Picture the following scenario: The funeral procession of Henry V passes through Westminster Abbey, and the following remark is made: “The King from Eltham I intend to steal, / And sit at chiefest stern of public weal.” In another universe a physician enters an exam room and hears the patient talking about his “stomach pain,” intake of “spicy foods” and “use of Advil for headache relief.” These are two entirely unrelated scenarios, yes, but the shared theme is that both dialogues contain important clues to a bigger picture. In the funeral procession, the bigger picture involves nobles bickering for the throne; in the exam room, that picture includes causes of the patient’s stomach pain. As readers of the play, we must make sense of the details in the same manner that that healthcare providers must make sense of each detail a patient gives. This involves asking the right questions: “What would stealing the young King Henry VI from Eltham accomplish?” What does Advil use have to do with stomach pain, if any?”
I was the “physician” in the scenario above. While taking the patient’s complete history, I learned he experienced headaches for which he sought relief by taking Advil. Regarding his diet, he noted that the spicy foods he recently ate might have irritated his stomach. I agreed that diet was a likely contributor to his stomach pains — he didn’t have any chronic health issues, rarely drank alcohol and never smoked. The intermittent and mild nature of his pain ruled out more serious stomach conditions, such as gastric ulcers and I suggested he cut out spicy foods and consider taking antacids for future relief. From personal experience, I know stomach pains aren’t uncommon and can be idiopathic and harmless. Even so, I suspected something else might be causing his pain, and my suspicions were confirmed during my ensuing talk with the attending. Only after my attending asked me to consider all the details — the headaches, Advil and stomach pain — did the dots fully connect.
Looking back, I was glad to have interviewed this “patient,” a trained actor working as a patient-teacher for first- and second-year medical students. The pieces of the puzzle finally fit when I realized that his excessive Advil use was likely the culprit of his stomach pain. Even so, I had lingering questions: How do I know what parts of the patient history are significant and what parts are not? For this patient, I needed to decide whether the spicy food in his diet was relevant to his stomach pain, or if the Advil and headaches were relevant. Do I consider both equally relevant? What was important and what was background noise? When is a seemingly tangential point actually critical to the differential diagnosis? These were the types of questions that my attending encouraged me to ask — the very same that I used in my critical reading, particularly for dramatic plays.
Unlike a novel with an omniscient narrator, a play gives readers only what the characters are saying and thinking. Therefore, the job of putting together a narrative is in the reader’s hands. This manner of putting together a narrative, or a set of possible narratives, is analogous to assembling a differential diagnosis. Serendipitously that evening, I revisited Shakespeare’s Henry VI, a trilogy of plays thought to be one of Shakespeare’s first theatrical works.
The first scene in “Henry VI, Part One” takes place in Westminster Abbey and depicts the funeral procession of King Henry V. The nobles are praising and mourning the loss of their former king while simultaneously bickering for the throne, passed down to the young Henry VI. When reading this or any other scene, the most important objective for readers is to make sense of the setting, tone and character dispositions. Readers must do this by paying attention to the dialogue and scene descriptions. Every character’s lines should be taken into consideration when imagining and interpreting scenes. Of course, every interpretation of a scene comes from an imagination of that scene, and vice versa. In the clinic, every fact a patient gives for an HPI and PMH should be taken into account for the differential diagnosis.
For my patient-teacher earlier, I had focused only on his stomach and gastro-related symptoms, leading me to ignore his headaches and excessive Advil use. This led me to attribute his stomach pain to his diet, which might have contributed to his stomach irritation, but wasn’t the primary cause. Each fact a patient gives is a potential piece of the final puzzle, much like how the clues in the play’s opening funeral scene furnish a potential storyline. For example, readers aiming to understand the scene’s direction and meaningfulness ought to keep in mind Winchester’s remark: “The King from Eltham I intend to steal, / And sit at chiefest stern of public weal” (Act I scene i). Not much later, and building on anticipation from the opening scene, France’s Joan of Arc declares to her followers:
Glory is like a circle in the water,
Which never ceaseth to enlarge itself
Till by broad spreading it disperse to nought.
With Henry’s death the English circle ends;
Dispersed are the glories it included (Act I scene ii).
From these excerpts, readers realize that England’s integrity is being challenged both internally and externally, and both challenges suggest an ominous future for the country. Indeed, the rest of this play and the following two plays in the Henry VI trilogy reveal the degradation of a unified England. The signs and symptoms of England’s transformation are revealed by what the characters say, similar to when signs of a patient’s disease are revealed by what the patient says. The physician, and the reader, must unify the many things being said to complete a logical story.