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January 21, 2006
Narratives and Medicine
Oxford University private courtyard where one student in the halls described it as, "the place where stories are exchanged: between student and teacher, reader and book, friend with another."
On my lastest trip to Barnes and Nobles--to find books my library does not have--I came across a new section; Physician Writers. The list includes Oliver Sacks (The Man who confused his Wife for a Hat), Michael Crichton (Jurassic Park), Sir Arthur Conan Doyle (Sherlock Holmes), Nawal El Saawadi (The Hidden Face of Eve: Women in the Arab World), William Carlos Williamson (winner of the 1962 Pulitzer Prize) and Cecil Helman (physician with training in Anthropology.)
The last of these, Helman, recently gave a book talk at UCL. He had just published a book of his memoirs (Suburban Shaman: Tales from Medicine's Frontline), and while reading from it, also wanted to partially explain this recent proliferation of physcians who have become writers. He used timekeeping as an analogy for the narrative. With a digital watch, when you look for the time, you literally see only the present--a "snapshot" of time. Prior to the digital era, however, one read the time on a watch with hands, and could see the time "before" as the time "after." In his opinion, recent medicine (for a multiple reasons) has limited physicians to look only for a snapshot view of patients lives (the breif moment they are sick and come into a clinic), when they would really prefere a fuller, contextualized view (the "before" and "after".) And yet even in these breif interactions, the physician works agrresively to form a narrative. Helman's booked is introduced with the idea that, "Medicine is not just about science. It’s also all about stories, and about the mingling of narratives among doctors, and between them and their patients." The narrative, for him, was the therapy as much as anything else.
The greatest gift you can offer anyone--a patient or otherwise--will be a story; the story you share and engage, the one you listen to and mold, the ones you commit to unfolding with enthusiasm and humility. This being Helman's perspective, he found it no surprise that with increasing pressures limiting the physicians ability to engage a full narrative, they are now writing them.
Amongst the latest additions to this writing genre has come from American physicians writing not about their medical career, but about their training: the 100 hour weeks, 36 hour shifts, the late night calls, the 'rites of passage' they 'fought' through, and the 'heroic' measures it took to 'survive' training. An initial read through such works might lead one to see them as a type of "narrative self-therapy." That the telling/creating of the narrative helps the medical student (or intern or resident) cope with the situation. The regularity of such language found amongst those in the medical profession has prompted some (anthropologists) to suggest it may be an intentional effect. The 'institution of biomedicine' works deliberately to make those in the sytem perceive they have taken on some "heroic" measures to become a physician. The arguement would then imply that if physicians saw their training as somehow more bearable, less than impossible, something closer to a "normal" 40 hour work week, the institution of biomedicine would lose authoritative power.
While on paper these arguements seem convincing, see the narrative in the red, half closed eyes of a resident completing a 112 hour week, and thoughts of him/her as a vehicle of institutional power is far from your first thoughts. I think, though, one like Foucault would argue that is exactly the point.
Posted by ami6 at January 21, 2006 01:35 AM
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Comments
How interesting to come across this post at this time, just when I was reading about a group of Case researchers who are interested in establishing a StoryBank, to collect stories from patients. They had not mentioned narratives as coming from the doctors, but were focused on the narratives that the patients aren't able to share in the short doctor-patient interaction. But this post demonstrates that the narratives are really dialectical as well.
Posted by: Roselle at January 30, 2006 06:56 PM
Nawal El Sadaawi is wonderful, too; she's really an admirable woman in many ways. Have you read anything of hers?
I hope all is well.
Posted by: Jacqueline Greene at January 31, 2006 06:21 AM