Monday, April 19, 2010 • 12:00 AM Comments ()

Literature in the VA

posted by Gregory Fahy

I have been a facilitator for Literature & Medicine discussions at the Togus Veterans Administration Hospital in Augusta, Maine for the past two years and have borne witness to some remarkable discussions. In my day job, I am a philosophy professor at the University of Maine at Augusta, but the Literature & Medicine program allows me to set aside the grading, assessment and reporting to focus on meaningful discussions with people who, in most cases, have worked in health care for over ten years. The group meets at 5:00 pm, once a month from January through May each year. I choose literature that tackles issues that they are addressing in their patients, from PTSD to sexual abuse of women soldiers, from dementia to mental illness, from end of life stories to disabilities. The short stories, biographies, poetry and novels are layered and rich enough for a nuanced discussion that can veer to touch on unexpected topics. We share a potluck dinner about half-way through our discussion and then continue on until 8:00 in the evening. I was initially skeptical that people who work full time at a VA hospital would be willing to stay an extra three hours on a weeknight to discuss literature. My skepticism was unwarranted; obviously people hunger to place their medical, technical and administrative work in a narrative context. We regularly have between 15-20 participants. They come from all areas of the hospital and all fields. We have physicians, nurses, staff, and administrators. I insist on informality—everyone is on a first name basis in the group; I am not Professor Fahy, but Greg.

Last year we read Linda Hogan’s novel People of the Whale. It is a story of a young Native American man, Thomas Witka, who has been psychologically scarred from his tour in Vietnam. He returns to his native village, but doesn’t feel completely at home. He participates in a whale hunt that forces him to re-evaluate his experiences of war. He searches for healing in his native spirituality and also in travel to the Vietnam Veterans Memorial in Washington DC, eventually finding a place of reconciliation. This year, we read Still Alice, a novel by Lisa Genova, Ph.D. Alice is a Harvard psychology professor who is diagnosed with early Alzheimer’s disease. The novel is told from her perspective as her disease progresses. Participants remarked that before reading the book, they had not been able to fully understand dementia from the perspective of the patient, that they could not put the book down, but also that they had difficulties in bearing witness to Alice’s struggles as Alzheimer’s consumes her mind.

I often pair poetry and short stories with these longer works. So, we read Donald Hall’s poem “Affirmation” along with Still Alice. It depicts the fleetingness and preciousness of experience. The last line reads, “Let us stifle under mud at the pond’s edge/ and affirm that it is fitting/ and delicious to lose everything.” In trying to come to terms with this line, we are also able to reframe the losses that Alice experiences.

I cannot provide specifics about discussions without violating our confidentiality rules and my participants’ trust. But I can say that some of the more memorable discussions for me involved discussants telling their own stories of patients or family members, illustrating how these very personal stories connected with what they read. It is impossible to remain unmoved in the face of these acknowledgements of loss and suffering. Other times, staff members talk about their own experiences in treating patients, their difficulties in coming to terms with patients with anger issues or diseases that cannot be healed. Often, discussions go silent. The best of the silences are not awkward struggles to find something to say, but rather recognitions that something revelatory has been shared and that this needs to be honored with silence.

Because there is a diversity of perspectives around our table– we have representatives from all political, social, and economic perspectives– respect and trust is critical for our discussions. Participants need to feel free to express their vulnerability in the face of the tremendous challenges that serving in the Veterans Health Administration entails. They also feel free to express disagreements of perspective and differences in their readings of the literature. We close without a summary; we finish unfinished. It would be problematic, to say the least, to fit one conclusion onto everyone’s sharing and discussion. And then we return home and dig into next month’s readings.

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