MDS Alert

Writing about your experiences may sound kooky, but it works.

The COVID-19 pandemic is an unprecedented global crisis, and it’s hitting nursing homes and facility staff especially hard. If you are feeling the stress of caring for residents, staying safe personally, and keeping your family safe as well, you’re not alone.

But how do you cope when so many of the regular options for stress relief aren’t available, due to social distancing measures, or even your own facility’s rules and regulations? Reflective writing can be a useful tool for processing experiences, and you don’t need any special equipment or access to other professionals to utilize it. If you don’t want to think of such a process as merely writing down your thoughts, feel free to apply a more intentional name: “narrative medicine.”

Look to These Benefits

Background: Narrative medicine is an educational movement that some medical schools and other places for clinical medical education are incorporating into their curriculum in order to both build empathy for patients and residents, as well as to check in with clinicians’ own biases and realities.

“Narrative medicine gives doctors, nurses, and social workers the skills, traditions, and texts to provide nuanced, respectful, and singularly fitting clinical care to the sick while also achieving genuine contact with their own and their colleagues’ hopes and ideals as health professionals,” says Rita Charon, MD, PhD, in her book Narrative Medicine. Clinicians and laypeople both use methods inherent to narrative medicine to get in touch with their own feelings about an experience, as well as connect with others.

It can be an especially poignant and effective tool right now, while so many crave connection to make sense of disparate situations in a collective experience.

“Narrative medicine offers a unique framework to explore and manage the complexity of healing. Its impact extends beyond the physician-patient relationship and into the relationships between physician and self, physician and colleagues, and physician and society,” say Samir Johna, MD, and Ahmed Dehal, MD, in their article “The Power of Reflective Writing: Narrative Medicine and Medical Education” in The Permanente Journal.

Use Writing to Make Sense of Your Experience

Compartmentalization is a go-to coping skill for many, whether they use their commutes to unwind so they don’t bring “work” home or, for clinical encounters, try to pack their feelings about a tough or sad experience with a resident into one corner of the heart or mind so they don’t bring the guilt or sorrow home.

But now, amidst the pandemic that is hitting the elderly and long-term care facilities particularly hard — and with fewer “normal” connections or support systems or distractions available — it’s especially important to process the intensity of the experience, and your place in it.

“The ‘self’ in question is necessarily both the professional and the personal self because clinical practice is informed by both medical and personal experience. Few medical educators writing about empathetic witnessing or narrative medicine, however, make note of the impact that a physician’s personal identity — including personal and familial illness history, ethnicity, gender, sexuality, class — may have upon their ability to hear, interpret, and translate patients’ stories,” say Sayantani DasGupta, MD, MPH, and Charon in their article “Personal Illness Narratives: Using Reflective Writing to Teach Empathy” in Academic Medicine.

Right now, if you’re working at a long-term care facility, you may be feeling sad about seeing residents’ social isolation. You may feel sad about your inability to touch to provide comfort, and frustration that the personal protective equipment (PPE) necessary to conduct interviews with residents is inadequate or inaccessible. Add the pressure of being essential personnel and the combination, for some folks at some facilities, of being called to the floor or facing cuts in pay or hours: It’s a lot. You may feel like you’re failing residents (or your colleagues or your family), through no fault of your own.

“Health care professionals’ guilt is a powerful engine for their behavior. We are burdened and also supported by a highly developed sense of personal accountability. When we inevitably err in the course of practice, we must deal with the tremendous pain of guilt,” Charon says.

Acknowledging any complicated feelings is both part of the process, as well as a result. “Although the specifics of the suffering may change — paralleling the technological realities of practice — the heart of the suffering remains the same: shame at being powerless, guilt and rage in the face of blame, and fear of all the dying.”

And right now, while social distancing is in effect for so much of the country, writing is an especially great method for processing these feelings and experiences. “Writing, or telling, gives a speaker the authority and the opportunity to reveal the self,” Charon says.

Try This Exercise — And Consider Sharing

Set a timer for five minutes and put a pen to paper. Don’t think too hard about what you’re writing, just jot down your feelings about what happened that afternoon or day or week. Don’t worry about editing — just get the words down. For some people, putting words to paper is cathartic in and of itself.

Interestingly, trying this exercise together with colleagues can really bring a team together through collective experience and shared witnessing.

Although most studies have been conducted with medical students and the results aren’t conclusive, evidence suggests that sharing your writing within a small group can be helpful. The difference between writing for yourself and sharing with a small group is one of connection.