Frans Meulenberg

A breath of fresh air: Images of respiratory illness in novels, poems, films, music, and paintings

The nature and severity of respiratory disease are typically expressed with biomedical measures such as pulmonary function, X-rays, blood tests, and other physiological characteristics. The impact of respiratory illness on the sufferer, however, is reflected in the stories patients tell: to themselves, their social environment, and their health care providers. Behavioral research often applies standardized questionnaires to assess this subjective impact. Additional approaches to sampling patients’ experience of respiratory illness may, however, provide important and clinically useful information that is not captured by other methods. Herein, we assert that novels, poems, movies, music, and paintings may represent a rich, experiential understanding of the patient’s point of view of asthma, cystic fibrosis, lung cancer, and tuberculosis. Examination of these works illustrates the broad range and major impact of respiratory illness on patients’ quality of life. We suggest that examining how illness is represented in various art forms may help patients, their social environment, and their health care providers in coping with the illness and in humanizing medical care. Medical students’ clinical skills may benefit when illness experiences as expressed in art are incorporated in the medical curriculum. More generally, Narrative Health Psychology, Narrative Medicine, and Medical Humanities deserve more attention in education, training, and clinical care of (respiratory) physicians, medical students, and other health care professionals.

You don’t Grow Old on Your Own

Age is a metamorphosis (particularly physical). A competition (in infirmities, illness and length of life). The bill you pay for your life. A liberation. A job you have to do. A confused script. Involuntary house arrest. A challenge. A punishment (at least), a disaster (at worst).

Eyewitness in Erewhon academic hospital. Part 12: the fall of the house of ethics.

For some seconds Gordon is blinded by the lights the television crews direct at him. More than 20 cameras focus on him, and one journalist yells “there he is!” Even Gordon is not used to that much attention, but vanity is a speedy advisor. Within seconds he has clad himself in the aura of important person, and knowledgeable ethicist, even if he has no idea what that many journalists expect from him at precisely this moment. Particularly when he has little time, preparing for the world conference on bioethics in Singapore. Then a wave of disappointment hits the gathered gossip-mongering press. The floodlights are turned off, microphones are lowered, the buzzing quiets down. “Guys, this is not Testosterone Tony.” This Tony, the athlete who participated in the Olympic Games in Beijing, at that moment leaves the hospital by a back door, far away from the paparazzi. The armoured car of his sponsor Nanosock disappears from sight softly humming and brings him to a private clinic where he will be pampered and detoxified . His career in sports is over, but his reputation can certainly sell sports socks with nanofibres against sweaty feet. The only price he has to pay is to admit he has sweaty feet, not true, but a small price to pay considering the alternatives. In front of the hospital the disappointed and somewhat offended Gordon tries to save his ego and asks the journalists: “Maybe I can be of help? Do you want an ethical analysis of Testosterone Tony and enhancing evolution? My name is Gordon Mc..” Nobody listens, nobody reacts. A day later. Nurses Jake and Gwen return from the medication round. Jake looks at the unlit room in the Nuttree Pavilion. “Where is everybody? Down with some contagious virus transmitted via sharing thoughts?” “They are off to a conference.” “A conference? Of ethicists?” “Yes, they can have conferences.” “Like a medical conference?” Jake is struck by surprise. “A lot less fancy, I would suppose. Even hope.” “What is it about?” “I don’t know, I heard Sven talking about some really important people coming there. Ones that would win the Nobel prize for ethics.” “But there is no Nobel prize for ethics!” “I know”, Gwen responds, “but that doesn’t stop ethicists from discussing who deserves it. Then Sven complained about having to choose between the particularist session or the meeting with the anti-theorists, and then he said something about an existential fatigue with principlism that he himself suffered from and that he was becoming a cantankerous old philosopher.” “What is that all about?” “Philosophical hush hush. Beats me. We can’t have them have crises of any nature, whether existential of other. We need them here to do their jobs and help us think through the issues.” “Well maybe we could do that ourselves for a change. See how we manage in these days of weaning from the ethicists,” Jake said prophetically, although of course he did not realise that. Prophets rarely do. Gwen: “Of course, no problem, it is just so time-consuming. By the way, I saw Sven walk into Sarah’s consulting room, just now. So he is not at the conference, guess he couldn’t decide to which session to go to.” “I think someone can write a PhD on the functioning of Sven’s brain.” Laughing they get back to work. Gwen is right. Opposite of Sarah Walters sits ethicist Sven Kremer. He is livid, which is very rare for Sven who, as he needs all his energy for thinking, cannot afford to get angry, his slightly narrowed eyes burn. “But that is impossible. Is that why I did all the thinking?” “I’m sorry Sven”, but Sarah’s body language is clear. She is not sorry at all. “Well how does this work with you doctors? You ask our advice in a complex dilemma, which patient should have an available donor liver. And I studied, and studied, and this advice”, he taps on the pile of papers in front of him, “.is sound. Well, I progressed to a certain extent.” “We operated 2 weeks ago, Sven, we had to. The time pressure was immense.” “Apparently everyone knows the patient was operated, except me.” “But we did operate the patient you suggest, so stop complaining.” Sven shakes his wary head. Dr Van Tintelen has tea with Jake after visiting her patients. “It’s really quiet, Jake, don’t you think so?” “What do you mean? Miss the Nuttree neurotics?” “No, since the tramp has gone, the continuous yelling in the corridors, all the bizarre rambling.” “I guess he’s not in Singapore. It seems he is philosopher. Or was. Don’t know.” “Come on, Jake, have you ever seen a philosopher wearing sandals?” “Sandals?” In the staff room the atmosphere is tense. Representatives of the Board of Directors will make an appearance. An unusual event. Nobody knows what is going on, not the nurses, nor the doctors (Dr Van Tintelen chats with Sarah: “With socks! Sandals with white socks!”), nor the ethicists, that is: the one ethicist, as Sven is the only representative. Two gentleman of rank enter, with in their wake Ishmael, today not in his cleaning outfit but wearing a trendy Bikkembergs costume and without the iPod that seemed glued to his head. He looks straight ahead, shows no emotion, greets no one. The company sits down. The chair takes the floor, a rather obese man wearing an expensive grey hand-tailored chief executive officer suit and a hand-painted Italian tie, as hospital directors like to think of themselves as chief executive officers and therefore dress like them, with a moustache, somewhere between 42 and 57. Approximately. “Ladies and gentlemen, welcome. I’m happy that you have been able to join this meeting. Let me be frank. We all know the costs of healthcare are soaring. That holds nationally, that holds for our academic hospital. I don’t want to go in to the causes. I do want to go in to the solutions. As board we ask ourselves daily do we want everything that is possible? No of course not! This board is in favour of efficient managing. So we have decided