Building Resilience An Innovative Reflective Writing Method the

Building Resilience: An Innovative Reflective Writing Method: the 55 Word Story Lucille Marchand, MD, BSN, FAAHPM University of Washington, Seattle Colleen T. Fogarty, MD, MSc University of Rochester, NY Jo Marie Reilly, MD University of Southern California, Los Angeles

Disclosures None

Objectives • Describe the use of 55 -word stories as a narrative medicine exercise which builds resilience. • Demonstrate and experience the 55 word story as a brief but effective narrative medicine reflective exercise. • Integrate the 55 word narrative method story into various clinical care and teaching settings in family medicine.

Narrative Medicine The practice of narrative medicine allows for increased awareness, reflection, healing and resilience building through close reading and reflective writing.

Narrative Medicine: Story-telling & Story-listening • Allows us to hear the story of another without interruption or advice giving (fixing and problem-solving) • Encourages generous listening, presence, witnessing, mindfulness and compassion. • Tells our stories to others- finding our voice.

Narrative Medicine increases Mindfulness Brings intention, presence, awareness, curiosity, being and doing, reflection to your life and work. Inner self inquiry.

55 Word Stories: A narrative medicine method • Originated by: Moss, Steve. The world's shortest stories: 55 fiction. 1995. • Late editor of the San Luis Obispo New Times. Originator of the method

55 Word Stories: A narrative medicine method • Later adapted by Anne Scheetz, MD & Mary Fry MD for use in medical narratives. • “To tell—in 55 words exactly—a story that helps us to understand, or to appreciate, something about a patient or about an experience of health care. ”

55 Word Stories: A narrative medicine method • The 55 Word Story- a fun, simple exercise you can use for self care, journaling, team support and debriefing

Opportunities with a 55 Word Story • Less intimidating for the “non-writer • More accessible for the “time-pressured” • Immediacy to this form of self expression and reflection • Easily adaptable narrative method writing form which builds resilience

55 Word Stories: Noticing, Reflecting…Healing Ø Noticing: Resilient clinician will notice what others may not. Heightened awareness and presence. Allows the hidden to become visible. Ø Reflecting: Writing and sharing the story. Connecting thinking with the heart and soul. Ø Healing: As we touch the vulnerable places in others, we have the opportunity to heal the vulnerable places within ourselves.

55 Word Story: Builds Health Care Team Resiliency Ø Find meaning in what we do. Ø Share our joy with others. Ø Be ourselves. Being present. Ø Generous listening. Ø Mindfulness in clinical practice and in our lives. Self reflection as a practice for meaning in our work and lives. Ø Acceptance of life, ourselves and others.

55 Word Story Example Perspectives Elizabeth Fleming, M. D. The flowers were fading in the corner of the room. She has been here too long. Multiple admissions for a body breaking down: dementia, hyponatremia, aspiration, infection. A nursing home fall caused a brain bleed and they chose surgery. Her daughter is frustrated. She doesn’t hear the patient who just wants to go home.

Write Your own 55 Word Story Ø Please take 20 minutes to write a 55 word story. This could be a clinical situation that touched your emotions, a poignant moment personally or professionally, your musings on a topic, etc. Ø Write as many words as you can for 10 minutes without editing. Then, take 10 minutes to remove any unnecessary words until you get to 55 words. Title not included.

Share your 55 Word story • Choose a partner • Each person will read their story twice without interruptions • After reading/listening to both stories, the pair may discuss briefly together

Large Group Reading

Discussion Ø What was it like for you to write the story? Ø What was it like to tell the story? Ø What was it like to listen and witness the story?

55 Word Story: Applications for teaching and clinical work Ø What are ways of incorporating this method into clinical care and teaching? Ø What are ways of incorporating this method into your self care or PC team self care? Ø Any other thoughts or feelings to share about this experience/method

55 Word Story as Scholarship • Include key elements of narrative: – Setting – Character/s – Conflict—something has to happen – Resolution—what is the outcome? • Pay attention to every word • Use “juicy” words

Publishing Venues for 55 Word Stories • Journal: Families, Systems and Health Co-Editors of poetry and 55 word Stories: Johanna Shapiro, Ph. D jfshapir@uci. edu Jo Marie Reilly, M. D jmreilly@usc. edu Editor: Colleen_Fogarty@urmc. rochester. edu • AAHPM Quarterly: Art of Caring Column Editor: Cory Ingram, MD Ingram. Cory@mayo. edu

References Fogarty CT. Fifty-five word stories: "Small jewels" for personal reflection and teaching. Fam Med. 2010 Jun; 42(6): 400 -2. Fogarty, CT, Gross, N, Mc. Laren, D. 55 -Word Stories: Small Jewels for Staying Soulful. AAHPM Quarterly; Spring, 2011. Grant WD. Life in 55 words: Part I. Fam Med. 2008. Apr; 40(4): 241 -4. Kabat-Zinn, Jon. Wherever You Go There You Are: Mindfulness Meditation in Everyday Life. New York: Hyperion, 1994. Kabat-Zinn, Jon. Whole Catastrophe Living: using the wisdom of the body and mind to face stress, pain and illness. Revised edition: 2013.

References Marchand, Fleming, Mastrocola, Gasper, Marty. Noticing…Reflecting…Healing: 55 Word Stories, AAHPM Quarterly. 2014; 15: 7 Marchand L, Gasper A, Go L, Schaefer E, Beasley J. More 55 -Word Stories: Noticing, reflecting, healing. American Academy of Hospice and Pallliative Medicine Quarterly. 2014 ; Summer (15): 14 -15. Merenstein JH, Wolfe S, Saurelsen S, Pritchard P, Weaver-Agosotoni J, Wilson S, et al. 55 -word stories and the care of the underserved. Fam Med. 2007; 39(3): 169, 169 -170. Moss, Steve. The world's shortest stories: 55 fiction. 1995. Scheetz, Anne & Fry, Mary. The stories. JAMA 2000; 283: 1934.

Presenter Email Contacts • Lucille Marchand – lrm 19@uw. edu • Colleen Fogarty – Colleen_Fogarty@URMC. Rochester. edu • Jo Marie Reilly – jmreilly@med. usc. edu

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