Making Hospice Work: Collaborative Storytelling in Family-Care Conferences

Publisher Website
Google Scholar
Abstract
^Making Hospice Work: Collaborative Storytelling in Family-Care Conferences* Peggy Carey Best We all tell stories. Stories are part of how we live in the world and make sense of it, and of ourselves in it. Embedded in our everyday conversations, they usually emerge spontaneously, often unremarked as "stories." Most work on storytelling assumes a story to be a continuous, discrete unit, with a beginning, middle, and end, turning on a point or complicating action, and having a single or primary narrator. Stories, however, may also take shape through interchanges among persons in both formal and informal settings, their collaborative origins obscuring their narrative nature. Such collectively generated narratives will be my subject. Specifically, to explore the process and potential importance of collaborative storywork (the making and telling of stories) in medicine, I will focus on hospice workers' construction of narratives in the context of interdisciplinary family-care conferences. Following Jerome Bruner, I suggest that narrative serves not only as "an instrument of the mind," shaping experience, but also as the repository of collectively authored meaning.1 Further, I suggest that such meaning can, in turn, provide a basis for healing for those who work in medical arenas and encounter daily what Christine K. Cassel, in a different setting, describes as a "contextual world of ambiguity, frailty, and human finitude... ."2 Narratives are interpretive accounts of events over time and signal a perspective on those events.3 Stories are one kind of narrative. Amy Shuman, in Storytelling Rights, argues that stories "categorize experience " rather than "recapitulate" it.4 Storywork is central to our lives because it has to do with meaning. Toward the end of her "research * An earlier version of this essay was presented at the Spring National Meeting of the Society for Health and Human Values in Tampa, Florida, May 1992. Literature and Medicine 13, no. 1 (Spring 1994) 93-123 © 1994 by The Johns Hopkins University Press 94 MAKING HOSPICE WORK story," Number Our Days, the anthropologist Barbara Myerhoff writes: "The tale certifies the fact of being and gives sense at the same time. Perhaps these are the same, because people everywhere have always needed to narrate their lives and worlds, as surely as they have needed food, love, sex, and safety."5 Stories are genuine fabrications, creative formulations through which people live and work on a daily basis; stories incorporate—along with events—hopes, values, and fears, and connect past and future in a narrative description of the present. Storytelling is one of the ways that people in any work situation attempt to manage their work. When I teach a class, for example, participants often tell each other stories about who they are, what they are doing, how they see the work of the class, and what it all means, all the while they are arguing about texts together, responding to questions and one another in speech and writing. Right now, I could be described as taking a turn by telling my research story in this journal as part of an ongoing conversation about narrative and medicine.6 What interests me is not that hospice workers engage in storywork, but how their particular stories are constructed and the effects of that process on the work itself and on the people who do the work. I will first sketch some of the organizational characteristics of most hospice programs and some particular to this work group. After locating myself in the research story, I will go on to suggest that there are some important differences between these collectively generated narratives that are the product of family-care conferences and other medical narratives in which the patient is the subject—the case presentation, the chart, and "conversation." Subsequently, I will cite some examples from one story in support of the idea that a collectively generated, révisable, and commonly held core understanding of "what the story is"—an agreed upon oral history, if you will—sustained over time, can enable care givers to work well together even under very difficult circumstances . Hospice work is carried out within the context of institutionalized biomedicine. The organization of work in this hospice program (and in a good number of others), however, is...

This publication has 11 references indexed in Scilit: