Khushboo Pal Paper 1 10/16/12

It was a fresh, fine Sunday morning and I was chatting with Ronnie in a hospice when the doctor came in for his regular check up. I left the room and waited till they were done, cause that’s what your trained to do in a hospice. When I left the room, Ronnie was not in his best mood but to my surprise when I went back inside, I saw him all cheery again. So, I asked him what the doctor said to make his mood all better, and he replied saying, “Oh, you know this doctor actually listened to what I had to say about my disease and not show his callous apathy toward me like the others, which made me feel so much better about myself”. I’ve been visiting Ronnie for a few weeks now and he has never been so comforted as he seemed then. This really obligated me to think about the extent of the impact a doctor can have on his patients by just empathizing with them. It also made me question, do your doctor’s words and consideration make you feel better than that of your friends or family at times? Is this what narrative medicine is about? Narrative medicine focuses on prioritizing patients needs, values and seeing the illnesses through their eyes. Doctors are well trained in their fields but a lot more can be achieved when doctors implement elements of narrative medicine in their practice along with reflecting upon it like we see in the works of David Watts, Oliver Sacks and Richard Selzer.
One important aspect of narrative medicine, i.e. the expertise to listen to the patients is very well portrayed by David Watts in his essay, “What Literature Can Do for Medicine: A Starting Point”. Watts describes a case in his essay where a lady comes to him with headache issues that she’s been facing for 10 years now. She comes to see him thinking that he would give her the same “chemical solutions” and the “clinical distance” that she’d been getting from all the other doctors. However Watts decides to take a different approach to diagnose her and lets her speak for a time more than what normally a doctor would give his/her patient before intruding. Even after she completed describing her pain and everything related to her problem, Watts just sits there in silence. This shows that Watts is actually listening to his patient and trying to mold the problem into shape, which is a very important part of an effective physician-patient relationship. Also, after further analyzing this case, I think, giving patients the time to just let the words and frustration out allows the patient to build trust in the doctor and gives them confidence to share what they are ashamed to say even to their family and this really is what narrative medicine is looking for. Watts here has done justice to narrative medicine in that he provided ample time to let the women finally come to the real problem, which ultimately led to the solution. At the end of the case, Watts mentions, “And we sat in that wow for a moment, not wanting either to embellish or to detract from the feeling of power that came from finding something big like that hidden so long” (Watts, 2012).”The feeling of power” here really implies the power of physician and self and the power of patient and self. In other words, there is more to than just helping a patient by prescribing a bunch of pills and that “power” makes the physician reach his/her own ideals as a health professional and also helps the patient see what the illness actually means and sometimes gives their life and self a new direction as in the case above.
While, Watts emphasizes on better communicating and listening to the patients, Selzer describes the art of surgery and metaphysically relates it to the art of writing in his essay,“ The Exact Location Of The Soul”. Writing and reflecting about the experiences physicians have with their patient’s plays a crucial role in narrative medicine. He portrays the idea of writing and medicine entailing each other in an eloquent manner throughout the piece. I think what Selzer wants to convey is that with writing you can make sense out of the disarray’s and refurbish meaning and continuity. Selzer touches upon this idea when he says that only doctors can produce great piece of writing about doctors. The doctors suitable for this task as suggested by Selzer are those who are through with their love of techniques, have entered into self-doubt and believe that they have done at least as much good as harm( Selzer, R. pp.18). In this way they can make out a way out of the chaos in order to heal and repair, which is the goal of narrative medicine. Moreover I really like how Selzer makes the readers think about “ the soul of the wounded body”. What I think Selzer means when he talks about finding the soul in the botfly case, is that the spirit of a person is more apparent when the body is wounded because, a wounded body is more empathized than a healthy one. When seeing others suffer dismays you, it is then the spiritual endeavor of medicine is complete and can be achieved through writing. However, according to me Selzer is a little over dramatic in his writing pattern and the way that he describes the surgical procedures as sacred and as hope for finding love is pushing the limits of what a reader can imagine through the essay. But nonetheless, Selzers’ approach of viewing writing as a means to see the spirituality of the body is very crucial for the doctors since it can make them more accepting of life and death as a natural process. Thus, in a way it will help doctors see their patients more than just a body and also keep them at the fine line of getting too involved so that they can handle the death of any patient in a professional way.
Sacks on the other hand fails to demonstrate the qualities portrayed by narrative medicine in some of the instances in his pieces. In his piece, “ The Lost Mariner”, he tries to make Jimmie, who has short-term memory lapses, aware of his situation when he thinks he is just twenty years old. Sacks thrusts a mirror into his face and makes him aware of his condition which very unsympathetic of a doctor to do. As a result the patient goes into a state of distress and it worsens his condition. However, to combat the effect Sacks handles the situation by distracting the patient immediately, which also shows that he empathizes with the patient, which is a more sensitive approach to deal with patients. This just confuses the reader and doesn’t play effective role in setting a good example for the readers, especially future physicians. Conversely through Jimmie’s story, Sacks talks about how a doctor can learn something beyond the scientific world and that there is something more to it like spiritualism or a soul, which is similar to what Selzer talks about. The difference, however, is that Selzer saw the soul in the body in some form and Sacks realizes the existence of soul through Jimmie. He realized that the soul is independent of the human body because it made Jimmie do the things which the Korsakov’s wouldn’t allow him to do. Adding to that, though diseases like Korsakov’s, Alzheimer’s, Autism do not provide hope scientifically or neurologically, essays like these fill the readers whether they are doctors or patient with hope that there is something like morals, values, feelings and give the patients a sense of self and doctors gratification that there is something that can help the patients, if not medicines. This can ultimately lead to a robust relationship between the doctor and the patient making it easier for them to deal with the horrid situations.
Talking about implementing narrative medicine in caregiving also leads us to vital questions like, what are the limits? How far can a caregiver go to “comfort”, “heal” the patients? What are some things that hinder some doctors to implement narrative medicine? Firstly, I think that reliability of both the patient and doctor can be an issue. To elaborate, sometimes the patient does not say all the truth hidden behind their disease. This could be because, either they are ashamed of revealing something or they simply don’t consider it to be that important. It also depends on the respective nature of individual patients. Some patients like Ronnie above like to share everything while the others don’t. On the other, the same can be viewed taking into the consideration how the doctor is. Some doctors just like to come straight to the point and aren’t that friendly which is big hindrance when it comes to treating the patient right. They may be experts in their field but being cold and distant not only makes the patient uncomfortable but also encumbers the treatment. Also, Watts in his essay, mentions that when the lady asked him about her husband he wasn’t able to say what he wanted to say and what the right thing to say was, just because they had known each other for less than ten minutes. Thus situations like these also limit the caregiver and that is where a fine line between the doctor and the patient comes into play. Thus to sum up, I think that doctors should first listen to their patients, ask questions in a non judgmental way, have something like an emotional pliability which allows the doctors to be emotionally attached to the level where they can cope up with something they think forlorn. Without all these measures the doctors that are being produced in today’s world are a risk of becoming aloof owing to all the pressure they have to go thorough while training and end up not being there when the patient needs his/her doctor the most as in the case of Ronnie.

Works Cited 1. Watts, D. (2012). What literature can do for medicine: a starting point. The Examined Life, 1(3), 1-10. 2. Selzer, R. The exact location of the soul. (Pp. 17-23). 3. Sacks, O. The man who mistook his wife for a hat. (pp. 23-40). Harper&Row Publishers.