When I entered a bright white room at the Madison VA Hospital this summer, I expected to spend roughly the following hour interviewing a veteran patient named John about his life. Before knocking on the door, I quickly double-checked a diagram of room assignments and the list of potential topics I had drafted, fidgeting with the pocket memo recorder in my hand. First, I would need to introduce myself, deliver a compelling spiel, and confirm that my interruption was a welcome one. Behind the crinkly fabric of a face mask, I tried to enunciate: “Hello. I’m with the My Life, My Story program. Is now a good time?” For the next ninety minutes, much to my surprise, I effectively did not speak again.
The My Life, My Story program (MLMS) is a narrative medicine project that started in 2013 at, ironically, this very same hospital in Madison, WI, though affiliate programs now exist across the country in all manner of healthcare environments. In each session, a writer interviews a veteran then drafts a 1000-word life history that, with permission, gets added to the veteran’s medical record so providers can engage meaningfully with their background. Having read a number of these stories now, I recognize that these write-ups usher forth more than just a medical chronology; they gently reveal patients’ values, senses of community, regrets, ambitions, fears, passions, and hopes for their futures.
John was the first veteran I met at the VA Hospital after receiving my security clearance for MLMS a few weeks prior. I should note that the program’s hired and volunteer writers don’t necessarily know in advance which patients they’ll interact with in any given session; rather, we poke our heads into in-patient rooms to see who might be awake, alert, interested in chatting, not contagious, not critical, and available for a solid chunk of time. I was anxious about conducting an interview with a stranger and tried to establish some parameters for my behavior and motivations before this first interview: How would I determine what content makes it into the story and what gets cut? What would I do to ensure my writing responsibly and ethically conveyed a patient voice? How would I inquire thoughtfully about military service and medical experiences that were perhaps traumatic? What would I do if someone else was in the room during the conversation and I needed to either request privacy or get their assistance with advocacy? Should I continue the interview if the patient was clearly emotional or in physical pain?
Luckily for me, John was a natural talker. After I spent a few clunky initial minutes reassuring him that I genuinely wanted to hear his story and that I would find his tales worthwhile, he gathered up the reins and never let go. With my list of fallback questions delightfully neglected, I scribbled furious notes and appropriately “mhmed” and gasped my way through our time together. He covered everything: his time stationed in the military, his terror over the possibility of fighting in Vietnam, complicated family dynamics, several major surgeries, a profound love of hard work, his beloved possessions and pastimes, and the grim waiting he was doing right then to confirm a diagnosis. Capturing enough contextual and emotional detail to fill my notebook, John delivered the entire story as he saw it, laying the groundwork for the mini memoir I would produce that would then circle back for his approval before its integration into his medical chart. While I had gone into the volunteer session imagining I’d need to play a major facilitation role, my involvement in our dialogue was more like that of a quiet potter, the shaper of a vessel made from already pliable, lovingly warmed clay.
According to Thor Ringler, the manager of the Madison-based MLMS team, “Clinicians can get access to a lot of medical data through a patient’s electronic medical record, but there’s nowhere to learn about a patient’s personality” (Sable-Smith). Additionally, providers (and especially residents on short rotation stints) have very little time to absorb information not readily available in charts. The life history element, then, affords an opportunity for patients to feel deeply heard, for medical staff to feel more informed about their patients, and, as plentiful research demonstrates, for health outcomes to improve significantly as a result of mutual investment in these cases beyond their medical dimensions.
Veterans in particular stand to benefit from this supplemental narrative approach to their care. As one study indicates, “veterans may exhibit service-related symptoms that will go undiagnosed (and untreated) without clinician knowledge of past military experience. Understanding a patient’s military background will facilitate the delivery of cross-cultural, patient-centered care” (Sabino, Johnson, and Geiger). In other words, storytelling practices at the VA Hospital can invite the disclosure of health concerns and distinct social needs unique to veteran experiences that might otherwise remain unnoticed and persist. Additionally, scholar Kalí Tal’s work discusses how trauma affects the development of stories, suggesting that “the device of flashback demonstrate[s] the connection between the healing process and the process of recovering and integrating the past and the present” (Tal). In that so many literary interpretations of the Vietnam War and other traumatic conflicts reduce the crisis to metaphor, Tal argues that testimony functions as an important recuperative technique for witnessing how trauma changes narrative. Here, I might add that testimony can extend beyond published literature to prove useful as a reparative genre on the level of an individual medical case.
As I was preparing the 1000-word life story I sent to John for his review, I recognized in our recorded interactions an alignment with Arthur Frank’s work on the humanities as literal therapeutic practice. Frank says that the job of a narrative humanist is to behave partly as a caring, insightful friend, and partly as a professional, to “enhance” and “energize” a life through its storying by restaging and appreciating it anew (Frank 22-23). Because “ill people’s stories are, at first, attempts to sort out what is at stake,” we must view each written narrative as an instance of a patient holding their own in the face of suffering (24).
But, with MLMS, that monumental effort to sustain identity through illness (immediate or past, acute or chronic, traumatic or not) isn’t undertaken alone. And if, after generating the story, “the self moves on, assuming an identity more or less continuous with the previous one, but changed,” as Frank writes, then as a collaborative process in which multiple lives are conjoined through shared engagement with narrative production, the My Life, My Story program aids in communal self-fashioning and community-fashioning. I likely will never get to see John again, and I certainly hope his journey involves less time in Madison’s VA Hospital and more time doing what he loves. But through the clarifying and moving story we shepherded into being together, we – patient, humanist, and clinician – all got to grapple therapeutically with what is dispensable and with what requires telling.
* Identifying information about the veteran represented in this narrative has been both abstracted and partially constructed from composite MLMS interviews in order to protect patient privacy.
Image Credit:
https://www.va.gov/minneapolis-health-care/stories/my-life-my-story-by-gene
Works Cited:
Frank, Arthur. “Chapter 1: Being a Good Story: The Humanities as Therapeutic Practice.” Health Humanities Reader, Rutgers University Press, 2014.
Sable-Smith, Bram. “Storytelling Helps Hospital Staff Discover The Person Within The Patient.” Health News from NPR, June 2019.
Sabino, Judith, Eric Johnson, and James F. Geiger. “A Cross-Cultural Health Care Approach to Improve Veteran Health Services in an Academic Community Hospital.” Lehigh Valley Health Network, October 2013. Poster presented at The American Public Health Association’s 141st Annual Meeting and Exposition, Boston.
Tal, Kalí. Worlds of Hurt: Reading the Literatures of Trauma. Cambridge University Press, 1996.