Commentary by:
Pascale de Kerckhove, MSW, RSW, Social Worker, BC Women’s Hospital, PHSA, and Palliative Care Social Worker – Medical Assistance in Dying, Vancouver Coastal Health Pascale de Kerckhove has worked as a Social Worker in the NICU at BC Women’s Hospital, at BC Cancer in Patient & Family Counselling Services, and more recently in adult palliative care, and Medical Assistance in Dying (MAiD).
Feature Article
Lanocha, N. (2021). Lessons in Stories: Why Narrative Medicine Has a Role in Pediatric Palliative Care Training. Children (Basel), 8(5).
Commentary
I selected this article as it reinforces how Dr. Rita Charon’s ground breaking work in the field of narrative medicine continues to influence medicine and medical education. In this article, Dr. Natalie Lanocha, a palliative care pediatrician, discusses the tools of narrative medicine and the impact that they have on the sustainability of her own practice.1 At its core, narrative medicine seeks to counter clinician burnout and compassion fatigue, while promoting resilience and empathy. This is achieved through thoughtful and respectful attention to patient stories.
After experiencing an emotionally painful response to a tragic situation in the PICU, Lanocha asks the question: “I wondered, how do I return to clinical duties and work as an effective pediatrician?”1 I had also asked myself this question early in my career as a social worker in a level 4 NICU as I grew more aware that witnessing tragedy, sorrow, and loss on a daily basis could interfere with my ability to provide effective and therapeutic social work services. As Lanocha states, pediatric palliative care providers “are uniquely exposed to repeated instances of children suffering from serious illness and loved ones navigating tragedy.”1 In 2012, one of my mentors introduced me to Dr. Charon’s work and the tenets of narrative medicine, and like Lanocha, this discovery was personally transformative.1
Narrative medicine enables health care providers to process and navigate the emotionally charged encounters inherent to pediatric palliative care. By reading, writing, telling and receiving stories, Lanocha states that even “in our darkest moments,”1 the tools of narrative medicine can enhance and sustain sound clinical practice. According to Charon, narrative medicine “requires the ability to recognize, absorb, interpret, be moved by, and act on the stories of illness”2.
When I met Dr. Charon in Vancouver in 2016, I was as excited as a teenager meeting her favourite rock star. I had already read her seminal book: ‘Honoring the Stories of Illness’2 and I had begun using some narrative medicine tools. During Dr. Charon’s one day workshop for health care providers, we listened to music, viewed images of art, read poems and excerpts of books – a full one day immersion in the humanities, with every ‘exposure’ carefully selected by Dr. Charon for the connections to medicine and illness. The main activity of the workshop, however, was writing. None of us attending the workshop professed to be prolific or talented writers, but we all understood over the course of the day that we were being exposed to the key of narrative medicine: writing emanating from personal observation, introspection, and self-reflection.
The narrative medicine tool which resonates most for me, is the parallel chart. Developed early on by Dr. Charon as she conceptualized and operationalized narrative medicine, the parallel chart is everything a heath care provider cannot write in the patient’s chart; it is the representation of what the healthcare provider feels as it pertains to a patient and their situation. Neither a journal entry nor a summary of a clinical encounter, the parallel chart is a space where clinicians can gather their impressions in plain language. It is in stark juxtaposition to the clinical medical chart: technical and quantitative. In the first four paragraphs of her article, Lanocha presents a parallel chart.1 One notices the expressive, evocative, and even poetic language and words which would never appear in a medical chart: ragdoll, porcelain, stormy, floppy, crushingly, wracking, crippled. Some words describe Baby G, others describe the author.
For several years, I hosted a parallel chart group for pediatric hospital social workers. Taking turns, we read aloud our own parallel charts which were focused on one patient/family. We then explored themes, language, subtexts, and narrative techniques. Therapeutic, revealing, and powerful, these sessions were emotionally draining, yet restorative.
Dr. Charon describes clinical encounters with patients and families as a “tremendous cauldron of experience” for clinicians.2 As Lanocha emphasizes, these moving and charged experiences need to be expressed, and narrative medicine offers a variety of tools and techniques to humanize patient stories and sustain self-care practice.1
Lanocha believes that narrative medicine has its rightful and important place in palliative care training.1 Now, more than ever, we as health care providers must find ways to process our clinical experiences while protecting ourselves from compassion fatigue, burnout, and feelings of helplessness. Weaving narrative medicine in my social work practice has helped me keep these negative practice outcomes at bay, and has allowed me to gain a more fulsome insight into the importance of patient stories.
Other articles recommended
1. Featured Article
2. Charon, R. (2006). Narrative Medicine: Honoring the Stories of Illness. Oxford University Press.