"tell me your story, show me your wounds"

 

I called my best friend last night. We don’t get to see one another very often anymore, but we talk every week. After we catch up on all the things that keep us busy, the conversation usually turns to friends and family. Here are a couple of the stories we shared this week:

•      My friend described the plight of a woman who has undergone eight operations in a futile effort to eliminate a recurring MRSA infection post-total knee replacement.
•      She expressed her concern for a neighbor in her seventies who took a tumble and broke her hip, and then, a few weeks later, fell again and suffered a subdural.
•      We discussed the plight of a woman from her church who is losing her battle against metastatic breast cancer.
•       I told her that a friend's daughter, recently married, had suffered a miscarriage over the weekend.

…not one happy moment among them.

The thing is these occurrences are not uncommon. We encounter them every day. In fact, stories like these are so commonplace we are tempted to dismiss their gravity and to overlook the emotional devastation that remains in their aftermath.

“Under the look of fatigue,
there is always another story.
There is more than meets the eye.”
~W H Auden~

But what if we knew those details? Are we interested, empathetic, compassionate, or simply curious enough to ask? Is there more to the story?

•      The woman with the recurring MRSA will be going off IV antibiotics in a week or two. Every time she does, the infection recurs…seven times, so far. If it happens this time, she will be staring down the barrel at an amputation…
•      Several months earlier, the neighbor who fell and her elderly husband became foster parents to their grandson who was 9 months old at the time…
•      The woman with the metastatic breast cancer had entered hospice care. The question that arose for my friend was whether or not it was too late to give her a call. What could she possibly say?
•      The young woman, who suffered the miscarriage at home, described herself as a “monster” for having unknowingly flushed her baby down the toilet.

There is always more to a story than first meets the eye. It pays to go deeper. To draw out the most painful details. How else will we know what a person needs? As healthcare providers and caretakers, how will we know what to do to help? What to say? How can we help them heal?

“Everyone you meet is fighting a battle
you know nothing about.
Be kind.
Always.
~various attributions~

Last night I spent an hour on the phone with another a friend whose autobiography should be titled, “Anything That Can Go Wrong, Will…” Her story is one of multiple oversights, erroneous assumptions, and mistreatment during a recent hospitalization that would give Stephen King nightmares, I kid you not. Untreated hypertension and untreated pain complicated by complacent nursing care. Today, she thanked me just for listening.

 

It turns out that narrative in medicine is alive and well in every community, in every neighborhood, and around every kitchen table.

What is your story?

“Tell me your story,
show me your wounds,
and I’ll show you what Love sees
when Love looks at you.
Hand me the pieces,
broken and bruised,
and I’ll show you what Love sees
when Love sees you.”
~from “When Love Sees You”~
~lyrics by Mac Powell~

jan

women's reproductive rights in healthcare

 

Women's health care focuses on their reproductive years. This is an important concern of every health care provider, so of course, I'm going to write about it. Assuring accessibility. Navigating patients' concerns, preferences, and options. Defending their choices.

I'm not one to publicly address political, ethical, or moral aspects of health care issues when I'm not directly or personally affected by them, but reproductive rights come under the umbrella of health and well being, not political manipulation, power, or control, so I have spoken up.

This is a copy of the letter I sent to every Republican senator in 2022. Roe v. Wade was at stake back then. Now that abortion rights have been overturned, though, we're still in danger of losing access to mifepristone and misoprostol, and to IVF. I will never have to make a personal decision for or against abortion or IVF, nor will my daughters, at this point...but my granddaughter may come up against the issue. And so might yours...

*

Dear_______:

I am writing to you regarding my concerns should the Senate move to undermine the reproductive rights of women by overturning the 1973 United States Supreme Court decision on Roe v. Wade.

I am a physician with over thirty years of experience in Family Medicine so I am familiar with the issues that impact the accessibility, efficacy, and safety of women’s health care. I am also the mother of three adult children, and the grandmother of three youngsters, so I know a lot about the sanctity of a woman’s body and her reproductive rights.

As a physician, it is my duty and privilege to assist my patients with the difficult decisions they have to navigate when it comes to health care. Whether or not it is safe to vaccinate their children. Whether or not to sign the Do Not Resuscitate order. Whether to carry an unintended pregnancy to term, especially in the case of rape/incest, or contraceptive failure. I don’t make these decisions for my patients. I educate them. I guide them through a labyrinth of questions and concerns, some of which they might not otherwise have considered. Things they might regret later on. Together we look at the pros and cons, the advantages and disadvantages, and the risk of unfavorable outcomes when we explore their treatment options. I don’t coerce them, or manipulate them, or mislead them to satisfy my personal, political, or religious agenda. I listen to the stories they share with me, and I respect the decisions they make for themselves.

It's not that I don't hold strong beliefs about a woman's reproductive freedom. I do. I am not declaring my support for, or my opposition to abortion. It is not my role, my duty, or my intention to impose my personal beliefs on anyone. Nor should you.

At the heart of Roe v. Wade is a woman’s right to decide for herself about elective abortion. Most of us will never have to confront this decision, but our daughters may, and our granddaughters may. The next time you give you daughter a hug, the next time you sweep your granddaughter into your arms, imagine her as a victim of rape. If you vote to overturn Roe v. Wade, be absolutely certain you are willing to watch her suffer. To make her suffer. Ask yourself if you will embrace her child of rape with the unconditional love you feel for your own children.

Because this is my fear. I fear for the infants born to these women. That they will be neglected, rejected, and abused because the color of their skin, or the texture of their hair, or their facial features mark them as different. As undesirable. As unlovable. I worry that they will end up in our emergency departments, abandoned on our streets, or cast off into the trash. How will we care for the ones who survive? Who will care for them? You cannot claim to support the right to life of the unborn unless you have a plan in place to protect and care for them after birth.

I worry, too, that women will, once again, be forced into back alleys and basements in a desperate and dangerous effort to terminate these pregnancies. That we will see a resurgence of the septic abortions and mutilations that compelled us to support women’s safety and well-being by passing Roe v. Wade in the first place. I am afraid the next generation will manifest a whole new class of traumatized, angry, and abandoned women and children.

But that’s not the only problem I anticipate. The decision to revoke the protections and human rights of women will set a new legislative precedent. It will confer authority to outliers and men in power to unilaterally eliminate the protections we have put in place to support immigrants and asylum seekers. To prevent gun violence. To feed the hungry and shelter the homeless. To access affordable health care, and to protect our privacy.

If Roe v. Wade falls, it will bring our constitutional democracy to its knees, a democracy that has flourished not in spite of, but because of, its diversity, inclusivity, and vision for over 200 years. Indeed, we have already witnessed the violation of basic human rights, the corruption of justice, and a surge in violence and fear among our most vulnerable citizens in the name of political power, self-proclaimed entitlement, and hatred.

This is not the America you and I grew up in. It is not the same country that bestowed upon us a path to success, security, and freedom. How can we deny it to others?

As a United States Senator, you are in a position to change the course of history as it is being written. Will you allow yourself to surrender to men who are hungry for power and control over the reproductive freedoms of women they don’t even know? Why are you afraid to stand up to them? Has your heart hardened against the humanity you are part of? What scares you about defending the rights of women? What prevents you from acting out of dignity, purpose, and principle?

When did you fold?

For the sake of all women and children, out of compassion for all who suffer, and in the name of human rights, I implore you to reconsider your support of the Republican leadership on this important issue. Vote to uphold Roe v. Wade. Do what is honorable, compassionate, and just, or explain to us why you refuse.

Thank you for your attention and consideration.

Yours, 

Janet F. Cincotta, M.D

*

Did this letter change anyone's mind? Did it make any difference at all? It did to me. I'm pretty proud of it.

"Each time a woman stands up for herself,

she stands up for all women."

~Maya Angelou~

jan

 

unspoken forces at work

Hippocrates is the one who advised physicians, "First, do no harm." Cicero proclaimed, "The safety of the people shall be the highest law"...lofty principles that, to this day, both challenge and inspire health care professionals.

It was Paraclesus, though, who declared, "The physician should speak of what is invisible...He becomes a physician only when he knows that which is unnamed, invisible, and immaterial, yet has its effects." He was speaking, of course, about the impact of the patient's thoughts, feelings, and emotions on his experience of injury and illness. On his ability to heal. These include his fears, expectations, and hopes...all invisible. All unspoken.

"O, what an untold world

there is in one human heart."

~Harriett Beecher Stowe~

In his book, "The Wise Heart," Jack Kornfield reminds us that the key to healing has to do with the patient's understanding of his illness. What is he fearful about? Why? What does he think will happen to him? How will he support his family? Who will take care of her children? It turns out making the diagnosis is sometimes the easy part. Uncovering the patient's hidden fears can be harder.

"You'd be surprised

what lengths people will go to

not to face what is real and painful 

inside them."

~Ian Kester~

For example, let's say a patient presents with breast cancer. She is forty-eight years old, two years older than her mother was when she was diagnosed. But her mother died following surgery and a full course of radiation and chemotherapy. This is what scares her. She jumps to the conclusion that this is her fate as well, despite the fact that her mother's cancer was far more advanced when it was detected. Despite the fact that treatment has improved in the twenty years since her mother's diagnosis. The patient's initial reaction to her diagnosis may be to give up right then and there...her unnamed, invisible, and immaterial thoughts, feelings, and emotions left unchecked. And unspoken.

"Your body hears everything

your mind says."

~Naomi Judd~

Or, let's say the patient is a middle-aged man who schedules a ten minute appointment with you so he can get something for his heartburn. But he isn't simply experiencing indigestion. He is actually having angina, and it's getting worse. He has convinced himself that it's just his stomach because the thought of a heart attack scares him. His brother had one last year, and ended up with a pacemaker and a defibrillator. His ten minute appointment includes an EKG and blood work, and it stretches into a forty-five minute dialogue about unstable angina and the need for hospitalization. He tries to laugh it off, but beneath his cavalier manner, he fears for his life. His family. His business. All of it invisible. All of it unspoken.

"A physician is obligated to consider

more than a diseased organ,

more than even the whole man.

He must view the man in his world."

~Harvey Cushing~

Clues to the unspoken forces at work in the patient's life include refusal of, or noncompliance with treatment. Denial, anger, impatience, or resistance. Reticence. Despair. 

The health care provider should handle these patients with care. Ask about their fears, expectations, and perceptions. Take time to speak about what you intuit to be unnamed, invisible, and unspoken. Do whatever you can to help him tell his whole story.

"Anything will give up its secrets

if you love it enough."

~George Washington Carver~

jan

a counter-cultural rant, with my apologies

 

I learned something new this week. I'm pretty sure it isn't true, but there it was. False marketing at its finest. I did not know that my whole body smells bad. I never noticed it. Now I'm told that I need a "whole body deodorant"...something new on the market. I'm sorry, but this strikes me as laughable.

~brought to you by Walmart~

I rank it right up there with "laundry sanitizer" when, all these years, I was satisfied that detergent and hot water did the job just fine. Even cold water. I wasn't really worried about pathogens when I folded my laundry or got dressed in the morning. I'm still not convinced I need to worry about them.

It's hard to know what to believe anymore. If the marketers can convince people they stink when, obviously, they don't...and that their clean, fresh laundry is crawling with dangerous microorganisms, what will they come up with next? 

Anything that will sell.

Don't fall for it. Even the Buddha knew better, back in the 5th century BCE:

"Believe nothing,

no matter where you read it or who has said it,

not even if I have said it,

unless it agrees with your own reason,

your own common sense."

~Buddha~

This is especially important today when people are desperate to break into the marketplace. But it affects us in other ways, as well. It raises questions about honesty, integrity, and ethics. About greed, arrogance, and fairness. It smacks of exaggeration, distortion, and fear. Falsification spills over into every aspect of our lives. Business and commerce. Politics and law. And now, personal hygiene and how we do our laundry.

This is just a cautionary note. A reminder not to jump on the bandwagon because of something you have read, or you wish were true, or because of something that scares you. No matter who says it or where you read it. No matter how many others believe it. No matter how loudly or insistently they proclaim it. Think for yourself...

"The important thing is not to stop questioning."

~Albert Einstein~

...and when you think you finally have the answer, go back and question yourself again.

jan

story healing: part 3

 

I spend a lot of time urging people I know to get their stories down…to enter them into a journal, or to confide in someone they trust…because I know that storytelling can be a healing practice. In the words of poet Sean Thomas Dougherty, this is important because, as he puts it, “Right now, there is someone out there with a wound in the exact shape of your words.”

The story you share will help you make sense of your own experience…and, trust me, someone else…somewhere…needs to hear what you have to say.

When people are struggling, it helps them to know that someone else has been through the same thing. It helps to know where you turned for support, for strength, for comfort. It helps to know how you managed to pull it off. They need to know how you survived. Hearing your story may be just what they need to begin healing, themselves.

It helps to believe that healing is possible. 

The question is: do you? Or have you given up?

Let’s find out.

Last week I promised you a writing prompt to get you started. 

Before you start, set aside some time when you won't be interrupted, say 15 minutes. That's all. The point is to write honestly and unapologetically about whatever comes to mind. 

This is your prompt: Write for 15 minutes about...

WAITING

...as in waiting for, or waiting with, or waiting while, or waiting until. Whatever comes up for you.

The point is to write something. This is, in and of itself, an act of raw courage. A mark of sheer humility and generosity. A sometimes painful yet healing balm.

If you can, share your first unedited effort with someone you trust. Or, better yet, share it with all of us. You may never know that what you have written might be what someone else needs to hear to begin healing at this very moment.

 "Good writing is not about good grammar.

Good writing is about truth."

~Nancy Slonim Aronie~

jan

 

 

 

 

 

 

story healing: part 2

The "scarlet fever" ward at Buffalo Children's Hospital
back in the day...

Last week I posted some background material about the healing power of storytelling. I had hoped to present it at the annual Pennwriters Conference this weekend in Lancaster. Until Covid struck. This week, as promised, I'm including a brief discussion of my brother's largely untold story, and how our lives unfolded because of it. You can find the full published version, "The Pull of Gravity," here.

Story Healing

Peter’s (Untold) Story

So…this story starts way back when I was three years old going on four, and my brother, Peter, was five.

I’m told that I was the first one to get sick, although I don’t remember that part of the story. I don’t recall the sore throat, or swollen glands, or fever I know now would have heralded the onset of strep throat. I suppose it was nothing to be alarmed about…nothing to see the doctor about…until the rash appeared, meaning that the sore throat I no longer remember had morphed into a case of rheumatic fever.

I don’t recall that part of the story too well. I do, however, remember the “scarlet fever” ward at Buffalo Children’s Hospital where I was admitted with a diagnosis of rheumatic fever.

To this day, I remember it in vivid detail. The pile of Little Golden Books on my nightstand. “The Little Train That Could” and “Peter Pan”. The girl in traction across the room from me. Alice. Ten-years old. The way I cried myself to sleep every night when visiting hours ended and my mother left to go home. I could go on…

And even though I never saw my brother there, a few days later I learned that he had also taken ill and that he was somewhere in the same hospital, at the same time, with the same diagnosis. Rheumatic fever. Before penicillin.

Because I never saw my brother there, I assumed that everything was the same for him as it was for me, so…when the ordeal ended for me, I thought it was over for him, too. But for reasons I didn’t understand, we left him behind the day I went home. No one told me why, and I was too young to ask. In fact, our parents never spoke about it except to say that he was “still sick.”

Which is why fifty years passed before Peter and I shared our thoughts about that time in our young lives…

It took fifty years for him to tell me how gravely ill he was when we were in the hospital together, how close to death he'd come, and all the ways he 'd suffered because of what happened there……none of which he'd ever shared with me.

We drifted apart over the years. I stayed up north; he moved south. I studied medicine; he went into engineering. I had three children; he raised two. Separated by time and distance, we became strangers.

It wasn’t until our mother’s health declined and her memory failed that we reunited to share the decisions we needed to make about her care. We resettled her in a nearby nursing facility, cleared out the old house, put it up for sale, and at last, we spoke.

At the end of the week, we popped open a bottle of good red wine, and Peter broke his silence. He told me about the day he coughed up blood in the hospital. How the nurses panicked, the doctors rushed in, and someone led Mother away.

He was pretty sure he was going to die because no one said a word to him about it. No one explained how something like that could happen, or what it meant…and he was afraid to ask. Instead, he suffered in silence…and he never let it show. When he was alone with his thoughts, he wondered how long he had to live, why no one prepared him for death. Why no one seemed to care. He was five years old!

Thankfully, he did recover. When he was finally well enough to leave the hospital, though, he learned that he would be kept in bed, in a darkened room, without visitors for a full year in order to rest his weakened heart when he got home. 

Family life for us unfolded around his illness. From fear for his life, to endless doctor's appointment, to supporting and encouraging his slow recovery. I was too young understand what was happening back then, and too little to have helped. By the time I found out, it was too late to help him.

Until he told me about it that night, no one knew what it was like for him to be in and out of recovery, in and out of therapy, and on and off antidepressants all his life. 

No one understood that he suffered bouts of anxiety and depression all his life because of the assumptions he made about his illness when he was too young to have known better…that he was frail. That he was a burden. That he was doomed. All his life he panicked at the slightest sniffle or cough. He sought affection in all the wrong places. He fell victim to addictions in an effort to find some measure of relief.

I am convinced that if someone had told him a different story…if someone had explained what was happening and what it meant…his entire life might have followed a different arc. Peter didn’t begin to heal until he started to share his story with a safe, supportive community that invited him to re-imagine the first chapter of his life. The way he explained it to me, part of him never emerged from the depths of despair, confusion, and fear he felt as a child because he didn’t understand what was happening to him..

As a physician, I know now that rheumatic fever damaged a valve in my brother’s heart. Because penicillin wasn’t available yet, the doctors couldn’t do much for him. His best hope for survival was to rest his heart and pray for it to heal…which is why he spent a year in bed, alone, in a darkened room…to rest his heart when he got home. Doctor’s orders.

My brother carried his untold story with him his entire life. If I had known sooner, I think we could have started the necessary revisions years earlier.

I could have explained to him how rheumatic fever had damaged his heart. Why he needed to rest when he came home from the hospital. How painful it was for our parents to watch him suffer, and how hard it was for them to comply with his doctor’s cruel orders. He would have grown up understanding how much we loved him and how scared we were that he might still die after he came home.

The point is that the stories we are told, as well as the versions we tell ourselves out of ignorance or confusion, can have devastating and lasting repercussions. It’s important to get them right. Peter’s entire life might have unfolded differently if someone had asked for his side of the story, and helped him tell it.

Does that make sense?

The sad truth is that he still struggles against the fear, dread, and shame that stalked him through his childhood. Because we didn’t know his whole story, we couldn’t help him navigate the pervasive trauma that shaped his entire life.

That was the story I felt I needed to tell. But, believe me, there are other stories I could share with you. I could tell you why I abandoned medical practice out of fear. Or why my husband and I went our separate ways after 42 years of marriage. Or why I stopped going to church.

There are some stories, though, that I can’t tell. Maybe you can. What it’s like to lose a child. What went through your mind when you first heard the word “cancer”. How hard it is to care for someone with dementia. Those aren’t part of my narrative, but they could be part of yours or a friend’s. The possibilities are endless. Maybe everything changed the day you learned your newborn needed open heart surgery. Perhaps it began when the doctor missed the diagnosis or botched the surgery.

Oh! You have a story to tell, all right. It’s in there, all right, even though it may have taken place decades ago. It comes back to you unbidden…out of nowhere…and it still makes your heart race, or your chest ache, or brings a tear to your eye. Perhaps a certain song comes on, or you catch a whiff of rubbing alcohol, or the late afternoon light enters the room at a certain slant, the way it did when you were in the hospital as a child. Or maybe you’re watching the evening news, and you see your own story unfolding in someone else’s life. You understand what they’re going through, and you know what they need because you needed it once, too. You are constantly reminded of the illness, or injury, or recovery that claimed a huge chunk of your life. You wish you could forget it or undo it, but you can’t. It stays with you because it’s an important part of who you are today. It is your story begging to be told.

…which is why you should start writing now if you haven’t already begun…or you should pick up the thread where you left off the last time you gave up on it.

Believe me…someone is waiting to hear from you. Someone, somewhere is hoping you will speak. Hoping you have the answer they are seeking. Hoping to heal.

Now is your chance. Next week, I’m going to invite you to respond to a simple prompt, and to just write freely about whatever comes to mind. It's a an exercise that is intended to encourage you to get started, because:

"The hardest thing about getting started

is getting started."

~Guy  Kawasaki~

jan

 

 

story healing: part 1

 

I spent last week at a memoir writing retreat in Massachusetts with Nancy Aronie, author of "Memoir as Medicine."

I've taken this workshop with her several times over the years. I went back this time because I was looking forward to presenting my own twist on the healing power of storytelling this week at the annual Pennwriters Conference in Lancaster, so I wanted to soak up some of her inspiration, humor, and wisdom to tide me over. And I did. Unfortunately...I also picked up Covid while I was there. Meaning I had to cancel my debut presentation this week...

...after all that work.

So, instead, I decided to put it here for any one who is interested. The title is "Story Healing"…the idea that putting our personal stories into words and sharing them with others can play a role in healing…not just emotional and psychological healing…processing the pain, feeling better about ourselves, easing the symptoms of anxiety and depression…but real physical healing that we can observe and measure.

Seriously. This is good medicine.

It interests me because, for those of you who don’t know me, I’m a physician. I practiced family medicine for over thirty years…until I retired, because my other passion in life is writing…and I had a story in me that I really wanted to tell.

So…I want to talk about what we mean by Story Healing…the power of getting our stories down and sharing them with others. Is there really anything to it? How does it work? What happens between us when we share our personal stories, and why it’s so important that we do.

I'll also be talking a tiny bit about the science behind the process. I'm going to share my family's story because I think it illustrates some of the painful consequences of keeping our stories under lockdown. And, finally, I'm going to provide you with a prompt to encourage you to begin sharing your story.

By way of introduction, I live near Harrisburg. I have three grown children and three grandchildren. I’m an avid walker and meditator, and now that I’m retired, a wannabe writer. I post this blog which is loosely based on the practice of narrative medicine, almost weekly. But…enough about me.

I’m more interested in who you are and what drew you to this space. Are you a healthcare provider? A nurse? Doctor? Therapist? First Responder?

Are you a caretaker?

Do you have a personal story about an illness or injury? About abuse? Trauma? Fear? Shame?

Do you keep your story under lock and key even though you’ve been over it a million times in your mind…and it just won’t go away?

Of course you do. We all do.

The point is that we ALL have a story to tell. The problem is that most of us never get around to sharing it. Instead, we make up excuses. We tell ourselves we don’t have time to write. We don’t know where to begin, or how to put our story into words. We tell ourselves that what we have to say isn’t important. That no one will be interested in it. Sometimes shame silences us. We blame ourselves for what happened to us. We have been conditioned to keep secrets.

Or…perhaps it’s simply too painful, or sad, or maddening to revisit. We’d like to pretend it never happened. We’d like to forget it…but we can’t.

So…our stories go untold…and as such, I’m telling you…they wreak havoc on our bodies.

The anger we keep bottled up, the grief we can’t bear, the shame we keep under lock and key all take a toll on us. We know that they raise levels of stress hormones and inflammatory chemicals in our bodies, like cortisol and adrenaline because we can actually measure them. And we know that these substances raise the heart rate, elevate BP, and raise blood sugar levels. This can lead to all kinds of problems in adulthood--hypertension, heart disease, diabetes, and autoimmune problems like lupus and RA.

Not to mention anxiety and depression.

Unless we acknowledge and explore the source of the problem, nothing we do or say will touch the cause of our pain. The rape. The abuse. The loss. All the medication in the world will not solve the problem. Traditional therapy will barely scratch the surface.

Honestly, it might be wiser to try storytelling.

*

There is, in fact, some science to support the idea that telling our stories can help us heal, not only emotionally and psychologically, but physically, as well. We know that storytelling can lower levels of inflammatory hormones in the body, because we can measure them…and we can observe their effects on the body. In studies where subjects were asked to write about a painful episode they had experienced vs a neutral topic like the weather or a favorite food…heart rate, BP, and sugar levels fell in the first group as compared to the neutral group.

In another study, participants underwent a small skin biopsy that left a tiny open wound. They were then assigned to write about a painful experience or a neutral topic. The open wounds healed sooner in the cohort that wrote about their pain.

In other studies, functional MRI scans of the brain demonstrated synchronization in electrical activity between the storyteller and listener. Their brain waves actually changed.

The point is that telling our stories affects us in ways we can actually measure and observe.

When you give your story a title, describe how it unfolded, and name the characters in it, you may begin to understand why it still disturbs your peace after all these years. If someone you trust is listening, you may come away with an entirely different perspective on it.

Let’s say, for example, that you’ve been struggling with guilt after a friend committed suicide. You pick up a book like “The Ticking Is the Bomb” by Nick Flynn whose mother took her own life. His story looks at suicide differently. He explores the fact that it was inevitable given the course of his mother’s life. It wasn’t his fault. After reading it, you might see things a little differently, too. It wasn’t your fault your friend found life unbearable. Perhaps you didn’t miss the clues because there were none. A layer of guilt falls away. The aching in your chest subsides. This is healing.

Or maybe your friend has been diagnosed with cancer, and it doesn’t look good for her. You have no idea what to say or to do for her…no clue how to support her. No clue how to just be present for her. Then you pick up a novel like “Talk Before Sleep” by Elizabeth Berg, and you learn all the ways you can comfort and encourage her, and even bring a touch of humor to the situation. This is healing.

When you tell your own story, you may finally be able to forgive yourself…or the person who hurt you. You may be able to cast aside some of the things you’ve always imagined were wrong with you, but never were. And still aren't. Inflammatory hormone levels come down. Your BP and blood sugar levels normalize. Anxiety and depression improve.

This is definitely healing.

When I was in practice, I listened to patients’ stories all day long. Of course, we didn’t call them stories. We took the HPI, better known as the history of the present illness…better described as the story of the present illness. We explored the PMH, or past medical history...or story. The patient’s FH or family history...or story.

Nowadays…those stories have been replaced by a series of bulleted lists in the electronic medical record. (Don't get me started...) Details go missing. You overlook the fact that your patient’s headaches started the day she discovered the cigarette burn on the sleeve of the sweater her ten-year old wore to school that day. Or that she can’t sleep because of the pile of unpaid bills collecting dust on the kitchen counter. Or that your patient has heartburn because he’s headed for divorce...

…unless, of course, you invite him to tell you about it.

Rita Charon, MD, PhD, at Columbia University College of Medicine, pioneered the practice of "narrative medicine" over twenty years ago as a tool to help medical students uncover the missing piece in their patients' histories.

This is how she begins with each new patient: "Tell me what you think I should know about your situation." Then she listens to the patient without interrupting, clarifying, correcting, or taking notes. Instead, she focuses her attention on what is revealed and how it is communicated, noting the patient's posture and gestures, images and metaphors, facial expressions, and the characters who play a role in the story.

When we reach into our patients' cholesterol laden hearts to understand why they are poisoning themselves with food, we need to know more than what they are putting into their mouths. When we encourage a friend to talk, we may discover that the real reason for this one's fatigue, or that one's intractable headache is end-stage disappointment, or anger, or shame that has festered out of sight for years.

Only then can we help them heal.

Stories form the basis of every relationship. They are the foundation of all friendship. They are an integral part of healthcare. They reveal who we are. They help us process what happens to us. They embody our unspoken fears, our deepest sorrows, our greatest regrets…

…which is why we don’t tell them. It’s hard to put them into words.

I know this because it took me fifty years to get mine down.

The good news is, it’s never too late to get started. This is your chance. 

Remember:

"The work of your heart is your gift to the world."

Next week I'll share the story that my brother kept under lock and key as a child, how our family's life unfolded around it, and why it took fifty years to reveal itself. Story Healing: Part 2.

 jan