Reading Guide: Medical Humanities Part 1, Initiation

Medical Humanities Curriculum

The experience of illness is both universal and specific. Each of us will at some time become a patient—experience an illness or disability that may be acute or chronic, mild or life-threatening.  All of us will experience sickness and death of a loved one. Some of us—doctors, nurses and other medical professionals—interact with illness from “both sides of the stethoscope.” The impact of illness on us as individuals, in our relationships to one another and in the broader socio-political context cannot be underestimated. 

Illness narratives, stories and poems that bring these issues to light provide a useful teaching tool. This reading guide is based on The Best of the Bellevue Literary Review, published by the Bellevue Literary Press. These readings provide a framework for considering the illness experience from a variety of perspectives.  This reading guide will be useful for teachers of literature, ethics, medical/nursing students, social workers, as well as for health care professionals, adult continuing education courses, general reading groups, and anyone interested in thinking more deeply about literature of the human body.

Part 1–Initiation–includes sections on Patients, Doctors, Coming of Age.
Part 2–Conflict: Grappling with Illness–includes sections on Disability, Coping, Madness, Connections, Family.
Part 3–Denouement–includes sections on Mortality, Death, Loss, Aftermath

Written by: Danielle Ofri , Ruth Oratz , Harold Horowitz,  Jerome Lowenstein , Suzanne McConnell , Frances Richey, Kathryn Coffman , Marylu Ekiert , Meghan Holeman

---

PART I: INITIATION

PATIENTS

The Plagiarist by Hollis Seamon

1. Why doesn’t the teacher notify the Dean’s office of Derrick’s plagiarism?
2. What does the teacher learn about herself? What does the student teach?
3. Is Althea sick? What makes us healthy and what makes us ill?  
4. Althea loses her beloved dog, the love and friendship of a colleague—what does she gain?
5. How does she use poetry to understand her situation?
6. Note the importance of rhythm in this piece—the heartbeat, the meter of poetry.
7. Discuss metaphors for the rhythm of the heart. 
8. Contrast the cardiologist’s explanations of Althea’s medical condition with her own experience of it. 
9. What is the power of language in this story?  How is it used in poetry, in word play, in communication, in silence?  
10. Quotes and excerpts from different authors appear throughout the story, set in different narrative frames.  (An example is the story of Flush, drawn from reality, appearing in Barrett’s poetry, then in Woolf’s fiction, then in Althea’s oral narration to her dog.) Are these narrative strands borrowed? Stolen? Recycled? How does this compare to Derrick’s actions? What is the story’s final assessment about plagiarism?
11. Althea’s parting injunction to Derrick she seems to be equating language and words with life?  Is this really true?    
12. Compare the interactions and relationships between Althea and Derrick and those between the doctor and Althea. Are there differences and/or similarities between these relationships that cast different lights on sickness and the experience of sickness from different perspectives?  

Having an MRI/Waiting for the Laundry by Jan Bottiglieri

1. How do we learn about this woman’s life?
2. How does she reveal to us who she is, where she comes from, where she is now?
3. Are there different types of memory? What is the nature of this memory?
4. Discuss the sounds in this poem.

The Road to Carville by Pat Tompkins

1. Why is Gar conflicted about driving Eldonna to Carville?
2. What defines a patient? Is Eldonna sick?
3. How is Gar’s ambivalence displayed by the author?
4. How has Gar’s war experience influenced his feelings about Eldonna and the other patients he drives to Carville?
5. How are animals used in this story?
6. What do you think about the ethics of Gar’s decision?
7. Is this a story about Gar or about Eldonna?  Does anyone change or grow?  Who?  How so?

What Were the White Things? By Amy Hempel

1. Why does the author delay going to the specialist’s office?
2. Who is speaking? Elaborate on their meanings.
3. How does the author connect all of the “white things?” How are they related?
4. Questions recur throughout this piece.  What kind of questions, posed by whom to whom?  What kind of information is being solicited?  What questions are left unanswered, and why?  
5. The author juxtaposes a scene of an artist displaying slides to an audience and a scene of a doctor displaying slides (Xrays?) How do they reflect upon each other?  How and why does the author position these two scenes in such a manner? 
6. Comment on these lines:

• • “finding the mystery in the clarity” 
  • “the mind wants to make sense of a thing, the mind wants to know what something stands for.”

Angina by Alicia Ostriker

1. What is the poet anxious about?
2. How does the poet use images from nature to describe her chest pain?
3. What does the deer stand for?

Cold Kiss by John Kay

1. What is cold in this poem? 
2. Do you feel hopeful at the end of the poem?
3. What does it mean to “sidestep” time?
4. How and why are italics used to create what effect at which point in the poem?
5. Does the word play offer humor? Bitterness? Irony? Is it effective?

Nesting in a Season of Light by Angela Wheelock

1. Did Dr. Brown or the visiting doctor treat the patient incorrectly?  Was Dr. Brown honest? Was it right for him to tell the patient that he “missed the ectopic but saved her life” (45)?  Did the missed ectopic pregnancy change the patient’s relationship with Dr. Brown?
2. “Listening is the greatest gift we can offer to one who grieves” (47).  Who was listening to the narrator?  Did the narrator derive solace or succor from being listened to, from telling her story?  
3. Discuss the juxtaposition of the patient’s possible death and her effort to create new life.
4. Comment on the line: “[Grief] isn’t really like sadness; it is more like feeling you’re going crazy” (46).
5. Is pregnancy/infertility a state of health or sickness?
6. How do the narrator and her husband process their grief?
7. What is the relationship between the narrator and her husband?  Does it change?  How?
8. How are the images of nature used—particularly elements of fertility and growth—in relation to the narrator’s personal situation?  
9. In this story, the medical world seems to offer more ambiguity than certainty. Does nature offer something different? Are nature and medicine posed as antithetical to each other?
10. What is Dr. Brown’s role?  Is he an antagonist or ally? Is he a source of support and comfort?  Does he stand for something beyond himself? 
11. What does the narrator take from the image of the young moose near the end?  
12. The narrator reads a number of books throughout.  What kinds?  What do they tell her? What do they tell us?  

Fissure by Deborah Davis

1. The narrator provides various definitions of “fissure.”  How does the narrator’s experience of “fissure” compare with or reflect upon the medical and dictionary definitions?  
2. Describe the style of the piece, the way in which it “converts” a horrific episode of rape into “ordinary” prose.
3. How does the rape affect the narrator’s view of and experience of her own body?  
4. Is there any parallel between the rape, the examination, and the enemas? Do you think that even patients who have not been victims of assault might find these procedures to be violating?
5. What are the “ironies” of the doctor’s visit? 
6. Is the hope of healing a possibility by the end of the piece?  If not, does the narrator find an insight that enables her to live with her wound? 

---

DOCTORS

She Makes the First Cut by Linda Tomol Pennisi

1. Is the mother speaking directly to her daughter?
2. Discuss medicine as art.
3. How does the poet use the imagery of the hands?
4. Comment on the structure and the flow of the poem.
5. Discuss the musical instruments and the meaning of music in this poem.
6. Connections between medicine and music

I Want to Tell My Daughter Not to Name the Cadaver by Linda Tomol Pennisi

1. Discuss the connection between this poem and “She Makes the First Cut.”
2. Why doesn’t the mother want her daughter to name the cadaver?
3. What connects the mother and daughter?
4. What does the mother understand about the experience of dissecting a cadaver that perhaps her daughter/student doesn’t know?
5. Is the mother a doctor? A musician?
6. Discuss the blurring of boundaries between the mother, daughter, and cadaver.
7. Note the symmetry of the poem’s structure.

MUD by Thomas McCall

1. How does “medspeak”, acronyms, medicalization of language help health care providers cope with stressful situations?
2. How does the nurse Darlene help the student and help Leslie?
3. Compare & contrast the student’s image of his wife and Leslie.
4. How does Leslie respond to the student? What do we understand about her character?
5. What does the author mean by “Apathy or anarchy had formed one unit to its neighbor” (57)?
6. How do the student’s feelings about this baby change from “already a goner” (56) to “incandescent, Heaven’s light” (59)?

The Initiation by Alicia Ostriker

1. Was the head surgeon helpful to the intern?
2. Is the poet a man or a woman? Would the gender of the author make a difference in the response to the last line of the poem: “Boy, he said…” (60)?
3. Discuss the use of family relationships as a literary device.

Love Is Just a Four-Letter Word by David Watts

1. How did the bedside conversation affect the young woman?
2. Does “ unflinching frankness “ bring a new perspective?
3. Did the student overstep the acceptable limits of professional behavior?
4. What would he have said to an older unattractive woman
   

Field Trip, Ypsi State by Roy Jacobstein

1. Whose voice is dominant in this poem?
2. What does the student learn in his interaction with the patient?
3. What do you think he expected from Psych 402? How is this experience different from his expectation?

Ask Him if He Knows Jesus by C.E. Smith

1. What does the author mean by “contradictions precluded infallibility” (65)?
2. Is there a role for religion in medicine?
3. Is it appropriate for Dr. Mitchell to ask David to pray?
4. Why is David relieved to see that Camilo is still paralyzed after they pray over his legs?
5. Is the miracle real or not?
6. Discuss the role of translators.

Shobo by Dannie Abse

1. Who are the characters in this poem? Where are they from? Where is the action taking place?
2. What is the patient’s concept of health, sickness, and the cause of his illness? What is the doctor’s concept of these?
3. What does the poet mean by “malignant eidolon” (75)?
4. Describe the structure & rhythm of the poem

Prisoner by John Stone

1. What is the prison? Who is the prisoner?
2. Does the poet feel that this research is morally correct?
3. What metaphors does the poet use for the illness?
4. How does the opening quotation from Auden relate to the rest of the poem?
5. Discuss the historical references.

---

COMING OF AGE

First Born by John Grey

1. Is someone who is in the hospital, but not sick, really a patient?
2. What defines a patient? (Is it the condition they have or the care they receive?)
3. Do we do patients a disservice when we don’t differentiate the healthy from the sick?
4. Why is the husband defensive about his wife “illness?” Does he feel threatened or powerless in the face of the changes occurring to her?
5. Is the husband embarrassed by her good health, and that they will all leave the hospital happy and healthy? (Was obstetrics always this way?)
6. What brings these individuals together in the hospital experience?
7. What is each one waiting for? 
8. Discuss the image “two steps behind her smile” (78).
9. What image in the poem stands out most for you?
10. What do you make of the final image?

Breathe by Caroline Leavitt

1. Why is the woman angry in the beginning of the story?
2. What were you were expecting to happen when his mother knelt down before Sammy as he was leaving for school?
3. “There was only one thing that could hurt him and that was his asthma” (81)—discuss the impact of illness on the boy. 
4. Both the doctor and Sammy’s mother use the phrase “Don’t hold your breath” (83). What are the different implications?
5. Discuss the power of the inhaler.
6. “As he loses his breath, she deflates” (86)—analyze the use of breath and air in the writing.
7. How do you feel about a mother abandoning a sick child because “I deserve a life too”?
8. Can you empathize with the mother?

If Brains Was Gas by Abraham Verghese

1. What does the title of the story mean?
2. What is the relationship between JR and the girl?
3. Discuss the line “A little girl inside me began to weep, even though I knew I should be relieved.”
4. Contrast the image of JR’s dentures in the beginning of the story with the image at the end of the story.
5. Who grows up in this story?
6. The author is a man and he is writing in the voice of a teenage girl— is this credible/authentic?

See Photo Below by Rick Moody

1. The poet provides a clue as to the meaning of his poem in the footnote—how does this relate to the text?
2. What is prohibited and what is allowed?
3. Note the rhyme scheme: reprobation, veneration, liberation, information, termination…comment on other structural and rhythmic aspects of the poem.
4. The last verse “feels” different than the rest of the poem—why?
5. “Driven by passion, he and his sweetheart drive to a neighboring state whereupon they lie down gently.” What image does this provoke for you?