OBJECTIVE (AND METHODS)
My classical high school, personal and family experiences, medical degree, complementary psychology exams at the University, specialization in Hygiene and Preventive Medicine and a two-year postgraduate medical bioethics course are the consequence, I think, of my curiosity to understand that mysterious, magical event of infinite Beauty called life. During my work as a physician, I began to collect notes and stories of the patients I encountered. Certainly I was conditioned by my studies. The written stories I deposited in drawers (they stayed there for almost 20 years!) but they asked me questions and convinced me more and more that “Health is not only the absence of disease, but physical, mental, sociorelational to spiritual well-being” (WHO Definition of Health). To have this confirmed, I did a master’s degree in Milan concluded a few months ago in Applied Narrative Medicine held by Dr. Maria Giulia Marini and Dr. Francesca Bracco as my Project work tutors. My goal with this project was to show that the concepts of health, illness, are not only about the body and physical conditions, but also and above all about the cultural conditions of the human being that seem to be its fundamental characteristic. So I took up the hundreds of stories/stories from the drawer, trying to see if the stories themselves, the stories heard during the visits, often at home, were diagnostic and therapeutic in addition, of course, to the interest aroused by the purely medical part. The stories, however, leave an anecdotal record of the many visits made.
NARRATIVE EVIDENCE:
A CASE STORY OF 98-YEAR-OLD WOMAN WITH ORTHICARIOID REACTION
A house without books is like a body without a soul (Cicero) The nursing home nurse calls me because a patient, 98 years old, has itching and adds that it is a recurring problem. “But until now it has not been discovered what is the cause of the hives? I reply. The answer is as lapidary “no!” as it is sufficient to go and discover the mystery. I quickly arrive at the nursing home next door and the nurse takes me to the patient. The woman is in bed intent on scratching and complaining, “You have to experience pain to understand what it is.” She is elderly, but she amazes me with her lucidity. “I am ninety-eight years old and what can one do? You have to move on!” She tells me that she has this itch every night after eating and that maybe it is a reaction to some medication, but it shocks me that she has had it for almost two years, which is since she entered the nursing home. It makes me think that she may be allergic to some situation. But it is equally clear that it needs to be investigated with blood tests and dermatological examination. And while thinking this I see a book on the bedside table turned over with the spine up, lined with a light brown paper. “Who reads books here?” I ask. “Me, I like to read!” “And what do you read?”“Romance novels.” I go with the nurse to her study. I read the chart. He had drug diabetes and now they give more drugs to quell the itching after returning from the hospital. “No one investigates the soul.” It occurs to me. I leave directions for the family doctor on the report. On my way out I stop by to say goodbye to the lady who tells me she has six children who love her. She has worked in the countryside. A lot. “I gave birth to them, of course I had to work. I had a cow and goats.” She tells me briefly about her children. It is good to listen to her. A little earlier the nurse had told me, “I’ve been working here for years, first old people came in on their own legs, now young people come in who are less and less independent!” I stop by to say hello two days later. The lady pretends not to recognize me and to be asleep, but as I was about to leave so as not to disturb her I hear her say,” Thank you for your charity. Always remember that those who do good like you do, it comes back to them!” And she sends me a kiss. These are the stories to tell. I can see myself, should I make it to 98, with a nightstand full of books and someone open on top. Some time later this nice lady gave me a small book of her autobiography. She died a few days before her 100th birthday.
CONCLUSIVE NARRATIVE EVIDENCE:
Both this story and the other ten stories in the project work confirmed to me the correctness of my psychosomatic and holistic approach to medicine. What emerged from the stories was the clear benefit to patients and to the physician himself from listening not only to symptoms, but to listening to the patient’s overall context. Almost always the symptoms were related to situations of the patient’s discomfort with himself or with people in his relationships. Either overtly or latently. And it was precisely listening that dislodged this awareness in the patient and the physician. There is scientific evidence that listening is already 70% of diagnosis and therapy, but the Greeks already knew this concept well (know thyself from the Oracle of Delphi).
NEXT STEPS (WHAT TO DO…)
My diagnostic ability has greatly increased because of the awareness I received almost as a gift from these stories. The patients themselves encouraged me to divulge what came up in the dialogues. If it is true as Maslow says (see Pyramid) that one must first take care of the primary needs in order to meet the higher needs, mindfulness can influence the primary needs and can make a difference. So doing physical activity (which also influences the mind), proper nutrition, cultivating reading and the arts in general can give health and longevity. So from overmedicalization to an accentuation of the medical humanism that narrative medicine offers, with possible greater health, happiness and economy. Hence the transformation of this Project Work into a publication of 50 stories dealing with the ten major diseases with the aim of making citizens-patients more aware and thus healthier and longer-lived.
roccocicerello30@gmail.com