The Parallel Chart is an exercise created by Dr. Rita Charon, the founder of Narrative Medicine, in which the patient’s history is transcribed alongside a mirrored piece of the physician’s reaction to the interview. The purpose is to expose the biases and reactions of the provider as a person, which may affect how the provider behaves as a physician. The following pieces are the result of a Narrative Medicine class assignment I completed in this style. My hope is that they convey the benefits of the exercise.

Patient Narrative

When I enter the coffee shop, Mrs. P is straightforward and practical, moving us twice before finding the right spot to discuss her husband of 60 year’s health. After asking about my background and evidently finding it satisfactory, she starts at the beginning, with how she met Mr. P here in this small Virginia mountain town where he had spent most of his life and ran the factory his father had built. Mrs. P (then still a Ms.) moved from Richmond to teach physical education in town. They had two children together, one of whom is a doctor in Norfolk and the other who runs marathons and lives in Northern Virginia. This, Mrs. P says, was a very happy life.

In 2013, at the age of 80, Mr. P had spinal surgery. Mrs. P didn’t get into the specifics, but says this surgery left her husband with meningitis. He spent a week in the hospital, at times unable to speak, before eventually recovering. His next brush with neurological devastation would come in 2019. The day it happened, Mrs. P was on the phone with her daughter, who was hoping to get ahold of Mr. P. It was then she noticed her husband’s car in the driveway, having evidently just pulled in. She brought the phone out to him, only to find him slumped, unresponsive in the passenger seat. She hung up with her daughter immediately, called emergency services, and soon Mr. P was in the hospital, unconscious, intubated and with a CT confirming a massive stroke.

It wasn’t until Mr. P was awake and stable that Mrs. P had a moment to look through their legal documents. There she found his advanced directive. The document specified that he did not wish to be kept alive by ventilator or fed through a tube. But by then, it was too late to honor his wishes. He had regained consciousness and was, miraculously, making some improvement with physical therapy.

He was discharged to a long-term care facility, the only one in the area that would accept their Medicare. For the last four months, Mr. P has lived there. His right side is completely paralyzed and, consequently, his speech is hard to understand. Still, he has made far more progress than anyone anticipated. Being conscious is a huge achievement in itself, and Mr. P is now able to use a slide board to get out of bed and into a wheelchair with little assistance. Mrs. P visits him every day, but will likely never be able to take him home. She herself has scoliosis which requires her to use a cane and, looking at her slight figure, I can’t imagine her lifting a wheelchair-bound man onto the toilet, no matter how strong her love for him. Her children have been frank with her about the impossibility of Mr. P ever coming home with her as a caretaker.

Until now, this sounds a bit like a miracle— an older man with a massive stroke making such a recovery is rare. But his care is draining the savings Mrs. P was supposed to live on for the rest of her very healthy life. Medicare has also said that his physical therapy will no longer be covered, as the trajectory of Mr. P’s recovery has plateaued. The narrative quickly shifts to concerns over Mrs. P’s financial longevity. Where will Mr. P go when Medicare stops paying for his time in the long-term care facility? Will he end up like the other patients on his floor, whose isolation Mrs. P sorrowfully recounts to me? Their families have stopped visiting; their care has bankrupted whatever loved ones they had. Now they lie in bed most of the day in a room shared with an equally depressed roommate. Right now, these are Mrs. P’s biggest concerns. These are also her kids’ concerns, and the nightmares of the ladies she used to play bridge with, who now must coax her out of her house and into some small fraction of the community engagement she used to enjoy.

There are, even in this dire situation, some positives. Mrs. P is healthy and surrounded by people who remind her to take care of herself. She plans to move to her son’s town when Mr. P does eventually pass. And her attitude is notable; she is realistic, but upbeat. She is not afraid of restarting in a new town. She is not ashamed to reach out to her friends and her pastor for help and to honestly share that some days she just needs to “have a pity party.” She has all the cognitive ingredients of a person who will overcome hardship. 

Parallel Chart

I did not intend to live in southwest Virginia, or even in the United States. For most of my life, I did not intend to be a doctor. I certainly did not imagine myself in a chronically long-distance relationship. I don’t regret any of these facts of my current life, or the decisions that put me here, but it becomes increasingly apparent as we age that every commitment we make chips away at our freedom just a little. Each decision closes a few more doors to rooms we may have liked to wander.

I think about this as I wind my way along the mountains, wondering who lives here and why. I think about the 85-year-old woman whom I am about to meet and the only thing I know about her— that she is her very ill husband’s caretaker. I am confronted with this shameful fear I have of finding myself similarly trapped in some tragic situation.

When I enter the coffee shop, I am doing my best to be cordial and bright, but in the back of my mind is that sadness and fear, and a desire to get on with this assignment so I can go back to my very self-directed, yet-to-be-trapped life. I am ashamed that I feel this reflexive pity; the very presence of the feeling belittles the woman in front of me.

Mrs. P tests my assumptions immediately: “Before we start, I’d like to know who I’m dealing with. Tell me about yourself.” I give her the elevator pitch of why I am here and the type of doctor I want to be. She warmly shares that she is also from Richmond originally and landed here for work, met her husband, and stayed for the next 60 years. I verbalize that this is “so romantic” but internally, I acknowledge that her trajectory is my personal nightmare. We move around the café twice to get the right acoustics and lighting (the sun is setting and constantly in someone’s eyes).

I clumsily prompt her with a half-formed question, and she graciously goes into the story of her husband’s illness. She is calm and measured, but acknowledges the shock and sadness of what has happened. At times, I catch a whiff of underlying depression in her words, but those moments are bookended by a healthy situational awareness. She is open and honest, but not overwhelmed by her feelings.

Although I am initially overcome by the hopelessness of the situation, I find myself uttering encouragement the whole time; Mrs. P is handling the sudden institutionalization of her husband and financial woes in the most admirable way I can imagine. She has a community and children who care about her well-being. This makes me hopeful and, strangely, very proud of this woman I have only just met. Because of this newfound admiration, I really want her to like me (my eternal vice), which causes the phrasing of my questions to become palpably over-cautious. Realistically, Mrs. P doesn’t notice this shift, but I certainly do. I remind myself not to overthink it and to focus instead on the person in front of me.

I ask if she feels wronged by everything that transpired with the advanced directive—there are a lot of directions in which a finger could be pointed for her current situation. “It was me that didn’t find the advanced directive,” she says. “The doctors were doing the best thing they could for a patient. You expect a doctor to do what they were trained to do.” I hope every patient I encounter is so merciful when their life is turned upside down. I like to think this is how I would react in the same situation. I give people the benefit of the doubt, and Mrs. P seems to as well. I think I’ve found a thread of similarity between us and now I can follow it down to the true, difficult stuff.

The moment Mrs. P admits to me that ever since the stroke, she has prayed for her husband to die, I feel immediately closer to her. I would be wishing for the same thing in her situation, but I feel intrinsic shame about it. I believe that truly empathetic and caring people don’t feel this cagey annoyance at the toll another’s illness takes on their own life. So I feel terrible for instinctively shielding myself from it. I experienced this recently in caring for a friend. While others around her lost themselves in worry, I viewed my role as a utilitarian one: alleviating the burden of those more affected by her illness than myself. Truth be told, I couldn’t wait to get out of that house as soon as my purpose was served. I did not, in these moments, feel like a good, empathetic person.

Mrs. P asked her priest if wishing death upon her husband made her a sinner. I wanted to hug her when she told me this, but honestly, she didn’t need comforting. She has made her peace with the idea that altruistic love and self-preservation can coexist. I admire this. I want this revelation for myself.

I think I have some handle on who this woman is now, so I muster the courage to ask her, frankly, about her position on medical aid in dying. She is emphatically in favor (though, like a good Catholic, she denounces suicide in the same breath). I may have looked too excited, because she then asks if her answer surprised me. This leads to one of the most honest conversations I’ve had with someone about the biases with which we entered an interaction. We laugh over what we each feared this interview would be and are pleased that our expectations weren’t met.

Finding Mrs. P an unexpected kindred spirit, I become fixated on figuring out what the rest of her life will look like. I so want her to be free of this nightmare. I ask her if moving to a new town after all this will be difficult. She says, “Maybe for some people. If you stayed cooped up in your house all day.” I have no doubt Mrs. P will not be cooped up. She will be out on the town, embracing this new phase of life.

I leave feeling less caught up in the work that I still have to do and less afraid of the future. It strikes me that hers is a story that is not often told. I think about how lucky it is that a stranger like me was there to witness this often un-witnessable transitional moment in the twilight of a person’s life. It feels cosmic and rich. I drive back towards Roanoke and think about who lives in the middle-of-nowhere houses I pass. I think about how the people in those houses got here and what fills their days. 

I don’t expect to have many patient interviews in my career where I bond with a caregiver over wishing death upon a loved one. I don’t expect to have the impeccable timing of seeing a person halfway between the worst days of their life and a happier future. It all fills me with gratitude: Gratitude that she was open and honest with me; gratitude for the privilege of entering this special, private place; gratitude that I was able to have a small revelation in an hour at a coffee shop in a small Virginia mountain town.