Walking through the doors of Columbia University Medical Center: Hammer Health Sciences Teaching and Learning Center, I fear that I may be grossly underqualified to be here. Everyone looks so official, bustling by in scrubs, varying lengths of white coats, and other official attire that speaks “I’ve worked hard to earn a place here.” I tread slowly and methodically, and my fingers fumble as I check in and am handed my identification card that allows me to walk freely through the doors of the CUMC campus, becoming my life preserver for saying that I, too, belong here.
I’m in New York City; specifically, at Columbia University’s Summer Institute in Narrative Medicine. Narrative medicine is an interdisciplinary approach that recognizes the value of a patient’s story and, in so doing, exposes Western medicine’s narrow focus on the physical, tangible biological factors of health and disease that often overshadow the patient’s humanity. Narrative medicine relies on the core principles to recognize, absorb, interpret, and be moved to action by stories of illness. In doing so, it also recognizes the complexity of each individual and highlights the many stories we all bring to an experience.
During the past year, I have become a strong proponent in the work of narrative medicine, surrounding myself with literature on the topic and exploring narrative practice in my own literary work. During the spring semester, I worked with the support of Dr. Emily James on a research project called Mid-Century Narrative Medicine: Sylvia Plath’s Confessional Practice, where I sought to bridge the gap between several disciplines – including medicine, psychology, and literature – within the framework of poet Sylvia Plath. Coming from my solid foundation in studying psychology, this research worked to address a class of more “invisible” diseases: mental illness.
The structure at the institute was designed in a way that maximized every effort in fostering deep, intellectual discussions on the complex topics narrative medicine grapples with. Each topic began with some form of a lecture given by one of the “pros,” ranging from Dr. Rita Charon, MD, world-renowned for her ground-breaking research in narrative medicine, to Craig Irvine, Ph.D., author and Director of Education of the Program in Narrative Medicine at Columbia University’s College of Physicians and Surgeons. Following the lectures, we broke off into small groups consisting of about 6 people, where we were first given an open-ended prompt followed by exactly five minutes to write a response. We were always given the same guidance: begin writing immediately, keep your pen moving across the paper the entire time, and if you draw a blank and don’t know what to write next, continue writing “I’m stuck” until the next thing comes to mind. (It may sound silly, but that actually works!)
When we read our work aloud afterward there was one catch: no prefacing your writing by saying things like “Well, I didn’t really know what to write, so it probably won’t make sense…” or other ways of trying to explain yourself beforehand. This was a challenge. You mean we’re supposed to read without explaining it beforehand? Nobody’s going to understand the tangled mess of words I have written down. What I came to learn through this intentional structure so lovingly encouraged on us was the ability to trust the power of my own writing. I learned that by attempting to preface my work with a rushed explanation of what I’d been thinking when I was writing or how I want my listener to understand it, I am essentially minimizing my own work and stripping my writing from the innate power it dares to hold.
One evening, we attended an event called Intima Presents Life-Writing: An Evening of Readings about Bodies, Illness and Care. Intima: A Journal of Narrative Medicine is an online literary journal focusing on healthcare, medical stories, hospitals, and caregivers. This event we attended featured some of the published authors who had come to read excerpts of their published works and share their varied and diverse experiences surrounding healthcare.
Before the institute began we were told about this event and encouraged to bring along any of our own pieces we’ve worked on to share as well. In the weeks leading up to it, I had assumed there was absolutely no way that I would get up in front of a room full of people to read anything I’ve written. However, at the last minute as I was packing my bags, I threw in a copy of a narrative essay I had written called “Returning Home,” which talked about my experience as a nurse’s aide working in the field of senior home healthcare. In this particular piece, I detail the pain – yet honor – I had of being by the side of one of my beloved seniors as he passed away peacefully. I had written it as part of a final project for the ENGL 202 class called Medical Narratives, taught by Dr. James, which was in essence my first attempt at narrative medicine. I figured it didn’t hurt to throw it in, just in the unlikely event that I had a moment of gumption and courage to speak.
With the first several days of the institute under my belt, I had surprised myself by actually beginning to ponder over my “definitely no” decision about choosing to present my work that I had previously made prior to arriving. Armed with the practice the last few days had given me with sharing my work, I had actually begun to think that maybe, just maybe, this was something I could do. I was absolutely terrified, but had been encouraged by the other people at the institute – students and “the pros” alike – to go for it. I think deep down, I knew that if I let fear make the decision for me, I would later come to regret it. So, despite the trepidation of exposing my work to the room, I did it anyway. To those not as familiar with narrative medicine, it’s important to remember that autobiographical accounts in the scope of narrative medicine are deeply personal in nature because they deal with illnesses, often leaving the patient immensely vulnerable and helpless. Although my piece I chose to share came from my perspective as the provider, the vulnerability still remained because despite being the provider, we are still greatly moved by the patients we encounter.
I did it. Remembering the “rule” about not prefacing my work or minimizing it in any way, I began to speak. I told the story of my first experience having one of my own patients die, which was magnified by the fact that I was with him when it happened and came far sooner than we had imagined. It was a very emotional experience to write about and gave me confidence in sharing my work as well as the conviction to allow my voice to be heard. As I finished reading aloud, I looked up at the audience and remember seeing several members wipe tears from their eyes, a clear example of the power narrative medicine has in humanizing us all in a world that seeks to remove all emotion from the medical field.
That experience really set the stage for what I would learn on the last day during my favorite lecture, “The Failure of Witnessing in Medicine” by Kristen Slesar, LCSW, MS. In addition to teaching at Columbia University, Kristen is a trauma psychotherapist and former Sexual Assault Forensic Examiner with many years of experience testifying in the most abhorrent criminal cases of sexual violence. I could write a book on all the insight I learned from her lecture alone, but the most important thing she emphasized is probably the best example of the purpose of narrative medicine. She emphasized time and time again how any line of work we do involving people and professional care impacts both the patient and the provider. We often think of the professionals as being a stone wall, never showing any emotion – both publicly and privately – for the work that they do. Yes, there’s a time and a place for that; if you’re an emergency surgeon, breaking down sobbing in the middle of operating on a child gunshot victim probably isn’t the best time for emotions. But that doesn’t mean it’s never to be discussed. When we talk about our line of work, we usually talk about the horror of the case, because everything is seen as putting the patient first. We don’t allow providers to talk about how they themselves are impacted. Because we are all human beings, we are going to be impacted by the people we serve, and that is okay.
Across America, medical schools and other graduate programs are implementing programs in narrative medicine to complement the preparation of our future providers for the kind of work they will encounter. In fact, research shows that those who tell their story fare better in the work that they do. This means less “burning-out,” which ultimately means fewer medical errors, as well as the patients’ experience being enhanced by feeling that they are more than just a disease to be treated. Narrative writing allows you access to something you may not have been able to access before because you can talk about the experience from your perspective and the way you tell that story, patient and provider alike. Narrative medicine is about writing from the patient’s experience, yet also includes bearing witness to our own experience as providers.
My experience at Columbia’s Institute in Narrative Medicine was truly life-changing. My earlier fear of “not belonging here” was laid to rest within the first morning of the institute, and I was thoroughly engaged throughout its entirety. Not only did I get to learn more about the topic of narrative medicine, but I was also given the opportunity to connect with the world leaders in this subject and work one-on-one with them, sitting down together and collaborating on the work I have done and getting encouragement on where to dive deeper into my study. I met others who share a similar desire to make narrative medicine an everyday part of clinical practice, and left with an even stronger desire to continue in this field. My goals of becoming a counseling psychologist were further strengthened with the knowledge that narrative medicine will unequivocally be a part of my practice.
I extend my most sincere appreciation and gratitude to the St. Thomas community that has supported and encouraged me in forging my way through this unique, interdisciplinary study. I am immensely grateful to Dr. Emily James, whose support and collaboration have gotten me to where I am and who continues to inspire and encourage me to seek out the paths less traveled. I am also very grateful to the Grants and Research Office for funding my spring research through the Collaborative Inquiry Grant, as well as the English department and Dr. Amy Muse for the funding and support that allowed me to travel to Columbia University.
Finally, I want to encourage all of my fellow peers at St. Thomas who have a passionate interest but are unsure the precise area of study it falls under: seek out those professors and other students who share a similar interest, and utilize their knowledge and expertise in further exploring those topics. Find those who challenge you to dive deeper into those interests and encourage you to walk those uncharted paths. I started this interest as a student majoring in Psychology, with a great interest in health and an underlying love for literature. Now, I am additionally getting a minor in English and regularly use the support and expertise from both departments as a way to study what I am most passionate about. The support I have experienced has blown me away and allowed me to find the precise area of study I am interested in and has shaped the career path I intend to follow.
Megan Vaughan is a senior at St. Thomas with a major in Psychology and a minor in English. Megan has a great interest in the interdisciplinary field of narrative medicine and plans to use this interest in becoming a counseling psychologist.