Telling stories is among the most memorable and emotive ways of communicating. In the world of biomedicine, we devote much attention to abstract ideas – concepts – but our appreciation of the meaning and importance of these ideas often comes from stories. When we apply them to problems we encounter, we incorporate them into our own narrative – the stories of our colleagues, our patients and ourselves.
Have you ever attended a lecture and emerged thinking, “I have no idea what that was that all about”? I had one such experience in my second undergraduate year. Our class at University College London had succeeded in required first year courses in statistics, chemistry, and the like, and we were now glad to begin studying what we’d really come to university to learn – in my case, Zoology. Zoology began with a course on animal cell biology. The teachers were sympathetic and lucid, but the Zoology Department had a new Chairman, an immunologist of the high renown called Avrion Mitchison. He liked to be called “Av.” Av had not previously taught undergraduate students, but wanted to be involved in the day-to-day life of the Department, so he’d decided to help as a teacher in the animal cell biology course. This was of some concern to us, because his intellect was reputed to be stratospheric. We sat through his first lecture. Afterwards, I believe I recognized that he’d spoken about something to do with immunology, but exactly what, I could not say.
This would have been troubling enough, but what happened next made the situation even worse. While I was walking down the stairway in the Zoology Department after the lecture, animatedly discussing the experience with a fellow student, I encountered a little old lady walking up the stairs toward us. She stopped us and introduced herself as Naomi Mitchison, Avrion’s mother. “Tell me,” she asked with concern, “do you find him to be a good lecturer?” To appreciate the full toe-curling embarrassment engendered by this question, you’d have to know what we already knew, that Naomi Mitchison was actually Lady Mitchison, Baroness of Carradale, a member of the British aristocracy; she had been awarded a CBE (Commander of the British Empire) as an author of distinction, and was therefore a prominent intellectual; and, even more awe-inspiring to us, she was the daughter of the physiologist John Scott Haldane and sister of J.B.S. Haldane, and therefore a member of a scientific dynasty that we venerated. Mercifully, I have little recollection of what I said, except that it was a heart-felt attempt to punt.
After the embarrassment subsided, the issue was how to tackle Av’s subject remained. I decided to take an approach I’d stumbled upon the previous year while grappling with the results of quantum chemistry, a subject for which I lacked anything close to sufficient mathematics. What I did was to turn to the stories of the people who had originally developed the subject, what their life-circumstances had been, what drove them to pursue their research, and what it meant to them. I immersed myself in stories of the development of immunology, the scientists who founded it, and the enormous impact they’ve had on the lives of all of us. My fear of immunology dissipated, and I started to ask the questions that would help me understand what I’d come to regard as a fascinating subject. My regard for Av was never damaged, indeed steadily grew. He once told us a story about his first Chairman - it must have been the Nobel laureate, Peter Medawar, at Mill Hill – who, upon Av’s arrival as a junior faculty member, had asked whether there was anything he felt he needed. Av looked around his office, which was entirely bare of furniture, and replied tentatively that some shelves might possibly be useful. Medawar had looked around the office, thought for a little, and then responded that this seemed a reasonable request. The next Saturday, Av happened to go to his new office to unpack some boxes, and was surprised to find Medawar there with a hammer and nails putting up shelving himself! What a remarkable story about mentorship, and how revealing that Av would recall it! When I graduated, Av asked me if I’d consider joining his laboratory to do my Ph.D. research. I had to decline because I had already decided to study human genetics and evolution instead.
Curiously, immunology soon caught up with me again. I decided to learn how to make monoclonal antibodies against a protein I was interested in, and then how to determine the amino acid sequences of antibodies to help discover how it’s possible for each of us to mount specific immune responses against a seemingly limitless universe of antigens – a fascinating issue that remains very important in medicine. The technologies I learned subsequently allowed me to contribute to many interesting projects both immunological and non-immunological.
Students smile wryly when I tell them stories about scientists who discovered the things they have to learn. But stories help us appreciate the importance of knowledge by stimulating us to imagine what medicine was like before particular discoveries were made. Stories invite us to ask questions about things we presently understand incompletely or incorrectly, and to become engaged in better understanding. And stories foster the optimism that individuals or small groups of people working together, often under adversity, can make a difference if they’re willing to think of the right questions and determined to seek the answers. The Dallas geneticist and physician, Mike Brown, tells how the Nobel-prize-winning work on cholesterol metabolism that he and Joe Goldstein began at the National Institutes of Health in Bethesda, MD all stated with a little girl who had xanthomas – deposits of cholesterol - on the skin of her arms and legs. She suffered from familial hypercholesterolemia, and had experienced her first myocardial infarction at the age of eight years. Think of the number of lives that have been saved by Brown, Goldstein and that little girl!
Teachers communicate stories, and invite students to participate. For doctors-in-training, the invitation is to continue stories of science and humanity in caring for their patients. There’s continuity between medical school stories and patient stories. The story told by each new patient contains something of what the physician has seen before, and something that’s new. The physician practices life-long learning with the help of patients as teachers. Likewise the teacher looks to students as mentors. It helps if teachers are good at explaining, but the most important thing they do is to invite and encourage us to learn. Some of my colleagues fear that teachers risk setting up a relationship of dependency between themselves and their students that diminishes students’ willingness to learn independently. I haven’t experienced this. I have fallen heir to the stories of great teachers.