from one of my favorite authors, Jeanette Winterson, from her memoir (with one of the best titles ever) Why Be Happy When You Could Be Normal? (New York: Grove Press, 2011). The book’s title comes from an admonishment her abusive, Fundamentalist Christian adoptive mother frequently gave her growing up. Jeanette was frequently locked in a coal cellar and then locked out of her house by her mother (for being “sinful and gay”) before she ran away from home permanently at age 16. In short, she had a tough life as a child. Poetry and literature saved her.

Towards the end of her memoir, Winterson writes eloquently of the complex relationship between madness and creativity. She admits that she often hears voices and realizes “…that drops me in the crazy category” but doesn’t much care. “If you believe, as I do, that the mind wants to heal itself, and that the psych seeks coherence not disintegration, then it isn’t hard to conclude that the mind will manifest whatever is necessary to work on the job.” Then she writes of the part of herself that acted out from her childhood trauma—the acting out in rage, self-harm (including suicidal ideation), social isolation, and “…sexual recklessness—not liberation.” She questions whether this madness could be the creative spirit. But she answers emphatically: “No. Creativity is on the side of health—it isn’t the thing that drives us mad; it is the capacity in us that tries to save us from madness.” pp. 170- 171.

April is National Poetry Month. Also, it is National Child Abuse Prevention Month as well as Sexual Assault Awareness Month—with this year’s theme (appropriately enough with the #MeToo movement) of Embrace Your Voice.

 

Service-Learning Changed My Life

Version 2I am forever grateful for the liberal arts education that included meaningful community-engaged service-learning. (Thank you Oberlin College!) I continue to wrestle with ways to bring the humanities and real service-learning* into my own work teaching undergraduate nursing students. The combination of a grounding in the humanities (in my case medical ethics through Biology and Religion majors) and service-learning, changed my life—and my career—for the better.

In my sophomore year at Oberlin, I took a child psychology course with Dr. Friedman that included a service-learning opportunity of working as a Big Sister or Big Brother to a child or young teenager at a children’s group home on the outskirts of town. Starting in that course and continuing until I graduated and left Ohio, I was the Big Sister for a young girl (she was 12 when I started working with her and I was just 18). I took her on weekend outings around the college town, taught her to swim in the college pool (I was a lifeguard and swim instructor), and visited the town’s Santa for a photo that I treasure. At the time I started working with my little sister I was a pre-med Biology major and thought I had my future life and career clearly charted. But that service-learning experience, accompanied by further private reading study on child abuse with Dr. Friedman, led me to medical ethics and on into a career in nursing.

It is instructive to re-read one’s college term papers. I am fortunate that my mother, who was my best proof-reader, kept all of my early writing going back to my age 7 haikus, and she gave them to me in a package before she died. (Thank you Mom!) Here is an excerpt from a term paper titled “Child Abuse: A Wider and Closer Look” that I wrote for Dr. Friedman in 1979:

“Who would contest that poverty creates the most stressful situation imaginable? If we want to truly treat child abuse, we have to face the fact that poverty is a very real influence. How can anyone possibly cure poverty? That question touches a sore spot in all of us comfortably full and well-clothed individuals. We recognize an inconsistency in our moral structure and in our social structure. The harming of children—all of the legislation, psychoanalysts, psychiatrists, and self-help groups in the world won’t cure it. The idea of changing our society is radical and frightening because we would have to risk losing what we have and feel safe with. How long will the present interest in child abuse last? Will we take the chance and try to cure child abuse, or will we continue placing Band-Aids on the sore, with our heads turned away from the real problem?”

Indeed, four decades after writing that paper I continue to ask similar questions—and to work towards finding solutions to those big, wicked problems. But it was my foundational liberal arts education combined with service-learning that is what prepared me for my life and my career.

* Real service-learning is (as defined by the University of Washington Carlson Leadership and Public Service Center):

“Service-learning is a learning experience that combines service with the community with structured preparation and reflection opportunities. Service opportunities are tied to academic coursework and address concerns that are identified and articulated by the community.

As students engage in service-learning, they learn about the context in which service is provided, the connection between their service and their academic coursework, and their roles as community members.”

Listening to Skid Road

IMG_4007Listening to Skid Road: Join us for a lunchtime panel discussion on the intersections of health, homelessness, and racism in King County, as well as explorations of the moral responsibilities of the University of Washington in addressing these issues. Hear from panelists who participated in the oral history collection for the Skid Road project, currently on display in the University of Washington Odegaard Library. Panelists include Krystal Koop, MSW; Nancy Amidei, MSW; Sinan Demirel, PhD; Rebekah Demirel (author of the memoir Nothing’s for Nothing: Transformation through Trauma) and Eric Seitz, RN; with Josephine Ensign (PI of the Skid Road project) as moderator.

Date: Tuesday February 6, 2018
Time: 11:30am-1:30pm
Place: University of Washington Odegaard Library, Room 220
Light lunch and beverages provided
Open to the Public

4culture_colorSpecial thanks to public historian Lorraine McConaghy, PhD for her support and mentorship throughout this project.

This project was supported, in part, by an award from 4Culture. Additional support for the audio portion of the DS videos comes from Jack Straw Cultural Center. My Skid Road project was also funded, in part, by the University of Washington Simpson Center for the Humanities, the University of Washington College of Arts and Sciences, the National Endowment for the Humanities, and Humanities Washington.

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Read Like You Give a D@#n

IMG_3959Empathy is in short supply. Anti-empathy, racism, xenophobia, misogyny and all things ugly are being modeled and stoked by too many people and institutions—including, of course, the President of the United States. Effective resistance to all of this comes in many forms. It is not enough and is self-indulgent to be simply outraged. Fire and fury is not the answer. Do something: Read like you give a d@#n.

You do not need to read or re-read Ray Bradbury’s dystopian novel Fahrenheit 451, or review the history of book-burning, book-banning, author suppression and outright killing (as by Hitler during WWII), to know that books and the mind (and empathy) expanding knowledge they contain is powerful stuff indeed.

My beloved local library system, Seattle Public Library (SPL), has a gutsy and well-read patron who posted “Sh**hole Countries: A Reading List” on their BiblioCommons site. The SPL has added a disclaimer that the post and the list of recommended books is not a publication of the SPL, but kudos to them for supporting the sharing of diverse opinions and resources. Even if you happen to find the content of the brief post either too in-your-face or borderline offensive, be sure to look at (and hopefully read) some of the amazing books on the recommended reading list.

Of course, reading real literature (non-fiction, fiction, poetry, plays) does not necessarily build empathy and equity. Mind and heart expansion require having at least a doorway or a window or a crack in the walls of mind and heart for them to open and expand. But good books and reading them like you give a d@#n do have amazing, lovely, powerful, radical effects on not just the individual reader but also the world.

For the past three summers I have posted a summer reading challenge list of books that have a social justice, global, and health humanities bent. (See “Summer Reading Challenge with a Health Humanities/Social Justice Slant” from June 2, 2015; “Summer Reading Challenge 2016” from May 28, 2016, and; “Summer Reading Challenge: Global to Local” from June 11, 2017.) You don’t need to wait until the summer or a vacation of some sort to start reading real books, radical books, world-view changing books.

Field Notes on Witnessing

IMG_9363On this sunny Sunday in Seattle, I awake and find my essay, “Witness: On Telling” published in the Field Notes section of Intima: A Journal of Narrative Medicine. This is one of my most digging deep and making it real sorts of essays I have ever written. It is the second part of a two part bookended longer essay on the complicated role of witnessing to the traumas of others and of ourselves. The second essay is titled “Witness: On Seeing” and both are part of my forthcoming book collection of essays and poems, Soul Stories: Voices from the Margins.

In this essay I explore how and why and in what forms we tell (and listen to) stories of trauma and what Arthur Frank terms “deep illness.” I parse out the typology of illness stories as presented in his landmark book, The Wounded Storyteller. I challenge health care providers to increase our capacity to listen to—and to hear—different types of illness stories, including the more distressing (and closest to the reality of trauma) chaos stories.

And I look forward to being part of the upcoming (October 20-22) Northwest Narrative Medicine Conference in Portland, Oregon. I’ll be giving a Saturday keynote address titled “Endurance: The Limits of Resilience” and a Sunday writing workshop titled “Radical Self-Care for Social Justice and Health Equity.”

Soul Stories: The Book and I

IMG_2241One midwinter’s day in Seattle in 2009, I sat at my desk at home writing a federal grant proposal for investigating ways to improve health care for homeless young people. I stopped typing midsentence and gazed out the window at the rain and wind rippling the bamboo leaves in my garden. I asked myself what I was doing with my life.

I was a tenured professor teaching community health and health policy to nursing students at a large university. I was a nurse practitioner working with homeless teens and young adults in a community clinic. I loved teaching and I loved my work as a nurse, but this type of writing was not what I longed to do. I needed to find a way to merge my work in health care with my love of writing—of real writing, not the stiff, academic, formulaic writing required by my academic job, and certainly not the cold, distant medical writing in my patient clinical chart notes. Real writing to me was expressive, creative writing—reflective writing that allowed the “I” back into the frame, as, of course, I am doing now. So, as if it were a crystal ball, I typed into my computer’s search engine the words “healthcare” and “literature.” Among the results were links to narrative medicine and to the Narrative Medicine program at Columbia University in New York City. Developed over the past several decades by physician and literary scholar Rita Charon and her colleagues, narrative medicine (as defined by Charon) “fortifies clinical practice with the narrative competence to recognize, absorb, metabolize, interpret, and be moved by the stories of illness.” (…)

And as for real writing within my own life? In retrospect, it was fortuitous that I submitted my last federal health care grant back in 2009, at a time of extreme funding cutbacks during our country’s Great Recession. The reviewers’ feedback was that it was a worthwhile proposal and that it would have received funding if it had come in a year or so earlier, when they had more money. Around that same time, I sat in a faculty meeting where a successful older researcher showed a PowerPoint slide with a series of rolling hills leading off into the distance and a road with National Institutes of Health (NIH) grant signs, one after the other, leading over the hills and fading into the sunset. Her point was that this was how our lives as university researchers should look: this slide represented our marching orders. I stared at the slide and then whispered to a colleague, “and then you die.”

I have nothing against NIH or the researchers who stake their careers on NIH or similar grants, but I knew that slide did not represent the life I wanted. I was forty-nine years old at that point, and my mother had died the year before; the sunset in the slide seemed very real. My husband had also recently commented that if I had used the same amount of time, effort, ink, and paper that went into my grant-writing, I would have written a book manuscript—or several—by then.

Instead of revising and resubmitting my rejected NIH grant proposal, I began to write what became my first published book, a medical memoir titled Catching Homelessness: A Nurse’s Story of Falling Through the Safety Net. This was a book about my work with and spiral into homelessness as a young adult. Through the writing of Catching Homelessness, I did what I consider real writing. The act of researching and writing the book, a book which wove in pertinent events from my personal as well as professional lives, helped give some narrative cohesion to my own fractured and oftentimes confusing existence.

While writing a later chapter of that book, “Greyhound Therapy,” which deals with gender-based violence, I brushed up against a then mostly closed door to my own childhood traumas. I made the decision to keep that door closed: to open it within Catching Homelessness would have led away from the main purpose of the book, which was to illustrate the complexities involved with homelessness and its attendant ills. I knew that to open the new door would require a much different book, one that contextualized the effects of trauma on individuals and communities, and the ways that narrative and storytelling factor into health and healing.

That much different book became Soul Stories: Voices from the Margins. The opening of that door and the personal exploration of what was behind that door led to this book. In writing it, I allowed myself to stray from the clear objective facts of science and medicine into the murkier subjective part of what it means to be human, and what it means to find healing in the face of trauma. This book is the result of that labyrinthine journey.

Note: The above is an excerpt from the Preface of my book manuscript Soul Stories: Voices from the Margins, currently accepted for publication by an academic press, details to follow.