Introduction:
When Ryan McCarthy, MD, created the “Healthcare is Human” project during the COVID-19 pandemic in spring 2020, he felt compelled to chronicle the stories of healthcare workers on the frontlines of this momentous historic event. Teaming up with photographer Molly Humphreys and a friend, Kym Mattioli, a radio producer, they swiftly combined visual and audio components to the storytelling. Renée K. Nicholson joined in 2022, and these partners have been creating beautiful artifacts ever since.
Since then, “Healthcare is Human” has been telling stories from healthcare as told by the individuals who serve on the frontlines of “a complex and fragmented system,” says Dr. McCarthy. The project—told through photography, podcasts, museum exhibits, film, a forthcoming book, art installations and a poetry workshop—has grown exponentially. A partnership of talented artists, the “Healthcare is Human” series searches for meaning in all aspects of healthcare, viewed through the lens of Appalachia.
Most recently, Dr. McCarthy, an internal medicine doctor and Program Director for the Internal Medicine Residency at Berkeley Medical Center at West Virginia University School of Medicine, is collaborating with Nicholson, who is a memoirist, essayist, poet, and the former director (2020-2024) of the WVU Humanities Center on this signature program of the West Virginia University, Eastern Campus, Internal Medicine Residency in Martinsburg, WV. They are also collaborating on a forthcoming book about the rural model of narrative medicine which is exemplified by the project.
Dr. McCarthy and Nicholson describe the human stories surfaced in “Healthcare is Human,” as the practice of narrative medicine, a discipline of medicine founded by Dr. Rita Charon at Columbia University in New York City. Dr. Charon is a general internist, literary scholar and the Professor and Founding Chair of the Department of Medical Humanities and Ethics and Professor of Medicine at Columbia University. The practice focuses on understanding the well-being of both the patient and the caregiver.
“In a sense, it’s what this entire project is built around – learning about what makes healthcare human,” says Dr. McCarthy. “Our vantage point is small-town America, tightly knit communities where social capital and analog skills dominate.
“Any person working in this field knows the simple truth that healthcare is hard. But projects like this which highlight the real, human stories of healthcare workers, nurture our own humanity. These stories remind me why I decided to pursue medicine in the first place and give me the energy to continue working and putting forth my best to help my patients and my community,” adds Dr. McCarthy.
Dr. McCarthy & Renée Nicholson
On telling stories, lessons learned and sparking motivation for change through interviews with real persons in healthcare
Dr. McCarthy on finding solace through stories (an excerpt from his series, “100 Days in Appalachia."
The podcast, “Healthcare is Human," when it started, was a way to give the outside world a view of the people–not just the doctors, but the nurses, ambulance drivers, all of the hospital support staff–who were grappling with the pandemic, scared and on the frontline. But as a result, I was accidentally washed ashore to a place of arts, humanities and clinical practice, a strange and unfamiliar land called narrative medicine. I found it through happenstance and desperation – clinging to a life raft. But I now make regular pilgrimages to this oasis. And I plan to show as many of my colleagues the way to this lush, secluded island.
Narrative medicine invites me to see each patient encounter as an opportunity to receive a new story, and, in doing so, be invited to help craft the ending. It is easy in healthcare today to fall into habits where patient interactions are mere transactions, which can be reduced to lists, protocols, and algorithms. These computer-driven habits, which are about to get markedly worse in the age of AI, are the opposite of narrative practices, which see each person as a one-off, existing in a set of circumstances which have no precedent. For this understanding, that I must choose to practice medicine in this way, I am forever grateful.
Nicholson on listening to loss
My brother died in the summer of 2019 from metastatic colon cancer. He was only 42 years old and should have had a lot of his life ahead of him. As I found myself at an academic institution slashing programs and positions, I started to see the futility in my role–one that should have been a dream job, losing financial and other support year over year–and began wondering what advice my brother might give me. He used to like artistic pursuits, and in the last years of his life started drawing again, not a lot but enough that I could see the joy it had once provided him. I bought him a sketchbook, but when he died, we found it untouched. However, my parents found my new collection of poems in his bed after they removed his body. I have been thinking of this image: pages of poems found in a now empty bed. I don’t know if he was well enough to read them, or why he had them so close, and maybe that doesn’t matter. Sometimes the dead leave us living signs of what we might do next.
I’m currently working on a memoir that incorporates narrative medicine, which has been at the core of both my creative work and scholarship. It’s tentatively titled The Night is Yours Alone, and it is not only about my brother and his journey with cancer; it’s about how I’m writing my way through the healing process of losing him. Neuroscience has helped us understand that grief is a learning process, and writing is also a learning process. I’m discovering the self I might be by looking back at the self I once was.
Dr. McCarthy on witnessing raw emotion in medicine. (Excerpted from KevinMD.com)
On this particular day, my heart rolled off my arm and crashed on the cold exam room floor. I summoned the strength—from where? I don’t know. Ginny cried, and between sobs, she described a brain tumor, the one that left him in a bed for a year. I handed her two tissues (one was never enough) and heaved my stool forward. I wrapped my entire arm around her as tears poured off her nose and distorted the phone screen. I glanced down and saw a college kid, her grandson, one who was bald and, honestly, looked my age. Our legs touched, and now that I was flush against her chair, I felt her warmth. I rubbed Ginny’s back and rested my big, balding head on her shoulder. I didn’t say a word; I simply sat as a witness. Whatever else was the reason for her visit, it didn’t matter. Did anything else—could it possibly—matter?
Ginny had sailed bravely for a long time and couldn’t go any farther. Acutely aware of her pain, I sat silent, honored by her trust. The heft of my head remained perched on her shoulder. I wanted her to know that I was a harbor, and it was safe to drop her anchor. With no more wind, she ran aground and then threw everything overboard.
These moments happened to me. Or, more accurately, I existed in a space where these moments were possible. Given what I know today about our universal need for emotional safety, I strived to cultivate the one that lived in my office. And, to complicate matters further, I have doubled down, figuratively speaking, on keeping my heart enmeshed in my hand. Failing to do so would be turning my back on the reason I became a doctor in the first place.
“I wear my heart on my sleeve.” This folksy expression used to puzzle me, as I was never sure what it meant exactly. But now, I know how it applies to the kind of doctor I am. By helping others, I keep getting hurt in the process, a fact I didn’t appreciate until recently.
Being emotionally available for my patients is a daily commitment. When I rolled up my sleeves and got to work, I exposed my heart, the organ I long ago plucked from my rib cage, where it was safe, and I stuck it out on the sleeve of my lab coat.
Nicholson on the urgency of narrative medicine
In working with many different healthcare groups—individuals working substance abuse, end-of-life, oncology healthcare workers and more—it has become very clear how the power of telling stories can be healing and validate a person’s lived experience, whether they are provider or patient. I’ve found that stories provide the self-expression, the authenticity and heart connection that is needed in patient and healthcare worker relationships. Practicing narrative medicine is part of self-care, about how we care for ourselves after we’ve experienced trauma.
The Mindworks Questionnaire/Dr. Ryan McCarthy
1. What is your idea of perfect happiness?
A. Dr. McCarthy: I am entirely content spending a day drinking coffee as the sun rises, working in the hospital; exercising outside with my dog; talking with my wife Erica and, at some point during the day, eating cheese and crackers.
2. Which living person do you most admire?
A. Dr. McCarthy: Even though he died in the past year, I have to say Jimmy Buffett, a man who followed his artistic dreams and, along the way, sang songs, wrote books, travelled the world, brought joy and humor to countless people. His wisdom and observations inspire me to follow my own authentic path and look for adventure in the mundane.
3. What do you consider your greatest achievement?
A. Dr. McCarthy: My happy marriage and Isaac, Liam, and Eliza, my three children.
4. Who are your favorite writers?
A. Dr. McCarthy: Mel Brooks, Tony Bourdain, George Carlin, John Cleese, Tina Fey
5. Describe yourself in six words.
A. Dr. McCarthy: Husband. Father. Doctor. Professor. Athlete. Writer.
The Mindworks Questionnaire/ Renée Nicholson
1. What is your idea of perfect happiness?
A. Nicholson: I’m not sure I have an idea of perfect happiness, but I have had moments of calm and contentment. One such time was when I went to visit my brother, Nate, while he was receiving hospice care. There was a golden hour, a short shining time when he was lucid, free of pain, and when we could just be together. I remember he implored me to make root beer floats. I went to Publix and fetched the IBC root beer and the Breyers vanilla ice cream. He was so happy to dip a spoon in, scoop up a bite, and in that moment, even though I knew it wouldn’t last, I felt content. My brother smiled and for a moment we were just like we were as kids, without a care in the world, just enjoying something sweet together.
2. What do you consider your greatest achievement?
A. Nicholson: In 2015-2017, I was embedded in a cancer center in my home state, West Virginia. Every Wednesday I came to the infusion center and sat with patients and helped capture a bit of their lives—first as oral histories, which were transcribed and worked into stories for the page. My family goes back to generations before West Virginia was even a state, and I remember one day when one of the patients talked about picnicking in cemeteries to visit her people. My family had a cemetery on the old farm in Jackson County, West Virginia. She talked about how people saw cemeteries as sad or maudlin, but she saw them as personal history. I sat with another patient who drove a school bus, and talked about how he once helped a kid who was upset to calm down by simply driving him around the block and talking with him. These people shared with me wonderful stories like this every week. In total, I worked on over seventy stories, and they make up a kind of history of the people where I live. Each time I brought them a draft of their story, in a crisp blue linen folder, it was my greatest achievement, because I saw how my talent and skill could be in service to others.
3. Who are your favorite writers?
A. Nicholson: One of my favorite writers is a novelist named Jason Kapcala, North to Lakeville, Hungry Town, who I’ve known since graduate school. He is the purest writer I’ve ever met, so in the process he writes the best sentences and won’t let merely good or passable ones stand. Every revision—and there are many—make a draft you didn’t think could get any better, get better. Joan Didion is the writer I idolized as a young writer, and I still think The Year of Magical Thinking is working on me every time I sit down to write memoir. Diane Seuss is a poet I much admire, not only for what she can do with form, but how she pushes past what it can do, the punk rock of poets in that way. Peter Makuck was someone who seamlessly worked between short fiction and poetry, and both were remarkable. He could also recite all his poems by heart and translate them on the spot into French. He was so kind and supportive of new writers, and especially me, which I’ll never forget. The West Virginia poet Randi Ward, whose tiny, ultra-compressed poems make you consider them the same way her arresting photographs do—slant, intense, and lingering. Ask me this question tomorrow and it will be a new cast of writers and poets.
4. Describe yourself in six words.
A. Nicholson: Sometimes aqua, other times bright pink.
5. What are you most grateful for?
A. Nicholson: I’m grateful to be a writer, to have found this form of expression. Even the days—the many, many days—when the words never seem to come out right, I’m grateful that some find their way, grateful to have had the chance to write books, and poems, and essays, and even an errant short story here and there. I’m also grateful to have been a dancer, and to have had those stories to write. To learn some of the classical repertoire, to be taught by luminaries, to know the backstage as well as the stage lights.
6. What’s next on your bucket list?
A. Nicholson: I’m not sure, but maybe, just maybe, one day I might write short stories or a novel. Just don’t hold your breath.
