Stories in the Time of COVID-19 : Academic Medicine

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Invited Commentaries

Stories in the Time of COVID-19

Kumagai, Arno K. MD1; Baruch, Jay MD2

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doi: 10.1097/ACM.0000000000004174
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Abstract

Giovanni Boccaccio’s Decameron was born of pestilence. A group of young nobles flee plague-ravaged Florence and take shelter in a villa in the Italian countryside, where they pass the time by telling stories. In the time of COVID-19, a new plague that has swept across the planet, stories are also being told—not to just pass the time but to try to make sense of the incomprehensible loss and suffering. These stories are being used in the education of physicians, but for whose benefit and to what end? The health humanities—literature, art, philosophy, and history centered on illness and patient care—provide a lens through which we may consider the uses and misuses of stories, both as testimonies to experience and as tools for understanding ourselves and society.

Throughout human history, storytelling has been one of the principal ways in which meaning is passed from one person to another, among members of communities, and down through generations. Stories teach lessons and share cultural wisdom. They help us form empathic connections and focus on collective values and goals. 1 The struggle to find the words that are “just right” to frame our experiences and tell our stories is a process of self-discovery that helps us learn how we think and feel and understand ourselves and others better. Stories arising from the COVID-19 pandemic are no exception.

In much the same way that the attacks of September 11, 2001, inspired many Americans to enlist in the armed forces Classics, the pandemic is inspiring a record number of students to apply to medical school, many of whom appear to be motivated by the “Fauci effect,” 2 a desire to emulate infectious disease specialist Dr. Anthony Fauci. This phenomenon has been fueled by narratives arising as the pandemic unfolds. Early COVID-19-inspired stories focused on the heroism of frontline health care providers. These stories of struggles and triumphs soon expanded beyond health care workers to include the experiences of other essential frontline workers, such as individuals who drive buses and stock supermarket shelves.

As SARS-CoV-2 has tested clinicians, scientists, and researchers, people have encountered conflicting and changing narratives. For every story about tragedy or the mind-numbing experience of identical days/weeks/months, there has been a story of unexpected opportunity or a moment of deep meaning. Conflicting hyperpartisan perceptions of science and society have produced radically different stories about shared experiences. And some narratives have challenged others: What if the self-sacrificing health care worker experiences burnout? 3 What if the frontline worker refuses the supposedly complimentary label of “hero?” 4 What if the battle does not end with a resounding victory and happy ending but rather becomes an interminable war of attrition?

What do stories of COVID-19 reveal about ourselves and our societies? We have witnessed great creativity, ingenuity, and acts of kindness, but also loss of control and predictability, deep divisions, inequities, isolation, loneliness, and despair. As the pandemic stretches on, there is a lack of an ending, a lack of a completed narrative. In this context, storytelling becomes an act in which we struggle with an ongoing stream of events and possible outcomes 1—a practice of interrogation and response to an experience that no longer feels like a massive bleed that we can staunch and move on from, but more and more like a slow hemorrhage over time. How should we engage in storytelling in this context?

The health humanities can help us explore what has happened and what is happening in generative and sometimes provocative ways. They provide us with a vocabulary for our conversations about seismic events and enable us to look critically at the act of storytelling itself to understand its motives and ends. They teach us to raise uncomfortable questions and address difficult truths. There is no question that there are heroes among us; however, there are many among us who struggle on the front lines, who may choose to do so not only out of a sense of duty and citizenship but also out of sheer necessity to survive—the caregivers, farm workers, meat processors, teachers, custodians, and grocery store clerks who must report to work, where they may be vulnerable and exposed, to support themselveses and their families.

Who benefits from these stories? This is the question that the Brazilian writer Paulo Freire asks when he challenges us “to read the world.” 5 Who benefits when privilege and power allow isolation and self-preservation in relative comfort for only some or when stories of heroism obscure gaping differences in safety?

The health humanities provide us with creative and analytic tools for understanding and locating ourselves in stories that resist complacency and comfort. Stories can prompt questions and disrupt taken-for-granted assumptions, beliefs, and worldviews. Through stories we learn that there is no “right” way to be as physicians, that one size does not fit all. In the face of great inequity and injustice, we learn that the stories that have nurtured the medical profession for generations cannot support us any longer. They do not have the same weight they once did; they require a fundamental refocusing.

Many of these stories and the beliefs that sustain them—such as the primacy of science, the credibility of public servants, the apolitical or “neutral” practice of medicine, patients before profits, and medicine as a moral profession that cares equally for all, including the vulnerable and the marginalized—have become contentious during the pandemic. The health humanities provide us with the means to question the current validity and application of these stories and ask an uncomfortable question: Have these stories been in decay for some time or were they perhaps never quite true?

This questioning of storytelling and its motivations is not meant to devalue or demean stories that portray resilience, heroism, or unity. It is intended to give space to individuals whose stories do not quite fit traditional narrative arcs, whose suffering may be without overarching meaning, whose journey may be without a clear destination. By encouraging us to question existing norms and examine experiences from multiple points of view, with an open mind and an open heart, the humanities may provide some of our most critical instruments in these turbulent times. By thinking differently and probing our discomfort, strengths and weaknesses, and what sets us apart and what brings us together, we cultivate the will and energy to write what can happen next and propel ourselves to action as physicians in the service of human beings and their lives.

Finally, what if the story of COVID-19 is not a sweeping narrative with a neat ending? What if the tragedy continues and our fears mutate into new anxieties? What then? The humanities suggest we should create new stories that fit more authentically into the time of COVID-19 and prompt us to answer the call to action to address the needs of those most affected.

Storytelling is an act in which we struggle with an ongoing stream of events and possible outcomes. It allows us to hold dialogues with each other along our shared journey, to construct meaning out of the chaos to fit our individual and collective lives. In this time of instability and discomfort, storytelling helps us understand the subtext of our actions, our motivations and passions, our fears and vulnerability, and the connective tissue that binds us together.

References

1. Benjamin W. Titan S. Lewis T. The storyteller: Reflections on the work of Nicolai Leskov. In: The Storyteller Essays. 2019New York, NY: New York Review Books Classics48–73
2. Marcus J. “Fauci effect” drives record number of medical school applications. National Public Radio. https://www.npr.org/2020/12/07/942170588/fauci-effect-drives-record-number-of-medical-school-applications. Published December 7, 2020 Accessed May 13, 2021
3. Lai J, Ma S, Wang Y, et al. Factors associated with mental health outcomes among health care workers exposed to coronavirus disease 2019. JAMA Netw Open. 2020; 3:e203976
4. Brogan KF. Calling me a hero only makes you feel better. The Atlantic Magazine. https://www.theatlantic.com/ideas/archive/2020/04/i-work-grocery-store-dont-call-me-hero/610147. Published April 18, 2020 Accessed May 13, 2021
5. Freire P. Pedagogy of the Oppressed. 1993, New rev. 20th-anniversary ed. New York, NY: Continuum
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