The Coastal Star

Health & Harmony: Life stories can help medical pros get to the root of patients’ issues

By Lona O'Connor

People who are sick expect a nurse to take a medical history as part of the process of healing. But they might be surprised if the nurse asks them life-history questions that don’t seem medical.

Pat Liehr, associate dean for research and scholarship at the Christine E. Lynn College of Nursing at Florida Atlantic University, has been studying the connection between healing and life stories for more than 20 years. Nursing students at FAU are trained in the techniques of collecting important life events and personal values from their patients. Their goal is to enlist the aid of patients in maintaining their own health. 

In one instance that Liehr and her colleague Mary Jane Smith cite in their published study, patients who were asked about their lives by nurses showed a drop in blood pressure. 

More than 100 million Americans, or about one-third of the population, have hypertension, otherwise known as high blood pressure, which is connected to heart attacks, strokes, aneurysms, memory problems and dementia.

“Hypertension has long-term outcomes that are devastating to the cardiovascular system, the kidneys, the brain,” said Liehr. “It affects a lot of major systems.”

Liehr does not make exaggerated promises for the health effects, either physical or mental, of sharing life stories. But she emphasizes that gathering the details of one’s own life story is best done with a trained professional.

“This is another resource for you to get your hands on,” Liehr said. “One of the examples that sticks out in my mind is about a woman with high blood pressure. In a story group, she said, ‘I’m told that I’m not supposed to eat any meat. But I’m the daughter of a butcher. I’ve grown up eating meat. I need some help.’ ”

That important detail might never have emerged from a traditional medical history, but it did get snared in the net of a storytelling session, said Liehr.

“Everyone has those little keys that open doors,” she said.

A health crisis can be the critical moment to get a patient to think about how life events have affected his health — and buy into the cure.

Liehr and her colleagues at the FAU College of Nursing follow a protocol for collecting life stories, listening closely for the details that might help with the treatment and engage their commitment to the cure.

They may start by asking for a family tree, a history of marriages, deaths and other significant life events — or in some cases offer a blank sheet of paper for the patient to begin writing a life story. Based on the facts they collect, they can then ask questions about the patient’s values.

One of the case histories Liehr and Smith wrote about in their 1999 study on collecting life stories was that of a 35-year-old computer programmer with hypertension. He told the interviewing nurse that he had been working 14-hour days for years. His weight had crept up and he was in the early stages of hypertension. He looked and felt older than his years and his father had died from a stroke at age 52.

“He was asked what was important to him in this moment of medical crisis,” said Liehr. “We start in the present with what matters to you right now and the nurse helps you reflect on it.”

The man told the nurse that what mattered most to him was his two young children. The nurse asked how he was finding time for them with his long workdays. 

“That’s why this is hard to do by yourself,” said Liehr. “People don’t reflect on those things. They just barrel through their days.

“He said, ‘I’m trying to make a good life for them,’ and the nurse asked, ‘What is a good life for them? Have you asked them about that?’ You are calling on people to reflect on their reality, their hopes and dreams. You support their examining it. Then you help them find a way out of it.

“When you’re confronted with a life-threatening circumstance, we want to find out what it’s going to take for you to say, ‘Hey, wait a minute,’ to slow it down and really reflect on what’s happening. The advantage of sitting with a health-care provider who cares to listen is that you have a chance to sort that out.”

Other people, such as survivors of a heart attack or bypass surgery, may become hypervigilant about their health and possibly paralyzed by fear. Other heart patients choose to deny that anything is wrong.

“That’s not a way to appreciate every moment, that’s not a way to move on,” said Liehr. “You need help to do that.”

Though she confines her research to what nurses and other health professionals can do to help their patients heal, Liehr sees larger implications for the storytelling form.

In an earlier study on trauma survivors, Liehr interviewed survivors of the 1941 bombing of Pearl Harbor. Other colleagues interviewed survivors of the atomic bombs at Hiroshima and Nagasaki, Japan. That experience had a powerful effect, not just on her professional interest in storytelling, but instilling a passion for the possibility that storytelling might heal large groups of people.

“What all the survivors told us was to make sure that we passed their stories on to other generations — and to the country on the other side” of the war.

In 2014, Liehr and a Japanese colleague were able to help fulfill the survivors’ request. They had asked FAU doctoral student Kathryn Morris to write a performance based on the Japanese and American survivors’ interviews.

The resulting piece, With Their Voices Raised, has been performed by both Japanese and American students whose high schools were near the bomb sites.

In her dissertation, Morris wrote, “With Their Voices Raised not only conveys the memories and fears of the survivors, but in its conclusion reveals how these victims of war have elected to live their lives in a quest for peace — choosing ‘hope over hate’ in a shared world.”

Liehr has also collected anecdotes of indigenous people in America and Australia.

“Indigenous cultures survive through oral traditions, and part of that is story sharing. When they have lost every shred of their dignity, they still have their stories,” said Liehr. “When people use story theory the way we talk about it, they will respect the dignity of every human.”

Lona O’Connor has a lifelong interest in health and healthy living. Send column ideas to Lona13@bellsouth.net.

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