Bridging The Divide: How Narrative Medicine Heals
People heal by many different paths, and yet there are aspects of the journey we all share. What does it mean to be sick? How can others understand what we're going through when our bodies suffer ill health? How do we overcome the loneliness of chronic or fatal diseases? Illness is isolating and dividing; it sets us apart from those who are healthy. We go to the hospital when we're sick. We go there to die. We are even born in hospitals, away from home, because our society is uncomfortable with life's endings or even its beginnings.
I'd never seen someone die until the start of my third year of medical school. The resident and I were summoned to the room of a five-year old little girl who was losing her battle with leukemia. Her family lived an hour away. It was a Friday evening and her parents had been gone from their other children for five days. When they left at sundown, she was sleeping.
But soon after, she awoke. Her breathing became irregular, she closed her eyes, and she died. It would turn out to be the most peaceful death I would ever witness. Her nurse, the resident, and I sat by her still body, continuing to stroke her skin even though she was gone. We wanted her to know she was not alone. For the next hour, our beepers stayed silent and we honored her spirit as it slowly slipped away from the room.
What I learned as a result of one little girl's death was so much more valuable than the random assortment of scientific facts I might have read that day. I learned that to be a healer is to be with people. To witness and honor someone’s suffering is to help them begin to unravel what illness means, and why they are sick. To be with a baby as he is born, or someone as she dies, is to ease the passage, to bridge the divide.
When we get sick, we lose our health and our identity as a well person. For short-term illnesses (colds, broken bones, etc) we pull back from the world and await recovery. For chronic or life-threatening illnesses, this inability to engage in routine life is frightening and terribly isolating. The path toward healing is to connect with family, with friends, and with physicians. The telling of stories, and the listening to stories are the means by which we can end our isolation. It is this need to be heard, to have others bear witness to our suffering that is the basis of healing.
Diagnosis is medicine’s primary goal. But to diagnose is to label. Too many doctors talk about “the heart attack in room 110” or “the gall bladder in 501”, never learning that “the heart attack” is Gene, a retired mechanic who has a stash of Tootsie Rolls ready for his grandchildren’s daily visits, and that the “gall bladder” is the single mom of two teenagers, whose own mother is in a nursing home with Alzheimer’s, and who really, really needs to go home. This role of the narrative in medicine - learning how people’s lives impact their illness and how illness is only a part of the story of who they are - is essential to create a healing doctor-patient relationship.
Unfortunately, medical history taking is taught as a rigid outline, a system designed to be efficient and reproducible, not to fulfill the patient’s need to share their experience in illness. And because we have been programmed to communicate by checking off past diagnoses and answering doctors’ directed questions, most people don’t know how to make their unique stories heard.
At Columbia University’s Program for Narrative Medicine, doctors teach students to value the uniqueness of each patient. Telling our stories makes us healthier. Studies show that narrative can reduce cancer-associated pain and improve wellbeing. Writing and poetry therapy strengthen the immune system. In its many forms, communication helps unlock the healing within.
Eighteen years ago a little girl died from leukemia and her family struggled to make sense of their senseless loss. I wish I could tell them that her story still lives in me.