“Wouldn’t you want someone to tell your story? Ultimately, it’s the best proof that we mattered. And what else is life from the time you were born but a struggle to matter, at least to someone?” — Elliot Perlman
At home on maternity leave with my third child, I sat down on the couch rocking my newborn to sleep when I felt I could actually hear myself think for the first time in 9 years. A mom, a volunteer health care clinician working in street medicine, and a PA working in trauma, HIV medicine, and primary care have made for rich but busy and long days. But on that day, between the soft sighs of this new life, I realized that the stories that I had tucked away in my mind like dust bunnies in the glorious nooks and crannies of a Swiffer duster needed to find their way out.
Witnessing an individual’s journey of life and illness, with its bending and weaving trajectory, is part of the sacred privilege given to us through the practice of medicine and grants us wisdom through the observation of hundreds of lives. In the practice of street medicine, which is the direct delivery of primary care to people experiencing homelessness living in parks, underpasses, and abandoned buildings, we have the privilege of witnessing those lives lived as society casually passes by, seemingly blinded to the suffering happening at their feet.
At first, being a witness in solidarity with our street medicine patients was like having a repeated epiphany where I saw the world from a different perspective. What education had so freely been given to me from my patients seemed to fit so nicely in the Tupperware storage container I had created for it in my mind. I stored the stories there and tried to use their teachings to better the care I gave to all my patients, from the trauma bay to the outpatient HIV clinic. For a time, I felt satisfied that I had used their stories for the greater good while protecting myself from the harshness of the real reality that the stories told.
But then, it wasn’t enough. First, I started to feel like the dragon Smaug from the Hobbit (minus the fire breathing, though my kids might disagree), sitting selfishly on my heaps of golden treasure, guarding their secrets. Only taking a story out of storage judiciously, sharing their riches in vague stories I would tell my parents or PA students during lectures. I wanted to do the stories justice, but I didn’t know how and so I shared just a snippet and then put it away for another time. Second, I realized how heavy the stories were. I had made the mistake of trying to bear their sorrows, injustices, and burdens as my own instead of holding the burdens with my patients in an act of solidarity.
I didn’t know it at the time, but what I was searching for was narrative medicine. Narrative medicine is medicine that is practiced with narrative competence that asks clinicians to recognize first when a story is being told to you, to absorb and interpret the story, and to be moved by what was heard.1 Founded by Rita Charon, MD, PhD, of Columbia University, narrative medicine challenges us to expand our ability to empathize with our patients by learning how to listen to what is really being said and sharing it with others in a meaningful way that richly represents the diverse perspectives that interplay to create a patient’s illness experience.
While narrative medicine is often tangibly carried out in the form of written narratives, it can also be through poetry, spoken word, and song lyrics. In fact, when I teach introduction to narrative medicine workshops, I always start with a comic strip drawing activity where participants are asked to depict a positive or negative experience in health care using only stick figures. Stick figures, the great equalizer of artistic ability, followed by storytelling and listening serves as a gateway to the liberation of narrative medicine.
Fundamentally, narrative medicine asks us to think about 4 central relationships that need to be explored through our action of storytelling:
- Ourselves (the clinician)
- The clinician and the patient
- The clinician and a colleague
- The clinician and society
If you search your mind for a story that either enraged or enthralled you, I am certain you will find it centers around 1 of these 4 relationships. Putting further structure around the stories requires knowing who is the audience? Whose perspective is leading the story? Are you expanding on a moment during an encounter (like a great love song) or are you taking the listener or reader on a journey across time? All of these questions (and many more) help to shape the story that is ultimately told.
Narrative medicine has given me a way to bring honor to the beautiful, and sometimes raw, stories that have been shared and witnessed on the street. It allows me to share some of these riches with others in a way that l hope brings honor to the patients and the stories they have trusted me with. But it also gives me a way to share the sorrow, suffering, and joy of street medicine with many hands. The creative parts of our brains shouldn’t wilt away just because we have become experts in scientific method. I am certain we are capable of both.
I started sharing my stories through a blog online. I would publish it into the cyber abyss and walk away to let it marinate in the world as I rejoiced its exit from my brain. While I was convinced only my mom would read it, I was amazed at the thousands who read my stories and readers who shared their stories back with me. It became a way to learn from others and support each other’s journeys.
Practicing narrative medicine has made me a better listener, a better communicator, and ultimately a stronger advocate. The hierarchy of society still supports that I will have seats at tables where decisions are made that my patients will never be invited to. Rather than view myself as a ‘voice for the voiceless’, I am more like a loudspeaker that amplifies what the patients have been saying all along. And in the end, don’t we all want to know that someone heard us and that our story was told in places where people listened?
Corinne T. Feldman, MMS, PA-C, is clinical assistant professor of Family Medicine in the Primary Care Physician Assistant Program at the Keck School of Medicine of USC. PA Feldman also is director of the Street Medicine track for the USC Family Medicine residency. She has provided primary care for people experiencing unsheltered homelessness since 2007 and contributed to the development of shelter and street-based care in Lehigh Valley, Pennsylvania, and in Los Angeles. She currently sees patients at USC Street Medicine.