Prof. Einat Avrahami: To be prepared for death is a democratic move.People who are terminally ill should share their emotional world in the doctor’s office, according to an Israeli researcher. They should write letters and journals, and share them with their friends and family, too.

Prof. Einat Avrahami, from the department of English at Tel Aviv University has recently written a book The Invading Body (University of Virginia Press), which provides autobiographical accounts of the chronically ill, and features American writers who have chronicled their own accounts of dying.

The book can help the ill and their families understand the dying process, and gives insight to medical practitioners, she says. Avrahami believes there are gaping holes in the traditional medical system – especially in America – that can only be filled when doctors and nurses become more interested in the patient’s emotional experience, as an intensely important and meaningful story.

Her research is part of a new field that combines art and medicine, known as narrative medicine. Avrahami is the first in Israel, and among the first in the world, to research and practice this.

“The goal is to teach the doctor to recognize his or her own personal life story, and to be able to read the patient’s story, so that both can combine and create a mutual story in the clinical encounter,” says Avrahami, who currently gives seminars in narrative medicine to doctors, nurses and medical clowns.

In her recent book, Avrahami investigates an array of testimonies from the terminally ill, ranging from author Harold Brodkey’s struggle with AIDS, to Hannah Wilke’s self-portraits of cancer. While most people profiled in her book have since died, a few people – breast cancer survivors – have lived on.

A whole chapter in the book, in fact, is devoted to breast cancer. Avrahami argues that in contrast to the usual practice of immediate breast reconstruction, doctors should wait up to several years before they consider it together with the patient. “Women who have gone through it, testify that it is too quick,” she says.

Even though it saves the medical system time and resources, breast reconstruction is a painful and prolonged procedure that can lead to as much as 10 additional surgeries. “The autobiographies reveal that this shouldn’t be done to sick women,” says Avrahami.

This book is special, she notes, because it is one of the first to give a voice and platform to the sick, as they experience their own condition. This is different from current medical and cultural discourses, which give a dominant voice to medical practitioners who treat patients as objects.

The medical profession is the dominant voice in medicine, and belittles the experience of the sick, she says. This intensifies the feeling of loss of identity and control that patients experience when they become ill.

People have the right to express their own experience, and if they live on, it can teach them and others, even people who are not ill, about what they have lived through, Avrahami reasons.

Avrahami’s dream is that her book will be taught in medical and nursing schools around the world. But it is an important read for the general public as well. Americans especially, she says, do not like to discuss the physical deterioration of the body.

“People are approaching death and nobody talks about it in polite society. I would like to break this shell of fear and tact. All of us will be hurt by death sooner or later. To be prepared for it is a democratic move,” she concludes.


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