“Why poetry?” you might ask. Why indeed? Of the many venues available to validate the human condition, poetry is perhaps the most poignant. In a poem, we see the pathos of both practitioner and patient laid bare, crystallized before our eyes, whispered under the ebb and flow of our collective breath. Poetry presents the human heart with its joys and sufferings, trials and travails. But what, you might ask, does that have to do with the practice of medicine? more»
In his recent column In Defense of Naïve Reading, Professor Robert Pippin speaks to the state of literary criticism as it is taught on university campuses. His contention is that, although the current trend is to scrutinize the literary arts through the lens of the natural scientific research model — with the ultimate end of developing a “science of meaning” — creative works themselves were never crafted to serve research. Rather, their authors penned them as works of art, works meant to speak to us at the deepest level of our being.
In Pippin’s words: “Literature and the arts have a dimension unique in the academy, not shared by the objects studied, or ‘researched’ by our scientific brethren. They invite or invoke, at a kind of ‘first level,’ an aesthetic experience that is by its nature resistant to restatement in more formalized, theoretical or generalizing language.”
Pippin goes on to say: “Likewise ─ and this is a much more controversial thesis ─ such works also can directly deliver a kind of practical knowledge and self-understanding not available from a third person or more general formulation of such knowledge.”
I was reminded of these words during small group discussion at our recent Cell2Soul gathering on Nantucket. One of the presenters, a young physician, published author and director of a narrative medicine course, put forth his observations on illness. Illness, he maintained, separates us from our bodies. Illness diminishes us physically and morally. Illness alters the way we perceive the world and our place in it. Illness threatens us at the core of our being.
This young physician examined illness in various spheres of influence: illness and the self, illness in the doctor-patient relationship, illness and the family unit, illness and the community. He is working to formulate a theory of illness and its impact on the individual, the family, the community and society, in part to provide a framework for and justification of the study of narrative medicine in the medical school curriculum.
I applaud his efforts. In academic settings it is always necessary to justify what students need to learn to become competent in their chosen careers. A well-developed theory lends credence to academic study — and ultimately, acceptance of the particular discipline. In Pippin’s words: “We certainly need a theory about how artistic works mean anything at all, why or in what sense, reading a novel, say, is different than reading a detailed case history.”
When I engaged him in further discussion, the young physician maintained that the illness narrative could not stand alone by itself. It is too soft a subject to garner academic recognition.
Personally, I believe that narrative, like art, whether in written, cinematic, poetic or visual format, is sufficient to speak by itself. Although narrative understandably deals with the particular, it encompasses the universal, and so becomes relevant on a profound level.
Simple vignettes, simple narratives, in the hands of a skilled teacher, can be used to impart universal truths — scientific or moral — which every clinician needs to learn.
The stories recorded on the pages of Patients Are a Virtue have been several years in the making. Some were written down within hours of the actual encounters; others were not recorded until years later. This latter fact testifies to the meaning of an epiphany—an awakening, a revelation steeped with an intensity not easily forgotten.
These tales can be read on several levels. First and foremost, I offer them as encounters typical in daily clinical practice. Sir William Osler, one of the 19th century’s leading proponents of humane medical practice, wrote: “Dealing as we do with poor suffering humanity, we see the man unmasked, exposed to all the frailties and weaknesses; and you have to keep your heart soft and tender, lest you develop too great a contempt for your fellow creatures.” In moving through these tales, I hope that the general reader is able to sense that underlying tenderness as each story unfolds.
As illness narratives, these tales also serve to introduce the student to the art of medical practice. He or she can follow the clinician’s thought processes that lead to accurate assessments of the patient’s condition. A perceptive reader will find that, in some instances, try as the clinician might, he can offer only a listening ear or a gentle touch: many conditions have no cure otherwise. And the student will also witness those occasional failures of diagnosis; along with the clinician, he will learn to profit from these mistakes.
Finally, the stories themselves illustrate the healing process inherent in the clinician-patient relationship. As clinicians, our willingness to suffer with the patient through the act of compassion holds up this inherent hope.
Years ago I read that the best advice for an aspiring author is to write about what you know. I let it up to my readers to decide to what extent these tales measure up.