Thursday, 19 April 2012

Humanising medicine?

photo: George Marks

The week that I started my residency with Nursing Studies, Prof Jane Macnaughton from Durham University gave a public lecture at the university entitled ‘Medical Humanities: a challenge to medicine.’ It was an apt coincidence as I pondered what I, as a writer, had to contribute to a department focused on the training of nurses as practitioners, researchers and leaders in their field.

She opened the lecture by contrasting two pieces of writing which shared a subject matter but read as if from two different worlds. The first was from the New England Journal of Medicine:

"Side Affects of Adjuvant Treatment of Breast Cancer
Many women with breast cancer who are receiving adjuvant therapy have fatigue, and about two thirds of them rate the level of fatigue as moderate or severe. … The fatigue appears to resolve after treatment. In a survey of nearly 2000 women with breast cancer who were evaluated three years after adjuvant treatment, the level of fatigue was similar to that of age-matched women.” 

The second was a poem by the late Julia Darling:


I did not imagine being bald
at forty four. I didn’t have a plan.
Perhaps a scar or two from growing old,
hot flushes. I’d sit fluttering a fan.

But I am bald, and hardly ever walk
by day, I’m the invalid of these rooms,
stirring soups, awake in the half dark,
not answering the phone when it rings.

I never thought that life could get this small,
that I would care so much about a cup,
the taste of tea, the texture of a shawl,
and whether or not I should get up.

I’m not unhappy. I have learnt to drift
and sip. The smallest things are gifts.

from Sudden Collapses in Public Places, Arc Publications 2003  

Both texts deal with the fatigue that comes with cancer treatment.  The NEJM study is functional, evidence based, measuring the effects of treatment. It is a necessary text, but it tells us nothing of the experience of illness, the life that has grown small, its focus on the things to hand rather than the far horizon.

Jane MacNaughton spoke of how the field of Medical Humanities emerged in the United States as a way of ‘humanising medical students’, an attempt to counter an overly technical and atomized view of disease and illness with a broader view which valued cultural and historical interpretations, which had space for the subjective.

I do not think that nurses are in need of ‘humanising’ in this sense. I believe that people enter nursing from a motivation to care for other human beings, yet it's hard to ignore recurrent stories in the media asserting that nurses no longer care as they used to. Just two days ago the Prime Minister announced a new initiative to increase nurses' standards of care and compassion. It has even been suggested that too much education at too high a level is to blame for this perceived 'crisis' in nursing, as if you cannot have a heart as well as a brain.

During my time in Edinburgh, I hope to get closer to the truth of these issues, to talk to a wide range of nurses and nurses-in-training, to gather their stories and encourage them to take a step back, to reflect not just on the facts of their working lives, but to help shape that experience into meaning through writing. This blog will grow to contain these stories and my own assorted encounters with the culture and history of nursing.

With thanks to the MHRNS  for organizing the Jane Macnaughton lecture, and especially to the Leverhulme Trust for funding the residency. If you are interested in Julia Darling’s poetry, you can find out more on her website, which includes a diary of her last years.

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