By Susan Gallagher
The young woman—a medical student—sat down in front of the room, smiled and composed herself. “If harsh words fall, but no patient is around to hear them, do they make a sound?” She continued: “Nights on trauma are kind of like a box of chocolates; you just never know who you’re gonna get.”
For the next 10 minutes, this future surgeon, Danielle Jameison, recounted a memorable experience from her rotation in the emergency department in which a team of doctors, surgeons, fellows and residents unwittingly cast judgment on a dying patient whom she identified with more than they would ever know. The room was silent and the audience was rapt, applauding enthusiastically when she finished.
It wasn’t a TED stage or a local storytelling event. It was the culminating assignment of a global health class called “Storytelling in Medicine and Health.”
Learning how to craft a story may be an atypical approach to preparing future health practitioners, but for Duke pediatric oncologist Ray Barfield, one of the instructors, storytelling is powerful tool that lies at the heart of medical practice. “Everything else, including all of the drugs and the procedures, is in service to what is disclosed through storytelling, because that is where humans live,” he says. “They don’t live in the world of molecules thrown together.”
Global health student Victoria Hsiung echoes this sentiment: “This course challenges us to think more deeply about the relationship between patients and healthcare providers, which are so complex and can vary greatly between contexts,” she reflects. “It reminded me that in all our rigorous study and planning and fieldwork, we can’t lose touch with the importance of humanity, of the stories that we share with the people we meet, bond with and work with.”
Barfield notes that building storytelling skills helps healthcare providers learn how to listen and understand patients’ stories as they unfold, which enables them to get to know their patients more deeply and, ultimately, provide better care.
Barfield, a professor of pediatrics and Christian philosophy, co-teaches the course with French, romance studies and global health professor Deborah Jenson and Jeff Polish, founder of The Monti, a live storytelling venue in Durham, North Carolina. Romance studies doctoral student Silvia Serrano supports the course as a Bass instructional fellow in digital education.
Not many Duke courses have multiple instructors, but Barfield, Jenson and Polish each play a unique, complementary role. “To understand the deep structures of storytelling, it takes the experience of a seasoned storyteller and the insight of a scholar, and then I show up as the physician who can translate in between the two of them,” Barfield says.
Barfield and Jenson, who co-directs the Health Humanities Lab at Duke’s Franklin Humanities Institute, met at a campus event hosted by the Trent Center for Bioethics, Humanities and the History of Medicine. Discovering a mutual passion for health humanities, they soon began scheming about offering a storytelling course at Duke. Barfield, who knew Polish from The Monti and a few storytelling projects at Duke, came up with the idea of inviting him to co-teach the course.
Polish was immediately intrigued. He’d been running The Monti for eight years and had noticed a recurring two-pronged theme across many of the stories he’d helped develop: many people don’t feel heard by their physicians, and at the same time, physicians often suffer from burnout and sadness because they don’t have time to process their experiences.
“So when I was presented with this opportunity to co-teach a class that may improve things, where we’re training students to connect with people on a deeper level and reduce the distance between the patient and the healthcare provider, I was definitely interested,” says Polish.
But future healthcare providers are not the only students who can benefit from the class. Cross-listed in several departments, the course draws graduate divinity students, medical students and undergraduates from a range of academic disciplines, including pre-health and global health.
The team has woven several elements into the curriculum that resonate particularly well with global health students. “We read health-related texts from and about other cultures that give students insights into the distinct cultural lexicons of health and healthcare,” Jenson says. “We also address structural violence in healthcare through readings, lectures and discussions.” For example, the class studies clinic notes as narratives that sometimes reflect negative impressions of patients that may affect the care they receive.
And by sharing their personal health-related stories, the international students in the class also help shed light on the role culture plays in a healthcare setting. Likewise, many of the global health students use the story platform to deeply reflect on their fieldwork experiences.
Hsiung believes that the humanities, in this case storytelling, can have as significant an impact in the global health arena as biomedical interventions. “If we define health as encompassing the whole self, then global health must also consider the whole of the experience of the self to be important, and that means prioritizing the humanities alongside the sciences, as this course does,” she says.
The course encourages students to listen, practice self-reflection, embrace vulnerability and cultivate humility. Lily Koning, another global health student, sees direct connections between these practices and global health. “This course fosters reflection in a way no course I’ve taken at Duke ever has,” she says. “It prompts me to think about my motives, my actions, my thought processes and my relation to others. In the field of global health, which is fraught with ethical issues in a cross-cultural context, this reflection is vital.”
Serrano, the teaching assistant, notes that listening to others’ stories can be just as transformational for students as developing and sharing their own narrative. This process, she says, “models the practice of sitting still, listening with an open heart and finding connections with each other.”
Throughout the course, students engage with multiple storytelling formats, from blogging to podcasts and sound exploration to performance art. For their final project, students can choose to write a paper, create an audio essay or contribute to a “Sounds of Health” collection on the Sonic Dictionary, an archive of hundreds of audio recordings created by university students. For example, an undergraduate epilepsy researcher, Julie Uchitel, recorded and reflected on sounds from an EEG machine.
The Storytelling in Medicine and Health students leave the class with an understanding of story structure and delivery and the role of humanities in health settings, but what may be even more powerful is the sense of community and shared humanity they develop among their diverse classmates. Serrano recalls a recent conversation she overheard between a few students: “They were reflecting on how, at the end of the semester, through their stories and class discussions, they knew each other in a very deep way that’s unique to this class.”
And Hsiung can relate to that. “Listening to others’ stories in the class was so profound,” she says. “In those moments, we all shared the pain, the struggles, the triumphs, the doubts and the realizations of the storyteller.”
Listening to others’ stories in the class was so profound. In those moments, we all shared the pain, the struggles, the triumphs, the doubts and the realizations of the storyteller.Victoria Hsiung, global health student