Using the Humanities to Help Heal
There’s a famous passage in John Steinbeck’s East of Eden that ruminates on the existence of monsters. Not just the grotesque physical monster that we might associate with horror films and ghost stories, but the “inner monster,” the “malformed soul” who, like his fictional antagonist Cathy Ames, is entirely without conscience or principle.
The first time Travis Hughes encountered this passage was immediately before one of his daily patient rounds as a medical resident at Spokane’s Providence Sacred Heart Medical Center. That might seem like an unusual moment to start thumbing through the classic novels of American literature. But this was actually a formal, albeit casual, session called A Daily Dose of the Humanities.
“Daily Dose” is an ongoing educational initiative that’s part of the Providence Internal Medicine Residency program, and is designed to enrich the curriculum at the University of Washington School of Medicine in Spokane. During these regular ten- to fifteen-minute morning gatherings, medical students and residents like Hughes as well as their mentors are invited to share a work of visual art, music, or literature with the larger group. They then take the remaining time to briefly discuss and reflect on it.
The reading from East of Eden and the conversation that followed left a lasting impression on Hughes, now in his third year of the Internal Medicine Residency postgrad program. He thought about Cathy Ames and how she actively used her lack of humanity to, in the words of Steinbeck’s narrator, “make a painful and bewildering stir in her world.”
“She is just described as the truest form of evil, mostly because she has no emotional connection to other people. She feels no remorse and very little empathy,” he says.
“That has always stayed with me—that I shouldn’t lose touch with my emotions.”
The risk of that happening among medical professionals is very real. The pressures of the job have always required a certain degree of clinical detachment, or else the outcomes—both good and bad—would result in a constant rollercoaster of emotional extremes. That wouldn’t just be exhausting to the point of premature burnout. It could also compromise their ability to diagnose and treat patients effectively.
More recently, the adoption of electronic medical record (EMR) software has sterilized the emotional connection between medical professionals and their patients. Almost anyone who has visited a doctor’s office in the past decade will be familiar with how computer-mediated checkups and consultations have become. Via their screens, assistants, nurses, and physicians are all able to access a common database of digital patient information, which can improve the efficiency and accuracy of their care.
At the same time, EMR software also has the potential to reduce living, breathing, hurting patients to cold, hard data. Or quantifiable units that have to be checked off like a to-do list.
A Daily Dose of the Humanities arose in 2014 as a way to counter these two dynamics. It was the brainchild of Dr. Darryl Potyk, now chief for medical education at the University of Washington School of Medicine in Spokane. He was quickly joined by Dr. Judy Swanson, the school’s internal medicine clerkship director. Both sit on the faculty of the Providence Internal Medicine Residency.
“The main thing that sparked this was our interest in the humanities and medicine,” Potyk says, “and for many people, the humanities and medicine is a big, overwhelming topic. How do we integrate the arts into the sciences? And how do we do that in a formalized way? So we came up with this idea of just sharing the things we’re interested in.”
Potyk’s soft spot is for music. Swanson’s is for visual art. And Dr. Judy Benson, who heads Providence’s Internal Medicine Residency program, completes their collegial trinity with her love of the written word.
In one of the earliest trials of the Daily Dose program, Potyk played a pop song for the group, which typically consists of an attending physician, medical residents, and medical students. Beyond his own personal affinity for music, he thought it offered a “pretty low bar” in terms of its accessibility.
“Everybody just seemed to love it,” he says. The response was so encouraging that Daily Dose quickly became a regular part of the curriculum. Potyk has since gone on to share songs by Neil Young, Neko Case, R.E.M., and many other bands. One track by the X Ambassadors, “Renegades,” stands out to him because of the way it combined sight and sound.
“You listen to the song, and then you watch the video, which is all about disabled people being renegades and not letting their disabilities define them. It’s super cool, super inspiring, and as we think about patients, it’s a good reminder that nobody ever asked to be sick. They have to deal with whatever cards they’re dealt in whatever way they can.”
“It puts my heart and mind in a more generous, empathetic position. And it makes me think about what life is like as a patient. I’m not just seeing a lab value, I’m seeing a person who’s similar to me.”
Not all of the shared art is meant to have such a direct message. For some Daily Dose sessions, simply taking the time to focus on something that straddles the personal and the professional worlds can be like a meditative act.
“It gives us a breath of fresh air before we have to dive into what we have to get done for the day,” says Potyk. “It’s like, let’s just take ten minutes and cleanse our brains and think about this more holistically. In many ways, it helps center us and remind us why we went into medicine and why we’re doing the things that we do.”
In the era of COVID-19, reminders like that can be all the more vital. Swanson says that the pandemic has become an obvious point of concern for many of the residents, and that’s carried over into what they choose to discuss during Daily Dose. Just recently, a student bought in a painting that depicted a medieval surgery in which a physician was lancing a plague bubo.
“You had the older physician advising the younger physician, totally intent on what he was doing,” she says. “And there were a lot of people in the background, hovering around, trying to see what was going on. It was interesting to see that there were a lot of the same reactions. And, of course, there was no personal protective equipment.”
In Swanson’s opinion, the historical parallels and the awareness of modern medical advances “helped to relieve some anxiety“ toward COVID-19 among the group. One of her favorite shared paintings is one that has nothing to do with science, like Joseph Wright of Derby’s An Experiment on a Bird in the Air Pump (1768), or even medicine, like Rembrandt’s The Anatomy Lesson of Dr. Nicolaes Tulp (1632). It’s Pieter Bruegel’s Landscape with the Fall of Icarus (circa 1560). What makes Bruegel’s rendition of this legend so memorable is that Icarus, famed for flying too close to the sun with wings made of feathers and wax, is reduced to two tiny legs poking out of the ocean.
To Swanson, this offered a dual lesson on the need for both humility and observation.
“The resident who brought it said, ‘Here we are, walking down the wards every day, and we have no idea what’s going in that patient’s room when we aren’t there. There are tragedies that occur that we’re not aware of.’ We can tell a lot about what’s going on with a patient, but with the EMR in place, it’s so much easier to go with the scientific data rather than to look at the person in the gown in front of you,” she says.
Along with creating common ground between physician and patient, A Daily Dose of Humanities has also fostered better relationships between the physicians-in-training and their more seasoned counterparts.
“It’s what I call a leveler,” Potyk adds. “Medicine and medical training can be so hierarchical. But here there’s no hierarchy in sharing your feelings or your thoughts about a piece of art. And you’re truly getting to know your fellow team members in a way that’s personal and that may not come about in the course of our daily work.”
Those are exactly the wide-ranging benefits that residents like Hughes have taken from the program.
“I find that I learn not only about shared human experience but also about the people that I work with based on the choices of art that they bring in,” he says. “It puts my heart and mind in a more generous, empathetic position. And it makes me think about what life is like as a patient. I’m not just seeing a lab value, I’m seeing a person who’s similar to me.”
Outside organizations have also taken note of the enthusiasm for A Daily Dose of Humanities and its clear anecdotal results. Medical professionals in other states have reached out to Potyk for advice on how to implement similar programs—all with the goal of cultivating nurses and physicians who can instinctively balance compassion and duty.
“It started off as a way for us to integrate the humanities into what we do in a bite-sized way that’s also sustainable,” he says. “But it’s just been amazing and gratifying to see the residents and students really enjoy what we do.”
E.J. Iannelli is a freelance writer, editor, and translator based in Spokane. He’s a regular contributor to regional newspapers and magazines as well as the Times Literary Supplement.