Carolyn Roy-Bornstein

“How’s the baby in the box?” I asked. It was how I had come to greet the mother of a jaundiced newborn every morning that I’d rounded on the pair. The mother smiled and peered through the clear plastic of the incubator that housed her daughter—the third child in her family I had cared for.

“Breast-feeding like a champ,” she reported. “Maybe a little less yellow?” she added hopefully.

The infant was less yellow. Her bilirubin had peaked. We would discontinue phototherapy, check for rebound and discharge her later that day. And I would continue to take care of her and her family for 15 more years until my retirement.

“The baby in the box is all grown up,” I will comment to her mother on our last visit together. Mom will nod and agree. We will look at each other silently, smiling through tears.

Similar scenarios played out daily as I saw each of my families one last time. Every visit a good-bye. Some patients I had cared for since the day they were born. Some were even “grand-patients”, my fond label for those children whose parents I had also taken care of when they were little. And then there were the newer patients—the young ones I would never see grow up. 

My interactions with patients in those last days were increasingly nostalgic; my wistfulness over the end of my career grew steadily. I thought constantly about the coming years and what my days would look like. It was clear to me that to live a meaningful retirement, I needed to merge my two passions—medicine and writing. In evolving away from caring for patients (to paraphrase Serena Williams), I would have to lean into a different kind of care.

 In narrative medicine, I have found that throughline – the connection between a practice made up of my own patients and one in which I care for the caregivers.  

 I began leading narrative medicine workshops for family medicine residents at the program where I was on faculty early in my career. I started our sessions by pointing out all the ways that literature can benefit a physician’s education. Close reading of poetry sharpens our observational skills. Studying representational art improves clinical acumen. Reflective writing, then sharing that work, fosters empathy and deepens our relationships with each other. 

We read Pablo Neruda’s “The Poet’s Obligation”, reminding ourselves of what drew us to this caring profession in the first place. We read Naomi Shihab Nye’s poem “Famous,” exploring our own personal strengths and gifts. Theodore Roethke’s villanelle “The Waking” launched a conversation about life and death, God and nature, purpose and fate. Literature became our common bond, the great equalizer bridging any gaps between our ages and experience.

Then Covid hit. Hard. Our writing sessions took a back seat to ramped-up call schedules, tele-medicine training, and the steep learning curve needed to care for critically ill patients with a novel and deadly virus. I felt the absence of our sessions like a drought. I wondered if the residents felt the same.

As the pandemic wore on, the residents got worn down. They were exhausted and overwhelmed, one death-filled shift bleeding into the next. 

  “The residents are really hurting, Carolyn,” the program director told me one day. “Can you help?”

And here was my chance to make a difference. I would no longer be caring directly for patients suffering from Covid. But I could support the doctors who were. I could provide solace through literature. Offer comfort in words. 

At first our sessions were held online. Residents logged in from call rooms and nursing stations. They came from clinics or their own living rooms. They came masked; they came wearing headphones. Eating sandwiches or drinking coffee. But they came. And they were hungry for this space, this clearing. This time away from the pressures of call and the hospital and death.

Eventually we met in person. Still masked, we shared poetry. We read Fran Bartkowski’s “Hospital Haiku” trying to find that “back door” that all our hearts needed in order to let go of the suffering we were constantly bearing witness to. We did reflective writing exercises using the prompt “How have you shown yourself compassion?” Some residents shared their work with the group. Some sat silently with their words. One woman cried.

Her hand had been the first to shoot into the air when I’d asked if anyone wanted to share what they’d written. But when I invited her to read, she froze. Tears brimmed in her eyes. Her voice cracked. 

 “I’ve changed my mind. I don’t want to share,” she said. “But I think I’ve given myself a lot of compassion this year.”

 “I’m glad,” I whispered gently.

Initially I used literature selections from well-known narrative medicine curricula or from suggestions made by other writers-in-residence who had mentored me. But as I found my footing, I started letting one session feed another. Recently some of the residents shared their fear that they were becoming part of an uncaring medical bureaucracy that ignored patients’ wishes, providing care they may not agree with or see the need for. So, I prepared a session using William Carlos Williams’ “The Use of Force” as a springboard to talk about these profound issues of autonomy, advocacy and beneficence. 

Though the “affiliation” that  happens when we share our written words generally refers to our relationships as colleagues, I often find residents deepening their relationships with themselves; that is, they discover aspects of their deeper selves which they were unaware of before. Sometimes they see a past decision or action in a new light. Recently one of the residents wrote beautifully about bearing witness to the death of one of her patients, his young son at his bedside. We listeners were all, to a person, moved.

 “How did it feel to write those words and to share them?” I asked. The resident paused, gathering her thoughts.

 “I guess I was carrying a lot of guilt for not doing more for my patient at the end of his life,” she said quietly.

 My heart cracked.

 “I noticed you used the past tense just then,” I told her. “I hope that means you’re letting go of it.” 

She nodded in silence.

I have traded in growth charts and vaccinations for poetry and prose. I am still exploring that liminality between retirement and relevance, between patients and posterity. Still finding my post-retirement way. But I have found my throughline.  I no longer care for children and their families but for the doctors who treat them. Nourishing those doctors with story. Creating space for them to reflect through writing. Using literature to center us all in a turbulent world.