- [Narrator] Live from your public media studios, WVIA presents "Keystone Edition Arts", a public affairs program that goes beyond the headlines to address issues in Northeastern and Central Pennsylvania.

This is "Keystone Edition Arts", and now Erika Funke.

- Welcome to "Keystone Edition Arts".

The art of medicine goes all the way back to Hippocrates.

We'll celebrate the arts and medicine with our three guests.

And you are invited to take part by calling 1-800-326-9842.

Sending an email to keystone@wvia.org and on social media at #Keystonearts.

Paul Lazar opens the way for us.

(strumming music) - [Paul] What's art got to do with medicine?

Research confirms that the arts reduce patient's level of depression and situational anxiety, contribute to patient satisfaction and improve the medical providers' recruitment and retention rates according to "Americans for The Arts".

Some of the medical organizations in our area that put this research into practice includes St. Luke's University Health Network, which has an artist in residence who works with oncology patients.

The Wright Center, which has art groups in several of its locations, as well as at Keystone Mission and the Recovery Bank and photos from patients and employees adorn the walls of their office in Clark Summit, Lehigh Valley Health Network, where a mural was completed on their Cedar Crest Campus healing garden wall in September, it's the second mural at the hospital.

The first was done on the walls and ceiling of a burn unit operating room.

And Geisinger Commonwealth School of Medicine, which publishes a literary magazine called "Black Diamonds", featuring art work and creative writing done by students, alumni, faculty, and staff of the school.

For "Keystone Edition Arts", I'm Paul Lazar.

(soft music) - If we observe the Chinese character for listening, we noticed that it's divided into quadrants, with a stylized ear on the top left an eye in the lower right and a line in between with a heart at the end.

To the lower left there's representation of a king, suggesting the mind.

In sum understanding requires observation, listening, total attention to what presents itself and to the heart.

If the spirit is strong, the heart will be strong.

The listening will be better, and the consequent actions will be straight.

That from Dr. Maria Marini who is dedicated to patient centered care and calls the image, the ear of the heart.

We might take this Chinese character as our emblem, as we introduce our three guests.

Leana Pande is a first year medical student at Touro College of Osteopathic Medicine.

She's also a visual artist whose work has been published by the American Medical Women's Association and the Geisinger Commonwealth School of Medicine.

And in July of 2021, she was given a one-person exhibition at the Wyoming valley Art League.

Dr. Amanda Caleb, who is professor of medical humanities at Geisinger Commonwealth School of Medicine.

Having previously served as founding director and professor of medical and health humanities, and professor of English at Misericordia University.

She's published articles and book chapters on topics from dementia to the marginalization of people with disabilities during the pandemic.

And Dr. Kathy Wang, who is an endocrinologist and practitioner of traditional Chinese medicine.

Born in Beijing, Dr. Wang grew up during China's cultural revolution.

She emigrated to the US to participate in genetic endocrinology research at the University of Iowa and later studied neuroscience at the Albany Medical Center.

You're invited to join the conversation by calling 1-800-326-9842, send in an email to keystone@wvia.org and on social media at #Keystonearts.

Welcome Liana.

There's no question that you are able with the greatest of the tale to render the heart and the ear and all the other organs as accurately as possible, but in your work, you also move in a more abstract direction.

Think of that still life with the brain and the skull and the piece of coral, there's still life in a certain sense.

What draws you to creating spleens and spines and such, and in different ways?

- I've always been drawn to science and particularly medicine as a med student.

And I really enjoy the colors and shapes and patterns that I can see in anatomy that I don't think is emphasized as much if you're just interested in science.

So as an artist, I like to draw out those certain patterns and shapes that I see and emphasize them more.

And try to bring attention to what I'm seeing, that isn't necessarily in a textbook.

- And the wonderful, exciting thing is you've just completed your first semester at med school, and you were commissioned by your med school to create murals for the walls outside the lecture halls.

Now that's got to be more than decoration.

Tell us about the project.

- It's sort of an ongoing project.

I have one four by five foot canvas of sort of a minimalist realistic heart.

It's got all the shapes and proportions correctly, but it's just, it's flat and I've created a couple of shapes there.

And there's a couple of canvases that I've done the outlines for that other students will help fill in the colors for.

And I'll teach them a little bit about how to paint.

And as I spend time at Touro, will continue to hopefully fill up that hallway with more canvases.

- It's a wonderful honor for you so early.

And they discovered your talents right away.

There is a story that Brewer Eberly tells.

He's a doctor who went to med school back in 2013, and he's written an essay and he wistfully, that's the tone of the essay, wistfully remembers his first year in med school and the first anatomy lab.

And he says he and his fellow students would enter the lab quietly with a great respect and they would meet what they called the first patient, that would be the cadaver, right?

And it was almost like a ritual, he said, and those early days were marked, as he remembered it, by reverence, fear and awe.

And one of the things that I sense when I see your work is that you have, and you have never lost a sense of wonder as you behold these organs and various sections of the body that you're going to create.

And you seem to see that there's a beauty, a kind of beauty there.

Even if there's some disease that's associated with it, what is it, or what is it that resonates with you in terms of you have the ability to make a heart or a brain feel fleshy, feel real, how do you do that?

You talk about layering, tell us what that's all about.

- It takes a lot of observation of what you're looking at, just looking at texture, color, shape, and breaking it down into small components.

And a special admiration, I'd say, for each little segment and pulling it together.

So when we actually went into the cadaver labs for the first time, it was really daunting and we were afraid to make any kinds of mistakes.

And each section looks completely different, but I've added colors to my painting.

And then just looking at the cadavers now it's given me a different admiration for texture and shape, because it's all beige and a real person.

It's not going to be bright green or bright blue, like I like to depict it.

So it is a matter of piecing it together the way an artist's eye can see it rather than a scientist.

- And we just saw an image on the screen of actually a painting of your the section of the cadaver.

And it's really, if you stand back and look at it, it sort of could be an abstract painting in a certain way if we didn't know it was an abdomen or whatever it was, right?

- Yeah, it is the section of the abdomen.

It's going to be hung in the anatomy lab at my school.

They told me to pick a section that I had trouble learning and then really enjoyed.

And this is the one I did.

It's got the liver, the pancreas, spleen, gallbladder, and I made it so that the textures are exactly what they would be, but I gave it sort of its own fun coloration.

It's not all bright yellow.

It's probably sort of like a really, really pale yellow.

The only thing that's accurate, I think is the gallbladder color.

It has this like bright green color to it in the cadaver.

- And does that help you, as you suggested it might, learn the segments of the body in that way, but what does it do for your fellow students?

Does it help them in any way to see what you've done?

- When they see my art, I think they see something completely different from the science lab.

I think often when I'm learning like color in science terms, it's different than color that way that artists sees it.

I found that to be different in like our histology and pathology classes finally, but traditionally I think scientists have like a very primary sense of color, but as we get more into classes that require stains and observation and recognition of shapes and patterns, like in a slide, it is closer and closer to the way an artist thinks.

- That fascinates.

We began with the term ear of the heart and in the book of Proverbs, there's a phrase, "the hearing ear and the listening eye.

And I wondered if that phrase resonates with you at all.

The listening eye.

Does that mean anything to you in terms of how you pay attention.

Do you sort of think could you think in those terms?

- That's definitely true.

I like to look and observe more than other people.

Especially in the last year or so, we've been looking at people with just their masks.

I'm more trained, I think, to read my friends from their eyes and how their emotions are.

You can sort of, as an artist, observe and learn more than when you do anything else.

I think visually I can see things that would be useful in patients later on, because we're always talking about, especially in our osteopathic school, paying attention to the whole person and observation of how someone's sitting, what they're doing, different colors.

So that's been really helpful for me.

- Well, that's a wonderful transition to Dr. Caleb.

It's lovely to be able to move from a medical student to someone who teaches medical students.

Welcome Dr. Caleb, it's so good to have you here.

And as we said, you're a professor of medical humanities at the Geisinger Commonwealth Medical College in Scranton.

And you're the faculty advisor for the "Black Diamonds Arts and Literary Magazine" where Leana's work has appeared.

You're holding a PhD in English from the university of Sheffield in the UK, and that's where we want to begin, with Shakespeare.

and Falstaff's remark.

"It is the disease of not listening.

"The malady of not marking that I am troubled with all.

Is there wisdom there and does it affect what you do in the medical humanities, Dr. Caleb?

- Absolutely, there was wisdom there, and I love that you went back to Shakespeare, I'm a trained Victorianist, but a lot of the roots of thinking about medical humanities, we can go back to Shakespeare and further back, but really thinking about our relationship with literature and with metaphor in particular and how often we use metaphor to make sense of our own illness, and our experience with health, I think is key to understanding how to have better health outcomes and better patient care.

- Yes.

And as you're surrounded by... You have Sherlock Holmes over your shoulder there, your right shoulder, and you're wearing "Hound of the Baskerville" around your neck.

What do we, as just in humans in general, we know we are helped to get through life through stories and literature.

What ways does that apply to doctors and to patients?

- Well, I think first of all, humans naturally tell stories.

We're storytellers.

We tell stories to other people, we tell stories to ourselves, and the important part of storytelling is that there's a teller and a listener, and it's about building relationships.

And we tell these stories to understand our place in the world, to understand our relationship to other people, and so it's important that we can translate that to healthcare outcomes and to patient care, because if physicians are better listeners and better communicators, they're going to do better in working with patients as partners and improving the goals of care that are really shared by the physician and the patient.

And so I would give an example, if I were teaching a Christmas Carol, and I mentioned that because it's over my shoulder as well.

I might have my students look at structural issues like social determinants of health, like poverty that would impact the Cratchit family, or access to healthcare, since we don't see physicians in the text.

But I'd also look at individual factors as well.

So what is the lived experience of a chronic illness for the Cratchit family?

What's it like for the family to help care for tiny Tim?

What are the priorities of the family?

How does the illness fit in within their prioritization?

All of those factors really contribute to how we understand the text.

And if a physician or med student can read that text and look for all those clues that help us understand that lived experience in a fictional work, then we can translate that to understanding the lived experience of a patient in the clinic or in the office.

- Well, we just saw some of the remarkable work that Leana creates, and they're hearts and spleens and things like that.

Is it possible that the work that you're doing in medical humanities, listening, doctors listening better and that kind of way, helps patients, and maybe even themselves, connect better to bodies, to bodiliness because that's such a key issue when a body is now suddenly ill or broken.

- I think that's a great question.

And what I would say is because things like narrative medicine and the medical humanities, help physicians be better listeners, they can really be more attuned and attentive to the needs of their patients.

And go back to that idea of a partnership in care.

And if they're more attentive to the needs of their patients, they can also translate that to the patients being more attentive to their own bodies.

So if you think of a physician as a detective, which I think is a very apt analogy, they're looking at clues from a body and trying to put all these different clues, these symptoms together, to understand what is the illness, what is the reason the patient is here today and how can I solve this sort of mystery in front of me?

And so they become very good listeners and very good readers.

And then the next step really is to share that skill with your patient.

How can the patient be a better reader of their own body to understand the aches and pains and what it means to feel in good health?

Because often we only know help through not being ill or illness through not being healthy, but really be attentive to what's going on in the body.

And also to really think about ways in which we can approach healthcare beyond the biomedical model and treatments, and think about things like the value of the arts for patients to make sense of their own illness experiences.

And I'm thinking of the many examples out there of people going through cancer treatments and writing their own personal narratives like Audrey Lord.

And that really allows them to have a better understanding of their own illness and their own body.

And in turn those of us who have the privilege to read these texts, have a better understanding of the illness and that lived experience as well.

- We know that the world of medical school is stressful to the max and probably Leana can nod her head here, but we know.

How do you help them after you've taken them on these wonderful literary explorations?

How do you help them not lose touch with what they've experienced when they're now out on rounds and in an emergency room, is there a way to help them just change the way so it's part of them?

- Yeah, I think the important thing is if they learn these skills and these techniques well, and practice them a lot in the med school setting, they will take shape in their professional identities.

So I think of one quick example from Geisinger Commonwealth School of Medicine, we have the family and community centered experience, which partners a medical student with a family from the community over a 12 month period.

And they meet with the family and they listen to their story.

And that story might be about ill health, but it might be about economic challenges, it might be about educational attainment, being empowered, being disempowered, and they follow that whole story with that family.

And the idea is that when you were in your office and you're seeing a patient for a 20 minute period, there's a whole rich story about why that patient came to see you and a whole rich experience that's gonna follow that 20-minute experience.

And really the students and physicians need to understand that whole person, that it's not just the 20 minutes of, I have this issue and I want help with it, but all the ways in which they'll form their experience of health outside of that examination room.

And so something like the family and community centered experience is very powerful and very humbling, because students aren't the experts by any means, their medical knowledge isn't being employed there, it's actually their listening skills and their ability to follow the narratives of the families.

- Well, it's wonderful.

And we hope our listeners will go to our website and hear what you have to say about Charles Dickens and pandemics.

More of that indeed.

It's wonderful to have you with us, Dr. Wang, we are just talking about listening better and more deeply.

We know that you are an endocrinologist, a specialist though in traditional Chinese medicine and a musician.

And your work with patients is almost defined by the way you listen to each one of them and by your ability to resonate with them every bit as much as the ancient Chinese instrument you've mastered does.

So we welcome you and we're asking if you would help us as you welcome a patient.

And how would that be?

Even before words are spoken, you're hearing, you're listening reverberating, right?

- Yeah.

First of all thank you for organized program like this and I'm so glad to hear the two charming ladies, what their field and what they're working on.

I'm so happy for the entire society come to this way already.

A need of always a for searching the more improvement.

It is very important for the doctor able to sense, actually.

We use our six sense to sense what we can help this person in front of you, what they they're looking.

So it's very important for a doctor have that sense.

That's needs to be yearly training and the knowledge.

So my ideal clinic should be like, waiting room have different color, shape and music.

Before the patient come to you, you should collect all this information.

You can pin down which system the patient is need help.

(Guzheng strumming softly) That's how the traditional Chinese medicine for diagnose the patient.

The first one is observe, smell, listen, and the palpitations.

So everything it's so important.

When the patient walk towards you, you should able to already recognize by how he carried his self.

How he's walking.

What's the voice of patient have.

You very much pin down which system need more tuning or help.

- Now, you have a wonderful skill at an ancient instrument.

If you could briefly tell us about the guzheng, we'll move on to your playing of it.

- Okay.

So guzheng is a ancient traditional Chinese music instrument, have now developed to have 21 string with 21 bridge.

Original it's very small.

Like the character you use the Ching listening.

(Guzheng strumming) There's a king listening.

Only instrument only in the palace, only king and their family able to listen.

Okay, that's how that works form like that.

And so since the first instrument, it's Asian, the flute find it from 9,000 years ago.

So this music healing it's existed.

Only things by this many years developing and very few people did a research on this field.

So as we know, Chinese instrument most the tuned in the pentatonic only five tone, like a C, D, E, G, A, without half step.

So these five tone exactly match our five elements for the medicine theory.

So basically all the mentality like cupping or acupuncture, or the earth medicine, What we do for healing the patient it's like adjust or tuning one of these elements or we move their chi.

Or now some people translated for the energy.

Energy sometimes you couldn't see but you can feel just like our finger touch the patient wrist, that cup of style like a three point have a parallel both side.

That area can tell us how this patient's chi goes, which system it's weaker than another, and what we do doesn't matter to us which modality.

It's like a straining or regulate patient chi in the entire system.

So music, the tone, the five tone or even more I can do exactly as acupuncture needle or the massage.

So that's the way (Guzheng strumming) we use music to heal the patient.

- One thing, Dr. Wang, when you were here, you spoke about the balance and beginning in the mountains or with the mountains and ending with the water.

And I asked you about ying and yang and you said, yes, it's that kind of always that balance, trying to get the patient balanced?

- Yes, that's the way I always do.

Actually any disease or illness in the world, all because the patient lost the balance.

Ying and yang is imbalanced, that's a little more easier, but the five elements, it's not a balance.

That is another balance too.

So that's the music can come into the healing.

It's really now during the pandemic, there are so many depression or other mental health issues.

So I think music healing can play a very important job in this.

- We can't thank you enough and want to hear more, and thank you Leana Pande, thank you Dr. Amanda Caleb.

Thank you for watching.

For more information on this topic and links to our guests and resources, please visit wvia.org/keystone and click on keystone edition arts.

And remember you could watch this episode or any previous episode on demand, anytime, online or on the WVIA app.

For "Keystone Edition", I'm Erika Funke.

Thank you for watching.

Dr. Wang.

(Guzheng strumming softly)