Personal Narrative as Medical History?

I am the daughter of a storyteller.
Personal narrative has been alive in my cell memory since I was born.
My research as of late has been on the medical history- this charting of abnormality we all fill out at the doctor, which helps them to pathologize and diagnose, yet misses most of our actual history of 'health'.

About two years ago I had Cellulitus (a bacterial skin infection) on my face.
I recently switched doctors and so I had my medical records shipped to me. In the ‘notes section’ of this chart, my Doctor had written:
Patient presents with swelling and rash on ears (and face). Bumpy and hot to the touch. Skin is swollen to capacity and has burst… oozing a sticky yellow fluid, between water and puss. Left ear grotesque. Diagnoses: Cellulitus. Treatment: Penicillin and Benadryl.

Aside from feeling slightly woozy from the description, I was intrigued. Here was a history of my body that somebody else had narrated, and I had never seen. Not only that, I remembered the experience completely differently. In my memory it was not my ears that mattered so much, but my eyes, mouth and cheeks: a parenthesis in the Doctors description, but the most painful for me. I remember that all I wanted to do was cry, but could not because my eyes were swollen shut. I remember my cheeks stung and dirt kept collecting on the moist (pussy) skin so I had to lay with a wet washcloth spread across my face to keep from further infection

As Foucault points out in ‘The Birth of the Clinic”, “I cannot be present to a temporality that exceeds my own capacity for self-reflection, and whatever story about myself I might have to give has to take this into consideration. It constitutes the way in which my story arrives belatedly, missing some of the beginnings and preconditions of the life it seeks to narrate”.

Interestingly, a year before I received these charts, I had a flare up of the exact same symptoms that landed me in a Brooklyn emergency room. When my medical history was taken, nobody asked if I had ever had the same thing happen before. I was diagnosed this time with an allergy to Penicillin, the very drug that was used to treat the initial condition. It is hard for me to narrate the significance of these events on my physical body, in part because it is impossible for me to understand them apart from the context in which they emerged. Swollen to the point of having no facial features, my body became unrecognizable to my ‘self’. In order to give an account of myself in a way that was meaningful to the Brooklyn ER Doctors, I needed to remove myself from the actual experience; citing exact moments of swelling and symptoms, and leaving out the rest of the story. Reflecting on this experience and flipping through the charts that documented my medical history I cannot understand them as ‘mine’ without attaching experience to them. In my present embodiment I carry a mark of those stories. I still have a scar on my left ear from the broken skin that the doctor described as the biggest he had ever seen. Yet if asked for proof, ultimately, it is the charts that become the ‘official’ history of my body and not the scar. The scar, however, carries a story, one that is more ‘mine’ than the chart.

In a medical history form there are a prescribed set of questions that are meant to engage and evoke answers that fit into a prescribed way of understanding the body and its past or present malfunctions. The chronological history of the ‘event’ of malfunctions as well as a number of vague lifestyle questions such as overall diet and exercise lead the practitioner to a fuzzy framework of understanding the body they are treating.

The Health Care Financing Administration (those who decide what medical procedures will or won’t be reimbursed) and American Medical Association require the history component of the examination to the following elements (commentary in italics is written in a guide for medical students by chairwoman Donna McCune ).
• Chief complaint (CC)
“The CC states why the patient is in your office. It is a brief description of the reason for today's visit including symptoms, conditions, problems, diagnoses, physician-recommended return, or other explanation. It is usually stated in the patient's own words. This entry is an essential part of every chart note. There must be a reason the patient is sitting in the examination chair.”

• History of present illness (HPI)
The CC and the HPI have a similar connotation. The HPI is a chronological description of the present illness from the first sign or symptom or from the previous encounter to the present. It contains subjective symptoms not observable by another (e.g., pain and nausea) and objective symptoms that are observable (e.g., redness, swelling).

• Review of systems (ROS)
An ROS is a listing of any signs or symptoms the patient may be experiencing or has experienced organized by body system. The ROS is not a history. It is a review of systems directly related to the problem(s) identified in the HPI as well as any pertinent current medical problem(s). There are 14 possible systems: constitution (general health), integumentary, eyes, musculoskeletal, ears nose throat, neurological, cardiovascular, hematologic lymphatic, respiratory, allergic/immunologic, gastrointestinal, psychiatric, genitourinary, and endocrine

• Past personal, family, and/or social history (PFSH)
The PFSH has three parts:
Past personal (current medications, allergies, prior illnesses/injuries, operations/admissions) Family (members living, health status, hereditary conditions related to the present complaint or illness) and Social (marital status, employment, tobacco, alcohol, drug use).


The author of this guide may provide insight into why health histories of the last one hundred years are only concerned with moments of rupture. Unless there is scientific capital to be gained, liability says that it cannot be done.
This locks Doctors into a system from which they must obtain very specific information and ignore the information that doesn’t fit into the box of what insurance says is important. In relation to what she is suffering from, the patient becomes an external fact; the medical reading takes her into account only to place her in parentheses. This enables classificatory medicine to presuppose a certain configuration of disease. The above framework for taking a medical history is used by all Doctors who are members of the American Medical Association. It takes into account a certain history of the body and completely ignores or bypasses another, assuming that illness happens in a prescribed and methodological way. Arthur Kleinmen, in his preface to Patients and Healers in the Context of Culture (1980) offers, “Clinicians tend to be simplistic about clinical practice. Their tendency toward positivistic scientism and atheoretical pragmatism discourages attempts to understand illness and care as embedded in the social and cultural world. Their reliance on ‘common sense’ often masks ignorance of relevant behavioral and social science concepts that should be part of the foundation of clinical science and practice”. (7)

Just a whole slew of thoughts today....