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| Andre Lijoi, M.D. |
His grandfather, Bruno Lijoi (1891-1984), left the town of Sant’Andrea Apostolo dello Ionio, located “at the instep of the boot,“ for his first trip to the Americas in 1913. He went back and forth across the ocean several times as he worked as a coal miner in Virginia, a gaucho in Argentina, and a laborer in Ohio. His wife Angela (1895-2003!) stayed in Italy, longed for his periodic returns, and bore and raised their four children.
Though he had only a third grade education, Dr. Lijoi’s grandfather “was a wise man” who abandoned Italy for good in 1935 as he saw the rise of Mussolini's fascism and sought to avoid his son being conscripted into the army. Andre’s father was 15 when the family arrived in the States and he served briefly in Roosevelt’s military (until he hurt his hip).
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| Grandparents Bruno and Angela Lijoi |
Dr. Lijoi’s mother’s family came here in 1928 from Alvito, a small mountain town in central Italy between Naples and Rome; she was only eight. After Ellis Island, her family first settled in the Corona neighborhood of Queens (Ironically, an area that was struck hard by the novel coronavirus earlier this year.)
Both families ended up in the village of Suffern in Rockland County and everyone needed to learn English. Monsignor Robert Ford (1918-2016), a wonderful Irish priest, helped Andre’s father with the new language and helped him get a GED. As his father, Salvatore, worked as a barber (from age 12 in Italy to 32 here), eight-year-old Andre sometimes shined shoes for a quarter. Sal attended Fordham at night and studied education. He first became a teacher, then a guidance counselor, and, finally, a principal of two schools (at the same time!). Andre’s mother studied, too, and used her own teaching degree and a Master's in library science to work as a children’s librarian.
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| Andre's family in New York |
He considered doing “bench work” (that is, basic science) but was drawn to clinical medicine (both an art and a science) as he worked as a clerk in the local public library. He discovered there that he had a penchant, a knack, for listening to the patrons as he helped them find what they were looking for and voiced concerns about their health and the care they received.
So he changed plans and went to the Georgetown School of Medicine, “heir to the Jesuit traditions of care of the sick and commitment to service and social justice” (from the Georgetown website).
He said that the first day at Georgetown the classmate in line standing right behind him as they were “picking up something” was Jamie Ferrara. Jamie had just come back from Oxford where he studied philosophy and literature. He had befriended Father Timothy S. Healy (1923-1992), who was studying Shakespeare there with one of the world’s experts. Fr. Healy, it just so happens, was president of Georgetown University. When Jamie asked Andre if he wanted to join a poetry group he was forming for medical students Andre did not hesitate; he said yes. |
| Father Timothy Healy chatting with MotherTheresa (from Georgetown.edu) |
So, “once a week for four years” Andre and the others, he said, met with Fr. Healy over dinner or breakfast; a much-needed break from their medical studies. The group read all of Shakespeare, and they made their way through Yeats and Eliot. He told me that while he didn’t quite “get” the poetry at the time, he somehow “liked it.” Shakespeare? Well, it’s, you know, Shakespeare.
After finishing medical school in 1980 Andre did a Family Practice residency at the University of Maryland where there wasn’t much time for literature. After this, in 1983, he went to the Appalachian region of Kentucky, in Hyden, to work for the Public Health Service. He soon found out that “when you ask a question, you get a story.” He was, as he said, “immersed in a narrative culture.”
Commenting on that rich tradition, Kentucky novelist Silas House has written: “The thing, always, is the story. The beauty is in the testimony itself, even when there is ugliness mixed in, too. In these mountains, we know what it’s like for the eyesore and the magnificent to coexist. The true beauty is in that complexity.”
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| Transporting of coal (from Roger May) |
So, the visits with his struggling, impoverished, but always proud patients were longer, but the days went by faster. After six months of listening, the young idealistic doctor understood that the story-telling was “really helpful.” Both for the doctor and the patient.
(A personal aside: I have sometimes imagined that it would be nice if we could press a specially-inked paper to our bodies like a second skin and that when it is slowly peeled off it would reveal an image, sort of like a Rorschach, of what’s going on inside. It could then be gently handed to the doctor. She would see where things are not right, where we are hurting, where we need fixing; I would not need to tell her.)
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| Rorschach card #2 (from erzebet-s) |
Anyway, after the enlightening period in Kentucky Dr. Lijoi moved to Hanover and enjoyed a busy private practice for seven years. His wife, Laurie, practiced with him for a while, but then left medicine to raise their two children, Katherine and Peter.
Andre joined the WellSpan Family Medicine faculty in 1995, where he has remained. He worked closely with his colleagues and learned a good deal from Drs. Bruce Bushwick and Richard Sloan as they encouraged him in his nascent role as a teacher.
And as Dr. Lijoi showed medical students and residents how to take care of their patients, and how to care for their patients, he found that the process of getting the story, of writing the story, and of telling and then re-telling the story, could be a powerful tool.
This task begins with engaged listening and meticulous observation, skills worthy of Osler (as in, “Listen to the patient…”). It also requires the ability to record, to make known to others, to share, and to objectivize the findings. It requires a commitment from the doctor to get it right. And it cannot be rushed.
Surely, discovering the (sometimes) hidden narrative, how things got to be the way they are, is needed in acute conditions, where the tale is short and the effort is focused. But it is more vitally important in patients with chronic illness and loss of function, making up the bulk of medical practice now. Here, the process can span decades, and the whole being of the person and their social supports are relevant to the unfolding story.
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| Dr. Rita Charon |
Dr. Charon, a general internist trained in Medicine at Harvard and, later, in English (with a Ph.D. from Columbia) noted that “along with scientific ability, physicians need the ability to listen to the narratives of the patient” to grasp their meanings. (Charon 2001 p. 1897).
Here is where we begin to get a bit technical, so bear with me. Dr. Charon emphasized the critical difference between generalizable scientific or logical knowledge and the “particularized” or singular narrative way of knowing that is set in time and space. Narrative, she notes, is concerned with the “motivations and the consequences of human actions” (Charon 1993, p. 149). She believes that skill in acquiring this type of knowledge of individuals can be fostered through critical and “close reading of literature and reflective writing.”
And that “through narrative knowledge, humans come to recognize themselves and each other, telling stories in order to know who they are, where they are from, and where they are going,” (Charon 1993, p. 149).
But how does listening to or reading a story actually work as we try to understand each other? How does it bind the teller and the listener together in a communal act? This is where I needed to turn to my husband, the neurologist.
The primate brain, you see, contains a set of so-called mirror neurons, first identified by Italian neurophysiologist Giacomo Rizzolatti in 1992 in monkeys. Some fire, or are activated, during specific actions (of course) but also when we are observing another individual perform the same motor activity. Other neurons fire when slightly different actions are observed, but would nevertheless achieve the same goal. This mirroring also happens as we share memories or express emotions.
When you tell me something that affects you deeply the areas of your brain and my brain that light up during a functional MRI scan are essentially the same. I, in a sense, experience your subjective experience. This mimicry results in learning and is critical for language and social and cooperative activities. And, listen to this... the process is completely involuntary, it’s how we are wired (together).
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| Nearly the same cortical areas are activated during the execution of a movement and simply observing it. (from Semantic Scholar) |
So, anyway, Dr. Lijoi decided to formally study narrative medicine in depth and he trained with Dr. Charon at Columbia. He loved the work and the warm camaraderie. He received formal certification in 2019.
Andre has brought this back to the students, residents, current and retired medical staff, clergy, and interested nurses at the York Hospital. He runs didactic sessions with the residents and monthly hour-long get-togethers with the others. At each session, he is joined by a practice partner, a novelist, and a poet. Everyone is encouraged to share their reactions to a short work of fiction, a poem, or, perhaps, to a work of visual art. And they have to write something meaningful to themselves. He believes strongly in this and hopes that the work is valued and will be continued by someone else after he retires (he’s not ready to, quite yet).
He used Eric Carle’s children's book about creative expression and imagination, “The Artist who Painted a Blue Horse” and Mary Oliver’s tribute to the artist, “Franz Marc’s Blue Horses,” for his first original presentation to the residents. He wanted them to see that when you are the artist you get to pick the colors and that when you are the doctor “you must try to know best where to place your brush” on the canvas of the life of the patient. You can even paint outside the lines. He said that he always wears blue and pink when he presents (only then did I take notice of his pink polo shirt and blue patterned socks).
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| Franz Marc's "Die groẞen blauen Pferde" (1911) |
He is partial to Mary Oliver’s poetry and the work of physician-writers such as William Carlos Williams and Anton Chekov and often uses these authors in his talks.
Dr. Lijoi is not shy when sharing his passion. He wants his trainees to feel the same way he does about the “beautiful profession” that he so loves. Though Don Quixote’s lovingly-imagined lady Dulcinea del Toboso is in real life a poor peasant girl, as his squire and confidante Sancho Panza repeatedly reminds him, he doesn’t abandon the poetic dream of her unmatched beauty. And he doesn’t give up his knightly task of righting wrongs and doing justice. Dr. Andre Lijoi wants his students to remain similarly idealistic when it comes to their patients and their own stories.
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| Adam Driver and Jonathan Pryce in "The Man Who Killed Don Quixote" Directed by Terry Gilliam (2018) |
Andre has given of his time and he has been given back. He told me that when he learned that when he had received the Pennsylvania Family Medicine Doctor of the Year award in 2008 he reflected on why he went into medicine, and on all of those who influenced him. He felt deeply touched by the patients and colleagues who wrote in support of his nomination.
Dr. Lijoi was most grateful, he said, for his first and most important teachers, his parents. As immigrants, they wanted the American dream for their children more so than for themselves. They emphasized and demonstrated Christian virtues and the benefits of serving others. He recalled and acknowledged his many formative influences from high school, college, medical school, residency, and practice. He gave thanks to God.
In his free time, Andre enjoys hiking with his wife (and even his grown kids), especially in National Parks, and he likes fly-fishing. He is deeply involved in his church and its several ministries and is a lector, a reader there.
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| Peter. Laurie, Andre, and Katherine |
And he “loves” (and finally “gets”) poetry: reading between the lines, hearing what is unspoken, listening to the silence between the first and second heart sounds, between the “lub” and the “dub,” as the heart fills and then empties itself.
So as we try to share our experience of illness, of non-well-being, with our doctors, our words, conveyed through our breath, are all-important. And the accuracy and honesty of our telling, our confiding, our confessing, opens the way to healing. And the narration and reading and re-telling of the story over time is part of the process as we grow. A simple bullet list of our ICD-10 diagnoses won’t do; taking away my story, a story that has become part of me, is not acceptable.
And as we live through Covid-19 times and adapt, and as we write our own stories, we need to look after one another. We have to ensure that everyone has the opportunity to succeed and that nobody gets into trouble.
Andre fishing at Maroon Bells
From “Sometimes” by Mary Oliver
Instructions for living a life:
Pay attention.
Be astonished.
Tell about it.
References:
Charon, Rita. The Narrative Road to Empathy in Empathy and the Practice of Medicine, Spiro, Howard et. al. Yale University Press. New Haven and London 1993.
Charon, Rita M.D., Ph.D. "Narrative Medicine: A Model for Empathy, Reflection, Profession, and Trust." JAMA 2001; 286, 1897-1902.
House, Silas in "A Love Letter to Appalachia" by Roger May (https://bittersoutherner.com/roger-may-love-letter-to-appalachia).
Iacoboni, Marco. "Imitation, Empathy, and Mirror Neurons" Annu. Rev. Psychol. 2009.60:653-670.
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| I call these "My Buddymundas" (whatever that means) (My morning friends, I guess...) |
By Anita Cherry (11/28/20)