Learning from stories: ghosts and devils

Humans love stories.  We love both telling and listening to stories.  People particularly seem to like stories about health and illness, and about real and fictional health professionals doing their jobs.  Television, film and literature are awash with medical dramas and autobiographical narratives that influence the way health care is perceived. Health professionals like to swap stories of the patients and clients they have encountered.  It helps us to reflect on what we did or didn’t do well, to learn from our experiences, and to share our concerns and stresses.

Many health professional programs now include courses focussing on health and medical humanities.  Broadly speaking, these cover cultural, social and spiritual aspects of clinical practice. They are promoted to integrate the art and the science of health care through consideration of a range of interdisciplinary perspectives including philosophy, history, social sciences, art, literature, linguistics and narrative. 

One of the stand-out memories of my general practice training was a regular afternoon session with a local GP educator.  It was run as a book club, well before such clubs became fashionable (or at least in my part of the world).  We discussed works which could give us new perspectives on life, considered how people’s lives were affected by environments and circumstances, the diversity of the human condition, and how, and more importantly why, health professionals’ behaviour is affected by their experiences.

Health professional educators encourage learners to read widely beyond their curriculum.

Here are two examples of writing that have affected the way I think about practice. Both are by one of my favourite authors, Hilary Mantel, who died last year.  She is perhaps best known for her Thomas Cromwell Tudor trilogy.  In 2004 she published a memoir Giving up the Ghost, which recounts her childhood with its ghostly half-remembered presences and, later, struggles with ill-health.  Part of her story is based in locations in the north of England that I know well.  At university in the 1970s, Hilary developed symptoms that her male GP diagnosed as anxiety – perhpas he thought not surprising for a young woman living away from home, studying hard and missing her boyfriend.  She was prescribed a benzodiazepine (mild tranquilliser) that made things worse.  Eventually, suffering from chronic pain and unable to conceive, she diagnosed her condition through researching the symptoms in a library.  Endometriosis was confirmed and in her late 20s she had abdominal surgery including hysterectomy.  She was devastated.  Her doctor, perhaps trying to be empathic, told her that at least she would no longer need to worry about contraception.  

I read this and hoped I had never misread a situation with a patient as badly as that: think before speaking.

And consider endometriosis as a possible diagnosis more frequently.

Her 2010 essay Meeting the Devil is in the aptly titled Mantel Pieces (2020). It offers a disturbing perspective on the experience of staying in hospital.  Prior to her operation, the surgeon, perhaps trying to be reassuring, says ‘For you, this is a big thing, but remember to us it is routine.’ This ‘big thing’ does not go well. Her abdominal wound breaks down, she has hallucinations (including of the devil) from medication, and describes the ‘melancholia’ of a shuttered room. Asked the standard question about pain on a scale of one to ten, she supposes that one is a ’love bite’ and ten ‘the fiery pit of hell.’

I am left wondering if that question is ever useful…

4th Estate 2020

Giving up the ghost – Hilary Mantel. Harper Collins, 2004.

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