In the practice of our days, to listen is to lean in, softly, with a willingness to be changed by what we hear.
-Mark Nepo (Cancer survivor and poet)
My happiest times in the office are when patients tell me stories. Some people just can’t help themselves; they easily share their experiences of illness, children, lives, or struggles. More often, though, the stories need to be called out. These accounts, the hidden or subtle, are often even more interesting. When the office is slow, I might hear an elaborate tale. When things are hectic, I might have to survive on a vignette or an update. I have shared many of these stories through my blogs and essays.
This practice of intentionally listening to and recounting patient stories falls under the broad heading of “Narrative Medicine.” Medical schools around the country are modeling curriculum and seminars on the Program in Narrative Medicine
developed by Rita Charon, MD, PhD, at Columbia University in New York. Every medical school hopes its graduates will be good listeners. Good listeners make better caregivers.
Over the past two years, the Medical Humanities Program
at The Medical College of Wisconsin has developed a Humanities Track for first year medical students. Part of their experience involves shadowing practicing physicians during their office encounters. These students might not understand the intricacies of sub-specialty medical care, but they do understand people. During this first exposure to clinical medicine, the students start to build skills that will help them later listen to the story lying beneath their illness.
I ask my students to write, not about the disease, but about the person. With the students’ permission, below are two examples of what they have submitted.
I had a blind patient with recurrent cancer. Here are one student’s reflections about the office visit:
||The human fight for survival and well being is incredible. People will go to the ends of the earth to live a happy full life. I was fortunate to meet an amazing patient that I will never forget. |
The patient had been blind since a young age and had been diagnosed with cancer for many years. His cancer was [extensive and recurrent]. It is not his blindness and loss of voice that I will always remember, it is his fight and spirit that will never leave me. This patient would not give up his fight with cancer and would go to the ends of the earth to defeat it. Every punch that cancer threw at him, he countered with two or three punches of his own.
Sometimes we have bad days and let little things bother us. This patient did not know what a bad day was. This is a perfect example of living life to the fullest. To go through life without vision is amazing in itself; but to not be able to talk and battling cancer on top of the blindness is unimaginable.
Here is another submission. A man who had his voice box removed several years before came for an office visit. He could only talk using an electrolarynx
(a vibrating device that he holds against his neck). Here is what the student remembered of the encounter:
||Someone in the room curiously raised the topic of Mr. M’s age. |
Before anyone could reveal his age, Mr. M quickly turned it into a quiz, “How old do you think I am?” he asked with an anticipatory smirk.
“77.” said the other student in the room. “69. 82.”
Finally Mrs. M answered with a roll of her eyes, “He will celebrate his 90th birthday during this month!”
Mr. M laughed. It was the kind the laugh where the shoulders bounce up and down with a big grin but no noise actually comes from the vocal folds.
If someone in Mr. M’s situation wanted to find a reason to complain and find misery, he could find several reasons to.
The fact: life is never going to be as easy as it once was. Did that mean the rest of his life had to be less fulfilling and enjoyable than it once was?
What made him different? Was it the fact that he had only minor complaints from an otherwise successful laryngectomy? Was it the fact that he made jokes using his artificial speaking mechanism? Was it the fact that his dear wife of many years was by his side at the appointment, asking questions and holding all of his prescription bottles? Was it the fact that he smiled a lot? Was it the fact that he held his hands up in triumph when none of the patient care staff could guess his age? Maybe.
All I know is when I have my 90th birthday, I want to be 90 years young!
The experience of having first-year medical students shadowing me in the office is interesting and, quite frankly, lots of fun. I sense that the early immersion into Narrative Medicine reinforces their understanding that the patient’s story is critical to understanding their illness. Hopefully, being a good listener now will prevent decent medical students from becoming miserable doctors
||The following is feedback received for this blog:|
Dr. Campbell: Thank you for your nice comment on my posting at the NYU lit med blog. I welcome the opportunity to talk with you about my project...and to visit you and your colleagues sometime to discuss it...all best,