The Last Word: Narrative Care in the Clinical Context
There is an old African proverb that says, “When an old person dies, a library burns.” People are composed of their personal stories. Stories shape us and give us identity. Stories pull us together at reunions, reminding us of our history while drawing us into the future. The elderly are especially fond of telling their stories. It’s our task as physicians and clinicians to both hear and find meaning in the stories they share.
I first met Frank, a newly admitted patient on the oncology unit, near the end of his 20-year struggle with cancer. As a visiting hospital staff chaplain, I found him sitting quietly on the side of his bed. He soon opened up, and over the next several days, he began telling me the story that was a central theme in his life. It focused on the beaches of Normandy, June 6, 1944, where he survived and helped liberate France in defeating the Nazis. The image of his unit came to life in his retelling of that historic event. This proud veteran had lived a life with meaning, earned medals, kept mementos, and made his family proud of his service. During those few days, Frank taught me about narrative care and the importance of listening.
The authors of Storying Later Life: Issues, Investigations, and Interventions in Narrative Gerontology,1 speak to narrative care as “Core Care.” We’re reminded that every person is not only a biological being but also a biographical being. Stories made through our living are unique to each of us. They carry great meaning by helping us find our place in the world. Health care personnel can provide narrative care as hearers of patients with stories to tell.
Provides of narrative care can acknowledge, honor, and respect a person by listening to their library of stories. Story listening in health care is not just the purview of chaplains, social workers, or counselors. Physicians (especially geriatricians), nurses, patient care assistants, and others can offer themselves as enablers of storytelling. In doing so, they broaden the scope of health care by relating to the whole person—biological and biographical.
How do we become good story listeners? Rita Charon, MD, PhD, teaches and writes about narrative medicine, calling on physicians to strengthen their clinical practice by becoming competent in narrative care. In a 2007 commentary,2 she suggests three areas, or movements, upon which to focus.
• Attention. Be “fully present” with the patient. Paying attention to words, emotions, and body language, as well as hearing the questions that are both spoken and unspoken, lead to narrative competence. This task takes energy of mind, body, and spirit and reminds physicians and others to prepare before entering the patient encounter.
• Representation. In health care, listening means “re-presenting” the patient’s story to others. Charon states, “narrative writing in clinical settings makes audible and visible that which would otherwise pass without notice.” To be competent in narrative medicine is to combine the story listening with story writing in clinical context. Narrative writing asks readers “for witness, for presence, for answer.” Narrative readers hear the clinicians and see the patients as the illness stories are “retold” and “re-presented” through the writing.
• Affiliation. Connection happens when physicians and other health care workers attend to and represent the patient. This is the goal of narrative medicine. When patients are acknowledged and seen beyond their illnesses, then the care recipients and the caregivers join together as humans with stories to tell and narratives about which to care. Providing narrative care as a clinician in the office, the hospital, or the home connects one human to another. Narrative care breaks down barriers of professionalism that may distance us from patients, from persons who want and need to be heard in the midst of illness and suffering. Their library of stories becomes opened and cared for in respectful ways.
— Rev. Doug Laws, MEd, MDiv, MS, is a gerontologist and retired United Methodist minister with over 25 years as a health care chaplain.
2. Charon R. What to do with stories: the sciences of narrative medicine. Can Fam Physician. 2007;53(8):1265-1267.