Kitchen Table Wisdom
Author: Rachel Naomi Remen
In what is a most compelling endorsement of the narrative tradition of medicine, this book demonstrates why story-telling is such a fundamental pillar of the healing process. By using deeply moving and life-changing anecdotes, the book convincingly illustrates the remedial power of stories, from easing suffering and dispelling fear, to healing shame and restoring the sense of worth (page xxii). The author draws her stories from her clinical practice, which she says has been enriched more by stories than by disease processes. She also draws from the wisdom of her rich family heritage, and from her own personal experience of living with a chronic disease (pages xxxvi and xx). The book challenges the attitudes of those in the medical fraternity who, because they only ‘measure truth in terms of hard data‘, are contemptuous of the value of story-telling in patient care. The author counters this negative notion by pointing out how ‘medicine is as close to love as it is to science‘, and how story-telling, itself a kind of love, encompasses medicine’s feminine healing values of softness, gentleness, and warmth (pages xix, 65, 164 and 241). The book actively encouraged doctors to complement their knowledge and skills with the power of narrative, and to reflect on the spiritual and emotional dimensions of medical practice, and on the philosophical attitudes that give meaning to chronic illness and suffering.
The nature of human interactions lies at the heart of this book, and the author underlined this when she asserted that ‘we are a part of each other’s reality‘. The book views every chance meeting as an opportunity to make connections, and it argues that the value of such encounters relies on the ability to pay attention, as manifested by ‘the most basic and powerful‘ act of just listening (pages 142-143). Indeed the author contends that listening is ‘the oldest and perhaps the most powerful tool of healing‘ which, more than ‘the wisdom of our words‘, has the potential to induce profound changes in people (page 220). In this regard, she deplored the poor listening that typifies many medical encounters in which the patient and physician, entirely focused on the disease, fail to make meaningful connections (page 158). Discouraging the natural human impulse to speak and interrupt rather than to listen, she maintains that ‘a loving silence has far more power to heal and connect than the most well intentioned words’ (page 144). She illustrated the gratifying nature of clinical connections with the story of a physician who has delivered ‘hundreds of babies‘ but, totally immersed in the technical aspects of his work, has only just begun to appreciate the beauty of connecting with newborns as they open their eyes (page 160).
If there is an overarching theme in this all-embracing book, it must be that of kindness. In a rebuke to the excessive emphasis medicine places on technical skills, the author asserts that it is kindness, and not competence, that defines the measure of ‘the worth of any lifetime‘. The book advocated kindness in all medical encounters, but it particularly urged doctors to do ‘kind things‘ to those whose lives they are unable to save by their best medical efforts (pages 42 and 45). The story that perhaps best illustrates the power, and also the rarity, of kind acts is when the author helped a fellow airline passenger, disabled by stroke, to clean the yoghurt that he had accidentally spilled on himself. This compassionate, but otherwise mundane act, was recognised and rewarded by the airline crew as a singularly laudable deed. That this simple act of kindness was considered worthy of acknowledgement prompted the author to regretfully note that, ‘perhaps we are no longer a kind people‘ as ‘we seem to have become numb to the suffering of others and ashamed of our own suffering’ (page 145-147).
An outstanding quality of the book is the author’s insightful and philosophical view of chronic and painful diseases. Rather than dwell on the misery and despondence that accompany debilitating disorders, she reflects on the positive values that sufferers can extract from their disabilities. Asserting that suffering is ‘intimately connected to wholeness‘, and that it has the power ‘to promote integrity‘, she urged chronic disease sufferers to look beyond their suffering and see the ‘grace, mystery, and adventure‘ that lie beyond it (pages 118 and 75). She goes further to argue that ‘in some basic way it is our imperfections and even our pain that draws others close to us’ (page 113). This tranquil perspective of suffering no doubt evolved from the author’s life-long suffering with Crohn’s disease, a condition she initially ‘raged‘ against for ‘robbing me of my youth‘, but subsequently cherished for giving her much more ‘in exchange‘ (page 30). The author projected a similarly sanguine attitude to death, viewing the process of dying as ‘a time of healing‘, and death as a means of attaining ‘wholeness‘ (pages 93-95).
A thread that runs throughout the book concerns the spiritual dimension of medicine, a subject that is little acknowledged in contemporary medical discourse. In contradiction to the rigid scientific paradigm of modern medicine, the author makes liberal references to many spiritual and religious traditions, and urges patients and doctors to allow for ‘the presence of the unknown‘ in their conception of disease (pages 79, 105, 245, 261, 303, 261-262, 35, and 66-67). Many of her stories reflect this intangible aspect of medicine, and this is perhaps best illustrated in her interaction with her five-year old patient who was dying of leukaemia. She had gone into his room to correct his mistaken understanding that he was going home that day. However, what transpired when he looked up and their eyes met was transformative: ‘in that moment things changed. The room became very still and there seemed to be a sort of yellowish cast to the light. I had a sense of an enormous presence and I remember thinking wildly that we had stepped outside of time. Suddenly I was aware of the overwhelming guilt I felt about this little boy. For months I had done things to him that caused him pain and I still had not been able to cure him. I had avoided him then and felt ashamed. As our eyes met, it seemed that somehow he understood this and forgave me. All at once I was able to forgive myself, not just for this little boy but for all the children I had treated and hurt and couldn’t help throughout my career. It was a sort of healing‘. That moment lasted just a heartbeat, but it evoked ‘a deep sense of acceptance and mutual respect‘. He sadly died shortly afterwards, going home as he had rightly predicted (pages 95-97).
The emotional health of doctors was very close to the author’s heart, and the book addressed its multifaceted aspects in detail. The author was particularly concerned with the subject of physician burnout, a condition she attributed to the way doctors deny, rather than grieve over, their harrowing clinical experiences. Arguing that ‘we burn out because we have allowed our hearts to become so filled with loss that we have no room left to care‘, she points out how unrealistic it is to be ‘immersed in suffering and loss daily and not be touched by it’ (pages 510-513). She blamed the vulnerability of physicians to burnout on their medical professionalism which makes them incapable of expressing natural caring‘, and which instils in them an impossible scientific objectivity and detachment. She also blamed their training for setting them on the impossible pursuit of perfection by teaching them to rely on their competence and expertise when faced with emotional concerns (pages 61-62, 78, 161, and 46-47). Acknowledging that ‘competence may bring us satisfaction‘, she nevertheless maintains that it is in finding meaning in our familiar and routine tasks that we attain ‘a deep sense of joy and even gratitude‘ (page 162).
This is a carefully crafted book, each story selected for the lesson it imparts, each character portrayed with touching compassion. Whilst the author had no clear outlined themes, the emphasis on kindness and connectedness are powerful and recurrent. She challenges the modern orthodox view of medicine which she characterised as technology-driven and detached from what it means to be human. On the contrary, she advocates the neglected but worthy principle of seeing patients as people. It is however her story-telling that enlivens this virtuous principle as no other approach could possibly do. The book’s lessons are profound and life-changing, not only for healthcare, but for society as a whole. Whilst not touted as a self-help book, much of the wisdom the author dispenses are profoundly philosophical and food for personal growth.
The diverse stories in this book reflect a unique, touching and deeply life-changing perspective on human interactions, the foundations of medical practice. The use of stories to advocate lessons is not new, but this book takes it to a very high level. With short stories intertwined with philosophical lessons, the book brings home to physicians what it is that their profession is really about. Her clinical attitude, insightful and sometimes unorthodox, is a source of guidance for nurturing the patient-doctor connection. I found this to be one of the most moving books I have ever read, and I cannot recommend it highly enough to all doctors.
Publisher, Place, Year: Riverhead Books, New York, 1994
Number of chapters: 9
Number of pages: 337
Star rating: 5