York County Medicine Summer 2020 - 7

YO R K C O M E D S O C . O R G

FEATURE:

Narrative Medicine:

A Jewel on the Physician's Tool
Belt in the Era of COVID-19
By: Andre Lijoi, MD
WellSpan York Hospital
Narrative Medicine

O

n an April day three years ago the Family
Medicine residents at WellSpan York Hospital
spent the morning learning about managing
chronic pain and the impact of the opioid crisis on
their patients and practice. Following the didactic, the
group watched Amy Winehouse's music video, Rehab.
They discussed the words of the song, the images
projected and their reflections about their personal
experiences trying to help patients with addictions.
They were asked to write for 5 minutes to this prompt:
"Write about someone you know with an addiction
and write one thing they told you about it." Volunteers were asked
to share what they wrote. One participant wrote, "You almost died...
you remember I was there when your child was born...you must get
sober and I will do whatever I can to help you...your child has only
one mother and she is not replaceable. I saw her 18 months later, she
was sober. I asked, "what prompted you to make the break?" She said,
"someone told me that my child has only one mother and she is not
replaceable."
That was the first Narrative Medicine session presented to
residents at WellSpan York Hospital. As the presenter I was not
prepared for the response. Participants responded with these
comments: "I finally feel human again." "I never expected to have
an experience like this. Ordinarily I wouldn't sign up for a program
like this." "This experience today took me to places inside myself
that I try not to go with patients." Monthly ever since, Family
Medicine Residents have received "a dose" of Narrative Medicine as
part of their professional development curriculum.
Narrative Medicine is a discipline that is predicated on the fact
that illness and the care of patients occurs in the context of three
types of stories: stories that patients and families tell us, stories that

health caring professionals tell each other, and stories
that we tell ourselves. These stories are the way human
beings make sense of their lives and convey meaning
about them, especially the deeply emotional, lived
experiences of life. These stories inform us about the
suffering our patients and we ourselves encounter.
Narrative Medicine was established in the year
2000 at Columbia University by Internist Rita
Charon, MD, who also has a PhD in Literature. There
has been no other time in modern history where close
attention to these stories has been more important
than during the international public health crisis perpetrated by
COVID-19. Narrative Medicine Practitioners cultivate the capacity
to receive and interpret these stories and are committed to act on
them. This article will share how Narrative Medicine is being used
at WellSpan York Hospital during the era of COVID-19.

Narrative Medicine Basics
The fundamental skill in Narrative Medicine is close reading
and in the clinical encounter, close reading translates to listening
carefully, even radically and watching closely. We learn this by
turning to the arts and humanities examining any work that might
draw our attention. We examine poems, songs, movie clips, music
videos, paintings, photographs, short stories or a page from a
novel. We read, look and listen carefully for details or clues that
tell us something about the story being presented. We call on our
imagination to help us to piece together the story depicted. Dr.
Charon tells her students that we don't have very much time when
we see our patients so we must be very good at getting at the story.
Thirty-five years ago, I embarked on my first post residency
position with the Public Health Service, deep in the mountains of
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