The Ultimate Writing Prompt

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 NYU Literature, 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).

Of Poems, Hearts, and Hands

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….

Why Iowa?

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.

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