The first veteran Mukta Awasthi, MD, interviewed was 99 years old. His name was Peter Yim Yee.
Born in San Francisco and raised in Reno, Peter had come to Stanford as a young man before World War II interrupted his education. He served in combat and liberation campaigns, then returned home to finish college and medical school at Stanford. He went on to spend 50 years caring for patients as an anesthesiologist.
Near the end of Peter's life, with his family gathered around him, he sat down with Awasthi to tell his story.
“He shared that knowing his patients was important to him and was a huge part of his practice,” says Awasthi, a clinical assistant professor in the Stanford Division of Hospital Medicine. “So hearing his story was a full circle moment for both of us.”
His children recorded the conversation. Later, they used excerpts from his own words in a memorial to their father.
The interview was part of My Life, My Story (MLMS), a narrative medicine program Awasthi leads at the VA Palo Alto Health Care System. Through the program, veterans participate in a semi-structured interview about their lives. The conversation is then shaped into a concise, first-person narrative and, with the veteran’s permission, added to the medical record for members of the care team to read.
“It literally gives the patient a voice in their chart,” Awasthi says.
Putting the Person Into the Record
Most medical charts are built around illness. They document symptoms, diagnoses, medications, procedures, and treatment plans. They are indispensable to medical care, but they rarely capture the experiences that shaped the person receiving it.
“The medical chart is filled with narratives that are directed, dominated, and written from the perspective of the healthcare team,” Awasthi explains. “They contain our interpretation of situations and may even contain our biases.”
“Two patients may be afflicted with the same illness, but the illness does not affect them in the same way,” Awasthi says. “Each patient has a unique set of life experiences, history, values, and goals that simultaneously influence how they wish to be cared for and how their disease manifests.”
MLMS began in 2013 at the William S. Middleton Memorial Veterans Hospital in Madison, Wisconsin, as part of a broader VA effort to advance patient-centered care and whole health. It has since spread to more than 90 VA medical centers and several non-VA institutions, with more than 10,000 patient stories collected.
At the Palo Alto VA, the program grew from Awasthi’s desire to better understand the people she and her colleagues cared for.
For her, that desire was also deeply personal.
“Over 25 years in medicine, the most precious moments have been spent sitting at the bedside allowing the patient to share who they are when they are not in the hospital room burdened by their illness,” she reflects. “The motivation to start MLMS at Palo Alto VA was to reinforce the concept that the best care is delivered when we marry the science of medicine with the story-driven art of medicine.”
A Story That Changed the Care
The Palo Alto program has now collected roughly 300 stories from veterans receiving care in settings that include outpatient clinics, inpatient units, hospice, nursing homes, rehabilitation, and spinal cord injury services.
Some stories read like living history. Others are stories of perseverance, family, work, grief, or love. Some make Awasthi laugh. Others make her cry.
“All impact me,” she says. “Each story offers a window into a patient’s life.”
One was written by a high school student volunteer after interviewing a veteran with a spinal cord injury. Awasthi remembers it as a deeply moving account of struggle, love, perseverance, and triumph.
A month after reading it, she was assigned to care for the veteran.
“The story helped me connect with him and his family in ways that I could not have in the brief time I had with him,” she says.
The veteran was gravely ill. Because Awasthi already understood something about his history, relationships, and family dynamics, she was able to enter difficult conversations with a foundation that might otherwise have taken days to build.
The veteran eventually died from complications of multiple medical problems. But his story changed how Awasthi and others accompanied him and his family through his final illness.
Providers who had cared for him for years were moved to tears when they read it.
“They learned things about him they had not known,” Awasthi says.
The Freedom to Simply Listen
The program is powered by a wide range of interviewers, including physicians, residents, students, staff members, and volunteers. At the Palo Alto VA, it has also become part of an ambulatory care elective for residents.
Awasthi meets with residents before and after they interview one of their clinic patients. Many describe it as one of the most meaningful experiences of their training.
“It was nice not to discuss medical issues or have a strictly set agenda or time constraint and just get the chance to talk to my patient as a human being to learn about their life experiences,” one resident wrote.
Another reflected on how the interview changed the relationship: “It has made me build a closer relationship with my patient since I got to know more about him as a human and the experiences that made him develop certain perspectives.”
That freedom – to listen without trying to diagnose, redirect, or reach the next item on an agenda – is increasingly rare in medicine.
“In training it is very easy to lose sight of why we go into medicine, the human connection,” Awasthi says. “We get lost in the day-to-day tasks of orders, admissions, discharges, tight schedules, documentation requirements.”
Over time, she says, patients can begin to look like collections of diseases, acronyms, and tasks. A medical “one-liner” may efficiently summarize why someone is in the hospital, but it can never convey the fullness of the person in the bed.
“If we miss the background story and begin to see each patient as a list of diseases or tasks, we easily lose sight of the fact that there is a person behind this patient and illness and cannot provide the best care.”
Giving People Their Voices Back
Awasthi now sees possibilities for the program across nearly every corner of medicine and medical education.
At the VA, MLMS has been combined with art and music. Stories have become legacy pieces for hospice patients and people with dementia. High school and college volunteers use the interviews to learn the foundations of empathetic listening, while medical trainees refine skills that will shape their future clinical practice.
Speech-language pathologists are using the program with patients relearning to speak after strokes or tracheostomies, “to literally and figuratively give their voices back,” Awasthi says.
The model has also entered inpatient rehabilitation, social work, research, and quality-improvement projects. Awasthi is collaborating with Stanford’s medical humanities program to develop a curriculum for students, and she hopes to expand the project through podcasts, books, exhibitions, and a more robust digital presence.
