The patient was already in the cubicle when I arrived. Fifty-eight years old, cirrhosis, ascites, confusion — the ED notes had been written in the familiar clipped tones of medical shorthand.

His sister stood at his bedside, anxious, hovering like someone who had already told this story many times that day.

“Doctor, he’s not normally like this.”

Her voice was urgent, but I was tired. It was late; my list was long. I moved through my questions, filling in the blanks on the clerking sheet. How long had he been confused? Any fevers? Past medical history? Medications?

He muttered under his breath, lapsing into silences, eyes flicking toward some distant point. I noted hepatic encepalopathy, likely precipitated by SBP (spontaneous bacterial peritonitis)*. His story — or rather, my version of it — was written before he had truly spoken. And my version of it wasn’t even in prose - just the medical shorthand that we were all used to.

Days later, after antibiotics and fluid, his mind cleared. And then, the floodgates opened. He began to talk in fragments, like someone slowly remembering his own life after a long sleep. About his boat. About his wife who had died last year. About how he had stopped taking his diuretics because “what’s the point now?”

None of this made it into the official record.

On paper, he was a cirrhotic man with ascites and infection, improved with antibiotics. But the story he carried was of loss, grief, and slow unraveling. I had been so busy writing the medical story that I’d missed his.

That moment has stayed with me.

The Medical Record as a Dominant Narrative

Hospitals run on stories — but not all stories are created equal.

Every patient encounter is translated through multiple narrators: the patient tells their story to the nurse; the nurse reframes it for the doctor; the doctor condenses it for the notes; the team abstracts it for the ward round. Along the way, details are trimmed, metaphors lost, silences filled in, until what remains is a crisp, linear narrative that fits the format of the electronic health record.

We often treat the medical record as the definitive story. But it’s not. It’s a curated, selective narrative authored mainly by clinicians, shaped by institutional priorities, time constraints, and the need for legibility within a system built for efficiency, not nuance.

Narrative scholar Arthur Frank writes:

“Whoever tells the story, tells the life.”

In medicine, the storyteller is often the clinician — and what we choose to write determines what is remembered. Lab results and timelines make it onto the page. Fears, metaphors, and moments of human connection often do not.

Power, Voice, and Translation

Not everyone speaks the language of the hospital. Some patients rely on family members or interpreters. Others hesitate to contradict a doctor’s framing. Some are too sick, too intimidated, or too practiced in hiding vulnerability.

Even when they do speak, their words are filtered through clinical templates. Consider the familiar phrase: “Patient denies pain.” This tidy sentence flattens a spectrum of possibilities: maybe the patient doesn’t have a shared understanding of what “pain” means. Maybe they’re stoic, or fearful of being seen as “difficult.” Maybe they don’t want their daughter — standing at the bedside — to worry.

“The original is unfaithful to the translation.”
— Jorge Luis Borges

Each retelling within the clinical system is a translation — from lived experience into clinical discourse, from metaphor into measurement. But translations are never neutral. They involve choices about what to preserve, what to flatten, and what to omit. And often, the original — the patient’s lived story — is the one that gets betrayed in the process.

Family members, often keepers of the richest narrative threads, become “collateral historians” in the notes — their voices subordinate, supporting actors in a biomedical script.

And cultural narratives, especially in multilingual contexts like Singapore, are often mistranslated or quietly lost. A patient who frames illness as karma may be written up as “expresses fatalism.” A family’s protective silence becomes “non-disclosure.” These aren’t neutral acts; they’re narrative translations shaped by power.

When Stories Collide

Sometimes the divergence between narratives is stark.

A patient sees illness as divine punishment; the doctor sees a viral aetiology. A family clings to hope; the medical team sees futility. A patient believes they’re “doing better” because the doctor smiled; the doctor smiled because they didn’t know how to say the cancer had progressed.

These aren’t just disagreements — they are competing stories about reality. And often, the clinician’s story wins. It’s the one that gets entered into the notes, presented at MDTs, codified in discharge summaries.

But whose story carries the emotional truth?

Whose story is remembered?

Holding Multiple Narratives

Narrative medicine asks us to resist the urge to collapse stories into a single thread. Instead, it invites us to hold multiple perspectives side by side — patient, family, clinician, system. None are complete; all are necessary.

In practice, this means:

• Letting patients speak uninterrupted, even briefly, before shaping their story.
• Recording key phrases verbatim, not always translating them into clinical jargon.
• Acknowledging differing perspectives explicitly in the notes:
  “Patient frames illness as divine punishment. Family sees hospitalisation as opportunity for spiritual healing. Medical team sees advanced liver failure.”
• Reading stories back to patients to check: “Is this what matters most to you?”

This isn’t about abandoning biomedical narratives. It’s about creating narrative space — room for polyphony, for stories to coexist without erasure.

The Ethics of Storytelling

Whenever we write or speak about patients — in case notes, teaching rounds, publications, or even casual conversations — we act as storytellers. That carries ethical weight. We shape how others understand a person. We influence the arc of care.

Before pressing “save” or presenting a case, it’s worth pausing to ask:

• Whose voice is dominant here?
• What story might be missing?
• Am I telling this story with or about the patient?

Beyond the Hospital Walls

This question — “Who gets to tell the story?” — extends beyond the bedside. It’s about whose narratives shape health policy, medical curricula, research priorities. Historically, the voices that dominated were those of physicians, administrators, policymakers. Patients were objects of stories, not narrators of them.

But this is slowly changing. Patient advisory councils, co-authored narratives, narrative research methods — these are small but meaningful steps toward narrative justice. They remind us that stories told about people without their participation are incomplete, sometimes dangerously so.

Closing Reflection

The man with cirrhosis went home weeks later. His discharge summary read: “Admitted for ascites, treated with antibiotics and diuretics, improved.” But the moment that mattered was not captured there: the quiet afternoon when someone finally asked about his wife, and he wept. That was the moment his story returned to him.

Narratives in medicine are always plural. The question is not whether we tell the story — but whose story we choose to tell, and how faithfully.

“Nothing is built on stone; all is built on sand, but we must build as if the sand were stone.”
— Jorge Luis Borges

As clinicians, we are both witnesses and architects of stories. The stories we write shape what future teams will see, how care is remembered, and sometimes, how reality itself is constructed. Borges reminds us to build carefully — with humility, imagination, and reverence for the shifting ground beneath our words.

Further Reading

• Frank, A. (1995). The Wounded Storyteller. University of Chicago Press.

*Hepatic encephalopathy is a condition that happens when the liver isn’t able to clear toxins from the blood as it normally would. These toxins can build up and affect the brain, leading to confusion, personality changes, or even coma in severe cases.

Spontaneous bacterial peritonitis (SBP) is an infection of the fluid in the abdomen that sometimes occurs in people with advanced liver disease. This infection can put extra stress on the body and often triggers or worsens hepatic encephalopathy, which is why treating the infection usually leads to an improvement in the patient’s mental state.

Victoria Ekstrom is a consultant gastroenterologist at Singapore General Hospital and co-lead for Narratives in Medicine at SingHealth Duke Medical Humanities Institute. With a background in behavioral science, she is passionate about the intersection of medicine, communication, and the arts. Through her writing, she explores how narratives and humanities can transform patient care and medical education.