A Patient Named Noname

IMG_0787I once had a patient named Noname. She was a thin wisp of a young woman who came to the community health clinic where I worked as a nurse practitioner. This was back in the late 1990’s soon after I had moved to Seattle from the East Coast. I was still having a bit of culture shock, getting acclimated to Seattle’s rain, tree-huggers, and serial killers. When I first met Noname I was dating a man who was a tree-hugger but thankfully was not a serial killer. He was way into natural food and meditation, so I had Namaste continually playing in my head like an annoying Bee Gees song. So when I looked at the new patient name ‘Noname’ on the patient chart and entered the exam room, I greeted her as Noname, pronouncing it as if she were a cousin of Namaste. She laughed nervously and corrected me: her name was no name. As in she didn’t want to give her real name, so it was just a placeholder of sorts. It wasn’t as if she was in clinic that day for any sort of health complaint that would make her concerned for her privacy. I never did get the story of her name, of her no name.

I remembered Noname this past week as I began teaching an eight-week Narrative Medicine course at the University of Washington, Bothell. I have close to 45 wonderfully smart and creative nursing students, all in their BSN-completion program. That means they all have their RN either from diploma or community college programs and are back to take the courses necessary for their BSN. They are all working full or part-time as nurses so they have a lot of ‘real life’ experience to draw upon.For the first in-class writing prompt I used one of my favorites learned from Dr. Rita Charon and her colleagues at Columbia University’s Program in Narrative Medicine: Write the story of your name. Everyone has rich stories to tell about their names—including the patient named Noname. I find this writing prompt to be an excellent starter prompt, as well as a way of allowing people to introduce themselves in a unique way. Of course, with 45 people in class we didn’t have time for everyone to read their stories out loud, but I have had the privilege of reading all of them and it helps me to get to know the class. I pointed out that this writing prompt can even be used effectively with patients. For instance, I’ve found that it is so much better to ask a patient (with a strange to me name), “Can you tell me the story of your name?” versus the usual “What country are you from?”

After presenting them with some basics of Narrative Medicine—what it is, where it came from, Dr. Charon’s approach to close reading—we practiced close reading together using a variety of short pieces of poetry and prose and film clips. The poetry I used was from Cortney Davis (I Want to Work in a Hospital), Raymond Carver (What the Doctor Said), Rachel Haddad (Stereotactic Biopsy), and Suzanne Edison (Teeter Totter). For the film narrative/close reading I showed them clips from the movie Magnolia (1999)—specifically two clips that are available on YouTube. One clip is the regret deathbed soliloquy by Earl Partridge (played to perfection by Jason Robards), and the second clip is of the male hospice nurse (played also to perfection by Philip Seymour Hoffman) on the phone trying to track down Earl’s estranged son (played—OK—also to perfection—by Tom Cruise). I love these two clips because they portray hospice care and hospice nursing so truthfully. They lent themselves to some rich class discussion and close reading skill building.

For the last in-class close reading and writing exercise I turned to writing by one of my favorite local authors, Judith Kitchen (Distance and Direction/ Coffee House Press, 2001); Half in Shade: Family, Photography, and Fate/ Coffee House Press, 2013). I used her sample short essay F-Stop, which is surprisingly complex for such a short prose piece (available on her website). We first did a close reading of this essay. Then I showed them a photograph of a man reading to three small children around a campfire. I asked them to write the story of this photograph—to just make one up—thus pushing (or pulling?) them into the realm of fiction writing. I could tell that many of the students struggled more with this writing prompt. Some told me they had never been asked to write fiction before in nursing school. But they persevered and came up with some wonderfully rich stories.

I’ll be writing a series of posts over the next seven weeks of this Narrative
Medicine (for nursing) course. Since Narrative Medicine isn’t ‘done’ very much in nursing schools—and I think it should be—my hope is to share my experiences with others who may adapt it for their own teaching.

6 thoughts on “A Patient Named Noname

  1. As a former UWB grad (2003), RN (who has also never had an opportunity to write fiction in nursing school-yet) I am both intrigued an envious of the class. I look forward to learning more.

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    1. Thanks Joy! I hope to be able to take a writing workshop with Judith Kitchen somewhere, sometime. Thanks for sending the link to her new essay. I’m having a lot of fun with this narrative medicine/health course….

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  2. I’m really looking forward to hearing how teaching & learning in this new class goes for you and your students. Thank you for generously sharing your experience in posts on your blog. I’m still pondering how to engage a whole outpt staff in this reflective and creative process. It prob would help if I had more training, but part of me feels like just starting and seeing where it takes us.

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    1. Hi Ouri,
      I think you could do this quite well with your outpt staff and would highly recommend just plunging in and doing it! Start small, start simple, slide some NM brief reading/writing with some other more ‘normal’ staff update/development activities like on teamwork, communication, patient safety, handling ‘difficult’ patients/parents, and then see where that leads you. I’d be willing to come over there sometime and help co-lead a session if ou think that would be of help.
      ~Josephine

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