Medical Teacher
ISSN: 0142-159X (Print) 1466-187X (Online) Journal homepage: http://www.tandfonline.com/loi/imte20
Those who stay Joseph J. Taylor To cite this article: Joseph J. Taylor (2015) Those who stay, Medical Teacher, 37:7, 693-694, DOI: 10.3109/0142159X.2014.1001342 To link to this article: http://dx.doi.org/10.3109/0142159X.2014.1001342
Published online: 06 Feb 2015.
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Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=imte20 Download by: [University of Wisconsin Oshkosh]
Date: 07 November 2015, At: 11:25
2015, 37: 693–694
PERSONAL VIEW
Those who stay JOSEPH J. TAYLOR
Downloaded by [University of Wisconsin Oshkosh] at 11:25 07 November 2015
Medical University of South Carolina, USA
Futurism was an early twentieth century art movement that celebrated the dynamism of technology and industrialization. Futurists were consumed by the speed and complexity of modern life, even as it compromised human relationships. A century later, Futurist observations about technological advancements are particularly relevant for healthcare providers who endeavor to practice ‘‘patient-centered medicine’’ rather than ‘‘illness-orientated medicine’’ (Balint 1969). Busy workers are sometimes consumed by the speed and complexity of modern medicine, even as it compromises human relationships. The purpose of this essay is to describe how States of Mind, a Futurist masterpiece by Italian artist Umberto Boccioni (1882–1916), shaped my experience with patient death and ultimately revealed the role of personal context in caring for grieving patients. States of Mind is a triptych about perspectives. True to the spirit of Futurism, these paintings are set in a turbulent train station where travelers depart from their loved ones. Each one conveys a unique internal milieu of emotion through colorful geometric distortions of the external environment. In the multicolor I: The Farewells, swirling smoke plumes obscure the features that distinguish the travelers from their train. This technique depicts the train as a powerful machine that completely engulfs the humanity surrounding it. The scene suggests that technology can shift priorities and transform life into a series of transitory experiences. In the azure II: Those Who Go, oblique transit lines propel the forlorn travelers further from their homes. Each traveler on the train has the same facial features, as though the collective face of modern humanity has been fractured into multiple pieces. The powerful train literally and figuratively carries the collective traveler away. In the jade III: Those Who Stay, vertical lines of melancholy rain down on the loved ones who were left behind. This scene conveys a deep sense of inertia as those who stay struggle to adapt to the loneliness and depersonalization of their industrialized lives. Boccioni’s triptych cleverly represents the art of medicine. When I first encountered these paintings, I viewed them as a general reminder that each situation can be viewed from a multitude of perspectives. What I perceive during a patient encounter, for example, might differ dramatically from what the patient perceives during that same encounter. These two
subjective accounts capture critical elements of what objectively transpired. After a poignant interview in a widowed patient’s home, however, States of Mind took on an allegorical meaning. Instead of train stations, healthcare workers experience solemn valedictions in hospitals and clinics. When patients die, we sterilely document the farewells. Debriefing may remind us of those who go and help us to balance the opposing forces of paralyzing empathy and obdurate professionalism (Vallurupalli 2013). Unfortunately, there are few reminders of those who stay. Perhaps the most neglected state of mind in the context of patient death is not that of the conflicted provider or the suffering patient, but that of the grieving family. My initial call to Mr. Stevenson went unanswered. ‘‘You have reached the Stevenson Family. We can’t come to the phone right now. Please leave a message and we will call you back’’. To callers without context, this familiar voicemail greeting sounds completely innocuous. To those with context, however, it is an eerie reminder of the fragility of good health. Unlike human beings, voicemail greetings do not expire. They simply live on until someone deletes them or records over them. The reason why Mr. Stevenson chooses to let his wife greet callers posthumously remains unknown. A visit to the Stevenson home, however, reveals that Mrs. Stevenson is hardly just a ghost in a machine. Mr. Stevenson lives with his disabled son on a quiet suburban street. The most noticeable feature of their home is the custom-built wheelchair ramp leading from the cracked driveway to the weathered front door. To those with context, the home feels tired and worn as though the structure itself has gone through emotional turbulence. Inside, Mrs. Stevenson has a presence through her absence. She is a specter hiding in plain sight, a spirit who manifests through folksy crafts and baubles and photographs. On the back of the front door, a wooden duck offers a farewell to visitors as they leave. On the walls, sconces filled with lifeless plastic peonies flank faded wedding photographs. In the credenza, effeminate trinkets and dusty china rest idly. The de´cor could not be more misplaced for a retired bodybuilder and his motorcycle-loving son. After greeting three excitable small breed dogs, I was invited to sit on a tired couch. Pale green threadbare carpet
Correspondence: Joseph J. Taylor, MD/PhD Student, Brain Stimulation Laboratory, Institute of Psychiatry, 67 President Street, Room 504 North, Charleston, SC 29414, USA. Tel: 843-792-5729; Fax: 843-792-5702; E-mail: [email protected] ISSN 0142-159X print/ISSN 1466-187X online/15/70693–2 ß 2015 Informa UK Ltd. DOI: 10.3109/0142159X.2014.1001342
693
Downloaded by [University of Wisconsin Oshkosh] at 11:25 07 November 2015
J. J. Taylor
stretched over the floor like algae on a calm pond. Vertical wood paneling lined the walls. The only item in the room that felt new was the television, a medium-sized flat screen perched on a small entertainment stand. To my right, Mr. Stevenson sat quietly in a worn lounge chair. To my left, Mr. Stevenson’s son slumped in a wheelchair and gingerly readjusted his new prosthetic leg. With porcelain angles looking on like reporters, I began the interview. My initial questions focused on Mr. Stevenson’s past medical history. Over time, however, I began asking Mr. Stevenson about his fascinating life and the woman who continued to define it months after her death. My new focus became the emotional turbulence that he experienced following this loss. I asked him to help me understand what his wife meant to him and how he navigates without her. Mr. Stevenson cathartically opened up. I heard about the full arch of their romance, from the blind date on which they met to the day that she died nearly sixty years into their marriage. I heard about square dancing and tattoos and cruises to Mexico. I heard about their love of Buicks and their unfulfilled plan to buy a new one before she died. I tried to imagine how it would feel to be surrounded by reminders of true love lost. I had read Mr. Stevenson’s chart before I left the clinic. I knew he had taken care of his wife through cancer and infections from bacteria like pseudomonas aeruginosa. Despite this preparation, I lacked the personal context that is filtered out by clinic walls. Visiting the patient in his home enabled me to vicariously experience the farewell and to encounter the spirit of those who go. Most importantly, my visit enabled me to consider the perspective of those who stay. It suddenly felt as though I was experiencing a horridly personalized version of Boccioni’s painting. The room’s pale green carpet shifted into the pyocyanin color of pseudomonas aeruginosa and grew like a biofilm over the walls, surrounding me in the same blue-green hue of melancholy that Boccioni created a century earlier. The room’s wood paneling eerily echoed the vertical lines with which Boccioni conveyed the burdens shouldered by III: Those Who Stay. What began as a routine interview became a conduit through which I experienced a brief flash of my patient’s internal milieu. The concept of patient-centered medicine revolves around simple humanistic principles. Patients feel empowered and appreciated when we express an authentic interest in learning something about them that may not show up in their medical record. As healthcare providers, it is our sacred duty to step outside of ourselves in order to serve and understand our patients and their families. We cannot truly empathize with our
694
patients unless we understand their state of mind. It is this empathy that will dynamically improve our capacity to connect with our patients as well as ourselves; it is this selfless context that will enable us to establish an ‘‘overall diagnosis’’ and to care for grieving patients (Balint 1969). At the end of my interview, I thanked Mr. Stevenson and his son and extricated myself from the tired couch into which I had sunk. I said goodbye to the dogs who had loyally sat beside their owner. The porcelain angels watched quietly as I navigated my way across the algae pond of green carpet. When I reached the door, the wooden duck finally had a chance to offer me a farewell. I thanked Mr. Stevenson again and quietly closed the door behind me. As I pensively walked down the wheelchair ramp, I remembered how Boccioni and the Futurists were simultaneously enthralled and dismayed by technological advancements (Chipp 1968). Even in the early twentieth century, they recognized that the speed and complexity of modern life might leave neglected human relationships in its wake. In hospitals and clinics, the pace and complexity of modern medicine might also leave neglected human relationships in its wake. Like Boccioni’s States of Mind, my visit with Mr. Stevenson reminded me that personal context is absolutely critical when caring for grieving patients. The power of this insight brought me to a halt at the end of the wheelchair ramp. Parked in the driveway, and meaningful only to those with context, was the brand new Buick that arrived too late.
Notes on contributor JOSEPH J. TAYLOR is a PhD/MD student at the Brain Stimulation Laboratory at the Medical University of South Carolina.
Acknowledgments The author would like to thank W.L., MD, for his insight and guidance. Declaration of interest: This work was supported by the National Institutes of Health [F30DA033748].
References Balint E. 1969. The possibilities of patient-centered medicine. J R Coll Gen Pract 17(82):269–276. Chipp HB. (Ed.). 1968. Theories of modern art. Berkley, Los Angeles and London: University of California Press. Vallurupalli M. 2013. Mourning on morning rounds. N Engl J Med 369(5):404–405.
ISSN: 0142-159X (Print) 1466-187X (Online) Journal homepage: http://www.tandfonline.com/loi/imte20
Those who stay Joseph J. Taylor To cite this article: Joseph J. Taylor (2015) Those who stay, Medical Teacher, 37:7, 693-694, DOI: 10.3109/0142159X.2014.1001342 To link to this article: http://dx.doi.org/10.3109/0142159X.2014.1001342
Published online: 06 Feb 2015.
Submit your article to this journal
Article views: 76
View related articles
View Crossmark data
Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=imte20 Download by: [University of Wisconsin Oshkosh]
Date: 07 November 2015, At: 11:25
2015, 37: 693–694
PERSONAL VIEW
Those who stay JOSEPH J. TAYLOR
Downloaded by [University of Wisconsin Oshkosh] at 11:25 07 November 2015
Medical University of South Carolina, USA
Futurism was an early twentieth century art movement that celebrated the dynamism of technology and industrialization. Futurists were consumed by the speed and complexity of modern life, even as it compromised human relationships. A century later, Futurist observations about technological advancements are particularly relevant for healthcare providers who endeavor to practice ‘‘patient-centered medicine’’ rather than ‘‘illness-orientated medicine’’ (Balint 1969). Busy workers are sometimes consumed by the speed and complexity of modern medicine, even as it compromises human relationships. The purpose of this essay is to describe how States of Mind, a Futurist masterpiece by Italian artist Umberto Boccioni (1882–1916), shaped my experience with patient death and ultimately revealed the role of personal context in caring for grieving patients. States of Mind is a triptych about perspectives. True to the spirit of Futurism, these paintings are set in a turbulent train station where travelers depart from their loved ones. Each one conveys a unique internal milieu of emotion through colorful geometric distortions of the external environment. In the multicolor I: The Farewells, swirling smoke plumes obscure the features that distinguish the travelers from their train. This technique depicts the train as a powerful machine that completely engulfs the humanity surrounding it. The scene suggests that technology can shift priorities and transform life into a series of transitory experiences. In the azure II: Those Who Go, oblique transit lines propel the forlorn travelers further from their homes. Each traveler on the train has the same facial features, as though the collective face of modern humanity has been fractured into multiple pieces. The powerful train literally and figuratively carries the collective traveler away. In the jade III: Those Who Stay, vertical lines of melancholy rain down on the loved ones who were left behind. This scene conveys a deep sense of inertia as those who stay struggle to adapt to the loneliness and depersonalization of their industrialized lives. Boccioni’s triptych cleverly represents the art of medicine. When I first encountered these paintings, I viewed them as a general reminder that each situation can be viewed from a multitude of perspectives. What I perceive during a patient encounter, for example, might differ dramatically from what the patient perceives during that same encounter. These two
subjective accounts capture critical elements of what objectively transpired. After a poignant interview in a widowed patient’s home, however, States of Mind took on an allegorical meaning. Instead of train stations, healthcare workers experience solemn valedictions in hospitals and clinics. When patients die, we sterilely document the farewells. Debriefing may remind us of those who go and help us to balance the opposing forces of paralyzing empathy and obdurate professionalism (Vallurupalli 2013). Unfortunately, there are few reminders of those who stay. Perhaps the most neglected state of mind in the context of patient death is not that of the conflicted provider or the suffering patient, but that of the grieving family. My initial call to Mr. Stevenson went unanswered. ‘‘You have reached the Stevenson Family. We can’t come to the phone right now. Please leave a message and we will call you back’’. To callers without context, this familiar voicemail greeting sounds completely innocuous. To those with context, however, it is an eerie reminder of the fragility of good health. Unlike human beings, voicemail greetings do not expire. They simply live on until someone deletes them or records over them. The reason why Mr. Stevenson chooses to let his wife greet callers posthumously remains unknown. A visit to the Stevenson home, however, reveals that Mrs. Stevenson is hardly just a ghost in a machine. Mr. Stevenson lives with his disabled son on a quiet suburban street. The most noticeable feature of their home is the custom-built wheelchair ramp leading from the cracked driveway to the weathered front door. To those with context, the home feels tired and worn as though the structure itself has gone through emotional turbulence. Inside, Mrs. Stevenson has a presence through her absence. She is a specter hiding in plain sight, a spirit who manifests through folksy crafts and baubles and photographs. On the back of the front door, a wooden duck offers a farewell to visitors as they leave. On the walls, sconces filled with lifeless plastic peonies flank faded wedding photographs. In the credenza, effeminate trinkets and dusty china rest idly. The de´cor could not be more misplaced for a retired bodybuilder and his motorcycle-loving son. After greeting three excitable small breed dogs, I was invited to sit on a tired couch. Pale green threadbare carpet
Correspondence: Joseph J. Taylor, MD/PhD Student, Brain Stimulation Laboratory, Institute of Psychiatry, 67 President Street, Room 504 North, Charleston, SC 29414, USA. Tel: 843-792-5729; Fax: 843-792-5702; E-mail: [email protected] ISSN 0142-159X print/ISSN 1466-187X online/15/70693–2 ß 2015 Informa UK Ltd. DOI: 10.3109/0142159X.2014.1001342
693
Downloaded by [University of Wisconsin Oshkosh] at 11:25 07 November 2015
J. J. Taylor
stretched over the floor like algae on a calm pond. Vertical wood paneling lined the walls. The only item in the room that felt new was the television, a medium-sized flat screen perched on a small entertainment stand. To my right, Mr. Stevenson sat quietly in a worn lounge chair. To my left, Mr. Stevenson’s son slumped in a wheelchair and gingerly readjusted his new prosthetic leg. With porcelain angles looking on like reporters, I began the interview. My initial questions focused on Mr. Stevenson’s past medical history. Over time, however, I began asking Mr. Stevenson about his fascinating life and the woman who continued to define it months after her death. My new focus became the emotional turbulence that he experienced following this loss. I asked him to help me understand what his wife meant to him and how he navigates without her. Mr. Stevenson cathartically opened up. I heard about the full arch of their romance, from the blind date on which they met to the day that she died nearly sixty years into their marriage. I heard about square dancing and tattoos and cruises to Mexico. I heard about their love of Buicks and their unfulfilled plan to buy a new one before she died. I tried to imagine how it would feel to be surrounded by reminders of true love lost. I had read Mr. Stevenson’s chart before I left the clinic. I knew he had taken care of his wife through cancer and infections from bacteria like pseudomonas aeruginosa. Despite this preparation, I lacked the personal context that is filtered out by clinic walls. Visiting the patient in his home enabled me to vicariously experience the farewell and to encounter the spirit of those who go. Most importantly, my visit enabled me to consider the perspective of those who stay. It suddenly felt as though I was experiencing a horridly personalized version of Boccioni’s painting. The room’s pale green carpet shifted into the pyocyanin color of pseudomonas aeruginosa and grew like a biofilm over the walls, surrounding me in the same blue-green hue of melancholy that Boccioni created a century earlier. The room’s wood paneling eerily echoed the vertical lines with which Boccioni conveyed the burdens shouldered by III: Those Who Stay. What began as a routine interview became a conduit through which I experienced a brief flash of my patient’s internal milieu. The concept of patient-centered medicine revolves around simple humanistic principles. Patients feel empowered and appreciated when we express an authentic interest in learning something about them that may not show up in their medical record. As healthcare providers, it is our sacred duty to step outside of ourselves in order to serve and understand our patients and their families. We cannot truly empathize with our
694
patients unless we understand their state of mind. It is this empathy that will dynamically improve our capacity to connect with our patients as well as ourselves; it is this selfless context that will enable us to establish an ‘‘overall diagnosis’’ and to care for grieving patients (Balint 1969). At the end of my interview, I thanked Mr. Stevenson and his son and extricated myself from the tired couch into which I had sunk. I said goodbye to the dogs who had loyally sat beside their owner. The porcelain angels watched quietly as I navigated my way across the algae pond of green carpet. When I reached the door, the wooden duck finally had a chance to offer me a farewell. I thanked Mr. Stevenson again and quietly closed the door behind me. As I pensively walked down the wheelchair ramp, I remembered how Boccioni and the Futurists were simultaneously enthralled and dismayed by technological advancements (Chipp 1968). Even in the early twentieth century, they recognized that the speed and complexity of modern life might leave neglected human relationships in its wake. In hospitals and clinics, the pace and complexity of modern medicine might also leave neglected human relationships in its wake. Like Boccioni’s States of Mind, my visit with Mr. Stevenson reminded me that personal context is absolutely critical when caring for grieving patients. The power of this insight brought me to a halt at the end of the wheelchair ramp. Parked in the driveway, and meaningful only to those with context, was the brand new Buick that arrived too late.
Notes on contributor JOSEPH J. TAYLOR is a PhD/MD student at the Brain Stimulation Laboratory at the Medical University of South Carolina.
Acknowledgments The author would like to thank W.L., MD, for his insight and guidance. Declaration of interest: This work was supported by the National Institutes of Health [F30DA033748].
References Balint E. 1969. The possibilities of patient-centered medicine. J R Coll Gen Pract 17(82):269–276. Chipp HB. (Ed.). 1968. Theories of modern art. Berkley, Los Angeles and London: University of California Press. Vallurupalli M. 2013. Mourning on morning rounds. N Engl J Med 369(5):404–405.
