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Arachnoid Mater


unforgettable but



a single sanguine sample

declares its delinquency

    dolor rubor

       the fulmination inside her head

           crimson crawling along her silken web

             wracking nerves

           a family waits, wonders, and bargains

    inside, strangers purport to understand

humans and their humours they hope

anatomy, capricious as it is, will now

permit them entry

anaesthesia standing by, Neith reminds them yet again

      a moment astray and the web is unwound

          they bate their breaths so that she may breathe

Competing interests

None declared.

Provenance and peer review

Not commissioned; internally peer reviewed.



A fullness in the neck,

a slight fluttering of the heart,

a warmness of the skin.

No need for coats or heating.

And then the crescendo of the flutterings,

all goes quiet with the feeling of being

removed and disconnected from the body.

All energy seeped out now.

The pill is swallowed and abstinence follows.

And gradually, the crescendos lessen;

we are now in the second movement of this concerto,

diminuendo or andante perhaps?

Further visits for the jelly but the nemesis remains,

hidden from the waves. Beware the silence now,

as the flutterings may return at any time

with renewed vigour. Be vigilant for vivace

as andante may not last forever.

Will this concerto ever end?

Competing interests

None declared.

Provenance and peer review

Not commissioned; internally peer reviewed.

Pillow talk


"The parents of my 28-week preemie twins stopped me in the garage".

He broke the sleepy and blissful silence.

She knew it would be another sad story.

"They pleaded with me to decide which one to let go, for lack of money".

"Mom-and-wife-drowning-at-the-same-time situation?"

"Yep, a close contest".

Yet, this time, the dreadful question was not asked by the jealous wife,

but by a poverty-stricken couple,

who believed that he could save the day, as he had done before.

But they never knew their

helplessness, desperation, trust, artlessness, or whatever,

were drowning another human soul alive.


Jiena Sun received her PhD in American Contemporary Literature, with a special focus on physician writers, from SUNY-Binghamton in 2012. She is an associate professor in the English Department of Wuhan University, PR China. She has published in Medical Humanities, Interdisciplinary Literary Studies and other Chinese journals. Her dissertation...

Bedside manner


Then there came a time

when my body was set free

by the lost memory

of my mother's loving eyes,

my body set free

to glide high riding

impossibly silent

flowing snowy slopes,

my body set free

to slide skinny

slip-stream strokes through

black and frigid crater lakes.

Set free by a memory

or was it just

wishful thinking

and not a lost memory at all,

not lost like the riding

and sliding.

So now here I lie

convinced that I

am ready to die,

quivering butterfly wings

pinned to crisp white linens.

Here you come now

to my side,

a newborn's cry

meeting mother


What is this gift that

you ask of precious me

like a beggar

kneeling beside my bed

holding my hand

you say

I love you

and I will stay here with you.

Competing interests


Provenance and peer review


White coat


Its feigned objectivity

crisply ironed with the cost of ignorance.


by the wearer's lack of intention.

Far from pure ––

with calculated aloofness.

How soon it forgets,

though rarely forgives

our shared history.

Priding the consumer's need

in its sustenance and power.

Its fabric no longer delicately woven

from dreams of multicolored shepherds

set free,

seeking to heal.

Now mass produced,

fit to provide

for an economy of its kind.

Forgetting that without you,

I am not.

May wrinkles and stains fall upon it,

graceful reminders of its truth.

Competing interests

None declared.

Provenance and peer review

Not commissioned; internally peer reviewed.



A whimsical bark to start,

a slight whistle accompanies,

a burning in the windpipe.

No respecter of Morpheus.

The barks continue as paroxysms,

Becoming more and more frequent,

Poco a poco crescendo

Until all goes quiet

A feeling of eerie hiatus

The pills are swallowed.

The paroxysms eventually begin to dwindle;

But not before another crescendo;

Will it ever end?

The nemetic flute returns,

leader of the orchestra. Beware any silence now,

as Morpheus may never return.

The paroxysms finally pass,

time for Morpheus to return now;

the flute and orchestra take their leave

The opus has concluded.

I suffered from pertussis pneumonia. The symptoms were unpredictable, uncontrollable at times and frightening taking several weeks to subside despite antibiotics. I wrote the poem "paroxysms" after one attack of whooping at night. Dr Medford lives and works as a respiratory consultant in Bristol, UK.


Chief complaint: "He predicts earthquakes"


Everyone working there, except the pediatrician, spoke two or more languages.

For each young patient, staff would crystallize the medical issue, a terse "chief complaint,"

using the parents' own words, on why they were bothering to see a Western doctor,

even when the children didn't, wouldn't or couldn't complain for themselves.

It's a parent's concern, via a native vernacular, through an interpreter's ear,

twisted with some medical phrasing, a flashing linguistic triple flip,

leaving the doctor to decipher the situation for clinical intervention,

one further contortion in the tumbling run, with the full expectation of a two footed landing.

And this young one predicted earthquakes. Taller and chubbier than expected,

the child hovered outside the door, apparently shy about entering the exam room,

already crowded with adults: his mother, an aunt, an interpreter and a doctor.

He reportedly described earthquakes often; his uncanny timing with the...

Handsome cat


Cocooned in her blanket

She asks again

If I've seen the kitten's photo

Framed at her bedside

He's a big tabby now

And you should see his markings

You should see him now

He is such a handsome cat

All alone in a four bed ward

Her youth stolen by tainted blood

Now cancer invades her

All alone, no one visits

Oncology promised to assess her

No notes in the chart

They haven't come

We remind them once again

With each day

Her will drains

She barely eats

And it grows

Twice more

We do our dance

As her walker gathers dust

As hope fades

Have you seen him?

You should see him now

You should see his markings

He's such a handsome cat

Competing interests

None declared.

Provenance and peer review

Not commissioned; internally peer reviewed.



Before there was red, there was orange.

A generation of quiet that lived pale by comparison,

the 1950s were muted.

Dramatics were hidden.

Mystery was timeless.

The frenetic was only for youth.

Orange was a presence that shot straight from elastic into a future that hoped for heaven.

Into living room rugs and 70’s furniture,

an intensity took its place.

Orange was not enough.

Its colour, faded. Its ambition, muddled.

Its pallor, too tarnished to blush.

In a stratagem to overthrow what was once alive and above,

a new generation took place.

"Mom, it’s not a retirement home, it’s a village.

A community. A life of recumbent safety"

Competing interests

None declared.

Provenance and peer review

Not commissioned; internally peer reviewed.

On Amyloid Protein


I watch your eyes tracing my face.

Furrowed brows suggest blurred image.

Slow, slow, not in haste—

Mine is a forgotten visage,

Erased like tales of the village,

You fondly shared, from where you came.

I watch your eyes tracing my face,

And pray you will recall my name.

Your calloused hands will think of mine:

"We have held these some other place!"

The embers of your past will flame—

And I will hear and help to heal,

Waiting for signal or for sign.

Slow, slow, with hands to feel—

As I carry onward, blind,

Hoping that which I seek, I find.

Competing interests

None declared.

Provenance and peer review

Not commissioned; internally peer reviewed.



My telomeres are endless,

Nanobots course through my blood,

Not a cyborg,

No 3D-printer organ curiosities,

Evolution speculation,


On ethical dunes that scatter and reform,

Tenuous bindings from your unenlightened age,

Your history leads to me,

You wanted me,

Yearned for me.

Know all you create,

I am You,

   A creator,

      A destroyer,

         In perpetua.

Competing interests

None declared.

Provenance and peer review

Not commissioned; internally peer reviewed.

Tonio: Telling Time


What did he already know, straddling his mother’s broad lap,

hiding his face, listening at our halting and stuttering and murmuring babble,

the nonsensical sounds of statistics and ‘choices’ rushing like noise,

perplexing his parents past their own understanding,

shifting from one leg to the other, unfathomed,

watching the waters well up around him, then spill,

Of the future, for the first time foreseen,

far from the red-and-blue striped swingsets

and the ants and the pebbles at the playground,

far from the bright candy wrappers at the deli,

and his mother’s silken neck, where he loved to rub his hot cheek?

Tonio turned, eyes wide, cried and clung a while,

his tears obscuring the flood of our own fears.

Slowly the quietness of the small room returned.

He had spied the box of silly, tattered toys;

he wanted them, right now, endearing just for the present,


New way of seeing


The cover of our September issue features a detail from Jacques Fabien Gautier d’Agoty’s Mylologie complette. I have had the good fortune to see many of Gautier’s works at the Dittrick Museum of Medical History, and the even better luck of teaching courses through their use. The students might read Frankenstein (a work preparing to celebrate its 200th birthday), and they might see anatomies of the body online, or listen to me speak at length about the value of early anatomists to the medical future. But it wasn’t until our hands-on class, where white-gloved students could see the highly coloured Gautier in person, that the message became clear. One of the anatomies displays the body in full, high colour, still deeply penetrating—and seven feet in length. The hushed whisper around the room: it’s a person, isn’t it? The body, only yet in two-dimensions, became real.

This is a colourful...

The ghost of pandemics past: revisiting two centuries of influenza in Sweden


Previous influenza pandemics are usually invoked in pandemic preparedness planning without a thorough analysis of the events surrounding them, what has been called the ‘configuration’ of epidemics. Historic pandemics are instead used to contrast them to the novelty of the coming imagined plague or as fear of a ghost-like repetition of the past. This view of pandemics is guided by a biomedical framework that is ahistorical and reductionist. The meaning of ‘pandemic’ influenza is in fact highly ambiguous in its partitioning of pandemic and seasonal influenza. The past 200 years of influenza epidemics in Sweden are examined with a special focus on key social structures—households, schools, transportations and the military. These are shown to have influenced the progression of influenza pandemics. Prevailing beliefs around influenza pandemics have also profoundly influenced intervention strategies. Measuring long-term trends in pandemic severity is problematic because pandemics are non-linear events where the conditions surrounding them constantly change. However, in a linearised view, the Spanish flu can be seen to represent a historical turning point and the H1N1 2009 pandemic not as an outlier, but following a 100-year trend of decreasing severity. Integrating seasonal and pandemic influenza, and adopting an ecosocial stance can deepen our understanding and bring the ghost-like pandemic past to life.

From Face/Off to the face race: the case of Isabelle Dinoire and the future of the face transplant


Isabelle Dinoire, the world's first face transplant recipient has died, 11 years after the procedure that brought her unwanted fame and media attention. While medical debates centre mainly on ethical and medical concerns like immunosuppressant use, the psychological hazards of face transplants are still being overlooked. Using medical and media reports and examining the gendering of clinical and patient narratives, this article argues we need to look again at face transplants and their motivation for individuals as well as society.

A comparative study of cognitive behavioural therapy and shared reading for chronic pain


The case for psychosocial interventions in relation to chronic pain, one of the most common health issues in contemporary healthcare, is well-established as a means of managing the emotional and psychological difficulties experienced by sufferers. Using mixed methods, this study compared a standard therapy for chronic pain, cognitive behavioural therapy (CBT), with a specific literature-based intervention, shared reading (SR) developed by national charity, The Reader. A 5-week CBT group and a 22-week SR group for patients with chronic pain ran in parallel, with CBT group members joining the SR group after the completion of CBT. In addition to self-report measures of positive and negative affect before and after each experience of the intervention, the 10 participants kept twice-daily (12-hourly) pain and emotion diaries. Qualitative data were gathered via literary-linguistic analysis of audio/video-recordings and transcriptions of the CBT and SR sessions and video-assisted individual qualitative interviews with participants. Qualitative evidence indicates SR's potential as an alternative or long-term follow-up or adjunct to CBT in bringing into conscious awareness areas of emotional pain otherwise passively suffered by patients with chronic pain. In addition, quantitative analysis, albeit of limited pilot data, indicated possible improvements in mood/pain for up to 2 days following SR. Both findings lay the basis for future research involving a larger sample size.

Bioethics and imagination: towards a narrative bioethics committed to social action and justice


Recently, the involvement of various authors coming from the social sciences and the arts has reinforced the humanistic component of bioethics. Their contributions vary from very theoretical perspectives to rather practical ones. In this paper, Martha Nussbaum's books, The Fragility of Goodness (1986), Love's Knowledge (1990), Cultivating Humanity (1997) and Creating Capabilities (2011) are analysed from the vantage point of narrative bioethics. It is argued that Nussbaum's notions of ‘Narrative’, ‘Imagination’ and ‘Cultivation’ open up the possibility of developing an action-oriented form of narrative bioethics, that is, a bioethics committed to social action and justice.

A deep ethics for mental difference and disability: the 'case of Vincent van Gogh


Despite a growing prevalence of mental illness diagnoses and treatments, there remains remarkable interpretive diversity regarding the meaning of these diagnoses and their implication for mental healthcare. Humanities scholarship devoted to language, power and ethical cares of the self provides invaluable tools for navigating interpretive diversity in this domain. This scholarship suggests that ethical questions of informed consent regarding mental difference and disability go much deeper than the usual standards. Ethical questions of informed consent go back to the very language choices people use to narrate and navigate the mental difference or disability. Making these ethical choices between different ways of understanding psychic difference is fundamentally about making narrative and lifestyle choices. This article considers these issues in the context of the many interpretations of Vincent van Gogh's life and their ongoing relevance for contemporary approaches to mental difference and disability.

Narrative empathy and illness memoirs: Arthur Frank's At the Will of the Body and Kathlyn Conway's Ordinary Life


This article analyses the concept of narrative empathy in illness memoirs. These texts negotiate the narrative identity of an autobiographer as he or she recounts the disruptive experience of illness, an experience in which physical and emotional traces dramatically and definitively shape our sense of self. While narrative emotions are certainly deployed in these autobiographies in order to connect with the readers and promote social change, this empathic connection is not so much aimed at arousing compassion but rather more positive emotions on the experience of illness. I will explore the emotional representations of cancer in Arthur Frank's At the Will of the Body (1991) and Kathlyn Conway's Ordinary Life: A Memoir of Illness (1997), focusing on the identity strategies these authors use in order to become affirmative models of disability and illness, showing the damaging effects not of disease or impairment but, rather, of the cultural mythologies that interpret those conditions in reductive or disparaging ways.

'Deal with It. Name It: the diagnostic moment in film


The moment a serious diagnosis is announced creates an important crisis for a patient, as it shifts their sense of self and of their future potential. This essay discusses the creative representation and use of this diagnostic moment in film narratives. Using Still Alice, A Late Quartet, Wit and Cléo from 5 to 7 as examples, we describe how each of these uses the diagnostic moment in relation to narrative construction and characterisation in recognisable ways. We associate the diagnostic moment with certain narrative and visual devices that are frequently implemented in films as means for character development, and for managing the audience's empathy. This is the case whether or not the diagnosis is contested or accepted, and whether the diagnostic moment is the frame for the narrative, or a closing device. By analysing its representation in film, we emphasise the cultural significance of diagnosis as a life-transforming event.

The art of medicine: arts-based training in observation and mindfulness for fostering the empathic response in medical residents


Empathy is an essential attribute for medical professionals. Yet, evidence indicates that medical learners' empathy levels decline dramatically during medical school. Training in evidence-based observation and mindfulness has the potential to bolster the acquisition and demonstration of empathic behaviours for medical learners. In this prospective cohort study, we explore the impact of a course in arts-based visual literacy and mindfulness practice (Art of Seeing) on the empathic response of medical residents engaged in obstetrics and gynaecology and family medicine training. Following this multifaceted arts-based programme that integrates the facilitated viewing of art and dance, art-making, and mindfulness-based practices into a practitioner-patient context, 15 resident trainees completed the previously validated Interpersonal Reactivity Index, Compassion, and Mindfulness Scales. Fourteen participants also participated in semistructured interviews that probed their perceived impacts of the programme on their empathic clinical practice. The results indicated that programme participants improved in the Mindfulness Scale domains related to self-confidence and communication relative to a group of control participants following the arts-based programme. However, the majority of the psychometric measures did not reveal differences between groups over the duration of the programme. Importantly, thematic qualitative analysis of the interview data revealed that the programme had a positive impact on the participants' perceived empathy towards colleagues and patients and on the perception of personal and professional well-being. The study concludes that a multifaceted arts-based curriculum focusing on evidence-based observation and mindfulness is a useful tool in bolstering the empathic response, improving communication, and fostering professional well-being among medical residents.

Can narrative medicine education contribute to the delivery of compassionate care? A review of the literature



Narrative Medicine has emerged as a discipline from within the medical humanities1 and takes inspiration from philosophy, literature, poetry, art and social sciences theories. In particular, it is underpinned by philosophical approaches such as phenomenology, postmodernism and narratology, proposing that clinicians must attend to the lived experience of their patients and apply the science to the person.2 Meanwhile, the link between medicine and literature is evident in the growing volume of texts written about professionals', or lay people's experiences of illness and disease.3–8 In exploring this link further, Charon9 has contributed greatly to consolidate the theory of Narrative Medicine. She defines it as ‘medicine practiced with the narrative competencies to recognise, absorb, interpret and be moved by the stories of illness’.9 She suggests that, in exploring texts...

I cut therefore I am? Avoiding labels in the context of self-injury


Non-suicidal self-injury (NSSI) represents a critical global health concern. While our understanding of NSSI has evolved dramatically over past two decades,1 the language used to refer to those who self-injure has not. Terms such as self-injurer and self-harmer continue to be used throughout the empirical literature2 and likely in clinical settings. From a humanistic standpoint, these referents may perpetuate unhelpful discourses and exacerbate the stigma that many individuals already experience by labelling and ostensibly equating them with the behaviour enacted. Indeed, guidelines have been offered to improve and offer a more socially judicious nomenclature when referring to those who experience mental health difficulties (eg, avoiding terms such as schizophrenic). However, the use of self-injurer or self-harmer fail cohere with such efforts. Clinically, these terms may be inadequate and impractical in the sense that they seemingly connote similarity across individuals who self-injure by grouping them together....

Wandering the hallways of my mind.: Reflections of a demented person.


Wandering the hallways of my mind.

I am lost.


Familiarity and mystery lie waiting around every corner. But which corner?


Shadows of a face I once knew so well,

Figures shrouded in the mists of time,

Fading beyond the reach of an outstretched arm.


The soft patter of little feet,

The gentle curve of a reluctant smile,

The warm tears of unkind years,


Wandering the hallways of my mind.




Competing interests

None declared.

Provenance and peer review

Not commissioned; internally peer reviewed.



Who writes the script

and sets in motion the

interdependent dialogue?

It cannot be unwritten

until eyelids close.

Who authors the script?

It cannot be monographic.

The bard's hand should be writing

carefully, coveting

the lines of the patient speaker.

This script is rewritten

every 30 days or more, and

our small cast replays it:

agonist and receptor,

and spectator.

There's no stage, and still I hear

footlit steps—moored depressors—

here and there

a grain of sand

in skittish undertow.

Competing interests

None declared.

Provenance and peer review

Not commissioned; internally peer reviewed.