Narrative critical care: a literary analysis of first-person critical illness pathographies

Background: Life-threatening illness can be devastating for patients as they experience shifting levels of consciousness, recurrent delirium, and repeated setbacks. Narrative Medicine and its sub-discipline Narrative Critical Care increase healthcare professionals' understanding of the patient perspective, and interpretation of their stories is a means to improving practice. Purpose: We aimed to investigate book length first-person accounts of critical illness to gain a deeper understanding of universal and individual patient responses and to provide an example of Narrative Critical Care. Method: We performed a comparative literary analysis of five books supported by the Biographical Narrative Interpretive Method (BNIM) that moves through stages of structural analysis, thematic analysis, and cross-case theoretisation. Findings: Universal patient responses evolved through five existential dichotomies of life/death, sanity/madness, before/after, gain/loss and inner strength/external support. Individual patient responses were expressed as turning points along the illness trajectory, and biographical continuity was restored by integration of new self and old self. Conclusion: We uncovered commonalities and differences in storied accounts of critical illness and survival. New insights might enable healthcare professionals to personalize patient care. More consistency is needed during transitions and rehabilitation of intensive care survivors.