2014, 36: 1005–1006
PERSONAL VIEW
Talk to me ANN L. WEBER & ROBERT A. SWENDIMAN University of North Carolina, USA
Abstract While physicians and patients both turn to writing in order to reflect, heal and advocate for social change, few have the opportunity to write with one another. I met Ann Weber, a doctor in social psychology from Asheville, North Carolina, as a fourth year medical student on the wards. Both Ann and I continue to search for answers, but as inveterate learners and writers, we now heal and grow together. This piece offers insight into how simple actions during patient care can promote humanism and patient-centeredness in medicine.
The Student ‘‘This sounds like a med student case.’’ The resident pointed me in the direction of the fifth floor, Room A543. Bloody diarrhea. I was spending a month as a fourth-year ‘‘acting intern’’ on the inpatient Family Medicine service in Asheville, North Carolina. ‘‘It’s irritable bowel syndrome!’’ the resident called out from the workroom, as the door closed behind me. Having read How Doctors Think by Groopman (2007), I remembered that patients with irritable bowel syndrome typically have gone through the works: repeat tests, expensive procedures, and many years before a diagnosis. And sometimes the diagnosis is wrong. I knocked on the door and introduced myself. Her name was Ann, and she had soft hands. I pulled up a chair next to her bed and sat, not anticipating the power of that simple action. I asked her to talk to me.
The Patient ‘‘Talk to me,’’ he said. He’d already surprised me by introducing himself with his first name. Now, instead of asking me a branching series of questions, he was inviting me to talk? I was non-plussed – feeling as though I had at last heard a familiar voice in a foreign, faintly hostile nation. I’d been ‘‘in country’’ for two days. My adventure started a few days prior, in the wee hours of the night: severe
abdominal cramping followed by diarrhea and blood from the rectum. I hurried to my doctor’s office at first light, received a battery of lab tests, and was referred to the emergency room. There, I waited for what seemed like days, but was merely ten hours, as other, truly critical patients were triaged ahead of me. Admitted to the hospital after midnight, I finally slept briefly. Between IV sticks, pulse checks, and a new rite of greeting – the scanning of the wrist-band’s bar code – at last I qualified for morphine, the first in my life. While this improved my outlook, it took a toll on my coherence. Pairs and trios of physicians solicitously questioned me. I found myself in terra incognita, and my voice wavered; I was defensive, disoriented and often confused. I felt oddly stranded, as if dropped alone into a strange culture. My room, with nothing of mine, was neither mine nor really a room. Frightened and in pain, I reflected on my helplessness. How could I heal – or even assist my healers? I discerned patterns: people in scrubs with first-name badges arrived at all hours, efficient, though not brusque. I welcomed the contact, their physical touch. Physicians wearing white lab coats with discreet ‘‘Dr.’’ badges were thorough but pressed for time. I wanted to ally with them, but soon refrained from offering any context for my answers. Normally a confident academic, I was already becoming unnaturally passive, a ‘‘good patient’’. Then Robert strode into my room. Rather than coming to my bedside and hovering over me – where I lay supine, selfconscious, and vulnerable – he walked right to the visitor’s chair, sat at eye level, relaxed, and spoke the magic words: ‘‘Talk to me’’. Talk – really?! Because talking is not just answering questions, nor is it chatter. Talking also means telling, a mix of attribution and entertainment to engage with the listener. Such account-making is as old as our species; some suggest we are better-classified as Homo narrans, ‘‘storytelling humans’’ (Harvey et al. 1990). I considered him for a moment, then told Robert my story. Occasionally, he posed questions, but it was a normal
Correspondence: Robert A. Swendiman, University of North Carolina School of Medicine, 125 Finley Forest Drive, Chapel Hill, NC 27517, USA. E-mail: [email protected] ISSN 0142-159X print/ISSN 1466-187X online/14/111005–2 ß 2014 Informa UK Ltd. DOI: 10.3109/0142159X.2014.916788
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conversation, almost my first since my symptoms had begun to separate me from the realm of social discourse. Once more a teacher, I explained my unique experience. Simply by telling what only I could know, in my own words, I felt myself becoming once again an active participant in my own well-being. But why should this be so? Telling my story with its meaningful context provided a vital component in my recovery: a sense of control. Regaining a sense of competency in an environment of learned helplessness is critical to improving health, healing, and achievement (Langer & Rodin 1976; Langer 1989; Seligman 1991). Humans are ‘‘meaning-seeking’’ creatures. We need to understand the causes and implications of key life events, especially when such events are unexpected or unpleasant. We urgently ask, ‘‘Why?’’ and then formulate story-like accounts (Weiss 1975; Harvey et al. 1990). As a narrative psychologist, I know it is not the accuracy of one’s story that proves its worth; the value lies rather in the coherence and sensibility a story offers the story-‘‘teller’’. This ‘‘opening up’’ process is a powerful component in healing (Harvey et al. 1990; Pennebaker 1990). Eventually I was diagnosed with acute ischemic colitis. Even before I met Robert, my medical condition had started to improve. But after our brief, powerful exchange, I myself began to heal. Once invited to tell my story, I heard myself making sense of a frightening, alienating experience, more competent now to undertake the challenging journey toward wellness. At the conclusion of Ephron’s (1983) novel Heartburn, the narrator responds to her therapist’s question, ‘‘Why do you feel you have to turn everything into a story?’’: Because if I tell the story, I control the version . . . Because if I tell the story, it doesn’t hurt as much. Because if I tell the story, I can get on with it. (pp. 174–175)
The Student I myself got on with it. Over the next several months, I rotated on a number of different services across the state. I saw many other patients and did not think of Ann, until one day I returned home to find, amongst the bills and shopping magazines stuffed in the mailbox, a note: Hi there, Yes, I have actually thought of you frequently during the medical Disneyland of tests since my hospital stay in June. Not sure if you would remember me, but you made a great impression on me. I felt less like a patient and more like a partner in the process of healing. I really appreciated your simply sitting down opposite me (instead of standing over me, which can
1006
be so intimidating for a person stuck in bed!), and memorably saying, ‘‘Talk to me’’. It was such a relief to feel once again like a person, not a case. I’m grateful I was ‘‘yours’’. I wish you the best in your professional life to come! Sincerely, Ann I was moved by her words. I always try to sit and listen, but I thought of all the patients with whom I was rushed and cursory. Rounding in the morning simply to get the information I needed. How had they been feeling? How often had I stood over them, waiting for responses, hearing rather than listening? I messaged Ann to thank her for the opportunity to be part of her care. When she told me that she was still going through tests, still ruling out diagnoses, I offered that we continue the healing process together. I asked that she tell her story, one more time. We both are inveterate students, telling and listening to learn whatever we can of healing.
Notes on contributors ANN L. WEBER, Ph.D., is professor of psychology (retired), University of North Carolina at Asheville. She completed her B.A. at the Catholic University of America and her M.A. and Ph.D. at the Johns Hopkins University. ROBERT A. SWENDIMAN, BA, MD/MPP Candidate, is a fourth-year medical student at the University of North Carolina School of Medicine, Chapel Hill, NC, and Dubin Fellow for Emerging Leaders at the Harvard Kennedy School of Government, Cambridge, MA. He is an incoming general surgery resident at the Hospital of the University of Pennsylvania, Philadelphia, PA.
Declaration of interest: The above authors listed are qualified for authorship. To our knowledge, there are no conflicts of interest, financial or otherwise, concerning this submission.
References Ephron N. 1983. Heartburn. New York: Alfred A. Knopf. Groopman J. 2007. How doctors think. Boston: Houghton Mifflin. Harvey JH, Weber AL, Orbuch TL. 1990. Interpersonal accounts: A social-psychological perspective. Oxford: Blackwell. Langer EJ. 1989. Mindfulness. Boston: Addison-Wesley. Langer EJ, Rodin J. 1976. The effects of choice and enhanced personal responsibility for the aged: A field experiment in an institutional setting. J Pers Soc Psychol 34:191–198. Pennebaker JW. 1990. Opening up: The healing power of confiding in others. New York: Avon Books. Seligman MFP. 1991. Learned optimism. New York: Knopf. Weiss RA. 1975. Marital separation. New York: Basic Books.
Copyright of Medical Teacher is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
PERSONAL VIEW
Talk to me ANN L. WEBER & ROBERT A. SWENDIMAN University of North Carolina, USA
Abstract While physicians and patients both turn to writing in order to reflect, heal and advocate for social change, few have the opportunity to write with one another. I met Ann Weber, a doctor in social psychology from Asheville, North Carolina, as a fourth year medical student on the wards. Both Ann and I continue to search for answers, but as inveterate learners and writers, we now heal and grow together. This piece offers insight into how simple actions during patient care can promote humanism and patient-centeredness in medicine.
The Student ‘‘This sounds like a med student case.’’ The resident pointed me in the direction of the fifth floor, Room A543. Bloody diarrhea. I was spending a month as a fourth-year ‘‘acting intern’’ on the inpatient Family Medicine service in Asheville, North Carolina. ‘‘It’s irritable bowel syndrome!’’ the resident called out from the workroom, as the door closed behind me. Having read How Doctors Think by Groopman (2007), I remembered that patients with irritable bowel syndrome typically have gone through the works: repeat tests, expensive procedures, and many years before a diagnosis. And sometimes the diagnosis is wrong. I knocked on the door and introduced myself. Her name was Ann, and she had soft hands. I pulled up a chair next to her bed and sat, not anticipating the power of that simple action. I asked her to talk to me.
The Patient ‘‘Talk to me,’’ he said. He’d already surprised me by introducing himself with his first name. Now, instead of asking me a branching series of questions, he was inviting me to talk? I was non-plussed – feeling as though I had at last heard a familiar voice in a foreign, faintly hostile nation. I’d been ‘‘in country’’ for two days. My adventure started a few days prior, in the wee hours of the night: severe
abdominal cramping followed by diarrhea and blood from the rectum. I hurried to my doctor’s office at first light, received a battery of lab tests, and was referred to the emergency room. There, I waited for what seemed like days, but was merely ten hours, as other, truly critical patients were triaged ahead of me. Admitted to the hospital after midnight, I finally slept briefly. Between IV sticks, pulse checks, and a new rite of greeting – the scanning of the wrist-band’s bar code – at last I qualified for morphine, the first in my life. While this improved my outlook, it took a toll on my coherence. Pairs and trios of physicians solicitously questioned me. I found myself in terra incognita, and my voice wavered; I was defensive, disoriented and often confused. I felt oddly stranded, as if dropped alone into a strange culture. My room, with nothing of mine, was neither mine nor really a room. Frightened and in pain, I reflected on my helplessness. How could I heal – or even assist my healers? I discerned patterns: people in scrubs with first-name badges arrived at all hours, efficient, though not brusque. I welcomed the contact, their physical touch. Physicians wearing white lab coats with discreet ‘‘Dr.’’ badges were thorough but pressed for time. I wanted to ally with them, but soon refrained from offering any context for my answers. Normally a confident academic, I was already becoming unnaturally passive, a ‘‘good patient’’. Then Robert strode into my room. Rather than coming to my bedside and hovering over me – where I lay supine, selfconscious, and vulnerable – he walked right to the visitor’s chair, sat at eye level, relaxed, and spoke the magic words: ‘‘Talk to me’’. Talk – really?! Because talking is not just answering questions, nor is it chatter. Talking also means telling, a mix of attribution and entertainment to engage with the listener. Such account-making is as old as our species; some suggest we are better-classified as Homo narrans, ‘‘storytelling humans’’ (Harvey et al. 1990). I considered him for a moment, then told Robert my story. Occasionally, he posed questions, but it was a normal
Correspondence: Robert A. Swendiman, University of North Carolina School of Medicine, 125 Finley Forest Drive, Chapel Hill, NC 27517, USA. E-mail: [email protected] ISSN 0142-159X print/ISSN 1466-187X online/14/111005–2 ß 2014 Informa UK Ltd. DOI: 10.3109/0142159X.2014.916788
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A. L. Weber & R. A. Swendiman
conversation, almost my first since my symptoms had begun to separate me from the realm of social discourse. Once more a teacher, I explained my unique experience. Simply by telling what only I could know, in my own words, I felt myself becoming once again an active participant in my own well-being. But why should this be so? Telling my story with its meaningful context provided a vital component in my recovery: a sense of control. Regaining a sense of competency in an environment of learned helplessness is critical to improving health, healing, and achievement (Langer & Rodin 1976; Langer 1989; Seligman 1991). Humans are ‘‘meaning-seeking’’ creatures. We need to understand the causes and implications of key life events, especially when such events are unexpected or unpleasant. We urgently ask, ‘‘Why?’’ and then formulate story-like accounts (Weiss 1975; Harvey et al. 1990). As a narrative psychologist, I know it is not the accuracy of one’s story that proves its worth; the value lies rather in the coherence and sensibility a story offers the story-‘‘teller’’. This ‘‘opening up’’ process is a powerful component in healing (Harvey et al. 1990; Pennebaker 1990). Eventually I was diagnosed with acute ischemic colitis. Even before I met Robert, my medical condition had started to improve. But after our brief, powerful exchange, I myself began to heal. Once invited to tell my story, I heard myself making sense of a frightening, alienating experience, more competent now to undertake the challenging journey toward wellness. At the conclusion of Ephron’s (1983) novel Heartburn, the narrator responds to her therapist’s question, ‘‘Why do you feel you have to turn everything into a story?’’: Because if I tell the story, I control the version . . . Because if I tell the story, it doesn’t hurt as much. Because if I tell the story, I can get on with it. (pp. 174–175)
The Student I myself got on with it. Over the next several months, I rotated on a number of different services across the state. I saw many other patients and did not think of Ann, until one day I returned home to find, amongst the bills and shopping magazines stuffed in the mailbox, a note: Hi there, Yes, I have actually thought of you frequently during the medical Disneyland of tests since my hospital stay in June. Not sure if you would remember me, but you made a great impression on me. I felt less like a patient and more like a partner in the process of healing. I really appreciated your simply sitting down opposite me (instead of standing over me, which can
1006
be so intimidating for a person stuck in bed!), and memorably saying, ‘‘Talk to me’’. It was such a relief to feel once again like a person, not a case. I’m grateful I was ‘‘yours’’. I wish you the best in your professional life to come! Sincerely, Ann I was moved by her words. I always try to sit and listen, but I thought of all the patients with whom I was rushed and cursory. Rounding in the morning simply to get the information I needed. How had they been feeling? How often had I stood over them, waiting for responses, hearing rather than listening? I messaged Ann to thank her for the opportunity to be part of her care. When she told me that she was still going through tests, still ruling out diagnoses, I offered that we continue the healing process together. I asked that she tell her story, one more time. We both are inveterate students, telling and listening to learn whatever we can of healing.
Notes on contributors ANN L. WEBER, Ph.D., is professor of psychology (retired), University of North Carolina at Asheville. She completed her B.A. at the Catholic University of America and her M.A. and Ph.D. at the Johns Hopkins University. ROBERT A. SWENDIMAN, BA, MD/MPP Candidate, is a fourth-year medical student at the University of North Carolina School of Medicine, Chapel Hill, NC, and Dubin Fellow for Emerging Leaders at the Harvard Kennedy School of Government, Cambridge, MA. He is an incoming general surgery resident at the Hospital of the University of Pennsylvania, Philadelphia, PA.
Declaration of interest: The above authors listed are qualified for authorship. To our knowledge, there are no conflicts of interest, financial or otherwise, concerning this submission.
References Ephron N. 1983. Heartburn. New York: Alfred A. Knopf. Groopman J. 2007. How doctors think. Boston: Houghton Mifflin. Harvey JH, Weber AL, Orbuch TL. 1990. Interpersonal accounts: A social-psychological perspective. Oxford: Blackwell. Langer EJ. 1989. Mindfulness. Boston: Addison-Wesley. Langer EJ, Rodin J. 1976. The effects of choice and enhanced personal responsibility for the aged: A field experiment in an institutional setting. J Pers Soc Psychol 34:191–198. Pennebaker JW. 1990. Opening up: The healing power of confiding in others. New York: Avon Books. Seligman MFP. 1991. Learned optimism. New York: Knopf. Weiss RA. 1975. Marital separation. New York: Basic Books.
Copyright of Medical Teacher is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
