There was a version of this business that almost existed.
It had a cleaner elevator pitch. A more recognizable category. A name that would have required less explanation at networking events and fit more naturally into the dropdown menus on business formation paperwork.
It was a communications firm. Or a personal branding consultancy. Or an executive storytelling coach — that last one was particularly tempting because “storytelling coach” is a phrase people nod at immediately, whereas “narrative strategy and organizational development rooted in Narrative Medicine” tends to produce a thoughtful pause and then a question about what exactly Narrative Medicine is.
I almost built that version. I spent real time with it. I knew how to position it. I knew how to price it. I knew how it would look on a website.
I didn’t build it. And the reason I didn’t is the thing I want to tell you about.
The Internal Pressure to Simplify
Here is the honest version: the pressure to make MyelSyn simpler, more marketable, more immediately legible did not come primarily from outside. It came from inside.
There is a particular kind of anxiety that founders know well — the anxiety of explaining yourself to someone who is waiting to categorize you. In professional settings, categorization is a form of social currency. When someone asks what you do and you can answer in four words, the interaction flows. When the honest answer requires context, requires a bit of patient unwinding of why two things that don’t seem related are actually deeply connected — you can feel the moment when the other person is still with you and the moment when they have started to drift.
I felt that anxiety often in the early stages of building MyelSyn. I am a physician. I trained in Narrative Medicine at Columbia University. I spent years studying how stories operate in clinical encounters — how a patient’s account of their own illness carries information that diagnostics miss, how the practitioner’s interpretive framework shapes what they see and what they overlook, how the quality of the relationship between clinician and patient affects clinical outcomes in ways that the evidence is quite clear about but clinical practice is slow to integrate.
None of that is what most people mean when they hire a business consultant.
And so the question I kept sitting with was: do I translate this into something that fits the existing category — or do I build something that explains why the category needs to be expanded?
What Narrative Medicine Did to My Understanding of Organizations
The simplest way I can say it is this: studying narrative in clinical settings taught me that organizations have the same problems patients do.
Not the same symptoms — though sometimes they are surprisingly similar. The same underlying dynamic: a gap between the official account of what is happening and the actual experience that is shaping behavior, eroding trust, and producing outcomes that nobody planned for and nobody wants.
In the clinical encounter, this gap shows up when a patient tells the story the doctor seems to expect rather than the story that is true. It shows up when a clinician’s diagnostic framework forecloses on an explanation before the patient’s account is fully heard. It shows up in the space between what is documented and what actually happened in the room.
In organizations, the same gap shows up everywhere. The strategy that leadership says is working and the one that the frontline team is living inside. The culture described in the values document and the one practiced in the performance review. The story a founder tells about what the company is for and the story employees are telling each other about what they are actually required to be.
This is not unique to struggling organizations. The gap exists in healthy ones too. The question is whether leadership has the tools and the intentionality to surface it — and whether the organization has the resilience to work with what it finds.
Narrative Business Practice emerged from trying to answer that question systematically. Not as a theory I developed in isolation, but as a framework I built — and keep building — from the intersection of narrative medicine, organizational psychology, behavioral science, ethics, and the actual, imperfect, instructive experience of working with real organizations in real moments of challenge.
The Moment It Stopped Being a Theory
I was working with a leadership team early in the development of what would become MyelSyn’s approach. The organization was mid-sized, mission-driven, and genuinely struggling with what they described as a communication problem. Leaders were not aligned. Teams were not executing. There was tension at the senior level that nobody was willing to name directly.
I went in with a framework. I had questions. I had a structure for the conversation.
What happened in that room was not in the structure.
Somewhere in the middle of the second session, the founder — a person of considerable intelligence and genuine commitment to his organization’s mission — stopped answering my questions and said something that I think about often.
He said: “I don’t think the communication problem is the problem. I think the communication problem is what happens when people can no longer find the words for the real problem. And I have not been willing to say what the real problem is.”
He then said it.
The room shifted. Not dramatically — not in the way that makes for a compelling scene in a movie. Quietly. Like something that had been held at a careful distance for a long time was finally allowed to be close.
And from that moment, the conversation — and eventually, the work — was different.
That is what Narrative Business Practice™ is oriented toward. Not the smooth surface of the communication problem. The honest, often uncomfortable, frequently generative story underneath it.
What MyelSyn Is Not
I want to say this clearly, because clarity matters here.
MyelSyn is not a branding agency. We do not help organizations craft better-looking messages for the same underlying dysfunction.
We are not a communications firm. Effective communication is a consequence of this work, not the goal. Organizations that have done this work communicate better because they have done the harder thing of surfacing and reshaping what they are actually communicating — including what they are communicating through their silence, their gaps, their avoidances.
We are not a conventional executive coaching practice. There is excellent executive coaching in the world. The work is different. It is organizational as well as individual. It is concerned with the stories that move through systems, not only the stories that live inside single leaders.
What we are is harder to name and more important to build. A consulting practice rooted in the conviction that organizational culture, leadership effectiveness, and team alignment are primarily story problems — and that story problems require the kind of rigorous, empathetic, interdisciplinary attention that has not, historically, been available to most organizations.
The Narrative Medicine foundation is not an academic credential that I use to distinguish myself in a crowded market. It is a clinical framework that taught me to take human narrative seriously as a source of knowledge, insight, and healing. And I am eternally grateful to Prof Rita Charon for answering the call to start Narrative Medicine. Applying it to organizations is not a metaphor. It is a genuine extension of what the discipline is for.
For the Founders Whose Stories Don’t Fit
If you are reading this and you are building something that is difficult to explain at networking events, I want to say something to you directly.
The difficulty of explanation is not evidence that you are building the wrong thing. Sometimes it is exactly the opposite.
The most important work often looks the most unconventional when it begins. It does not fit the existing categories because it has not been done this way before. It requires patience — with the question, with the audience, with yourself — and the willingness to keep making the case for something that has not yet been fully seen.
I almost built the simpler version because the simpler version would have been easier to explain. But it would not have been true. And I have spent enough time in the study and practice of narrative to know what happens to work that is not built on something true: it performs well for a while, and then it doesn’t hold.
The harder, more honest version requires more of everyone involved — including, and especially, the person who built it.
That is not a reason to tell a different story.
It is a reason to keep going.
