Stephen Wolff, a newly minted physician assistant, found his first job at a hospital in Maine a few months ago.
And then COVID-19 struck, leaving health-care professionals all over the country almost too exhausted to think, let alone reflect on the nuances of humanity.
But Wolff had received unusual training while working for his master’s degree at Drexel University’s College of Nursing and Health Professions — he had taken a course at the Barnes Foundation designed specifically to help medical and health-care students to see, and to consider what it is they are actually seeing.
One day recently, Wolff was with a non-COVID patient with a deteriorating heart condition. The man lay ill, and afraid, in his efficient, if isolating, hospital room, with virus patients on the rise just outside the door, harried nurses, and clipboard-wielding doctors coming in and out. But, said Wolff, there came a moment for a pause, a moment for a family meeting. The man’s wife and daughter were there, via a video call, along with the attending doctor and Wolff.
Wolff recalled that the “palliative care nurse practitioner who was there was helpful just because it’s a good time to pause, from all the stuff that he was getting done in the hospital, the drains, the IV lines, the medication, and just take a step back and say: ‘All right. You know, you’re towards the end of life here. What are your goals to maximize happiness and minimize symptoms? When you do get to a point where it’s hard to control your heart-failure symptoms, what do you want the end-of-care life to look like here?’
“The patient responded very well. It was one of my first meetings. It totally went well.”
The Barnes experience was a huge help in learning to pause, listen, and reflect with a very ill patient, Wolff said.
“The Barnes taught you to look deeper into a painting, the time frame it was made, and the colors and every little detail that went into it,” he said. “And just taking a step back for our patients and figuring out, on a day-to-day basis, what quality of life you want as you move forward, I think, was a very valuable experience and a good thing for the patients.”
Bill Perthes, the Barnes director of adult education, had long thought about “medical students using art and the arts in general music, poetry, the wide range of the arts, as a way of sort of engaging with ideas that relate to medical training or the practice of medicine.”
In 2016, in conversation with Adrian Banning, associate clinical professor in the Drexel physician assistant department, and with the backing of the Sheldon Weintraub Fund, Perthes began putting together a curriculum.
In 2017, the first classes began, often utilizing Henri Matisse’s The Music Lesson (1917), a big, lush painting that dominates Gallery 19 — “a woman at the piano teaching a kid,” as Wolff recalled.
Perthes said that he’d lead groups into the gallery, point out the picture, and have students look at it for a minute, then turn away and write down everything they remembered seeing. When they turned back around, Perthes asked questions: What did you see? Are there things that you see only after turning back around? Do you see the painting differently after reconsidering new elements? Did listening to classmates change the way you now see the painting?
Perthes is driving at teasing out “the challenges of bias,” he said.
“We look for things that we are familiar with or that interest us, and we disregard things that we don’t,” he said. That, he noted, was a process “aligned with things like diagnosis, right?”
“The physician looks at a chart, they go in to talk to a patient, and often times they’re trying to verify what’s already on the chart rather than looking at the patient and seeing if there’s something there that perhaps is not on the chart, that was missed.”
Ivanka, a former Drexel student who is now a physician assistant in a New York City hospital (she asked that her last name not be used), said the Barnes class opened up a more generous way of seeing.
“You watch your patient get wheeled in, they’re sick, their vital signs are bad, they’re often gasping for air,” she said in an email. "Your first thought is inherently, ‘that’s another COVID patient.’ But as you listen to their story, learn that they love their job as a paralegal or taking their kids to the beach on the weekends, you remember there’s so much more to them than being a patient in the ER. It’s easy to get wrapped up in the pandemic. All around you there are alarms sounding, monitors beeping, patients crying and you’re just trying to keep everyone alive.
"As you take a step back, look at your patient from a different angle, you remember she’s a person, with wants and needs and a wish for life to return to normal. You remember that a smile or a kind word goes a long way, and that medicine is just as much an art as it is a science.”
Banning, the Drexel professor, said the Barnes experience is important in helping students understand the ambiguity that often permeates clinical life.
“A lot of times in medicine the situation isn’t black and white or the answers aren’t black and white — we might not have a definitive diagnosis,” she said. "There’s just a lot of unknowns. Even though in science and in medicine we try to get as close to the truth and an accurate answer as we can, sometimes you have to live with knowing that you don’t know, or knowing that you might not know.
"That’s hard for the type of person who goes into medicine. And that happens a lot in art, as well. You might not know what the artist intended when they created something, and the title may not tell you any more about that. We might not know why someone chose to put shading in a place, or use a certain color palette.