I was delighted to have an essay accepted for this week’s “A Piece of My Mind” section of the Journal of the American Medical Association (JAMA). For those of you with access to JAMA online, you can find the essay here.
The editors of JAMA have been kind enough to publish three of my essays (10-10-2007, 2-27-2008, 4-8-2009). Before they would accept this essay, however, Associate Senior Editor Roxanne Young gave me a tough assignment. The journal wanted the family’s permission. After all, if the family happened to see the article, might they not recognize themselves?
At first, I was resistant to calling the family. Couldn’t we just change a few of the details of the story? Maybe we could change the patient’s gender. I worried: what if the family refused to grant permission to publish?
Most of all, though, I realize that contacting the family would be uncomfortable for me. The essay was about a failed resuscitation attempt. The experience was traumatic to the staff, the residents, and the nurses; I could not begin to imagine the potential effect it had on the family. Furthermore, it had been a long time since the events chronicled in the essay had occured.
I realized, of course, that the editors were correct. I worked up the courage and called the family member who I had known best. It was a wonderful conversation.
We talked about the patient and about how each of the family members had coped with the events and his death. She was surprised to learn how much the physicians had been affected. We talked about how much all of us missed him. Permission was granted and soon the essay was accepted.
I had a similar experience with a previous essay. When I called the patient, a man whose religious beliefs affected his medical care, he was delighted to share his thoughts and provide additional resources. After the contact, I realized how much I had enjoyed talking to him again.
In both cases, the conversations had offered each of us a moment to remember an event that had been very important to us.
Medical bloggers like me often write stories about their patients. As bloggers, we do not routinely obtain written consents like the one required to publish in JAMA. Some bloggers change identifying details. Others leave out important data. Sometimes, however, people spot themselves in the essay and, occasionally, this lack of formal permission has gotten bloggers into hot water.
For me, these moments of contact have been wonderful experiences. In each case, they have allowed me to better understand the patients, the families, and, of course, the final chapter of the stories I am trying so hard to tell.
