Narrative medicine is not a parochial act, and it does not require that the physician and the patient belong to the same identity community. What it does require is that the patient and the physician or the nurse or the social worker feel that they are part of a fellowship, but not of belief or race or ethnicity. It is a fellowship of mortality. All of us are going to die. All of us, as humans, live within time, and that is what the humanities can bring to this process of taking care of people as they move toward their end, not to be macabre. I am not macabre. But I think all of us, to the best of our ability, must try to remember that this is temporary. We doctors are not unlike the person in our examining room, the person in the operating room….
The opposite of humility is what? Arrogance, superiority, maybe even ironic distance? It is the idea that I know more about you than you know. My shoulder goes up. That is the kind of posture that creeps into the physician and the medical student. You have got a mass in the head of the pancreas, a bad thing to have. So I know more about you than you know. I know what that means. Do I not want ironic distance, to be separate from you? Do I not want to be on a plane a little above you?
I can go on about what David Foster Wallace has to say about ironic distance and how what is wrong in the medical setting is, as my students tell me, not a dearth of empathy. It is an excess of irony. That kind of distance, in which I take refuge in the fact that the head of my pancreas is doing just fine. Now multiply that by twenty times a day. So, that accounts for the unavailability, the being out-of-reach that so many people experience with their internist or their surgeon, even their psychiatrist….
Steven Marcus would always say, “Every word counts.” And you had to mine the meaning, the implication, the allusion, the beauty out of the language, and pay attention to the figural language, to the temporality, the spatiality, all of those things that we do as readers. And as you get better at it, you do it all at once.
We train people to listen in a way that every word counts and to pay attention to what figures the patients are using. Where do they start? What is the beginning of this story?
And what am I listening as? ….
I am not listening only as an internist. I am not listening as a social worker. I am not listening as a psychologist or a psychoanalyst. All of those have frameworks for how to listen. And finally, with great relief, I realize I am listening as a narratologist. I am listening to how the story gets told. At what point do the tears come? At what point does the tempo shift? At what point does the plot change?
By doing that, I stop myself from what some people call binning, putting things into bins, oh, this sounds like acid reflux, oh, this sounds like gallbladder disease. I don’t want to do that….
It is a matter of radically, radically unframed listening. We are teaching, in our workshops, radical listening, which is a listening unperturbed by what it is I expected to hear. And it is equally powerful in a clinical conversation as it is in a conversation about politics, where nobody agrees. Do you see?
For other posts on narrative medicine, see here
For other posts on medical humanities see here
This is a really excellent article. I have not heard the term ‘ironic distance’ prior to this, but it really makes perfect sense to me from my perspective as a chaplain. We use the phrase ‘leaving the room’ to describe the flight from immediacy within an encounter. It happens for many reasons. Thinking in terms of narrative is something I am going to try to do as I go forward. Thank you for posting this. I will share it among my colleagues.