Narrative Medicine and the Fine Art of Listening: A Memoir Moment

Posted by Kathleen Pooler/@kathypooler

 

“The greatest gift you can give another is the purity of your attention.” Richard Moss, MD

 

The field of Narrative Medicine has emerged gradually over time.

 

Dr Rita Charon, professor of medicine and executive director of Columbia University’s Narrative Medicine program defines narrative medicine as “medicine practiced with narrative competence to recognize, absorb, tell and be moved by the stories of illness.”

 

She is the author of Narrative Medicine: Honoring the Stories of Illness.

 

narrative-medicine-charon-rita-9780195340228

Narrative Medicine: Honoring the Stories of Illness by Dr Rita Charon

 

When I attended nursing school in 1964-67, we studied ‘interpersonal relationships and therapeutic communication.” It was a given that the nurse’s role was to consider the individual person in caring for the patient while the physician’s role was to concentrate on diagnosing and treating disease. We called it the nursing model and medical model. Together we would work as a team to deliver safe and compassionate care to our patients.

 

Listening to the stories of illness is at the heart of any compassionate, caring relationship. As Dr Charon cites in this article from the Journal of American Medical Association (JAMA),

 

“words nurse the wounds medicine cannot describe.”

 

It comes as a welcomed relief to me to see that the field of Narrative Medicine encourages a holistic approach for all healthcare providers.

 

I have been privileged to have served as a health care provider both as a registered nurse for forty-four years and as a family nurse practitioner for the last fifteen of those years.

 

Here is a story of a time I listened to a patient. It was 1974 and I was a staff RN in a busy emergency department of a 400-bed hospital:

 

Sacred Ground

 

50 year-old  male with crushing chest pain of three-hour duration. No known heart history. His wife is on her way,” the paramedic reported while whisking the ambulance stretcher past me on the way to the trauma room.

 

As I helped pull the man onto the exam table, his wide eyes and ashen color left no doubt about the urgency of his condition. We buzzed around him like a swarm of bees. While hooking him up to the monitor, starting an IV (intravenous), rattling off questions, I looked over at him and noticed his eyes searching. He clutched his chest and looked so scared.

 

“Mr Michaels, we’re giving you some medication in your veins to help the pain,” I said as I leaned in closer to his stretcher.

 

“Where’s Rachel? I need to see Rachel. Please go get her,” he pleaded, his salt and pepper hair now drenched with sweat. He had a look of terror in his eyes.

 

Sensing the desperation in his plea, I signaled to a co-worker to take my place and briefly left the room while the frenzied attempt to save his life continued.

 

A thin, scared young girl with long straight light brown hair and big brown eyes slowly inched her way around the corner when I called out for Rachel.

 

“Rachel, your dad wants to talk with you,” I said. When I bent down to put my hand on her shoulder, I wanted to wrap my arms around her frail, frightened body.

 

“Is my Daddy going to be OK?” she asked as she looked up at me and fiddled with the button on her dress. I sensed she knew he wasn’t.

 

“We’re doing everything we can, Rachel. Come with me,” I said as I took her hand and led her to the room.

 

I guided her to the head of her father’s bed through the maze of IV tubing, monitor wires, medical orders and staff rushing by.

 

Mr Michaels reached out his arm and pulled her head next to his, kissing her forehead.

 

“Take good care of your mother, Rachel. Daddy loves you very much.” He said. 

 

I love you too, Daddy.” She said and began sobbing.

 

He nodded, signaling me it was time to leave.

 

After ushering Rachel to the waiting room to the care of another nurse, I returned to the room. He was being resuscitated. As soon as I left the room with Rachel, he had gone into full cardiac arrest. After all attempts were deemed futile , he was pronounced dead.

 

Precious moments and sacred ground.

 

 I’m so glad I listened.”

 

 

I hope you will enjoy this YouTube video of a TED talk by Dr. Sayantani Das Gupta, professor in the Medical Humanities program at Columbia University. She talks about “Narrative Humility and the importance of reading and interpreting our patients’ stories.”

 

How about you? Have you experienced the healing aspect of storytelling and being listened to?

 

I’d love to hear from you. Please leave your comments below~

 

Next Week:

Monday, 3/31/14:  ” Finding My Way From Memoir to Fiction by Author Doreen Cox”

 

 

 

 

Comments

  1. says

    Thank you, Kathy, for highlighting this incredibly important aspect of writing as a way of healing, as well as sharing your own personal experience as a healthcare provider. Some doctors and nurses can be so cruel, perhaps not purposefully, but due to lack of training to stop for a moment and LOOK at the patient as a human being with thoughts, emotions and opinions. Who better than you to know how important this is both to family and to patient to have a compassionate and listening ear during the greatest of life’s crises – illness and even death.

    This scene you describe in the trauma room is very touching, very human and the title of the piece “Sacred Ground” most apt. I hope you continue to share as both a memoirist and as a nurse in the exciting and important field of narrative medicine.

    • says

      Thank you, Susan. This is a topic I am passionate about from both sides–as a healthcare provider and as a patient. I am thrilled that the study of Narrative Medicine is gaining momentum and has become an integral part of the curriculum in medical schools, thanks to Dr Rita Charon. I appreciate your ongoing support and encouragement to keep telling these stories. Indeed, it is sacred ground.

  2. says

    Narrative medicine & Narrative humility (according to Dr. Gupta) are both ways to define compassion, I think.

    One of the summers before college I worked in a nursing home, where there were plenty of opportunities to listen. But I knew I couldn’t deal with the life/death aspect of medicine which solidified my choice of teaching as a career. My students were young adults, most of them in the throes of major life decisions.

    More than one has told me that something I said changed their lives. The funny thing is this: I don’t remember voicing anything profound, but apparently it suited their needs at the time. And that’s all that matters, I guess. It was “they” who were doing the listening.

    • says

      Amen, Marian! Listening is one of the most challenging and yet powerful tools we all have. It requires being truly present in the moment. It sounds like you accomplished that with your students. Thank you for sharing this perfect example of how listening made a big difference in the lives of your students. It always amazes me how little we really have to do to make a positive difference.

  3. says

    Kathy, this is a great post, and I especially appreciated the introduction to the concept of narrative humility and to Dr. Gupta’s talk. I think I will use this talk with students in my adult ed class on storytelling in the local parks/rec program.

    Humility isn’t sexy, but it’s a requirement for learning.

    And our stories are vital to the kind of wholeness both a good doctor and a good memoirist have to offer.

    • says

      Thanks, Shirley. I’m thrilled you will share Dr Gupta’s talk with your students. Everyone should see it. I agree, storytelling and listening to each other’s stories are important facilitators of the healing process. I appreciate your comments, as always.

  4. says

    Kathy, this story brought tears to my eyes with its beauty. The man who knew his time had come, just like that. Your attentiveness and compassion with that young girl. The whole scene. Sacred ground. How true. Beautiful!

    • says

      Thanks, Sharon. This is one of many profound moments I have experienced in my nursing career. I recall it in vivid detail as if it happened only yesterday. When I reflect upon my nursing career and the patients I was privileged to care for, I feel an overwhelming sense of gratitude for all they taught me about living and dying. Sacred ground indeed. When I get these memoirs “out of my system”, I hope to write more about that sacred ground. I appreciate your comments.

        • says

          Oh,thank you dear Linda. Writing this post and reading all these lovely comments has stirred up my desire to do something more with all these stories that are churning inside. I appreciate your encouraging nudge! Thanks so much for stopping by. Your ongoing support is greatly appreciated. :-)

  5. says

    This is lovely, Kathy, and highlights the value of true compassion. Somehow it reminded me of a program at a nursing school here where the nurses are trained to do art based on their interaction with their patients. It is therapy for the nurses-in-training, but among other things, teaches them to listen with compassion.

    • says

      Thanks, Mary. I love the idea of doing art based upon patient interaction. I still have a pencil sketch I did of a patient I had cared for while on rotation in a psychiatric facility during nursing school. It does force one to still still and listen with compassion. I appreciate you stopping by and sharing. Thanks!

  6. says

    Kathy, this is such a powerful story and very powerfully told! I was right there with you, seeing the poor man and his daughter, feeling their fear and pain. You don’t have to write fiction, my friend, when you’ve had so many of these kinds of experiences!!

    • says

      Thanks, Debbie! Yes, truth is sometimes stranger than fiction and fiction is often based upon the truth. My nursing career certainly provided me with much fodder for storytelling. I appreciate hearing you were transported into the story. What a lovely compliment.Thanks for stopping by!

  7. Dody says

    Thank you, Kathy, for posting this particular experience. It reminded me that, in the midst of the most calamitous of events, there are always fresh air moments. This is one of those days in which I miss my mom so much; she would have enjoyed reading this post, discussing it with me. Richard Moss’s work got me through a tough period of time in my life; your quote of him brought me back in time. Rita Charon’s book is enticing! By the way, have you ever stumbled onto a book by Stephen Levine: Healing Into Life and Death? I had not heard the term, Narrative Medicine, before; I have, however, experienced its power.

    • says

      Dody,I am so touched by the vision of your mother wanting to read this post and discussing it with you. As a writer,that is an ultimate compliment as the story connected you to your own story. I am in awe of Dr Rita Charon’s bold work. I have never heard of Stephen Levine’s book but will check it out. Also , I am reading Dr Lani Leary’s book “No On Dies Alone” about helping our loved ones “author their own death”. It’s fabulous. Here’s a link to the Google+Hangout Interview with Dr Leary by Jason Matthews and Marla Miller:https://www.youtube.com/watch?v=AZFRlkIGX2Q. Thank so much for stopping by and sharing your thoughts. I’m excited to feature you as my guest here on Monday, 3/31.:-)

  8. says

    Powerful emotions, profound moments, poignant words. Great message, Kathy, not only to those in the medical field, but to all of us. Though you may no longer be at the bedside nursing, you continue to walk on sacred grounds healing hearts daily through your words. I will pass this on especially to my doctor daughter and nurse in training niece.

    • says

      Thanks, Pat. It was so hard to leave my nursing career but, as you describe so eloquently, nursing never left me. Your words are so touching, “healing hearts through words”. Truly a sacred mission.BTW, you are doing the same through your words with your trailblazing message for young women. I would love to hear your NCAA speech. I already know I would need to keep tissues at hand! Thank you for sharing with your doctor daughter and nurse in training niece.