The Gift of Stories

Last year, I shared a story about what I’d like to call a healthy degree of precocious curiosity about the human body and what my parents refer to as an inexplicable amount of craziness that led me to voluntarily staple my tongue. That courageous and completely unnecessary self-inflicted surgical procedure has left me with a permanent scar on my tongue. This unusual accumulation of granulation tissue on my tongue is now not only an interesting anatomical and histological finding, but represents the story of a “unique” phase in my life.

As I studied anatomy last year, your loved one, my very first patient, shared innumerable stories with me. Each lab session was filled with incredible medical discoveries. Muscles, nerves, and blood vessels are all logically arranged to accommodate our daily actions and behaviors. The mighty organs throughout our body are carefully protected by bone and layers of tissue. And individual body systems, like the eye, operate with an awe-inspiring amount of coordinated refinement. The smartest engineers and most brilliant architects may be able to create an equally powerful human body with various updates and improvements, but they will never be able to surpass the exquisite original because the artificially constructed designs cannot capture the exceptional narratives of your loved ones.

Your gift to me was much more than a gift of medical discovery because you have given me the privilege of being a part of your favorite stories about your loved ones. The slightly enlarged triceps and biceps of the right arm that we studied during our musculoskeletal sequence illuminate a possible vigorous tennis career. I bet his tennis serves were dramatic and the lightness of his feet meant he also had an unbeatable net game. The beautifully tapered fingernails that we delicately worked around as we studied the intricacies of the hand echo elegant dinner parties. Did she have a string of pearls that always added an extra touch of grace to her favorite blue dress? The clarity of the lungs that gleamed at us the first time we were able to take a look at the thoracic cavity give hints about a love for the great outdoors. Hiking, fishing, hunting, it’s likely that he did it all, but his favorite thing to do was probably taking the family out camping, right?

The most remarkable aspect about your gift is that it is a boundless gift that continues giving. This summer, I had the fortune of traveling to Ghana to conduct research. Since I’m still in the preclinical phase of my medical education, I jumped at every opportunity to shadow doctors, sit in on procedures, and interact with patients. I brought your loved one with me wherever I went. If I needed to take a pulse, I’d quickly locate the radial artery. While watching a hernia repair, I’d almost instantly recall the contents of the inguinal canal. Where is the anesthetic injected for spinal anesthesia? That’s right. The subarachnoid space. Every single time, I instinctively made correlations to what was in front of me to my first patient. Did you ever think that your loved one would have the opportunity to travel across the Atlantic Ocean to Ghana? And I’m just a second year medical student whose career in medicine is only just beginning. The stories of your loved ones will travel even farther and will touch more patients than you could ever imagine.

My first year of medical school was defined by the time I spent in anatomy. I spent hours probing through various anatomical structures and yet I feel like I only scratched the surface in my pursuit of medical scholarship. But what I did learn during those hours in anatomy lab, as I slowly built an intimate rapport with my first patient, was the invaluable lesson of the joy and fulfillment gained through listening to the stories of every bump, kink, and scar. It is the magnetic draw for these patient narratives that led me to inevitably mature from the dangerous narratives of attempting surgical procedures on myself to attending medical school and working towards becoming a doctor. Your special gift, my first patient narrative, is one that will always stay with me as I continue to learn and never stop listening. Thank you.


Delivered at the University of Michigan Medical School Anatomical Donations Memorial Service (Sept. 15, 2010)

The first IHI Open School advanced case study

A few months ago, a 29-year-old woman was living independently in a small suburb in the southwestern United States. She enjoyed cooking for friends and playing her guitar. Today, she's been admitted to a nursing home because she can no longer care for herself. What happened?

Two weeks from now, students and residents all over the world will gather in interprofessional teams and analyze the complex series of events that ended up harming this patient. They'll also design an improvement project that could help prevent similar problems from happening to other patients in the future.

Want to participate? Here's how the IHI Open School's very first advanced case study event will work.

• Visit the advanced case study page and download the instructions.
• Form a team. Teams can consist of 2-12 people and must represent at least two professions. Residents and students from a broad range of fields, including nursing, business, pharmacy, medicine, law, policy, engineering, public health, and related fields, are encouraged to participate. If you need teammates, find them on our Facebook page.
• Register your team by Friday, October 1st. Registration is capped at 25 teams, so register early! (Registration is open now.)
• Download the case from the IHI Open School home page on Thursday, September 30th. You'll have two weeks to work on it with your team.
• Email your team's presentation to openschool@ihi.org by Thursday, October 14th.
• Selected teams will present their work to IHI faculty in a series of live webinars the week of October 25th-29th. Teams will be notified by October 20th about whether they will be invited to present.

We are really excited about this case study event. It's a chance to flex your knowledge of safety and patient-centered care, lead system improvement, practice your teamwork skills across professions -- AND get feedback from the experts at IHI.

We hope you'll form a team and sign up! If you have questions, leave a comment or email openschool@ihi.org.

Costs of Care Essay Contest!

Medical bills are a leading cause of personal bankruptcy and health care providers decide what goes on the bill.

According to the Congressional Budget Office, the United States spends $700 billion dollars each year on tests and treatments that do not measurably improve health outcomes--a figure comparable to our total spending on the Iraq War. And here is where things become truly awkward: few providers understand how the decisions they make impact what patients pay for care.

Let's recap. Medical bills are bankrupting Americans, providers decide what goes on the bill ($700 billion dollars of which might not need to be there), and providers rarely have information about what things cost. That seems like something we ought to fix, doesn't it?

If you agree and have a story to tell about it, there could be $1000 in it for you. Remember a time you got a medical bill that was higher than you expected it to be? Or a time when you wanted to know how much a test or treatment might cost and couldn't find out? Costs of Care, a Boston-based nonprofit, is offering $1000 for short anecdotes illustrating the importance of cost awareness in medicine. We want to hear your story.

The submissions will be judged by a high profile crew of policymakers, doctors, and journalists that include Atul Gawande, Michael Dukakis, Jeffrey Flier, Michael Leavitt, and Tim Johnson. Submissions will be due by November 1st to contest@costsofcare.org. Additional details are available at www.costsofcare.org/essay

Dr. Neel Shah is the executive director of www.CostsOfCare.org, and a resident in Obstetrics and Gynecology at Brigham & Women's Hospital in Boston.