Narrative medicine

"As the patient tells, I listen as hard as I can--- not taking notes during this segment of the interview, not interrupting unless critical, not indicating one way or another what I consider salient or meaningful or interesting. I try my best to register the diction, the form, the images, the pace of speech. I pay attention--- as I sit there on the edge of my seat, absorbing what is being given--- to metaphors, idioms, accompanying gestures, as well as plot and characters represented for me by the patient.... I listen not only for the content of his narrative but also for its form--- its temporal course, its images, its associated subplots, its silences, where he chooses to begin in telling of himself, how he sequences symptoms with other life events. After a few minutes, the patient stops talking and begins to weep. I ask him why he cries. He says, 'No one ever let me do this before.'"

"Radical listening is the effort to be present, to bear witness, and to listen without your biases and assumptions. It's about curiosity, not judgment."

"...physicians are like literary critics, who...arrive at the text [of the patient] laden with theory, assumptions, hypotheses."

"Considering how common illness is, how tremendous the spiritual change it brings, how astonishing, when the lights of health go down, the undiscovered countries that are then disclosed, what wastes and deserts of the soul a slight attack of influenza brings to view, what precipices and lawns sprinkled with bright flowers a little rise of temperature reveals, what ancient and obdurate oaks are uprooted in us by the act of sickness… when we think of this, as we are so frequently forced to think of it, it becomes strange indeed that illness has not taken its place with love and battle and jealously among the prime themes of literature."

"...I was a reader and I went to meetings and conferences about literature and medicine, and...what I'm doing as a reader is what I want to do for my patients. I want to be a good reader for them in all the ways in which I was learning on my own how to read complex novels-- following the time, the temporal complexity, and metaphors, and when they stop telling one story and start another one."

"When I invited her to just tell me, I said, "I'm going to be your doctor. Tell me what you think I should know about your situation.""

"Being heard shows us that we are of worth, of value. It restores our humanity. Being allowed to tell our story helps us connect our own dots and see different possibilities. For so long, my story was frightening and hopeless and despairing. I needed to tell a better story in order to heal. I needed to first be able to share my story before I could start to co-create new stories. Stories that make both biological and biographical sense. Stories that put order to the chaos and make meaning of my experiences."

"We talk a lot about good listening but closely listening is not so much about listening for diagnostic features or listening to respond or listening to tell someone to do something. It is the ability to hold the space for uncertainty, hold the space for ambiguity."

"Too often people’s illness stories are dismissed as being “unreliable” or “chaotic”, or that the person themselves are in some way “difficult” or want to complicate the issue of their condition. There are great injustices that are done to people’s stories if you can’t make sense of them, or you don’t value the knowledge a story contains. A story’s meaning is not only in what is said, but also in how it is said."