I believe that the time I devote to my creative process results in a deeper understanding of my patients’ plight.
Most of the poems from my first collection of poetry, OURSELVES, come from vivid memories of my first years in nurse training: the shock and drama of illness; the strengths and weaknesses of those I worked alongside, and bearing witness to the vulnerabilities and suffering of patients. At times, it could be overwhelming. Unconsciously, these memories were stored to be decanted later, when I was ready to write about them.
The poems, written many years after my first year of training, have a resonance of themes in my workplace today. We have modern technology, better hospital buildings, far more specialist care, improved communication pathways, but still, nothing is new, it has happened before, it has been felt before. OURSELVES is my chain-link between practice and reflection; from then to now. It was not written at a conscious level to understand and improve my clinical practice: this was an unexpected outcome and the creative process gave me pleasure as well as a deeper understanding of my role as a nurse.
Narrative medicine is defined as ‘an interdisciplinary field that enhances healthcare through the effective communication, empathy and understanding between clinicians, caregivers and patients’ (Greenhalgh, 1999).
I have chosen three poems from my collection which have helped inform my practice, both then and now.
He was yellow, in his eyes and skin: a mizzler
– Medicine wasn’t for him. His father a doctor, his before
Shoved him down a one-way alley, no U turns, no going back.
In drawers, plastic bags and high shelves he learnt
A new language, and held it close in prayers of comfort;
Parables and hymns: barbiturate, valium, pethidine and heroin.
Stick-thin and itchy he roamed days in the dead of night
Rising from a murky forest with shrugged apologies
His bruises told their own story.
We watched him darken like a kipper on the turn
The canteen lady begging the week before he died:
Lord above doctor, will you look after yerself?
This poem is written about an SHO (second year as a doctor) who disintegrated before the whole hospital’s eyes: drug addiction was (and remains so today) a problem for healthcare staff due to easy access. This episode came back to haunt me when, in recent years, working in general practice, we had a locum doctor who, it quickly came to light, was alcoholic. He was hired for a two-week stint. Clinically he survived by doing very little and his notes were scant: consultations often simply said “chat”. He was not fit to work: not in a reeling alcoholic sense, but in his lack of clinical judgements and decision making.
I discussed him with colleagues over lunch, remembering the young doctor on my first ward. He’s only here for two weeks; we need the appointments, we’re so short-staffed, he’s not doing any actual harm. The practice manager and GPs did not want to take on the complicated reporting system as they were already overwhelmed with paperwork and staff shortages. I worked part-time and the locum would be leaving the practice a week after I met him. I knew it would cause ructions if I took action and had no idea how to proceed without the backing of my seniors. No one took action. Nothing was done. He completed his locum stint and left. We heard a year later that he’d died of alcoholism. Would the outcome have been different if we’d taken responsibility to help him? Like the young SHO, I’ll never know, but with both individuals I felt complicit in failing to reach out to them.
Working in healthcare was and remains demanding. Emotionally and physically, it can be exhausting. Most healthcare professionals will have experienced shock, sorrow, frustration and bone-marrow tiredness. This is our job, the nature of the beast. And, yet, every worker in healthcare has – “a moment” – in their career. It reminds us why we do what we do and why we care for others. Often, it’s not the dramatic life-saving moments, but the small intimate connections with our patients that matter.
I take an old woman a glass of water
She has few pleasures left in life.
It’s cold and sharp
Hill spring it says on the bottle.
She cups the tumbler as a chalice
And sips from a mountain spring
As a child she’d drunk in streams.
She smiles at the genie inside
And offers me a taste: it’s sweet.
I hand it back and we make a toast
Fingers touching around the glass
Careful not to spill one drop of magic.
On social media sites, radio and tv there is open discussion of how to address the dislocation, loss of identity and prejudice felt by immigrants. We argue that society is no longer prepared to tolerate racism, and yet it remains covertly institutionalised and engrained in everyday life. Compared with their white colleagues, healthcare workers from ethnic minority groups are more likely to report bullying, harassment and abuse from patients and colleagues. They are also more likely to enter into the formal disciplinary process; and they are less likely to be employed in senior positions (WRES, 2021).
It is mandatory for healthcare staff to attend ethnicity and diversity updates, yet the same old attitudes remain bubbling under a thin veneer of political correctness.
When I was little I was given a black dolly.
She had a blue maid’s outfit, white shiny eyes
And the packet said: with golly hair.
Cindy and Barbie sneered hard plastic, and no
Matter how I arranged and sorted the toy box
– Golden and thin, they wouldn’t let her be.
My first ward; all the cleaners were black.
And in every face
The truth I’d seen in her eyes, was blinking back.
‘Narrative medicine involves the intimate interface between people, who yield and gain from the experience of stories involving the clinical encounter.’ (Charon, 2001)
As a writer who is also a nurse, I am in a uniquely privileged position to observe. Stories and poetry tell us what it is to be human, and we are at our most human within the healthcare setting, both as professionals and patients. Creativity tries to make sense of the world. It is increasingly acknowledged that creativity goes hand in hand with medical interventions to promote wellbeing and self-worth (Davies, Knuiman, Wright and Rosenberg, 2014). With disease management increasingly becoming a long-term strategy, the role of creativity is more relevant than ever for today’s health care.
Since the publication of OURSELVES, I have spoken to medical students at the Humanities in Medicine Symposium at Sunderland University. While preparing for the symposium, I considered my creative journey analytically. I believe that the time I devote to my creative process results in a deeper understanding of my patients’ plight. There is an emotional tuning-in to their worries, with a deeper understanding of the importance of active listening with improved empathetic engagement.
Beda Higgins is a multi-published and award-winning author and poet based in Newcastle upon Tyne. Her two short story collections ‘Chameleon’ and ‘Little Crackers’ were longlisted for the Edgehill Prize. Beda’s debut poetry collection OURSELVES, published by Indigo Dreams, was the Joint Winner of the Geoff Stevens Memorial Poetry Prize 2020 and was shortlisted for the Pigott Poetry Prize 2021. Beda is a general and psychiatric nurse, and is a recipient of two Queen’s Nursing Institute Awards.
Charon, R., 2001, Narrative Medicine: a model for empathy, reflection, profession, and trust, JAMA. 286(15):1897-1902. doi:10.1001/jama.286.15.1897
Davies, C., Knuiman, M., Wright, P. and Rosenberg, M., 2014, The art of being healthy: a qualitative study to develop a thematic framework for understanding the relationship between health and the arts, BMJ
Greenhalgh, T., 1999, Narrative based medicine in an evidence based world, BMJ 1999; 318 doi:
NHS Workforce Race Equality Standard (WRES), 2021, 2020 Data Analysis Report for NHS Trusts and Clinical Commissioning Groups, [online] Workforce-Race-Equality-Standard-2020-report.pdf (england.nhs.uk)
Intima: A Journal of Narrative Medicine is a literary journal dedicated to promoting the theory and practice of narrative medicine, an interdisciplinary field that enhances healthcare through effective communication, empathy and understanding between clinicians, caregivers and patients.