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NARRATIVE MEDICINE APPROACH One of the key protocols of narrative medicine training involves learning to listen—and read—closely, in preparation for learning to read between the lines of a patient's narrative. This narrative goes far beyond what is revealed by the case notes, and it bridges several gaps also left by the biopsychosocial approach, which too often boils down to attempts to educate and "correct" the patient, however gently, but does not always leave room to explore aspects of their own story that might reveal the solution. Although what follows is not a substitute for training in narrative medicine, it is enough of a sample to provide a sense of how differently it can work to the other approaches. Close Reading Exercise As you read the following patient narrative, start by highlighting or underlining anything that stands out to you in general, and make a note of your observations. Then, come back to the following points and attempt to answer them. These are the elements you should look for in close reading. 1 Observation. What sensory elements are present in the narrative? What do you or the narrator see, hear, smell, touch, or feel? Perspective. Whose perspective is the story told from? Is there more than one? Are some perspectives suggested, rather than stated? How are they communicated? Form. What is the type (genre) of writing? Is it a story, a poem, a dark comedy? What imagery or symbols are used? Is the story told in chronological order, is it chaotic, does it point to other stories? What is the tone? Is it relaxed, friendly, formal? Voice. Whose voice is narrating? Is it in the first person, second person, or third person? Is the narrator close to you or distant? Are they self-aware? In other words, do they seem aware of the implications of their narrative? Mood. What is the mood of the narrative (sad, neutral, amused, hurting, calm)? What mood does it leave you in after reading it? Motion. How does the story move? Does something change between the beginning and end? Does it take you on a journey? Does it move in circles, or does it communicate a feeling of being stuck? As you read on, take a few moments to note your responses to the points above. Take your time to work with the story, to observe the word choices, and to think about this patient as a whole person. Patient Narrative Last winter, I spent several months in excruciating pain. First my back went, and I spent two months in bed. Then, I could barely use my hands. It drove me crazy. The winter was so cold I had to keep carrying in the wood wearing a belt for my back, but my hands would ache day and night. At one point, I couldn't type. My fingers kept going blue as soon as the temperature fell. N. said I should wear gloves in my office, but I thought that was ridiculous. Every morning I thought it might be a little better, but my hands have become monsters. They have a mind of their own. I looked at the symptoms, and I'm starting to think this has to be rheumatoid arthritis. I'm the right age, and after everything that happened in the last couple of years, maybe my body decided to take revenge on me. Dr. G. gave me the name of a rheumatologist. He was very nice, thought this was probably lupus, and sent me for a battery of tests. I spent a week convinced I knew what I was going to die of. I felt strangely relieved. After so much death, it was like a new friend had moved in. I knew what would take me. But I was 42 m a s s a g e & b o d y wo r k s e p te m b e r/o c to b e r 2 0 2 1 One of the key protocols of narrative medicine training involves learning to listen—and read—closely, in preparation for learning to read between the lines of a patient's narrative. CHRISTINA WOCINTECHCHAT/UNSPL ASH.COM