In her best-selling book, "Kitchen Table Wisdom: Stories that Heal," pediatrician Rachel Remen draws her material from 20 years of working with cancer patients, her own personal struggles with a chronic disease and the wisdom of her grandfather, a rabbi who shared spiritual lessons with her at the kitchen table during her childhood. Dr. Remen emphasizes the healing power of storytelling in her work as medical director of the Commonweal Cancer Help Program. She also shares these insights with the medical students she teaches at the University of California at San Francisco.
This year I have been fortunate to participate as a small group leader in the PRACTICE course for first-year medical students, a new addition to the University curriculum. The course emphasizes many of the psycho-social aspects of medicine so eloquently illustrated in Dr. Remen's book, and it is quite a departure from the technological disease-centered medicine I was taught in the '70s. It is in some ways a step back in time to the days of Sir William Osler who observed "It's more important to know what sort of a person this disease has, than what sort of a disease this person has."
The most innovative model for this form of patient-centered care was the Planetree Hospital in San Francisco. The standard sterile environment is transformed into a patient-friendly atmosphere through architectural redesign and rethinking of the relationships between staff and patients. Patients can read their charts and can record their own version of their histories alongside the regular chart entries. This setting provides a unique opportunity for patients to begin to understand their own stories and to gain some perspective on the difference between curing and healing.
Dr. Remen observes that, "Technology has failed us in our search for wholeness." In contrast, the medicine of indigenous peoples has always emphasized the importance of storytelling to facilitate the integration of life experiences into the process of healing. Shamans practice the art of soul retrieval to restore parts of the soul that have been lost along life's journey. Modern psychotherapists may assist us in accomplishing a similar metaphysical goal through the release of past traumas.
These ideas have been popularized recently by James Redfield in the "The Celestine Prophecy." In the "Sixth Insight" he notes the importance of "clearing the past" to enable us to "engage the flow" of life in the "Seventh Insight." "Our whole lives are about finding the combined truth of our early family and then continually evolving this truth into higher and higher form until the telling of it becomes our mission. It becomes our way of uplifting the world."
"The Container"-my favorite story of Dr. Remen's-illustrates this insight quite well. She tells of an angry young man who lost a leg to osteosarcoma. "In our second meeting, hoping to encourage him to show his feelings about himself, I gave him a drawing pad and asked him to draw a picture of his body. He drew a crude sketch of a vase, just an outline. Running through the center of it he drew a deep crack. He went over and over the crack with a black crayon, gritting his teeth and ripping the paper."
After weeks of exploring the sources of his anger with Dr. Remen, he discovered he had an unsuspected gift for alleviating the suffering of others with similar afflictions by the sharing of his story. "In our final meeting, we were reviewing the way he had come, the sticking points and the turning points. I opened his chart and found the picture of the broken vase that he had drawn two years before. Taking a yellow crayon, he began to draw lines radiating from the crack in the vase to the very edges of the paper. Finally he put his finger on the crack, looked at me, and said softly, 'This is where the light comes through.'"
Dr. Remen closes the story with the observation that "Suffering is intimately connected to wholeness." Psychiatrist Viktor Frankl, the Holocaust concentration camp survivor who died the same week as two other notable voices of compassion-Princess Diana and Mother Teresa-once wrote that we can discover meaning in life "by the attitude we take toward unavoidable suffering." In his book, "Human Energy," scientist and priest Pierre Teilhard de Chardin concludes that "the sick man must realize that in proportion to his sickness he has a special function to perform, in which no one can replace him: the task of cooperating in the transformation of human suffering."
Dr. Larry Burk is an associate professor in the Department of Radiology.