Dr. Rita Charon talks of narrative medicine, which is about absorbing, interpreting, honouring and being moved by the stories of patients
Every patient feels like telling the doctor more and more or the same things over and over again. Rita Charon understands this phenomenon and has evolved a new aspect of treatment called narrative medicine. In a talk titled “Honoring the stories of Illness”, she talks of how medicine should be the support that holds a patient’s hand through the tunnel without an opening.
“I came to medicine because I was a lifelong reader and as a reader I understood, once I opened my practice, that what I did in the office, what patients paid me to do was to pay exquisite attention to the narratives they gave to me which were in words, narratives, facial expressions, in their body, in what other people said about them and that it was my task to co-hear these stories and make sense. To take these multiple contradictory narratives and let them build to something that we could act upon,” says Dr. Rita Charon, Professor of Clinical Medicine and Director of the Program in Narrative Medicine at the Columbia University College of Physicians and Surgeons.
“I realised,” says Charon, “that I did not know very much about stories. I went to the English department and asked them to teach me something about stories and how they worked…they joined me in the idea that the knowledge they had, very special narratological knowledge could do something in the world. I want to tell you how the story training, awakening and nourishing my own sense of story transformed my teaching and practice.”
Charon continues, “My colleagues and I in Columbia created a field called narrative medicine…which we define very simply, as clinical practice fortified by the knowledge of what to do with stories. First of all, having a sense of story and then being able to recognize it when someone is telling you a story, to absorb the story and receive it whole including even those unsaid hints and guesses about what might be left unsaid. To absorb, interpret and honour them and then be moved by them to action. We found very effective economical ways to teach the skills of reading, writing and story-telling and receiving to medical students, nursing students, doctors…all those who come in and out of hospitals.”
Charon says that it keeps people’s imagination alive and so they do not become insensitive to the sufferings they see daily.
“There were amazing transformations in my own practice. As I improved my own capacity to read closely, I was able to listen closely where every word counts. So in the office when I saw a new patient, I would not ask a million questions anymore…instead I would say I am your doctor I need to know a great deal about your situation. I let people talk...I learnt patients were deeply thirsty to give detailed, profound accounts of themselves…”
Charon tells of a woman who suffered from breast cancer. After 20 years, a new cancer reappeared and this time even though the operation was successful, the woman had got a certain fear which would see her knocking at the doctor’s door every other day. Finally Charon realised that she and the patient were sitting in the glare of death and that was what was upsetting the patient.
Quoting from a book Charon says, “…Zeus (Greek mythology) envies the mortals. He says it is death that gives your life meaning. In the dying, in the limits of life we have meaning and we pour ourselves into that which endures…family progeny, art, dance…those things which will endure in time…they are available to us only in the presence of death.”
Charon answers a very basic question, “When I ask what is medicine for, my patients and students have been able to teach me that these narratives help us to form clearings… we come together in the clearing of story-telling within this human gift of mortality…so that no one has to be in the glare of sickness or death alone. Any one in any place has the chance to make the contact.”