Case Repertory began as a conversation between myself and Damian Tarnopolsky, most likely over a beer in Sin & Redemption, across from Toronto’s Art Gallery of Ontario. Make of that name what you will. I put it to him that while more and more physicians and healthcare workers are inquisitive about Narrative-Based Medicine, and signing up for creative writing seminars at the University of Toronto’s Narrative-Based Medicine Lab, the classic case report is slowly being erased from those medical and scientific journals with the highest impact factors and citation indices.
This seems a tad rash. The case report has always conferred a forum to document new findings and experiences amongst small patient populations (sometimes n = 1) with idiosyncratic or newly discovered diagnoses. Combining its (not always unproblematic heritage) with our interest in Narrative-Based Medicine, we imagine Case Repertory as inviting the dual goal of original narrative case studies by healthcare workers that are also “deep-reads” influenced by science and art.
When we announced our first call for submissions, we asked that you “write about the case that keeps you up at night,” or “share a private learning that might offer a lesson for the broader public.” Privately, we mulled over, “What exactly are we looking for?” Personally, I was of the mindset, “We’ll know it when we see it.” Another way of saying, “If we build it, they will come.” The submissions we received during that first window exceeded our expectations, not only in empathy and consideration, but also, that elusive ingredient, craft.
The Editorial Board (Ashna Asim, Miriam Colleran, Allan Peterkin, Damian Tarnopolsky, and myself) were pleasantly surprised at both the number of submissions, and the quality of writing on show. Our first publication showcases four such pieces, while others accepted from the first window are in “pre-production” for future publication.
Alyssa Boyd’s piece, “The Beam of Light,” is a sparkling piece of work that embodies all that we aspire to experience with Narrative-Based Medicine: compassion, impact on self, reflection, and celebration. Reading this was a gift and we hope it feels the same for you.
Like Boyd’s piece, Yuliya Rackal’s “The Dance of Family Medicine” places the patient at the centre of the writing. It gives that patient, who likely succumbed to their diagnosis, a presence and voice without ever speaking for them. The back and forth between physician and patient illuminates the humour and lightness that can be found in even the most harrowing of moments, and demonstrates beautifully the power of kinship between patient and carer.
Written from the perspective of a caregiver, Paula Holmes-Rodman’s “Fall in the Foothills” expands the universe of Case Repertory still farther—and stands in its own right as a lyrical, magical, devastating reflection on loss.
Speaking of “back and forth,” our third offering, “FND,” is a fractal of fragile beauty from Miriam Colleran and Tríona Seery. Delivered via two narrative voices—parent and patient, physician and physician’s child— “FND” dances back and forth from one perspective to the other. While, as often found in medicine, there is no easy release or definite resolution here, it did answer two major questions for me, namely, “I’ll know it when I see it,” and, “How do we deal with consent for publication?”
In our original call for submissions, we stated: “All identifying features of patients, colleagues, and other people appearing in the submission must be altered or removed. Authors must contact all patients, colleagues, and any others written about in the submission to request their consent to be depicted in the piece and inform them that every effort will be made to disguise their identity. This consent must be documented and kept by the author.”
While this may seem somewhat ambiguous, it is clear when a piece of writing honours the patient(s) in a manner that is both free of the possibility of recognition/identification and, actively engages the patient voice so as to make them a collaborator in their own story. If, as in “FND,” the patient contributes to the writing then consent is obvious. If, as in “The Beam of Light” and “The Dance of Family Medicine,” a patient is long since deceased but the writing and narrative radiates empathy, compassion, due care, even regret, then, “We will know it when we see it.”
Thank you, stay healthy, keep healing, and send us your work.
Conor Mc Donnell
Editor-in-Chief, Case Repertory