MD or IMDB?
Google “Dr. Yvette Lu British Columbia” and in 0.38 seconds you’ll get her family practice, her RateMDs.com rankings, LinkedIn profile, Wikipedia entry, personal website, and of course her Internet Movie Database (IMDb) profile. Wait… her what?
Three days a week, she’s mild-mannered Dr. Lu, family physician in the Surrey-based practice she shares with her mom. Diminutive and soft-spoken, Lu exudes a gentleness and warmth that any patient would respond to, and is as attentive and she is articulate. But ask about that “interest in acting and performance” listed on her CV below her medical experience and awards, and she’ll transform before your eyes. She has a superpower, you see.
Actor, director, producer, composer… Lu’s artistic accomplishments are as extensive as her medical ones. Food for the Gods (Vancouver Asian Film Festival) and Alive and Kicking (Near Enemy Film Festival award winner) are titles you might recognize. She has even been cast as (you guessed it) a doctor.
Will the Real Yvette Lu Please Stand Up?
It’s generally understood that there is no more rigorous undergraduate training than that of medical school, and few fields more difficult to break into than that of acting. Lu has succeeded at both. How?
“In medicine I need to listen well, to communicate, to have empathy and compassion,” says Lu. “And all those things are so important in acting as well. Being an actor makes me a better doctor and a better person.”
Fifty percent of the North American population is dealing with at least one chronic illness.
Her dual professions have woven themselves through the whole of her life. Lu grew up immersed in books and listening to her grandmother’s traditional Chinese stories. Active in theatre every summer during medical school at UBC, Lu chose to write her final research paper as a play. Stories from the Closet: A Play About Living with Chronic Illness is described on Lu’s website as “a young woman’s fantastical odyssey into the world of hospitals, doctors, and illness.” The young woman is a composite of three female subjects Lu interviewed, and the play is a series of 10 monologues delivered by a solo performer. Six years on, Lu is still regularly asked to perform it for doctors, medical students, and patients and their families, because it gives voice to a silent story that is becoming ever more prevalent.
Fifty percent of the North American population is dealing with at least one chronic illness. Ambiguity about everything from onset and cause to impact and treatment can lead to a profound loss of one’s sense of self. Lu found through her research that “coming out” as a person with illness mirrors coming out as a queer person in a surprising number of ways, and her title reflects that. The subtitle is equally significant. Living – especially living well – with a chronic illness requires that a person create a new meaning for their life. Human beings create and ascribe meaning by telling stories, and it was out of recognition of the power of storytelling to create meaning from illness that the field of narrative medicine emerged.
The Doctor’s Story
“On average, physicians interrupt patients within eighteen seconds of when they begin telling their story.” So writes Jerome Groopman in How Doctors Think, the book Yvette Lu is reading at the time of her conversation with Trek. Recanati chair of Medicine at Harvard Medical School, Groopman quotes a colleague as saying, “I believe that technology… has taken us away from the patient’s story. And once you remove yourself from the patient’s story, you no longer are truly a doctor.”
Strong words. They are both commentary on, and cry for help from, today’s medical professionals in response to unsustainable pressures. Doctors have long recognized that the practice of medicine is as much art as science, and now, in an elegant backlash against the commodifying effects of modern health care, doctors and medical schools are returning to story.
Dr. Rita Charon is a physician, author, and literary scholar, and the founder and executive director of the Program in Narrative Medicine at Columbia University. She coined the term narrative medicine in 2001 and defines it as “medicine practiced by someone who knows what to do with stories.” Still in its infancy, narrative medicine boasts few hard studies that demonstrate its efficacy as either a diagnostic or healing tool. But there is an implicit understanding that it is offering something necessary: over 50 per cent of North American medical schools now include some form of narrative medicine training in their curricula. UBC introduces medical students to narrative medicine in their first year by inviting Lu to speak to the Doctor, Patient and Society class. Lu steps up to the podium, no notes in her hands, no lecture to give, and begins to perform Stories from the Closet.
To Bear Their Patients’ Suffering
The Student’s Story
“It was amazing,” says Alvin Ip of Yu’s performance. Ip is a first-year medical student at UBC and a volunteer with the Richmond Centre for Disability. “At the end, I felt like I knew someone inside and out… her feelings, ideas, needs, and expectations. [It] reminded me of how important it is to not only treat the disease, but also comfort… the patient.”
Fellow first year Michelle Chiu agrees. A volunteer with Canuck Place Children’s Hospice, Chiu says, “Yvette’s play gave us a glimpse into the impact of chronic illness [and] provided me with valuable insights that I will bring to my patients.” She adds that “studies have shown a marked decrease in empathy as students progress [in] their training. I believe that [narrative medicine] techniques are effective in countering this.”
A quick Internet search for “medical student empathy decline” produces 210,000 results. Chiu isn’t kidding. Explanations include medical schools’ emphasis on clinical detachment and on technology; a lack of empathetic role models; an encouragement of elitism; and institutional focus on research over teaching. And then there’s the curriculum itself. At UBC, it includes 12 medicine-based courses in the first two years as well as five practice‑focused courses each year; 10 specialty rotations in third year; and a year of clinical practice. Students who find stress more prohibitive than motivating may shut down emotionally in order to cope.
In a 2004 New York Times article entitled “The Writing Cure,” Melanie Thernstrom says, “Medical students are so flooded by feelings they have no time to examine or process that a significant proportion are thought to be suffering from post-traumatic stress disorder.” What narrative medicine allows is that opportunity for examination and processing. Medical schools that have incorporated its techniques into their curricula might offer opportunities for students to analyze literature; to write a book about a patient and his illness over the course of a year; or to keep “parallel charts,” records of their own feelings about and responses to their patients. It is, as Jerome Groopman at Harvard says, the responsibility of medical schools to develop in young physicians “the ability to bear their patients’ suffering.”
When Has It Been Hard?
The Patient’s Story
Hard. It’s almost a funny question. I don’t even know where to begin.
It’s hard when you don’t know what’s going on… when you know something’s wrong but nobody believes you… And then it’s hard when they do find something. Then you have to face it. And even though at that point you don’t really know what you’re in for yet, you know something has changed and that now you’re sick. It’s grief. I’m being dramatic, I know, but it feels like a part of me died before it had a chance to live. I had a plan and then – [makes a noise like a bomb exploding]…
It gets better. Eventually, you put the pieces back together into something new. It’s not what it was before, but it works, and it may even be better than what it was. But it doesn’t go away.
(Excerpt from Stories from the Closet — copyright Yvette Lu)
Yvette Lu allows time after each public performance for people to speak with her – and they do. “People have said to me, ‘this is my life. This is exactly how it feels,’” she says. “When I hear that, it reminds me that this is really important.” Asked about the reactions of her research subjects, the three women on whose experiences she based the play, Lu replies, “They haven’t seen it!” She tries to explain: “Part of [why I wrote] it is for people who are ill and really isolated. Part is for family and friends so they know what their loved one is going through. And part is for doctors. But for people who are very much struggling, it might not be the right time to see it.”
The patient doesn’t need to see the play; she’s living it. She needs you to see the play. To the extent that telling one’s story may be healing, it is so because someone else is willing to bear witness to it in all of its ungainly, painful detail. There are times in our lives when we are able to bear witness to our own suffering; there are other, overwhelming times when we require the grace of another who is prepared to fulfill that role. Narrative medicine is about preparing young doctors to do so for their patients.
“You don’t just use stories and you don’t just use science,” Lu says of narrative medicine. “It’s how they work together, how they interface. People in all areas are realizing you have to look at the interface. That’s where the exciting things are happening! We come from a storytelling culture, and stories can only help us.”