Tuesday, June 4, 2019

Why I, a Physician, Write

“One would never undertake such a thing if one were not driven on by some demon whom one can neither resist nor understand.”
 – George Orwell, “Why I Write”

I remember my first encounter with great literature. Before bedtime, my father would read Great Expectations to me, using different voices for different characters. I remember Pip and Miss Havisham, though I don’t think I fully understood Miss Havisham’s peremptory and eery commandment to Pip to love Stella. I remember the stygian scene with the convict in the graveyard. I also remember reading Sherlock Holmes under my covers, enamored with his brilliance and the game that was afoot. I remember tearing through the Lord of the Rings books and the first few books of Robert Jordan’s The Wheel of Time series. Great stories left a large impression on my childhood. The thrill of diving deeply into an engrossing world still makes me a bit giddy. Even when I read books far more socially complex now, books I would never grasp as a young reader, like Thomas Hardy’s novels, I am reminded of the initial excitement I once felt discovering new stories.

As a child, these stories didn’t remind me of my own life or people in my life, they were just thrilling. I fantasized about writing my own stories one day. I created comic books with different monsters, though my drawing was appalling. I once sat down to hand-write my own epic fantasy story – I don’t think I got very far. I suspect, then, that my desire to write and tell stories was present at a young age. But I lacked the sedulousness to work on my drafts. I would write an essay for school or a story at home and immediately hand it in or toss it aside, assuming that was the end.

Since then, of course, I have written more and learned more. The process certainly has not gotten any easier, especially as time spent writing crowds out time for other things in life like music, friendships, reading, TV shows, and family. Indeed, the time invested has not been trivial. Just as an example, I was covering the intensive care unit one night during my first year of residency and during the few brief quiet moments of the night I was reading a book about the psychology of the Nazi war criminals for an essay for the Jewish Review of Books.

Why do I attempt this seemingly crazy task? It is a question prompted by a recent fellowship interview, when an interviewer asked me: Why do you write? And what drives a physician (and there are many physician-writers) to write?

In 1946, George Orwell explored the reasons for his own writing in an essay entitled “Why I Write.” Orwell explains that there are four great motives for writing: egoism, aesthetic enthusiasm, historical impulse, and political purpose. Writers, he argues, “desire to seem clever, to be talked about, to be remembered after death…. It is humbug to pretend that this is not a motive, and a strong one.” Because of this, serious writers are “vain” and “self-centered.” Of course, there is an element of solipsism in writing. No writer, physician or otherwise, writes without anticipating some kind of audience. It does help give our writing purpose, to know that it affects or influences others. But such an aspiration is not unique to writers, as Orwell concedes. All professionals – scientists, artists, politicians, etc. – desire, to some extent, to be remembered through their research, art, or deeds. No ambitious citizen can deny that this plays some role, large or small, in what he or she does. But the entire writing motive is not necessarily self-aggrandizing: Writers appreciate beauty, “pleasure in the impact of one sound on another, in the firmness of good prose or the rhythm of a good story.” An author, no matter what his or her topic, attends to “aesthetic considerations.” And the content matters, too. Essayists, novelists, political journalists all “desire to see things as they are, to find out true facts and store them up for the use of posterity.” In other words, they aim to portray the world as it is, to draw away the curtains. And there is also a “political purpose” to this. Though writers do want to see things as they are, they also want to imagine the world as it might be or “to alter other people’s idea of the kind of society that they should strive after.” Orwell does not argue that one of these is more important than the other: “These various impulses must war against one another,…fluctuate from person to person and from time to time.”

Most of what Orwell says pertains to physician-writers. For some of them, for instance, politics drives much of their work. Atul Gawande, a surgeon and public health researcher, is a good example. Gawande’s books, like Being Mortal or The Checklist Manifesto, both agitate in some way for reform of our medical system. In Being Mortal, he urges us as a society to rethink the way we take care of the elderly and those closest to death such that we provide them with more independence and choice and less invasive care. In The Checklist Manifesto, he discusses the importance of checklists for the safety of patients in a hospital, in particular during surgeries.

For most physician-writers, however, I suspect that the primary purpose is to reveal to the reader what the world of medicine is like – a world that contains the kinds of riveting stories that fiction offers.

Physician-writers face unpleasant facts; or, rather, unpleasant aspects of life. Most of the stories I relate on this blog are tragic in some way – some of this comes out of a frustrating sense of injustice, but a lot of it comes out of a sense of the inevitability of tragedy and the beauty and rare success coupled to that struggle. Thomas Hardy reportedly said, “The business of the poet and the novelist is to show the sorriness underlying the grandest things, and the grandeur underlying the sorriest things.” The physician-writer shows the sorriness and grandeur underlying our physical life. In that sense, I write with a historical impulse, “to see things as they are.” What is medicine really like? What does it mean to be sick and helpless? What does it mean to be sick and poor? How do physicians react to all of this?

Perhaps the thrill and romance from childhood stories has faded somewhat, but the hunger for nonfiction as a grounding tool has taken their place. This blog provides, among other things, a way to impart the great complexities of medicine and diseases, which are often only understood by other physicians and the victims of those diseases.

I wish I could write a novel with the same flair for storytelling and the same talent for diction and the same eloquence as Dickens or Hardy. That I cannot is unfortunate. But stories about medicine are powerful and the most I can offer. And I am “driven on by some demon” to write about them; a purposeful struggle to put to the page these stories that are filled with meaning, and that might otherwise disappear.

I will never retire this task, whether it’s through this blog or elsewhere. But as my career advances I ought to give myself space to breathe. I start my fellowship in neurovascular disease this summer and have an important specialty board exam this year, both of which require, I think, all of my intellectual energy. So things will be quiet on this blog for now, but look for more in the coming year.

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