Peirce Johnston, MD, UC Professor, Clinical Psychiatry and Behavioral Neuroscience
Learning objectives
- Define narrative medicine
- Engage with writing or other forms of creativity that stimulate reflective practice, empathy, humility and self-expression
Assignment: The 55-word story
DUE April 15th
Working with patients and communities, especially vulnerable ones, requires self-care and a reflective practice is one method. As you saw in the readings, one way to reflect is to write a 55-word (exactly, only) story. See the article above.
Your assignment is to write a 55-word story related to a significant experience for you – regarding service, advocacy, your next steps or your past four years… you can choose the story.
How to Write a 55-word Story (From Fogarty article)
1. Think of a compelling story based on your experience (as clinician, patient, other?).
2. Write down everything you can think of.
3. Don’t edit, just write (phrases, words, key chunks of memory).
4. Put it away (optional and can be done at any time between # 2 and finishing).
5. Read over your writing and begin to clarify the idea or storyline that you want to convey.
6. Begin editing, sometimes ruthlessly.
7. Share your work with others for reactions and feedback.
8. Keep editing until you get to 55 words. Use your word counter, and also double check manually.
a. Title doesn’t contribute to word count but shouldn’t be more than seven words.
b. Contractions count as single words.
c. Eliminating articles (the, a, an) can help with word count.
9. If you cannot cut enough words, you probably have material that either would lend itself to
a longer essay or become multiple 55-word stories.
10. Given the brevity, formatting can make a big difference.
Please submit your 55-word story; AND:
(1) Why this story and (2) How you felt writing this story
For him, CAIN is home. Refuge. Resource.
There’s connection here, and someone to listen.
Talking at a mile a minute: vaccines, X, celebrities, India, track stars, produce, GMOs, childhood.
He gets one head of lettuce, then leaves.
“Nothing organic, watch what you put in your body.”
Thank you, my friend. Until we meet again. Tomorrow.
I felt a sense of fondness writing this story. This is about one of the shoppers at CAIN who is near and dear to my heart. I think that his story deserves to be heard, and I am honored that he has given me the privilege to listen to it over the past four years. While I may not have heard everything that he wanted to share, I am certainly better off for what I have learned about him by listening, and with what I have learned about myself while listening too.
Yes!: vibrations, energies, pineal gland calcifications, harmony, radishes, flowers, avocados, and calories. Sentences I’d never heard before forming stories that represent the importance of narrative medicine. Some stories we’ll never forget, and this is one.
Megan,
Thank you for sharing this story with us! That’s awesome that you had the opportunity to form a longitudinal relationship with this person and got to listen to his stories. That’s the best thing about the career we’ve chosen, and it sounds like you’re going to be in a perfect position to make a lasting impact on your patients in the future.
She hesitated, eyes searching table. Spanish trembled from lips; curiosity answered. I pulled a chair close and opened a story. She spoke of Guatemala, of fear, of her son studying medicine far away. Leaving, she smiled, lighter. “Tell him,” she said, “I was heard.” In that moment, clinic felt less foreign, more like genuine connection.
“Making something different.” That’s the impression that I hoped to leave as a young wide-eyed medical student when CAIN was started. I can say that years later, many would argue we’ve done just that. Whether it be small nods or fruitful conversations, we bridge gaps in a wanting community one clinic at a time. I feel grateful composing this because I’ve learned as much from my patients here than they have from me. I’m thankful they have “simply given me a chance” and helped guide my next chapter of residency.
A crooked smile underneath a white helmet, lanky legs in a wheelchair. He lifts his helmet so his blue eyes meet mine. “HUG?” he exclaims, pulling me tight, fingers scratching my back. “HAPPY?” he asks. “I am,” I say, as the tears from interviews, evaluations, and test scores fade away.
In writing this story, I felt the exact same sense of relief and warmth that I felt in that moment. Service and advocacy for me fulfills this larger purpose that reassures me I picked the right field to make a difference for people I care about. In addition, it reminded me that no matter what insecurities I felt about my academics, the only thing that mattered to the individuals I cared for was that I was there, I listened, and I loved them.
Trong, this was so touching to read and really emphasized for me the thing that matters most: our patients. I think in med school especially it’s easy to get caught up in how we appear to our peers and superiors, and while that can be a normal and healthy part of growth, I can relate to that sense of fulfillment from helping care for someone that will always mean more than any great evaluation or amazing test score ever would!
Heat exhaustion? Heat stroke? AMS? Should they call 911?
She’s a regular. Everyone knows her.
Can I get her some water?
She paces. Into the shade. Into the sun.
She doesn’t want my water.
She walks away.
Nine months later, on a beautiful crisp day, she’s walking the same path.
Relief. That’s her.
She’s alive.
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I wrote this story because I recently saw a community member that I had been worried about last summer during the long stretches of 90+ degree days. Many CAIN guests were significantly affected by the heat, and they were similarly significantly affected by the long stretches of freezing temperatures this winter. I worry for specific members of the Northside community, especially the unhoused, whenever there is severe weather now. I felt like I could put my worry about this specific person from that specific day last summer to rest after writing this story.
I cut away packing tape from his partially amputated hand
“I wouldn’t be here without her”
His wife asks: “How do you spell dehiscence?”
Can’t take EMS; electric wheelchair might get stolen. needs bus fare
Respite ineligible; can’t take stairs
Nursing home? Requires leaving wife alone on street.
“cold winter, did my best” he says
I wrote this story about a recent encounter with the street med team. I had just finished an ER rotation and felt confident in my capacity to redress his wound. I was excited to be able to help with my fully stocked street med bag (a smattering of Dollar Tree finds). I wasn’t prepared to find what was underneath and I tried to keep my cool. I was even less prepared to advise someone with this level of social complexity. I felt angered by the options for someone so vulnerable. My own sense of urgency was palpable in my communication with him. I learned a lot from watching Dr. Kiesler gracefully discuss his options without bias or pressure towards one particular choice.
Writing this makes me feel impassioned with my why for entering medicine: I want to treat those that society at large prefers stay hidden. But it isn’t enough to just see these patients and I feel angered, heavy, and saddened by that. He deserved gold standard care just as much as anyone else. Instead his hand was self-wrapped in packing tape when he ran out of wound supplies. I feel hopeful, too – I hope San Francisco trains me in a system I can replicate elsewhere to get closer to health equity for all.
Feeling Alone
What am I feeling? Overwhelmed? Scared? Both?
Feeling sent to the wolves by my team, alone.
Don’t cry. Don’t cry. Don’t cry.
Supposed to be an easy bump out, now a rapid response.
Such a kind, talkative man.
My fault? Team implied so.
Alone he goes to the ICU.
Alone I go to the workroom.
I chose to write about this patient encounter because it was one of my least favorite days of medical school. It is significant to me because it makes me scared to take care of patients in the hospital, and very nervous about my inpatient time coming up in residency. One of my patients decompensated while on my IM AI, and, instead of creating a teaching moment on warning signs or reassurance that these things happen sometimes, my attending implied that it was my fault for not asking the senior about giving him an extra dose of lasix the day prior. My senior didn’t step up to protect me and everyone else stayed quiet too. It was a very traumatic day since I felt like this patient’s decompensation was all my fault. At the time, there was no reflection because we were on rounds and the next patient was already being presented. It was hard to reflect on this now because I still feel a lot of guilt about this patient and sadness and anger that I had these feelings in what was supposed to be a learning experience, where students can make mistakes knowing someone has their back. I also feel sad that this patient came to mind for this reflection, rather than the hundreds of other wonderful patient encounters I’ve had through the last 4 years, but I am also grateful for the time and space to process this tough experience further.
“Hey Adam?” Her hospital stay concluded. I returned unsure what she would say but saw a smile – “Thank you for listening to me. For the first time in a while I have hope for the future”. I acknowledged her kind words, and departed. I hope I impacted her future, but she undoubtedly impacted mine.
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I wrote this story because it was the most impactful moment I had for advocacy within the hospital. This was a patient who had a significant healthcare history and whose chart was extensive for things that impacted her care. I was so glad I got to take care of her, because she taught me how important it is to advocate for your patients. While writing this story, I felt a genuine connection to this patient and all the emotions of this experience came back to me. I was flooded with a genuine sense of pride at how I was able to help her moving forward, and none of that would have been possible without advocacy.
Foot Care for the Souls:
I trimmed nails for a man without housing.
He asked how to treat thick, discolored toenails without a doctor.
I had no answer.
Another client whispered:
Vaseline nightly.
His face brightened.
I learned medicine is listening, sharing, and restoring dignity.
Many answers come from community.
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Writing this story felt like a refresher on the perspective I try to have when caring for patients: I’m not the one with all the answers. In this moment, I felt very stuck because I didn’t have anything to help the man I was caring for and I also didn’t know who else to ask. It just so happened that another community member was listening in to our conversation, and it was the perfect reminder that oftentimes the community, the patient, and others around you may already have the answer you’re looking for. It just takes humility and openness to listen