Narrative Medicine

Narrative Medicine is a relatively young branch of medicine. It uses poetry and other narrative forms to strengthen the training and understanding of doctors and other healthcare providers, and to enrich and relieve patient and caregiver experience. It aims to humanize the practice of medicine and improve the quality and outcomes of decision-making, treatment, and therapy. It encourages doctors to reflect and empathize, stimulates a fuller connection between healthcare providers and their patients, and recognizes that knowing the psychological state of a patient and that person’s unique history or culture can be a vital element of good medical care. Poetry has the power to stir the emotions and tap into human experience in a way that permits deep, personal communication and insight.

In a posting on CHMP (Center for Health Media and Policy) at Hunter College in March 2011, Internist Dr. Rita Charon, who founded the field of narrative medicine, characterized narrative medicine as a “clearing” to “connote that the field, young as it is, is like a clearing in the forest, a place where sunlight shines and the undergrowth blossoms, and birds and animals pass through.” “There’s a beauty and there’s an enclosure and there’s a safety,” she said, “and “this kind of safe clearing is what the narrative practice of medicine seeks to create, a place where the stories of patients and providers alike can be told and heard, given and received.” She speaks about this clearing as a place where “patients and families and doctors and nurses and social workers and chaplains and poets and novelists and intellectuals and artists gather…to know together what it means to have a body, to be mortal, to age, to become ill, to become better, and to be alive.” http://centerforhealthmediapolicy.com/2011/03/09/on-the-clearings-of-narrative-medicine

Serenity

White
water lilies
float
atop the pond;
a petaled quilt
to keep
me
warm.

[Rose Bromberg]

Maples

So much depends
upon

the needle
hitting

each blue vein
as though

it has tapped
a living tree.

Letter from Ward Three

I.
I am busy today watching my ceiling crack grow
green in plaster. My hands fold over the collapsed
melon of my womb; this is where my five babies
floated like pink letters in a mailbox. I remember
doctors in the delivery rooms, postured shells
in olive gowns, slapping the child until he found
his voice like a fingernail against the blackboard.
They are all that became of me, ribbons and shoelaces
that bind me to corners of the rooms where it rains
yellow trees and paper cranes beat their wings
forgetting where it is they wanted to fly.

II.
I had some nice things once: a wedding band,
lavender stationery, a black lace slip. I could put
clothespins in my mouth, taste the clean wood,
and hang diapers in neat rows.
My fingers sifted darkness
like sand on the beach. Maybe you think I will die;
I am weightless as an old movie on the screen. I urge
myself back over and over
through steel wires like miners
feeling their way through tunneled cave-ins.
I am harmless as the back door of a valley;
quiet as a gray plowhorse
pacing these unclean tiles.

III.
There’s a tied storm rising in the gulf. Thinking back,
I forget the man’s face buried among the babies,
the owner of giant fists, the climbing on and off,
the milkman’s sandy smile, my broken picture of Jesus.
Blood on both sides of my table, winter,
a piano with no song.
Naturally, I believe the boats will come for me,
or I would never invent footsteps
falling close in the night.

Once, I was young, a woman with enormous eyes;
the thing about living is hesitation,
the snowflakes saying your name,
the leaves gossiping, and the sun telling you
it is easy—that bread is better than hay,
that everything that needs you is real.

[Jeanne Bryner, from Breathless]

A Boundless Moment

He halted in the wind, and—what was that
Far in the maples, pale, but not a ghost?
He stood there bringing March against his thought,
And yet too ready to believe the most.

“Oh, that’s the Paradise-in-bloom,” I said,
And truly it was fair enough for flowers
Had we but in us to assume in march
Such white luxuriance of May for ours.

We stood a moment so in a strange world,
Myself as one of his own pretense deceives:
And then I said the truth (and we moved on).
A young beech clinging to its last year’s leaves.

[Robert Frost]

Other sections of the Purple Scooter Poetry website contain poetry that might be used in narrative medicine settings, including some of the playful medically-oriented work by the featured writer, Genevieve Wood.

Wheelchair Manhattan

In my Chrysler mobile
Toward the Empire State,
Walkers by me reveal
Their bodies truncate:
     A bosom a fly,
     Buttock on thigh—
     Anatomies vie
For my short-sighted eye…
Partly people, half-passing by.

Post-Post-Surgery Mystery

I’m healthy enough to pursue my quest
For the culprit who sat on my fatty chest;

But the trail is strewn with fading clues
As to how I acquired this hidden bruise,

Which blossomed after I arrived home—
Surprising me into this plaintive pome.

Now, I’m not one to wail and complain
Of hospital injuries, localized pain;

I bravely endured all the tests and tubes—
But I’m sorely depressed by my purple boobs!

Is this what they mean by “recovery blues”?
Shouldn’t they warn you of volatile hues?
     Dammit, j’accuse!

When I catch up with the man, or machine,
That an-esthetically treated me mean,
     BOOM!

Oh, whell….It’s only minor wear and tear….
At least, though weird, my bozoom’s still there.

[Genevieve Wood, from On The Crest of a Wave]

EXPLORE

—For transformative storytelling, tune in to The Moth Radio Hour.  The Moth is a nonprofit organization that seeks and shares true life stories from people in all walks of life from around the world.  Its programs, which are offered in real time and also archived for later viewing, are supported by grants from the National Endowment for the Arts, the Public Broadcasting System, the New York State Council on the Arts, the New York City Department of Cultural Affairs, and the John and Catherine MacArthur Foundation. http://themoth.org/radio

—The Literature, Arts, and Medicine Database initiated in 1993 at New York University Medical Center maintains a large multimedia database of annotated poetry, prose, and other arts as a resource for teaching and research in narrative medicine and the “medical humanities.”  http://litmed.med.nyu.edu/Main?action=aboutDB

—Where We Live: Putting Humanity Back Into Medicine: Can the Humanities Make a Better Doctor? (June 6, 2011, Your Public Media) and Can Literature Make a Better Doctor? (June 3, 2011, Science Friday) are two recent narrative medicine discussions aired on NPR.  Guests included doctors from Harvard Medical School, Yale University, Beth Israel Deaconess Medical Center in Boston, Columbia University’s Narrative Medicine Program, and authors of “How Doctors Think” (Houghton Mifflin, 2007) and “The Cure for Grief” (Scribner, 2008).  To hear these segments: http://wnpr.org/post/putting-humanity-back-medicine and http://www.sciencefriday.com/program/archives/201106036

—Dr. Rita Charon of the Columbia University of College of Physicians and Surgeons founded the field of narrative medicine. The first degree program in narrative medicine was begun by Columbia’s Program in Narrative Medicine in 2009. http://www.nlm.nih.gov/changingthefaceofmedicine/physicians/biography_58.html , http://www.narrativemedicine.org/

—A compelling perspective on “Poetry and Medicine” is given by Rose Bromberg, Resident Poet, Narrative Medicine, Columbia University, 2008, The Medscape Journal of Medicine. The poem presented above was written by Ms. Bromberg to “express relief and provide comfort after an unpleasant medical experience.” http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2329765

—Stories in Medicine: Doctors-in-Training Record a Different Type of Patient History, includes a article by Margot Adler and an NPR segment (available via iTunes) in which a doctor-in-training is interviewed about his experience and Dr. Rita Charon offers comments and answers questions. http://www.npr.org/templates/story/story.php?storyId=1480863

—Dr. Lewis Mehl-Madrona, founder of the Coyote Institute, certified in psychiatry, geriatrics, and family medicine, looks to principles in Native American Medicine to improve medical training and healing. In the foreword to his book Narrative Medicine: The Use of History and Story in the Healing Process, author Thom Hartmann writes: “Every invention grew out of a story. Even the stories of the stories grew out of stories—consider Plato’s story of the shadows on the walls of the cave…. In a similar way [for those of us who grew up in modern Western culture], our bodies are our stories. Not just our body decorations, like the way we wear our hair or our piercings or tattoos or makeup, but our bodies themselves…. We create and re-create ourselves in a way consistent with our stories about ourselves and the world around us…each of us carries in our entire body the legacy of our stories.” http://en.wikipedia.org/wiki/Lewis_Mehl-Madrona