Transformational Times, No Longer in Emergency Mode, Continues to Hone Narrative Competence

From the March 17, 2023 issue of the Transformational Times

Transformational Times, No Longer in Emergency Mode, Contines to Hone Narrative Competence

Adina Kalet, MD, MPH 

 

 

On the newsletter’s third anniversary, Dr. Kalet considers how the Transformational Times has provided an opportunity for many people to tell stories, thereby sharpening a skill set and sensibility that is central to caring physician-patient relationships… 

 

 

 

It takes courage to share our stories with the world.  

 

- First Lady Michelle Obama (Instagram post).    

 

 

 

Aaron Burr to Alexander Hamilton: 

 

Why do you write like you're running out of time? 

Write day and night like you're running out of time? 

Everyday day you fight, like you're running out of time. 

Why do you write like it's going out of style? 
 

- Lin-Manuel Miranda (Hamilton) 

 

 

 

As we reached our third anniversary of the Transformational Times, I peeked at my own words in our inaugural issue on March 20, 2020. After all, anniversaries are ripe moments for reminiscence and reflection.  

 

I am not surprised by the powerful visceral response to my own words.  

 

Two memories of March 2020 grab me almost simultaneously. First, I recall being in my Kern Institute office back then, preparing for what we genuinely feared might be a few weeks of “sheltering at home.” I could not know; it was not yet known. Second, I am sucked back to New York City on September 11, 2001, where I am emerging from the subway and boarding the M15 bus on my usual commute uptown to the hospital. Something is not right. Rather than the usual intense rush typical at this time of morning, people are milling about, forming loose scrums on street corners, looking downtown, and scanning the sky. It is a liminal moment, before it was known what had happened, before so many people had died, before our hospital prepared to care for thousands of wounded who never materialized, and before months of grief and sorrow.  

 

In that first issue of the Transformational Times—before we knew what we know now—I wrote, “What I have learned is that how we respond to emergencies matters.” This was my truth at the time. I am proud of how we in the Kern Institute responded to our  emergency, what we have created over the past three years, and how we might continue to serve our particular mission.  

 

In our first issue, you could already see the seeds of the process we have refined over the past three years for collecting and sharing narratives; some essays were fewer than 100 words and some contributions were in the form of poetry or visual art. Submissions came from clinicians, students, staff, patients, and community members within and beyond our institutional walls. We conducted “Take Three” interviews to ensure we included the voices of those who didn’t have the time or confidence to write out their own important stories. And from that day forward, with an urgent need to communicate, capture, and reflect, we wrote “like we were running out of time.”   

 

A weekly newsletter is an ambitious undertaking! Luckily, we didn’t truly understand what we were up against, or we likely would have hesitated. Instead, we just told our stories, engaged with each other, shared ideas, and encouraged others to do so. Our readers tell us that our work has helped them become expert “story listeners.”  

 

We recently published the 150th issue of the Transformational Times. We started the newsletter because it was the right thing to do and had no idea at the time how long it would continue. To be honest, we still don’t know, but we hope it continues to be a place of discovery and healing for our Kern community. We thrive because of stories. 

 

Narrative competence  

 

The effective practice of medicine requires narrative competence, that is, the ability to acknowledge, absorb, interpret, and act on the stories and plights of others. 

 

 - Rita Charon, MD, PhD - Literary scholar and physician  

 

Dr. Rita Charon coined the term Narrative Medicine. Narrative Medicine recognizes that patients approach threats to their health much as literature utilizes structure, plot, characters, and metaphors to tell stories and create meaning. She and her colleagues propose that Narrative Medicine is an “uber” clinical skill because becoming facile with these literary elements and sensibilities not only validates the patient’s experience of illness, but also encourages creativity and self-reflection in the physician. They have demonstrated that narrative enriches students’ listening and observation skills, thus enabling enhanced therapeutic relationships and healing.  

 

Much as medical educators strive to endow students with cultural competence and humility, Narrative Medicine seeks to provide each student with narrative competence. Dr. Charon insists that arts and humanities deserve a central role in medical education, and that becoming skilled in Narrative Medicine involves the close reading of creative works, writing “in the shadow” of these texts, and discussing the reflections with others. Her extensive scholarship has been widely lauded and, in 2018, she was invited by the National Endowment for the Humanities to give the Jefferson Lecture, one of the highest honors our government confers for intellectual achievement.  

 

On June 2, 2023, the Kern Institute will partner with the MCW Department of Medicine to host Dr. Charon as she gives the inaugural William T. Choi Lecture. Watch this space for invitations to spend time learning from this world-rocking medical educator during her visit to Milwaukee. 

 

 

The MCW Med Moth Cultivates Communal Narrative Competence 

 

Since 2019, MCW has had its very own “spoken word” event called Med Moth, modeled on the iconic Moth Radio Hour, a nonprofit launched in 1997 to celebrate the “commonality and diversity of human experience through the art and craft of true, personal story telling.” Of all our Kern Institute community happenings, our MCW Med Moth events are my personal favorite (don’t tell our Grand Rounds speakers!) because it is the most reliably creative, surprising, and inspiring.  

 

Under the mentorship of faculty advisor Cassie Ferguson, MD, student leaders recruit storytellers. The team hosts preparatory workshops, run either by the Milwaukee storytelling organization, Ex Fabula, or by Bruce Campbell, MD, who completed a certificate in Narrative Medicine at Columbia. The workshops refine and rehearse each storytellers’ true stories, emphasizing narrative skills in the process.  

 

This past year we were thrilled to receive generous support from The Charles E. Kubly Foundation to expand our MCW Med Moth programing.  

 

The student-run team sets up the room as an intimate café, with a single microphone on a spot lit stage. Refreshments are readied. Then ten or so storytellers perform their spoken words. This year, for the first time, we invited past storytellers to transform their oral work into written essays for the Transformation Times. Some were shared in the January 27, 2023 issue and some are shared today. I encourage you to give a “close read” to Dr. Himanshu Agrawal’s “Later, Jesus,” Dr. Bruce Campbell’s “The Sign,” and Dr. Brett Linzer’s “Overcoming Shame…” Appreciate the complex plots, compelling characters, and provocative metaphors. Then share your reflections with a colleague, friend, family member and with us at the Transformational Times.  

 

 

Narrative competence takes a village

Good storytelling, like playing a musical instrument, is learned through disciplined and  deliberate practice with feedback, studying of craft (e.g., spelling, style, and grammar) and creative risk taking (e.g., creating and embracing a good metaphor). At the Transformational Times, we learned that everyone has something important and interesting to say, and that their stories can be coaxed, shaped, and refined. To our delight, almost no one has refused an invitation to write for the Transformational Times when invited. While experienced writers need structural guidance (~1000 words, first person, etc.), inexperienced writers gain confidence and courage when given personal support, feedback and “light hand” editing.  

We are proud of the hundreds of voices we have curated because, as Rita Charon has demonstrated, doing so can transform medical education. Toward this end we have recruited a new team member, Karen Herzog, an experienced journalist with a fine copy editor’s eye, to work with authors to craft their words.  

 

 

There’re a million things we haven’t done... just you wait!  

 

Over the past three years of the Transformational Times, we have faced emergencies and made some trouble, raising issues, proposing solutions, and challenging each other to be the best we can be. We have not shied away from controversial issues or from asking the questions about our moral obligations or exposing our blemishes. But, in celebrating the holidays and rituals of our lives and the traditions of our profession, we have engaged with the gratitude, joy and fun whenever we could.  

 

We are not “throwing away our shot.” The Kern Family Foundation has given the Medical College of Wisconsin an unprecedented opportunity to do something meaningful and important. Doing this work requires convincing others to join the work.  

Feedback from readers compels us forward. It is thrilling when one of my Director’s Corners “hits a nerve.” Often, I get a brief email or text (“shofar, great!”) or someone stops me in the hallway and starts talking mid-conversation (“...I have been thinking about my mentor lately”). it usually takes a few beats for me to realize that they had been having this conversation with me in their head since reading my essay. While this is  disorienting for a moment, it immediately leads to a deep and welcomed connection.   

 

 

As the urgency abates, “just you wait” 

 

In the magnificent musical, Hamilton, Lin-Manuel Miranda asks how a “bastard, son of a whore, and a Scotsman, dropped in the middle of a forgotten spot... impoverished in squalor grow up to be a hero and a scholar?” Hamilton and Miranda understood that life is short, and crises are opportunities. Because of his narrative competence and passion to create a “more perfect union,” Alexander Hamilton rallied John Jay and James Madison to write the 85 essays we now call the Federalist Papers within six months. These men were hellbent on having an impact!  

 

In March 2020, we could not have known what havoc the COVID-19 pandemic would bring. Now we know there have been 6,866,434 (as of March 2023) deaths worldwide.  We still do not know all the consequences the events over the past three years have had on us as individuals, on our  work, or on the larger society. For now, this emergency has loosened its grip and I, for one, am grateful for having had the opportunity to  create something meaningful.  

 

Happy Third Year Anniversary, Transformational Times!  

 

 

 

Adina Kalet, MD MPH is the Director of the Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education and holder of the Stephen and Shelagh Roell Endowed Chair at the Medical College of Wisconsin.