‘Write Rx’ is a narrative medicine column offering ‘prescriptions’ for narrative medicine exercises. Each column entry begins with an introduction to the theme of the entry, offers literary excerpts to expand on that theme and concludes with questions that invite students to explore a corresponding narrative medicine topic. The goal is to offer space for reflection for busy medical students, as well as foster medical students’ communication toolkit in the increasingly complex space of patient care. Topics include cultural fluency, illness cognitions and more.
Today’s topic: We bring our cultural backgrounds and perspectives to every encounter, and so do patients. These remain unexamined until we become aware of inconsistencies or differences between viewpoints. Awareness of our own personal biases and perspectives may help us explore the conflicts that arise in caring for patients with varied perspectives.
Thomas Browne, a physician, writer, polymath and intellectual, lived over four hundred years ago, yet remains one of the most widely cited authors today. This is partly owing to the Delphic nature of his prose. His first published work, Hydriotaphia, Urn Burial, or a Brief Discourse of the Sepulchral Urns, was inspired by a discovery of ancient burial urns in Norfolk, England. Urn Burial explored funeral rites and traditions and the transience of life. A prosaic stanza from the piece portrays a layered study of artifacts from a lost culture through the eyes of a 17th-century educated Englishman of Protestant upbringing. The amalgam of two distinct cultures is striking and may serve to broaden our understanding of how our own background colors our experiences.
“But man is a Noble Animal, splendid in ashes, and pompous in the grave, solemnizing Nativities and Deaths with equal lustre, nor omitting Ceremonies of bravery, in the infamy of his nature. Life is a pure flame, and we live by an invisible Sun within us.”
–Thomas Browne, “Hydriotaphia” p.82
This quote shows a glimpse into ancient Anglo-Saxon culture which the burial urns provided. Browne was able to draw strong links to his own culture and express universality among practices. Whether millennia old or as recent as his own seventeenth century, Browne discerned the universality of burial practices. This quote distills those practices to their base elements of our preoccupation with life and death. “Pompous in the grave” plays with the idea of spiritual assurance or certainty, in keeping with the divided ideas of the late 1600s, when theology began increasingly to clash with scientific advancement.
Consider: Browne’s allusion to life as flame calls upon mythic origins, while the work ‘Urns’ as a whole catalogs an extensive overview of Christian burial, as well as speculation on some uniting principles between cultures — for example, the ‘solemnizing of Nativities and Deaths with equal lustre.’ Consider how every actor in the health care space brings a cultural background shaped by experience and/or tradition and precedent. How might cultural values inform our reactions to bad news, such as life-limiting diagnoses, or the death of a loved one? What about our reactions to good news, such as a birth?
Twentieth-century Argentinian writer, Jorge Luis Borges (1899-1986), was such a great fan of Browne that he translated his works into Spanish. Many of his works take inspiration from Browne. Borges’ characters possess mystical qualities and often interpret dreams as reality or foreshadowing, a common literary theme in the South American tradition originating from Quechua cultural beliefs that considered the dead to enter in communication with the living during sleep.
“In that vision … I saw the delicate bone structure of a hand; I saw the survivors of a battle sending out post cards … I saw the oblique shadow of some ferns on the floor of a hot-house; I saw tigers, emboli, bison, ground swells and armies; I saw all the ants in the world.”
–Jorge Luis Borges, “The Aleph” [“El Aleph”]
The original is unfaithful to the translation.
–Jorge Luis Borges, “Sobre el Vathek de William Beckford”
The vision described in the Aleph has the weight of certainty or premonition for Borges’ characters which we may not decipher without cultural awareness of the importance of the word ‘vision’ to his culture. The second quote deals in an interesting exchange: because translations also communicate the message of a work, sometimes the translation can be more effective than the original at transmitting the message.
Consider: Consider Borges’ character in “The Aleph.” What challenges might arise in a physician-patient alliance when a patient has a strong belief, in Spanish, ‘fe’, in fate or premonition?
Write: The quotes by Jorge Luis Borges illustrate the fundamental imprecision we deal with when translating between languages. Take this time to consider how communication is achieved. Who participates? What qualities must sender and receiver of a message exhibit in order for the content of the message, its intention and meaning, literal or figurative, to be transmitted effectively? Write or draw a diagram which you believe encapsulates this dynamic.
Back to Browne:
Besides confronting a number of scientific phenomena from horticulture to a vast number of superstitions regarding disease, Sir Thomas Browne also published the encyclopedia Pseudodoxia Epidemica, the first of its kind to stress the precedence of keeping current with scientific literature. He also originated many English words. Examples of his coinages, many of which are of a scientific or medical nature, include: ‘ambidextrous’, ‘antediluvian’, ‘analogous’, ‘approximate’, ‘ascetic’, ‘anomalous’, ‘carnivorous’, ‘coexistence’, ‘coma’, ‘compensate’, ‘cylindrical’, ‘disruption’, ‘exhaustion’, ‘ferocious’, ‘follicle’, ‘generator’, ‘hallucination’, ‘herbaceous’, ‘holocaust’, ‘insecurity’, ‘indigenous’, ‘locomotion’, ‘medical’, ‘migrant’, ‘mucous’, ‘prostate’, ‘polarity’, ‘pubescent’, ‘therapeutic’, ‘suicide’, ‘ulterior’ and many others.
Consider: prior to his creation of “anomalous,” how did we describe an artery whose path differs from the conventional? Precision is a careful art we must hone, particularly when communicating with patients with whom we do not share a common language. When reflecting on the doctor-patient relationship, do not neglect to consider the many layers of a message, from literal meaning to implied meaning, to intent, as well as its dependencies on successful language and cultural competency in order to be fully understood.
Suggested Texts:
Hydriotaphia, Urne-Buriall, or, A Discourse of the Sepulchrall Urnes lately found in Norfolk, Thomas Browne
Pseudodoxia Epidemica or, Enquiries into Tenents and Commonly Preserved Truths, Thomas Browne
Image courtesy of Fiona Doolan
Now and for the foreseeable future, providers and patients wear masks. An essential element of the doctor-patient relationship – nonverbal expression – is much reduced. When what is on our faces is anathema, we rely more heavily on narratives. Consider each entry of ‘Write Rx’ a prescription for a narrative medicine exercise that just might help you find the right words to relate to patients in this changed space. Here I hope you will find a bit of inspiration for reflection amidst the rigors of medical school, not in the least thanks to some famous physician-writers, excerpts from whom serve as an entry point for each exercise.
Columnist
School of Medicine at Trinity College Dublin
Fiona Doolan is a 4th year medical student at the School of Medicine at Trinity College Dublin, Dublin, Ireland, graduating in 2023. She holds a B.S. in physiology from Boston University, 2017. She is host of the podcast CXR: Careers x Radiology. CXR is a long-form interview podcast introducing radiology to the medical student. It was inspired by the explosion in virtual connectedness worldwide during the pandemic, and from a deep curiosity about the specialty. Fiona is an avid runner and aspiring radiologist.
Write Rx
Now and for the foreseeable future, providers and patients wear masks. An essential element of the doctor-patient relationship – nonverbal expression – is much reduced. When what is on our faces is anathema, we rely more heavily on narratives. Consider each entry of ‘Write Rx’ a prescription for a narrative medicine exercise that just might help you find the right words to relate to patients in this changed space. Here I hope you will find a bit of inspiration for reflection amidst the rigors of medical school, not in the least thanks to some famous physician-writers, excerpts from whom serve as an entry point for each exercise.