TUNING UP: Narrative Practice and Attuning to Others | Shreya Tamma and Daniel Mahoney
David Bowie often alluded to feeling like a visitor from another planet. In truth, he was the one who made the rest of us feel less alien. The first time I listened to his narration of Prokofiev’s Peter and the Wolf, I was struck by how his voice seemed to hover just outside the orchestra, an interloper stitching himself into a score already in motion. No disrespect to the man from Mars, but what really makes Prokofiev's music legendary is its orchestration. Each character is represented by a different instrument. The bird flitters about as a flute, the cat prowls as a clarinet, the grandfather grumbles through a bassoon, the wolf snarls with French horns, and Peter himself is carried forward by the steady arc of the strings.
Bowie recorded the piece as a Christmas gift for his son. Listening years later, I felt at once that the real gift was something else entirely: a reminder that any outsider could belong. When I later played this recording for our palliative care team, I wasn’t simply introducing a whimsical children’s tale so much as offering the same invitation Bowie extended years ago. Here is a language that required no fluency, only listening. Here was a way of making the unfamiliar habitable. I invited a graduate of the Narrative Medicine program at Columbia, an outsider as far as the team was concerned, to co-facilitate the workshop.
We began by playing a few clips from this piece. We asked members of the team to close their eyes and listen closely. What personality traits did each instrument suggest? What emotions did the music evoke? The prompts were straightforward, but their effects were immediate. One nurse nodded along to the flute, a fellow tapped her fingers to the rhythm. There were gasps, a small laugh, a sigh. Some participants described feeling the music in their bodies; others saw colors bloom across the dark canvas of their eyelids. In those few minutes, something began to shift: each person turned inward, and also, toward one another.
The format of each workshop is simple and intentional: listen together, reflect together, then write and share in a circle.
As a facilitator, I was listening on more than one register. I listened for the music, for the room, and for myself. I was alert to the subtle signals that precede discomfort: the stiffening of shoulders, the restless shift in a chair, the bouncing of knees. I wondered, briefly, whether I had asked too much by inviting people to close their eyes. The workshop was shaping up to be an exercise of my ability to hold my own uncertainty alongside everybody else’s. Ultimately, what emerged was not scripted, but it was consistent.
The creative piece becomes what Zachary Jacobs and others in “Expanding the Scope of Narrative Medicine by Emphasizing Stories from Minoritized Communities” in the Journal of General Internal Medicine) refer to as our 'third object,' our shared key signature, grounding us in a tonal center.
It offers language (notes and rhythms) that guide our reflection. Before playing Peter and the Wolf, we asked participants to listen for tone, pitch, tempo, de/crescendo, and volume. We suggested they try to detect a melody, to consider whether the piece had thematic coherence. One trainee spoke about her early experiences learning piano and guitar, and how she treasured these ten minutes to just listen during this workshop. Her comment was a reminder of how easily sound can carry memory, and how sharing those memories can shift how we see each other. The piece functioned as a shared score, giving everyone a place to enter. Some participants stayed close to the music, commenting directly from what they heard. Others moved into more personal terrain, using metaphor or memory. Each contribution enriched the whole, and the room seemed to open.
Writing came last. In the shadow of the music, participants shaped short narratives – controlling pace, tone, and emphasis, deciding what mattered enough to name. When participants write and share, they contribute their own novel melodies to our collective arrangement. Some voices are bold and resonant; others enter tentatively, like an echo sustained in an empty room. Together, each one contributes to the harmony of trust. In our workshop, a participant commented on how another’s volume changed while reading aloud. He began with strength and clarity, then softened toward the end. Another remarked on a colleague’s wavering voice and spoke about the courage it took to keep reading. These observations asked us to notice courage, restraint, vulnerability.
More than emotional reflection or respite, however important those skills may be, narrative medicine workshops teach clinicians to hone and strengthen skills critical to the practice of medicine. Though the hidden curriculum teaches us to appear steady for our patients, or to appear strong for our team, the reality is that professionalism-as-stoicism restricts our full humanity. Vulnerability is rarely named, let alone given space. Through the workshop, any unspoken weight we carry begins to take shape in language.
Practicing narrative medicine also means offering sustained, ethical attention to another’s experience, something clinicians already do. Taking a patient’s history is more than data collection; it’s the act of assembling a narrative from fragments. The more ambiguous a case, the more keyed in we must be to every detail, from a patient’s offhand comment about their dreams, to the absence of a family member usually present at visits, or to an illness described not in pain scales but in metaphor.
These skills are techniques, like physical exam maneuvers. As Abraham Verghese described in a 2011 Ted Talk, "A Doctor's Touch," the physical exam is not only diagnostic but deeply relational, a ritual that affirms the patient’s presence and the clinician’s attentiveness. Both people may know the rules, but there is a greater intimacy when they begin to play in tune. A similar kind of deliberate practice, honed by Olympians and piano virtuosos alike, is offered by the narrative medicine workshop, where attention itself becomes a form of care.
The idea of a safe space is far older than its modern framing. I have come to think of safety less as comfort than as permission – the permission to stay with something unresolved, to listen without needing to fix or respond. In clinical training, silence is often something to fill, a gap signaling uncertainty or error. Here, silence carries weight, like rest in a musical score. In many Eastern and Indigenous healing traditions, restoration has long been understood as a collective act, one made possible through ritual, storytelling, and bearing witness in community. These practices recognize that healing unfolds not just through introspection, but through shared presence. Modern therapeutic spaces mirror this wisdom in support groups, peer-led circles, and trauma-informed retreats. Across these models, the same principle holds: people speak more freely when they feel held by the group.
When the group read aloud our writing in the Peter and the Wolf session, our collective responses were an orchestra, with each voice carrying its own timbre and cadence, each story distinct but somehow in tune with the next. Bowie teaches us that isolation, loss, or burnout can be reined back into orbit – a chance to harmonize alongside the voices around us until we find a shared key. The flute did not compete with the bassoon, and the oboe didn’t overpower the strings. Each voice made the others more complete. We had become, quite literally, attuned to one another.
In the days that follow our workshops, I may be hearing things, but I often sense traces of them lingering among my colleagues. They surface in small moments: a nurse pausing mid-conversation and smiling, later telling me she caught herself listening for tone rather than content; a trainee recalling the music during a difficult family meeting.
This kind of attunement sharpens our clinical work. Clinicians who regularly participate in creating a shared safe space learn to carry it forward wherever they go – into exam rooms, team huddles, and conversations shaped by loss. The process of breaking down barriers to vulnerability and openness becomes second nature. We learn to say: here is where I was honest, and here is where I felt heard. Come sit with us. There is room for your voice here too.
Shreya Tamma is a second-year medical student at Baylor College of Medicine with a background in narrative medicine. She is passionate about weaving storytelling into medical education, climate health and justice-oriented work. Tamma founded and helps lead the HERB Collective, a student initiative that cultivates gardens in Houston as spaces for food justice, education and reflection. Her writing and workshops explore how story can foster belonging and serve as a platform for advocacy within medicine. Outside of her studies, she enjoys long-distance running, baking with friends and practicing yoga with her grandfather.
Daniel Mahoney is a pediatric palliative care physician in Houston. He writes essays, fiction and poetry addressing themes related to narrative medicine, end of life care, and planetary health.