Preclinical medical students are introduced to illness 8.5 by 11 inches at a time. From thousands of PowerPoint slides, we learn about aberrant biochemical pathways, mechanisms of pathogenesis, and lists of treatment options. From textbook pages filled with classic physical exam findings sensationalized by images of the infirm, we cannot help but imagine that sickness invariably leaves its victims disfigured, disabled, and depressed. Furthermore, the preclinical curriculum compounds this problem—too often, the human impact of sickness takes a backseat to testable, sterile facts and the vocabulary of medicine.
For more than a decade, the University of Michigan Medical School’s Family Centered Experience (FCE) program has sought to correct this. Through the FCE program, first- and second-year medical students are taught to appreciate the human impact of disease by learning directly from patients with chronic illness and their families. During home visits, we saw families struggle with severe chronic back pain, recount the trauma of a loved one’s heart attack, and confront the fear of relapse. At the same time, however, we saw these families prepare dinner, care for pets, and raise children. We came to appreciate illness as a terrible, yet often manageable burden. While our FCE families did struggle, oftentimes profoundly, from the consequences of their illnesses, their diagnoses ultimately led to adaptation and perseverance rather than submission and resignation. Their resilience inspired us and prompted us to share their successes.
Our work, ADLs—Activities of “Disabled” Living, explores and refines the viewer’s attitudes about disability and functionality. Here we employ the classic style of the “Penmen” posters, wherein we invite the viewer to identify two identical figures among many variations. Despite this invitation, the viewer searching for a matching pair will soon become frustrated as no two images are the same—in form. Instead, the viewer notices that each image has a sister in which the theme of every action is identical, except that in the complement image the participant is wheelchair bound. In that moment, the message of the work becomes clear: Through accommodation and perseverance, those suffering chronic illness may participate in daily living on equal grounds with those without such a diagnosis. It is only our bias that leads us to believe otherwise, and the greater a viewer’s bias, the more delayed—and more poignant—the message becomes.
As a whole, ADLs—Activities of “Disabled” Living celebrates the resilience of the physically or mentally disabled by depicting their ability to adapt and, in some cases, acquire optimal functioning in tasks related to activities of daily living (ADLs). We chose to invoke the term ADLs because of its medical and legal relevance when deciding whether or not an individual will be classified as disabled.1,2 Because of the wheelchair’s cultural association with disability, it is used repeatedly in our piece to symbolize all conditions that affect ADLs.
We hope to encourage patients newly diagnosed with a physical or cognitive impairment, and that these depictions of adaptability will provide both them and their caregivers renewed hope about the capacities of the disabled to live active, independent lives.
Acknowledgments: The authors would like to thank Dr. Arno Kumagai for his guidance throughout this project, Chris Blevins for his assistance in creating the piece, and above all, the families who inspired the original work.
Joshua M. Peterson, Daniel P. Marcusa, Anthony N. Hage, and Caroline A. Vitale, MD
J.M. Peterson is a medical student, University of Michigan Medical School, Ann Arbor, Michigan.
D.P. Marcusa is a medical student, University of Michigan Medical School, Ann Arbor, Michigan.
A.N. Hage is a medical student, University of Michigan Medical School, Ann Arbor, Michigan.
C.A. Vitale is associate professor of internal medicine, Division of Geriatric and Palliative Medicine, University of Michigan and Geriatric Research, Education, and Clinical Center (GRECC), VA Ann Arbor Healthcare System, Ann Arbor, Michigan; e-mail: [email protected]
1. Katz S, Ford AB, Moskowitz RW, Jackson BA, Jaffe MW. Studies of illness in the aged. The index of ADL: A standardized measure of biological and psychosocial function. JAMA. 1963;185:914919.
2. Hercules-Doerr K. Looking into the disability “crystal ball”. Prof Case Manag. 2013;18:157159.