Writers in medicine (or doctors in writing)

At my UChicago interview, I was asked about my one school award in writing (an essay from freshman year on illicit stimulant use). My interviewer asked me what I was going to do, going forward, to exploit my talents (he was flattering me; I don’t think I have any skill or patience for serious writing). Stupidly, I said I didn’t have any such plans; writing’s not much of a hobby of mine. He seemed disappointed. I tried to recover by saying how writing skills will help me as a doctor and/or scientific investigator. Result: not accepted. Heh.

But here I am, writing a blog post! I’m starting to entertain the possibility of writing more, mostly just to keep my verbal abilities from stiffing up like my high school debate skills did (T likes to say my speeches nowadays are too ejaculatory [see definition 1]). I don’t like writing for school normally because it takes forever for me to come by a good idea and find the best words to articulate it. For a blog, however, the pressure’s off.

After the jump/break, I look at the paths of three well-known contemporary authors who have clinical training and their thoughts on writing. As one NYTimes article put it, a “breed of physicians who also have literary DNA in their genome” appears to be “rapidly multiplying these days.” Several of them wrote books that T read over the summer and reviewed in a previous post.

Atul Gawande. BAS in political science and biology from Stanford. MA in philosophy, politics, and economics from Oxford, on a Rhodes Scholarship. MD from Harvard. MPH from Harvard. Surgery residency at Brigham and Women’s. MacArthur Award. National Book Award finalist. NYTimes bestseller. Harvard surgeon, (associate) professor, global health and policy advocate. Tall, dark, and a great talker.

In Better: A Surgeon’s Notes on Performance, Gawande notes that he didn’t start writing until he became a doctor, when he encountered a pressing need to write.

For all its complexity, medicine is more physically than intellectually taxing. Because medicine is a retail enterprise, because doctors provide their services to one person after another, it can be a grind. You can lose your larger sense of purpose. But writing lets you step back and think through a problem. Even the angriest rant forces the writer to achieve a degree of thoughtfulness.

Just write, he says, even if it’s just a blog post. “What you write need not achieve perfection. It need only add some small observation about your world.” He ends with a thought that may resonate with blog and forum readers everywhere: “Most of all, by offering your reflections to an audience, even a small one, you make yourself part of a larger world.”

What Gawande says about medicine being physically taxing probably applies mostly to his field, surgery, and to interventional subspecialties of medicine and radiology. I still take stock in his advice for two reasons. 1) I’m most interested in surgery and the interventional specialties but T insists I would prefer more intellectual stimulation. 2) My research mentor and a postdoc in the lab recently warned me that the first half of medical school will be very boring intellectually. You have to memorize large amounts of information but you don’t have to think critically about much of it at all. If you believe what Gawande says, then, writing will be an important outlet and cultivator for thoughts in my future.

Sid Mukherjee. BS in biology from Stanford. PhD in immunology from Oxford, on a Rhodes. MD from Harvard. (Sounding familiar?) Pulitzer Prize winner in non-fiction. Medicine and oncology residency at Mass General. Now an assistant professor at Columbia, runs a basic science lab.  Invented the word “simplisticness” in an interview. (It’s okay. Having a Pulitzer allows you to take such liberties with English. Being POTUS does not.)

Sid(e) note: Mukherjee was a fellow in the lab of David Scadden, a hematologist who once told a group of college students doing science research that he was an English major in college and had decided to be a doctor because he saw medicine as the actualization of the humanities. That’s quite different and refreshing from the usual refrain heard at medical school interviews: I like science, I like people, I like medicine because it combines science and people.

Mukherjee tells a nice story about what motivated him to write his book, The Emperor of All Maladies. “I was having a conversation with a patient who had stomach cancer,” he recalled, “and she said, ‘I’m willing to go on fighting, but I need to know what it is that I’m battling.’ It was an embarrassing moment. I couldn’t answer her, and I couldn’t point her to a book that would. Answering her question — that was the urgency that drove me, really. The book was written because it wasn’t there.”

According to the NYTimes,

He wrote most of it in bed, propped up on pillows, and by mastering what he called the “art of full indiscipline.” “Instead of saying, ‘I’ll get up every day at 5:30’ or, ‘I’ll write from 9 to 12,’ I did the complete opposite,” he said. “I said: ‘I will write during the day for 5 minutes, 10 minutes, whatever. I’ll write in stretches until the book is done.”

To each his own style, I suppose. Maybe he didn’t have a deadline. Others are more goal-oriented and need specific steps to get things done.

Abraham Verghese. (yet another Indian American) MBBS from Madras. Medicine residency at East Tennessee State. MFA from Iowa. His research interests are in “clinical skills and the bedside exam.” His tenured appointment at Stanford as professor and senior associate chair for the theory and practice of medicine was highly unusual because his CV consisted of not scientific journal articles, but a bunch of essays, short stories, two memoirs, and, today, a bestselling epic novel, Cutting for Stone.

Despite having always having an urge to write, as Verghese explained in one interview, he became a doctor rather than a journalist because “Indian middle class families are very much like Jewish middle class families. You can either become a doctor, a lawyer, an engineer, or a failure.”

Once he started practicing medicine and seeing its harsh realities (we can’t cure everything!), however, Verghese turned to writing fiction and short stories because 1) it gave him some control over the destinies of characters he could not control in the daytime, and 2) fiction let him arrive at some sort of truth of the world. (T insists the latter is true; I still prefer non-ficition, where you can get the truth directly.)

He sees his writing coming out of the medicine he practices as a day job, not separate from it. Medicine drives his stories. He doesn’t write full time now. Rather, he writes slowly, in the evenings, on the weekends. And on two protected days of the week in a secret office at Stanford. Like Mukherjee, someone else with a day job, he doesn’t rush anything. “Writing my first book took four years; the second, five; the third, eight.” Life goes on.

Life has to go on, because the substance of life drives stories. Empty prose does not. Medicine is full of narratives. “My writing was primitive and crude in a way, but it was shocking, it had stuff in it.” He wrote about AIDS at the height of the epidemic; others in the workshop he took in Iowa wrote about dating.

When asked for writing advice, he says this:

Get a good day job, one that you love, preferably one that consumes you and that puts your boat out in the river of life. Then be passionate about it, give it your all, get good at what you do. All that gives you plenty to write about, and it also takes the pressure off the writing.

Reading all this, I feel okay not having any aspirations related to writing. My muse will come naturally, if it does at all, with a career in medicine.



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