By Elizabeth Lahti, MD
My pager goes off. I don’t look at it, but place my hand over the button to make sure it doesn’t go off again. I’m in my patient’s room. She is well kept with white hair pulled off her face. Her eyes rest shut. She lays still, her skin starting to cool. Her chest has ceased to rise and fall, and no pulse hammers against my fingers when I place them gently on the inside of her wrist. I sit with her family. In silence we honor her life. Her daughter and husband thank me for taking care of her. Her death is not unexpected. Decisions to stop treatment are in the past. Airplanes from the east coast have arrived in time. Stories have been told and re-told.
I finally release the husband’s hand and stand to go towards the door. I glance at the text message on my pager. Mr. G died. Family at bedside. The hospital corridors are quiet. It is Thanksgiving today. I take the elevator down to the 5th floor and walk past the resident work room and the nurse’s station to a closed door at the end of the ward. I knock with light knuckles and open the door without waiting for a reply. I know what waits behind the door.
In what seems like an impossibility my pager goes off for a third time. It calls me to another patient room. Another family at the bedside of a loved one who is gone.
On this particular Thanksgiving I had a surreal experience. Three of my patients died. Each death was what I would describe as a good death. They were not unexpected. No alarm bells or violent resuscitation scenes. No intractable pain or gasping for air. Each patient was accompanied by people who loved them—but I trembled with the gravity of the day.
I started writing about my patients when I couldn’t leave the experiences at the hospital. I brought the patients’ stories home with me. I expanded on the stories with fiction because the real ones were often incomplete, unsatisfying, unbelievable, perplexing or devastating. I wrote myself into the stories in ways I could not have done at the bedside. I imagined my patients as friends or family members; I grieved their losses and experienced their illnesses in my own words. I wrote to understand the incomprehensible.
David Whyte, the poet and philosopher, says he turned from his career as a marine biologist to a poet because “scientific language wasn’t precise enough to describe the experience I had.” I too began to write prose and poetry because medical language wasn’t precise enough to describe the experiences I had. For me writing about my patients resulted in a newfound ability to listen, experience and respond to their stories in a different way—because suddenly I had another layer of language with which to translate illness. It was a language I learned neither in medical school nor residency, but years before when I studied literature and language.
People ask me all the time, what is narrative medicine? Rita Charon describes narrative medicine as “medicine practiced with narrative competence: the ability to listen, absorb and be moved to action by the stories of illness.” It is that, but it is so much more. I first discovered the term narrative medicine by sheer coincidence. My sister, living and working as a social worker in New York, stumbled upon a one day seminar and called me that night.
“You have to come to New York,” she said.
In 2012, I went to my first Narrative Medicine workshop at Columbia University. When I met Rita Charon and others, I felt as though I’d found my tribe. Suddenly, what I was doing and experiencing had a name, a history, and a momentum forward. This was extraordinary for me and changed the course of my career. Since then, I have entered into a world where narrative and medicine connect—which is everywhere. What I have come to learn is that to understand the stories of illness one must also understand the stories of wellness—of the patient, the student, the nurse, the case manager, the specialist, the resident, the caregiver and the scientist. One must be intimately self-aware, but also open to the vast possibility and perspective of others.
Recently, I visited the 911 National Memorial in New York. One wall is covered with small canvases of different shades of blue. Hundreds of artists were asked to paint, from memory, the color of the sky that beautiful September morning before the towers fell. The result is that no panel is the same. Such a simple task, and yet impossible to replicate what another individual saw, absorbed and experienced.
Although each canvas is different, no canvas is untrue, and they coalesce to represent the fuller story of that sky. I believe narrative medicine does the same. If we listen closely, recognize the ways each individual colors their story, and honor the authenticity of each of those stories, then we will engage in collaborative care made up not only of patients and doctors and nurses and caregivers, but of humans who experience illness and wellness together.
The NWNM Conference is an opportunity for those of us in the Pacific Northwest to build our own narrative medicine network. One that includes health professionals, patients, scientists, caregivers, artists and others. We will have the chance to explore our own stories at the intersection of what Susan Sontag called the Kingdom of the Well and the Kingdom of the Sick. Beyond recognizing our own stories, we will build skills in listening, understanding and responding to the stories of others. I look forward to meeting you.
By Elizabeth Lahti, MD
You can follow Elizabeth on Twitter @narrativemd