Ray Barfield on the importance of knowing a patient’s whole story


We can’t understand the meaning of these
deep decisions that we make around our bodies, around these mysterious experiences when we’re on the threshold of dying, unless we think about the whole story. So we’ve got to ask the question, and this is not a question that’s very often asked in medical school, but it’s
asked in the divinity school regularly. What is a story? I’ve learned as a physician
who has the privilege of teaching in the divinity school that stories are a central part of
how the divinity school approaches human experience, and they’re very powerful. So I’m going to give you an example of a story, and I’m going to do
it using the [NOISE] different parts of a story that can—that form essentially the
core of any great novel, any great story, no matter how it’s on the surface structured.
So if any of you want to write stories or if you want to write a novel, I’m about
to tell you how to do it. [LAUGHTER] Every great story that’s ever been told has these parts. Number one: “once upon a time.” “Once upon a time” introduces us to the
person and to the situation. “Once upon a time,” there was a composer in Vienna named Salieri. Has anyone here seen or heard of Amadeus? All right. That’s the story
I’m telling here. Once upon a time, there was a composer named Salieri, who had traded
his entire life in service to God in exchange for the privilege of exploring music in Vienna.
Second part of a story: “And every day,” Salieri composed beautiful music for the king,
and he was honored in the court, and he enjoyed being honored in the court. “Until one day,”
Wolfgang Amadeus Mozart showed up in Vienna. And this little man suddenly caught the attention
of everyone in the city, including the king. They loved his music, but when Salieri heard
his music, he knew that God was speaking through this irritating, foul little man. “And because
of this,” he began to become jealous and to question why God had given such a talent to such an awful little human being. “And because of this,” he began to plot ways to block Mozart’s music, and eventually plotted a way to have him die. “Until finally,”
he ended up at the bedside of the dying little musician as he was composing a requiem, and Mozart died a pauper’s death and was buried in a pauper’s grave. “And ever since that
day,” Salieri was confined in a sanitarium, listening to the laughter of God, bitter and
resentful. What’s a story? “Once upon a time,” there was a little girl, 15 years old. “Every day,” she enjoyed playing her piano, going to school, playing with her
friends, playing with her animals, being with her parents. “Until one day,” the doctor
walked in because of some funny cells and said, “Sweetie, I’m sorry. I have some
hard news. Those funny cells are leukemia.” “And because of this,” she began chemotherapy,
which required that she be in the hospital and that she be away from all the activities
and friends that she loved. “And because of this,” her hair began to fall out. She
began to become thin because of poor nutrition. She became lonely. She became sad. “Until
finally”—and here we’ve got two possible paths, right? Maybe medicine cured her. The
other path, maybe medicine can’t cure her, and we have to walk in and say, “I’m sorry,
but it’s back despite our best medicine.” This part, “and ever since that day,”
in the first scenario, will have one appearance. In the second, if there is no cure, and her
days are short, it’s going to have a different appearance. And this is certainly—we should
be—we should be asking about the story throughout the entire illness—but in that space of
“ever since that day,” we will have no idea how to help her make decisions and live
her life to the fullest in the final part of her life if we understand nothing but the
biology of her cancer, because biology will never tell us what matters to her. The only
way we can know what matters to her and actually help her with decisions is if we know the
whole story, which means we have to stop and listen and use skills that are much more like listening to stories than like what I learned in medical school.

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