Jen Hartmark-Hill is a Family Medicine physician, medical educator and research mentor. She is the director for the Narrative Medicine & Health Humanities Program at the University of Arizona College of Medicine-Phoenix. Her story "Dear Patient"… — **Jen** *Hartmark-Hill is a Family Medicine physician, medical educator and research mentor. She is the director for the Narrative Medicine &* *Health Humanities* *Program at the University of Arizona College of Medicine-Phoenix. Her story "Dear Patient" appears in the Fall 2017 issue of The Intima.*

In her thought-provoking piece, “Dovetail,” the poet Zoe Mays reflects on the unsettled decision-making abilities of an acquaintance with cancer. “Did I say this would make sense?” summarizes the patient’s philosophy on her condition and the cacophony of chain reactions that characterize her after diagnosis.

Arthur Frank, the renowned socio-narratologist, posits that humans act in accordance with the breadth or narrowness of their stories.(1) Those of us with deficient narrative resources may find ourselves in the midst of a disjointed “chaos narrative” which is not conducive to healing. While the patient in Mays’ poem suffers from the ravages of cancer, she also appears to be suffering from narrative emptiness and a lack of hope.

Our opportunity and privilege as physicians, nurses, therapists and healers is, as Rita Charon eloquently states, to stand with patients as they stand “in the glare of the knowledge” of their own mortality.(2) We can diagnose anguish resulting from narrative poverty just as we diagnose symptoms and side effects. Exploration of the patient’s story, values and hopes for the future can foster a therapeutic relationship that nurtures both patient and provider. This can happen even in the face of death and few answers.

In my 55-word story, “Dear Patient,” I ponder another type of illness narrative described by Arthur Frank–that of a restitution narrative, in which the patient receives a diagnosis, goes through treatments and is restored to health.(3) For my patient, this took the temporary form of colon cancer remission. My reflection encompasses my journey with him through the stories he chose to share. In his state of restored health, he was able to return to spending time with his sons and his friends doing what he enjoyed. Years later, when he was found to have a rapidly aggressive recurrence, I wondered if he had time to find meaning and personal growth through his struggles. This would have been characteristic of the third type of narrative described by Arthur Frank–the quest narrative.(3) He and I did not get the chance to explore this together. His rapidly evolving story took on an unexpected life of its own, even as my patient lay dying. In the end, I was left to acknowledge the meaningfulness of our interactions, even in the absence of a comforting sense of closure.

1. Frank, A. Why Illness Needs Better Stories: Medical Humanities for the Patients.2017. Mayo Clinic Humanities in Medicine Symposium Plenary, Rochester, MN.

2. Charon R. At the membranes of care: stories in narrative medicine. Academic Medicine. 2012 Mar; 87(3):342.

3. Frank AW. The wounded storyteller: Body, illness, and ethics. University of Chicago Press; 2013 Oct 18.

Jen Hartmark-Hill is a Family Medicine physician, medical educator and research mentor. She is the director for the Narrative Medicine & Health Humanities Program at the University of Arizona College of Medicine-Phoenix.