In the 1990s when I started medical school, nobody warned me how my job was going to hurt me emotionally. Maybe it’s better they didn’t, as I might have been scared away.
I must admit, there were a few omens I foolishly ignored early on. Still, I could not have dreamed that one day, like a human rain barrel, I would become a repository for an Appalachian avalanche of pain and suffering. Today, as a primary care doctor, it feels like I am forever standing at the bottom of the hill – and you know what they say about what flows downhill.
I am grateful for my education in treating heart attacks, strokes, cancer and other diseases, and I am in debt to my West Virginia University mentors, especially Dr. Christine Kincaid, an elegant woman who served as my “medical mom” in the early years. But, as I learned later, my own psyche was often washed down the gutter during the process of serving the person in front of me. I was wounded for so long, unable to reconcile the physical pain, addiction, sexual abuse, mental illness, bleeding from so many places and premature death that accompanied being a West Virginia doctor, an Appalachian doctor. In this regard, I, too, was traumatized by these generational problems.
Do I just swallow all of this and pray that one day I won’t, in fact, explode?
As I headed into the third decade of my career, I had no way of answering that question, but four years ago, when the world was flooded by COVID-19, as an act of survival, I created a project called Healthcare is Human to help me cope. This podcast, when it started, was a way to give the outside world a view of the people – not just the doctors, but the nurses, ambulance drivers, all of the hospital support staff – who were grappling with the pandemic, scared and on the frontline.
But as a result, I was accidentally washed ashore to a place of arts, humanities and clinical practice, a strange and unfamiliar land called narrative medicine. I found it through happenstance and desperation – clinging to a life raft. But I now make regular pilgrimages to this oasis. And I plan to show as many of my colleagues the way to this lush, secluded island.
Narrative medicine as a discipline has an Ivy League pedigree and was created at Columbia University at the turn of the century. Its founding mother, Dr. Rita Charon, holds a PhD in English, in addition to being an internal medicine doctor like me, and, with her combined skills, created a new discipline of medical humanities.
The goals of narrative medicine today are the same as they were at its inception: to use artistic skills and creativity to more fully absorb the stories of our patients. And, in the process, to more fully embrace them as human beings. And, in doing so, providing better healthcare.
Where has this been all my life?
When I discovered narrative medicine, I brought the perspective of an experienced, small-town doctor from Martinsburg, West Virginia. As I have since blossomed in this field’s sunshine, I’ve come to appreciate the formal and rigorous programs at institutions like Columbia, but I also know that my free-range experience does not fit into this urban greenhouse.
My narrative practices are analog, practical and self-taught. In this regard, they are born of necessity, and fit for purpose, making them wholly Appalachian. I have no formal training, but have (with my talented collaborators) been telling West Virginian stories for more than four years. In that sense, I am following in the footsteps of mountain folks before me who often used a ramshackle approach to finding solutions for their own problems because there was, really, no alternative.
In short, I was so angry in 2020 about the lack of representation for Appalachian health voices in our national conversation about COVID-19 that I decided to do something about it. And doing so has changed everything for me, and hopefully, for my patients too. Narrative medicine invites me to see each patient encounter as an opportunity to receive a new story, and, in doing so, be invited to help craft the ending. It is easy in healthcare today to fall into habits where patient interactions are mere transactions, which can be reduced to lists, protocols, and algorithms. These computer-driven habits, which are about to get markedly worse in the age of AI, are the opposite of narrative practices, which see each person as a one-off, existing in a set of circumstances which have no precedent. For this understanding, that I must choose to practice medicine in this way, I am forever grateful.
Healthcare is Human has organically grown in the Mountain State and centers around the storytelling skills of photographer Molly Humphreys and our audio producer, Kym Mattioli, two incredible women who create a platform where healthcare stories are authentically expressed. We’ve been successful because of our artistic integrity: inviting individuals to tell their own stories in their own words, and with their own image. If that isn’t authentic, then what, exactly, is? We add the original poetry of Renée K. Nicholson and music composed here in West Virginia, and the resulting pie has a light and flaky crust, one that can only be baked with our recipe.
As I contemplate what narrative medicine has done for me in the past four years, I know for sure that it has refreshed my compassion and made me a better listener. And I will take that because, given what I do for a living, I am always trying to build a better rain barrel.
But, what excites me the most is that my work in narrative medicine through Healthcare is Human is now on the cusp of modeling and teaching these skills to medical students and young doctors in our forthcoming internal medicine residency at the Berkeley Medical Center.
Our goal is to more fully embrace the stories of our patients, and, by doing so, be better healers. We will do this utilizing time-honored Appalachian storytelling traditions, the ones which have fortified us in these hills, be it around a campfire, in a church, or in the ICU waiting room.
Appalachian healthcare workers first need to be guided to the shore of narrative medicine and then, like I have experienced, will feel the healing that only comes from telling stories as a way to celebrate, commiserate and love. It is primal and visceral and, oh, so beautiful.
The citizens of Appalachia need nurses, hospital staff and doctors who listen and embrace the whole wonderful, wounded, real, imperfect and tragic people who turn to us for help. In bringing our artistic skills to the bedside, we will find the beauty, humor, ingenuity and soul that forms the backbone of our greatest natural resource: the folks we call neighbors, friends and kin.
Healthcare is Human podcast is available on major platforms. Visit Facebook and Instagram to see hundreds of incredible photos by Molly Humphreys, native of Shepherdstown, WV. Ryan McCarthy MD is the program director at the internal medicine residency at the Berkeley Medical Center in his home of Martinsburg, West Virginia.