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February 5, 2003

Once Upon a Time . . .

JAMA. 2003;289(5):612. doi:10.1001/jama.289.5.612-a

Across the back of my grandmother's trailer in Texas was a wide screen that kept a row of yellowing Reader's Digests from sliding off the windowsill. On afternoons when it was too hot to go outside, I read "Laughter, the Best Medicine" and "Humor in Uniform," but what kept me up at night were "All in a Day's Work" and "Drama in Real Life." That adults used stories to make it through a Day's Work, that Real Life was full of Drama, made me yearn for my future. And for a day filled with Work, Life, and Drama, medicine is hard to beat. But whence the stories?

Certainly, patients tell us stories; we demand them: What happened? When? How? And then we tell these tales again and again. "This is a 55-year-old woman who presents with . . . " is our "Once upon a time . . . "—no less formulaic, and no less infinite in its narrative potential. But our doctor stories, whether we write them down or not, are not the same ones patients bring. They are reaction, analysis, diagnosis, invention, strategy—what we do when faced with a patient's narrative. That days are full of events is inevitable; that they may be filled with stories depends on how we navigate.

Stories, and the narrative mode in general, constitute an outlook, a strategic meaning-making. The difference between a string of events and the tale taken home at the end of the day is that we deem this particular series of events worthy of a second thought, a moment of reflection, worthy of the telling—we allow to this day's work, the accumulation of meaning beyond habit. The ability to take in someone's story, to track and contextualize the meaning of a term—what does this patient mean when he says painful, when she says dizzy, when he says weak—is only part of the job. We are readers when we try to understand what has happened to our patients. We are writers when we try to understand what has happened to our selves.

In this issue, Jonathan Auten shows us the way a single finding—"A left pupil, fixed and dilated"—yields events of 50 years ago, while Kimberly Mulcahy-Hawes' narrator tells us more than she realizes. Michael McWilliams wonders if this is the end, while Michael Hope struggles with knowing more of the story than his patient does. And, finally, when his patient can't fill in the blanks, Boris Veysman tells himself a story.

murmur, the creative writing section of MSJAMA, accepts submissions on a rolling basis. Send files to Teri Reynolds at treynol@itsa.ucsf.edu.