Other Features: Teaching and Learning Moments
Mr. Kelly is a second-year medical student, University of Michigan Medical School, Ann Arbor, Michigan.
Ms. Noorulla is a second-year medical student, University of Michigan Medical School, Ann Arbor, Michigan.
Mr. Mundy is a second-year medical student, University of Michigan Medical School, Ann Arbor, Michigan.
Dr. Skye is assistant professor, Department of Family Medicine, University of Michigan Medical School, Ann Arbor, Michigan.
Dr. Perlman is assistant professor, Department of Family Medicine, and director, Family Centered Experience, University of Michigan Medical School, Ann Arbor, Michigan.
Editor's Note: This Teaching and Learning Moments essay was contributed as a companion to this month's AM Cover Art selection.
Like its subject, Portrait of a Chronic Illness is more complex than it might seem at first glance. From a distance, the viewer sees a portrait; however, there is something peculiar about it. As the viewer approaches, the portrait transforms into the sea of paperwork that comes with aggressive health care over the course of a chronic illness. Similarly, it is often the case that, when viewed from a distance, the life of a patient managing a chronic disease seems relatively normal. It is only when one looks closely and intimately that the devastating effects are revealed.
The orderliness of the pieces of paperwork—that they are all parallel and not completely jumbled or chaotic—represents the nature of chronic, rather than acute, illness. The life of the patient has been reorganized around the disease and treatments into a strict schedule. When living with a chronic illness, required forms and paperwork, daily medications, financial information, and frequent clinic visits are often kept in meticulous order.
While referencing the barrage of paperwork involved in managing a chronic illness, this project also demonstrates how an illness can completely overtake the life of the patient. The likeness of the patient was recreated from an existing portrait, in which the patient's illness is not evident. Here, however, artifacts of health care and disease (the paperwork) constitute all that the viewer sees; it has enveloped the patient's portrait. From the original image, the medium has changed, as illness can result in changes in the life and even identity of the patient. Nevertheless, the patient's expression is the same as it was in the previous, illness-free portrait. Even though a chronic illness disrupts a patient's life, personal strength and perseverance can preserve her spirit. Even though the illness has brought about change and constant reminders of its presence, the focus of the patient's life, and this portrait, is still herself, not the illness.
This portrait was created as an interpretive project for the Family Centered Experience (FCE), a required first- and second-year course at the University of Michigan Medical School and a major part of the medical school curriculum. In the FCE, pairs of medical students make scheduled visits to the homes of volunteer patients and their families in order to share the volunteers' experiences with chronic illness. These home visits, as well as readings, assignments, and small-group discussions, serve as a foundation for the students to explore the experience of chronic illness from the patient's perspective. Students consider personal experiences and background, as well as psychosocial, socioeconomic, and cultural influences on the patients' understanding of and living with chronic illness, and reflect on the impact of illness on self, family, work, and school. The FCE complements the biomedical training that students receive during their first two years in medical school and aims ultimately to train physicians who are equally skilled in understanding both the complexities of clinical medicine and the personal and psychosocial aspects of illness and its care.
The authors would like to thank Matthew Kloiber for his photography of the original work.