Narrative Medicine

An exercise in Narrative Medicine is an invaluable experience.  Physicians are constantly limited by time; it is rare to be afforded the opportunity to simply listen and learn from a patient’s story.  This is ironic, as it is the patient’s story and their interpretation of their experiences that shapes how they understand and perceive their illness including causes and cures, which impacts their day to day lives as well as their acceptance of western medicine.  An hour is certainly not enough time to hear, let alone fully understand a patient’s story, but it does give the listener a glimpse into the events that have shaped a person’s understanding of illness.

“Margaret” is a 49-year-old Acholi woman from Babo who was admitted to Lacor Hospital for persistent headache, right flank and back pain, and chest pain associated with a cough and several days of hemoptysis.  As I knew I was limited by time, I did not probe into the “normal” line of medical questioning regarding her symptoms.  Rather, I tried to ask questions that would allow me to understand her perceptions and beliefs regarding her symptoms.  Even this was difficult as there was a language barrier and my strong temptation to learn more about her symptoms. 

She proceeded to tell me that many of these symptoms had occurred before; this was the 4^th episode of headaches and vague body pains, but the first time she had chest pain and blood in her sputum, which is why she decided to come to the hospital.  Her prior 3 episodes (which started in 1982) were all treated either through traditional healers and herbs, or from western medications she obtained from a pharmacy; she had never been admitted to a hospital.

I have learned that like in many other cultures, the “left” is bad luck to the Acholi people.  She told me that she had left leg pain, which she was told could only be healed through traditional methods, as there was “no other option”.  I wondered if she thought this was significant.  My suspicions increased when she told me that her mother thought she was “charmed” and that perhaps someone had bewitched her with “ju-ju”.  But she did not believe this; she didn’t know of any reason for someone to do this to her and if this were true, she would be dead by now, she explained.  She told me that she believes that western medicines are effective, which is why she came to Lacor to be treated.  What wasn’t clear to me was why she didn’t seek western treatment in any of her prior episodes other than the fact that this time, she was coughing blood.  I believe her mother played a large roll in influencing the treatment choice.  Her mother was brought up a lot in conversation and then I learned that her mother is now dead.  Is this why she is for the first time seeking medical treatment at a hospital?

I learned more about her family.  She has 6 living children (with one set of twins) and 3 others who passed away as babies.  She wonders if her son, who was born in 1982 the year her pains started, also has the same affliction; he also gets similar headaches and pains.  She has had three husbands.  Her first husband was a much older man who “took” her when she was 14 and she became pregnant at age 16.  Her mother rescued her from him so that she might return to school, but that did not happen.  She was “taken” by another man who ended up beating her.  They separated in 1982 and he later died of AIDS.  At this point in the interview, it became clear to me that the year 1982 was not insignificant (i.e., this was when her symptoms started, her son was born, and she separated from her abusive husband).  I felt that she was trying to tell me more as she kept bringing up the year, but I could never get more (interestingly, she originally told me she was a widow before explaining that she had 3 husbands and that the last one was still living).  Her third husband is still living, but again, her mother “rescued” her from him 3 years ago because he also beat her. 

Just as I felt we were starting to uncover her story, our time was up.  I wanted to ask her so much more.  I wanted to know what her childhood was like and if the war disrupted her upbringing.  I wanted to know how much schooling she completed, how she provided for her children, and what role religion plays in her life.  Does she have a social support?  Any siblings or close friends who she can confide in?  What brings her joy, sorrow, and sadness? 

Frustrated that I didn’t have time, I thanked her and asked her if she could tell me anything more that she felt was important for me to know about her.  To this she responded, “Please, tell me what is causing the pains I’m having and what you are doing for them.  Also, I want to know how I can make sure my children can attend school.  What can you do for them?”