LONELY PATIENT
The Lonely Patient
By Michael Stein
William Morrow, 2007
222 pages
ISBN: 978-0-06-084795-1
$23.95
Numerous authors have suggested that the act of the physician telling the patient's story is one means of healing the patient. But can a physician really know and understand another person's experience? The vast majority of practicing physicians, after all, do not suffer from disabling chronic illness.
Michael Stein, a general internist and novelist who is Professor of Medicine and Community Health at Brown University, addresses this problem in his new book, The Lonely Patient. This book is Stein's more or less successful account of learning to speak the emotional language of illness.
Much of the book focuses on the stories of patients, one of whom is the author's brother-in-law Richard, an 8-year survivor of sinus cancer. Richard denies, ignores, and minimizes his condition, prompting Stein to write, "I longed for a rich, fully formed vocabulary with which to speak to him about his illness and to help him understand it." (p. 5)
What speaks as loudly as the patients' stories is the experience that Stein himself undergoes as a physician trying to learn the illness language. Of his relationship with Richard, he says, "The pressure to say the right thing was enormous." (p. 214)
Stein comes to believe that healthcare providers can understand the basic emotions of illness even if they do not experience them firsthand. From his own clinical practice, he suggests 4 major emotions that specifically affect the chronically ill: betrayal, terror, loss, and loneliness. Each of these emotions is treated in a chapter of its own, and much of the text works towards defining the emotions themselves and a means of talking about them. Notably, Stein shies away from the language of grief -- denial, anger, bargaining, depression, acceptance -- and does not mention the work of Elisabeth Kubler-Ross or her contemporaries in his narrative of the experience of illness.
The author is an accomplished novelist, and this is his first venture into nonfiction. His writerly talents are on display in the crisp language that appears throughout the book. He chooses to apply the novelist's tools to these stories, writing, "How can a doctor understand the terror, losses, or loneliness of a patient if he can't imagine it for himself?" (p. 203) But attempting to try to feel what the patient feels is treacherous ground. Stein is telling other people's stories of illness, and his credibility for the reader depends as much on his ability to genuinely represent what another human being is feeling as it does the world that his mind can conjure.
Stein's storytelling skills are most convincing in the lengthy opening chapter, entitled "Betrayal," in his telling of Joanna's story about suffering from a painful and incurable neurologic condition; his characterization of chronic pain sometimes has the feel of revelation. Joanna's story would provide valuable fodder for any physician, nurse, or trainee who is struggling to manage the care of a patient with chronic pain.
As the book progresses, however, it becomes less clear whether a story represents his empathetic imaginings, the patient's raw experience of illness, or some mixture of the two. He offers an extensive meditation on the case of a teenager named Leila, who develops a prominent neck scar after having a tumor removed, and only towards the end of the long essay does he quote her directly. When he does, it is revealing: "Why don't we ever keep bad pictures of ourselves?" she asks. "They're at least part of the truth." (p. 164)
In fact, many of the most startling passages are quotes from his patients or from patients' published stories of illness, such as Lucy Grealey's Autobiography of a Face, as though the physician simply cannot know and describe the illness experience as well as the patient herself. If this is so, wouldn't it be more instructive to bypass the physician storyteller altogether and seek out the patient's direct account of illness?
We take it almost for granted now that the physician can describe what a patient is experiencing, that the physician can and should be empathic. Legions of scholars have urged physicians to recognize the emotional impact of illness, beginning with the anthropologist Arthur Kleinman some 20 years ago, when he published The Illness Narratives, and including physician scholars like Rita Charon and William Donnelly, who have advocated that medical students write about their patients' emotional states. But as Stein makes his way through the country of chronic disease, he demonstrates just how challenging the practice of empathy can be, even for a provider with top-flight narrative skills. This is an important lesson for physicians, and especially for those who nurture physicians in training.
And so the question remains: Can physicians become empathic healers without significant life and illness experience?
Stein suggests that a physician can recognize and learn the primary emotions of illness, and with experience offer shareable examples, so that the sick patient does not feel that he or she is suffering alone. This is a reasonable and attainable idea for care providers, and one which is likely a comfort to many ailing patients. But perhaps Stein might have emphasized more strongly that sometimes there isn't a right thing to say, that the physician cannot have the answers for every situation that might arise, that sometimes the physician can provide an exit from the loneliness of illness simply by listening.
By Michael Stein
William Morrow, 2007
222 pages
ISBN: 978-0-06-084795-1
$23.95
Numerous authors have suggested that the act of the physician telling the patient's story is one means of healing the patient. But can a physician really know and understand another person's experience? The vast majority of practicing physicians, after all, do not suffer from disabling chronic illness.
Michael Stein, a general internist and novelist who is Professor of Medicine and Community Health at Brown University, addresses this problem in his new book, The Lonely Patient. This book is Stein's more or less successful account of learning to speak the emotional language of illness.
Much of the book focuses on the stories of patients, one of whom is the author's brother-in-law Richard, an 8-year survivor of sinus cancer. Richard denies, ignores, and minimizes his condition, prompting Stein to write, "I longed for a rich, fully formed vocabulary with which to speak to him about his illness and to help him understand it." (p. 5)
What speaks as loudly as the patients' stories is the experience that Stein himself undergoes as a physician trying to learn the illness language. Of his relationship with Richard, he says, "The pressure to say the right thing was enormous." (p. 214)
Stein comes to believe that healthcare providers can understand the basic emotions of illness even if they do not experience them firsthand. From his own clinical practice, he suggests 4 major emotions that specifically affect the chronically ill: betrayal, terror, loss, and loneliness. Each of these emotions is treated in a chapter of its own, and much of the text works towards defining the emotions themselves and a means of talking about them. Notably, Stein shies away from the language of grief -- denial, anger, bargaining, depression, acceptance -- and does not mention the work of Elisabeth Kubler-Ross or her contemporaries in his narrative of the experience of illness.
The author is an accomplished novelist, and this is his first venture into nonfiction. His writerly talents are on display in the crisp language that appears throughout the book. He chooses to apply the novelist's tools to these stories, writing, "How can a doctor understand the terror, losses, or loneliness of a patient if he can't imagine it for himself?" (p. 203) But attempting to try to feel what the patient feels is treacherous ground. Stein is telling other people's stories of illness, and his credibility for the reader depends as much on his ability to genuinely represent what another human being is feeling as it does the world that his mind can conjure.
Stein's storytelling skills are most convincing in the lengthy opening chapter, entitled "Betrayal," in his telling of Joanna's story about suffering from a painful and incurable neurologic condition; his characterization of chronic pain sometimes has the feel of revelation. Joanna's story would provide valuable fodder for any physician, nurse, or trainee who is struggling to manage the care of a patient with chronic pain.
As the book progresses, however, it becomes less clear whether a story represents his empathetic imaginings, the patient's raw experience of illness, or some mixture of the two. He offers an extensive meditation on the case of a teenager named Leila, who develops a prominent neck scar after having a tumor removed, and only towards the end of the long essay does he quote her directly. When he does, it is revealing: "Why don't we ever keep bad pictures of ourselves?" she asks. "They're at least part of the truth." (p. 164)
In fact, many of the most startling passages are quotes from his patients or from patients' published stories of illness, such as Lucy Grealey's Autobiography of a Face, as though the physician simply cannot know and describe the illness experience as well as the patient herself. If this is so, wouldn't it be more instructive to bypass the physician storyteller altogether and seek out the patient's direct account of illness?
We take it almost for granted now that the physician can describe what a patient is experiencing, that the physician can and should be empathic. Legions of scholars have urged physicians to recognize the emotional impact of illness, beginning with the anthropologist Arthur Kleinman some 20 years ago, when he published The Illness Narratives, and including physician scholars like Rita Charon and William Donnelly, who have advocated that medical students write about their patients' emotional states. But as Stein makes his way through the country of chronic disease, he demonstrates just how challenging the practice of empathy can be, even for a provider with top-flight narrative skills. This is an important lesson for physicians, and especially for those who nurture physicians in training.
And so the question remains: Can physicians become empathic healers without significant life and illness experience?
Stein suggests that a physician can recognize and learn the primary emotions of illness, and with experience offer shareable examples, so that the sick patient does not feel that he or she is suffering alone. This is a reasonable and attainable idea for care providers, and one which is likely a comfort to many ailing patients. But perhaps Stein might have emphasized more strongly that sometimes there isn't a right thing to say, that the physician cannot have the answers for every situation that might arise, that sometimes the physician can provide an exit from the loneliness of illness simply by listening.
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