The Forgotten Text is twelve chapters of narrative medicine about the formation of a physician from 2015 to 2020. The book was a Bioethics Practicum written deliverable— a required course where master students are exposed to bioethics field experience. The Forgotten Text was written by a master of bioethics student at the Johns Hopkins Berman institute, who was on an academic leave between her third and fourth year of medical school at Puerto Rico. Her third-year medical education was atypical — Hurricane María, a Category 5 hurricane, razed her island on her very first third year clerkship.
The Forgotten Text explores, under an ethical lens, the encounters and challenges that medical students may face during their education. The analogy is akin to a butterfly’s metamorphosis, which convey a mysterious transformation process from caterpillar to a butterfly; or maybe a caterpillar enhanced with wings.
The medical note is a unique language system, its own narrative text that is focused on the diagnosis, assessment and management. The medical note has a specific format— “Mr. R is a 47 years old male with history of diabetes and hypertension that presents to the emergency department with a 8/10 chest pain since 30 minutes ago”—which omits non-relevant medical information about the patient. Anthony Moore describes the patient’s story is the missing text in the medical note (Moore, 1978).
But what about the medical student’s story? Would that be forgotten? Medical school is transformative—the field is not for caterpillars— therefore, pre-medical students needs to be equipped with the skills and tools to strive in the medical field. The Forgotten Text discusses three components of narrative medicine described by Charon: physician self, physician-patient, and physician-public trust (Charon, 2001). In the case of this book, the physician-self will not reflect the physician’s practice experience, but her formation into a physician during medical school.
Narrative medicine is a tool that allows the writer to share her experience breaking time and space barriers. It also allows the reader to continue the dialogue with a different kind of text found in the medical literature. The handprint of The Forgotten Text is the incorporation of emoji inside the text, which hallmarks the everyday written conversation of the writer’s time. Even though narrative medicine cannot be generalized due to the particularity of the situation and interpretation of the author, it still sparks conversations, points out possible grey zones, and most importantly shares insight of what others in the profession may also be enduring.
Vivian V. Altiery-De Jesús, MBE is a fourth-year medical student at Puerto Rico. She completed her master of bioethics at the Johns Hopkins Berman Institute in 2020. As a first-year medical student, Vivian developed the Structured Ward Rounds (SWR), an activity that allowed first and then second year medical students to have an early exposure to ethics at the bedside. During her first and second year, Vivian published periodically on Facebook Mini-Reflexiones, short Spanish narrative pieces about her experience during medical school. Her experience during Hurricane María prompted her to formalize her education in bioethics. In 2018 she presented “My experience during Hurricane María” at the Latinx Seminar of Professional Development, Latino Public Health Network. In 2020 she published “One Hug Away” from Home in the Tendon: A Medical Humanities Creative Journal Issue 2 Reflection on Trauma.
The Forgotten Text
Charon, R. (2001). Narrative medicine: a model for empathy, reflection, profession, and trust. Jama, 286(15), 1897-1902.
Moore AR, Royal Melbourne Hospital (1978). The missing medical text : Humane patient care. Carlton Australia: Melbourne University Press ;Forest Grove, Or.: 249.
Banner image: Suzanne D. Williams on Unsplash.