Why Do Doctors Write? | The New Yorker
The first patient I ever wrote about wasn’t actually my patient; as a first-year medical student, that possessive grammatical construct—“my patient”—hadn’t yet entered my consciousness, much less my lexicon. In any case, by the time I met him, he was already dead. I’d followed my fellow-students into the bowels of the medical examiner’s office, just north of Bellevue Hospital, past the silent storage areas of unclaimed bodies and into the clamor of the autopsy room. There he was—a boy, maybe twelve years old, claiming hardly any space on the metal table.
His jersey was pushed up to reveal a smooth preadolescent chest. His pristine basketball sneakers were oddly bright in a room that has since receded into shadow in my memory. I hardly registered the narrowness of the gap between our ages because I was blindsided by how small the bullet hole was. I didn’t have the language to articulate how something so tiny could carve such devastation.
A decade passed before I could write about that moment. By then, I’d finished medical school and residency, spending years in contiguity with such suffering that—against the advice of my academic mentors—I took off for eighteen months to temp as a travelling doctor, filling physician shortages in small towns and then wending through Central America to accrue some much-needed Spanish. In lonely strip malls and dusty markets, I began scribbling in notebooks. The boy on the metal table was the first ghost to come forward. I didn’t know then that I was slipping into a time-honored role, that of the doctor-writer. After all these years, though, I’m still trying to make a diagnosis: why is it that doctors write?
In one sense, doctors have always been writers, penning case reports since antiquity. Literary writing by doctors is a more modern development. Anton Chekhov and Oliver Wendell Holmes, Sr., were physicians, but their writing feels largely independent of their clinical day jobs; the term “doctor-writer” is generally reserved for the actively practicing physician whose writing stems directly from patient care. This model crystallized in the late twentieth century, with the neurologist Oliver Sacks and a pair of Yale surgeons, Sherwin B. Nuland and Richard Selzer. When I was a medical student, reading Sacks’s “The Man Who Mistook His Wife for a Hat” was revelatory. “Biologically, physiologically, we are not so different from each other,” Sacks wrote. “Historically, as narratives—we are each of us unique.” Medicine, he showed, could be an avenue into those narratives, and thus into that uniqueness.
There was no shortage of reading during med school, but it all felt strictly transactional—I memorized facts in order to ratchet forward in my training. Sacks, Nuland, and Selzer made me realize that there was someplace to go with all these facts. They wrote directly about medicine, dissecting the layered resonances of illness and the intricacies of being a doctor. Nothing could have prepared me better for my surgery rotation than Selzer’s explanation of how to use a scalpel, in his memoir, “Down from Troy”: “One holds the knife as one holds the bow of a cello,” he wrote. “The knife is not for pressing. It is for drawing across the field of skin.” In these writings, the doctor was a character in the story. Readers got to climb into the doctor’s shoes—an experience that could be uncomfortable, at times repugnant, but undeniably eye-opening.
These writers spawned a generation of doctor-writers. Today, it can seem as though every doctor leaves residency with the equivalent of a book bubbling inside. This is hardly surprising, as medical training catapults ordinary people into the extraordinary, where life-or-death stakes are no mere metaphors. If there’s a certain sameness to many medical memoirs—first baby delivered, first death, first resuscitation, first recognition that medicine cannot always cure—that doesn’t necessarily detract from readers’ fascination. Books by doctor-writers carry a special charge because of the true-life nature of the drama. But it’s not simply that, or at least it shouldn’t be—otherwise such writings border on exploitation. The nearest way I can describe it is a sense of awe, rekindled daily as we treat our patients, at the human condition and the ceaseless wrenching thereof. Where else can one grapple with something simultaneously so astonishing and so brutal, except on the page?
During my training, I devoured all the literary writing by doctors that I could get my hands on, desperate to understand “the anatomy and physiology of a hospital,” as pediatrician Perri Klass put it in her memoir, “A Not Entirely Benign Procedure.” The book—and her magazine columns that preceded it—offered me a crash course in the “grisly evidence of how thin the barrier is between normal life and disaster.” Abraham Verghese’s début, “My Own Country,” appeared during my residency, catching me in the Stygian pit that marks its midpoint. A bookish doctor raised by an Indian family in Ethiopia before training in internal medicine and infectious disease, Verghese touched down in a rural white Appalachian town just as H.I.V. was fracturing the community. Stereotypes, fears, and vulnerabilities piled up as patients—and the doctors caring for them—were buffeted by forces they could neither control nor predict. When Verghese described living “in a culture of disease, a small island in a sea of fear,” he articulated a dislocation that I hadn’t even realized I was experiencing, and one that was undoubtedly dwarfed by what my patients were living through.
When I bolted from my medical training, I had my own set of stories threatening to burst, though I don’t think I recognized them as stories per se. They were simply the contours of exhaustion. One of my first temp assignments was in a remote corner of New Mexico. In a modest community library, I stumbled across “The Blood of Strangers,” by an E.R. doctor named Frank Huyler. Most medical memoirs don’t make much of place—a hospital is a hospital is a hospital—but Huyler’s was set in the Southwest, with prose as angular and unadorned as the landscape outside my window. The stories were prose-poem length, whittled to the bone. Characters were bare outlines. Dispatched during a busy shift to pronounce a patient dead, Huyler pondered the randomness of life and death in the E.R. “Odds whisper around us, wheels turn, molecules whir like bobbins. And then, maybe once or twice in a whole life, events conspire, statistics align with the force of diamonds against us, and they knock us out, there is no chance, the wind blows through us, we’re gone.” The starkness of Huyler’s writing needles into an essential loneliness of medical practice. Despite all the wards, teams, departments, colleagues, it is so often just you and the patient—and the perilous stakes. I only understood this chilling solitude when I read Huyler.
“His erection startled me,” is the opening line of Rafael Campo’s essay collection “The Desire to Heal,” which I read as I was starting out as an attending physician. When Campo—a gay Latino man studying medicine at Harvard—found himself overwhelmed by stress, junk food, cigarettes, and zealous dieting, he ended up in a clinic office, both observing and fantasizing as the doctor examined him: “When he spoke, the pain ceased. . . . I could feel him listening to my heart and lungs, understanding all that which I had for so long found impossible to say.” The doctor “ran his hands over my body, extracting each gossamer toxin that was a shadow of my form, and dissolving it in a pool of sunlight,” Campo wrote. I realized that he was articulating what so many patients yearn for—a clean sweep of their ills from a physician who deeply understands their individual needs. (Campo’s nirvana is shattered, of course, by the reality of the actual medical evaluation, with its “punitive lubricated finger.”) One doesn’t often feel the pulse bounding off the page in doctors’ writings, but Campo’s book drove home the point that every character in the medical transaction—A.I. notwithstanding—is human, throbbing with impulses, often contradictory.
But what about the patients? What is their stake in this medical-literary enterprise, and what are they owed? Novelists may casually stitch family members into their books, but doctors have a fiduciary duty to their patients, not to mention an ethical one. A patient converges with a doctor in a singularly mortal moment, baring their wounds with the presumption of care and healing. There is an inherent asymmetry of vulnerability here; doctors and patients are not equals at the Thanksgiving table.
Within the medical profession, there are differing views about the ethics of doctor-writing. Some argue that a doctor must obtain formal consent from patients before writing about them, just as for any medical procedure; others think that the uniquely vulnerable position of a patient makes truly informed consent impossible. When I’ve asked patients if I can write about them, they’ve usually been amenable, often eager; many have spent years trying to get their story heard and welcome an opportunity to see it validated in the public record. There is still often a degree of unease, though, and most doctor-writers respond with various compromises: requesting written or oral consent, changing identifying characteristics, creating composite characters, using only broad outlines, waiting years, waiting until patients are deceased, shifting from nonfiction to fiction, or ditching narrative altogether and turning to poetry. Although there are few formal guidelines, a consensus has formed around consent when possible, de-identification when not, and adherence to the admonition that the patient’s welfare always comes first.
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