This week’s JAMA has an essay in its series, A Piece of My Mind, titled The Stories We Tell Ourselves. The author, palliative care physician Danielle Chammas, MD, writes about the importance of the words we choose when we speak and our task as physicians to help our patients view their circumstances in the best possible light and to rewrite their stories.
She writes:
Stories allow for the integration of loss, fear, and suffering into one’s life. They become the vehicle through which clinicians can help patients redefine what it is they are hoping for (rather than lose touch with hope all together).
Is somebody a patient, a victim, a survivor, a burden? What does it mean to be a fighter? To do everything? Did we give up on a loved one, or did we honor their dignity? Did we choose to not resuscitate, or did we choose to allow a natural death? Whether intentional or not, clinicians are often an important source of vocabulary that these writers draw from. With each choice of words, clinicians affect narratives, and some words wield particular power. Just, for example, has the power to diminish. How boxed in does one feel when their identity slips into just a patient, just a diagnosis; when hospice becomes just about dying rather than living one’s final days to the fullest?
Dr. Chammas’ essay touches at the essence of being a healer. Our duty as clinicians is not only to treat the disease but also the patient — to ease suffering and help our patients move beyond the present, to wherever their abilities and circumstances allow them to go. We don’t “get over” losses, be that the death of a loved one or the loss of our own health or abilities, we will always remember and live with our losses. We must integrate them in a way that somehow makes sense in order to be able to carry on. This really sank in with me when I attended a Harvard course in the Catskills titled The shadow of the Object, which I blogged about back in 2009:
The title of the course was “The Shadow of the Object”, which is a quote from an enigmatic passage in “Mourning and Melancholia” by Freud. It was held in an old, slightly run-down family resort in the Catskills in upstate New York, very similar to the setting of the movie “Dirty Dancing”. In its heyday, this resort was a summer haven for middle class families from New York City – a chance to experience nature and participate in organized activities while mingling with people of their own kind.
The central idea of the conference was that we never “get over” loss or trauma – we just have to find ways to carry it with us in a fashion that makes sense for us. It is a simple notion, but it has profoundly affected how I have counseled patients from that moment on. There is such a tendency in our society to focus on the “positive”, to downplay the importance of sadness in a healthy and balanced life.
One particular thought we brought with us from “The Shadow of the Object” is the concept of moving through grief by finding ways to honor the legacy of the lost loved one. I have found that to be one of the most healing things you can teach those left behind after someone they respect and love passes away.
Helping patients rewrite their stories, which don’t have to be written, I just mean how they explain things to themselves (and perhaps others), is a big task that can take time over several encounters. But choosing our own words very carefully is something we do, or should do, in every visit, every day.
I wrote about this, too, in 2009:
https://acountrydoctorwrites.blog/2009/09/13/the-power-of-words/