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/ 168 / 6 the patient’s story The apprehension of narration The physician enjoys a wonderful opportunity actually to witness the words being born. Their actual colors and shapes are laid before him carrying their tiny burdens which he is privileged to take into his care with their unspoiled newness. he may see the difficulty with which they have been born and what they are destined to do. no one else is present but the speaker and ourselves, we have been the words’ very parents. nothing is more moving. But after we have run the gamut of the simple meanings that come to one over the years, a change gradually occurs. We have grown used to the range of communication which is likely to reach us. . . . and then a new meaning begins to intervene. for under the language to which we have been listening all our lives a new, a more profound language underlying all the dialects offers itself. . . . it is that, we realize, which beyond all they have been saying is what they have been trying to say. . . . We begin to see that the underlying meaning of all they want to tell us and have always failed to communicate is the poem, the poem which their lives are being lived to realize. no one will believe it. and it is the actual words, as we hear them spoken under all circumstances, which contain it. it is actually there, in the life before us, every minute that we are listening, a rarest element—not in our imaginations but there, there in fact. it is that essence which is hidden in the very words which are going in at our ears and from which we must recover underlying meaning as realistically as we recover metal out of ore. —The Autobiography of William Carlos Williams (1967: 361–62) in chapter 5, we examined the scene of narration; here, we examine the patient ’s narration itself, the narrative knowledge it gives rise to, and the ways that knowledge fails to be apprehended by physicians. as we have already noted, the story a patient brings to the physician is usually among the first and most important pieces of information about that patient that health care workers encounter. These stories—narrated by the patient or, in special cases, by others—present information organized in specific ways that call for specific kinds of listening; that define, to a large extent, the patient-physician relationship; and that help define the scope of healing and care in particular cases. Many things are important about the patient story, the first of which is The Patient’s Story / 169 that it is often the most important diagnostic information the physician is going to have. another, overlooked factor is that it allows us to understand that much of the burden of doctoring is a shared burden, just as, we noted in chapter 3, narrative itself can fruitfully be understood in relation to its shared deliberation. When the physician is getting ready to enter the room to see the patient, it should dawn on her that the patient has a story he wants to tell. in fact, that story is what created the need to come and see the physician in the first place, and physicians sometimes forget that the person sitting in the consulting room made the appointment because he has a story to tell. The doctor did not send his people around the neighborhood gathering these people up to come because he had something to tell them. But sometimes physicians act this way; they sometimes act as if they have something to tell their patients, rather than thinking that the patient’s story is going to make the difference in what the physician says. in fact, if the physician will take a little time to remember that the patient has a story to tell, he will also understand that it is that story’s agenda that is going to run the show—or, to use a train metaphor, that the patient and her story will drive the train. Under these circumstances, the physician has a primary job of listening and attending to that story in special ways, and the whole enterprise of doctor-patient interactions goes better. While the patient has a story to tell, she must join with her physician to discover the “end” of the story, the patient’s chief concern inflected by the physician’s knowledge about medicine and his phronetic ability to discover with his patient what...

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