Widening the Differential

By Julia “Jay” Ruby, OHSU School of Medicine Class of 2018

My medical school orientation, like many other foreign experiences, was terrifying. Each day was packed with numbers, graphs, handshakes and competencies. Coffee became an all day occurrence, and the days blurred into one another. One thing stands out though. I remember the moment we were told about a new Narrative Medicine course: throughout our training, we would be required to reflect, in writing, about our medical school experiences, and share these reflections word for word with our classmates. Reflections? Writing? My ears perked up. As an undergraduate creative writing major, this was finally something that felt comfortable, familiar. But what I remember even more vividly was how varied my peers' reactions were. Some, like me, were excited to have an avenue to expand beyond the dot phrases and summary statements of medical writing. We were excited to force ourselves to not only characterize a patient's pain, but describe the invisible feelings in a room, the view of the sunrise from the VA skybridge, or the comforting quality of a therapy dog's fur coat. Some of my classmates were less comfortable with this challenge. This also made sense to me. You don't have to be a good writer to be a good doctor; in fact, you don't even have to take a college English course. I had already been told that in medicine, brevity is beauty. Despite my initial excitement, I began to worry a little. How would this whole narrative medicine thing play out? Would some students dread the sessions, while others, like me, chomp at the bit for those two hours each month? Would sharing our writing be divisive or uniting?

The first few narrative medicine sessions were awkward. We sat in a room with a dozen other students, sometimes in silence, waiting for the next volunteer to share their reflection. Not knowing quite what was expected of us, the first few sessions were full of reflections that felt a little scripted, a little safe. But as the weeks went on, people began to go further. One of my classmates narrated a surgery from the perspective of the body part being operated on, which elicited a wave of chuckles throughout our classroom. Another student tearfully compared learning about a dying patient to her own experience of loss, followed by a long moment of solemn, soft silence. Narrative medicine became less of a requirement and more of a haven, a safe space where we could share what we might not feel comfortable sharing on the wards or in a lecture hall. I remember one classmate, who was previously skeptical about narrative medicine, tell me he had “drank the kool-aid,” which although a silly analogy, made me smile. Making ourselves vulnerable to each other in our sessions reflected the unique relationship patients and doctors cultivate: one where emotions and empathy are paramount. Having a space free of judgment or rules, a rarity in medical education, is something my peers and I have come to cherish and appreciate, regardless of our interest and experience with writing. Our shared stories have brought us closer to each other and our patients alike.