“The people who come to see us bring us their stories. They hope they tell them well enough so that we understand the truth of their lives. They hope we know how to interpret their stories correctly. We have to remember that what we hear is their story.” —The Call of Stories
As a medical student deeply interested in education, books and writing, I try to read widely, and am always looking for reading material at the intersection of these interests. Thus when a friend of mine described Robert Coles as a gifted writer, one who placed great emphasis on the value of stories to the practicing clinician, he seemed like the perfect fit. I had previously read some of his shorter pieces, but my friend suggested I read The Call of Stories: Teaching and the Moral Imagination. Before the idea of “narrative medicine” took hold as a focused, named discipline, there was Dr. Coles — not the first physician by any means to focus on stories, but a prominent figure in the American landscape of doctors who both paid attention to their patients’ stories and recorded some of the most meaningful ones. This book is a collection of some of those stories and people, many of whom were not patients but rather college and medical students that Coles mentored and taught. This diverse perspective makes this book of particular interest to the medical student community.
Coles weaves insights about medical education and the specific concerns and desires of medical students throughout the book, but the first chapter is probably the most relevant and personally significant. In it, he writes about two of his attending physicians when he was a resident. One of his attendings was a very cerebral, academic psychiatrist, who liked to focus on psychotherapy and well-characterized diagnoses; he worked largely with theories and classical ways of classifying the behaviors of his patients. Coles does not criticize this approach. He contrasts the first attending with the second, a physician whose primary focus was the patient story. The opening quote is related by Coles as a pivotal speech given by this second physician. He did not want formal “presentations” of patients, and he did not want his residents to work with their patients with a singular goal in mind — namely, trying to solve their problems. Instead, he encouraged Coles and others to elicit stories from their patients — not necessarily with any end goal, but because it would allow them to open up. Coles and his resident colleagues were skeptical at first, but they learned to appreciate how it allowed them to connect deeply with patients. Coles and his colleagues eventually found that this approach was often of more therapeutic value than traditional pharmacologic or psychoanalytical approaches.
Any reader with stories to tell (read: all of us) can spot the value of this, and Coles took it to heart: this book is essentially a collection of essays and meditations on the importance of telling stories. Many of these are transcripts of conversations between Dr. Coles and others. These stories comprise the bulk of the book, though Coles intersperses some of his own ideas and thoughts throughout the narrative. He uses these stories to paint pictures of what the “moral imagination” is, as represented in his thinking and in the words of his students. He defines it broadly, as a worldview that tries to be open-minded and explore what it means to live in the world and act rightly. Given the amount of time he spends writing down what his students have told him, the cliché about learning more from one’s students than one teaches them seems to be true of this doctor.
In addition to these personal narratives — often directly in conjunction with one or more — the author offers discourse on a varied crew of authors and their stories. He writes about this in the introduction: “My book’s title is autobiographical: one keeps learning by teaching fiction or poetry because every reader’s response to a writer’s call can have its own startling, suggestive power…” (pg. xix). These writers include many well-known authors, some I already read and many I now want to read. Several of them are, like Dr. Coles, in the tradition of doctor-writers. There is an entire chapter about William Carlos Williams, with whom Coles met regularly as a medical student; for readers of WCW, these “behind the scenes” looks at Williams’ thoughts and behavior give an interesting perspective that one cannot get from his own writing. Coles references Chekhov and Dostoevsky, Ralph Ellison and John Cheever, Flannery O’Connor and JD Salinger. Except for a few valuable notes of his thoughts, these other writers are mostly referenced with respect to the deep impact they had on one or more of his patients, or his students. In this way, the power of stories is emphasized twice, and the reader is left with renewed wonder at the value of listening and insight gained by both the speaker and the listener during this process.
Coles writes deliberately and thoughtfully. His writing is not overly complex, but his work does require a slow approach and careful consideration of the message he attempts to convey. Since the book is not one cohesive story — each chapter is essentially a distinct essay on a certain topic, patient or author — it lends itself well to reading and resting and reading again. I personally found the insights into certain authors, especially the insights that connected literature and medicine, to be fascinating. Any lover of books and learning would benefit from, and enjoy reading, these stories; however, they hold special significance for doctors and doctors-in-training. Medical students can benefit from reading by being reminded the importance of letting patients speak; we can often neglect this activity in medicine, despite its ability to address so many of the problems we encounter. I highly recommend the collection to any student pursuing psychiatry, as these writings specifically emphasize the connection between telling stories and treating the mentally ill. Even so, Coles insights are diverse enough to intrigue and challenge just about anyone.
“We have to keep making the effort… the more palpable the connection between the story and the reader’s story, the better the chance that something will happen. Look, these novels or short stories aren’t meant to save the world. But a story can engage a reader – not every reader, and some readers only somewhat, but plenty of readers a lot, a whole lot… art reaches the mind and the heart, and in a way that doesn’t easily get shaken off.” –William Carlos Williams to Robert Coles, pg. 120
Prints, Pages and Pagers aims to look closely at the lives of medical students and doctors, real or fiction, whose lives and experiences are told in novels, short stories, poetry or any kind of writing. These book reviews are an opportunity for medical students to learn from the many fascinating stories produced by the field of medicine, and maybe to read something other than a textbook.