Just Like Us

IMG_4517This was the first in my summer reading challenge (with a health humanities/social justice slant): Just Like Us: The True Story of Four Mexican Girls Coming of Age in America, by Helen Thorpe (Scribner, 2009). I ran across this book last month at Denver’s lovely downtown ‘LoDo’ Tattered Cover Bookstore (a highly recommended indie bookstore). I asked the helpful information desk woman to direct me to books by local authors, and this was one she recommended.

I give it a one (sunny peace symbol) out of five–also known as ‘I did not like it.’ While it is generally well written, I found it to be too superficial in its treatment of the complex issue of immigration. At one point in the book, Thorpe likens her struggles to be taken seriously as a journalist (while being known mainly as the wife of the Mayor of Denver) with the Mexican young women’s struggles to assimilate to life in the United States. Really? How did that statement get past the book’s editors? In addition, the author lost credibility to me when she admitted to not speaking or understanding Spanish, when the families of the four girls she highlights in the book are mono-lingual Spanish-speaking.

The Problem(s) With Narrative Medicine

booksNarrative medicine is growing in popularity in academic medical centers and healthcare settings. Developed over the past decade by physician and literary scholar Rita Charon and colleagues at Columbia University, 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.” There are textbooks on narrative medicine (such as the one by Charon shown here), workshops, undergraduate courses, and masters degree programs in narrative medicine (the Program in Narrative Medicine at Columbia University), and even the venerable Modern Language Association is considering establishing a new forum related to narrative medicine (to be called Medical Humanities and Health Studies). I love narrative medicine and I teach narrative medicine, but I don’t love/teach it without having some serious questions and reservations about this whole ‘movement’ or religion as it sometimes seems to be.

Current narrative medicine discourse assumes an ideal encounter between an empathic physician and a cognitively intact, compliant adult patient. What does this mean for providers or for patients who fall outside these parameters? What does it mean for people excluded from health care? What does it mean to be attuned to the narratives, not only of individual patients, but also to the larger, often silenced metanarratives (grand narratives or ‘big granddaddies of stories’) of power and exclusion?

In its current form, narrative medicine allows little room for critical reflection or exploration of larger structural inequities and structural violence within health care, including those from the medical gaze (a term from Foucault to describe how modern medicine often treats patients as just a physical body, instead of treating the person who is ill or injured). Narrative medicine largely ignores the limits of narrative, especially within the contexts of trauma, suffering, and oppression. What I mean by this last statement is that there are times when people have experiences that don’t fit neatly into a story-line, a narrative of what happened. There are human experiences beyond narrative, and this is where poetry/metaphor and gesture can be more effective means of  personal meaning-making and communication. This is where Arthur Frank’s chaos stories can occur.

Even within narrative, we often have a rigid, scripted notion of what a good, straight, linear, satisfying (and effective) story arc should be. It is usually the hero slaying demons and dragons of some sort, having a nice masculine climax, and emerging at the end triumphant and transformed–and even stronger and more handsome! We want soft-focus lens Hallmark moments that make us feel all warm and cozy inside. As applied to the treatment of cancer, Barbara Ehrenreich’s hilarious yet disturbing essay “Welcome to Cancerland” (Harper’s Magazine, November 2001) is a terrific take on this topic.

I’ve been thinking about these problems recently in regards to my work with narrative advocacy/ policy narrative, and to my teaching of narrative medicine to nursing and other health professions students. Over the next month or so I’ll be writing a series of posts exploring ways to ‘do’ narrative medicine and narrative advocacy differently. I’ll also include a list of resources that I’ve found to be helpful.

The first resource I’ll make a pitch for is the work on narrative humility by physician and writer (and faculty member at Columbia’s Program in Narrative Medicine) Sayantani DasGupta. She recently wrote a brief essay, “Narrative Medicine, Narrative Humility: Listening to the Streams of Stories” for the journal Creative Nonfiction (Summer 2014). In her essay, DasGupta describes her work in narrative medicine as teaching people to listen,  “…(but) what I’m ultimately interested in is teaching people to listen critically, to listen in socially just ways. I want to teach healthcare providers to listen not only to comfortable stories, or stories of folks who are just like them, but also stories that challenge them, stories that are from the margins, stories that are traditionally silenced.”

Hear Hear!!

I Wasn’t Strong Like This When I Started Out: True Stories of Becoming a Nurse


For those of you in the Seattle area who are interested in narrative advocacy from a nursing perspective, save the evening of Thursday April 18th, 2013 . I’m working with Lisa Oberg and Joanne Rich of the University of Washington Health Sciences library to host a nurse writer panel discussion and reading 6-8:30 pm at Suzzallo library, in the Smith Room (photo is of the Smith Room/ free and open to the public). I’ll be there along with some other author/contributors to the anthology True Stories of Becoming a Nurse (see below for information).

The following is the press release for the book.

I Wasn’t Strong Like This When I Started Out:
True Stories of Becoming a Nurse
Edited by Lee Gutkind
Featuring new work by Theresa Brown, Tilda Shalof, and others.

As editor Lee Gutkind points out in the introduction to I Wasn’t
Strong Like This When I Started Out, “there are over 2.7 million
working RNs in the United States (not to mention our many LPNs
and LVNs), compared to about 690,000 physicians and surgeons.
There are more nurses in the United States than engineers … or
accountants and auditors … And, yet, many of us take the work
these men and women do for granted.”

This collection of true narratives captures the dynamism and
diversity of nurses, who provide the vital first line of patient care.
Here, nurses remember their first “sticks,” first births, and first
deaths, and reflect on what gets them through long demanding
shifts, and keeps them in the profession. The stories reveal many
voices from nurses at different stages of their careers: One nurse-in-training
longs to be trusted with more “important” procedures, while another questions her ability to care for nursing home residents. An efficient young emergency room nurse finds his life and career irrevocably changed by a car accident. A nurse practitioner wonders whether she has violated professional boundaries in her care for a homeless man with AIDS, and a home care case manager is the sole attendee at a funeral for one of her patients. What connects these stories is the passion and strength of the writers, who struggle against burnout and bureaucracy to serve their patients with skill, empathy, and strength.
Pub. Date: March 2013, ISBN: 978-0-393-07156-6, 5 ½ x 8 ¼, Trade Paper, 278 pages,
$15.95, Distributed by Publishers Group West

Lee Gutkind has explored the world of medicine, technology and science through writing for more than 25 years. He is the author of 15 books, including Many Sleepless Nights: The World of Organ Transplantation, and the editor of five anthologies about health and medicine, including At the End of Life: True Stories About How We Die.
In Fact Books is a new imprint founded and edited by Lee Gutkind, editor and founder of Creative Nonfiction. In Fact Books titles help create an understanding of our world through thoughtful, engaging narratives on a wide variety of topics and real-life experiences. All titles are distributed by Publishers Group West. For more information, please visit http://www.infactbooks.com.
For interview requests and other media related questions, please contact:
Hattie Fletcher at fletcher@creativenonfiction.org or (412) 688-0304.
Early Praise:

A startling collection of stories from the bedside.
—Paul Austin, author of Something for the Pain: Compassion and Burnout in the ER

The elephant in the living room of healthcare is that providers care deeply about and are affected by the people they tend. The best ones are, anyway. In I Wasn’t Strong Like this When I Started Out, nurses recall pivotal moments with patients and families that changed them from onlookers to active
participants in the art of healing. This excellent collection chronicles those experiences in funny, eloquent, and often piercing essays. It should be required reading for anyone beginning a career in healthcare—nurses and physicians alike. —Margaret Overton, MD, author of Good in a Crisis

Within these pages, we learn what it is like to protect a dying patient from a futile procedure, to smooth a newborn’s wrinkled brow for a postmortem photo, to work in a foreign country where medical equipment is improvised from household supplies. These stories teach us the essence of nursing—that even when cure is not possible, comfort is. —Catherine Musemeche, MD, surgeon and author

The nurses in this collection bear witness to life, death, suffering, joy—the many aspects of humanity itself. These are no saccharine tales of self-sacrifice, of stereotypical Florence Nightingale-like ladies with lamps. The men and women in this collection tell stories that cut to the bone, exposing their profession’s deep emotional, intellectual, physical, and spiritual trials. Yet, in those struggles emerges great beauty and human connection. This collection exposes not only the strong, beating heart of nursing, but its brain, muscle, sinew and nerve endings—alive, pulsating, raw, real.
—Sayantani DasGupta, MD, MPH, co-editor, Stories of Illness and Healing: Women Write Their Bodies

An honest and compassionate collection of life in nursing. In voices of novices and veterans in the field, it’s an intimate portrayal of how growth is a two way street. Whether listening, touching or just remembering, when you do anything you can to help your patient, your life is also shaped in the process. They are not just lessons, but gifts, that transcend any hierarchy in medicine.
—Gulchin A. Ergun, MD, Clinical Service Chief, Gastroenterology

Like most physicians, I have a long list of nurses who have mentored me, influencing my practice of medicine in the way they live their lives and care for their patients. This book is a testament to those wise nursing colleagues–and to the paths that have brought them their wisdom.
—Marion Bishop, MD, PhD, Emergency Medicine physician and essayist

With tenderness, honesty, humor, and some anger, the authors of these engaging essays draw us into the complex beauty of nursing from an exhilarating variety of perspectives. This welcome, eye-opening collection should be required reading for every medical student and apprentice hospital administrator.
—Margaret Mohrmann, MD, PhD, University of Virginia

In these powerful narratives, twenty-one nurses unfold what it means to practice their profession: what they are thinking and feeling when they care for patients and when they go home, how they came to choose this difficult and rewarding career, their satisfactions and frustrations, their triumphs and traumas. Moreover: they write exceedingly well.
—Charles Bardes, MD, author of Pale Faces: The Masks of Anemia and Essential Skills in Clinical Medicine

Poignant recollections from often ignored voices in medicine. These wonderful stories resound with truth. —Sandeep Jauhar, author of Intern: A Doctor’s Initiation

Note: My essay “Next of Kin” is included in this anthology. I am the “nurse practitioner wonders whether she has violated professional boundaries in her care for a homeless man with AIDS” included in the book blurb above.

In order to complete the sites visits and other research necessary for writing my essay, I received a 2011 Individual Artist Award from 4Culture. Therefore, this project was supported, in part, by an award from 4Culture; thank you 4Culture.4culture_color


Where to Get Your Words Out

American Journal of Nursing
American Journal of Nursing (Photo credit: random letters)

Here are some specific resources for where to get published. This is primarily intended for writers of personal essays, short stories and poems dealing with health and health care-related issues. I’ve geared the list towards nurses, but all of the journals included here accept writing from any type of health care provider, as well as from patients and family members.

Remember to do your homework before submitting to any of these journals or blogs: follow their current submission guidelines and read their published content to make sure it is a good fit for your work.

Good general all-around resources for writing and publishing:

  • Duotrope. They have recently added a nonfiction category to their excellent searchable database of literary journals and magazines, as well as information on small presses open to book manuscript submissions.

Good resource for almost all things related to medical humanities (intersection of medicine/healthcare and creative work):


  • American Journal of Nursing. I’ve linked to their editorial manager page that has information for potential authors. Check out their Art of Nursing, Viewpoint, and Reflections sections as these are the ones accepting more creative types of writing. (They also pay a $150 honorarium for each published piece!).
  • Bellevue Literary Review/NYC Langone Medical Center. Excellent print publication. Highly selective and they can take up to six months to review a submission, so I don’t recommend them for first-time authors. But I highly recommend the journal for reading good narrative medicine type writing. They also have really cool archived historical photos from Bellevue Hospital, the oldest continuously running hospital in the U.S. (although Hurricane Sandy seriously affected their buildings and operation).
  • Creative Nonfiction. This print journal is highly selective, only includes creative/narrative nonfiction, and is not primarily geared towards health-related writing. But the editor, Lee Gutkind, has his heart in medical narratives.
  • Pulse: Voices from the Heart of Medicine. “An online magazine that uses stories and poems from patients and health care professionals to talk honestly about giving and receiving medical care.” You can sign up to get a weekly short essay (800 word limit) or poem (they currently are closed to poetry submissions as they have too many to review).
  • The Examined Life Journal/University of Iowa Carver College of Medicine. A relatively new (now biannual) print journal from the medical school linked with the most prestigious writing school in the country. This is where Abraham Verghese honed his writing skills. They have a new annual writing contest/deadline is January 10, 2013.

Blogs can be a good place to get started as a writer. Consider submitting to an existing group blog to have your work included as a guest blogger. An excellent one is HealthCetera at the Center for Health Media and Policy at Hunter College. Joy Jacobson, MFA (health care journalist and poet) and James Stubenrauch, MFA (writer and editor) are both Senior Fellows at the Center for Health Media and Policy, Hunter College School of Nursing. They both have worked as editors for the American Journal of Nursing. I ‘spoke’ with them via e-mail this past week and they wanted me to encourage my students (and other nurses) to consider submitting a guest blog post.

So no excuses! Get your words out and get them published.

Nurse Writers Arrive in Wiki-land

English: Manuscript handwritten by Walt Whitma...
English: Manuscript handwritten by Walt Whitman, American poet, for his poem “Broadway, 1861” (Photo credit: Wikipedia)

As I wrote in a previous blog post “Nurses and Writing: Writers and Nurses” (3-31-11) the term “physician writer” is well-known and accepted by the general public, while the term “nurse writer” is not. Physician writer has had an extensive Wikipedia entry since March 2008.

Thanks to Dr. Thomas Lawrence Long, Associate Professor-in-residence at University of Connecticut School of Nursing, there is now a Wikipedia entry for “nurse writers.” Dr. Long has a PhD in English and a master’s degree in Theology. He teaches writing at a school of nursing and maintains a nurse writing website/blog resource called NursingWriting. Here is his Wikipedia definition of nurse writer:

“Nurse writers are registered nurses (RNs) who write for general audiences in the creative genres of poetry, fiction, and drama, as well as in creative non-fiction. The published work of the nurse writer is analogous to that of the physician writer, which may or may not deal explicitly with health topics but is informed by a professional experience of human vulnerability and acute observation.”

Nice definition, with the possible exception of the RN part. (Can’t an LPN writer be called a nurse writer? Plus, the RN designation is a relatively recent invention and may not translate to all countries). He also includes a list of nurse writers, beginning with 19th century writers, ranked by date of birth. Curiously, he left out Walt Whitman and Mary Seacole, who were both born before Florence Nightingale (who he lists first.) Including a well-known male nurse/writer (Whitman) and a nurse/writer of color (Seacole) would be a good idea. So someone out there who wants to add these, please do. While they’re at it they can add Mary Jane Nealon (Beautiful Unbroken: One Nurse’s Life, Graywolf Press, 2011) to the 21st century list.

Nurse writer Theresa Brown has a recent post (on Hunter College’s Center for Health Media and Policy blog Healthcetera) “Calling all nurse writers,” in which she encourages nurses to write. As Ms. Brown points out, nurses typically spend a lot of time with patients, have many stories to tell, and have a unique perspective on health care provision.

I have had many inquiries lately from nurses seeking advice on how to develop as creative writers. Here is my (very biased) advice:

1. Read. Read widely. Read great/classic literature as well as current writing from authors in a variety of genres. Read/subscribe to literary magazines. (My current list of literary journals includes Creative Nonfiction, The Examined Life, Bellevue Literary Review, and Fourth Genre. These are all top literary journals in my writing genre of literary nonfiction/narrative medicine.)

2. Write. Write something that is creative–for your eyes only– every day. Even if it is for just five minutes in a bathroom stall at work, during a sacred bathroom break, and you have to write on a paper towel–incorporate writing into your life.

3. Find/join a writer’s group/center in your community. In Seattle I recommend Hugo House as an excellent resource for writers at all ‘levels.’

4. Join  NYU‘s Medical Humanities listserv. Even though this is ‘hosted’ by NYU’s medical school, it is interdisciplinary and their website is an excellent resource.

5. If you are an academic or have to do academic writing in your work, find a way to purge that part of your writing brain–or at least find a way to compartmentalize it. Academic writing is formulaic and anti-creative.

6. Find a way to share your writing. This could be in a supportive writing group or class, at open-mic venues in your community, by submitting to a journal, or by posting to a blog.

Becoming a Nurse: The Book

Creative Nonfiction’s anthology is currently in press and due to be released March 12, 2013. The book’s full title is I Wasn’t Strong Like This When I Started Out: True Stories of Becoming a Nurse (Lee Gutkind, editor/In Fact Books).

Here is the official book blurb:

“This collection of true narratives reflects the dynamism and diversity of nurses, who provide the first vital line of patient care. Here, nurses remember their first ‘sticks,’ first births, and first deaths, and reflect on what gets them though long, demanding shifts, and keeps them in the profession. The stories reveal many voices from nurses at different stages of their careers: One nurse-in-training longs to be trusted with more ‘important’ procedures, while another questions her ability to care for nursing home residents. An efficient young emergency room nurse finds his life and career irrevocably changed by a car accident. A nurse practitioner wonders whether she has violated professional boundaries in her care for a homeless man with AIDS, and a home care case manager is the sole attendee at a funeral for one of her patients. What connects these stories is the passion and strength of the writers, who struggle against burnout and bureaucracy to serve their patients with skill, empathy, and strength.”

Lee Gutkind, dubbed by Vanity Fair as the godfather of creative nonfiction, is currently Distinguished Writer-in-Residence at Arizona State University’s Consortium for Science, Policy and Outcomes—where, among other things, he is “(…) helping scientists, engineers, nurses, lawyers, philosophers, etc share what they know with a general audience.” (Creative Nonfiction blog post 7-7-08).

In Fact Books is the new book imprint of the Creative Nonfiction Foundation. They have published two books this year: An Immense New Power to Heal: The Promise of Personalized Medicine(Lee Gutkind and Pagan Kennedy), and At the End of Life: True Stories About How We Die(Lee Gutkind, editor). Gutkind has a special interest in the narrative of medicine, beginning with his 1990 book Many Sleepless Nights: The World of Organ Transplantation (U. Pittsburg Press). In the introduction to the anthology he edited, Becoming a Doctor: From Student to Specialist, Doctor-writers Share Their Experiences (Norton/2010), Gutkind marvels at how there are so many writers who are doctors and doctors who are writers.

I look forward to reading Gutkind’s introduction to the “Becoming a Nurse” anthology, specifically how he addresses the paucity of nurses who are writers/writers who are nurses. Gutkind was reportedly surprised that they did not receive a flood of submissions for their “Becoming a Nurse” anthology, and wondered why there weren’t more nurses who write about their work.

I can think of many reasons why there are not more nurses who write (see my blog post “Nurses and Writing: Writers and Nurses” 3-31-11). Besides the fact that nursing is a servile, mainly female, “functional doer” profession that doesn’t require a basic four-year liberal arts education, nurses who want to write about their work are bullied out of it by their bosses. Quite frequently I hear from nurses who are writers (or who want to become published writers) that they have been threatened with termination by their employers if they continue to write about their nursing work—even when they are appropriately changing details in order to protect patient privacy. Because of the differences in professional power dynamics and the rigid hierarchy within the health care system, doctors who are writers do not have this barrier to writing—or at least not to the same extent.

But what that means is that Gutkind’s anthology on “becoming a nurse” is all the more important a contribution to the growing field of narrative medicine/nursing/health care. The book serves as a platform for a total of 21 nurses from around the world to tell their stories about what it means to become a nurse.

Transparency here: my essay “Next of Kin” is included in the anthology. My essay is the “a nurse practitioner wonders whether she has violated professional boundaries in her care for a homeless man with AIDS” in the book blurb. Thanks to a grant from 4Culture, I was able to complete the site visit/research for my essay (and book from which this essay is taken) last fall, in time to submit it to Creative Nonfiction.

At 320 pages and retailing at $15.95, the book I Wasn’t Strong Like This When I Started Out: True Stories of Becoming a Nurse ( is available for pre-order from your favorite bookstore—like mine here in Seattle: Elliott Bay Book Company. And if you live in (or want to travel to) the Seattle area, stay tuned for information on several group readings/presentations by some of the authors from the anthology—at Elliott Bay Book Company and at the University of Washington Health Sciences Library. Both events are still in the planning stage and will most likely be in mid-March.