“…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.
“Art is the outward manifestation of human experience in the world. Art is necessary for survival. To be human and alive is to be an active art maker. Everything that humans create in their act of living is art.” -Tamati Patuwai, MAD AVE ‘Healthy and Thriving Communities’ Glen Innes, New Zealand
It was a happy accident, an unintended yet very welcome consequence of studying ‘how the Kiwis’ do community health from the ground (literally) up, from the community members’ perspectives. The recent experience has changed how I think about community health, has deepened my respect for the power of art (and libraries) to change lives, and has even altered how I view my own community back home in Seattle.
First, a brief recap of the experience to provide some perspective. What I’m referring to here is the recent University of Washington Study Abroad in New Zealand 5-week immersive program I co-led with Jim Diers, a social worker and internationally-acclaimed community development expert. Here is what our course description said about the study abroad program:
“Empowering Healthy Communities is an interdisciplinary Exploration Seminar in New Zealand, focusing on how various communities organize and advocate for overall health and wellbeing. In this seminar, we will combine community-engaged service-learning, community case studies, readings, reflective writing, student independent projects, and immersive living experiences, to challenge students to think more broadly and creatively about participatory democracy, civic engagement, sustainability, and the social determinants of health. This course is grounded in an international, community-engaged, service-learning format aimed at creating opportunities for transformational student learning. We will address the meanings of ‘diversity’ within global and local communities; issues of power and privilege; social justice; what it means to be civically engaged at the local and global levels; and the tensions and differences between tourism vs. travel, and community service vs. engagement.
New Zealand is an ideal location for this Exploration Seminar. The country has a unique blend of indigenous and immigrant cultures, and its people have a rugged, “number eight wire” can-do, and highly creative approach to solving individual and community problems. In 2014, New Zealand ranked number one in the Harvard Business School’s Social Progress Index for overall wellbeing, while the U.S. ranked number sixteen, just above Slovenia. New Zealand spends one-third less per person on health care than we do in the U.S., yet they have much better population health outcomes. How do they do it? That is one of the main questions we will ask and explore through our work and study in New Zealand. In addition, as New Zealand is a world leader in environmental sustainability efforts, we will challenge ourselves to go ‘as green’ as possible: living in youth hostels, recycling, walking and taking public transportation, and eating a mainly vegetarian diet for our group meals.”
As we discussed with the students at the beginning of our program, New Zealand slipped somewhat in the 2015 Social Progress Index, but is still in the top tier/top ten of the 133 countries with sufficient comparison data to include. In 2015 for the ‘Health and Wellness’ category, New Zealand ranked 9th and the U.S. ranked 68th. And somewhat ironically in light of our study abroad program, the U.S. ranks first world-wide in the Access to Advanced Education category, and is weakest in Health and Wellness and Ecosystem Sustainability. I tried to remind students of this fact, especially when some of them grumbled about the vegetarian meals and relying on public transportation.
Using connections through the amazing New-Zealand group Inspiring Communities, we focused our time on a variety of local community groups working to empower and improve the places they call home. The Central Business District/ Karangahape Road in Auckland. The Avondale and Henderson communities on the outskirts of Auckland. Devonport and Waiheke Island, both more affluent communities. The Ruapotaka marae in Glen Innes. Then south to the Wellington area communities of Porirua, Bromphore School, and Epuni. Consistent through all of these communities was an emphasis the community members placed on the use of the arts to catalyze positive change and to enable community wellbeing. That and public libraries, which community members treasured as being the heart and soul and ‘mind food’ of their communities. Places where true democracy happens. Places to “dream up and enact crazy ideas.” Places that nurture “the freedom to change.”
Art, including literary art, was literally everywhere we turned in these communities. And not just the typical government-sanctioned commissioned public art we are used to seeing in the U.S., but also much more grassroots , low barrier, “anybody can participate” community art shown in my photos in this post.
This sort of art not only beautified the communities, it also built community identity and promoted wellbeing. Walking around my hometown of Seattle this past week, I’ve been searching for similar sparks of community wellbeing through art and have had a hard time finding them. Yes, we do have some great bus shelter artwork, as well as some building and wall murals–and our public library system has been one of the best in the country (and hopefully will remain so despite a very silly rebranding effort), but I cannot find the same level of empowering healthy communities through art. Perhaps this is an important ‘take home’ message, one we could use to improve community health and wellbeing in the U.S. More art, less guns.
What do art and poetry and Seattle’s largest public hospital have to do with each other? My colleague, poet Suzanne Edison, and I set out together this week on a mission to find possible answers to that question. We spent a half day doing our own art walk through the lovely and eclectic collection of public art at Harborview Medical Center in downtown Seattle. Then we sat in one of the hospital’s street-side cafes facing the Medic One emergency bays, sipped coffee amidst the occasional swirl of red lights and sirens, and wrote Ekphastic poetry in response to pieces of art that particularly moved us.
Our wonderful King County-based arts and culture organization, 4Culture, has a useful webpage with links showing photographs and describing some of the major pieces of art at Harborview. As they state:
“The Public Art Collection at Harborview has been growing since 1977 and is based on the belief that the arts can counterbalance the emotional, psychological, technological and institutional intensities of the medical center by reducing stress and conveying a sense of individual dignity and worth upon all who enter its doors.”
In choosing the artwork for display in public spaces–busy hallways, specialty clinics, and the numerous waiting room areas–careful consideration is given to things like inclusion of a diversity of artists, artistic styles, and themes. Peggy Weiss, who directs the art program at Harborview, explained to me that they have to try and balance having art pieces be interesting and healing across the wide range of patient populations they serve. (See my previous blog post “A Photo Ode to Harborview” from 1-31-15 for another ‘take’ on Harborview and for photos of its outdoors View Park artwork).
I took photographs of pieces of art and of particular spaces inside and outside the main Harborview (old) hospital, being careful to exclude any people in order to respect patient (and staff and patient family member’s) privacy. Here are some photos of art that I found most engaging and moving:
This piece, ‘Journal,’ with its collection of enigmatic words, such as ‘refuge,’ ‘passage,’ ‘quest,’ ‘search,’ and ‘restore,’ lent itself to our first writing prompt: Take a word from the journal and write from it. I chose ‘refuge’ and wrote a free form poem that took me in surprising directions. The other writing prompts that we came up with were: 1) Write as if two pieces of art are in conversation, 2) Take one piece of art and write from its perspective, and 3) Have a figure in a piece of art be in conversation with the artist.
My main poem that came out of our art walk/Ekphrastic poetry writing day is titled “Harborview Refuge,” and has somehow manifested itself back into its own piece of art of the same name. Using my black and white photographs on various photo transfers (packing tape and acrylic gel medium), along with bits of my poem written on strips of bandage tape, here is my work-in-progress:
As you can see from these three photographs included in my mixed-media art piece, I am taken by the Art Deco architecture and details of Harborview’s main hospital, which opened in 1931. The almost Gothic gargoyle-looking figure on the right adorns the top of the pillars at the main entrance to the ‘old hospital,’ next to the emergency department.
Harborview Medical center has a tradition of ‘poetry happens.’ Seattle-based writer Wendy Call was a Harborview writer-in-residence in 2010/2011. She worked on a project Harborview Haiku and American Sentences. As part of her project, Wendy shared her poetry with patients and staff and also encouraged them to write their own haiku/American Sentences.
And for anyone who wants to read some recent examples of ekphrastic poetry (and perhaps be inspired to write/submit your own poem in response to a photograph), take a look at Rattle‘s Ekphrasis Challenge.
I’m glad that we got the chance to return to Christchurch for another week. The dust has settled so to speak on the initial shock at seeing the level (and seeming freshness) of destruction in the downtown/CBD Red Zone. This time I think we could begin to see more of the signs (and freshness) of the community resilience in the downtown core.
These are some photos of my favorite bright spots in Christchurch. Roll call in order of appearance:
1) Greening the Rubble and the Gap Filler projects, and specifically their shared space at the Sound Garden made of recycled found post-quake artifacts such as fire extinguishers, battered metal street signs, Aussie flip-flops and the like. As you can see from the photo, the Sound Garden is fully wheelchair and bicycle and stroller-friendly. While I was there a father and his school-aged daughter rode up on a bike and they played and laughed in the garden for at least thirty minutes. From their Kiwi accents and topics of conversation, they seemed to be a local Christchurch family out for a Waitangi Day of fun.
2) Across the street from the Sound Garden are these lovely, otherworldly yet oddly inviting sculptures called Tree Houses for Swamp Dwellersby Julia Morison (Scape Public Art). As Christchurch residents now know all too well, their city is built on a swamp (liquefaction is an ongoing problem). These beautiful sculptures are sending green shoots out towards the sky. What you can’t see from this photo is that each sculpture has a little garden of plants living happily in its crown. An uplifting and happy space for me, especially given the fact that my group of students were bogeying down to their music blaring over loudspeakers at the Dance-O-Mat (another Gap Filler project) right beside these sculptures.
3) The Gap Filler’s Pallet Pavilion. Blue-painted wooden pallets stacked high to make protective walls around an outdoor cafe/bar/performance stage–complete with free wi-fi. While I was there, a very good Latin band was performing to an adoring crowd. The Pallet Pavilion is coming down at the beginning of April. A temporary installation that lasted a few years. Our students volunteered for a while there, wiping down tables (that collect dust from the building and demolition all around them) and watering plants.
4) The Transitional ‘Temporary’ Cathedral built almost completely out of cardboard and designed by the Japanese ’emergency architect’ Shigeru Ban. The very sweet church lady inside the day I visited said that the parishioners loved how light-filled the cathedral is. She laughed and said she doubted they’d want to return to the cold, dark stone cathedrals even if they are repaired. All of the old stone churches I’ve seen around Christchurch sustained extensive earthquake damage and are still closed. I was surprised when she told me that the church was built to last for fifty years. Being in Christchurch though does blur the distinction between permanent and temporary.
Yesterday we wrapped up the student-led group presentations in our narrative medicine course. There were eight in total over a period of four weeks. As I mentioned before, I chose the eight topics: aging, cancer, death/dying, disability, drug addiction, infectious disease, mental illness, and racism. During our first class session students signed up for one of the eight topics. My instructions for the group projects were as follows: each group will do a class presentation on their topic for 45 minutes. For your presentation please include a one page (front/back) handout that includes your main references on the topic as well as two in-class writing prompts. The group project/presentation was worth 40% of their final grade. I referred them to the excellent website/resource NYULiterature, Arts, and Medicine Database as a starting point for resources, but asked them to expand upon this, bringing in different arts and literature examples they found particularly helpful.
There are two things I would do differently with the group presentations the next time I teach this narrative medicine course. One is that I would set some parameters around the main focus of their presentations. All eight groups used PPT for their presentations, but more than a few had many ‘busy’ PPT slides with statistics on the ‘dis-ease’ topic of the day–stats such as prevalence of suicide. And their writing prompts reflected this clinical gaze, for instance showing a video clip of a person about to commit suicide by jumping off the Golden Gate Bridge; their writing prompt being “How would you feel if you were on that bridge with them, and what would you say to them?” Which leads to the second thing I’d change in the course, and that would be to find a way to help guide the groups in writing good writing prompts. I wouldn’t want to be too controlling with it, but I would want to help students develop more artful/less clinical writing prompt and response skills. For instance, for the above student-generated writing prompt I’d suggest changing it to, “Write about a time you worked with a patient who was in despair.” But I mostly resisted the temptation to step in during class and refine the student’s writing prompts.
Writing good writing prompts is a more advanced skill and one that only comes from lots of trial and error. I don’t know of any specific guides or sources of narrative medicine-type writing prompts, but here are two books I turn to when I’m stuck for ideas. The main one is Kim Addonizio and Dorianne Laux‘s The Poet’s Companion: A Guide to the Pleasures of Writing Poetry (WW Norton & Company, 1997). For instance, at the end of their chapter “Images” they have this excellent writing prompt: “Describe a pair of shoes in such a way that a reader will think of death. Do not mention death in the poem.” (Perhaps Joan Didion used this writing prompt for the powerful shoe portions of her book The Year of Magical Thinking). A second resource is Susan Zimmerman’s Writing to Heal the Soul: Transforming Grief and Loss Through Writing (Three Rivers Press, 2002). A prompt she includes in the chapter “Experiencing Death” is a common but still effective writing prompt: “Write about your own first experience of death, the awakening to the fact of death’s reality.” My students used this one in their presentation on death/dying. It was an effective prompt based on the quality of student writing.
For the ultimate writing prompt–one that I haven’t used in class but plan to try out is “Write your own obituary.” A twist on this one is included in Brenda Miller and Suzanne Paola‘s Tell It Slant: Writing and Shaping Creative Nonfiction (McGraw Hill, 2005–second edition 2013). In their chapter “Last Words” they include the writing prompt: “What are your ‘last words’? What would you write if you knew your time was up?” There’s a recent example of a Seattle-area writer who wrote her own obituary, which her family paid to be published in the Seattle Times on July 28th. It was written by Jane Lotter, age 60, who died at her home on July 18th from uterine cancer–under our state’s Death with Dignity Act. Michael Winerip wrote about it for the NYT“Dying with Dignity and the Final Word on Her Life” (Aug 5, 2013).
In our narrative medicinecourse we have moved into group presentations. On the first day of the quarter I had students sign up to be in one of eight groups to work on group projects and to do a group in-class presentation. I picked eight topics, using the list of topics (keywords) from NYU’s Literature, Arts, and Medicine
database as a guide. The eight topics I chose this summer were: Aging, cancer, death/dying, disability, drug addiction, infectious disease, mental illness, and racism. The group assignment was to research and expand upon the topic resources listed in the NYU database—to approach this as if they were doing an in-service training on the topic at their work site. I asked them to produce a one-page (front and back) handout of their favorite resources, along with two to four possible in-class writing prompts and reflective questions. Each group was given 45 minutes to present on their topic and to lead the class in discussion and reflective writing. (Note: our class sessions are four hours long, although we don’t typically go quite that long).
This past week the first two groups did their presentations (on aging and cancer) and both did an excellent job. The groups used an interactive PPT presentation, weaving in poetry, prose, artwork, comic books, YouTube videos, and movie clips. I was impressed by the range and depth of their presentations and class discussions, as well as their application of the close read drill adapted from Dr. Rita Charon’s work. Group members also shared some of their personal stories related to their health topic and did this in a moving but professional way.
When I was planning this narrative medicine summer course, I was resistant to the idea of building in group projects. As a student I always preferred to have individual assignments since I could then control the time commitment and the outcome. I knew that the majority of my students in this course would be busy with their nursing jobs and families as well as with school. But a colleague convinced me to use group projects, saying the students were used to them and that what they came up with was typically of high quality. I have purposefully allowed time at the end of each class session for students to meet in their groups for planning purposes and I stay around to answer any questions that may arise. Some groups have also set up online discussion boards on our course website to facilitate their group planning. (In my mind, this is the only really useful function of online discussion boards.) That seems to have worked well for them so they don’t have to meet in person outside of class.
Two things particularly struck me from the in-class presentations and discussions. One was the number of students who had personal experience with either a close friend or family member or a patient who was given a diagnosis of a serious cancer over the phone or in a voicemail message. We talked about how insensitive that is and what nurses can do to influence physicians, nurse practitioners, and other healthcare providers to think through how to give bad news in a more supportive way. The other thing that stood out to me in the class discussion was a comment a student made that this narrative medicine class is “A place to stop and to process these things we don’t get to process.” Other students said they agreed with what she said and talked about how nurses are so much into the care giving role, not only at work but also in their personal lives, that having a time and space to stop and reflect on how it is affecting them is a powerful thing.
Ah yes. There were really three things that struck me during last week’s class session. The third was that this is all heavy stuff to process and write about and how much environmental context matters—as in the actual physical classroom setting. We have a nice smallish amphitheater classroom with excellent acoustics, state-of-the-art audiovisual equipment that is easy to use, reasonably comfortable chairs and tables, and a full bank of windows looking out over a grassy marsh full of birds. I’d forgotten what a pleasure it is to teach in a classroom with windows. It also helps that it is one of the loveliest summers in Seattle’s history. Teaching this narrative medicine course in a windowless classroom in the middle of a Seattle winter would have a much different feel.
Last week in my narrative medicine course I had two local authors come to class to read some of their writing and lead class discussions. The first guest speaker was Suzanne Edison, a poet and psychotherapist. She also leads Seattle-area workshops
on therapeutic poetry writing with parents of children with chronic illness, as well as with adolescents with chronic illness—at Seattle Children’s Hospital
and at Odessa Brown Children’s Clinic. Suzanne read poems from her two poetry chapbooks Tattooed With Flowers (2009) and What Cannot Be Swallowed (2012). In our first class session this quarter we had done a close reading of her powerful poem “Teeter Totter.” Students had questions about some of the metaphors and lines in her poem, so last week they were able to ask Suzanne about them directly. (“Teeter Totter” also appeared in Ars Medica, Fall 2009).
Suzanne led the class in a poetry-writing session that she has developed. First, she asked students to write about a time they had an interpersonal conflict of some sort. Then they went through their prose piece and circled four to five words that stood out to them. Suzanne had them do some other tasks in order to come up with an expanded list of words (a dozen or so). Finally, Suzanne asked them to write a poem (in any form) using all of their words. Several students wanted to share part of or the entire poem they had written, and one student commented on how powerful it was to ‘get it out there.’ Students pointed out that reliving the stressful, difficult interpersonal interactions through the poetry exercise brought on stress responses (sweaty palms or changes in heartbeat and breathing), but that writing the actual poem gave them some distance from it and left them feeling more peaceful. Suzanne explained that the poem is a way to create a container for these powerful memories and emotions. One student wrote of this
as “framing the event in the bubble of a poem.”
I prefaced this poetry-writing exercise by letting the students know that what
they wrote was for their eyes only—that I would not ask them to turn in this
writing to me. Suzanne and I had incorporated the same writing exercise last
fall in my undergraduate community health course, when I did ask students to turn in their poems to me. I got feedback from some students that they found this to be intrusive into their personal lives when they didn’t really know me. Duly noted, and very true since it was a class of 150 students (vs. 40 students in the narrative medicine course). So this time around I set the parameters upfront that they wouldn’t have to share their poems with me. Instead, the first writing prompt I gave them for in-class writing was to share a fragment of their poem, or a key word, and to reflect on what surprised them most about what came out of the poetry exercise. This seemed to work out much better. It probably also helped that this class is specifically on narrative medicine, and students expect to do more creative and personal writing in it than they typically do in a more traditional nursing course.
The second guest author was Mary Oak, author of Heart’s Oratorio: One Woman’s Journey Through Love, Death and Modern Medicine (Goldenstone Press, 2013). (see my previous post/book review “Heart’s Oratorio” from 3-24-13). She read passages from her book and answered student questions. As one of the selections she read was about her stay in the ICU and how disorienting it was, students had questions for her about this. They also asked her what motivated her to write the book and about her development as a writer. Since Mary writes about her genetic heart condition and is a mother, students also asked what the ramifications are for her children, and what that feels like now that’s she’s lived through serious cardiac complications. Much of Mary’s book is set in Seattle and she mentions specific hospitals (Northwest Hospital and University
of Washington Medical Center) and some medical personnel by name. This led to an interesting class discussion on the ethics and legalities of nonfiction medical-related writing. Several students mentioned recent ‘compliance trainings’ they’ve had to go through in their jobs as RNs in Seattle-area hospitals, where the message was that ‘they could never ever write about their work in any context whatsoever!’ They were concerned since they were asked to write about their work for class assignments (like for my course). We reviewed the basic parameters on this for academic writing: 1) no patient identifiers such as name, age, super-rare medical condition, etc.; and, 2) no specific names of providers, hospitals, clinics, care facilities—although I acknowledged this can lead to strange permutations, such as “a large Level-I Trauma Center in the Seattle area” (there is only one Level-1 trauma center in Washington State—in fact within a four state radius—and that would be Harborview Medical Center). And then I briefly discussed various legal and ethical parameters as designated by specific journals, differentiating what I was asking them to write about versus writing for publication. I got on my soapbox briefly to rant about how hospital administrators try hard to intimidate nurses (and others even lower in the food-chain) into not writing about their work—but the intimidation is real and nurses can and do lose their jobs over this stuff—and it is easy for me to rant from the relative security of my tenured academic soapbox.
Back off my soapbox, Mary read them a lovely poem by a nurse poet friend of hers, Lise Kunkel, who works in hospice nursing in New York State. The poem had to do with her hands while caring for a hospice patient. So for my last writing prompt I had students think of a significant patient-nurse interaction they had had and to write it from the perspective of their hands: Tell the story your hands could tell. Since I was really stuck back on my soapbox and hadn’t thought through the specific writing prompts I wanted to use for that class session, this one was completely made-up on the spot. I had no idea what students would do with it until I read through their writing this week.
Wow—just wow! That prompt worked, as nurses most definitely identify and
communicate with their hands. Some students wrote from the perspective of their hands: the punishing abuse from the frequent application of hand sanitizer; the uncertainty of where to place their hands during certain patient-nurse or healthcare team interactions; the patient assessment of skin warmth or clamminess or bulges where there shouldn’t be bulges—and, as one student stated, providing “a loving touch, not a medical touch.”
Addendum: I received an e-mail from hospice nurse Lise Kunkel with a link to one of her published poems, “Reading Aloud to Dad (for Jiggs)” in Oncology Times, 3-10-09, vol 31(5),p. 34. She also told me the name of the poem that Mary Oak read to my class last week: “The Hands of a Hospice Nurse.” She uses some of her poems in trainings she does for hospice volunteers through the Care for the Dying Cooperative in NY State. Lucky volunteers and lucky patients….