“If language shapes inequitable systems, then their disruption relies in part on our ability to effectively wield language in subversive ways”
Dr. Irène Mathieu, MD
Buried within a smattering of bullet points and data nuggets, these evocative words flashed across the slide deck of Dr. Irène Mathieu, MD. As Assistant Professor of Pediatrics at the University of Virginia School of Medicine and an award-winning poet, Mathieu thinks medical students could benefit from a stronger background in the humanities. Over the course of her guest lecture, “Playing Between the Lines: Poetry by a Pediatrician,” Mathieu dropped many such pieces of wisdom linking the study of language, and more broadly the humanities, with the practice of medicine. She shared this wisdom through a variety of methods, including original poetry, anecdotes from her life, and the latest research into the field of narrative medicine. The lecture was organized by the Trent Center for Bioethics, Humanities, and History of Medicine and hosted by Dr. Sneha Mantri, MD, MS, Assistant Professor of Neurology at Duke University School of Medicine.
The field of narrative medicine, hardly twenty years old, can trace its roots to Columbia University, when a group of physicians and scholars, spearheaded by Dr. Rita Charon, MD, PhD, sought to change the discourse surrounding traditional medical training. Emphasizing various humanities-based approaches, narrative medicine seeks to increase the propensity of physicians to perceive strife, uncertainty, and complexity in the pursuit of caring for complex illnesses. In her discussion, Mathieu cited multiple studies that detail the positive impact of an exposure to the humanities on the empathy, wisdom, tolerance for ambiguity, and resistance to burnout in medical students. More recent studies have shown that narrative medicine experimental training programs have similar impacts.
Like many of her contemporaries, Mathieu sees the utility in narrative medicine to impact not only the personal lives of physicians, but also the systems in which they interact. By approaching treatment through the lens of narrative medicine, she believes that physicians can better reimagine health systems into more equitable entities. In her pursuit of greater health equity, Mathieu identified two concepts that every physician should strive to possess: structural competency and critical consciousness. Structural competency, a term coined by her colleagues in an influential 2014 paper, proposes a model of patient engagement that goes beyond the realm of cultural awareness and further into understanding upstream, systemic issues such as zoning laws, food delivery systems, and health insurance. Critical consciousness, the ability to recognize the inherent contradictions and inequities within society, complements the structural competency framework. By consistently engaging in critical reading and reasoning, future physicians will be better able to reflect on the “power, privilege, and the inequities embedded within social relationships”.
While Mathieu recognized the power of narrative medicine, she also acknowledged how poetry has never had its proper place within the prose-heavy field. In her eyes, however, incorporating poetry into narrative medicine frameworks makes a lot of sense. For one, it allows a deeper level of vulnerability and dynamicity that literary fiction and theory cannot provide. More practically, however, poetry tends to err on the shorter side of literature (Mathieu calls them “multisensory micro-stories”), offering a less time-consuming alternative for busy medical students and residents.
For most of Mathieu’s life, her passion for poetry and medicine developed on parallel tracks. It wasn’t until her undergraduate years that she began to think of poetry more externally and started to seek out opportunities for publication. Around the same time, through her work in various global health initiatives, she witnessed the power words and policy can possess over the healthcare needs of entire populations. She identified a need for a humanities education, replete with poetry and theory and fiction, as critical to increasing equity within the healthcare system. When Mathieu assumed her latest role at UVA, on the eve of publishing her third poetry collection, the critically acclaimed Grand Marronage, she was given the opportunity to integrate her poetry within the university medical curriculum. Today, Mathieu has a secondary appointment as Assistant Director of the Program in Health Humanities at UVA’s Center for Health Humanities and Ethics. The parallel pathways of her life had converged.
As Mathieu revealed during her presentation, much of her poetry has little to do with her daily medical practice. Rather, she views poetry more along the lines of an escape. This escape takes the form of a critical reflection, by connecting the quotidian with themes of family and love, excess and presence. Mathieu’s poetry has the rare ability to walk readers through her complete narrative process, from the barest of sensory details to the ambiguities of emotion.
Perhaps there is no more fitting an ending to this article than an invitation to join Mathieu’s narrative world. After all, no amount of prose can substitute for a real poem. Below is a particularly striking excerpt of Mathieu’s artistry from the first stanza of her poem, “the forest fire of family trees”:
the problem is we don't know that many ways of doing things for instance, neither of us can fry an egg without public radio chattering in our ears, & there are worse blueprints for a home, like what my grandfather taught my uncle. we think we know people until we see the way they eat a banana, totally unlike how we peel and devour the fruit, only instead of eating a banana it's something way bigger, like loving another person.
