When I Used Food Stamps

English: Logo of the .
English: Logo of the . (Photo credit: Wikipedia)

Just in time for Thanksgiving come the huge additional cuts to Food Stamps being considered by the U.S. House-Senate Farm Bill Conference. Many of my colleagues are joining the “Food Stamp Challenge,” attempting to limit their spending on food to the current food stamp daily allotment for an individual (in my home state of Washington this is $4.20/day). Many of my health reporter colleagues on various list-servs and social media sites are debating how to cover the issue of food stamps and food security. There’s a dismaying amount of whining from the health reporters about how much junk food people buy with food stamps. As if people with food stamps should only be able to shop for kale and arugula at Whole Foods…

This is my food stamp story:

When I was twenty I worked for a home health agency in Boston.  I worked as a home health aide for minimum wage–$3 an hour at the time with no health benefits. I had dropped out of school and was living on uncooked Ramen noodles and peanut butter.

One of my clients was a 29-year-old African-American woman who was homeless, or rather had been homeless until she was hit by a car and ended up in the hospital. When I worked with her she was recovering from a broken leg and she stayed at her aunt’s small apartment in Roxbury. It was my first experience using food stamps. She would give me her food stamps and a grocery list and I’d go down to the small corner market and trade the scrip for food. People in the store looked at me funny and seemed to wonder why a clean-cut white girl in khaki pants and a polo shirt was using food stamps. Sometimes things were so turbulent in her apartment I couldn’t get in to see her.

Food security is not just a basic human need; it is also basic human dignity. If you have an elected official who is a conferee on the House-Senate Farm Bill Conference, please send them a strong nudge to not slash Food Stamps in favor of lining the pockets of large agribusinesses. Representative Suzan DelBene of Washington state ((Legislative District 1: Apple and tulip and grape (wine) grower and Microsoft country))–please protect Food Stamps.

See: Cut in Food Stamps Forces Hard Choices for Poor by Kim Severson and Winnie Hu (NYT 11-7-13).

Of Poems, Hearts, and Hands

hand. (Photo credit: bambola_world)

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….

Heart’s Oratorio

It is Spring Break and instead of heading to warm beaches I’ve been indulging in a massive reading intensive, staying up into the wee hours of the morning IMG_0775finishing book after book as if they were bonbons. Some have been disappointing reads (like biting into a chocolate bonbon only to discover a nasty fake cherry filling): Kathryn Schulz’s Being Wrong, Ryszard Kapuscinski’s Travels With Herodotus, and Michelle Kennedy’s Without a Net). Others have been rewarding, such as Colum Toibin’s The Blackwater Lightship and Ivan Turgenev’s Fathers and Sons. But one book stands out as a keeper and worthy of future re-reads and study: Mary Oak’s Heart’s Oratorio: One Woman’s Journey through Love, Death, and Modern Medicine (Goldenston Press, 2013).

First, a disclaimer. I know Mary from my monthly writing group—the Shipping Group—that meets at my favorite bookstore, Elliott Bay Book Company. Mary is a quietly strong and centered woman. But that is not why I love her book. I love her book because it is beautifully written and tells a powerful and unique medical narrative. I love her book because it helped me to view the medical system from a different perspective.

Mary has died twice in the past decade. The first time she died was in 2007 in the Houston airport while running to catch a connecting flight to Paris. She collapsed in the airport terminal. Otherwise healthy but having asymptomatic ‘athlete’s heart,’ she experienced sudden cardiac death, then was brought back to life through the actions of emergency medical personnel and hospital treatment. Back home in Seattle, Mary underwent two cardiac surgeries at Northwest Hospital. During the second surgery, to implant a cardiac defibrillator, Mary’s heart stopped once again. But that is just the background medical drama of her story. The real story is Mary’s spiritual journey through it all. Mary comes from a long line of homeopath and Christian Science healers and had avoided most all things allopathic. But as she writes, “Nothing like sudden death to invite a different perspective.” Mary’s book is also a love story: her love and care for her children who may have inherited her cardiac condition, as well as her love of David who becomes her husband and cares for her through her illnesses.

Although I neither share Mary’s spiritual beliefs nor her long family history of spiritual healers, I was drawn into a deeper understanding of and respect for them through her story. I can envision using her book in the nursing education that I do. Many parts of Mary’s medical narrative occurred right here in Seattle in hospitals where my students are trained and may eventually work—so it is literally close to home. Mary describes walking past my own university office (in the world’s largest and ugliest university building/photo attached here) on her way to find her medical records:

“Then I walk city blocks’ worth of narrow hallways with low ceilings and polished tan vinyl floors. I pass countless numbered doors. Only one is open: to a room of legless and armless dummies on the floor for a CPR training. No one is there. As I walk past various laboratories and offices, I wonder how much debt I will incur with this latest round of medical consultations. Will I live to pay it off?”