Oncology narrative, so can help physicians

ONE thing is the narration of the disease, and the other is the work that can be done about this narration through the tools of literature. With the objective to get “the diagnosis and more appropriate therapies the most shared and, above all, to take really care of those who suffer”. A difference which is well known to those engaged in narrative medicine, as well as the name of Rita Charon, considered as the founder of this discipline, that on 13 February he was at the House of Culture in Milan for the presentation of the first Italian translation of his essay “narrative Medicine - Honoring the stories of the patients” (Raffaello Cortina Editions, 296 pp, 25 €).

Medical internist and a scholar of literature, Charon directs the Program in narrative Medicine at Columbia University in New York and his studies have been published on some of the major scientific journals, from the New England Journal of Medicine in The Lancet. His experiences, many of which are described in the book, demonstrate that this method is able to find solutions to problems that today are very common in the world of medicine, in a context in which health systems struggle to ensure that resources, particularly in terms of staff, in which, at times, are put above the concerns of corporate and bureaucratic to the needs of the people. And where there is much talk about multi-disciplinary teams, but they often lack the culture of sharing that would allow you to actually to the patient to be “at the centre”, as they recite the slogans.
Oncology narrative, a project for doctors and health care workers is an example of the project that Charon conducted within the team of the department of pediatric oncology at Columbia University Medical Center. “The more we go forward the more we realize how many problems this approach can help to solve”, said: “We have already discovered some years ago that can help doctors and healthcare professionals of areas and different skills to develop mutual trust. Sometimes - jokes - even being cute. Why is this approach within teams has the immediate effect to cancel the hierarchies.”

As also described in the eleventh chapter of the book, Charon brought together the operators of the department, from oncologists to surgeons, from nurses to social workers: for two months, once a week, all to talk about poetry. “We've got to do something that none of them was good: they read poetry, discussed their meaning, trying to write. It was the first time they spoke of something that concerned their work. Incredibly, they had worked together for more than ten years and discovered only at that time that one of them had lost a son because of cancer”.

The research group, Charon was tested both at the beginning and at the end of the experiment, the ability of the group to interact as a team: “at The end of the two months - he explains - we have observed how it had become much easier for each one to legitimize the points of view of others, and above all, to speak of what was causing the most discomfort on the job. This is the real point: to address the “disenchantment” that often experience our health workers, that has very special characteristics”.

it is Not only the fact of being often in front of people who are very sick that can't be saved, " explains Charon: “But, you know what would be the right thing to do and not be in conditions to be able to do, because maybe the system does not allow it. It is a concept borrowed from the military world: it is not fatigue, it is not sadness, but you see betrayed their vocation. Feel that we are not doing good. It is a wound to the moral. What is it, then? You should take a 'supply' of our sense of to be good and to do this we need someone who is in the same condition. For this time we put together operators and we do the same kind of work: we allow them to share this wound. That does not mean to complain or vent, but to reform the self and, at the same time, join forces to oppose with the system that is causing this wound. Our doctors have not only need of a holiday, but for personal growth and justice”.
How it all began All of the work, Charon is started by a seminar in English Literature followed while working in the department of Primary Care: it was a lightning strike that led her to pursue a master's degree, driven by its own teachers. “They knew even before me that the study of literature would make me a better doctor, because they knew the power of the representation language of the human life. It was true: back from my patients, I realized that I was just listening in a different way. Of course I knew from the first the right questions to do as a doctor, but sometimes it seemed to me to have a second brain, because I could listen not only to what referred of the symptoms, but also like they were telling, the words chosen, the metaphors, what are the spatial and the temporal dimensions. I was just listening as same as reading a novel. And I have developed a new approach: at the first visit, I always say that I'll be their doctor and that for this I need to know everything you think I should know. And their tell the story”. It seems little, but this declaration of willingness to listen to completely change the doctor-patient relationship. “All of us are, we were or will be patients. And then we all know inwardly in the cleavage that sometimes exists between the body seen as an object and our inner experience as patients. You have to start from here”.

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