As a rural physician working in Hospice and hospitalist medicine, I am constantly reminded that palliative care is not just a practice of medicine, it is a practice of story. We are not only assessing symptoms or facilitating goals-of-care conversations. We are bearing witness to the deepest fears, the most sacred memories, and the unspoken questions that arise at the end of life.
I once cared for a man in his late sixties, a farmer and patriarch, who had lived on the same land his entire life. He was dying of metastatic pancreatic cancer. When I arrived at his home, his daughter was bustling around the kitchen while his wife stood silently at the foot of his recliner. He barely opened his eyes when I introduced myself.
In those early days, he refused almost all medication. His daughter, a nurse, wanted everything that could be offered. His wife seemed afraid to speak. They were locked in a dance of silence and urgency, each carrying their own version of his story, each hoping I might somehow validate the one they thought mattered most.
At first, I focused on the clinical. Pain. Nausea. Constipation. Dyspnea. I tried to apply my skills like puzzle pieces to a life I didn’t yet understand. But the interventions didn’t fit. The patient pushed away his pills. His daughter cried in frustration. His wife stayed silent.
Eventually, I stopped asking what was wrong and asked instead, “Can you tell me who he is?”
That question cracked something open. The daughter pulled out a photo album. The wife brought the instruments he made and used in their traditional ceremonies. They spoke of teepee prayer meetings, great harvests, and years of many employees on the land. In a quiet moment, the patient rasped, “I’ve been trying to die on my own terms. But they don’t see me anymore.”
He wasn’t resisting treatment. He was resisting erasure.
That moment marked a shift in the way I practiced—not just with this family, but with all the ones to follow. I began each visit not with medications, but with stories. I asked about childhood, legacy, unfinished business, and favorite meals. I learned to hold silence, not as an absence, but as an invitation.
Narrative has taught me that symptom management alone is never enough. Behind every request for pain control or discharge planning is a story: of grief, of identity, of love. When I ignore that, I risk practicing medicine in fragments. When I invite story, I am practicing whole-person care.
This isn’t always easy. Sometimes stories are heavy. I’ve carried the story of a woman estranged from her son, who died wondering if he’d ever forgive her. I’ve carried the story of a father who begged me not to sedate him too much because he didn’t want to miss the sound of his child’s voice one last time. And I’ve carried the story of a colleague who doubted herself after a patient’s family accused her of giving up too soon.
These stories live in us. They change us. They come home with us, whether we like it or not.
I believe the most honest way to practice palliative care is to let our own stories be present, too. I am the daughter of a man with dementia. I have known anticipatory grief. I know what it is to feel helpless at a bedside. These experiences shape my empathy, my boundaries, and the questions I ask. I no longer see the line between my personal and professional lives as a barrier. I see it as a bridge.
One of the greatest values of narrative in clinical care is that it softens our armor. It reminds us that even when we cannot cure, we can still heal. Story offers dignity where medicine cannot. It offers meaning in moments of loss. It brings the clinical team into authentic relationship with the people we serve.
There are risks, of course. Stories can bias us. We may overly identify, or distance ourselves out of fear. We may get so lost in a family’s narrative that we lose sight of our role. But the alternative: a sterile, transactional approach to dying, feels more dangerous to me. The discipline lies in holding stories gently, without owning them entirely.
When our team meets in interdisciplinary rounds, I often find that the most helpful details are not in the chart. They’re in the chaplain’s reflection, the nurse’s recollection of a favorite song, or the social worker’s note about a family’s origin story. These are not just anecdotes. They are clinical data. They help us build plans that honor the person, not just the diagnosis.
If every human is made of stories, then the role of palliative care is not to write the final chapter, but to bear witness with reverence and truth; to remind our patients that their stories matter, and to let their lives echo in our own.
In the end, the farmer died with his wife’s hand in his and his favorite dog curled by his side. His daughter sat nearby, quiet for once. I hadn’t done much, just a few doses of morphine, a few hard conversations, and a question that invited them to remember who he really was.
And maybe that’s what this work is.
We do not save lives. We save meaning. We listen. We remember. We carry their stories forward.
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