Tag Archives: Illness Narratives

Week 11: Canonical Babbling in Peed Onk: Childhood Cancer and Death Stories

*Lorrie Moore, People Like That Are the Only People Here
*Raymond Carter, A Small, Good, Thing
**Proposal for Final Project due

Your reflection this week can be brief, but please still post and comment on another post about the impact and effectiveness on these fictional short stories.

We opened class with our guest speaker, Dr. Joy Brooke Fairfield, Assistant Professor of Media Studies at Rhodes College. She led us through several improv exercises that touched upon the fun of making mistakes, creating a safe space by consenting to improv, hilariously breaking bad news (ie. a superhero firing their sidekick), and breaking bad news like in A Small, Good Thing. It was a playful hour full of laughter and observation that encouraged students to stretch themselves outside of their comfort zone.

After reflecting on our experiences with medical improv, we wrote in the style of People Like That Are the Only People Here. During our class readings this week, we explored two different short stories that touched upon pediatrics: A Small, Good Thing by Raymond Carver and People Like That Are the Only People Here by Lorrie Moore. Even though we have talked throughout the semester about the value of first person narrative and insight, these stories exemplified how impactful and truthful fiction has the potential to be.

We then spent some time encountering first hand narratives from children and adolescents with cancer, as featured in my book Chronicling Childhood Cancer: A Collection of Personal Stories by Children and Teens with Cancer. It was refreshing to encounter these stories again for the first time since I have been an oncologist. Memories of my time with each of these young authors flooded back to me. I remembered kneeling in infusion centers, perching at the center table in the playroom, or pulling up an armchair to sit at the bedside inpatient. I remembered how so many of these kids were excited to participate in this activity (and some terrified by the idea), one telling my frankly that he didn’t think he had ever really spoken about his cancer this much. That idea still stuns me, that many children and adolescents with cancer might not have the space to tell their stories. Even though it was a decade ago, I remembered it as though it were yesterday.

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Week 9: Ethics of Narrative in Medicine

*Part II Chapter 7: Attention, Representation, and Affiliation from Rita Charon, Narrative Medicine (pgs 107-130)

*Part IV Chapter 9: Bearing Witness and 10 Bioethics from Rita Charon, Narrative Medicine: Honoring the Stories of Illness (pgs 177-218)

*Healing Narrative: Ethics and Writing about Patients, AMA Journal of Ethics

Reflecting on what you have learned about narrative medicine so far this semester, what ethical considerations must be made when we think of narrative medicine? Some examples of ideas to reflect on include: 

-ethics of practicing narrative medicine clinically with patients (i.e. how to do so equitably)

-ethics of sharing the stories of our patients and/or colleagues and/or loved ones (i.e. issues of attention, representation)

-ethics of how society tends to share certain narratives and silence others, and why this occurs

-ethics of how healthcare systems use patient narratives (i.e. for marketing, for donors)

Are there narratives that we have encountered this semester that feel less ethical than others? If so, why?

This week, we took a step back to reflect on the ethics of narrative medicine. We began with a writing prompt: Write a story about a healthcare experience that isn’t yours to tell. We talked about what makes a story yours to tell, and different writing techniques for writing a story that isn’t yours to tell.

After briefly discussing Beauchamp and Childress’ 4 Biomedical Principles of Ethics, we launched into 3 work groups to define our own policies about Consent, Patient Care, and Marketing/Fundraising. We unpacked what best practices of using stories in these different spaces might look like and created our own standard practices for ethically using stories. Topics included de-identification in narrative and the importance of obtaining patient permission, reframing stories propagated amongst healthcare professionals, and imagining patient-centered approaches to storytelling for marketing/fundraising purposes.

We returned to the same story we wrote about earlier and wrote again: Write about the same healthcare experience as a story that is yours to tell. We reflected on how different this experience felt, and how different the stories were that emerged.

After our break, we began an informal debate to illuminate different perspectives to consider with the ethics of storytelling in medicine. Students were each assigned as patients, families, clinicians, or hospitals. We discussed stories that emerged earlier in class or scenarios that people wrote about in response to the writing purpose.

I concluded class by sharing my own imperfect framework for considering the ethics of narrative medicine:

Who- who is telling the story? Who is receiving the story?

What- what is the story being told?

When- at what time is the story being told?

Where- location of storytelling, i.e. at the bedside, in elevators and stairwells, social media

How- rhetoric, tone, language used to tell story, making space for storytelling?

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Week 8: Embracing Illness- (Dis)Ability in Children’s Literature

*DSM-V entry for autism

*Chew and Raymaker, 10 Autism Controversies

*Autism blogs (Disability in an Ableist World, The Obsessive Joy of Autism, The Significance of Semantics: Person-First Language: Why it Matters)

How is disability different than illness? Reflect on how narratives or depictions of disability compare to illness narratives. OR Write about examples of Ableist language and the implications of using Ableist language. 

This week, we entered into the world of disability studies to learn more about neurodiversity and autism in particular. After the writing prompt “On Being Different,” inspired by the Pulse- Voices from the Heath of Medicine 2023 Writing Contest, we viewed the video “In My Language” by Amanda Baggs. After briefly defining neurodiversity, we did a Disability Rounds activity with 7 minutes per station.

We analyzed several videos about autism:

I stim, therefore I am [Loud Hands Blogaround], Rethinking Autism: Autism Support Group, and “Fixing” Autism

We reflected on several children’s books about autism:

Little Rainman: Autism — through the eyes of a child by Karen L. Simmons

I am Utterly Unique! Celebrating the Strengths of Children with Asperger Syndrome and High-Functioning Autism by Elaine Marie Larson

The Kaleidoscope Kid: Focusing on the Strengths of Children with Asperger Syndrome and High-Functioning Autism by Elaine Marie Larson.

And lastly, we unpacked the following figure from a recent study published in May 2022 by Weir et al. showing that “Autistic adults have poorer quality healthcare and worse health based on self-report data.”

We had interesting conversations demonstrating a range of reactions and thoughts about these different autism narratives. Many people were in particular surprised to hear about the idea of using identity first language for Autism, since this is very different from the person-first language we most often try to use for illness. We talked about what differentiates disability from illness, what it means to be on medication for a disability, and how we decide when to use medications for disabilities. It was a great introduction to the idea of disability studies with so much more to talk about!

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Week 3: Diagnosing Illness Narratives

*Part III Chapter 6: Close Reading from Rita Charon, Narrative Medicine (pgs 107-130)

*Arthur Frank, The Wounded Storyteller (pgs xi-xiii, 75-84, 97-102, 115-119)

How do Frank’s 3 types of illness narratives help us and in what ways might this framework limit our understanding of illness narratives? What stories do people tell through social media about illness and how does society receive these stories? Give an example of what common responses to illness narratives might suggest about societal understandings of health inequity. OR Create a narrative about illness that uses common elements outlined in Frank’s illness narrative categories.

Our class began discussing questions posed by Ann Jurecic: “Where did [illness narratives] come from? Why are we so interested in reading them now? Why are so many people interested in writing them now?” In groups, we tackled the illness narrative worksheet, each group focusing on a single category of Frank’s types of illness narrative. I asked for students to focus on examples in popular media, ie. film and art. We then discussed the benefits of this narrative typology and the limitations of this framework, unraveling some of the caveats that must be kept in mind when thinking about these categories. I shared brief slides about the evolution of medicine and narrative, patient- and family-centered care, and examples of using illness narrative types to inform communication strategies and in research.

Some highlights of our conversation include:

-Categorizing types of illness narrative is most helpful for the listener. Importantly, Frank’s illness narrative types are not distinct categories but rather can overlap. How people narrate illness is a dynamic process and different illness narrative types can be expressed at any given moment.

-Understanding how people narrate their experiences with illness can help us to better meet them where they are and provide patient- and family-centered care.

We explored the question of whether “survivor” falls under a restitution narrative vs. a quest narrative (answer: lots of caveats to consider!). The idea of knowing how to respond when a narrative contains elements of chaos and restitution/quest was explored, and the idea of how to best meet patients where they are with how we communicate. We also talked about how knowledge of these narrative types could impact clinical care. Class ended with an engaging creative writing prompt about personifying disease!

My Week 3 lesson plan, worksheet, and slides are included below:

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Judith Hannan: Missing Voices in Narrative Medicine

It is my honor to feature this blog post by Judith Hannan, author of Motherhood Exaggerated and The Write Prescription: Telling Your Story to Live With and Beyond Illness.

Recently, I participated in a Narrative Medicine workshop at Columbia University. This mini-version of the groundbreaking Masters in Narrative Medicine program created by Dr. Rita Charon posits that the literary arts—close reading, close listening, and writing—are a necessary adjunct to the medical arts to ensure compassionate, ethical, and high quality health care. Academics spoke about gathering and interpreting patient narratives, doctors led us in analyzing stories, and writers and film specialists examined work depicting the intersection of life and medicine. Missing was the voice of the patient unfiltered through the view of the doctor, professor, or writer.

I felt this absence again in Andrew Solomon’s otherwise excellent article in the April 26, 2016 issue of The Guardian. The title of his piece is “Literature about medicine may be all that can save us: A new generation of doctor writers is investigating the mysteries of the medical profession, exploring the vital intersection between science and art.” Is Solomon saying that only narratives by doctors have a place within the practice of medicine? And who is us? Is it medical professionals, patients, the general population? Are patient narratives being co-opted by the very people trying so hard to bring dimensionality to the people they are healing?

I am not a medical professional. I am a writer and teacher who focuses on stories of physical or mental illness from the point-of-view of the patient, caregiver, or family member. Writing my memoir, Motherhood Exaggerated, is what allowed me to understand how I had become transformed as a mother during my then eight-year-old daughter’s treatment for cancer and her early years of survival. For readers, the book gave them permission to tell their own stories. They brought me their tales like presents which heretofore had no one to unwrap them. It was then that I realized that the field of narrative medicine either had to expand to include the patient/caregiver voice or we need to create a new field—maybe narrative healing—not just to embrace but to elevate the value of these stories.

In a June 29, 2010 New York Times article, Dr. Abigail Zuger asked whether memoirs of illness should be held to the same standard as other writing. “Perhaps,” she said, “these books serve a different purpose from the usual book for the writer and the reader.” My second book, The Write Prescription: Telling Your Story to Live With and Beyond Illness, is a response to Zuger’s question. Personal reflection and intimate prompts help writers enter into their stories where they will find healing, not by moving on from the trauma that has occurred in their lives, but by discovering how to move with it. Unlike Zuger, though, I think all writers should tell their stories well, not for the purposes of publication or to attract more readers, but because better writing will result in greater insight and transformation. It is the difference between a recitation of what happened and placing those events within the larger context of a life, between cliché and a unique voice, between venting and discovering, between momentary catharsis and more lasting change.

Aspiring toward literary excellence will mean that the genre of illness narrative will broaden in appeal. Like any good book, the reader will both find a piece of him or herself as well as acquire a larger view of what it means to be human. And it will give control to the person whose story it is to tell. In “Fraying at the Edges,” (New York Times, May 1, 2016) N.R. Kleinfield creates an exquisite portrait of Geri Taylor during the years immediately after her diagnosis of Alzheimer’s disease. As Taylor talks about how so many services emphasize the caregiver and the later stages of the disease, she expresses a similar desire for control. “We don’t want to be done to, we want to do.”

This is an important message for anyone in the healing profession. Yes, doctors should continue drawing out the stories of their patients’ lives, they should continue writing and sharing their own humanity. But patient narratives have their own place. Their readership should extend beyond those who have had similar experiences to include the general population as well as those within the medical field.

If you want to contribute toward the language of medicine, the best way to approach your story is in small bites; trying to tell everything at once is too daunting and will prevent you from looking closely. Receiving a diagnosis can make you feel like you are no longer the same person. To remain in touch with the entire range of who you are, bring all your senses into your writing. Be aware not only of what is happening to you and inside of you, but what is going on around you. Read what you have written aloud to yourself. Writing gives us that tiny bit of distance that allows us to confront emotions, events, and fears that we might flinch from if we were speaking. Reading what you have written will help you recognize the feelings and discovery you have made.

You don’t need a special place to write or, particularly when you are starting out, a large amount of time. Here is a prompt you can do in ten or fifteen minutes.

NAMING AN ILLNESS

     My meditation teacher tells me that, whenever negative forces or thoughts arise, I should give them a name as a way of neutralizing them. It’s easier to talk to people than to feelings and talking can reduce the sting. Grief, for example, is an impenetrable block; Greta, though, is a woman with a soft voice, long hair shading her eyes, a slight limp; she is more comfortable in water than on land. I can lean into Greta to hear her speak, brush the hair from her eyes, take her hand and guide her to the rocking waters of the sea.

Anxiety is the character I meet most often. Her name is Sybil. She greets me with a stutter. I have known her for over forty years and she has changed. Her body is still made up of the same sharp angles. Her feet still pace as if they never need sleep, my heartbeat mirroring their uneven rhythm. She still takes me by the arm, whispers in my ear of things only her silver eyes can see. But it no longer takes as much strength for me to loosen her grip. Her hair, once black, spiky, and uncombed is now nearly white and contained by a headband. I used to Sibyl welcome; she loves a strong cup of Irish breakfast tea. These days I’m more inclined to stroke her long fingers, straightening and lengthening them before they can turn into claws.

Siddhartha Mukherjee, in The Emperor of All Maladies: A Biography of Cancer, says, “To name an illness is to describe a certain condition of suffering—a literary act before it becomes a medical one.”  The true literary act, though, is in the renaming of the illness, to give it a moniker that is uniquely yours. It is a way to address your illness in familiar terms and to communicate with others in a form they can understand.

Writing Prompt

Write about your illness, or that of someone for whom you are caring, as if it were a person. Give it a name. What does it look like—height, hair and eye color, skin tone, clothes, hands?  Describe its mannerisms, habits, and moods. Give it a voice. Talk to it. How, if at all, has naming your illness influenced your relationship to it?

 

03252014_LWC_Judi_Hannan_0470_Final 4x4.jpgJudith Hannan is the author of Motherhood Exaggerated (CavanKerry Press, 2012), her memoir of discovery and transformation during her daughter’s cancer treatment and her transition into survival. Her essays have appeared in such publications as Woman’s DayOpera NewsThe Huffington PostThe Healing MuseZYZZYVATwins Magazine, and The Martha’s Vineyard Gazette. She teaches writing about personal experience to homeless mothers and at-risk adolescents as well as to medical students, and is a judge of the annual essay contest sponsored by the Arnold P. Gold Foundation for Humanism-in-Medicine. She served as Director of Development of the 92nd Street Y and then for the Children’s Museum of Manhattan. She now serves on the board of the Museum, Jody Oberfelder Dance Projects, as well as on three boards affiliated with the Mt. Sinai Medical Center in New York—the Adolescent Health Center (where she now serves as President of the Advisory Board), the Children’s Center Foundation, and Global Health. She lives in New York.

 

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An open invitation for guest blog posts on illness narratives

When I first started this blog, I was excited to seize the domain illnessnarratives.com. Now several years later, however, I’ve realized that the focus of my writing here has evolved, and I’ve felt uncomfortable about how many of my posts have been about me and my writing rather than on illness narratives in general. This blog has been alive throughout a good chunk of my journey towards a career in medicine, from my undergraduate to my medical school education. It’s been challenging to find my direction, to balance sharing my own personal writing accomplishments and experiences with my thoughts on illness narratives that I encounter

To that end, I’d like to try something new. I’ve always felt it strange that I was the only voice in a blog that aspired to comprehensively survey the landscape of illness narratives.

This is an open invitation to anyone interested in writing a guest blog post. Here are some examples of what I’m hoping for, but I would welcome a post about anything that interests you related to illness narratives:

  • Review of an illness narrative, be it literature, film, music, or any other media
  • An illness narrative of your own
  • Thoughts about illness narratives as a genre
  • Ideas about the ethics of writing about illness
  • Any other interest you would like to explore!

Your blog post could be as short or as long as you like. It could be anywhere from a paragraph to a few pages; whatever works for you. All you have to do is email it to tkpaul@umich.edu, and I’ll get back to you as soon as I can. It’s that simple. Please don’t hesitate to let me know if you have any questions at all; this will be a learning process for me.

I’m hoping that this might change things up a bit, and that I’ll be able to breathe some life back into this website. Because it’s summer, the world is anew, and it’s time.

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[Cancer Knowledge Network] Discovering a Passion for Pediatric Palliative Care

This article is also available at the Cancer Knowledge Network.

As someone who loves spending time with kids, I was thrilled when I was placed to volunteer on the 7th floor pediatric oncology inpatient playroom at C.S. Mott Children’s Hospital. Although I was just in high school, I had an early interest in becoming a pediatrician, and Mott seemed like the perfect place for me to learn more.

From talking to teens at their bedside to playing video games or doing arts and crafts with kids, I enjoyed every minute I spent with patients and their families. These activities meant so much more to me as I began to see how integral they were to sustaining children through cancer. These children endure levels of pain that seem unthinkable at such a young age, and I helped them find distractions in board games and plastic food.

With the backdrop of illness, these normal activities were never quite the same. One minute, I was racing trains with a 2 year old. The next, I was gripping his tiny arms and legs to help his nurse draw blood. He put his entire body into his scream, thrashing wildly. But as I held him afterwards, his peaceful demeanor made me realize that I made a difference.

As I spent time with siblings and parents, I witnessed the many ways that cancer permeates the lives of loved ones. As a volunteer, I supported them in any way that I could. I came to believe that talking with kids and families, letting them engage in conversation, to get their mind off things if they so choose or voice their concerns, unleashes the therapeutic nature of the spoken word. From the weather to a child’s prognosis, these conversations illuminated different perspectives of how cancer affects lives. My experiences with these young patients and their families largely contributed to my own desires to devote myself to medicine.

When I started medical school a little over a year ago, I would tell people that I was interested in becoming a pediatric oncologist. Even then, I knew that my interests may change throughout the course of my medical training, but I also knew that this is where my heart was and where it still is, at least for now. Within just a few months, I found myself slowly gravitating towards another discipline that also works closely with children with cancer: the field of palliative care.

Palliative Care aims to improve the quality of life for patients and families, often by alleviating symptom burden, providing pain management, helping with decision-making, and furthering communication about goals of care.[1] Palliative care aligns with many of the aspects of volunteering that were most rewarding for me, as well as my own philosophies about how I hope to practice medicine. From striving to alleviate pain and relieve the suffering that patients experience throughout the course of treatment to engaging in important and intimate conversations with patients and family members about experiences with illness, palliative care prioritizes aspects of medicine that most move me.

Often, these quality of life measures are goals of medicine in general, but to have an entire medical specialty devoted to these important issues has the potential to greatly impact patients, especially those in need. The baby who won’t stop crying from the pain, the teenager who may have wishes that deviate from those of caregivers, the parents who are deciding whether a clinical trial is right for their child—there is no question that cancer diagnosis, treatment, and recovery can present a series of uncertainties, challenging decisions, unimaginable pain, and life-long symptoms and side effects.

I hope that palliative care training will help me to develop my skills and make a difference in the quality of life experienced by children with cancer. By specializing in both pediatric hematology/oncology as well as in pediatric palliative care, I believe that I will be able to develop a more comprehensive knowledge base and gain experiences to ensure that both perspectives will always inform my care. Palliative care embodies the kind of care that I hope to be able to provide for my own patients and their families some day.

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Returning to where it all began- WMU Medical Humanities Conference 2015

It’s strange to think that I attended and presented at my first conference two years ago to date; I have fond memories of that WMU Medical Humanities Conference as being one of my best presentations yet. This year, I was excited to return to talk about my illness narrative class, Grand Rounds: Exploring the Literary Symptoms of Illness through Narrative, and to discuss the role of illness narratives in pre-health education.

I love medical school, don’t get me wrong, but I miss this. It was so refreshing to have a conversation with humanities enthusiasts about the great educational impact of illness narratives, both from literary and medical perspectives and when considered at various stages in one’s career. It’s been a while since I’ve been so immersed in dialogue about illness narratives, so I enjoyed delving back into it and reflecting on how they’ve got me to where I am today.

It was nice to see some familiar faces in the crowd and to have a diverse group of people, most from humanities backgrounds but everyone with some interest in illness narratives and/or medical education. I decided to structure the session as an interactive discussion since I had more time, which was a bit unconventional at this lecture-based conference. But I think that as a group, we were able to further develop many of our personal thoughts and ideas regarding illness narratives as well as engage and interact with each other more, which I know that I found to be a rewarding and illuminating experience.

WMU lesson plan-Introducing Illness Narratives in Pre-Health Education

WMU Medical Humanities- Grand Rounds

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A noon conference for pediatrics residents with Chronicling Childhood Cancer authors

Perhaps it was the ambience of a brightly lit conference room overlooking downtown Ann Arbor. Maybe it was the audience of pediatrics residents at C.S. Mott Children’s Hospital, doctors devoting their lives to caring for children. Or it may have been this event’s focus on teens sharing their own advice for doctors based on their personal experiences. Whatever it was, something was very different about the Pediatrics Noon Conference that I led about the Chronicling Childhood Cancer book project from last year’s Literati book reading/signing event.

A couple months ago, I learned that residents hardly have an opportunity to interact with pediatric patients and their families outside of clinic visits. I was surprised–while medical school is peppered with patient presentations and opportunities to learn more from patients about their experiences, it seems as though these opportunities drop off in residency since residents have patients of their own.

That was unsettling to me, though. Especially with pediatric patients, I think that giving teens and young adults the chance to share their own experiences and perspectives can be invaluable, both for these youth as well as for people who are devoting their lives to caring for these individuals. It’s also a reminder of what it means to embrace PFCC, or patient- and family-centered care: the recognition that we as clinicians must view our patients as partners in their healthcare, and in doing so, acknowledge how much we can learn from our patients. Events such as these demonstrate that there are an infinite number of ways that we can improve and better care for our patients by hearing what they have to say.

At this event, I gave a brief overview of the research project before turning it over to three of the young authors themselves. Each individual shared some of their personal experiences and advice for doctors about just how much of an impact their interactions can have on patients. While the discussion was centered largely on the teens, their parents also contributed some insight. Overall, this was a change from the typical noon conference lecture, and it sounds like many appreciated what this unique noon conference had to offer.

I was more anxious preparing for this event than I have been in a while, and I think it’s because I’m more aware of how precious time in medical education can be. I know how much people fight over this time to make an impression on doctors in the making. It truly is incredible to me that I have had this opportunity; it’s crazy to think that I have been a part of their education, that I may have been able to influence the kind of physician that some of these residents may be with their patients.

One of the highlights for me was the very end. A number of people had to leave immediately since the event concluded right at 1pm, but I was amazed by how many people still chose to stick around and speak at length with each of these patients and their families. That meant so much to me, and I know that it meant a lot to the young authors. Instead of just getting their books signed and leaving, these residents took the time to connect with the teens and their parents. In the end, I know that this was the point of it all: to give residents a chance to get to know and learn from teens with cancer in a different way, and to make space for teens to share their personal experiences.

Pediatric Noon Conference- Outline

Pediatrics Noon Conference- Slides

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The Art of IF: Navigating the Journey of Infertility through Art

IF.

Short for infertility, a disease resulting in the abnormal functioning of the male or female reproductive system. There are many causes, some known and many unknown. It is often merely a matter of chance, a condition that arises with little explanation.

I have to confess that I had not thought all that much about infertility as an illness until I encountered ART of Infertility, a “an infertility artwork, oral history and portraiture project.” This art exhibit is a compilation of infertility stories expressed through various artistic media, by a diverse range of women who have experienced or are experiencing infertility.

I’ve been struggling to write about this exhibit for months now, but nothing I say seems to do it justice. I guess I just want to say that this exhibit moved me in inexplicable ways. The stories that these women share, the art that they use to express their own inexplicable emotions were incredibly powerful. Their words, their symbols, the hues and textures and things were all used to convey the spectrum of ways that infertility touched each of their lives and their selves.

The ART of Infertility prompted me to realize just how many potential triggers exist in our society for those who are infertile. As a society, we make so many assumptions about how those who are married will have children (or, side note, even those who are not married, for family planning comes up in many professional development discussions with women in medicine it seems). It reminded me of how intimately femininity is often intertwined with the ability to bear children. While this is not always the case, it’s one thing to make the decision not to have children; it’s another thing all together to not have the ability to make that choice.

For those with infertility, the constant reminders of one’s infertility may seem ever-present. Menstruation may be a monthly reminder, a taunt about the body’s reproductive shortcomings. Those struggling with infertility may be surrounded by constant reminders as their peers procreate without problem. There are so many challenges to one’s self that can be inflicted by infertility, challenges that are best told by those who experience it themselves.

I guess infertility is another illness that urges me to wonder how we as a society, as strangers, friends, and family to those invisibly suffering, can cultivate a more sensitive environment. Can we open our minds to the variety of ways that people choose to live their lives and the many aspects that may lie outside of their control? Is it possible for us to cultivate a culture of sensitivity that reconciles the course of majorities with the various paths taken by everyone else? How do we escape the limitations of assumptions and make space for human diversity?

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