Maybe it was the ducks. Escorted by a man in a red, black, and gold braid suit, plump mallards waddled from the elevator to the lobby fountain at The Peabody in Memphis, Tennessee. I had just returned from a walk to see the site of Martin Luther King Jr.'s murder, blocks away at the Lorraine Hotel, and had been profoundly moved looking up at the balcony where he had been shot. I was a child of the 1960s, when assassinations of important American leaders roiled the nation. Here I was, on my way to the next session of a conference for the Society for Health and Human Values (SHHV) in 1992, and decided, while staring at the duck parade, to pursue medical humanities as my scholarly work. It was a far cry from my training in the pharmacology of anesthetics, and, since no program, course, or recognition of the field of medical humanities existed at Stanford, a hard sell to some of those in charge of my nascent academic career in anesthesiology.
“Medical humanities enables us to contemplate, honor, examine, and at times celebrate anesthesiology, because medical humanities illuminates what it means to be mortal, to be embodied, to be vulnerable.”
My hope is that by reading the variety of ideas and perspectives expressed in this themed issue, and through understanding the motivations for creativity here, you will come to realize that what we as anesthesiologists do, and what medical humanities provide, are not so distant from each other. If you are already involved in the work of medical humanities, I hope this issue bolsters your resolve and opens doors for further engagement.
Medical humanities is an interdisciplinary academic field that examines, interprets, analyzes, and records health, illness, mortality, disability, caregiving, and health care with the tools of the arts, humanities, and qualitative social sciences (Med Educ 2002;36:508-13). It encompasses a wide range of perspectives, from anthropology to visual arts (likely, there are some X, Y, and Z disciplines, too), all of which enhance our ability to think critically about medicine. Note that medical humanities encompass a variety of nomenclatures. Each one, such as health humanities, social medicine, arts and health, and narrative medicine, emphasizes a different aspect of the field, but all endorse the importance of exploring the various contexts of medicine (I like the term “contextual medicine” for this reason).
Back to the ducks. Some time before, my colleague Dr. Pamela Fish and I had completed a qualitative study: we asked surgical patients to write a narrative of their perioperative experience, and we asked the anesthesiology resident to imagine they were that particular patient and write a first-person narrative from that patient's perspective (back in the day, many patients were admitted the day prior to surgery and kept overnight afterward; our residents hence had three points of contact – the preop, the anesthetic care, and the postop visit). We used content analysis to compare narratives and also surveyed the residents after they read their patients' writing. I had no idea where to publish this research. My recommendation: if you find yourself in a quandary, visit a library. In Lane Library, I stumbled upon a journal, Literature and Medicine, and, lo and behold, it seemed to hold promise. At the back of the issue was an advertisement for the next SHHV meeting (the society has since been folded into the American Society for Bioethics and Humanities, which, along with the more recent Health Humanities Consortium, are the premier medical humanities professional societies based in the U.S.).
I went to the conference, met numerous fascinating people from multiple disciplines, including the English professor of medical humanities at Northwestern, Kathryn Montgomery, PhD, who, as it turned out, was looking for manuscripts for an upcoming narrative medicine themed issue of the journal. Several revisions later, my first medical humanities paper was published (Lit Med 1994;13:124-42). I remember the day the reprints arrived (if you are as old as I am, you'll recall this phenomenon). My kids and I had just finished building a labyrinthine fort in the garage, constructed from kitchen appliance boxes, topped with a crayoned flag, and entered via a drawbridge and string contraption. When I think of the oxymoronic term work-life balance, this was the solitary, shining day I achieved it.
Medical humanities does not shy away from the difficult questions of medicine, and neither do anesthesiologists. We care for patients at their most vulnerable, we become the guide and voice of the patient, and we witness the entire gamut of human joy and suffering. Medical humanities helps us understand the human side of our responsibilities and how these responsibilities affect us. As a poet, I find many parallels between poetry and anesthesia care: rhythms, cadences, the arc of a poem or anesthetic, the importance of what is unsaid, the unknowns of what comes before and beyond, precision, structure, unpredictability, and focus (Anesthesiol Clin 2022;40:359-72). Just as with any metaphor, it is important to study critical differences between the two – please give me propofol, not a poem, when I need surgery. But I do want my anesthesiologist to have recognized the person in me. The tools of communication, in the short time we have to elicit trust and connection with our patient, can be enhanced by engaging with the humanities. “We have never lived enough,” writes Martha Nussbaum, but literature enables us to extend beyond our own selves, to better understand diverse experiences and lives (Love's Knowledge: Essays on Philosophy and Literature. 1990).
As I struggled with the decision in the early 1990s to change my scholarly focus, I was buoyed by my service chief, Dr. Jeffrey Baden, who advised me to pursue my passion. When Dr. Ronald Pearl became chair of my department, he supported me and the program I founded, Stanford Medicine & the Muse (asamonitor.pub/3G4CDAB). I hope you find, or become yourself, the necessary support. Medical humanities is a growing field; the expanding capabilities of medicine and its technology only create a greater need for attention to the humans in the room. Our journals, Anesthesiology (Mind to Mind section) and Anesthesia & Analgesia (The Human Experience section), among many medical journals, publish creative and reflective work. Writing groups, such as Writing Medicine, and literature and medicine discussion groups are good ways to network and support each other (asamonitor.pub/3PPg2LO). As you will read in this issue, anesthesiology students and trainees are engaged with multiple facets of medical humanities.
I started with ducks but will end with my other experience in Memphis. We embody history: in our DNA, in our memory and language, in environmental and human records. As I looked at the balcony where Martin Luther King Jr. was assassinated, I felt as if my gaze arched to the past. Then the moment expanded, through the present and toward imagining the future. I thought about how Dr. King's legacy endures, how his words continue to inspire and instruct.
Anesthesiologists have the expertise to shepherd patients through what would otherwise be unthinkable, to aid their healing and reunite patients with themselves and with their families. We bring our patients to their futures. We have skills no one else in medicine hones. The profound trust patients place in us, strangers to them, deserves thought and reflection. Medical humanities enables us to contemplate, honor, examine, and at times celebrate anesthesiology, because medical humanities illuminates what it means to be mortal, to be embodied, to be vulnerable. We may find, as did the supremely eloquent Dr. King, there are moments that “can only be articulated by the inaudible language of the heart” (asamonitor.pub/3hLxkwv). May we find a way forward, creating a stronger, more diverse community as we do, in our lives as anesthesiologists, with the tools, insights, and opportunities afforded by medical humanities and the arts.