Sylvia Plath in the pages of medicine

“Narrative medicine” is a trend in medicine that values the patient’s story. The term was coined by Rita Charon, M.D., Ph.D., Director of the Narrative Medicine Program College of Physicians and Surgeons of Columbia University. In an online publication of LitSite Alaska, Charon identifies the term as referring to “a medicine practiced with narrative competence and marked with an understanding of these highly complex narrative situations among doctors, patients, colleagues, and the public.” Narrative competence is the ability to hear and understand story, and in the context of medicine, it is the patient’s story that is of significance. Charon believes that reading and understanding literature is a way for physicians to learn to better understand their patient’s stories.

I was grateful to see evidence of the trickle-down influence of this movement as I began a new medical writing project yesterday. The first step in a new project is to review relevant medical studies and published guidelines. These are typically devoid of story but instead filled with statistics and demographics and methodologic analyses, etc etc. Yesterday, however, I read a report published by a national data system--surprisingly a government-funded national data system--that had literary quotes at the beginning of each chapter. How efficiently those quotes changed the entire feel of the document from that of a sterile repository of facts to one that was engaged in real life.

At the beginning of the chapter that told how many dollars were spent on this disease state and how many people will die despite all these dollars there was a quote from The Diary of Anais Nin,

“There are very few human beings who receive the truth, complete and staggering, by instant illumination. Most of them acquire it fragment by fragment, on a small scale, by successive developments, cellularly, like a laborious mosaic.”

At the beginning of the chapter that told demographic information about the patients who have this disease state there was a quote from The Ongoing Story by John Ashbery,

“A knowledge that people live close by is, I think, enough. And even if only first names are ever exchanged the people who them seem rock-true and marvelously self-sufficient.”

At the beginning of the chapter that told about how the heart may be affected by this disease state there was a quote from I thought that I could not be hurt by Sylvia Plath,

“How frail the human heart must be--a mirrored pool of thought. So deep and tremulous an instrument of glass that can either sing or weep.”

At the beginning of the chapter that told about children with this disease state there was a quote from Of Woman Born by Adrienne Rich,

“The mother’s battle for her child--with sickness, with poverty, with war, with all the forces of exploitation and callousness that cheapen human life--needs to become a common human battle, waged in love and in the passion for survival.”

At the beginning of the chapter that told about the nutritional support patients with this disease require there is a quote from Dubious Honors by M. F. K. Fisher,

“It seems to me that our three basic needs, for food and security and love, are so mixed and mingled and entwined that we cannot straightly think of one without the others. So it happens that when I write of hunger, I am really writing about love and the hunger for it, and warmth and the love of it and the hunger for it...and then the warmth and richness and fine reality of hunger satisfied...and it is all one.”

And there is more, one quote for each chapter.

My office is filled with many medical articles, treatment guidelines, association reports. This is the only document achieving a literary human dimension. A preface page included this statement: “Treating chronic disease requires a multitide of skills and a mind-set that will not allow adversity to fog our final vision.” Even that statement had a different flavor, a grander more human rally, than does the typical medical mandate “to optimize treatment thereby reducing morbidity and mortality.” More documents like this would be welcome additions to my small working library and to the healthcare community. Perhaps I will send this group my resume?