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INTRODUCTION

A group of physicians, writers, and educators sits around a conference table in a busy medical school, eating hurried lunches, coordinating course materials for medical students, and reviewing with excitement or concern what just happened in their first-year medical interviewing courses. More people gather, and the room quiets. Today, the novelist on the faculty reminds them that they are reading “Aquarium,” a personal essay written by writer Aleksandar Hemon who has lost his baby daughter to brain cancer. The mood in the room shifts from light camaraderie to an attentive sense of purpose. “I had such a hard time reading this,” a seasoned family physician sighs. “It made me want to run home and pick up my baby,” offers the hospitalist.

As the conversation develops, the novelist draws the group’s attention to the essay’s title and its governing image, an important metaphor for his experience with illness and loss. “The whole thing is about an aquarium,” an internist and literary scholar offers. “You feel very much like an outsider reading this,” admits a pediatrician.

After some discussion, the novelist offers a writing prompt: Describe an aquarium that you yourself have been in. The group members take out pen and paper and, heads bowed, write intently for 4 minutes. When the time is up, many offer to read their work. Some read aloud descriptions of experiences with literal aquariums, marveling at the foreignness of aquatic life. A psychiatrist and a general internist each read aloud what they wrote about—times when they felt isolated in family or work and unable to truly communicate with those around them. Some wrote about feeling that, as doctors, they are inside an aquarium; others wrote about the experience of being on the outside. “The whole patient experience is like being in a fishbowl,” reflects a pediatrician, “and in the story, the doctors are in a fishbowl too.” The internist and literary scholar replies, “But this story is like instructions about how not to be marooned. It gives a glimpse into that fishbowl but also says and then you can write. It opens up a way to talk about and then use the imagination and the power of words.”

WHAT IS NARRATIVE MEDICINE?

This session is a typical example of the kind of work this group does every week. They are medical educators, the faculty of Foundations of Clinical Medicine (Columbia’s “doctoring” course) who employ the techniques of narrative medicine to sharpen their clinical skills, deepen their teaching, and reflect on their work. Narrative medicine developed out of the integration of medicine and literary studies to fortify clinical practice with the narrative competence to recognize, absorb, metabolize, interpret, and be moved by the stories of illness. Its unifying tenet is that the giving and receiving of accounts of self are the central events in health care—whether the account is given by a patient, family member, ...

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