0:00:17.794,0:00:19.436
Thanks very much.

0:00:21.166,0:00:23.854
So, here's a doctor from New York,

0:00:24.027,0:00:25.607
dressed in black,

0:00:25.607,0:00:28.865
talking to you on September 13th.

0:00:29.535,0:00:32.384
And you're going to think[br]I'm going to talk about death,

0:00:32.384,0:00:37.947
as did all New Yorkers[br]over the past many days and weeks.

0:00:37.947,0:00:39.487
Well, I am.

0:00:39.487,0:00:44.676
But I'm going to talk with you about that

0:00:44.676,0:00:48.986
in terms of joy and in terms of truth.

0:00:49.866,0:00:52.546
I need to tell you[br]a little bit about my medicine

0:00:52.546,0:00:54.896
in order to get to the joy.

0:00:55.666,0:01:01.106
Todd is right that I came to medicine,

0:01:02.196,0:01:05.107
not knowing a whole lot about it,

0:01:05.477,0:01:10.604
but I came to medicine[br]because I was a life-long reader.

0:01:10.604,0:01:13.557
I was the kind of kid who would get[br]10 books out of the library

0:01:13.557,0:01:15.806
and read them all before they were due,

0:01:15.806,0:01:18.937
and I hope many of you were like that too.

0:01:20.027,0:01:25.938
And as a reader, I understood,[br]once I opened my practice,

0:01:25.938,0:01:30.787
once I finished all the business[br]of staying up all night being an intern,

0:01:30.787,0:01:37.297
that what I did in the office,[br]what patients paid me to do,

0:01:37.297,0:01:42.027
was to pay exquisite attention[br]to the narratives that they gave me -

0:01:42.027,0:01:44.659
which were in words, in silences,

0:01:44.759,0:01:50.690
in those facial expressions[br]that we saw earlier today,

0:01:50.880,0:01:54.078
in their body, in how the body changed,

0:01:54.078,0:01:59.987
in the tracings and pictures[br]that we had of their body,

0:02:00.067,0:02:03.576
in what other people said about them -

0:02:04.136,0:02:08.318
and that it was my task[br]to cohere these stories

0:02:08.318,0:02:12.137
so that they, at least provisionally,

0:02:12.137,0:02:13.916
made some sense;

0:02:14.286,0:02:18.907
to take these multiple[br]contradictory narratives

0:02:18.907,0:02:25.058
and let them build something[br]that we could act on.

0:02:25.478,0:02:27.189
So that's what we did.

0:02:27.829,0:02:29.104
I realized right away

0:02:29.104,0:02:33.989
that I didn't know very much about stories[br]even though I was a voracious reader,

0:02:33.989,0:02:38.528
and I went kind of timidly[br]to the English department -

0:02:38.528,0:02:40.157
I was at Columbia already -

0:02:40.157,0:02:41.756
I went to the English department;

0:02:41.756,0:02:43.487
I said, "Could you teach a doctor

0:02:43.487,0:02:46.978
something about stories[br]and how they work?"

0:02:46.978,0:02:47.988
And God bless them,

0:02:47.988,0:02:51.229
the English department[br]was very happy to take me in.

0:02:52.419,0:02:56.308
You know, I wrote prescriptions for them;[br]

0:02:56.308,0:02:57.747
(Laughter)

0:02:57.747,0:02:59.417
I gave them referrals.

0:02:59.857,0:03:06.498
But I think they really joined me[br]in the idea that the knowledge they had,

0:03:06.498,0:03:10.569
very specialized narratological knowledge,

0:03:10.569,0:03:14.176
could do something good in the world.

0:03:15.056,0:03:19.316
They didn't let me out[br]until I had a master's degree, a PhD.

0:03:19.316,0:03:25.767
They let me write a dissertation[br]on Henry James, who is my beloved author.

0:03:26.807,0:03:33.035
And I want to tell you[br]how the story training -

0:03:33.035,0:03:37.316
awakening and nourishing[br]my own sense of story -

0:03:37.316,0:03:42.217
how it transformed[br]my teaching and my practice.

0:03:45.007,0:03:50.557
This was not the first time that anyone[br]had put literature with medicine.

0:03:50.557,0:03:52.756
By then - this was the '90s already -

0:03:52.756,0:03:57.316
by then, there were persons in -[br]I hope you know this -

0:03:57.316,0:04:01.777
in philosophy, in history,[br]in literary studies, in ethics

0:04:01.777,0:04:05.258
who had come into medicine,

0:04:05.258,0:04:09.228
and they were all helping us[br]to improve our practice

0:04:09.228,0:04:12.836
based on human learning

0:04:14.006,0:04:17.536
in addition to the scientific[br]knowledge we all had.

0:04:17.536,0:04:19.290
So, I was by no means the first one

0:04:19.290,0:04:22.977
to bring literary studies[br]into the practice of medicine.

0:04:22.977,0:04:25.729
But somehow, by starting as a doctor first

0:04:25.729,0:04:31.758
and then getting all this training[br]in stories and how to understand them,

0:04:31.758,0:04:33.478
I think I had a more -

0:04:34.518,0:04:39.757
my sleeves were more rolled up[br]in using this knowledge.

0:04:40.487,0:04:44.562
So my colleagues and I at Columbia

0:04:45.302,0:04:50.928
kind of invented, or created, a field[br]that we called "narrative medicine,"

0:04:50.928,0:04:54.876
which we define very simply[br]as clinical practice

0:04:54.876,0:04:59.357
fortified by the knowledge[br]of what to do with stories.

0:04:59.867,0:05:02.585
So that with these skills -

0:05:02.725,0:05:06.907
in first of all having a sense of story,

0:05:07.287,0:05:12.147
and then being able to recognize[br]when someone is telling you a story,

0:05:12.147,0:05:13.486
to absorb the story,

0:05:13.586,0:05:15.455
to receive it whole,

0:05:15.535,0:05:17.186
to receive all of it,

0:05:17.186,0:05:23.788
including even those unsaid[br]hints and guesses

0:05:23.788,0:05:26.755
about what might be left unsaid,

0:05:26.835,0:05:28.147
to absorb them,

0:05:28.287,0:05:29.551
to interpret them,

0:05:29.681,0:05:31.566
to honor them,

0:05:32.276,0:05:34.457
and then to be moved by them

0:05:34.457,0:05:37.275
and to be moved by them to action.

0:05:37.415,0:05:40.796
So this is what we called[br]narrative medicine.

0:05:43.736,0:05:49.267
We found very effective, economical ways

0:05:49.267,0:05:50.816
to teach

0:05:50.816,0:05:57.605
the skills of reading and writing[br]and storytelling and receiving

0:05:58.105,0:06:01.157
to medical students, nursing students,

0:06:01.567,0:06:06.004
doctors, social workers,[br]chaplains, patients, families -

0:06:06.644,0:06:10.517
all the people who come[br]in and out of hospitals.

0:06:11.007,0:06:14.937
I'm assuming that some of you[br]are from healthcare,

0:06:14.937,0:06:20.386
either as professionals[br]or as patients or as families.

0:06:20.386,0:06:26.166
You know the kinds of silences[br]there are in those elevators in hospitals.

0:06:26.166,0:06:30.853
You know what happens[br]when you pass someone in the hallway

0:06:30.853,0:06:35.206
who has no legs or who's bleeding.

0:06:35.206,0:06:37.057
You know that.

0:06:38.147,0:06:43.035
Our challenge was to bring[br]to these people,

0:06:43.035,0:06:46.315
perhaps used to illness,

0:06:46.315,0:06:49.601
perhaps hardened against it,

0:06:49.761,0:06:54.433
ways to open their own springs[br]of imagination,

0:06:54.553,0:06:55.785
of creativity,

0:06:55.925,0:06:57.956
of receptivity

0:06:58.246,0:07:03.616
so that they would not just[br]not lose their sense of story,

0:07:03.616,0:07:07.187
but, indeed, build it.

0:07:10.447,0:07:14.685
There were amazing[br]transformations in my practice.

0:07:15.395,0:07:20.323
I work in a rather shabby clinic[br]in Presbyterian Hospital,

0:07:20.323,0:07:25.923
which is in New York - in the way,[br]way upper parts of Manhattan -

0:07:26.723,0:07:33.274
and as I improved[br]my own capacity to read closely,

0:07:33.274,0:07:35.346
where every word counts,

0:07:35.346,0:07:39.676
I was able to learn how[br]to listen closely,

0:07:39.676,0:07:41.776
where every word counts,

0:07:42.406,0:07:47.287
So, in the office,[br]when I saw a new patient,

0:07:47.497,0:07:50.849
I wouldn't ask millions[br]of questions anymore,

0:07:50.849,0:07:56.107
like, no doubt, many of you[br]have been asked by doctors.

0:07:56.107,0:07:59.584
Typically what we do,[br]faced with a stranger,

0:07:59.584,0:08:03.287
is we kind of start at the top[br]and work down.

0:08:03.287,0:08:04.621
I'm sure you've had this:

0:08:04.621,0:08:05.766
Do you have headaches?

0:08:05.826,0:08:07.444
Do you have nosebleeds?

0:08:07.454,0:08:10.637
Do you have trouble with your hearing?[br]With your swallowing?

0:08:10.657,0:08:12.607
Do you have trouble with your breathing?

0:08:12.607,0:08:13.995
And all the way down.

0:08:13.995,0:08:15.976
And what operations have you had?

0:08:16.036,0:08:17.515
And what allergies do you have?

0:08:17.545,0:08:19.586
And what medicines are you on?

0:08:19.586,0:08:21.816
So I learned not to do that,

0:08:21.816,0:08:23.807
and instead to say,

0:08:24.287,0:08:26.096
"I will be your doctor,

0:08:26.096,0:08:28.406
and so I need to know a great deal

0:08:28.406,0:08:32.395
about your body[br]and your health and your life.

0:08:32.545,0:08:36.954
Please tell me what you think[br]I should know about your situation."

0:08:37.854,0:08:39.648
And when I did that,

0:08:39.648,0:08:43.075
and when I let persons simply answer,

0:08:43.075,0:08:48.825
instead of writing things down[br]or typing or computing,

0:08:48.825,0:08:51.240
I would simply sit in my chair,

0:08:52.110,0:08:53.655
hands in my lap,

0:08:53.655,0:08:56.886
and absorb what was being said.

0:08:57.306,0:08:59.693
And what I learned,[br]right from the beginning,

0:08:59.693,0:09:06.036
is that persons were not only able[br]but deeply thirsty

0:09:06.216,0:09:10.360
to give profound, detailed,

0:09:10.360,0:09:13.764
eloquent accounts of themselves.

0:09:14.334,0:09:16.817
They didn't always know how[br]or how to start.

0:09:16.817,0:09:20.034
One woman says, "You want me to talk?"

0:09:20.034,0:09:21.936
(Laughter)

0:09:23.966,0:09:29.527
Another man, one of the first[br]to whom I made this invitation,

0:09:30.417,0:09:33.396
started to tell me[br]about the death of his father

0:09:33.516,0:09:35.653
and then the death of his brother

0:09:36.193,0:09:39.866
and then the trouble he was having[br]with his teenage son.

0:09:40.416,0:09:42.437
And then he starts to cry.

0:09:43.347,0:09:46.476
I broke my silence:[br]I said, "Why do you weep?"

0:09:46.796,0:09:51.497
He says, "No one[br]ever let me do this before."

0:09:55.257,0:10:01.017
So a woman I saw - I just saw her[br]a few days ago when I made a house call.

0:10:01.367,0:10:04.048
Well, she's been my patient[br]for a long time.

0:10:04.248,0:10:05.256
She -

0:10:05.256,0:10:08.025
as anyone I speak about[br]or [write] about,

0:10:08.025,0:10:09.615
knows what I'm to say,

0:10:09.615,0:10:11.156
has read what I've written

0:10:11.156,0:10:15.178
and has given, as we say,[br]informed consent for me to do so.

0:10:15.178,0:10:17.625
So I'm not breaking any secrets.

0:10:17.625,0:10:23.745
I certainly won't use the name,[br]but she has - we have her blessings.

0:10:25.105,0:10:27.874
She had breast cancer 20 years ago.

0:10:27.874,0:10:29.946
She had a mastectomy -

0:10:29.946,0:10:32.847
sorry, she had a lumpectomy,[br]small operation.

0:10:32.847,0:10:36.987
She was on medicine for five years;[br]she was told she was cured.

0:10:37.807,0:10:43.307
About a year ago, she developed[br]a lump in that same breast.

0:10:43.307,0:10:46.106
On biopsy, it was a new cancer.

0:10:46.636,0:10:49.425
She was stoic about the recurrence.

0:10:49.425,0:10:51.835
She underwent a mastectomy this time.

0:10:51.835,0:10:55.746
It's a big operation;[br]it was a disfiguring operation.

0:10:55.746,0:10:58.595
She declined breast reconstruction.

0:10:58.595,0:11:00.984
She said she was too old for that.

0:11:02.054,0:11:06.696
And she recovered uneventfully[br]from the surgery.

0:11:07.126,0:11:12.157
But then she began to worry[br]that the cancer would come back.

0:11:12.887,0:11:15.286
She was in my office every other week.

0:11:15.286,0:11:18.765
On the off-week, she was[br]in the office of the breast surgeon.

0:11:18.765,0:11:19.836
She felt a new lump;

0:11:19.836,0:11:21.836
she felt something funny under her arm;

0:11:21.836,0:11:24.386
there was something[br]not right about the scar.

0:11:24.386,0:11:27.043
She was terrified that it would come back.

0:11:27.353,0:11:28.867
We kept reassuring her:

0:11:28.867,0:11:31.506
"No, that's just how the tissues heal";

0:11:31.506,0:11:35.496
"No, that's your cancer markers."

0:11:35.496,0:11:39.017
We did blood tests[br]to make sure there was no cancer.

0:11:39.017,0:11:43.064
I did an ultrasound of the scar.

0:11:43.904,0:11:46.315
She could not be reassured,

0:11:46.315,0:11:49.593
and so she thought[br]that we were deceiving her.

0:11:50.783,0:11:54.005
Finally, after another one of these exams,

0:11:54.385,0:11:56.925
breast examinations in the office,

0:11:56.925,0:12:01.606
I thought I could imagine[br]what was deep to the scar.

0:12:02.346,0:12:05.506
I leaned back[br]against the sink in my office.

0:12:05.966,0:12:09.437
I told her I thought[br]I understood what the fear was.

0:12:09.697,0:12:15.345
I told her I thought what she feared[br]was that she would die,

0:12:16.445,0:12:21.687
that she had the courage and the vision[br]from these two illnesses

0:12:21.687,0:12:26.026
to know what many of us know[br]but refuse to really face up to:

0:12:26.026,0:12:28.666
that is simply we will die.

0:12:29.106,0:12:34.084
I told her that I thought[br]she was in the glare of this knowledge.

0:12:35.244,0:12:39.696
I said, "We don't know[br]what will end your life.

0:12:39.696,0:12:44.075
Your body may well harbor now[br]the disease that will do so.

0:12:44.075,0:12:45.695
It might be the breast cancer.

0:12:45.695,0:12:47.666
It might be something else.

0:12:47.936,0:12:51.025
But we know something[br]will take your life."

0:12:51.985,0:12:58.535
I said I couldn't do more than we had[br]to assure her of her health,

0:12:58.535,0:13:01.086
but here is something I could do:

0:13:01.246,0:13:06.326
I could stand with her[br]in the glare of that fear.

0:13:07.986,0:13:12.363
And right after that conversation,[br]I checked back with her by phone.

0:13:12.363,0:13:13.994
She said she felt much better.

0:13:14.054,0:13:15.705
She felt much more relaxed.

0:13:15.915,0:13:19.697
She wasn't worried the way she had been,

0:13:19.697,0:13:22.565
and she was sure that I was right.

0:13:23.345,0:13:25.160
Now, the way I knew that,

0:13:25.220,0:13:29.928
the way I came to understand it[br]is that I'd been writing about her,

0:13:29.987,0:13:33.095
and I'd been showing her[br]what I wrote about her.

0:13:33.095,0:13:38.099
And in that way, we made contact[br]through her illness,

0:13:38.159,0:13:39.524
through her fear,

0:13:39.594,0:13:42.295
through the glare of death

0:13:42.295,0:13:44.980
that was there now, in the room with us -

0:13:44.980,0:13:46.545
as it always is -

0:13:46.545,0:13:49.286
but there it was in the room with us,

0:13:49.286,0:13:50.825
and we could ...

0:13:54.485,0:13:55.965
accept it.

0:13:56.485,0:14:00.475
And more than that,[br]we made contact through it.

0:14:05.095,0:14:11.906
It helped me and this woman[br]to understand what medicine is for,

0:14:12.316,0:14:13.955
and even bigger than that,

0:14:13.955,0:14:19.397
in excess of the medicine,[br]what ordinary living is for.

0:14:19.397,0:14:22.935
It's for the making of contact.

0:14:22.935,0:14:24.926
It's through the contact.

0:14:24.926,0:14:27.084
And of course, illness exposes,

0:14:27.774,0:14:30.224
so that I'm privileged as a doctor

0:14:30.224,0:14:36.156
to be in situations where there is[br]very little separating me from a patient.

0:14:36.156,0:14:38.955
Do you see what I mean by "exposes"?

0:14:38.955,0:14:44.655
You're down to the floor of who you are[br]in the presence of illness.

0:14:47.865,0:14:53.194
So, not only did we kind of help[br]the immediate problem

0:14:53.194,0:14:55.564
with her own fear,

0:14:55.964,0:15:02.674
but we made enduring,[br]life-long contact -

0:15:02.874,0:15:04.524
the two of us.

0:15:05.784,0:15:08.515
This is possible all the time.

0:15:08.645,0:15:11.072
This is possible all the time.

0:15:12.162,0:15:13.216
I told her -

0:15:13.216,0:15:19.653
I think I told her about a novel[br]by John Banville called "The Infinities,"

0:15:19.653,0:15:22.159
in which he overhears Zeus

0:15:22.159,0:15:24.325
up on Mount Olympus

0:15:24.325,0:15:28.044
looking down at these mortals[br]that he's created,

0:15:28.044,0:15:33.805
and Zeus envies the human beings[br]their mortality.

0:15:33.805,0:15:38.094
He says, "It's your death[br]that gives your lives meaning."

0:15:38.754,0:15:41.654
And so my patient and I understand that,

0:15:41.654,0:15:45.724
that it's in the dying,[br]in the limits of the life,

0:15:45.724,0:15:47.824
that we have our meaning,

0:15:47.824,0:15:53.487
and that we pour ourselves[br]into those things that endure -

0:15:53.487,0:15:58.491
the family, progeny,[br]work, art, dance,

0:15:59.281,0:16:00.558
life,

0:16:00.638,0:16:01.956
play.

0:16:02.056,0:16:05.070
Those things that will endure

0:16:06.620,0:16:09.024
in time and with others

0:16:09.024,0:16:11.575
are those things that give us meaning.

0:16:11.575,0:16:14.464
And they're only available to us

0:16:14.464,0:16:19.513
through the presence[br]and the truth of death.

0:16:20.153,0:16:22.923
When I say, "What is medicine for?"

0:16:23.763,0:16:29.494
my patients have been able to teach me,[br]as have my students, what it's for.

0:16:29.494,0:16:31.934
When we teach narrative[br]medicine in groups,

0:16:31.934,0:16:37.554
it doesn't matter who - doctors,[br]nurses, chaplains, patients, families -

0:16:37.554,0:16:41.996
we all join together in a clearing.

0:16:41.996,0:16:47.904
These narrative storytellings[br]help us to form clearings -

0:16:47.904,0:16:49.455
you know, in the forest

0:16:49.455,0:16:53.905
when the trees kind of thin out,[br]and it's moss and it's ferns? -

0:16:54.035,0:16:55.335
and we're able,

0:16:55.335,0:16:58.065
many different ones of us

0:16:58.065,0:17:02.696
from often rather divided camps,

0:17:02.696,0:17:07.036
can come together[br]in the clearing of storytelling,

0:17:07.036,0:17:13.584
and within the clearing[br]of this human gift of mortality,

0:17:14.444,0:17:17.635
and that's where the truth is exposed,

0:17:17.635,0:17:21.495
and that's where the freedoms emit.

0:17:21.845,0:17:24.124
What medicine is for

0:17:24.334,0:17:30.414
is to donate the expertise[br]to an act of fidelity,

0:17:30.524,0:17:33.546
to give someone company

0:17:33.546,0:17:39.405
and to form staunch, sturdy affiliation

0:17:39.405,0:17:41.165
within our clearings,

0:17:41.265,0:17:42.956
within our dyads,

0:17:43.026,0:17:45.665
within our shabby clinics

0:17:45.665,0:17:51.064
so that no one has to be[br]in the glare of sickness,

0:17:51.064,0:17:53.536
or even the glare of death,

0:17:53.536,0:17:54.965
alone.

0:17:56.565,0:17:59.486
I'm fortunate to be a doctor[br]to be able to do this.

0:17:59.486,0:18:03.976
Anyone in any enterprise

0:18:03.976,0:18:07.146
has the chance for making contact,

0:18:07.146,0:18:10.567
as in this room - a clearing.

0:18:10.567,0:18:11.785
Thank you.

0:18:11.785,0:18:13.576
(Applause)