It was a year to the day after her husband died. Amy, a regular participant in our coproduction community of practice, had joined the group in a narrative exercise designed to promote perspective-taking, a key component of empathy. Prompted to write for 5 min about a healthcare experience, Amy described her experience of his death.
My daughter and I were speaking to my husband by a phone the nurses hooked up to his IV to enable us to see him. I saw his oxygen monitor drop to 60. I told him to push the alarm. He did, but no one came. We called the switchboard, it was broken, we called each department in the hospital as we talked to my husband, we called 911. 15 min passed, he stopped talking, no one came, at 20 min they came in and said oh we need a crash cart and turned off his phone, our only lifeline in COVID. It was the last time we saw him conscious.
The force and urgency of Amy’s prose evokes a visceral response. Exhausted by the cruelties of the pandemic, we may have the impulse to put this essay down and walk away from its raw pain. What kind of response could begin to address the suffering in this story?
Sometimes, all we can do is bear witness: be present to the stories of others, listen with what St. Benedict called “the ear of our heart,” in hopes that this promotes healing. Narrative medicine calls us to bear witness through “close reading,”1 letting stories work on us as we take them apart to see how structure and form can enhance the impact of content. In response to Amy’s narrative, we can offer a close reading of her text.
Its pace is insistent. After the four short sentences that start the story, which read like testimony, or a police report, the rest of the story unfolds in two long run-on sentences that propel us toward an ending that we begin to dread as we read. As when we watch a scary movie, covering our eyes and then peeking at the screen through our fingers, we don’t want to find out what happens, but we have to. As clinicians, we may feel personally the weight of this tragic failure, and the ironic cruelty that the only act the otherwise not specified “they” performed was to turn off the phone (“our only lifeline”). The last line is dispassionate, the narrator back in testimony form, trying to bring closure to a story that leaves us wanting a different ending. By using the form of a report, the narrator leaves the reader to experience and process the emotions that simmer unspoken and unnamed throughout the piece. If we work in healthcare, we feel accountable. If we are a family member, we feel the unspeakable betrayal.
A second prompt invited participants to write about the same healthcare experience from the imagined perspective of someone else who was there. The act of stepping into the shoes of another, choosing to see the story through their eyes is another potentially restorative narrative act.
Amy’s second piece offered the imagined perspective of the nurse who cared for her husband.
I was so tired, I thought I heard an alarm in bed B, but there were so many alarms and noises. It is strange we have had no codes today, unsettling as it is early afternoon and it does not seem normal that everyone is fine. Why am I unsettled by normal? I heard codes again in my sleep and saw them along with the dead patients we stacked in the hall until they could be transported to the refrigerated trailers outside. They died alone, no matter what families did to try to be with them. I hope the patient in bed B lives, his family and I worked to string his phone on to the IV pole as there are no IPADS or any of us left to help the families. Every day we bring him Starbucks when we go for ours. His smile and his encouragement, lights up our lives. She, the wife asked me to touch him as if he was my own father so he would feel safe and loved. Yesterday, he said, “if I die, I want my wife to have my antibodies, we have been together since she was 17”. It is scary and my face is raw from 12 h of wearing the same mask from patient to patient. They just cut our pensions, yesterday, and told us we need to work even if we have COVID. I remember my daughter asking me, “mom do you still love being a nurse?” I love people and I love medicine but I feel betrayed by the system that did not care for our humanity.
A close reading of this version of the story reveals a mix of humanity and inhumanity, distance and intimacy. The patient is referred to as “bed B” but then likened to the nurse’s own father; impersonal refrigerated trailers contrast with her raw face. The rhythm is staccato, the plot disordered. We jump from the nurse’s dreams of codes and dead bodies, to her hopes (that he lives) to her acts of kindness (Starbucks). The tenses similarly jump back and forth from past to present and back to past. The stringing up of the phone to the IV pole is a chilling echo for the reader who knows it as the agent of final disconnection. Despite its chaotic structure, this piece shows remarkable empathy for the nurse, her tiredness, her attention to details, her relationship with her patient despite efforts to stay at a distance. The word “love” appears three times; the story closes with the word “humanity.”
There are multiple versions of every story, and even our own stories change over time. Narrative practices encourage the emergence of various perspectives and provide ways of responding to them with curiosity. Stepping into the shoes of a person who sees the world differently is not easy; it becomes even harder when we feel misunderstood, injured, or unfairly attacked. Yet through the act of retelling and claiming the truth of her own story of unthinkable fracture and loss, Amy was able to move to a place of imagining (with compassion) the experience of another who was also traumatized, even as she worked in the system where the trauma occurred.
For Amy, this experience of retelling the story of traumatic loss was empowering. Afterward, she reflected on writing the two versions:
Almost forcibly facing our inner perspective and then seeing “the other” but leaving us in charge of their narrative is empowering and healing…I did not expect it to make a difference, bring closure, or serve as a catalyst to share further the healing power of empathy and community, but it did.2
Choosing a lens of curiosity rather than blame, Amy found a shared humanity in this tragic situation, and in the process of participating in this story-telling exercise experienced a sense of restoration—and even healing.
The pandemic has left many feeling overwhelmed, powerless, and alone in our own suffering. Authoring stories such as Amy’s can restore agency and allow us a way of making sense of difficult experiences. The value of giving voice to our own stories, uncovering the meaning they have for us, and having others bear witness comes partly through the process of reordering, reflecting, and integrating personal traumatic experiences into coherent professional narratives. Expanding our stories to include voices that represent the real or imagined perspectives of other characters can add even more value: these perspectives deepen and complicate our own truths and remind us of our shared suffering, ultimately promoting connection, empathy, and healing.
Acknowledgments
The authors are grateful to David P. Stevens, M.D. (Geisel School of Medicine at Dartmouth, Dartmouth Institute for Health Policy and Clinical Practice, Hanover, New Hampshire), for generous and generative conversation and close reading of the manuscript as it was in development.