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Physicians’ words, patients’ stories

Posted by on Tuesday, July 18, 2023 in Around the Medical Center, Summer 2023 .

Elizabeth Ebbens, MD, reads aloud her first-person narrative. Photo by Erin O. Smith.

Elizabeth Ebbens, MD, recently stood before fellows, residents and faculty to share words she’d written about a feverish 5-year-old’s emergency room visit.

The child’s mother voiced fear about the “C” word. Ebbens, a pediatric emergency medicine fellow, thought the patient’s mother feared COVID, so she ordered a COVID-19 test as well as labs to check blood cell counts and electrolytes. Despite normal findings, Ebbens’ reassurances were futile. That’s when she discovered the “C” word that was causing such anxiety was actually cancer.

“I see how much COVID has changed me,” Ebbens wrote. “And I would assume COVID is everyone’s worst fear. Truly COVID-19 was the worst of all things for such a long time — death, the end of the world. Yet for all its terror, COVID gave us just another name on a list of cuss words, cancer among them.

“To all my patients and their parents, to everyone, I acknowledge the ghosts of our darker COVID days still live in my chest years later. All of us in health care, from policymakers to front-line providers, are trying to bring peace back into the room…Moving from COVID-crushed to COVID-touched, we are learning to breathe again, trying to avoid the next worst thing.”

Ebbens wrote these words as part of the inaugural class of the Medical Humanities GME Certificate Program offered in 2022-23 to residents and fellows at Vanderbilt University Medical Center. Over nine months, she and 12 others learned to apply narrative medicine techniques to their own patients. Several class members even had original works submitted and published in medical journals.

Narrative medicine is a holistic practice approach that draws upon patients’ life stories — beyond diagnoses and lab values — to improve their care. Medical humanities integrate arts and humanities into medical practice. The certificate program’s founders argue that narrative and storytelling are essential roots of medicine and are deeply relevant, even in the hustle of modern practice.

“This certificate program was born of the deep belief that there’s no such thing as nonnarrative medicine, and that we can practice the skills we’ve learned through narrative medicine and oral history to become better physicians,” said Megan Dupuis, MD, PhD, assistant professor of Medicine. “And that writing, reading and storytelling connect us more deeply to the patients we care for every day.”

Dupuis co-directs the program with Chase Webber, DO, assistant professor of Clinical Medicine. Narrative medicine is usually taught to medical students, and Vanderbilt University School of Medicine has a long tradition of this. Webber and Dupuis felt it was vital for residents and fellows to have a refresher.

“The workload of residency is so challenging that finding a way to pull away from that and reflect with peers in a shared space, within a community of practice, was really the vision and the hope for this,” Webber said.

Ebbens, who now carries a notebook in the pocket of her scrubs, said writing helps her to process events, especially difficult ones, that occur during her clinical practice.

“I previously wrote poetry and played lots of music,” she said. “And then residency happened. And I had a three-year drought. This program has given me confidence that I can write, and it’s something I’m actually good at.

“People say, ‘Oh, the humanities, that’s the soft side. We are hard science here!’ But this is how we get through it. We are telling each other stories — often unconsciously — all the time.”