What if I told you that, as your doctor, I’d rather listen to your memoir than to your lungs? Or that while I find the sound of a beating heart a marvel to behold, I’m more interested in hearing the jazz song that you wrote or talking about the words tattooed on your left wrist. What if I asked not only about your symptoms, but also about your life, your narrative, and the story behind how you’ve owned more than 100 cars in your lifetime?
This is not to imply that I don’t care deeply about clinical medicine. I love being a doctor. As a hospitalist, I specialize in the care of acutely ill hospitalized adults, and I’m passionate about helping my patients on their road to recovery.
But when it comes right down to it, it’s the stories that keep me going. Illness can’t exist without narrative, and stories are the currency of medicine.
Sometimes the tales are uplifting, like the centenarian who tells everyone she meets that an aversion to shrimp was her secret to long life. Other times you have to look for the beauty beneath the sadness, like the time a homeless man told me that he calls his cardboard home “The Fortress.”
And sometimes the stories are heartbreaking, like discussing trade secrets of smoked pork ribs with a 35-year-old woman who was just denied a lifesaving organ transplant, her eyes full of tears as she argues the merits of a vinegar-based barbecue sauce she will likely never make again.
I am privileged to hear stories like these — intimate, extraordinary accounts of self — almost every day. Passionately attending to these narratives allows me to empathically connect with my patients and to stay resilient in the face of suffering by remembering why I became a doctor in the first place.
People choose careers in medicine to treat human beings — not their diagnoses — and to alleviate suffering of the body as well as of the mind and the soul. Western medicine has historically been rooted in an obstinate focus on disease processes rather than on the people with the disease, a tendency to treat the physical while ignoring the existential and the psychosocial. It’s hard to feel compassion toward a disease, so what you’re left with is mechanistic, depersonalized patient care.
In the latter half of the 20th century, the medical humanities were established in an effort to rehumanize clinical practice and teach budding doctors not only scientific and technical skills but also empathy and humanity. And while the number of health humanities programs has more than quadrupled in the past two decades, they remain fragmented and unstandardized. Establishing humanities as an integral and universal component of medical curricula is essential. Doctors need to learn the human side of health care. They need to be taught how to relate to their patients on a personal level. And there is no better way to connect meaningfully with patients than to listen to their stories and to fully receive them.
My belief in the importance of narrative is why I, like many other physicians, write creatively about my experiences in health care. It’s why I read the trainees I work with not only the latest scientific studies from JAMA and NEJM but also poetry by Emily Dickinson. It’s the reason I work with the Northwest Narrative Medicine Collaborative, a nonprofit organization that believes in the power of story to treat a heartbroken health care system. And it’s why, when I meet patients in the hospital, I take the time to be humbled and amazed by the stories they share — stories of illness and often of suffering but also of love and triumph and the passion of a life well lived.
So don’t be surprised if your doctor wants to spend more time listening to your stories than to your organs. Don’t be offended when she or he asks not only about your cough or your rash but also your hopes and your dreams. About your secret to longevity, your cardboard fortress, or your personal opinion on barbecued meats.
Zachary G. Jacobs, M.D., is a hospitalist in Portland, Ore., with a passion for creative arts and storytelling and a board member of the Northwest Narrative Medicine Collaborative. The stories in this essay are based on actual patient encounters, although personal details have been omitted or modified to maintain patient privacy.
Well said. Couldn’t agree more.
AS SHE STOOD DYING
“He didn’t pay any attention to what I said about my legs. He just kept talking, asking about my heart and my breathing. Well, if you can’t even walk anywhere, what’s the point?”
In retrospect, I must agree, although, at the time, I was focused on what I believed to be the more important matters of the heart.
When we first met, this little country woman had terrible, almost impossible to control high blood pressure, partially a result of a can to can’t work life on the farm, not having been born wealthy, a condition to which she didn’t even aspire; now her poor old wore-out blue-collar pump required no medicines for such control – barely able to generate enough blood flow to allow her to hold her head up or work her tiny gnarled fingers, much less power her legs.
Nonetheless, filled with that volatile admixture of remorse and repose, resplendent, still gleaming though not as bright as in sunnier days, replete now more with memories than vision, garlanded by still extant white bangs, mnemonic of a long-ago coquette, during her last visit to my office her blue eyes pierced to the quick.
Because in that mythical distant time where our most cherished memories reside, styling in feminine cowboy boots, in a riot of black heels clicking, erect elbows careening, little female knees flashing as the joyous cowboy on her arm held on for dear life, her strong legs perfectly syncopated to the thumping beat of the feral music as her skirt helicoptered around her as though her energy was limitless and time could never slow her step, an illusion that must be so as perfect youth can only be if it is endless. Evidently, Keats understood this as he wrote about the forever youthful figures, affixed to his old Greek bowl, who evidently also had just finished square dancing:
“For ever warm and still to be enjoy’d,
For ever panting, and for ever young.”
In that circumstance, the infancy of desire, the heart, in reality, a simple thing, is heard from only as a figurative organ, the literal one usually not raising its head until unveiled by the infirmities of old age. Now, looking back as a cardiologist involuntarily educated by the carnage of relentless time, the question constantly poses: which is the worse to be injured or broken?
In her simple country home, her static death bed did not become her, serving not as a place of rest, seeming instead one of fixation, only as a gathering point for her extended loving family, allowing them to hover round in not motion, their still unwilling faces frozen in anguish, riven with not yet tears, unable to face the obvious.
In my case, in the sad stunted attitude of farewell forever, relegated in finality to being only a passive observer, I stooped over her bed, looking down at her now of agonal breath and failing heart, and then, shuffling to the dark corner of the room, withdrew into my own private grieving space, thinking of what a feisty character she had been, her numinous smile and bright eyes and all the banter and jokes that had flowed between us in countless office visits over twenty-five years, but mostly of what a tragedy it was that her legs were already dead.
In a perversion of that famous Socratic dictum, most doctors believe that an unexamined death is one not worth having; thus, here, in that apparently pointless hopeless moment at the ebb of her time, no longer extendable by the pitiful futility of medical gestures, looking back at the panorama of her long life and my intersection with it, I finally slowly grasped that, in my line of work, the most profound wisdom manifests not from the arrogance of empathy, but, rather, the humility of understanding.
And so, I quit her place and went home and sat alone in the still dusk on my back porch, pondering and waiting.
Glad to see someone providing an alternate experience. Physicians need connections as too many are burning out. Personally, my PCP and her RN provide me with a 30-35 min consults;they often asks about my family/work/vacation plans. When she’s away, others in her practice do the same. I’m not sure how they do it (metro-large city/network) but apparently it can be done. I’ve referred 4 others to her practice and they have shared the same experience. It feels great to know I’m a person to her and not just a dx/billing code.
Really, in a ten minute slot you have entered the depths of narrative medicine? Are you currently reading any Chekov? Or maybe “ The Andromena Strain”? When is your memoir coming out?
Maybe fifty years ago a medical professional could do this but not now. Thanks so much for sharing a false positive narrative.
Oh, please… the author is a hospitalist! The patients are… in the hospital. He and they have plenty of time to get to know each other. Other hospitalists might use their downtime to read Chekhov, but let’s be thankful for those who don’t.
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