Narrative medicine: Stories nourish empathy

narrative medicine uses the power of story to help patients near end of life

I am devoted to the power of story. It compels me personally; it fuels my brand. I am also invested in helping caregivers, and promoting candid conversation about how we die. So it is no wonder that I found my way to exploring the field of narrative medicine.

“Narrative medicine is clinical practice fortified by the knowledge of what to do with stories,” said Rita Charon at TEDxAtlanta. Dr. Charon is a general internist and literary scholar at Columbia University who originated the field of narrative medicine,.

“Stories can offer the kind of contextual richness that promotes and nourishes empathy, prompting a provider to switch from asking ‘How can I treat this disease?‘ to ‘How can I help my patient?‘” —Kim Krisberg, AAMC News

Narrative medicine gives voice to the suffering, and takes into account a patient’s whole story—as Dr. Charon says, including “even the unsaid hints and guesses about what might be left unsaid.” There is story to be received in a person's words as well as their silences.

The more open we are—not just doctors, but all of us—to receiving those stories, the closer we become to making meaningful connections.

Every Word Counts

“Awakening and nourishing my own sense of story has transformed my teaching and my practice,” Dr. Charon said. “I was able to learn how to listen closely, where every word counts.”

When she first meets a patient, she says, she no longer goes down a medical history questionnaire recording answers, but rather asks for a patient’s story—“what do you think I need to know?”—and she listens. No writing, no typing, no computing; just listening…absorbing.

“Persons were deeply thirsty to give profound, detailed, eloquent accounts of themselves. They didn’t always know how, or how to start,” Dr. Charon notes.

She tells the story of a patient who, once prompted for his story, began to talk of his father who died, his sibling who died, and of his teenage son with whom he was having difficulty. He began to cry. Dr. Charon asked, “Why do you weep?” His response: “No one ever let me do this before.”

The Search for Beauty at the End of Life

I attended this month’s “Narrative Medicine Rounds” hosted by the Division of Narrative Medicine in the Department of Medical Humanities and Ethics at Columbia University Medical Center. The September guest speaker, Haider Warraich, M.D., author of Modern Death: How Medicine Changed the End of Life, talked about the search for beauty at the end of life.

“You’re down to the floor of who you are in the presence of illness,” Dr. Charon said in her TEDxAtlanta talk. And indeed, Dr. Warraich’s stories attest that, in dying, we are most fully human.

His most important lessons as a doctor did not come from senior physicians, he says, but from elsewhere: namely, from the interactions with patients nearing death and their families, and from the questions that arose within him as a result.

The stories he recounts are powerful and poignant and, while part of many physicians' daily experience, simply not spoken of much in today's death-averse society.

“We’re always searching for meaning....both within our personal lives and within our professions,” Dr. Warraich said. “Even as we search for meaning in the world around us, the search for meaning is an inward search. I don't think that meaning is a quality that exists in the world around us, but is a narrative that we find within ourselves and then paint the world with it.”

Doctors surrounded by suffering are pursuing "the search for beauty in the arms of death." And the search for beauty, Dr. Warraich says, is essential.

“What is perhaps the most magical thing about beauty is that it can't be defined, and especially in our modern world where it seems like the only things that count are the ones that can be counted, I feel like beauty is such a compelling concept because it eludes any degree of quantification,” he said.

“The search for beauty is not just a trivial pursuit, it is essential for our very survival.”

Guided by Stories

“For once in the hospital there were tears with no pain.” These words punctuated Dr. Warraich's story of a patient who witnesses her daughter's wedding in the I.C.U. after a a medical team helps orchestrate the last-minute nuptials before the patient died.

“It was the most full-of-life room I had been to in a long time.” Here, Dr. Warraich describes his response to a family's beautiful acceptance of their loved one's death.

While "any story that goes long enough will end with death,” as Dr. Warraich said on Wednesday, paying attention to the stories of individuals promotes empathy. And the many, many stories of the people Dr. Warraich encounters on his medical journey will continue to inform us all about the universality of life and death.