A Grand Grand Rounds

I participated in a panel discussion of Atul Gawande’s book, “Being Mortal” at my hospital today.  It was an honor to be asked, and to participate with several community physicians, and a nurse.  In the audience were physicians, nurses, social workers, chaplains, and community citizens who were interested.  The discussion was lively, centered around the need to ensure autonomy for patients as they age and as they approach the end of life.  Autonomy, as defined by Gawande, is defined as “the ability to be the author of one’s own story.”

We spent a lot of time discussing the power of narrative, in shaping and defining our sense of self, and in providing a powerful link to our emotions, memories, and thinking.  Since suffering is defined as the loss of our sense of self, it follows that disease produces an illness experience that alters our story, and that healing requires a skillful rewriting of that story.  The one and only owner of the story is the patient, and so the physicians and nurses need to learn how to assist the patient in rewriting the story in a way that preserves dignity and gives the patient a path to renewal.  Thanks to Dr. Gawande for writing such a thought-provoking book, and thanks to the Grand Rounds participants today.