Close Reading Drill Simplified

This past week in the Narrative Medicine course I am teaching, I introduced students to the approach to close reading (she refers to it as a drill) as taught by Dr. Rita Charon and her colleagues at Columbia  University’s Program in Narrative Medicine. I then had students apply this to do their own close reading of JD Salinger’s short story “To Esme, With Love and Squalor.”

As a way of introducing them to close reading I had them read Rita Charon’s chapter “Close Reading” in her book Narrative Medicine: Honoring the Stories of Illness (Oxford University Press, 2006). This is a weighty chapter in a weighty book and I have discovered that many of my students were simply overwhelmed by it. So here is my streamlined version of ‘doing’ a close reading drill as applied to narrative medicine. I present the elements of close reading in the order I like to do them myself because it is more the way I read and analyze what I read.

1.     Desire (Dr. Charon’s term). What appetite or emotion is satisfied by reading this? What bodily sensations do you have while reading this? What intellectual or emotional desires arise? Put more simply: what is the overall feeling you have when reading this? (A related and interesting question would be: And what does this reveal about you as the reader?)

2.     Frame. What’s included and what’s left out of this narrative? Where did this first appear—what was the intended audience of the work? For instance, Salinger’s short story first appeared in the New Yorker in 1950. What can we surmise about his intended audience?

3.     Temporal scaffolding. How is time handled in the narrative?

4.     Form. Structure, genre, narrator, use of metaphor, allusion (especially what other works are referred to either explicitly or implicitly?), and diction

5.     Plot. What happened.

Dr. Charon makes the case that learning the skills of close reading as applied to narratives, whether written or in plays, movies, etc, can help health care providers learn to be more attuned to the illness narratives of their patients. Careful reading, careful listening, it makes sense at some level and I am teaching that to my students. Salinger’s short story that I had them read and analyze through close reading is a complex but engaging piece of writing. It has enough content about the health effects of war—PTSD especially—that nurses and others in the health professions find it interesting. Salinger’s use of frame, time, diction, and metaphor are exquisite. So this short story makes for a good—but sufficiently challenging—narrative on which to practice close reading. I found that most students did well with this assignment and really dug in. Since class this past week fell on July 4th, this was an individual take-home assignment, so I have not yet had the opportunity to discuss it with them in class.

I always have these nagging questions in the back of my mind: Does close reading detract from the pleasure of reading? And by extension, does ‘close reading’ a patient’s illness narrative detract from the pleasure of the patient-provider interaction? Do we start thinking about patients less as people and more as stories to be analyzed, stories to be recorded in our heads and then later used as material for our own written stories? Does that start to distance us from our patients? Is it like walking up a familiar flight of stairs—pleasantly distracted—then thinking about walking up the stairs and by paying attention to it, tripping? If writers consciously try to pay attention to the craft of writing, does the art of their writing suffer?

I’ve been re-reading one of my favorite books, David Ulin’s The Lost Art of Reading: Why Books Matter in a Distracted Time (Sasquatch Books, 2010). He raises these questions as well—for writers and readers in general. He states, “(…) I recognize this as one of the fallacies of teaching literature in the classroom, the need to seek a reckoning with everything, to imagine a framework, a rubric, in which each little piece makes sense. (…) leaving us with scansion, annotation, all that sound and fury, a buzz of explication that obscures the elusive heartbeat of a book.”

If I used this class assignment again I would add the personal reflection writing prompt: Write about a time when you were so overwhelmed by emotions that you had difficulty communicating—or write about a time when you were caring for a patient experiencing this.



Cornbread Therapy and Sweet Survival

James W. Borton has edited an anthology entitled The Art of Medicine in artofmedicineMetaphor: A Collection of Poems and Narratives (Copernicus Healthcare, 2012). At 156 pages and including 78 poems and short nonfiction essays, the anthology will be available for purchase ($14.95) at the end of January 2013 from both Amazon and Ingram Books.

I met James Borton in 2011 at the University of Iowa’s Examined Life Conference: Writing, Humanities and the Art of Medicine. Mr. Borton is a career journalist who teaches English at University of South Carolina/Sumter Campus. A year or so prior to our meeting, Mr. Borton survived a major complication of heart bypass surgery that left him in a coma for close to a week. After his own life-threatening illness, he turned to the healing power of writing. He maintains a blog All Heart Matters and teaches courses and workshops on Narrative Medicine. His anthology includes the work of a diverse group of people—doctors, nurses, other healthcare professionals, patients, family members—who have taken his workshops or courses in South Carolina. With only a few exceptions this is an anthology of work by non-professional writers—which I consider to be one of the book’s greatest strengths. It makes the anthology fresh and highly accessible to a broad audience.

I’ve read the entire anthology twice over the past several days and have enjoyed it. Each time I read any of the entries I am transported back to my Southern roots. There are the frequent religious references to angels and prayer (this is the buckle of the Bible Belt after all), mixed in with mentions of Mississippi Mud Pie, cornbread, chopping cotton, fixing trucks, and reading Southern Living magazines in chemotherapy waiting rooms. There’s a lovely essay “Learning to Breathe” by Patricia Dale about her psychiatric hospitalization experience. Sam Watson’s poem “Another Reason to be Pleasant” should be required reading for anyone working in the OR or pre or post-op. Mailaika Favorite’s poem “Snake” has changed my relationship with my spinal cord and vertebrae. Selena Larkin’s poem “Sweet Survival” about living with diabetes, and Jennifer Bartell’s essay “Cornbread Therapy” about her chemotherapy experience, both conjure up the scrappy, witty and warm Southern women I know well. And finally, Debra McQueen’s two essays, “The Roundup” and “Alternative Medicine” are beautifully written and are ones I can see myself using in my teaching. So ring in the New Year by eating black-eyed peas with ham hocks and placing this book on your ‘to read’ list.

As usual, Arthur Frank says it well in his endorsement of The Art of Medicine in Metaphor:

“This anthology will be of particular use to people who want to write about illness and healthcare but are having trouble getting started. These poems and short stories show how writing teaches observation, observation precipitates understanding, and understanding can be a form of healing.”

—Arthur W. Frank, author of The Wounded Storyteller: Body, Illness, and Ethics (expanded edition forthcoming, 2013)

Why Iowa?

Prairie Lights Bookstore, Iowa City, facade de...
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I have been asking myself this question for the past two days, ever since finding myself in the midst of cornfields and cows. I am at the University of Iowa’s narrative medicine conference “The Examined Life.” This conference seems to be grain-fed on the reputation of the Iowa Writers’ Workshop. So many excellent writers have gone through this program. I envision a young Flannery O’Connor riding by train here from Georgia. But few if any writers were actually from Iowa and few if any stayed in Iowa. Now I know why.  I walked around ‘downtown’ Iowa City yesterday four times in the search of food. This is a drinking college town, as there are only bars. I hear from some current writers in the Writers’ Workshop that the pubs and writing go together. I stumbled into the one coffee shop I could find and it ended up being Prairie Lights, the town’s iconic independent bookstore. When I asked the bookstore staff member to direct me towards books by local authors, he looked at me blankly and then showed me to a table full of the birds and flowers of the Iowa prairies.

The conference itself is interesting in a low-key sort of way. Held at the medical school it is unsurprisingly dominated by physician-types, including many local medical students. As the building is attached to the hospital, some are wearing scrubs and/or white coats. The philosophers don’t seem to be here as they were in Seattle. Much of the talk is about cancer narratives and end of life and palliative care, and about how doctors don’t get enough training in how to talk to patients. The most interesting part of the conference so far was a reading and discussion by the writer Chris Offutt, who is a visiting professor teaching at the Iowa Writers’ Workshop. The short story he read, “Out of the Woods” had a hospital and a dead body in it, so that was the connection to narrative medicine. He’s a great writer and with a theater background, does a wonderful job at reading his own work to a largish audience.

I have been thinking about how place affects the nature of writing and of any other creative endeavor, including the nurturing of narrative medicine. Even though Iowa City is home to the premier MFA writing program in the US, it does not have a creative spirit. Based on my informal street level culture index walkabout last night, this is not a creative place. I did not see any bohemians out and about, except for one lone Rastafarian young man, but he was outside of a smoke shop so must have been part of their advertisement. No street level coffee shops in which aspiring and real writers can go to hang out and work out their writer’s block in community. In fact, I was lugging my laptop around in hopes of being one of those coffee shop writers. Instead, I am writing this on the shiny vinyl floor, in a hallway of the Cancer Research Laboratory. Carts of large red biohazard bins keep rolling past me.

Narrative medicine in Manhattan, seemingly shared between Rita Charon and her colleagues at Columbia, and people at the NYU School of Medicine has more of a cerebral, sophisticated air to it, fitting with the culture of NYC. There is a budding narrative medicine culture in Seattle, fed off transplants from other places, but affected by the writing and creative culture of the city. Seattle—rainy, soggy, foggy, moody somewhat depressed over caffeinated introverted intelligent contrarian process-oriented full of causes and grand passions and changing the world idealist tree hugging serial killer—Seattle. Moss covered alternative healing modalities Seattle. Narrative medicine cannot help but be different in such a climate. I hope that in the PNW climate of inclusiveness, narrative medicine can become more than it is now in the rest of the country.

~addendum reflection after the Examined Life Conference: Iowa City began to cast its spell on me after three days of being there for the conference. The conference cast its spell as well. I am typically not a joiner-love-conferences sort of person, but I ended up attending all but one of the conference sessions. Since returning to Seattle I’ve been trying to figure out if that’s because there was nothing else to do in Iowa City, or if it is a positive reflection on the conference. I think it was the latter. I’ll be going back, and hopefully more nursing-types will join me there next year. A group of us from the conference, along with some PNW narrative medicine/advocacy people are beginning to plan a conference on narrative advocacy, to be held here in tree-hugging coffee-chugging Seattle–hopefully in another year or so, so stay tuned for that. And while you’re here, check out our independent bookstore Elliott Bay Book Company.