A dire need for narrators in medicine

An American poet and political activist, Muriel Rukeyser, said the universe is made of stories, not of atoms.  I believe her.

As a seasoned storywriter and storyteller, I walked gingerly into the adult emergency services for my first shift as a volunteer at a legendary New York City public hospital. I sported a crisply ironed red polo with “emergency department volunteer” embroidered in white stitch.

Armed with a pocket notebook and a pen to tie up my hair, I was ambivalent and apprehensive to perform alongside my colleagues: focused pre-medical students in rapacious pursuit of the coveted MD degree. My instrument of choice was a writing utensil, so it is with good reason I shivered at the thought of nearing a stethoscope or a scalpel. I suffered from an incurable case of imposter syndrome; I feared someone would detect that I was better at languages than logarithms. Qu’est-ce que c’est organic chemistry? That was a foreign language to me.

I feared for my life and for the life of the patients I was about to meet. I wondered and worried how I — a hesitant traveler following a circuitous path toward a health care career — managed to get myself in a prestigious summer program and in the hustle and bustle of one of the nation’s busiest EDs. To the house staff, I thought I could contribute nothing more than open-mindedness, keen curiosity and readiness to learn. To the patients, I could contribute nothing more than an attentive ear and hearty conversation.

Rather than peek through a closed curtain to gawk at a stranger’s open fracture like the rest of my cohort, I was more interested in observing a beautiful and intimate relationship between a doctor and patient. Over the ten weeks of this summer program, I observed the importance of communication in medicine. I learned that the skills I sharpened as a writer are invaluable assets to this profession.

A good physician hears a chief complaint. A great physician listens, absorbs, and interprets the story of illness. I was awestruck at the divide, the marked difference between the physicians who did and the physicians who did not have the ability to connect with a patient. While some physicians overlooked a basic introduction, others mastered the art of medicine as they nourished the delicate doctor-patient relationship. While some physicians sifted through a medical chart for past medical history and chief complaint, some others read symptoms through the patient’s body language or subtle gestures. As a spectator, I took careful note.

I penned my discoveries in the lines of my notebook, constantly editing my pro-con list that details why I wanted, and I didn’t want, to become a doctor. My love affair with the selfless profession grew stronger with each passing day. I admired the personable interactions physicians shared with unfamiliar people and longed for the same. And with each interaction, I noticed that there is a dire need — a severely underestimated need — for narrators in medicine.

My experience as an ER volunteer confirmed the value of narrative competence in medical practice. For instance, residents were critiqued on how well they shared the patient’s story with the attending during rounds. Additionally, physicians concisely inscribed the patient’s story in a chart. These observations, among others, made clear that the physician’s story intertwines with the patient’s. At the bedside, these stories overlap and weave together to build a special, shared narrative. The physician closely reads the patient’s body as a text; patient as the character, illness as the conflict, and treatment plan as the resolution.

Simply put, the physician is both healer and historian. The practice of medicine is a tactful balance, a constant challenge to construe information rapidly and responsibly. Physicians, like writers, read between the lines; they interpret unspoken words to make a diagnosis and propose a course of treatment. In this way, a physician is both writer and editor of a life story.

As a volunteer, I befriended strangers. The interviewer in me asked unscripted questions. I comforted distraught patients and created strong bonds of trust. I was graciously welcomed in patient’s lives. We traded; I gave them sandwiches, they lend me their life stories. We shared; there was a mutual interest in getting to know one another. I entered the lives of the patients I met. Patients confided in me their stories of love and loss, desire and death, melancholy and madness. The collection of patient’s stories and struggles is secured in my notebook and kept close to my heart.

I ended that summer with a strong sense of accomplishment and purpose. I am grateful for my time as a volunteer. It was a privilege and an honor to make a small contribution to the patients that gave me such opportunity and insight.

In the end, I learned that even as a native storyteller, I could be a healer. I could use my skill as a writer for the sake of human benefit and for the greater good of humanity. After all, medicine, like the universe, is made of stories, not of atoms.

Sonal Kumar is a pre-medical student.

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