Writing about place (or physical and geographic setting) is a core element of fiction and creative non-fiction. While writing about physical location may, for some, conjure up images of exotic travels and far-away locales, this kind of writing has one foot firmly rooted in our everyday lives.

As Kayla Dean states in How To Write About Place In Creative Nonfiction:

“A common misconception about writing about place in creative nonfiction is that you have to write about particularly exotic spaces. Consider that debunked…you don’t have to be a world traveler to write about your life.”

Kayla dean

I’ve been thinking about the role of ‘place’ in narrative medicine (NM) – a field that explores the experiences of patients, caregivers, clinicians, and future clinicians through reading and writing. 

One of the ways NM explores place is by reading and writing about the physical environments where care is delivered: in hospitals, examination rooms, clinics, doctor’s offices, and even living rooms that have been (temporarily) transformed into care environments.

The ‘hospital-as-city’ metaphor invites us to think about hospitals as built environments. Historian Irina Davidovici states that “the hospital functions like a city. A network of internal public streets and service shortcuts link the most crucial functions” and points out that hospitals were re-imagined during the Enlightenment according to the principles of contagion and “flow” (of air, views, and medical staff). These re-imaginings shaped their physical layout. 

We see that reflected in contemporary narratives as well. The set of The Pitt – a new medical drama that takes place in an ER department – was designed to create a narrative flow by simulating the continuous physical movement of its characters. Set designer Nina Ruscio comments on the critical role physical layout played in the development of the show:  

“The whole show is about continuous motion, so the physical set wanted to be about continuous motion… Within [the set], I’ve got these curves so that wherever you are, you’re never at a dead end.”

Nina Ruscio

As an educator and narrative medicine practitioner, I’m especially drawn to texts that explore the hospital-as-city and orient us to the physical geography of care. These texts provide a powerful opportunity to reflect on being in the hospital and how physical environments shape our experience of care-giving and care-receiving.

I’ve written before about Donald Hall’s evocative poem, The Ship Pounding, which imagines the hospital as a large ship that never leaves port:   

Each morning I made my way / among gangways, elevators, / and nurses’ pods to Jane’s room / to interrogate the grave helpers / who tended her through the night

donald hall

There’s also Kevin Young’s Ode to a Hotel near the Children’s Hospital, where the author carefully attends to his immediate physical environment – a hotel – as a way to explore the experience of caring for a sick child while far from home. Writing this as an ode (a poem of praise) draws the reader’s attention to the most ordinary of objects and how they are imbued with the weight of illness, loss, and care-taking:

Praise the vending machines / Praise the change Praise the hot water / & the heat / or the loud cool that helps the helpless sleep.

Kevin young

In NM training sessions we also use visual images to foster “close looking” and reflect on what we otherwise take for granted in healthcare practice. The image above was created by ER physician Heather Patterson who wanted to document the difficult early days of COVID by photographing experiences between front-line workers, patients, and families.

I am struck by the complexity and “organized chaos” surrounding the humans at the center of this photo. It makes me wonder what kind of praise poem could be written about the ubiquitous tools and technology that facilitate care in this context.

Physician and narrative medicine scholar Rita Charon states that Attention is one of the key principles of NM. It makes me wonder: what if we walked through the everyday rooms and hallways of clinical environments with a writer’s eye and a tourist’s curiosity?

If walkers are “practitioners of the city” because walking enables us to slow down and see things we wouldn’t otherwise see (as suggested by writer Rebecca Solnit), can clinicians, patients, and families be “practitioners of the hospital” by paying closer attention?

References:

Dean, Kayla. How To Write About Place In Creative Nonfiction. Creative NonFiction. https://diymfa.com/writing/write-place-creative-nonfiction/

Davidovici, Irina. “H: Hospital-as-City – The Healthcare Architecture of Herzog & de Meuron.” In Adam Jasper, ed. Social Distance: gta papers. 2021.

‘The Pitt’ – Production Designer Nina Ruscio Drew Up a Blueprint Before a Single Script Was Written, IndieWire, Jan 2025.

Operating behind the lens. Queen’s Alumni Review, Nov 2021. Retrieved from: https://www.queensu.ca/alumnireview/articles/2021-11-12/heather-patterson-pandemic-photography