I’ve had many dreams that have gone awry. The one that disappeared yesterday was my dream of working in Narrative Medicine. Back when I started writing and getting published in 2007, before I started working at the clinic where I am now, I constructed a dream for myself of becoming a Narrative Therapist. I visualized using my degree in social work alongside my passion for writing. I applied seven times to six Masters of Fine Arts programs in creative non-fiction writing and received seven rejections. Devastated, but not depressed or suicidal (as I might have become in the past), I found my job and things worked out.

 Yesterday, I was reading an online literary journal and the bio of the author mentioned that she had a Masters of Science in Narrative Medicine from Columbia University. This is the description of the program from Columbia University’s website:

Health care and the illness experience are marked by uneasy and costly divides: between those in need who can access care and those who cannot, between health care professionals and patients, and between and among health care professionals themselves. Narrative medicine is an interdisciplinary field that challenges those divisions and seeks to bridge those divides. It addresses the need of patients and caregivers to voice their experience, to be heard and to be valued, and it acknowledges the power of narrative to change the way care is given and received.”

The application requirements are demanding and ones that I'm not sure I would be able to meet:

1. Two letters of recommendation, written by supervisors or peers who can attest to your capacity to engage in a rigorous academic program that calls for maturity and stamina, as well as the ability to receive and provide criticism.

2. A statement of academic purpose (500-750 words) addressing the followin:

• your purpose and interest in pursuing a degree program in narrative medicine

• how the degree program fits into your overall professional growth, focusing in particular on the connection between the program and your academic and/or professional experience

• your anticipated contribution to the program

• your anticipated contribution to professional field

3. Evidence of your promise in the field of narrative medicine. You may fill this requirement in a number of ways, including:

• A work of fiction, non-fiction, or poetry (published or unpublished) that you have authored that pertains in some respect to the field of narrative medicine, narrative and literature, medical humanities, arts and medicine, or related fields. Examples would be a first person narrative essay or memoir, or an interpretive essay of a work of art or literature.

• A scholarly paper (published or unpublished), article or book

• A syllabus for a course you have taught in narrative medicine or a related field, including an essay of no more than 1000 words describing and critiquing the course.

• A portfolio of interpretive art, a film you have made, images of a performance piece, or the like, with accompanying essay.

4. Professional résumé.

Additionally, the cost is prohibitive, coming in at almost $50,000 for the program. Plus with my umpredictable hours at my current job, can I really make the commitment to such a rigourous (as it is described) program which is a considerable distance from my home. Something would have to give and I don’t know what it would have to be.

So at this point pursing the Narrative Medicine program would not be a good idea. I have been able to come to that conclusion, though it hurts because it has been a long-standing dream and goal of mine. What I’m afraid I would have to sacrifice is my sanity — as a result of the stress, I would most certainly crumble and why would I risk that when I have come so far and built a life worth living?

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As a clinician I wonder when it is realistic to encourage my patients to pursue a dream or a goal and when it is the best decision to reality test with them the benefits and the possible consequences — creating a balance sheet.

If a client says she wants to get a job as a bookkeeper but can’t seem to pass the math portion of the GED, should I encourage her to keep trying? Or will it further damage her self-confidence, when it is possible she might succeed in another area?

If a client wants to get a 9 AM– 5 PM job in an office but is unable to make his therapy and psychiatrist appointments on a consistent basis, is it realistic that he is going to be able to stick to that office schedule? Perhaps a referral to VESID (Vocational and Education Services for Individuals with Disabilities— as it is known in our city) would be a better idea — where they assess interests and aptitudes — is the place to start.

What if it is the patient’s own lack of confidence that is holding her back? She has the skill —perhaps to obtain a job or return to college, but she doesn’t think she can do it. Often, I will disclose that I didn’t start graduate school to get my masters in social work until I was 38 years old — a sixteen year break from the academic world. I am honest with them in expressing that I harbored doubts and fears and returning after so long; could I keep up with the work? What if I tried and failed?

I encourage my patient to voice her fears and doubts. I have an expression I used when I decided to get my masters – I say that I took a leap of faith. A leap was necessary because there was no easy transition between having been out of school for so long and going back to sitting in class and writing papers and taking exams. I use that expression with my patient. Take a leap of faith in yourself.

If she is willing to try, it takes a number of sessions — and then she may or may not be ready to take a first step. Put together a resume or go online to look up a course of study at a school. If she can that’s great. If the anxiety is too severe, then we talk about it.

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In giving up the Narrative Medicine program (for now?) I had to admit to myself that I am not superwoman. That I can’t do it all. Coming to this conclusion was difficult for the perfectionist in me, the one that drove me to pursue the thin ideal that nearly took my life.

Giving up a dream, more than one dream is hard. But it doesn’t mean giving up on life.

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