A Conversation with Dr. Pramita Kuruvilla
I’m going to work a little backward because I really want to know more about your work in Narrative Medicine. I have seen and heard the words Narrative Medicine, but I am not familiar with it. You have held sessions for our Pre-Med Summer Shadowing students, and they just rave about the experience. Can you tell me more about your work in Narrative Medicine?
Narrative medicine is an area that I’ve been passionate about for a long time. Often in medicine, especially in Palliative Medicine, we are the guardians of people’s stories. Sometimes those stories are patient stories, and sometimes they can be our own personal stories or stories of our colleagues, students, and team. We bear witness to a lot of stories, and we often don’t realize their power. We don’t have time built in to think, examine, or reflect on the stories and their impact.
Narrative Medicine provides a space to think hard about what is affecting our souls, our sense of meaning, and what, in turn, affects the way we deliver our care professionally or the way we show our emotions in our personal lives. To me, narrative medicine is a very important area in my practice because it allows me to grow and develop some of the areas that I wouldn’t normally have expected as a physician and as a person.
I’ve been wanting to join a narrative medicine session for a while, but it’s so outside of my comfort zone. How are the sessions usually conducted?
Narrative medicine sessions are really different. There is no particular prescription for how the sessions are conducted. I adapt them to how I am feeling, how the participants’ needs show up, and what the shared goals are.
The basic idea is that people are coming together. They either have a prompt, or they have something to examine or read together. It can be a poem, an essay, or a work of art. People look at it together, have some time to digest it, and see what resonates with them. Once everyone has time to process, they are given a prompt to then create something themselves. It may be a 55-word story, a haiku, or with longer sessions, it can be art. People create the most amazing things! It’s astonishing when you all hear the same thing, called a “3rd object”, but each person creates very different reflection. It’s a pretty powerful space, which can feel very sacred and transformative for the participants. The work brings me a great deal of joy, and I couldn’t have done this without the encouragement and support of the DPM.
Are there other ways you’ve incorporated the humanities or would like to incorporate the humanities into your work as a physician?
I have a GYN-ONC focus in the SMS clinic. I was leading a narrative medicine session for a GYN-ONC support groups, and there was one patient who commented, “We see how doctors and nurses write about us in our charts, and we feel so flattened, so being able to describe ourselves in our own words is pretty powerful.” Part of my goal with narrative medicine for both patients and clinicians is to allow people to feel more authentic and empowered to be themselves. I want people to have a voice and know that it’s okay to not be okay. As people have time to process things, they are sometimes able to recover or grow that voice.
I’ve heard you mention it before, but I’ve never had the opportunity to ask. What is SoulFoodMD?
SoulFoodMD is my coaching private practice. It’s a life and career coaching practice. In many ways, it’s so similar to Palliative Care, minus the serious illness context. Just as we speak about “goals of care” in the palliative care world, I work with my clients to identify their “goals of life” in the greater trajectory of their lives and careers. What do people want out of their lives? What do people want out of their careers? Is there alignment? I help flesh out conversations where my clients can learn to prioritize what they most want in their lives and careers. A big part is holding space for the client to arrive at their own conclusions that best fit their lives. I chose the name because it’s very important to me that people find the things that feed their souls.
Is there a certain philosophy or school of thought that really guides you in either your work or daily life?
The night of my ten-year high school reunion, I was browsing through my senior yearbook, and I saw my friend’s high school quote, which was, “Look out for number one, just don’t step on number two.”
I was in the midst of my residency at the time, and I think this quote really stuck with me in a way that it probably wouldn’t have when I was eighteen. Health care is supposed to be a vocation, a calling. That sense of calling is often exploited in the current healthcare industrial complex. We are given a sense that we should martyr ourselves constantly, so I think that this quote is actually where I have been moving more and more in my life, recognizing that a lack of personal boundaries is not healthy, and yet we are always encouraged to do more on all fronts. This then leads to a more toxic environment and burnout, so I really appreciate the liberating ethos behind the quote. It’s thinking about it not as being selfish but as setting healthy boundaries that allow me to remain on a sustainable path and that allow me to be authentic, compassionate, and present for those around me.
You’ve written several articles and held leadership positions in Bioethics. What motivated you to focus on this area?
I think it all comes back to stories. I started out as a family doctor and then an ICU doctor. Part of the reason I loved the ICU was that the stories were right there. You are meeting with the patient and their family, and very quickly, you’re learning more about who that person in bed 8 in the ICU actually is. What are the things that they want? What are the things that they hope to achieve? I loved talking to my patients and their families and hearing stories. This very quickly led me to join the Palliative Care team, hearing more stories and using those stories to navigate the multiple choices of things they were offered. This then very quickly led me to Bioethics because there would be times that it was really unclear what the patient wanted, how to hear a story, or how to learn what are the things that are either causing conflict or distress.
It ultimately came back to hearing stories and always came back to helping a patient or family advocating for what they want or need. It’s so funny that all these are distinct fields – Palliative Care, Ethics, Intensive Care, Primary Care – and yet they are all the same. It’s all about listening to patients, holding space, advocating for justice, doing good, and trying really really hard not to do harm.
I’d love to now take it back to the beginning. Where were you born and raised? Can you speak to your upbringing and your family?
I was born in India, in the South of India, at the medical school where my dad attended medical school, and my mom went to nursing school. We left India for England and Scotland around the time I turned two. After a few years, we moved to Southern California in the early 80s, moved to upstate New York for a few years, and then back to Southern California. By the time I left for college, I counted that I had lived in almost twenty-two different places. I always say I grew up with a kind of military existence, although it wasn’t. It was just my parents as immigrants moving for work or training, wherever they needed to be. I moved around every year when I left for college, but after getting to the Bay Area for residency 20 years ago, I have been here ever since.
Was it always medicine for you or did you want to be something else growing up?
I was a reader. I didn’t have anything else to do since we moved a lot, so I was a big reader! When I was around 7 or 8 years old, I read a book about an oncologist taking care of pediatric cancer patients, and then his own daughter got leukemia, and he couldn’t save her. That’s what made me want to become a doctor. It had nothing to do with my dad being a doctor or my mom being a nurse. It was that Reader’s Digest Condensed book!
You mentioned your child just started first grade. How is family life?
I came to family life a little later than most, and I’m so used to being a doctor. Being a doctor has been my primary identity. This is one area that I’m trying to work on more. I have a lot of friends who are close to retirement now, and the ones who’ve only had identities as doctors really struggle compared to those who have worked to maintain their other identities. So, as I think about the next part of my career, I’m more aware that I need to focus on growing identities other than being a doctor, whether it’s more hobbies, or volunteer time at kids’ schools, or other family/community activities.
What do you do to unwind after a long day or on the weekend?
I’m still trying to figure that out! In my former existence, before having a partner and kids, it was doubling up on my ICU weeks, then I took two to three weeks off to see my brother in Australia, go to Europe with friends, or have a fabulous adventure.
This summer, I’m taking a six-week art class through my city arts & rec, two hours each week. It’s a creative artistic play class. We go in and we play with finger paints, coloring books, story-illustration, or collage creation. It’s been really nice to shut off my brain – or at least try to for those two hours a week. I don’t think I’ve created a collage since I was fourteen!