Deconstructing a Narrative Medicine Workshop

Choosing a Third Object and Writing Prompt

Tony Errichetti, PhD, MA

A frequently asked question among narrative medicine trainees practitioners in training is, how do we choose a third object (also referred to as "the text") and writing prompt?

The following is a deconstruction of a recent Simulationist Narrative Medicine Community workshop addressing the following:

Workshop Goals
A description of the goals intended to guide the participants' experiences.

Selection of the Third Object
An explanation of the process behind choosing the "third object" (also referred to as "the text).

Writing Prompt Development
Insights into how the writing prompt was crafted to encourage personal exploration and engagement with the workshop’s goals.

__________________________________________________________________

Narrative Medicine Workshop Goals

The choice of third objects evolves out of the Simulationist Community workshop goals:

·      community connection

·      enhancing mindful listening

·      fostering cultural humility

·      self-reflection

·      co-construction of meaning.

Third Object Selection

What is a third object, and how did I select one for this workshop?

A "third object" in narrative medicine is an external item—such as a piece of art, a poem, a photograph, a video, or an excerpt from literature—that serves as a focal point for discussion, reflection, or connection among participants.

Key questions in my selection process - does the piece both delight and confound me?

• Is it sufficiently layered and artful?
• Does it leave me with questions? I aim to present a piece that I don’t fully grasp, inviting the group to decode and co-construct its meaning together.
• For Zoom sessions, can the text fit on a single PowerPoint slide? For special programs, this guideline can be more flexible.

Session goal and third object choice: In the aftermath of the recent presidential election, I sought a text that might resonate with the collective unease around the nation's state and upcoming leadership. Yet, I wanted something subtler—something not overtly tied to these specific themes or events.

I searched through poetry sources about grief, protest, resistance, but everything felt too explicit, too direct. I didn’t want to guide the group toward feeling exactly what I was feeling.

Finally, I pulled The Tidewater Tales by John Barth from my shelf—a 1987 novel set in the Chesapeake Bay close to Washington, DC, about a "minimalist" writer with writer's block. The novel is set against a backdrop of fear over nuclear war, new world orders, and anti-progressive sentiments of the Reagan administration. In many ways, its themes seemed to mirror our own times.

The challenge was finding an excerpt from this dense novel that could fit on a slide and stand alone. The passage needed to be self-contained and impactful without requiring the broader context of the novel.

Here's what I found on the first page:

__________________

KATHERINE SHERRITT SAGAMORE, 39 YEARS OLD,

AND 8 ½ MONTHS PREGNANT,

BECALMED IN OUR ENGINELESS SMALL SAILBOAT,

AT THE END OF A STICKY JUNE CHESAPEAKE AFTERNOON

AMID EVERY SIGN OF THUNDERSTORMS APPROACHING

FROM ACROSS THE BAY,

AND SPEAKING AS SHE SOMETIMES DOES IN VERSE,

SETS HER HUSBAND A TASK.

Tell me a story of women and men,

Like us: like us in love for ten

Years, lovers for seven, spouses

Two, or two point five. Their Houses

Increase is the tale I’d wish you tell.

Why did that perfectly happy pair

Like us, decide this late to bear

A child? Why toil so to conceive

One (or more), when they both believe

The world’s aboard a handbasket bound for hell?

Well?

__________________

This excerpt met a few key criteria. First, it seemed to capture an underlying concern that resonates with many of us today, regardless of political beliefs:

“The world’s aboard a handbasket bound for hell.”

Additionally, the passage appeals to our narrative interests when Katherine Sherritt Sagamore assigns her husband a meaningful task:

“Tell me a story.”

Close Reading

Once I selected the text, the next step was to engage in the same process I would ask of the workshop participants, starting with my close reading the text (Brooks, 1947), taking detailed notes and asking myself questions on the following:

Word Choice:

• Why does the text describe Katherine as "becalmed" rather than simply "waiting" or "stuck"? What does this word choice suggest about her state of mind?
• What is the effect of using precise language like “39 YEARS OLD” and “8 ½ MONTHS PREGNANT”? How does this specificity influence our understanding of her situation?
• How does the phrase “the world’s aboard a handbasket bound for hell” shape the tone?

Figurative Language:

• What imagery is used in the passage, and what effect does it have? For example, how does the imagery of an “engineless small sailboat” contribute to the themes of waiting, vulnerability, or dependence?
• What is the impact of the metaphor “the world’s aboard a handbasket bound for hell”? How does this metaphor reflect Katherine’s anxieties or frame the couple’s view of the world?

Tone and Mood:

• What tone does Katherine’s poetic speech create? Does it feel nostalgic, ironic, hopeful, doubtful, or something else?
• How does the tone shift from practical description to philosophical questioning? What does this shift reveal about Katherine’s mindset?
• What mood does the language of the setting (“sticky June Chesapeake afternoon,” “sign of thunderstorms approaching”) create, and how does it interact with Katherine’s dialogue?

Structure of the Passage:

• Why does the passage start with the details of Katherine’s age, pregnancy, and location before moving into her request for a story? How does this build context for her question?
• How does the structure of her verse—its rhythm, rhyme, and enjambment—enhance or alter the meaning of her questions?
• What is the effect of breaking up the sentence structure with parenthetical references, such as “Two, or two point five”? How does this add nuance to her reflections on their relationship?

Patterns and Repetitions:

·      Why are there so many specific numbers and time references (e.g., 39 years old, 8 ½ months pregnant, ten years in love)?

·      What might these time markers suggest about the couple’s relationship and their place in life?

·      Are there repeated themes or ideas that give insight into Katherine’s mindset, such as stability, waiting, or impending change?

Character and Perspective:

·      What does Katherine’s choice to speak “in verse” reveal about her character?

·      How does her heavily pregnant state influence the way she sees the world and frames her question to her husband?

·      What might her character’s questions reveal about her hopes or fears?

Considering the Context:

·      How does the setting—a still boat on the Chesapeake Bay with a thunderstorm approaching—add to the emotional tension of the scene?

·      In what ways might this setting symbolize their relationship or their anticipation of the future?

·      How does the time of day (a “sticky June afternoon”) impact the mood, and what could it signify about their situation?

Interpreting the Themes:

·      What are Katherine’s questions ultimately about? Are they questions about love, time, the purpose of family, or something else?

·      How does the idea of “the world’s aboard a handbasket bound for hell” reflect the couple’s concerns or worldview?

·      What might Katherine be seeking when she asks her husband to “tell me a story” about another couple like them? Is she looking for reassurance, understanding, or answers to her own doubts?

Formulating a Thesis or Insight:

·      What insight or central idea emerges from Katherine’s questions and the setting of the scene?

·      How does this scene reflect broader issues such as generational anxieties or the conflict between personal joy and societal despair?

·      How might the physical state of being “becalmed” in a boat with no engine serve as a metaphor for the couple’s emotional or relational state?

Review and Synthesize:

·      How do the setting, character, and themes come together to create a sense of tension or reflection?

·      What larger message might this scene convey about love, uncertainty, and the future?

·      How does the interplay of personal experience and global fear shape the characters’ views on family and legacy?

The Writing Prompt

After the discussion of the text, participants are then asked to "write in the shadow of the text" (Feinstein, 2005) by using the text as a foundation, prompting participants  to go deeper and draw out personal insights, resonances, or tensions that the text inspires.

What was in the shadow of this text for me?  Katherine tasks her husband to "Tell me a story of a man and woman, like us..." This gave me the idea to try a writing prompt:  

Write about the story you would like someone in your life to tell.

Given the 4-minute writing limit, I didn't want to burden the participants with the impossible task of writing a story. Writing about a story, I hoped, would get participants to think about a story they would like to hear, in broad strokes, from someone close to them.

_________________________

Here are two examples of participants' prompted writing.

Example 1:

The Story I’d Like Someone to Tell

Sing for me that song – the one whose lyrics I often forget,

that song of determination and success despite sadness and fear.

Sing of community and joy and folks with good hearts, strong arms, and giving spirits.

Sing, please.  I so often forget those words.

Example 2:

Because I am so self centred, I would like someone in my life to tell a story about how I shaped his/her life for the better, how my presence, words or actions are remembered and appreciated.  I would really love that beautiful feedback and to see myself through another's eyes.  This could do wonders to erase years of self-doubt and help me see myself in a totally different light.

_________________________________

Summary of Steps:

·      Consider the goals of your workshop

·      Search for a third object that reflects your workshop goals

·      Close read the third object, making notes and asking yourself questions that can be asked of workshop participants

·      Develop a writing prompt derived from your close reading of the third object.

References

1. Brooks, Cleanth. (1947). The Well Wrought Urn: Studies in the Structure of Poetry. New York: Harcourt, Brace & Company.

2. Feinstein, Sandy (2005). Writing in the Shadows: Topics, Models, and Audiences that Focus on Language. In Power and Identity in the Creative Writing Classroom. Multilingual Matter LTD, Toronto.