So far in my career I have written four books about doctors—organ transplant surgeons, pediatricians, child psychiatrists, and veterinarians—and their patients. I have also written books about backwoodsmen, roboticists, baseball umpires, and other subjects, all compelling and interesting and provocative, but always I come back to medicine.
There are some obvious reasons for a writer to find endless fascination with doctors and their lives, especially a writer of creative nonfiction, the genre that makes fact more compelling and understandable through narrative. For one thing, the practice of medicine, especially in a high-acuity medical center (though also in private practice), is exciting and dramatic; there are plenty of stories to capture and relate. Every day brings new narratives and scenes populated by colorful and controversial characters, real people and their loved ones, who are often in real trouble. The raw material couldn’t be more exciting, mysterious, and obviously—for better or worse—life-changing.
Throughout many years of shadowing doctors as they work, I’ve seen patients rolled into the operating room on the absolute edge of death, then pacing the hospital corridor a week later, ready and anxious for discharge and home. I have seen patients die in the operating room, and physicians weeping in helpless frustration, although, thankfully, failure is not as frequent as success. I’ve seen patients terrified and confused because no one can understand what is wrong with them, why they feel so poorly or so frightened, until the right specialist—or therapist—somehow, magically, translates their symptoms into a diagnosis or quells their anxiety with assurance.
It’s not magic, of course. Success in medicine stems from a combination of clear thinking, hard work, repeated practice, and old-fashioned grit—often with many mistakes and false starts along the way. I would describe the writing process in the same way. Talent is important, but not necessarily the key component. Effective, powerful writing, like effective doctoring, demands a rare ability to avoid becoming discouraged while experiencing frustration—and the willingness, energy, and fortitude to keep trying. Ernest Hemingway frequently pointed out that he wrote the last chapter of A Farewell to Arms thirty-nine times, until he got it right. The best doctors and the best writers live and breathe this “never give up, never give in” philosophy.
In addition to possessing grit and determination, doctors, like nonfiction writers, learn to think analytically, unraveling and reconstructing the intimate details of a patient’s story from beginning to end. The doctor has to understand and solve the narrative quickly, just like a writer, although the writer writes a story to keep a reader engaged, while the doctor wants to find fast relief for his or her patient. (And these days, quick, efficient, effective work by the physician is mandated by managed care.)
Writers and doctors also share an intensity of obsession. Their hours are sporadic and often overwhelming, dictated by need rather than plans and schedules. While private practice may sometimes be less demanding than working in the trenches of a medical center, doctors’ personal lives are invariably determined by events beyond their control.
Writing about doctors has helped me to realize that they aren’t necessarily special people; they are, more precisely, ordinary people engaged in an extraordinary profession. Clearly, they are not perfect—not as doctors or as people. Sometimes doctors are distant and convey disinterest; sometimes they are egocentric and radiate superiority; sometimes they are angry or frustrated and treat people rudely; sometimes, alas, the health care system makes it impossible for them to do their jobs—and to demonstrate passion and empathy for their patients and colleagues when they most want to. The responsibilities of doctoring often surprise, test, and challenge them—but the best doctors meet and, when necessary, exceed the challenges. And the truth is, we ask more of our doctors, especially these days, than we do of people in almost any other profession.
Most of the doctors I have met—and there have been a great many over the years—have had a great appreciation for literature. And while relatively few of the doctors I have known had any urge to be creative writers, doctors who do write often show a real talent for telling stories and communicating complicated information in layman’s terms. Perhaps this has to do with their growing awareness of the need to understand their patients’ stories in order to understand how to treat them, and the importance of communicating so that their patients understand their message.
When doctors do sit down to write, they have a wealth of experiences and raw material to draw on. Physicians’ professional lives are steeped in drama; health and sickness, life and death, fear and courage, clarity and confusion are part of their daily routine. The fact that the stakes are so high in almost everything they do, in training or practice, leads to daily exhilaration and anxiety, but also to the need for personal analysis and reflection and an ability to roll with the punches, as the essays in this collection demonstrate.
In these pages, Perri Klass, a pediatrician, explains why she insists that her students appreciate the unique opportunity to learn from their patients’ stories as well as their bodies. Elissa Ely humbly accepts that the road to stability for one of her psychiatric patients requires that she, the doctor, follow instead of lead. Sandeep Jauhar discovers that a physician’s words can occasionally do as much damage as good. Sayantani DasGupta vividly portrays the driven mania of an intern. Chris Stookey tells the story of being hit with a mysterious malpractice suit as a resident. Lauren Slater probes the tragic ambivalence she feels about having walked away from her profession. And Robert Coles looks back on his intimate and inspiring relationship with the poet William Carlos Williams.
In this book about writers who are doctors and doctors who are writers, the two professions come together. After all, doctors are always writing patient and professional scenarios in their heads, rejoicing in their successes and reliving the ways in which they feel they were ineffective—or worse. What doctors do—everything they do—goes far beyond the act or the service itself. Their decisions and actions affect many people they will never know; in this way they are just like writers, whose books and essays, once written, take on a life of their own and affect readers in unknown and unpredictable ways. Perhaps, in the end, this is why so many doctors write: in their writing, not only their words and ideas but the people they write about will always live, if only on paper.