Criticism

The hospital has a weekly lecture series that covers a variety of medical issues, from new technology to trends in patient advocacy. I started going when I was a student because many of their topics touched on bioethics (an acute interest of mine).

Last week the topic was on medical writings and literary criticisms of it. I know my viewpoint is skewed because I'm in medicine... so when I see medical-themed books at Barnes & Noble, on a prominent table with lots of other "big name" books, they especially stand out to me. So I can't really tell if I'm just seeing more medical books because I'm more aware of them (and have started reading more and more of them), or if there are more being published.

Turns out, more are being published! More people are writing about their experiences as a patient, a family member of a suffering patient, or a medical professional. ... And by medical professional, I just mean doctors. No nurses. Just like in movies and TV shows, doctors get all the attention and nurses have the supporting role. (Yes, I am aware that Jada Smith has a whole show about her role as a nurse... but it's an absurd show and paints the nurse's role in a totally unrealistic light. There's enough drama and emotion without having an "us vs them" attitude portrayed. End rant.) I want to read a nurse's memoir. I want some thoughtful nurses to write. That's why I'm blogging... because it's how I process my experiences. I want to hear how other nurses process their's.

Anyway, about the talk. The speaker was a New York Times book critic. She is also a physician. She reads and critiques many books in the medical world, and she was giving us her opinion on medical writings. Something she pointed out that was very interesting is that the whole perspective on disease has changed in America in the last 50 years... disease used to be private. Now, there are breast cancer awareness bagels at Panera and comedians discussing their heart surgeries on HBO. There are loads of books about various diseases... from Alzheimer's to polio. One of my favorite books ever is a memoir written by a recovering alcoholic, explaining the way her mind thought about alcohol, how she experienced being buzzed, and how she felt without it. It made me 200% more sympathetic to my patients going through alcohol withdrawal in the hospital. I've read various short stories and seen a documentary on eating disorders that showed the true mental disorder behind the behavior... these aren't people making bad decisions, they're people suffering from an illness (not that ownership isn't part of the issue, but that's another blog post).

So the NY Times Critic posed the question of whether or not we should be evaluating these books at all. Should be treat them as true literature and critique their use of metaphors and character development, or should be excuse them from those standards? Many people write because they want to share their experience; an experience they either feel is so unique that it should be proclaimed or is so universal that others could find comfort by relating to it. This is for both the patients/families and the physicians... enduring the culture shock of being a resident and slowly taking on more and more responsibility for people's lives is definitely something worth writing about! And seeing a loved one slowly succumb to end stage Alzheimer's is something people will experience more and more (it is the 6th leading cause of death in America, according to the CDC). These experiences should be captured, but should we criticize how we capture them? How we present them to the public?

The Critic pointed out that it should sorta depend on their motivation for writing and publishing it. Is it because they just want to process it, and it happened to get published along the way? Is it to help illuminate the situation for others, an "this is life in the trenches" sorta story?

I don't think that it should matter why they decided to write and get published. I'm writing a blog to work through my own emotions on matters, and to help document my emotions to reference later. ("See how far you've come, Jenn!") I'm not seeking editors to work through these experiences and polish them for audience appeal. You can choose to read this or not... but you sharing in this experience with me isn't a big investment for me. However, if I choose to go down that road someday, writing my own nurse memoir, I hope to get my literary critique. I can't step into someone else's profession and ask not to be held to their standard. That's absurd. If you choose to write and then go through the effort to get published, you choose to open yourself up to THAT WORLD and all it involves.

One reason I feel that way is because a writer can do real damage to a story if they write poorly. You know it's true: give two people 3 talking points, and one will create a beautifully worded speech and deliver it with equal eloquence, and the other will give a dry lecture. Same info, two presentations... and two very different effects. One audience will walk away energized with knowledge, maybe contemplating these issues on their own, investing their own time and energy and money into that selling point so wonderfully presented. The other audience may almost feel contempt for the talking points because of the limp presentation, avoiding other opportunities to learn more about it, and internally labelling that topic "boring" or "irrelevant". A somewhat controversial example would be Al Gore's "An Inconvinient Truth"... information that has been presented by science magazines and environmentalists for years, but finally brought forward in an appealing (well, sometimes assaulting) way, and within 2 years there was new legislation about green house gases and tax breaks for "green" home improvements.

So what damage can be done from poor medical writings? I've read several physician memoirs, and all have been great. They've done a terrific job of showing the very human emotions and physical limitations of their jobs without appearing to shrug their shoulders about it. They aren't heroes and they aren't assholes: they're just people working in a strange world. They show the limitless advances of healthcare wrapped in a wet blanket of politics and emotions and conflicting opinions. As someone "in the trenches", I appreciate this raw view that highlights both the sacrifices we make and the failures we endure.

But speak to one patient with a negative experience with a nurse or physician and you'll be overwhelmed by the impact it made on their universal perspective of healthcare providers. One doctor talking about them to their family as if they weren't in the room or had already died. One nurse forgetting to draw the curtain before undressing a patient for a bath, or rolling his/her eyes at the complaint that the pain medicine isn't working. In short, one experience of feeling so entirely vulnerable and being met with an utter lack of awareness of their humanity, their HUMANNESS, and they are forever scarred. Being denied their significance and value when feeling the most insecure will burn and distort and sensitize that person for years.

Can a book do damage like that? I haven't read one that has, but from discussions with coworkers and "tell me how you really feel" moments, I can see how it could. And I think a solid critique should scare away those writers, or at least come to defend the offended audience.