Odd ducks

Jacques de Vaucanson’s Digesting Duck, 1739

A doctor told us a story of a patient he’d almost failed.

I suppose there are three basic stories in medicine, from the doctor’s perspective, at least:

1. We did all the right things and the patient did well;
2. We made some mistakes which put the patient at risk and the patient did not do well;
3. We made some mistakes but we corrected ourselves and the patient did well in the end.

Of course, 1 is too boring, 2 is too hard to admit, and so 3 is the only one with the drama and redemption to warrant narration. This was a good example, though: the doctors (working in the Emergency Room) were distracted by this patient’s profile and by the way he told his story, so that they almost missed the critical piece of the picture. But a detail in the patient’s story niggled away and eventually led to them calling for the right procedure which turned out well for everyone in the end.

The doctor telling the story, Rishi Goyal, is an ER physician but also happens to teach literature at Columbia University in New York, whose Narrative Medicine Program was one of the two organisations behind the conference I’ve been at this week. Goyal’s analysis of his own story suggested that more important than identifying with his patient (which he failed to do perhaps because of their disparate profiles) was finding a point of interest in his story, upon which the doctor could hang the care and attention required to do a good job. It made me think about what details I need to include in my stories to provide readers with a point of interest to care and attend to each character.

This was all part of what might be my favourite session in the conference: Kazuo Ishiguro, blues music and Shakespearean tragedy were lined up to help investigate emotions in literature and medicine. It was most enjoyable.

The last breakout session for me was also good although a bit more staid, not having any blues music played or lines from King Lear performed. But the speakers addressed currently relevant topics such as ‘mystery’ illnesses (I am trying to write a feature about Alzheimer’s disease as if it were the crime at the heart of a good detective story) and metaphors in descriptions of illness (eg Susan Sontag was against the use of metaphors in illness narratives because they too often collapsed a moral burden onto the patient’s shoulders).

Summation

Having reached the end of the conference, it would be nice to attempt a definition of narrative medicine, but I’m not sure that I can, really.

What lies within

or, The body as the antithesis of narrative

I dislike it when people refer to science writing as a form of translation because it suggests to me that these people think you can just interpret each bit of scientific jargon into an understandable phrase, string them all together and get a readable output. But this may be doing them a disservice if they are, in fact, considering a notion of translation I learned about at the Narrative Medicine conference today, called Skopos theory.

In this, the translator takes into account the purpose of the original text as well as the literal meaning of the text. For science writing, there may not be an original text to translate, but the purpose is to communicate certain concepts and facts. With this in mind, the finished article could be considered a translation of some kind of (perhaps hidden) scientific text. This is closer to my view that what I do is communicate scientific concepts using a different set of constraints to those of a scientist, for a different audience.

Opportunities to reflect on my writing, both professional (sciencey) and non (fictiony, formerly theatry), constitute a truly exciting benefit of attending this conference. The highlight today was perhaps Peter Carey’s talk. He described for us the moment during the long genesis of Oscar and Lucinda when “I knew I had a novel”. This was before the characters were conceived: in order to find them, he had to ask, “Who would really do that, and with what consequences, and with what meaning?”

Some other quotes (direct and indirect) from his talk that I liked:

How does the ‘talking cure’ work for someone who can’t talk?

David Small was a kid in need of psychoanalysis. His mother and grandmother raised him – if that is the right phrase – in a household where he was not allowed to have an opinion. A naturally outgoing and expressive child, all that creativity was stamped on. Then, in his mid-teens, he had an operation to remove a lump on his neck. The lump was a tumour that had grown down around his larynx but no one told young David this – when he woke up after the op and found he couldn’t say more than three or four words without getting a sore throat, he thought his mom had got her wish and managed to shut him up for good.

I was listening to David, who is now in his 60s, at a conference about narratives in medicine and healthcare, which started today at King’s College London’s campus at Guy’s Hospital. If the first half-day is anything to go by, the next two days are going to be fantastic. David is not a medical practitioner – he is an artist and he has drawn/written a book about his childhood. It is called Stitches, and I think it is probably amazing. Luckily for him, he found a psychoanalyst who was able to recognise his own upbringing in David’s story and empathise to the point of telling David (who was unable to speak for another 10 years) how he felt, and David was able to agree. David describes his analyst as the “perfect parent”. It was an incredible story in many ways, but I took away a couple of things in particular.

First, from my own experience of counselling (not psychoanalysis, which I would be really interested in trying if it weren’t such an expensive and rare commodity), the construction – or reconstruction – of stories about oneself seems to be at the heart of the process of finding resolution. Perhaps artists and story-tellers are at an advantage here, although I generally got distracted by the arbitrariness of re-telling your story in a positive light when you could just as easily cast it in a negative light – ie the positive tale had no particular authority, which made it rather an empty exercise for me. But what David has done with his book, it seems, is convert what is still a negative experience into something that he can be proud of: I mean, the book is a wonderful achievement which nevertheless incorporates his miserable childhood. It doesn’t rewrite that story as a happy one, but it also doesn’t leave it as a festering sore disconnected with anything positive. He describes the process of making this book as a kind of auto-psychoanalysis, where he was able to stay still, observe himself as he revived these memories, and listen to the crap he was talking from some sort of distance.

The other thing I really enjoyed in David’s talk was his agent’s advice when he was struggling to make progress with the book. Apparently, she told him the only advice she had was what they tell boxers: “Keep your head down and your hands moving.” Perfect advice for a writer, I’d say.