Photo by Mika Baumeister | Unsplash
In March of 2020, Laurel Braitman, PhD, did what many people did in the early days of the COVID-19 pandemic: She moved her work — as the Director of Writing and Storytelling at the Medicine & the Muse Program at the Stanford University School of Medicine — to an online platform. Braitman started facilitating virtual reflective writing sessions for health care professionals. More than a year later, people from around the world take part in the free, one-hour sessions she calls Writing Medicine. In the following interview, Braitman describes why self-expression and storytelling are so important, especially for those working “on the frontlines of humanity.” Braitman will be a keynote speaker at IHI’s Patient Safety Congress (May 11–13, 2021).
On how Writing Medicine started
I had been offering speaking and writing coaching to physicians and clinical students at Stanford for about four or five years. Turning it into virtual experiences was a little bit like having a birthday party because I was saying everyone could come, and then I worried no one would show up! We had about 80 people at the first session, and then the next week we had 90 people. The week after that, we had 120 people. It grew organically from there.
On the people who participate
While there are physicians associated with Stanford, which is where I am on faculty, the lion’s share of people now come from all over the world. They are health care professionals of every kind and identification. We have orthopedic surgeons in Cape Town to family practice physicians in Yellowknife to nursing students in Boston. We have a couple of veterinarians who wrote and made impassioned cases for why they should be considered frontline health care workers during the pandemic. We also have one middle school teacher because he argued that, by teaching six or seventh grade kids, he’s a mental health professional just like the other therapists and social workers in the group. [I estimate that] we’ve reached over 4,000 people. On average, 100 to 120 people join every week.
On why people take part
One thing that I learned while being on faculty at a medical school is how little training and opportunity there is for reflection. People who work in health care are on the front lines of humanity, even when a pandemic isn’t going on, and they are tasked with helping people make some of the most important decisions of their lives. They deliver news that could be joyful, painful, or somewhere in between, and often they aren’t given the skills to learn the best ways to do that. So, some people want to learn more about communication.
Another reason people come is because it’s a space for reflection. Health care is such a demanding field. There are very few opportunities to make meaning, yet almost everyone decided to work in health care because they care about health, because they care about other people. The great irony is that you often have very little institutional support to reflect on what brought you to health care in the first place. This is combined with a crisis of burnout among physicians, nurses, and other folks.
These writing workshops are a little bit of training on how to tell better stories, how to write, and how to entertain others with what you say. There are also opportunities to reflect on hard things, beautiful things, painful things, shameful things. It’s a place to be vulnerable among your peers in a way that you might not otherwise have.
[At the beginning], I offhandedly said, “As long as you people come, I will keep doing this, and I will do this as long as the pandemic lasts.” I have no plans to stop. If people find value in this, I’m here to do it. I think it’s important, and it’s brought me so much joy.
On why it's important to encourage health care workers to write about their experiences
It’s about making yourself uncomfortable in a positive way in service of communicating more authentically as a medical professional, but also as a human being. It’s really nice when someone reads their work for the first time, and the chat just lights up: You really should publish that. That reminds me of my experience in residency. Writing for me is always a medicine for existential human loneliness.
[We’ve created] a place, particularly since the pandemic has begun, where people are given permission by the other health care professionals [participating] to share what is keeping them up at night, what they wished they could have done differently, or what they wish they could have said out loud. In addition to people sharing stories, for example, of how they helped someone say goodbye to their loved ones with an iPad, there are lot of people expressing regrets: I wish I could have done more. I wish I had been more present. I wish I hadn’t left the room so quickly. I wish I wasn’t in a rush. I’ve also heard again and again people saying they feel numb and feeling ashamed of feeling numb.
On dealing with multiple pandemics
We’ve had a number of people in our writing community who are dealing with multiple pandemics at the same time. For example, we have many Asian women who are part of Writing Medicine who are — particularly in Northern California, where there have been a number of attacks on people of Asian descent — sharing about the stress and the pain of trying to protect their elderly parents who they no longer want taking their daily walk. Are those stories explicitly medical? No, but if we consider racism an issue of public health, which I absolutely do, then it is of a piece.
Last summer, many Black physicians and nurses in the group were writing about George Floyd’s murder and the major Black Lives Matter protests. One woman in the group, I know [writing in the group] has changed her life. She is a Black female anesthesiologist and last year she had her first child who is a Black boy. She was pregnant and working in the ICU during COVID-19 while the protests were going on. She came every Saturday and she wrote about her experiences.
As new faculty, she didn’t feel like she could share these experiences at her department meetings. But she ended up reading her work to the Stanford Medical School community. We’re sometimes like a gateway drug, for lack of a better metaphor, for preparing people to share elsewhere and on bigger stages. Some people get their work published. I need to keep better track of this, but dozens of people have published for the first time since coming to Writing Medicine. Many folks have published research and scholarly work for decades, but have never published a poem or an op-ed or a personal essay before.
On finding shared humanity
We have a history, particularly in the United States, of not healing our healers or expecting them to do it themselves. I think this is true across the board for the healing professions. [Writing Medicine] is a bit of an antidote to that because it shows us what we have in common. [Participants] find others who understand the depth of their commitment and who rejoice when they share something.
Humans are pack animals, and [the pandemic] has been hard because that which sustains us has been taken off the table. These places where we can find community become more important. We should all be practicing how to listen better to people’s stories that are different than ours, and this is great practice. At the end of the day, it's a way of reminding each other of our shared humanity, and I believe that's at the foundation of good medicine.
On how organizations might support a writing group
It’s my greatest dream that every organization does this. I have not invented anything here. The idea of gathering and prompting one another to share stories is something that humanity has been doing probably since before we invented fire. I can't imagine anything better than this happening in every institution. You just need more than one person, and you’ve got a Writing Medicine group.
If you start a writing group, it’s important to establish a boundary that whatever is shared in the space stays there, within reason. People should feel free to speak truthfully, whatever that means to them. People who share are being very brave. It should not be a place for mean-spiritedness.
My biggest requirement when writing is that you pretend that you're perfect for the duration of the time that you’re writing. You can go back to being mean to yourself after the hour is up, but while we’re together your job is to pretend that you’re perfect. You should also write what you would write if you weren’t scared of sounding dumb or being wrong. That fear is almost always the main stumbling block in communication, both written and oral.
Sometimes what people need to say is painful and hard, and institutions need to be sturdy and resilient enough to handle it. Part of creating healthy, authentic communication is not just letting people tell their stories but also listening as an institution when people say things that may be hard to hear. Organizations must also prepare to be held accountable for better and for worse. They need to act upon the kinds of concerns that come up in forums like these when it’s appropriate.
On hopes for the future
As we open up, I would like to spend more time with people in groups in person to do these kinds of reflective writing sessions. I would like to expand. I will be grateful forever to Stanford for taking a chance on putting a writer in a medical school and a hospital, but I also want to make sure that this isn’t something that only the most privileged institutions have access to.
Technology is allowing us to be many places at once and democratizing not just access to health care, but also democratizing the kind of resources available to our health care professionals. It should not just be five institutions in the United States that have good wellness support for health care workers.
I’d also like to enlarge who has access to these kinds of resources. I often a lot of support for physicians, for example, but what about everybody else? I hope there will be more conversations about this coming out of the pandemic. We’ve seen firsthand the mental health effects on people who have been working ceaselessly now for a year at great personal cost.
Editor’s note: This interview has been edited for length and clarity. Laurel Braitman will be the keynote presenter at the IHI’s Patient Safety Congress (May 11–13, 2021) on Thursday, May 13.
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