The power of storytelling

May 13 was Power Day for medical and nursing students, and keynote speaker Lucy Goddard Kalanithi, M.D. ’07, was recalling the night when a resident refused to give her husband his chemotherapy. She began to read from When Breath Becomes Air, her husband’s memoir of finding his calling as a physician and then facing terminal illness. Paul Kalanithi, M.D. ’07, died of lung cancer in March 2015 at age 36.

The passage she chose illustrated how issues of power affected the conversation between her husband and that resident at Stanford University Medical Center. Because Kalanithi’s liver enzymes were elevated, the resident had cancelled Kalanithi’s daily dose of Tarceva. “Some kid two years out of med school, no older than my junior residents, was really arguing with me?” Kalanithi wrote. Without the pill, he tells the resident, he will endure “10-out-of-10 pain.” If Kalanithi were not a fellow physician, the resident replies, “We wouldn’t even be having this conversation. I’d just stop the drug and make you prove it causes all this pain.” The resident refuses to phone his supervisor.

“What upset me most about the story was his willingness to allow Paul to have pain to prove him wrong,” said Linda Honan, Ph.D., R.N., who moderated Power Day.

The annual gathering of medical and nursing students began 16 years ago and was organized by Nancy R. Angoff, M.P.H. ’81, M.D. ’90, HS ’93, associate dean for student affairs, and Ann Williams, Ed.D., professor emerita of nursing. Their goal was to explore with students how power dynamics play out in clinical settings. On the 16th annual Power Day in May, the medical and nursing students spent the day on West Campus discussing power in its broadest sense, and how to use it constructively.

Kalanithi told the audience of nearly 200 that patients will remember how their doctors and nurses treated them—a manifestation of what Honan called “the power to influence our patients’ narratives.” In the end, Paul and Lucy did take control: their “fun bag,” an assortment of pills that Lucy carried in her purse, included a dose of Tarceva.

Honan asked the students about the resident’s reluctance to call a supervisor. “What’s so wrong with waking somebody up? How miserable is your life going to be?” If you’re afraid to make that call, Honan told them, “Get over it.”

Supervisors no longer have license to yell at someone who calls for advice, said Eve Colson, M.D., M.Ed., professor of pediatrics. “We’re changing the culture,” she said, adding that students can help by reporting abuse.

Lucy Kalanithi then described how power can be used to provide comfort. Paul’s oncologist had brought them bad news about Tarceva. “She sat down, and she said, ‘Tarceva works for a long time in some people. … You’re not that guy, and I really wish you were going to be that guy.’ … She was delivering terrible news, and then she was also in it, empathizing with us. … The way patients rely on you is not always connected to how much you can do for the disease. ‘I can’t do anything more for you’ is not a thing: You always can sit.”

The day before, Kalanithi spoke at the first “Community-Wide Read-In,” which brought together students, social workers, faculty, administrators and community members for a reading from her husband’s book. After her reading and a question period moderated by Anna Reisman, M.D., associate professor of medicine and director of the Program for the Humanities in Medicine, the audience broke into small discussion groups.

At the read-in, Kalanithi said that her husband had envisioned a “career arc” as a neurosurgeon and, much later, as a writer. With the cancer diagnosis, “Suddenly he’s in the last years of his life, the years in which he’d always planned to write.” Now, on a book tour 14 months after Paul Kalanithi’s death, she said, “Projecting Paul’s book into the future almost makes me feel like we’re still a team.”

On the day of her visit, When Breath Becomes Air was entering its 16th week on the New York Times bestseller list. “He may make a bigger difference in the writing of this book than he ever would have as a neurosurgeon,” she said. When the life unfolds in unforeseen ways, she said, “Rising to the occasion is the great privilege of our lives.”

For more about Paul Kalanithi’s memoir, see http://yalemedicine.yale.edu/autumn2015/news/chronicle/222160/