What happens when a novelist, two physicians, and a mysterious rash collide? This episode of “Read. Talk. Grow.” dives into Catherine Newman’s novel Wreck, using its plotline of medically unexplained symptoms as a springboard for a rich, empathetic conversation about the emotional weight of ambiguous diagnoses and the lived experience behind fiction. Host Dr. Denise Millstine and guests, author, Catherine Newman and Dr. Rebecca Thompson explore how Newman’s autofiction mirrors real patient journeys - full of anxiety, humor, waiting, and the emotional chaos of not having clear answers. Together, they unpack everything from pathology reports and the pitfalls of instant test-result access to the tenderness of caregiving, and the delicate dance between believing patients and navigating the unknown. The result is a thoughtful, deeply human discussion about how we make meaning, and find connection, when the body refuses to give clear answers.
This episode was made possible by the generous support of Ken Stevens.
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Dr. Denise Millstine
Welcome to the “Read. Talk. Grow.” podcast, where we explore health topics through books. Our topic is medically unexplained symptoms and also an excuse to talk to Catherine Newman again. Our book is “Wreck” by Catherine Newman. I'm your host, Dr. Denise Millstine. I'm an assistant professor of medicine at Mayo Clinic, where I practice women's health, internal medicine, and integrative medicine.
I'm excited about my guests today, which are both return guests. Catherine Newman has written a zillion pieces, columns, articles, and bean recipes for magazines and newspapers, in addition to two memoirs, two kids life skills books, and a middle grade novel. “We All Want Impossible Things” was her first adult novel and was featured on “Read. Talk. Grow.” for an episode about being a friend to a friend who's dying.
Her second novel, “Sandwich,” was released in 2024 and was also a “Read. Talk. Grow.” episode. We're talking about her third novel, “Wreck” today. She lives in Amherst, Massachusetts, where she's joining us from. Catherine, welcome back to the show.
Catherine Newman
Thank you so much. I'm so happy to be here.
Dr. Denise Millstine
Dr. Rebecca Thompson is also a repeat guest to this show. She's a family medicine and public health physician in Portland, Oregon. She specializes in women's and children's health. She's also the author of “Held Together: A Shared Memoir of Motherhood, Medicine, and Imperfect Love,” a decade long collaborative project about the joys, the challenges, and the everything in between of parenthood and family life, which was featured on episode 67 of “Read. Talk. Grow.”
Becca, you mentioned to me how much you thought Catherine's newest novel, “Wreck,” would be a good fit for the show. We're so excited to have you here to talk about this novel.
Dr. Rebecca Thompson
Thank you. Yes, Catherine, I have loved your work since I first became a mother myself. I remember discovering your writing back when my son was an infant, and he's in high school now. It's back in those early, you know, mommy blogging days when you used to write on Blogspot and, you know, I can say here, I've always loved your work because of this gift you have for capturing those beautiful, ordinary moments.
It's like you make me nostalgic. My kids are a little bit younger than yours, so you make me nostalgic for things that even haven't quite happened yet to me. Like lying in bed beside my kid, reading a book, and then imagining myself missing those days in the future. Right? It's beautiful. And you always bring in the humor and you're never afraid to call out the absurdity of being a human in the world, which I love, too.
Catherine Newman
Thank you, Becca, I appreciate it. It's funny for me because I just read your collaborative memoir and so it's funny for me to picture that you have teenager. In my feeling, very present, you have an infant.
Dr. Rebecca Thompson
Oh, thank you for reading. Thank you for sharing it.
Dr. Denise Millstine
“Wreck” is contemporary fiction that continues to follow Rocky, the main character of Catherine's prior book, “Sandwich,” who cares for her father and cares for and about her young adult children. When she notices some physical symptoms that seem initially straightforward, then worrisome, especially for a woman with anxiety, and then become mysterious and the workup of which becomes very frustrating.
We're going to focus on medically unexplained symptoms on this episode of “Read. Talk. Grow.” Catherine, tell us your inspiration for writing this plot line for Rocky and “Wreck” about her health.
Catherine Newman
You would think I'd be prepared for that question, given the premise of this conversation. So this is very autofiction. This plot line hues very close to an experience I had. I'm going to put it provisionally in the past tense just to make myself laugh. You know, it feels like a metaphor, the encroaching rash, but that is literally that was the start point of my own kind of medical mystery journey. So that was the inspiration. It's something I know a lot about. I have done a ton of inadvertent research into this phenomenon.
Dr. Denise Millstine
It's so interesting because sometimes you can tell when people really have lived a journey that's adjacent, because as amazing a fiction author as you are, there are just some details that we'll get into that, I think, either you had a close friend who told you every detail about some of the medical workup that she had done, or you're the world's best researcher for the most authentic moments, or you had some personal experience, and it's probably a combination of all three.
But I think as a reader, I am just grateful to authors who bring these authentic experiences into their work, which listeners should know. The plot line here is not necessarily only about Rocky's health condition. There's a lot more that weaves in that we won't necessarily focus on today. Becca, tell us your reaction to “Wreck” and also what it's like to work with patients who have mysterious illnesses.
Dr. Rebecca Thompson
Well, as you might imagine, I was prepared to like this book before I even started reading, but really, it didn't disappoint. From the very first opening scene, you pull me in with this duality about the rash, right? So Rocky is absolutely convinced that this rash she notices signals her imminent demise, right. But at the same time, she's embarrassed to be making a big deal out of something that she's like, clearly, you know, it's nothing to worry about. And any rational person would know that. And she doesn't really know where to put herself on this contradiction. Right. And as a reader, I completely sympathized with this, especially as a woman who's been told in the past that, you know, physical symptoms I was having were probably nothing to worry about.
And later they turned out to definitely be something to worry about and even something that was trying to kill me. Right. And we've all had that experience, I think, especially women. I loved these moments of ordinary things again, going on in our lives while we're grappling with much more complicated things, too. So like scenes of Rocky doing repairs around the house and balancing, like she's waiting on hold to make a doctor's appointment or get a result, and she's doing these ordinary things and trying to carry on with her life.
And this is just what life is made of, of sort of the monumental and the minuscule all at the same time. So as a reader, as a person, I loved that just in the book itself and kind of that whole tone of it. And then to your question, Denise, about working with other people with mysterious illness or as a doctor, Rocky's story really resonated with me, too, because I felt like I just wanted to sit down with her and explain everything and help her sort it out.
And even while I knew there wasn't going to be one single easy answer for her, I felt really drawn to her and wanted to help her as a physician. And this really is how I feel, how I felt working with my own patients. It made me think about, especially right out of residency. I found that, you know, as I was building my practice, a lot of women would come to me who—especially women, but again, all patients—who had been dismissed by other practices or other clinicians and they wanted to establish care, to find something different, to feel like there was something better than what they'd been taught to expect or what they were worthy of having in their care. And I always felt this drive to listen to them better than they'd been listened to before, and tried to help them sort out what we knew, what we didn't know, figure out what we should explore and what questions we should ask together next, and to just believe them. You know, believe them.
Catherine Newman
Yeah. I mean, in your book, that scene where—I say scene, I mean, it's just a piece of your life—but where on the one hand, you're living an embodied experience of a pregnancy going awry and you're a doctor and you're a curious person and a researcher. Like, if you weren't a doctor, you would still bring this curiosity, and you're pretty sure you're having a molar pregnancy.
And your practitioner knows better than to be like, that's ridiculous, but doesn't think you are. And you have to just lead that charge. And I appreciated that so much just because,
Dr. Rebecca Thompson
Thank you
Catherine Newman
Like for you as a doctor to hold the knowledge of what it feels like to say to somebody, there's something wrong here. And in this case for that person to say okay, let's look into it.
Dr. Rebecca Thompson
Right. It's about listening and believing. Even if we don't always agree with our patients, they deserve to be listened to.
Catherine Newman
Yeah, yeah. And it's incredible how much confidence as a practitioner it takes to A - listen to your patient and assume they're smart, which is a thing I've started to be a little wary of this sense of like, oh, I'm inherently not going to know what I'm talking about because I'm not a doctor, which is crazy talk. You know, I know a lot.
And also just the confidence - I mean, just back to Denise's question - the confidence to hang with something uncertain because it's so unsatisfying. As a doctor, you must live for the cure. You know, you live for the solution and to not even have the opportunity to get there because the thing itself unfolds so awkwardly and clinically and is such a mystery. And my very favorite practitioner, one of my stable of doctors, she just hangs with the uncertainty in this beautiful way and models that for me, instead of leaping to diagnoses to make everybody feel better, she's like, we don't really know. We're going to approach it this way. And boy, do I love her for that.
Dr. Denise Millstine
Well, and I think that's a surprise for many people. They think that I'm going to come with this list of symptoms and maybe have a couple of tests. And then the answer is going to be very clear. And Rocky's experience of thinking initially that it's going to be clear and then really not getting answers is more common than we probably like to admit.
Can we talk about the rash initially, Catherine. I really love how she just notices this rash. She's just, you know, having a normal day, an ordinary moment, as Becca has said, and she sees it and she thinks to herself, well, if it's a skin cancer, it's more basal cell carcinoma than metastatic melanoma. And even her doctor sort of says, oh yeah, this is probably going to be that. Was that intentional to start with something that even with a little internet support or talking to other people with skin cancers, is like, oh, this is going to be an easy diagnosis and no big deal. Was that intentional?
Catherine Newman
Definitely intentional. To start with her incorrect imagining that this is going to be clear. Definitely. Just like you're saying. And I think that, you know, just what Becca was saying about the monumental and the minuscule. I think for Rocky, who is a person who is very ready for another shoe to drop, that is her personality. I think there's something about this moment where she's wondering, is this going to be a thing where there's a Mohs procedure and I end up with four stitches and a scar?
Or am I just at the beginning of something that's going to change my whole life? And I think a lot of patients from an informal survey of just being a person in the world. But I know that so many people go through that experience of you're in a doctor's waiting room and you're like, this could be nothing and I also could look back at this being the last moment before I was catapulted into this scenario of life threatening illness. And I think Rocky's just hanging there for a minute.
Dr. Denise Millstine
Yeah. And I love how she uses that humor. She doesn't check with her anxiety. That she, at least at the beginning, it sort of doubles down, like it's just going to be this. It's just going to be this minor thing. You said a Mohs procedure, which for those who don't know, is where a dermatologist is also a dermatopathologist. They're looking at the pathology as they're removing what's typically a skin cancer and making sure that they get tissue that's not cancerous all the way to the edges. So very precise. A really fine surgical procedure that can be done, especially for skin cancers that are on sensitive areas.
Becca, this is a small point, but one of these ordinary moments that I just love about Catherine's novels as well. Can you just comment quickly about the accumulation of the dermatologic remedies that Rocky keeps in a literal shoe box? She writes, “…it's full of all the remedies he's prescribed white metal tubes of ointments and white plastic tubes of creams and gels and sponge tipped white bottles of clear liquid that she then goes on to say she's labeled things like for the neck, for the ear, for the vagina.” It's just hilarious that this collection in a shoebox. Can you just visualize that? Can you just see it?
Dr. Rebecca Thompson
Absolutely. I love that scene too. I mean, don't we all have these jars of mystery goop deep in a linen closet or under the bathroom sink somewhere, right? But if we're being critical, I feel like we could say, oh, squirreling this away, it's driven by Rocky's anxiety, right? It represents her—maybe to some degree, she wants to—maybe there's something universal about this, right? Just keeping this kind of a stash. But if we're being more sympathetic, I think we see that shoebox as a representation of her wish to protect her family, to heal them from whatever unpredictable thing might come along next. And we're all just searching for solutions to problems. These are little tubes of solutions, little half crusty old tubes and jars of things and ways to comfort ourselves and our loved ones that maybe just a half empty tube of ointment is a metaphor for that, right?
Catherine Newman
Yeah, I think it's a metaphor for that, for sure, Becca. And I think there's something for Rocky about it. I think there's also—and this carries throughout the book, as I'm sure was not lost on either of you—but she's got a lot of superstition. And a lot of, I think for Rocky, the idea that she would get rid of something has so much hubris for her.
Like, who am I to think I won't need this again? Or this feeling all the time, like as soon as you move forward in the world, like everything's okay, you endanger everybody. And hoarding this stuff in this weird way. And I will speak as a hoarder of weird stuff and not a hoarder in general. Like my house is not full of stuff, just the medicine cabinet and the cabinet under the sink.
Because there's this scene in that horror movie, “The Quiet Place” - if you haven't seen it doesn't matter. It's just an apocalyptic movie, right? It's everything that has. It's the end of the world as we know it. And there's a scene where they go to an old drug store to raid it, to find a thing to help their sick kid. That is so scarring to me. I'm like, I'm going to have it all right here in case something happens. I have like a de facto pharmacy. Should the end of the world happen and a neighbor gets whatever, I'm going to get my shoebox out and be like, I have just the thing for you. And so I think there is a mix of ways that it's symbolic. And one of them is like a very specific hypochondriac kind of disaster preparedness, not just caring for everyone, but that too, Becca, which is like a gentler version of it, but also just this feeling like if anything happens, she's ready.
Dr. Rebecca Thompson
You know, I also think it's so relevant that it's about the skin. These treatments are about the skin because skin is literally so visible, right. It's this—it can be this manifestation of all the other things we keep hidden inside our bodies. It can be a signal for things going on that we're not aware of yet. It can show those signals. And I think that's why part of why Rocky's mysterious illness beginning with a rash or at least the rash, is the first thing she notices. And in the opening scene of the book, it's so compelling and so relevant because it's a marker of something bigger, literally and figuratively.
Catherine Newman
Yeah, yeah. Oh my God, that is so true. And it's so true about the visibility. It's like you think about teenagers with acne and how that can actually endanger their mental health. Just the fact of having acne because they're so excruciated and self-conscious. As if acne is flashing a signal to everyone that there's something bad about them, you know? And I think there is something about the skin that does—you feel as though your badness is leaking out into the visible world, and people are going to look and be like, that person with the rash. There must be something really wrong going on there.
Dr. Rebecca Thompson
She's holding deep inside and trying to escape and tell us all, yeah, yeah.
Dr. Denise Millstine
What bad choices did she make? And that first shoebox in her closet. I want to talk about the pathology, Catherine. So when Rocky sees a dermatologist, he does a biopsy and does say to her, please don't read your pathology report when it comes out, because in this day and age, actually the pathology report or the results of the biopsy are available to the patient and to the physician at the same time, inexplicably, often in the middle of the night when the patient is probably looking and the physician most likely is not looking.
But she sees this granulomatous dermatitis and says to herself, I'm no dermatopathologist, but I understand that is not a cancer. I chew a celebratory melatonin gummy and power down my phone. And she's reassured by this. Tell us your opinion about patients reading their pathology report on their own, not necessarily with a doctor or a health care professional to turn to for clarification.
Catherine Newman
I have such mixed feelings about this, and I'm curious about whether you guys do too. On the one hand, it can be so hard to get anybody on the phone. It's almost impossible to imagine waiting to hear from somebody. I feel like I would wait for three weeks. So I appreciate, especially if it's something good and it dings in and everything's great. Like what could be better? And so I love that. And also it's like my body, my information, feels like I should have it.
And then there's the thing that happens to Rocky, which is stuff that is stuff you've literally never heard of. There's a vibe that something bad's happening. There's a pathologist weighing in with some coded language around likelihood and also a decoding chart for you. I mean, there's so much weird stuff that happens and I just have totally mixed feelings about it. I think it's, The idea that I wouldn't look at it is impossible. I would never not look at it. And so I appreciate more and more that I feel that some of this information comes with more clarity around the likelihood of whatever it is. Instead of that, there's just wild speculation that you have something really terrible. I don't know, what do you guys think about it? I just have—I'm of such a mixed mind.
Dr. Rebecca Thompson
Everything you said, I agree with that, both as a physician and as a patient. And, you know, there's this absurdity of expecting people who are not doctors or health care professionals to just decode all these things without any guidance. That makes no sense. I mean, we can believe that our patients are smart—like you—so I don't want to not give them that benefit of the doubt and want to empower them. But I think that's unfair to expect people to just be able to translate all these things for themselves without any guidance.
And I mean, Rocky handles this in such a relatable way. But there's also the bigger context. Like, It is part of the problem in our health care system today. Like you, Catherine, I hate to wait for the result. I want to, three weeks to wait to hear a result back is completely intolerable. But of course I would rather have it in context and have information with it and as part of the bigger picture. Right. So there's this balance. Right. The big part of the motivation—so there's the reason behind all this. A little bit historically, you know, a few years ago this started in its current form, The Cures Act in 2021, where it essentially mandated that people get their results without a delay, immediate release of notes and test results of the chart. And of course, the motivation for that was largely about giving people more autonomy, more ownership, like you said of their own medical data. This belongs to them. And that's great. And it does do that. But I think the flip side, as you alluded to, the unfortunate result is people are expected to navigate so much on their own right now and they can get really distressing results just dropped into this random moment of their lives with no one there to support them.
Dr. Denise Millstine
Hey listeners, we hope you're enjoying this episode of “Read. Talk. Grow.” If you find our discussions helpful and insightful, please take a moment to subscribe to and rate “Read. Talk. Grow.” on your preferred podcast platform and don't forget to tell your friends to listen. Your support will help us reach more readers and those eager to learn about health through books. As always, feel free to drop us a line at readtalkgrow@mayo.edu with suggestions for books, topics or any comments. Thanks for listening.
Dr. Denise Millstine
I think it also goes back to what we're talking about before, where the common perception is that there's going to be an answer. And when you get a pathology report like Rocky is, not only does Rocky know anything more than, well, this isn't a cancer, but her doctor also doesn't consider this to be the answer. He and the team also say, well, this means it's not a cancer and it could be this, and it could be this, and it could be this, and it remains nonspecific. And, Becca, I think this might be kind of where a lot of the mess of the health care system starts to get exposed for Rocky, because after this biopsy, she then has this whole slew of labs.
And I love this paragraph. Catherine, I'm just going to read it directly so Becca can comment about how this rings true. So she says “…there are lots and lots of results and I don't know what they all are or mean. And most of them seem fine. Everything in the lipid panel falls into the normal range. The syphilis antibody screen is negative—phew, right? As is the TB test. So I will not be going to a sanatorium for consumptive. The comprehensive metabolic panel looks mostly normal to be UN and chloride and albumin and whatever all else except for total protein, which is a little high. Something called the C-reactive protein is very high. But the LFT hepatic panel looks mostly good, though two of the liver enzymes are slightly elevated. Creatinine sounds too much like cretin, and so I'm glad it's low.” I mean, this is such a perfect summary of the panel of labs that Becca and I look at every day. Becca, do you agree?
Dr. Rebecca Thompson
Yes. It did also make me laugh. This contrast with the mixture of modern medical test names and data. And then this relief at not having to convalesce in a sanatorium, this antiquated idea. Right. I love that all that mix up. Right. And, you know, It all speaks to what we were just talking about. The system is so overstretched. People are trying to make sense of this jumble of ideas. And there's this tension for us as health care professionals, how we wish we could practice and support our patients. And the reality of what we have time for. Right.
And I wish there were maybe some leeway for people to have a say in what is released to them and with what kind of guidance, rather than just a blanket, you know, release of everything. But I think at the core, Catherine, what you said that resonates with me most is about the waiting being the hardest part. And if you can't get access to your translator, to your health professional in any sort of timely way, because that is just what the system is right now, I think that erring on the side of giving people autonomy and control over their own health data, it does have to prevail in that sense.
Catherine Newman
Yeah, it makes sense. Just when you were saying that, I was thinking about that part in your book where you say—this is when you're pregnant with your son—and you say, we know we're going to keep the pregnancy, so why would we do amniocentesis? Would we do it just because we're impatient? Just because whatever the information is we want, it's sooner and something that carries risk. You know something and decide not to do it. And I—that really—that struck me just because patience—it's very hard when the stakes are high as it tends to be with medical information. It's very hard to just be told to wait.
Oh, we can't schedule your MRI for five weeks. And then you're just like, okay. I will live these five weeks with this very strange, floaty, uncertain feeling. And then after the MRI, someone will read it in between an hour and eight days. You know, just all of this, just like you—you should take up a kind of meditation practice just to deal with the waiting and the impatience. And I had a friend who is an obstetrician and she got this. Her practice was so overbooked that she invested in this series of what was supposed to be these really subtle, positive subliminal messaging tapes to play in her waiting room where there was music, and then there was just supposed to be a subliminal something underneath calming everybody, and instead it was just a person being like, I like to wait. Waiting makes me feel good. And we laugh so much about that. Just the idea that you want your patients, I'm sure to feel like they're okay waiting and they're not losing their minds every second. But mostly they're losing their minds every second is my assumption.
Dr. Rebecca Thompson
Yeah, but I mean, the stakes are just so much higher, like you said in some of these decisions. And things are waiting for information so we can make decisions or just understand something more. It's like, this is true in all of life, but in things about our bodies and our health and our families' health. Right. It's heightened and it's just elevated to this next degree. Amplified. Everything is amplified.
Catherine Newman
Exactly amplified, and also the waiting itself. You're never sure if during that time, whatever this thing is, it’s getting a crazy toe-hold, right. You don't know what is happening to you and you just picture that it's proliferating.
Dr. Denise Millstine
Well, and you both make the point that this isn't happening in isolation. Right? It's not like Rocky has this period of her life where she carves out this—she's got some family things going on, and she's worried about her dad, and she's got her career. She's trying to spatchcock a chicken, whatever that means. I love that. No, but maybe this is a good point, Catherine, to talk a little bit about Willa, who's also Rocky's daughter that we see in “Sandwich” and she has her own health issues. Willa has migraines. She also has anxiety.
And this is a tough line for Rocky to walk, because she's starting to come to a point where she realizes this is progressive. This is bigger than, you know, that's what I thought was this minor skin cancer. But she doesn't want to worry Willa. Will you talk about that dynamic, especially as the character is a mother of a young adult daughter and how she is kind of sharing, not sharing where she sees it's the best choice to make.
Catherine Newman
Yeah, thank you for asking that. I mean, that's such a tender thing. And, you know, I know I wrote a book called “Sandwich,” but I'm really feeling it. I will talk about it in the context of the book, but I am laughing because I'm watching myself. I don't want to worry my parents, who themselves are struggling with all kinds of medical uncertainty. They're very old. My dad's 93. I don't want to worry them and I don't want to worry my kids who are in their young adult lives. They have better things to do than be like, oh my God, what's happening to our mom? And my daughter, like Willa, has anxiety and I especially don't want to worry her.
And I don't want to accidentally worry everybody more by not telling them stuff. And then they find out I'm not telling them stuff, and then they have to just—then there's that. Like, it could be anything, and they never can trust that I'm telling them anything, which is the worst kind of worrying to be stuck doing. And I find that is so challenging. And it's funny, I think that's also incredibly, honestly, maternal to still be taking care of everybody while you're struggling with your own health thing.
So I don't know, you know, I wanted—Willa's anxiety is touched on in the book “Sandwich” in the first of these two books. And I did want to explore it more because I know so many women my age who are helping teenagers and young adults navigate anxiety. And it's also such a weird time, because it's a time where your kids are starting to take over their own medical care. And so it's just very delicate. You know, you really want them to be as autonomous—I should speak for myself—what I want for my kids. I want them to be as autonomous as they want to be.
But also the idea of independence is laughable to me. Why is that even a goal? What on earth would I want to do in my life without all my beloved people helping and supporting me? I think it's a bizarre value, and especially around medical stuff, the idea that our kids should be independently managing their health. Wait. Ideally, nobody would be independently managing their health. We would all be in community. I mean, I feel that about everything, like the way you're now supposed to tell people that you're pregnant in the first trimester in case you have a miscarriage. Those are all the people I want to talk to about the miscarriage. I want to be supported. I don't want to be ashamed on top of every other thing.
So I guess I feel like all of this stuff is about kind of the way we create family and community, how we hold each other and what we—how we expect each other to show up. And it's obviously very complicated.
Dr. Denise Millstine
I love how authentically you you portray that because often we'll see, especially in fiction, that this is just a clear conversation and this is a clear choice. I'm telling, I'm not telling. I'm telling this much. And I think for people who are listening, who are navigating a health issue, that if they're struggling with how much is too much, how much is too little, that's a really normal struggle to try to answer for you and your daughter, for example, because you and your daughter are unique to another mother and another daughter. Right. And so that's not a simple, straightforward answer.
Becca, I wanted you to comment about when people have these new symptoms, how it can happen that a health care professional will then go back into the chart. And in Rocky's case, she'd had a mammogram—sounds like she had a callback. And then it was reassuring and she was told, your mammogram is fine, come back next year for your annual mammogram. But now that she has these symptoms, her doctor looks at it again and says, oh yeah, yeah, yeah, it was fine, except there were these lymph nodes that before you had symptoms I didn't care about. And now we need to chase this down. Will you comment about how important context is when we're looking at results in a chart.
Dr. Rebecca Thompson
Yes. One result never tells the whole picture. Right. There's nothing in isolation. Right. So it's actually made me think about there's this long standing tradition in medicine that radiologists sometimes get criticized about, they write, correlate clinically on every report. And we're like, oh, what do we do with that? But they're also not wrong. Right. So the clinical exam is an art. Right. But I think the bigger context, any of these data points like the lymph nodes or other, you know, looking back on old results with a new perspective, the medical history taking is even more of an art.
Now, this might be my bias, of course, because so much of my own work is in narrative medicine and these days especially. But I truly believe in the power of storytelling to guide our medical practices and in our experience as patients too, especially in primary care specialties. Because we rely so heavily on relationships and communication. There's that old aphorism: listen to your patient, he's telling you the diagnosis. And the William Osler quote. As a clinician, I feel like if we can combine the big picture of the range of tests and physical findings and connect that all to what our patients are telling us about their experience of health and illness. It's like when all that comes together, that's what creates the diagnostic skills. And we sometimes we might think of that as an intuition that we develop, but really it's just instincts that we develop over time from putting all the data into a deeper context and seeing our patient as a whole person.
Catherine Newman
That's so good. I just feel so heartened by that. I think that what this conversation's really doing for me, you guys, is I'm feeling like in every part of this conversation, what we're concluding is, we've been fed a false binary about everything. Just what you were saying, Denise. Oh, then you had a follow up mammogram and it was fine, as if the only choices were fine and not fine. Like cancer and not cancer instead of, in fact, it turns out to be some gray thing that isn’t, doesn't neatly fit the binary. But just for expedience sake, someone has told me, or Rocky, it's fine.
Or this fake binary between objective and subjective experience. You know that you have the pathological data and you have somebody telling their story to you about their experience and those things are in conversation. It's just amazing. I think there's something about what you guys are doing as doctors that is so revolutionary that has to do with seeing past those kinds of either/or about everything. It's going to be so healing for everybody.
Dr. Denise Millstine
We hope so. When Rocky's doctor looks at the mammogram again and says, there's this enlarged lymph node, Catherine, then she sends her for a lymph node biopsy. And here's a moment where I thought, either best researcher in the world or personal experience, because Rocky is having a biopsy of the lymph node done and there are two people in the room, there are multiple people in the room but there are two people performing the procedure. One is the attending physician who is experienced and is educating a younger trainee to do the procedure, and the nurse very empathetically comments, I am seeing some tachycardia, that Rocky's heart rate is going up and says gently, I wonder if you doctors might consider trading places. And one of them says, is that what you want and should I take over? It's your call.
Puts it on Rocky. So Rocky's fully crying now and says, I hate myself for it. But I say, I guess so, I'm so sorry. I'm just scared. The attending finishes the procedure in about one minute. So we forget how these common procedures are not common for the person undergoing them. And we all know that training has to happen, but that has to be done in the context of the patient's comfort. And I just was wondering if you would comment on that scene, Catherine.
Catherine Newman
It's so horrible because I live in fear of some horrible kind of medical NIMBYism. Like, I know people need to be trained. I just don't want them trained on me. Everyone feels that way. And I have had so many people in training do stuff to me. I only go to teaching hospitals, right? I'm in Boston and I'm at Mass General, I'm at Brigham. You know, it's always been this way. I'm always like, oh my God, you're a Harvard medical student., your parents must be so proud. It's always these literal children who are there doing whatever.
And that example is obviously, as you can tell, taken from real life. And I was talking to a friend of mine who's a doctor, and I was describing this, and I was like, God, I'm such a jerk. This training just needs to happen. And she was like, no, that was good information for them. Like, maybe that's a procedure that comes later in your training. Like maybe she wasn't actually adequately trained to be doing that particular thing just yet and they'll make a note of that. That's okay. That's still information for them. Part of the training is a holistic kind of training. It's not just her doing that one procedure and getting through it all the way. She learned a lot from that, which is such a, of course, loving thing to say to me because it made me feel so much better. But just about, you know, just the balance. Doctors need to learn and patients need to not feel like cadavers.
Dr. Denise Millstine
I know, I think that's such a beautiful way to approach it. And I know we're running short on time. So I'm just hoping before we wrap up, because this is important to my integrative medicine practice. Becca, if you would just comment on Rocky's experience with acupuncture and how you were struck by that shift from what is causing this, to finding healing, if you view that in the same way?
Dr. Rebecca Thompson
Yeah, I think that many people, when they're in the thick of trying to figure out some mysterious disease process, they want to explore any avenue possible. Right? And I'm a big fan of integrative medicine because again, with the dichotomies, right, people make an artificial distinction between Western and Eastern, you know, different modalities of medicine. Anything that works, it can just be called medicine. We don't need to split these up. And so acupuncture has some real evidence for certain conditions and for certain situations. And I welcome that as a physician, as a patient, you know, as a person advising friends and family.
I just think the one thing we want to be careful with when people are looking into kind of alternative modalities or whatever they call integrative and alternative, is that when they're struggling to find something maybe new they could do to improve their health or to take control of their health, that they don't fall into the converse of thinking that if what they're doing doesn't make them better, it's all their fault.
Dr. Denise Millstine
That's an excellent warning, and I often will warn people who include things like acupuncture for the purpose of healing and symptom management, but not to then dismiss the diagnostic workup because, as much as Rocky's experience isn't clean cut, often we do come up with the diagnosis and there are directed therapies that if you jump straight to symptom management. So that would be a warning that I had.
And I just wonder if we could leave our listeners with a short piece of advice if they're navigating a health situation that's muddy or uncertain, and what would the two of you offer to them as advice as they're listening to this show and reading “Wreck?”
Catherine Newman
I definitely have advice. It's a little hard won, and it's also a little annoying and it really is just everything is uncertain. Nothing is a given. And so to feel suddenly like, oh, I don't know what's going to happen next, it's just exposing that you already didn't know what was going to happen next. And so if you wait, if you think of what you're doing as waiting, you're going to miss all of it. We just have this. There's tons of uncertainty and so you live fully and presently as well as you can and not beat yourself up if there are days where you don't do that. But just to live with the uncertainty.
Dr. Rebecca Thompson
So much of what you said is exactly what I was thinking. So from the physician point of view, I feel like being trained in medicine has taught me a lot about making decisions with incomplete information. But being a patient has taught me much more about that, even. Right. And I feel like, again, it's living with that uncertainty. That's what your book so beautifully convey and the scene that comes to my mind, or the idea that I think I was left with the most, was you talk about how when people are writing into advice columns and looking for guidance, they're basically all asking the same question. People are different from me, and how do I survive it? And you say, the answer is with as much grace as possible.
And so I would like to extend that and say, we should all carry that over to ourselves, not just other people are different, but my experiences are so different from what I think I maybe was about to have, or the life I thought I would live and know that even when things are so different, even if we did think we knew what was next, that's just an illusion too. So if we can live in those in-between times, even when we don't know how our story is going to unfold next, those are the hardest uncertainties to live with. And if we give ourselves as much grace as possible, that comes down to your message that all we really have in the end is love for each other and ourselves and for these complicated stories.
Dr. Denise Millstine
I can't imagine ending on a more beautiful note. You both are so inspiring. It has been my absolute pleasure to talk with Dr. Rebecca Thompson, the author of “Held Together,” and Catherine Newman, the author of “Wreck” and “Sandwich” that we've talked about today. Thank you both.
Catherine Newman
Thank you so much. It's such a pleasure.
Dr. Rebecca Thompson
Thank you both.
Dr. Denise Millstine
“Read. Talk. Grow.” is a product of the Women's Health Center at Mayo Clinic. This episode was made possible by the generous support of Ken Stevens. Our producer is Lisa Speckhard Pasque and our recording engineer is Rick Andresen.
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