Narrative Secrets: Why Disclosure Day is the Hardest One for Clinicians by Maureen Hirthler

   Maureen Hirthler is a physician and holds an MFA in Creative Nonfiction from the University of Missouri-Kansas City .    Her piece,  “D/D”  appeared in the Fall 2014 Intima.

Maureen Hirthler is a physician and holds an MFA in Creative Nonfiction from the University of Missouri-Kansas CityHer piece, “D/D” appeared in the Fall 2014 Intima.

 “Disclosure day in the clinic is the hardest,” says Kathryn Cantrell in her essay of the same name. As a child life specialist, her job is to encourage disclosure—the naming of illness and the sharing of that name with loved ones. Yet her own story is suppressed: “My advisor said I shouldn’t disclose—that a hospital won’t hire me if I tell them I had cancer, that I understand the process.” 

The narratives of both patient and caregiver are central to a holistic approach to medical care. Secrets only complicate things, yet full disclosure is fraught with its own perils. What do we, as professionals, share with others?  Ann Casapini, in “Eight Grown Children,” approaches this question from another direction. What do we do if the true narrative serves no purpose? Are there secrets we should keep?  “Our reasons, which seemed so logical and practical when we made the decision to bring Dad here, now seem like lies.” 

I have experienced both places. Does sharing stories of my own depression with patients make me less of a professional, or does it open a connected space? When Cantrell repressed her story, there was a visible impact upon her psyche. Is there a duty to self to disclose? I know I feel better when I open my heart; but I feel the risk as well.

 My own 86 year-old father has an invasive squamous cell cancer occupying the upper half of his face.  “When will it heal?” he asks. “Why are we seeing all these specialists?” Is there any benefit to saying it will never heal, and it will continue to erode into his eye and brain unless we do something? And that something means blindness?

I do know that we need to respect narrative. I write about this daily. But these authors raise important questions about releasing narrative into the world. Sometimes it is essential; other times, best left unsaid. How will we ever know the difference?


 

Maureen Hirthler is a physician and holds an MFA in Creative Nonfiction from the University of Missouri-Kansas City. Her work has appeared in several journals, most recently in the Yale Journal of Medical Humanities, Hippocampus, Hospital Drive, Touch and the Mulberry Fork Review. Her essay "They Also Serve" from Touch - A Journal of Healing, was nominated for a Pushcart Prize. She is an Associate Professor at the Lake Erie College of Osteopathic Medicine in Bradenton, Florida. Her piece, “D/D” appeared in the Fall 2014 Intima.

© 2016 Intima: A Journal of Narrative Medicine