The obligation of narrative.

Did I tell you about the back pain patient who paused in our waiting room after being discharged just long enough to steal the coin change machine? He didn’t get away with it though, because he stopped in the parking lot for a smoke, where security found him. He ran, but got caught and roughed up by the police, and ended up back in the ED for worsening back pain. What a world we live in! I have another story, or maybe two or three. Listen to this one: it was my first ever patient encounter, during a physical diagnosis course in my second year of med school. I remember walking up the stairs to his room, thinking to myself that it would be a whole lot easier to get the information I needed off the chart rather than from the patient. I had to sit down and remind myself that wanting to be a doctor meant that I was really, sometime, going to have to see patients. He had a memorable story too, of course. It started with a terrible pain in his back and led to the discovery that he had prostate cancer with spinal mets. The way he told it he collapsed in his back yard, and woke up after having an orchidectomy. “And what do you think they served for dinner that night?” he asked. “Spaghetti with meatballs!” I had a little flight of fancy about what the menus might be for other diagnoses before beginning the “Definitive Medical Student Physical Exam” (you remember that — it takes 3 hours or so). At one point I said I would skip looking in his right ear, since the bed was up against a wall and he couldn’t sit up, but by then he too had decided I had to be thorough, so he insisted I try. If you consider the logistics, the only way to look in the ear closest to the wall of someone lying supine is to cram your breasts into their face, so maybe it wasn’t that silly for him to insist after all. That was my first patient encounter ever, and I still remember it all, despite the thousands of patients I have seen since. His story is fixed in my brain. Somewhere, too, is the story of your first patient — or at least, the first one that profoundly impacted you; and next to that story are all the others, such as the first family you had to console, or the first patient whose cancer you diagnosed. I was an Intern in the ED. A man had increasing dysphagia over months, and I told him, “obviously, you must be as concerned as I am about an acute oncologic process, so I’ve booked you an appointment tomorrow with a hematologist.” When I left the room, the patient said to his nurse, “Good news — I thought this was cancer, but I guess it’s not.” The nurse made me go back in and say the word “cancer,” and tell him “that’s what you’ve been afraid of and that’s what I’m afraid of for you, too.” His is another story I’ll never forget. Tell me about the first baby you delivered, or the first patient you harmed. How about the first one you saved? We each carry a multitude of tales, because storytelling is part of what doctors do, and we in Emergency Medicine are often witness to the best tales of all. We see it all: blood, chaos and tears, the acutely ill, the acutely psychotic, death and survival, misfortune and triumph indiscriminate of age or social class. What is the importance of storytelling, of narrative? Simply put, it is all. Narrative confers meaning to a life, in the same way that it conveys meaning to an otherwise confusing jumble of facts and figures. Just as the story of my first patient is etched on my brain, every patient and every laborious history taken are now etched on your brain. Every patient that we see is a story, and not just one that we enjoy telling, but one we have an obligation to tell, when we arrange follow-up or request consultations for the patients we see.