Sunday, September 18, 2016

never underestimate the healing power of storytelling

This week I came across an article in Psychology Today (you can read it here) that alerted me to yet another show-stopping demonstration of storytelling as a healing process.

It told about an elderly patient with dementia who had become increasingly confused and combative at home. When her condition deteriorated following a fall, her family took her into their home to care for her. Then, following a seizure, she was hospitalized and underwent a battery of tests including blood tests and brain scans that frightened and confused her. She experienced hallucinations that intensified her fear. Because she didn’t understand what was happening to her, she created a narrative in her mind that made sense to her. She convinced herself she was the victim of terrorists, and that she was being tortured. She became increasingly fearful and angry with her family because she believed they had allowed it to go on.

Instead of trying to convince her she was wrong, the family offered her a different story to explain her situation. Instead of taking offense at her accusations, trying to change her behavior, or medicating her, they created an illness narrative. They helped her understand that she had a disease called Alzheimer’s that was causing her confusion and forgetfulness. They reminded her of her fall and the seizure, and what tests she had endured. Little by little it all started to make sense to her and her anger and fearfulness subsided. Once she understood what was happening to her, she was able to accept her family’s care and to make peace with her prognosis.

Image result for terry pratchett quotes about alzheimers

The authors conclude:

A narrative is a powerful thing. A narrative not only makes sense of the past, but also allows one to see the self in the future. The problem is that we all know the future of the Alzheimer's narrative: gradual decline and the expectation of future difficult episodes. We know that we will have wonderful moments as well. Having this narrative, even with the known end to the story, has been a blessing. The narrative provides an understanding and a feeling of resolution. In addition, this shared narrative improved and repaired our damaged relationship.”

Never underestimate the healing power of storytelling.

Monday, September 12, 2016

plot points in retrospect

There is some truth to this observation:

We were reminded of this last weekend as we commemorated the lives that were lost as a result of the terrorist attacks of 9/11. I was at work that day so it was hard to keep up with events as they unfolded and reality set in. You probably remember exactly where you were and what you were doing that day, too.

The same is true for many of us when the space shuttle, Challenger, exploded. I was in the drugstore, at the checkout when I heard the news. When we learned that President John F. Kennedy had been shot, I was sitting in 9th grade algebra class.

Some memories stay with us because they are tragic, some because they are inspiring, or funny, or scary. Some moments in time stay with us for reasons we may not understand while others are lost forever. One hectic day blends into another until whole blocks of time fade from memory. All we know of our past are the moments we can recall.

A lifetime in medicine is no different. The years we dedicate to patient care—the unending procession of patients, the emergency admissions, and daily hospital rounds—leave us little time for reflection. We don’t purposefully commit each day’s events to memory. Nevertheless, some moments survive as vivid images that flash back to us uninvited years later, each one a glimpse back in time, back into the story of our lives.

Here are a few moments in medical practice that are forever chiseled into my psyche:
  •  A gentleman presented to the office with chest pain. His wife was seated next to him in the examination room as I placed my stethoscope on his chest. Suddenly, as I listened, his heart simply stopped beating. He slumped to the floor as his wife looked on. CPR failed to revive him. His story ended that day, while his wife’s story changed forever.
  • A “Code Blue” (cardiac arrest) summoned us to Labor and Delivery where a young woman had hemorrhaged following the delivery of a healthy baby. Her story ended there while, waiting in the visitors’ lounge, her husband poured himself another cup of coffee in joyful anticipation of the birth of their first child.
  • A patient was admitted through the emergency room for what was described as an unsuccessful suicide attempt. He thought he’d ingested rat poison from an unlabeled bottle in his garage. Instead, it turned out he’d actually swallowed sulfuric acid. Rat poison ingestion is treatable. Sulfuric acid ingestion is not. He was placed in a medically induced coma as his mouth, throat, and esophagus disintegrated. Life support measures gave friends and family just enough time to say goodbye before the doctors pulled the plug. His depression came to an agonizing end that day, while theirs was just beginning.

Looking back, I don’t remember how any of those days started for me. I forget what happened later on. But I do remember the look on his wife’s face when that first patient slumped to the floor. I remember watching the young woman’s husband cradle his newborn baby in his arms as the doctor explained what had happened to his wife. And I remember keeping the suicidal patient alive, if unresponsive, while his family confronted the unthinkable tragedy that, in fact, ended his life.

Oh, I could go on.

If life is a story worth telling, these are the plot points that change the story arc. 

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They have the power to turn comedy into tragedy, reality into mystery and hope into despair. 

Where do these memories hide, and why do they return?

Do long-forgotten memories ever intrude upon your thoughts? What triggers them? How will you use them to tell your story?


Monday, September 5, 2016

an outpouring of stories

If you want to hear an outpouring of stories about medicine, start a conversation about childbirth with a gathering of women or about sports injuries among men. Ask a group of doctors about their most difficult cases. Listen to any cancer survivor describe her diagnosis and treatment. Ask a child about the band aid on his knee. You’ll find a story there.

These stories serve us in several ways:
  •  By narrating our experience, we organize our thoughts about it. No longer are we plagued with a vague sense of fear or dread or uncertainty. We come to understand what our fear is based upon. The pregnant woman confesses, “I thought I did something wrong to cause the bleeding.” The basketball player says, “I thought I’d never play again.” The doctor admits, “I had no idea what to do next." 
  • Storytelling is an attempt to understand the cause and timing of an illness. Why me? Why this? Why now? What did I do, or fail to do, to bring this on?
  • It enables us to understand the role illness plays in our lives. How it affects our family and friends, our team, our job, our finances. Our future. It all comes out.
  •  It forces us to ask some difficult questions. What could I have done differently? How much pain can I bear? Who will take care of me? How long do I have to live? 

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This is a big deal. Illness disrupts our lives at the same time it grounds us. It forces us take a good hard look at what we value. Shared stories of recovery and healing dispel fear and give us hope. Stories of loss deepen empathy and help us confront denial. Stories of courage and faith strengthen us for our own battles.

The importance of storytelling in medicine cannot be overestimated. Most of us are bursting with stories, about to explode with the untold narratives we stuff inside because no one invites us to tell them.