HumaneMedicine

The Emerging Science of Narrative Medicine

This week’s Education Life section of the New York Times carries an article outlining a new offering at Columbia’s College of Physicians and Surgeons: a one-year graduate degree program in narrative medicine.

 

The offering is the brain child of Dr. Rita Charon, clinical professor of medicine at Columbia, and a leading advocate in this “emerging field” that “aims to treat the whole person, not just the illness.”

For the paltry sum of $50,000, participants can pursue courses in “philosophy, literary theory, psychoanalytic theory, and autobiography,” culminating with a “reading of literature that involves experiences of illness.”

 

This academic year 28 professionals have matriculated in the course. At $50,000 per student, that’s a whopping $1,400,000 added to Columbia’s coffers per annum. To me that seems rather outlandish, even if Dr. Charon does possess a Ph.D. in English in addition to her M.D. degree.

 

The gist of the program is to produce better doctors—those who can relate with a higher degree of empathy to patients—as well as leaders who can set up similar programs in other institutions of higher learning.

Anyone who has spent any time wrestling with literature will recognize the concept of irony, one of the dominant themes in the discipline. To my humble way of thinking, as one who has spent untold hours delving into the writings of past medical authors and mentors, the concept of a $50,000 graduate degree program to learn the art of narrative medicine is, well, rather ironic in itself.

 

My father was a teacher. He spent most of his career in the classroom, teaching students. (He eventually rose to the rank of department chairman, a position which required more administrative duties in his final work years.) I remember his words one afternoon in quiet conversation: “The only ones who know anything about teaching are those who work in the field.” (Lest readers accuse me of nepotism, let me add that I’ve heard the same sentiment echoed by any number of other teachers worth their salt.)

 

If I read former physicians like William Osler, Francis Peabody, William Carlos Williams and Albert Schweitzer, as well as any number of literary types such as Tolstoy, Chekhov, Cronin, et. al., I find that the “emerging discipline of narrative medicine” has been emerging for quite some time—decades, I’ll warrant, if not centuries; perhaps millennia.

 

Personally, over a thirty-year career in clinical medicine, I became involved in "narrative medicine" by listening to patients and trying to make some sense of their stories as I melded them with my own. I frequently visited with mentors (both living and dead) and learned from them as best I could. I started to write for my own edification—to put things into perspective, to learn from my mistakes, to identify what was important in caring for my patients. I published pieces to share what I learned with others, who likewise were searching for fulfillment in their roles as healers. All of this I did with no expectation of monetary reward—I did it for the love of it, and an amateur I remain.

 

Now that narrative medicine has become the "in thing," entrepreneur types are capitalizing on it, generating big bucks through workshops and programs like Dr. Charon’s at Columbia. Eventually, it will become tainted. (As Mark Twain said, 'Taint yours and 'taint mine.)

 

But for the time being, those of us who work in the field, listening to the stories of our patients every day, can continue to ride the common waves for as long as the surf's up.

 

—Brian T. Maurer

Wounded Healers

 

Henri Nouwen coined the phrase "wounded healer" in reference to individuals who have developed the ability to empathize with the sufferings of others through the sufferings that they have experienced themselves.

The other morning I greeted a woman who had recently had a total hip replacement.  I was surprised to see her out and about so soon after the surgery.  Another woman who had had a tumor removed from her lung last month approached the woman with the artificial hip and asked how she was faring.  “Don’t get up,” she said, but the woman rose from the bench; and I watched these two elderly women embrace—two wounded healers reaching out through their individual pain to comfort one another.

Freud said:  “Wherever I go, I find a poet has been there first.” To be a poet in this day and age is to have a broken heart. Here are the beautiful words of the poet Naomi Nye in an excerpt from her poem entitled Kindness.

 

Before you know kindness as the deepest thing inside,

You must know sorrow as the other deepest thing.

You must wake up with sorrow.

You must speak to it till your voice

catches the thread of all sorrows

and you can see the size of the cloth.

Then it is only kindness that makes sense anymore, only kindness that ties your shoes

and sends you out into the day to mail letters and purchase bread,

only kindness that raises its head

from the crowd of the world to say

it is I you have been looking for,

and then goes with you everywhere

like a shadow or a friend.

 

 

—Brian T. Maurer

Reading Binges

Nicholas Davies, a respected Atlanta internist, was in the habit of taking two weeks off every summer to read, play golf and relax. "I spend an inordinate amount of time thinking about what I shall read during my summer vacation. " he wrote. "It is a major concern... I must be some sort of reading nut; a bibliomaniac of sorts...

One evening I was having dinner with Stephen Lock, the BMJ's editor. We were talking about reading for pleasure and I said that I usually stayed with the classics. He agreed with this plan and said, "Yes Nicholas, you might have 500 more books that you can read in your lifetime. Stick with the best.. I have followed that disquieting pragmatic advice ever since."

Sadly, in 1993 Davies was killed in a plane crash while on official business for the American College of Physicians. Hopefully, his last years were enriched by spending time with the Immortals.

His essay, Readin Binges, which appeared in the British Medical Journal, is one of the most memorable pieces I have encountered.  Download Reading Binges    .  Please peruseit a your leisure.

Montaigne - Essays

The September 7, 2009 issue of the New Yorker magazine has a fine article about Michel E. Montaigne.  It is well-worth reading as an introduction to the man who invented the "essai."

Literary Lives

Me, Myself, and I

What made Michel de Montaigne the first modern man?

by Jane Kramer, September 7, 2009

ABSTRACT: LITERARY LIVES about Michel de Montaigne. Every French schoolchild learns the date: February 28, 1571, the day that the educated nobleman Michel de Montaigne retired from court and public duties, retreated into the tower of his family castle, near Bordeaux, shut the door, and began to write. It was his thirty-eighth birthday. His plan was to spend the second half of his life looking at himself. Montaigne’s pursuit of the character he called Myself lasted for twenty years and produced more than a thousand pages of observation and revision that he called “essais.” His first two books of essays appeared in 1580. By the time he published a third book, in 1588, everyone in France with a philosophic bent and a classical education had read the first two. His books were utterly original. They were not confessional nor were they autobiographical. They made no claim to composing the narrative of a life, only of the shifting preoccupations of their protagonist in an ongoing conversation with the Greek and Roman writers on his library shelves—and, of course, with himself. His belief that the self, far from settling the question “Who am I?,” kept leaping ahead of its last convictions was so radical that some describe Montaigne as “the first modern man.” He left his tower in 1580 for a year of traveling. He left it again in 1581 to become the mayor of Bordeaux. He was also a close friend and confidant of Henri de Navarre, as well as his emissary to the court of Henri III. Mentions Montaigne’s wife, Françoise de la Chassaigne. Describes the sour relationship he had with his mother, Antoinette Louppes de Villeneuve. “On Vanity,” perhaps Montaigne’s greatest essay, is a meditation on dying and, at the same time, on writing. It draws pretty much the whole cast of characters from his library into the conversation. The penultimate pages are an homage to Rome. But he ends the essay in the oracular heart of Greece, with the Delphic admonition to “know thyself,” and in a few pages turns the idea of vanity on its head, defending his pursuit of himself as the only knowledge he, or anyone, can hope to gain. It is the one argument for a “truth” he makes in a hundred and seven essays. Mentions Étienne de la Boétie. Montaigne was seven years into the essays when he suffered his first serious attack of kidney stones. When Navarre succeeded to the throne, in 1589, becoming Henry IV, Montaigne wrote to volunteer his services again. In July of 1590, Henry summoned Montaigne to court, but by September Montaigne was too sick to travel. He died at the age of fifty-nine.

Poirier and the Canon

Richard Poirier, an esteemed writer and critic, died in August 2009.  This is an excerpt from a Times editorial about his significance:  "He reminds us that we should never be complacent about the glories of the canon, which is made up of texts as frustrating and unfinished as ourselves. And he suggests that linking and hyperlinking are no substitute for a sustained encounter with the great writers of the past, who were themselves both tormented and thrilled by “what words were doing to them and what they might do in return."  Download R.Poirer

The Care of the Patient by F.W. Peabody

This paper originally appeared in the Journal of the American Medical Association (JAMA 1927; 88:877-882)  It is as valid and inspiring today as it was 80 years ago.  It is the most cited and revered article in the medical literature.  The JAMA article derives from a talk given by FW Peabody to the students at the Harvard Medical School on October 21, 1926.  After the talk, Peabody’s wife remembered him saying, “I am absolutely sure that this little lecture will be remembered long after anything of a scientific nature I have written has been forgotten.”  (The underlinings are mine in the essay are mine  – DJE) Download The Care of the Patient

Thoreau on "Walking"

          

         Thoreau's essay "Walking" is a brilliant introduction to this salutary activity.  One can walk anywhere, but the environs around Williamstown are perfect for this activity.  During this Winter Study period, spending an hour a day in an alfresco activity would be an anodyne for the body and the soul.

          "When he came to grene wode,
            In a mery mornynge,
          There he herde the notes small
            Of byrdes mery syngynge"

I think that I cannot preserve my health and spirits, unless I spend
four hours a day at least--and it is commonly more than that--sauntering
through the woods and over the hills and fields, absolutely free from
all worldly engagements.

I, who cannot stay in my chamber for a single day without acquiring some
rust, and when sometimes I have stolen forth for a walk at the eleventh
hour, or four o'clock in the afternoon, too late to redeem the day,
when the shades of night were already beginning to be mingled with the
daylight, have felt as if I had committed some sin to be atoned for,--I
confess that I am astonished at the power of endurance, to say nothing
of the moral insensibility, of my neighbors who confine themselves to
shops and offices the whole day for weeks and months, aye, and years
almost together. I know not what manner of stuff they are of--sitting
there now at three o'clock in the afternoon, as if it were three o'clock
in the morning.

Full Text of Thoreau's essay:  Walking  Download WALKING

John Keats (1795–1821) expresses a similar sentiment in just 14 lines!
 
To one who has been long in city pent,   
’Tis very sweet to look into the fair   
And open face of heaven,—to breathe a prayer   
Full in the smile of the blue firmament.   

Who is more happy, when, with hearts content,
Fatigued he sinks into some pleasant lair   
Of wavy grass, and reads a debonair   
And gentle tale of love and languishment?
   
Returning home at evening, with an ear   
Catching the notes of Philomel,—an eye     
Watching the sailing cloudlet’s bright career,   
He mourns that day so soon has glided by:
   
E’en like the passage of an angel’s tear   
That falls through the clear ether silently.