By Dave Hart
IN ONE CORNER OF THE SIXTH FLOOR of the Trent Semans Center stands a small structure, like a voting booth, entirely draped in blue fabric. Open the flap and step inside, and you find yourself— a real-time video of your own face plays on a screen in front of you. Upon that is superimposed an interactive image of a brain scan that journeys through the various layers of the brain as you move your head forward and back. It’s when you put on the headphones that the experience becomes truly unnerving. Voices — guttural, derisive, mocking, — whisper insistently. Some are too vague to make out. Others are clearer, thick with contempt. “You’re stupid, so stupid…pointless…disgusting,” one murmurs. “She knows,” warns another. “They all know. They see you…” Most people flee after a minute or two. People with the auditory hallucinations that sometimes accompany schizophrenia don’t have that option, says Lauren Sweet, the second-year medical student who conceived and constructed the interactive art installation.
“I tried to make a construct of auditory hallucinations,” says Sweet. “Here, you experience it only as long as you choose to. For people who have these hallucinations as a result of mental illness, there is no escape. I hope it will help people think about how disabling mental illness can be.”
Sweet created the piece as part of the first annual Scopes Medicine and Art Exhibition, a new initiative that invites first-year medical students to use artistic media to reflect on their experience working with a community partner who has a chronic health condition.
All first-year students participate in the community partner program, an adjunct to the clinical skills curriculum. Each student meets several times over the course of the year with their community partner, and, traditionally, then writes an essay reflecting on the experience. The Scopes exhibition, which opened with a reception at the Trent Semans Center in August, offers an alternative to the essay requirement and, more importantly, represents an effort to integrate the arts and humanities into medical education.
“There’s a desire among a lot of people to do more to bridge the health care side at Duke with the humanities and arts,” says Maya Talbott, who conceived and organized the Scopes program along with fellow third-year medical students Leonid Aksenov and Ashley Adams. “The goal of the community partner program is to foster the patient-practitioner relationship and help students understand the experience of living with chronic disease. After doing that and writing the traditional essay, we thought it would an interesting idea to offer the option of another approach.”
Seeing Patients as People
Sweet, whose community partner had schizophrenia, was one of seven students who embraced the new opportunity.
“Initially I thought, ‘Well, that should be easier than writing an essay,’” Sweet says. “Wrong.”
Alex Hish had no such illusions. He wrote and presented three poems based on his meetings with his community partner, a man named Ned Arnett, who, it turned out, also writes poetry. Arnett even had several poems included in the exhibition.
“It is more work,” says Hish. “But I learned so much. It forced me to think harder about my community partner and to observe more deeply. It gets at the parts of the experience that you don’t necessarily get in the day-to-day workings of medicine. It’s about what’s going on in his mind more than what’s going on in his body.”
Shan McBurney-Lin also worked with Arnett and wrote poetry for the exhibition. Art requires close observation and empathy, she says, and developing those skills is essential in the practice of medicine.
“At the end of the day, what people want is to feel respected, listened to, and cared for,” says McBurney-Lin. “They want to feel like they matter as individuals. I think programs like this can encourage that.”
Charis Spears wrote and performed an original song, Invisible Injury, based on her community partner’s experience with brain trauma. She tried to express her partner’s determination to be seen not as someone who was ill, but as someone in the process of healing.
“I went into medicine because I love people,” says Spears. “It was so meaningful for me to try to understand her experience through her eyes. I hope that as I go forward, I will always think about patients as deeply as I thought about her and her story. I hope I always think of them as whole people, with their own backgrounds, families, and life experiences.”
Safa Kaleem’s acrylic landscape, Path to the Sea, serves as a metaphorical exploration of her community partner’s experience living with Crohn’s disease. Every element in the painting reflects an aspect of that experience: the cobblestone path resembles the cobbled look the disease produces on the lining of the intestine; trees in both spring and fall foliage symbolize the omnipresence of the disease over many years; and the ocean in the distance echoes her community partner’s love of the sea.
“Her life is not an easy path—it has ups and downs and obstructions—but it’s still a beautiful path,” Kaleem says. “I loved getting to know her. She’s a profound inspiration, and this entire experience is going to help me keep in mind that every patient we see isn’t just a set of data or symptoms, but an individual human being. Every single person has a story worth telling, and worth hearing.”
Another Form of Healing
That awareness is one of the important benefits of incorporating artistic and humanistic elements into health care, says John Moses, MD, an associate professor of pediatrics and one of several faculty mentors who advised the students. Moses is a documentary photographer who teaches photography at the Duke Center for Documentary Studies and founded Documenting Medicine at Duke University, a multimedia program that encourages the use of documentary to explore medical issues.
“Using art, photography, and other media helps the practitioner develop the skills and understand the importance of listening, observing, and being with patients,” says Moses. “It’s not a trivial thing, but a fundamental part of good medicine. Patients’ stories often communicate important information that you can’t get otherwise. We have ever-more elaborate tests, but even the best tests can only tell you so much. Even when we can look at a patient’s whole genome, we’ll still need to talk to them about their lives and experiences.”
Sarah Alkilany, who created a screen print installation piece called Stages for the Scopes exhibition, says that connection can lead to more trust and openness between patient and practitioner. She incorporated her community partner’s Hindu faith into Stages in various ways, from its circular path—reflecting the Hindu belief in the cyclical nature of life—to the Om spiritual symbol that recurs throughout the piece.
“If you resonate with someone on a level beyond the data and studies, they tend to listen more closely and be more open to your ideas,” Alkilany says. “I’ve had doctors who took labs but didn’t make any effort to listen to me. I’ve had others who took the time to consider what was going on within the larger scope of my life. They might even suggest the same course of action, but I’m probably going to be more receptive to the second one.”
The humanities and artistic expression can also help health care practitioners deal with the stresses of the field, says Sruti Pisharody, whose series of photographs offer poignant glimpses of her community partner’s life dealing with various infirmities of aging.
“As we learn to be doctors, it’s wonderful to learn to deal with patients through a different lens,” says Pisharody. “This may be a less scientific form of healing, but it’s still healing. And it’s also therapeutic for the practitioner. Although medical schools, including Duke, have started to talk more about issues like physician burnout, there aren’t generally many solutions offered to help us build resilience. The humanities aren’t built into the medical curriculum, but a lot of us have our own artistic outlets that help us deal with those issues. The Scopes project is a way for a number of us to begin to address that as a community.”
A sizable and enthusiastic crowd attended the reception and exhibition, which were made possible by generous support from the Trent Center for Bioethics, Humanities & History of Medicine and in partnership with the Center for Documentary Studies and the Franklin Humanities Institute.
The turnout, and the creativity shown by the participants, heartened the Scopes exhibition’s organizers and offered a bright way forward as the program moves into its second year.
“We’ve gotten great feedback,” says co-organizer Leonid Aksenov. “We want to build on this and expand it in the future. The students told us this experience opened up new avenues of understanding, which is exactly what we were hoping. And in terms of what they’ve produced, wow. They have exceeded my wildest dreams.”