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Thanks very much.

2
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So, here's a doctor from New York,

3
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dressed in black,

4
00:00:25,607 --> 00:00:28,865
talking to you on September 13th.

5
00:00:29,535 --> 00:00:32,384
And you're going to think
I'm going to talk about death,

6
00:00:32,384 --> 00:00:37,947
as did all New Yorkers
over the past many days and weeks.

7
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Well, I am.

8
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But I'm going to talk with you about that

9
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in terms of joy and in terms of truth.

10
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I need to tell you
a little bit about my medicine

11
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in order to get to the joy.

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Todd is right that I came to medicine,

13
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not knowing a whole lot about it,

14
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but I came to medicine
because I was a life-long reader.

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I was the kind of kid who would get
10 books out of the library

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and read them all before they were due,

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and I hope many of you were like that too.

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And as a reader, I understood,
once I opened my practice,

19
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once I finished all the business
of staying up all night being an intern,

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that what I did in the office,
what patients paid me to do,

21
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was to pay exquisite attention
to the narratives that they gave me -

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which were in words, in silences,

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in those facial expressions
that we saw earlier today,

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in their body, in how the body changed,

25
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in the tracings and pictures
that we had of their body,

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in what other people said about them -

27
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and that it was my task
to cohere these stories

28
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so that they, at least provisionally,

29
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made some sense;

30
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to take these multiple
contradictory narratives

31
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and let them build something
that we could act on.

32
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So that's what we did.

33
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I realized right away

34
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that I didn't know very much about stories
even though I was a voracious reader,

35
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and I went kind of timidly
to the English department -

36
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I was at Columbia already -

37
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I went to the English department;

38
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I said, "Could you teach a doctor

39
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something about stories
and how they work?"

40
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And God bless them,

41
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the English department
was very happy to take me in.

42
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You know, I wrote prescriptions for them;


43
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(Laughter)

44
00:02:57,747 --> 00:02:59,417
I gave them referrals.

45
00:02:59,857 --> 00:03:06,498
But I think they really joined me
in the idea that the knowledge they had,

46
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very specialized narratological knowledge,

47
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could do something good in the world.

48
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They didn't let me out
until I had a master's degree, a PhD.

49
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They let me write a dissertation
on Henry James, who is my beloved author.

50
00:03:26,807 --> 00:03:33,035
And I want to tell you
how the story training -

51
00:03:33,035 --> 00:03:37,316
awakening and nourishing
my own sense of story -

52
00:03:37,316 --> 00:03:42,217
how it transformed
my teaching and my practice.

53
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This was not the first time that anyone
had put literature with medicine.

54
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By then - this was the '90s already -

55
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by then, there were persons in -
I hope you know this -

56
00:03:57,316 --> 00:04:01,777
in philosophy, in history,
in literary studies, in ethics

57
00:04:01,777 --> 00:04:05,258
who had come into medicine,

58
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and they were all helping us
to improve our practice

59
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based on human learning

60
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in addition to the scientific
knowledge we all had.

61
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So, I was by no means the first one

62
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to bring literary studies
into the practice of medicine.

63
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But somehow, by starting as a doctor first

64
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and then getting all this training
in stories and how to understand them,

65
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I think I had a more -

66
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my sleeves were more rolled up
in using this knowledge.

67
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So my colleagues and I at Columbia

68
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kind of invented, or created, a field
that we called "narrative medicine,"

69
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which we define very simply
as clinical practice

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fortified by the knowledge
of what to do with stories.

71
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So that with these skills -

72
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in first of all having a sense of story,

73
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and then being able to recognize
when someone is telling you a story,

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to absorb the story,

75
00:05:13,586 --> 00:05:15,455
to receive it whole,

76
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to receive all of it,

77
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including even those unsaid
hints and guesses

78
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about what might be left unsaid,

79
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to absorb them,

80
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to interpret them,

81
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to honor them,

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and then to be moved by them

83
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and to be moved by them to action.

84
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So this is what we called
narrative medicine.

85
00:05:43,736 --> 00:05:49,267
We found very effective, economical ways

86
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to teach

87
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the skills of reading and writing
and storytelling and receiving

88
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to medical students, nursing students,

89
00:06:01,567 --> 00:06:06,004
doctors, social workers,
chaplains, patients, families -

90
00:06:06,644 --> 00:06:10,517
all the people who come
in and out of hospitals.

91
00:06:11,007 --> 00:06:14,937
I'm assuming that some of you
are from healthcare,

92
00:06:14,937 --> 00:06:20,386
either as professionals
or as patients or as families.

93
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You know the kinds of silences
there are in those elevators in hospitals.

94
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You know what happens
when you pass someone in the hallway

95
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who has no legs or who's bleeding.

96
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You know that.

97
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Our challenge was to bring
to these people,

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perhaps used to illness,

99
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perhaps hardened against it,

100
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ways to open their own springs
of imagination,

101
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of creativity,

102
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of receptivity

103
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so that they would not just
not lose their sense of story,

104
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but, indeed, build it.

105
00:07:10,447 --> 00:07:14,685
There were amazing
transformations in my practice.

106
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I work in a rather shabby clinic
in Presbyterian Hospital,

107
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which is in New York - in the way,
way upper parts of Manhattan -

108
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and as I improved
my own capacity to read closely,

109
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where every word counts,

110
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I was able to learn how
to listen closely,

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where every word counts,

112
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So, in the office,
when I saw a new patient,

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I wouldn't ask millions
of questions anymore,

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like, no doubt, many of you
have been asked by doctors.

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Typically what we do,
faced with a stranger,

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is we kind of start at the top
and work down.

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I'm sure you've had this:

118
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Do you have headaches?

119
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Do you have nosebleeds?

120
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Do you have trouble with your hearing?
With your swallowing?

121
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Do you have trouble with your breathing?

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And all the way down.

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And what operations have you had?

124
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And what allergies do you have?

125
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And what medicines are you on?

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So I learned not to do that,

127
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and instead to say,

128
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"I will be your doctor,

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and so I need to know a great deal

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about your body
and your health and your life.

131
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Please tell me what you think
I should know about your situation."

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And when I did that,

133
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and when I let persons simply answer,

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instead of writing things down
or typing or computing,

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I would simply sit in my chair,

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hands in my lap,

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and absorb what was being said.

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And what I learned,
right from the beginning,

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is that persons were not only able
but deeply thirsty

140
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to give profound, detailed,

141
00:09:10,360 --> 00:09:13,764
eloquent accounts of themselves.

142
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They didn't always know how
or how to start.

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One woman says, "You want me to talk?"

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(Laughter)

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Another man, one of the first
to whom I made this invitation,

146
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started to tell me
about the death of his father

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and then the death of his brother

148
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and then the trouble he was having
with his teenage son.

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And then he starts to cry.

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I broke my silence:
I said, "Why do you weep?"

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He says, "No one
ever let me do this before."

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So a woman I saw - I just saw her
a few days ago when I made a house call.

153
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Well, she's been my patient
for a long time.

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She -

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as anyone I speak about
or [write] about,

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knows what I'm to say,

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has read what I've written

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and has given, as we say,
informed consent for me to do so.

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So I'm not breaking any secrets.

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I certainly won't use the name,
but she has - we have her blessings.

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She had breast cancer 20 years ago.

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She had a mastectomy -

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sorry, she had a lumpectomy,
small operation.

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She was on medicine for five years;
she was told she was cured.

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About a year ago, she developed
a lump in that same breast.

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On biopsy, it was a new cancer.

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She was stoic about the recurrence.

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She underwent a mastectomy this time.

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It's a big operation;
it was a disfiguring operation.

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She declined breast reconstruction.

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She said she was too old for that.

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And she recovered uneventfully
from the surgery.

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But then she began to worry
that the cancer would come back.

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She was in my office every other week.

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On the off-week, she was
in the office of the breast surgeon.

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She felt a new lump;

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she felt something funny under her arm;

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there was something
not right about the scar.

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She was terrified that it would come back.

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We kept reassuring her:

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"No, that's just how the tissues heal";

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"No, that's your cancer markers."

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We did blood tests
to make sure there was no cancer.

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I did an ultrasound of the scar.

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She could not be reassured,

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and so she thought
that we were deceiving her.

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Finally, after another one of these exams,

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breast examinations in the office,

189
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I thought I could imagine
what was deep to the scar.

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I leaned back
against the sink in my office.

191
00:12:05,966 --> 00:12:09,437
I told her I thought
I understood what the fear was.

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I told her I thought what she feared
was that she would die,

193
00:12:16,445 --> 00:12:21,687
that she had the courage and the vision
from these two illnesses

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to know what many of us know
but refuse to really face up to:

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that is simply we will die.

196
00:12:29,106 --> 00:12:34,084
I told her that I thought
she was in the glare of this knowledge.

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I said, "We don't know
what will end your life.

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00:12:39,696 --> 00:12:44,075
Your body may well harbor now
the disease that will do so.

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It might be the breast cancer.

200
00:12:45,695 --> 00:12:47,666
It might be something else.

201
00:12:47,936 --> 00:12:51,025
But we know something
will take your life."

202
00:12:51,985 --> 00:12:58,535
I said I couldn't do more than we had
to assure her of her health,

203
00:12:58,535 --> 00:13:01,086
but here is something I could do:

204
00:13:01,246 --> 00:13:06,326
I could stand with her
in the glare of that fear.

205
00:13:07,986 --> 00:13:12,363
And right after that conversation,
I checked back with her by phone.

206
00:13:12,363 --> 00:13:13,994
She said she felt much better.

207
00:13:14,054 --> 00:13:15,705
She felt much more relaxed.

208
00:13:15,915 --> 00:13:19,697
She wasn't worried the way she had been,

209
00:13:19,697 --> 00:13:22,565
and she was sure that I was right.

210
00:13:23,345 --> 00:13:25,160
Now, the way I knew that,

211
00:13:25,220 --> 00:13:29,928
the way I came to understand it
is that I'd been writing about her,

212
00:13:29,987 --> 00:13:33,095
and I'd been showing her
what I wrote about her.

213
00:13:33,095 --> 00:13:38,099
And in that way, we made contact
through her illness,

214
00:13:38,159 --> 00:13:39,524
through her fear,

215
00:13:39,594 --> 00:13:42,295
through the glare of death

216
00:13:42,295 --> 00:13:44,980
that was there now, in the room with us -

217
00:13:44,980 --> 00:13:46,545
as it always is -

218
00:13:46,545 --> 00:13:49,286
but there it was in the room with us,

219
00:13:49,286 --> 00:13:50,825
and we could ...

220
00:13:54,485 --> 00:13:55,965
accept it.

221
00:13:56,485 --> 00:14:00,475
And more than that,
we made contact through it.

222
00:14:05,095 --> 00:14:11,906
It helped me and this woman
to understand what medicine is for,

223
00:14:12,316 --> 00:14:13,955
and even bigger than that,

224
00:14:13,955 --> 00:14:19,397
in excess of the medicine,
what ordinary living is for.

225
00:14:19,397 --> 00:14:22,935
It's for the making of contact.

226
00:14:22,935 --> 00:14:24,926
It's through the contact.

227
00:14:24,926 --> 00:14:27,084
And of course, illness exposes,

228
00:14:27,774 --> 00:14:30,224
so that I'm privileged as a doctor

229
00:14:30,224 --> 00:14:36,156
to be in situations where there is
very little separating me from a patient.

230
00:14:36,156 --> 00:14:38,955
Do you see what I mean by "exposes"?

231
00:14:38,955 --> 00:14:44,655
You're down to the floor of who you are
in the presence of illness.

232
00:14:47,865 --> 00:14:53,194
So, not only did we kind of help
the immediate problem

233
00:14:53,194 --> 00:14:55,564
with her own fear,

234
00:14:55,964 --> 00:15:02,674
but we made enduring,
life-long contact -

235
00:15:02,874 --> 00:15:04,524
the two of us.

236
00:15:05,784 --> 00:15:08,515
This is possible all the time.

237
00:15:08,645 --> 00:15:11,072
This is possible all the time.

238
00:15:12,162 --> 00:15:13,216
I told her -

239
00:15:13,216 --> 00:15:19,653
I think I told her about a novel
by John Banville called "The Infinities,"

240
00:15:19,653 --> 00:15:22,159
in which he overhears Zeus

241
00:15:22,159 --> 00:15:24,325
up on Mount Olympus

242
00:15:24,325 --> 00:15:28,044
looking down at these mortals
that he's created,

243
00:15:28,044 --> 00:15:33,805
and Zeus envies the human beings
their mortality.

244
00:15:33,805 --> 00:15:38,094
He says, "It's your death
that gives your lives meaning."

245
00:15:38,754 --> 00:15:41,654
And so my patient and I understand that,

246
00:15:41,654 --> 00:15:45,724
that it's in the dying,
in the limits of the life,

247
00:15:45,724 --> 00:15:47,824
that we have our meaning,

248
00:15:47,824 --> 00:15:53,487
and that we pour ourselves
into those things that endure -

249
00:15:53,487 --> 00:15:58,491
the family, progeny,
work, art, dance,

250
00:15:59,281 --> 00:16:00,558
life,

251
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play.

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Those things that will endure

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in time and with others

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are those things that give us meaning.

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And they're only available to us

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through the presence
and the truth of death.

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When I say, "What is medicine for?"

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my patients have been able to teach me,
as have my students, what it's for.

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When we teach narrative
medicine in groups,

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it doesn't matter who - doctors,
nurses, chaplains, patients, families -

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we all join together in a clearing.

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These narrative storytellings
help us to form clearings -

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you know, in the forest

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when the trees kind of thin out,
and it's moss and it's ferns? -

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and we're able,

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many different ones of us

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from often rather divided camps,

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can come together
in the clearing of storytelling,

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and within the clearing
of this human gift of mortality,

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and that's where the truth is exposed,

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and that's where the freedoms emit.

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What medicine is for

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is to donate the expertise
to an act of fidelity,

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to give someone company

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and to form staunch, sturdy affiliation

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within our clearings,

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within our dyads,

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within our shabby clinics

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so that no one has to be
in the glare of sickness,

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or even the glare of death,

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alone.

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I'm fortunate to be a doctor
to be able to do this.

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Anyone in any enterprise

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has the chance for making contact,

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as in this room - a clearing.

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Thank you.

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(Applause)