Once seen that way, all medicine is truly narrative in nature. There is this quest for coherence that it inherent in everything we do in medicine. From the first Chief Complaint to the Assessment and Management Plan, the glue that binds the many concerns of medicine, is narrative. Without a narrative understanding of a patient’s story, without first making sense of it, making sense from it, all our most advanced tools flounder and fail. The human instinct for telling a story is how we structure our lives, and the human need for connection is fulfilled by the receiving of it.
It is this beauty and dynamism that occurs in every encounter between patient and doctor. (I use doctor here for effect, but my meaning includes all those who are providers of healthcare.) The unique circumstance created in an exam room is like none other, in the privacy of such a place, a disrobing occurs, not just of clothes, but of all the baggage and the barriers we carry. We reveal to our doctors our selves exactly as we are, asymmetrical bodies, all vanity shed at the door. The atmosphere is electric, the potential for life altering revelations held at bay, but ever present.
And the doctor, the receiver of such a burden, honored yet weary, attentive and present, objective and solicitous. Kind and generous in her gaze, compassionate in her stance, her mind whirring and collecting clues even as she enters the room. A gumshoe detective with a heart of gold.
And into this tableau comes Narrative Medicine, a phrase coined by Rita Charon, an Internist who has (literally) written the book on this. A book that elegantly places the storytelling of medicine within the rigorous framework of the Humanities and creates a new sensibility, as if out of thin air. But of course, not out of thin air; these are ideas that doctors have learned and explored on their own, sensed and tried to define in their own ways, many successfully, the majority not. The practice of Medicine has only in recent times become divorced from the discipline of the Humanities. Many have now understood the loss, and have stitched together a new phrase, Medical Humanities, and the profession of medicine is now irrevocably reconciled with her philosophical sister.
A Medicine that is practiced with an awareness of Narrative is powerful beyond mere words. Patients seek not just cures and balms, but also meaning and purpose, and sometimes, new meanings and newer perspectives created out of the ashes of the old. Understanding this chasm, between the kingdoms of the well and the sick, to paraphrase Susan Sontag, is to be able to navigate it safely, like a boatman delivering his charges to the opposite shore from where they can walk onwards.