Narrative Medicine: Honoring the Stories of Illness

Narrative Medicine: Honoring the Stories of Illness
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My favorite chapter, chapter 6 discussed the non-static nature between the reader and the writer and our assessment of stories often changes as we mature, quoting Lionel Trilling "A book reads us.

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Aug 23, Meredith rated it it was ok Shelves: literary-criticism , medical-research , philosophy-sci-med. What did I learn from this book? English professors refuse to listen to students whose experience blatantly contradicts their own.

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And they're obsessed with strawmen. Feb 02, Joseph Gascho rated it it was amazing. As I wrote after I read the book: Wow!! What a book! Combines photograph, diastole, medicine, ethics, Paul Farmer, writing. A pivotal book for me.

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Readers also enjoyed. About Rita Charon. Rita Charon. Books by Rita Charon. Trivia About Narrative Medicin These divides between the sick and the well are unspeakably wide. Levered open by shame, rage, loss, and fear, these chasms can be unbridgeable. And yet, to get better, the patient needs to feel included among those who are not ill. The sick person needs to continue to be, somehow, the self he or she was before ill- ness struck. For the sick patient to accept the care of well strangers, those strangers have to form a link, a passage between the sick and the healthy who tender care.

We need to see the chasms clearly if we want to bridge them. They seem to me the most urgent among the many divides that separate us. Doctors, who know materially about death, accept an actual, present awareness that we are mortal and we will die, while patients, depending on their own personal experiences with ill- ness and death, usually have not developed such concrete realizations. Doctors may look upon death as a technical defeat, whereas patients may see death as both unthinkable and inevitable.

The contexts of illness: Doctors tend to consider the events of sickness rather narrowly as biological phenomena requiring medical or behavioral inter- vention while patients tend to see illness within the frame and scope of their entire lives.

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They deal with two different things. The emotions of shame, blame, and fear: These emotions, among others, satu- rate illness and add immeasurably to the suffering it causes. Unless explic- itly acknowledged and examined, these emotions and the suffering they cause can irrevocably separate doctor from patient, therefore preventing effective care. Petersburg lawyer who becomes seriously ill.

Although written in the mid- nineteenth century, there has perhaps not been a more eloquent, accurate, and brave depiction of terminal illness and dying conveyed in literature.

With pauses for rest, he washed his hands and then his face, cleaned his teeth, brushed his hair, and looked in the glass. Always the same. There is a ring at the door bell. It is. The doctor rubs his hands vigorously and reassuringly. The pain never leaves me and never sub- sides. If only something.

Whoever occu- pies the role of the doctor—no matter what his or her actual physical health status—will stand for health to the person diagnosed with sickness.

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What dis- tinguishes them, fundamentally, is that Ivan is dying and the doctor is not. What gods failed to intervene on my behalf to spare my sight, my kidney function, my mind? An old man was dying.

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His lament conveyed to me that he was lost, that he felt alone, that he wanted to be with those who could recognize him, even in his altered state. Over the time that I helped to take care of him, I grew to know his body very well. I ex- amined him and drew his blood as tenderly as I could, slowly coming to know how not to hurt him.

Narrative Medicine: Honoring the Stories of Illness

Narrative medicine has emerged in response to a commodified health care system that places corporate and bureaucratic concerns over the needs of the patient. Trained in medicine and in literary studies, Rita Charon is a pioneer in and authority on narrative medicine. In this important and long-awaited book she provides.

I think he came to recognize me, or at least my hands on his body. Sarah and her daughter were usually in his room, staunch in the face of their suffering, bereft even before his death by the loss of him. They, too, lamented, their full vocabularies no more eloquent than his one word. The night he died, I remember I was on call and was often in his room. I always wonder what he must have suffered, having known.

I remember that the next day our whole team had to go his autopsy. The day after he died, his wife and daughter came to get his belongings from the hospital. His daughter gave me a gift to thank me for taking care of her fa- ther, a little scarf, that I have kept through many moves over the intervening decades.

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I behold it as a reminder of him and all that he and his family taught me about grief and about death and about love. Thinking of this man and his family helps me to dwell on the gravity of what we do every day. This moment changed their lives—for his daughter, there is before Daddy died and after Daddy died. For his wife, there is now widowhood. For him, of course, we cannot know. But equally powerful are the opposing candid realizations that all must die, that no one escapes death, and that death is never easy. Others—perhaps for religious reasons or psy- chological ones—sense their own portion running out or their own desserts coming to an end.

As Susan Sontag reminds us, the constant media exposure of the violence of war and repression and natural disaster simultaneously shocks the viewer and inures the viewer against repeated, unspeakable destruction of human beings. Instead of seeming to gloat about their own freedom from evident disease, doctors might reach to attain an equilibrium between their two deluded beliefs about death and then help pa- tients achieve a balanced perception of their own relation to their ends.

Doctors may look at death with the worry that they have caused it—purpose- fully, passively, through negligence or error—and patients may look at death as something that they fear or defy or desire. Death divides not only doctors from patients but also all the sick from all the well and the living self from the dying self.

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And yet, if death seems often to divide, it also unites as the universalizing, ultimately humanizing element of life. It was falling on every part of the dark cen- tral plain, on the treeless hills, falling softly upon the Bog of Allen and, farther westward, softly falling into the dark mutinous Shannon waves. It was falling, too, upon every part of the lonely churchyard on the hill where Michael Furey lay buried. It lay thickly drifted on the crooked crosses and headstones, on the spears of the little gate, on the barren thorns. His soul swooned slowly as he heard the snow falling faintly through the universe and faintly falling, like the descent of their last end, upon all the living and the dead.

My grandfather Dr. Ernest Charon, my father Dr. George Charon, and I are all marked by this mournful name. A year-old man was dying of a hepatocellular carcinoma, widely metastasized. We locate events in space and historicize them in time, registering their contiguity with related events while divorcing them from distracting ones.

The efforts to make sense of anything—the Battle of Gettysburg or The Wings of the Dove—require fundamental decisions about the spheres within which to consider them.

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Is he the fabricator of his own myth? I had neither the knowledge nor the experience to help her, I explained. Nor did I know what to do with my own suffering in the face of theirs. Paul Ricoeur, Time and Narrative, A metaphor can be taken from child psychology.

Differ- ences of interpretation proceed, in large part, from differences in how we con- textualize the matter at hand.