The Storyteller and the Stethoscope: Madonna

Medicine, at its core, is a profession of storytelling: receiving, retelling, and acting. In light of suffering and disease, there is a powerful impulse toward telling others of our plight. As physicians, an important aspect of our role is to receive these stories: this early step in healing not only informs our later interventions, but it also serves as a method of healing itself. Though we seek to provide our patients with as much autonomy as they need and desire, there is considerable relief provided when you know that you won’t have to endure this suffering and fight this disease alone – there is an angel by your side. Physicians don’t act in isolation: we retell the stories of our patients, whether as medical students and residents reporting to attending physicians, practicing physicians consulting our colleagues, or even as writers of case reports in medical journals or presenters in M&M (Morbidity and Mortality) sessions. This is all part of the process of delivering medical care, evaluating mistakes or unforeseen outcomes, and improving the practice of medicine. Storytelling, furthermore, is the platform on which we build our humanity and our connections to others. Lastly, with the stories of our patients in our minds, we must decide how to act.

There is powerful symbolism in the one instrument that all physicians carry with them: the stethoscope. It emphasizes that in order to heal, we must listen: to the stories of our patients, from their minds and from their bodies.

Madonna

Like many, she was born to a family that had lost everything in the second World War. As if poverty in a land with little social welfare wasn’t a hard enough challenge to live with, she had an even more difficult obstacle in front of her: she was a girl. Once her brother was born a year later, any dreams and aspirations she may someday develop were dead on arrival. Despite the scarcity of food, her brother was fed well enough; she was left with scraps and bones. Once as a small child, she broke her arm while walking home from school; her mother didn’t noticed until the next day. She did grow up and made it through high school, where she found her religious faith and secretly harbored hopes of becoming a nun. However, the nuns who taught her, recognizing her intelligence, her creativity, and her quality as a great listener, as well as her compassion, encouraged her to try to go to college and pursue an interest that would fully express all of her qualities. Despite the odds, she made it to college and met the man she would someday marry. They fell in love, and as they were looking toward the future, she decided to pursue a dream that had been developing for some time: she decided that she wanted to become a doctor. She had the heart, the mind, and the soul for this pursuit, and it seemed to be a natural fit.

However, her mother forbade it: how could she be so selfish, putting her own interests and dreams before the welfare of her family, especially when her brother could pursue the same career and make more money to support all of them? As her boyfriend trained in his own career in the U.S., she boarded a plane to this foreign place, leaving behind the few comforts of her home and her family in order to work in the U.S. and send money home. And that, she did: working in sweatshops, first in San Francisco, and then in New York City, obediently sending home the wages she made. Angered that she was being forced to slave away to fund her brother’s medical education, her boyfriend flew up to New York and married her on the spot, severing ties of dependence from her family.

For many years, they lived together happily, raising two sons. However, she never had the chance or the money to go back to medical school: instead, she did what she could, first working as a nursing assistant in a hospital and then as a tech in her husband’s research lab. If she couldn’t pursue her own dreams directly, perhaps she could still contribute to the welfare of others through teaching. And that, she did: she was sent to train in some of the top research facilities around the country so that she could return and teach researchers, medical students, and fellows.

The pair moved many times, finding better paying jobs and rapidly pulling themselves out of the poverty of their youth. However, she started developing abdominal pains, unexplained and sudden. Having dealt with pain and considerable suffering before, she didn’t think to complain or to see a doctor. Months passed, and the pain kept getting worse, sometimes making her cry out at night. Her husband didn’t know what to do: he was so frightened, and furthermore worried that the neighbors would think that he was abusing her. On the other side of the wall, her children lay awake in their beds, paralyzed and confused. She lost her appetite almost completely, and was only able to eat mint candies. He ceased his usual complaints about her “junk food” eating habits that he attributed to the days before they married. Eventually, they went to see the doctor: she had a rare and lethal form of ovarian cancer (sarcoma). The oncologist recommended surgery, which proceeded without complication. However, she wasn’t expected to live long. Her strength and appetite recovered, however, and her pain subsided. She went back to work, her children continued to grow, and life went on.

Soon, a new milestone in their live together arrived: her eldest son was accepted to an Ivy League college! She was very proud and happy, though this new development proved a challenge as her eldest son found college to be very disheartening and difficult. She and her husband did what they could to support him through the experience, despite her quiet knowledge of her cancer’s return. Surprisingly, during this time, she returned to visit her mother who was lying on her death bed. Her brother, however, now a well-respected doctor, refused to prescribe stronger pain killers for her than what could be found over the counter, further fueling the anger of her husband at the insensitivity of her family. Finally, when the spring semester grades arrived with her elder son excelling in his courses, she breathed a sigh of relief. Two weeks later, she was brought to the hospital, the pain of the cancer having reached a new peak.

She spent two weeks in the hospital with palliative care to minimize the pain. Her two sons and her husband stayed with her each day, talking to her, reading her poems, and trying their best to express everything they wanted to say. At one point, her temperature dropped rapidly, and when no nurses could be found, the three piled clean towels on her until she recovered to her normal body temperature. Excited by any sign of improvement, her youngest son went outside to greet the rounding doctor, wondering out loud when his mother would be able to return home. The doctor stared at him blankly, and saying nothing, went inside to check on her patient. In that moment, her youngest son finally received her pronouncement of death, without a sad smile, a hand on the shoulder, or a word from the physician. Saying their last goodbyes, the two sons were sent home, and her husband remained with her until her heart stopped beating, just shy of midnight before Bastille Day. Perhaps now, she was finally free of the pain and suffering. However, in life, though she couldn’t help but show the pain, she never showed herself to suffer. She was 49 years old.

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