Lauren Small and Ben Oldfield established a program in 2014 at Johns Hopkins for doctors, nurses and social workers to reflect on their patients’ stories. The weekly program, AfterWards, seeks “to illuminate stories of healing for the healers.” Photo by Chris Myers Photography

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In a conference room at Johns Hopkins Hospital in Baltimore, a group of doctors, nurses, social workers, therapists and other crucial caregivers take time out of their day to listen to a poem by W. H. Auden.

The poem, “Surgical Ward,” is often recited by Lauren Small, a novelist, essayist, editor, teacher and assistant professor of pediatrics at Hopkins. The reading is part of AfterWards — as in hospital wards — a monthly literary get-together devised in 2014 by Small and Dr. Benjamin Oldfield, and based on what is known as narrative medicine, a voluntary program meant to “humanize” the doctor-patient relationship.

Too often, Small noted, a visit to the doctor today is a quick in-and-out affair.

“Doctors are too busy, but they have to be reminded that patients are people, not just the disease,” she said.

AfterWards has been described as “a commitment by medical caregivers to understanding patients’ lives” through the reading and telling of stories, both literary and personal.

What is narrative medicine?

Narrative medicine, Small explained in an interview with the Beacon, “looks at how a patient speaks of a place in the context of stories — the stories in literary works, in poems, in paintings; the stories that the patients tell the doctors, the stories the doctors share with each other about their patients, the stories the doctors tell themselves about their work.”

In 2000, a New York physician and literary scholar first popularized the term narrative medicine, a century-old idea. Dr. Rita Charon went on to found the Narrative Medicine program at Columbia University.

A basic premise of narrative medicine, say the experts, is that patient accounts are similar to stories in literature, with a plot, characters (patients, family, friends, enemies, doctors, nurses, etc.), and metaphors.

The experts say narrative medicine “aims not only to validate the experience of the patient, but also to encourage creativity and self-reflection in the physician.”

In other words, doctors and patients should find the time and the ways to relate to one another on a more human level.

“Art and literature reflect the human spirit,” Small said. “By engaging in reflection on art or literature, clinicians reconnect with their own humanity and the humanity of their patients. They are reminded to consider their patients as whole people, not just a disease.

“Narrative medicine reminds doctors to consider their patients’ lives and stories — what they value, what they care most about — in tailoring treatments to their needs.”

Hundreds participate in discussions

The monthly “drop-in” sessions usually consist of up to 25 doctors and nurses, adding up to hundreds of front-line workers over the past eight years.

Each meeting consists of a discussion of a piece of literature or art with a medical theme, followed by writing based on a shared reflection.

One meeting, for example, featured paintings by Mexican artist Frida Kahlo, who suffered from chronic pain, to open a discussion about coping with pain. At another meeting, attendees watched a video of Amy Winehouse singing about her drug addiction. Along with discussing the lyrics, the group discussed how they care for patients with addiction.

At the end of each session Small encourages participants to write about the topic that was covered and to share their reflections with the group.

“Being able to process these experiences through art, literature, music and writing can be powerful,” Small said.

“It’s an opportunity to hear from colleagues they don’t normally encounter. The discussions inspire empathy and reflection through storytelling — also known as Narrative Medicine — and advance the joy of the medicine mission.”

After Oldfield, co-founder of AfterWards, left Hopkins, Small continued organizing the program on her own, inviting clinicians to be guest speakers.

“It keeps the sessions fresh and allows for a multitude of viewpoints,” she said.

Recently a doctor from the emergency room presented photographs of homeless people accompanied by their written reflections on their lives.

“It was very powerful and gave us insight into their world,” Small said. “Since homeless people often show up as patients at the hospital, it was useful for the clinicians to gain this insight.”

When healthcare workers step back from the constant stress of a hospital, they can heal themselves, she said. Small, who has a doctorate in comparative literature, is attuned to the stresses of physicians. Her father, brother and daughter are doctors, as is her husband, Donald Small, director of the Division of Pediatric Oncology at the Johns Hopkins Kimmel Cancer Center.

“Reflecting on art and literature in narrative medicine sessions is also a form of self-care for clinicians who might suffer from burnout as a result of the stresses and difficulties of their work,” Small said.

“They find taking time to view art or read literature and reflect on it nourishes their soul, and reconnects them with the joy of practicing medicine.”

Nurse Juliette Garlow has been attending AfterWards session since 2018, since she was in nursing school. She said in an email, “I’ve continued to participate in AfterWards because each session is unique and offers us a new way to reflect on our own practice.

“I use writing and cartooning on my own to help process experiences I’ve had working as a nurse. AfterWards is so wonderful because I can engage in a similar process with others and hear their stories and insight, which is incredibly enriching. It makes me feel hopeful and reminds me I’m not alone.”

Garlow added: “Storytelling can be a powerful tool, and it has helped me better understand what patients find helpful and what actions by the care team are memorable. I try my best to learn from each patient and family to improve my ability to care for others by listening to their stories. More importantly, it’s an enormous privilege to hear people’s testimonies of what is inevitably a life-changing experience.”

Novelist with a social justice angle

Small, 66, who lives in the Pikesville section of Baltimore with her husband (they have three grown children and four great grandchildren) indicated that her “strong interests in social justice, narrative medicine and the history of psychiatry” have shaped her life, professionally and personally.

And, she indicated, the three historical novels she has so far written offer her personal insights into those interests. Her most recent novel, The Hanging of Ruben Ashford, set in Baltimore, tells the story of a young psychologist who undertakes the defense of a Black man accused of murdering a White woman in the World War I era, when a flu epidemic is devastating the city and the world.

In 2018 Small published Wolf Constellation. At the center of the novel is Dr. Gus Thaler, a psychiatrist, who is treating a 15-year-old girl who has stopped speaking after her brother’s death. His search to cure the girl takes him back to a 19^th-century rabbi-healer who once exorcised a spirit from the girl’s grandmother.

Small’s first novel, Choke Creek, is based on the 19^th-century massacre of Native Americans in Colorado, which occurred after Colorado Territorial Gov. John Evans issued a proclamation calling on citizens “to kill and destroy, as enemies of the country…all hostile Indians.”

“Above all,” Small said, “my writing is informed by my passion for social justice.”