It wasn’t a great performance. It might not even have been good. But I did it. When I stepped down from the stage, I just felt relieved.
I had diligently memorized my lines. I started off by telling the audience about the time I nearly tipped over trying to put on my underwear. That drew a laugh, as I had hoped it would. For the next seven minutes, the performance went according to plan. Then came an emotional inflection in the script.
“I mourned the version of me who existed before critical illness. The Ian who took breathing for granted. The Ian who assumed his presence in his family’s life was a given.”
As I stared out at the audience, waiting for the next words to emerge from my mouth, my mind went blank. I didn’t panic. I’m an intensivist, for goodness’ sake.
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Instead, I coughed, clearing my throat as I looked down at the stage. Maybe the answer was there, at my feet. Perhaps the audience would think I’d gotten emotional after that line about my family. That seemed somehow preferable to the notion that I’d simply forgotten my next line.
It was like those painful moments we all have during training, when we’re asked about the alveolar gas equation during ICU rounds, or to name some apparently invisible structure in the operating room. It felt like ten minutes, but it was just seconds before my brain came back online. I looked up. Maybe they hadn’t noticed. The words flowed once more.
“The mortal threat seemed to be over. But the existential one remained. Would I ever feel like me again? Could I return as an objective clinician?”
I’d been selected at the end of the summer as one of four storytellers at After Hours, a spoken-word narrative event at CHEST’s Annual Meeting. In the ensuing six weeks, I had rehearsed with my coach, revising the story and committing the sequence of words to memory. But I’d mistaken memorization for performance.
As a 42-year-old pulmonary and critical care attending, I was skilled at the former and woefully inexperienced at the latter. I was onstage without protection: no podium, no speaker’s notes, and no slides. The last time I’d done anything like it was during my high school talent show twenty-five years earlier, when I’d composed and recited a satirical poem while banging on a pot for musical accompaniment.
This was different. Now, I was an intensivist. An academic leader. A husband. A father to four young children. I had much more to lose. And I was telling the story of my own brush with critical illness: a pulmonologist who’d fallen ill with influenza and asthma. If I’d made the story up, it would have felt almost too cute. But it was painfully real.
I’m comfortable managing difficult airways, complex shock, and ventilator mechanics. I make high-stakes decisions with incomplete information. I guide families through existential questions for which there are often no easy answers.
But that’s all about other people. When I do those things, I’m in control. I’m competent. Protected by my white coat, my blue scrubs, and my credentials.
Now I was onstage, unprotected, in front of an audience of my colleagues and peers. Telling my story. Describing my organ failure. My fear.
The irony is that the story I was reciting (and perhaps somewhat unsuccessfully performing) was itself about a different kind of performance. Mine was a story about a physician performing the role of a patient. As my wife can attest, that performance was subpar.
A frightened father performing good health on video chat, while wearing a high-flow cannula in his nose. A man speaking in a cartoonish, heliox-induced voice while trying to explain his frustration, because he felt his fear and dyspnea were being blamed on anxiety. A man who arrived home grateful to be alive, but uncertain when he would be able to return to the roles in which he thought he’d been cast. Husband. Father of four. Attending physician.
Perhaps it was a problem of framing. It wasn’t really a performance at all. It was just me, metaphorically naked, telling my story.
Afterward, several audience members came up to thank me. For being vulnerable. For being brave. For sharing. Some of them shared their own experiences with illness, or their own passion for writing stories. We exchanged contact information. I formed new connections.
Maybe it didn’t matter that the performance was merely adequate. That I didn’t dramatize the experience particularly well.
There is evidence that storytelling matters in medicine. Physicians who report more sacred moments of meaningful connection with their patients experience less burnout. The effect is greatest among physicians who discuss these encounters with their colleagues.
Maybe the point of my performance was the story itself. The words. Perhaps the point was to share what it felt like. What it meant.
As physicians, we need more spaces where we feel safe sharing our own stories, and enough time and mental bandwidth to truly listen to our patients tell theirs.
I told my story onstage. Others listened. We connected. We were human.
Ian Barbash is a practicing clinician, leader, and writer. He is an associate professor of medicine at the University of Pittsburgh and a pulmonary and critical care attending physician at UPMC. He graduated from Williams College and Harvard Medical School before completing residency at Massachusetts General Hospital and fellowship in Pittsburgh, where he remains on faculty and lives with his wife and four children.
In addition to his clinical work, he completed training grants from the National Institutes of Health and the Agency for Healthcare Research and Quality, led an ICU telemedicine program during COVID-19, and currently leads physician well-being programs. With a career spanning clinical care, leadership, academic research, and physician well-being, he brings a unique perspective to storytelling in medicine.
His writing spans critical care health services research and narrative medicine, with work appearing in JAMA, NEJM Catalyst, and Annals of Internal Medicine. His memoir, In the Unit, explores his experience with critical illness as both a patient and an ICU survivor. He writes and speaks about that experience to promote empathy for both health care professionals and the people they serve. He shares more on his website and on Substack.
