The Pen is as mighty as the Pill: Humanities in Medicine

This is not a post on radiology. It is a post on something much more basic; on understanding what goes through a patient’s mind and how can we humanize medicine and the doctor-patient relationship. And before you start changing the tab, let me assure you there is no philosophical exposition ahead (I don’t have that many grey hair yet). The JAMA has a lovely section called ‘Poetry and Medicine‘, and this short fantastic piece titled ‘Last minute pedicure’ is a must read for everyone who is a health care worker. I was fortunate to review it for the Tata Memorial Center Journal Watch, a weekly review of important scientific/interesting articles. I am sharing my review here.

PS: The Cafe Roentgen Journal Watch predates the TMC Journal Watch (just saying!!).

Sharing my review here:

At its core, medicine is about caring for fellow human beings. And yet, if there is one thing that medical school does not equip us as it should, it is empathy for the patient. Teaching humanities in medicine though is easier said than done, and this short touching piece is a timely reminder of the power of poetry, covering more facets of palliative cancer care than perhaps an hour-long talk. One can write an exposition on literally each word used in the poem, right from the title to the poignant last line. However, art after all is as much about the observer as it is about the artist, and I would rather leave the poem for the reader to enjoy without any commentary prejudicing his/her views. Hence, instead of critiquing the poem, I am sharing my own reaction to it.

I was of course deeply touched by the myriad issues covered by the poem with casual simplicity. It strikes me that, especially for this generation of trainees with their short attention spans, such bite-sized hard-hitting pieces will probably be quite impactful, a TikTok of humanities if you will in terms of influence (written without any disrespect to either medium). We all agree to the general principle that towards end-of-life, the number of days to live has less value than the ‘life’ in each day. This piece presents a vivid example of how the simple act of a pedicure is one such reason for delight in the patient’s last few months. Many of us would have envisioned it to be something grander, like a trip to Paris. Reading the poem makes us realize that it’s actually just a few simple indulgences (hedonistic or otherwise), that truly give life to a day; spending precious moments with loved ones, giving time for self-care or a hobby, or having a delicious meal polished off with an ice-cream at the end. And perhaps if we can do our bit, a visit to the hospital greeted by warm smiles and a caring physician may count as one of these small pleasures as well.

At another level, as the current era is one of narratives, this poem made me ponder whether it is time for us to try and change medicine’s narrative as well, especially in palliative patients or those with chronic debilitating conditions, from one of symptom alleviation or palliation to one which helps add more life to each day, and brings smiles rather than just remove tears. After all, if ‘Tender loving care’ is an acceptable prescription, why would ‘A trip to the beach’ or indeed a ‘Pedicure’ not be one?! Easier said than done of course, but perhaps food for thought.

The importance of Narrative Medicine was recently covered in a talk at our institute. Studies specifically on poetry have indeed shown that it may increase doctor empathy. Relevant poems can definitely have a positive (if not transformational) impact, on not just doctors but also the rest of the hospital staff as well as patients. Keeping such literature for reading in our waiting areas is something worth considering.

Medicine is all about patients, and not about bed numbers or file numbers or images. This poem brings the patient to life in front of our eyes like nothing else can. And while we wield enormous power with our scalpels and drugs and radiation, perhaps it is time to realise that the pen and its impact is probably an equally mighty weapon in our armoury, especially in palliative or chronic illness patients. 

Post-script(s): For those who like going down rabbit holes, here are three I recommend digging into.

a. Do go through the other poems in JAMA’s series on ‘Poetry and Medicine’.

b. During my final year residency, Dr Ravi Ramakantan, a renowned radiologist, had discussed a poem on a similar theme with radiology residents in an interactive 40-min conference session He has shared his thoughts and the audience responses in this must-read article here.

c. I recently read the most honest and raw account on losing your loved one to cancer here; do remove 5 minutes to read it, but do it alone, so that no one notices those teary eyes you will certainly get by the end. 

– Akshay Baheti, Tata Memorial Hospital

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