Narrative medicine proposes a multifaceted use of narratives to bring insight and awareness into the experience of patients, caregivers, and healthcare providers. However, deciding on whether to use fictional or non-fictional narratives usually rests on unexamined assumptions about which form is trusted to have an impact on its readers or viewers. This chapter aims to contribute to an appreciation of how narrative fiction and memoir can respectively represent experiences of illness and suffering and how readers engage with them. To that effect, the author draws on Lucy Caldwell's short story “Multitudes” (2016) and Colm Tóibín's novel Nora Webster (2014), both admittedly informed by autobiographical experience, to consider the insights that they provide and the questions they raise on the power and limitations of fiction and memoir, namely whether there are limits to the testimonial power of memoir; whether fiction can prove enabling to articulate otherwise inarticulate experience; and whether the differences in the writing of memoir and fiction are replicated in how we read each form.
“To know my own story, I need to encounter stories that are not mine.” – Arthur W. Frank, King Lear: Shakespeare’s Dark Consolations.
“With greater or less ability we fabricate fictions not so that the false will seem true but to tell the most unspeakable truth with absolute faithfulness through the fiction.” – Elena Ferrante, In the Margins: On the Pleasures of Reading and Writing.
TopNarrative, Healthcare, And Vulnerability
In the middle line of the middle stanza of her poem “Kindness”, Naomi Shihab Nye reminds us that, “You must see how this could be you”. This is “the Indian in a white poncho / [who] lies dead by the side of the road”, this is “how he too was someone / who journeyed through the night with plans / and the simple breath that kept him alive”. This is about acknowledging not only our differences, but also our fundamental similarities: the breath that keeps us alive, the plans that keep us going, and the fact that one day we, too, embodied creatures that we are, will lie dead.
Facing illness, death, and suffering is challenging, whether we are a patient, a healthcare professional or an informal caregiver. Most of us will find ourselves in at least two of these roles in the course of our lives, those of patients and/or informal caregivers. However, some will spend most of their lives in the role of healthcare professionals. They will devote a significant part of their youth and young adulthood training to become good healthcare providers, acquiring biomedical knowledge, learning procedures, and emulating their role models. In the process, some may unwittingly develop a misguided sense of immunity, as if their white coats might protect them from the hazards of illness, as shown by studies of doctors who become patients (Klitzman, 2008). This may alienate them both from their patients and from themselves, from their experience in the face of others’ suffering, their need to make decisions in the face of uncertainty, and the existential vulnerability that they share with their patients. They may thus learn, despite themselves, to separate the professional from the personal and likewise reduce the ill person to the role of patient (Casal, 2014). And yet, as Arthur W. Frank (2022) cautions us, “The first vulnerability is believing in your own invulnerability” (p. 15).
The introduction of Health Humanities into the training of healthcare professionals originates from the awareness of how unhealthy such a state of affairs is to everyone involved and how important it is better to understand the complex predicament of professionals, patients, and informal caregivers, as well as the intersubjective nature of their relations. As argued by philosopher Nicole Piemonte (2018), the humanities in healthcare education aim to “teach by indirection with artistic representation [which] can open students up to new horizons of understanding, revealing to them what it might be like to live with a serious illness or injury” (p. 142). Critically, she notes, “teaching by indirection” remains humbly aware of the approximate nature of the understanding we may reach, for, “One can only ever approach the suffering of the other; one cannot experience the same suffering in the same way” (p. 80). This subjective engagement with the other’s predicament thus carries a correlate awareness of the self, of one’s own experience as a healthcare student or professional. This self-awareness is all the more urgent in a professional culture conditioned to overlook “how emotions affect the practice of medicine”, as Danielle Ofri (2013) points out:
The emotional layers in medicine…can often be the dominant players in medical decision-making, handily overshadowing evidence-based medicine, clinical algorithms, quality-control measures, even medical experience. And this can occur without anyone’s conscious awareness. (p. 3)