By: Anne McTiernan
After almost fifteen years as a research physician, I grew tired of the relentless cycle of applying for grants, failing to obtain funding, and reapplying with variable success. Conducting clinical trials was rewarding, but the responsibility seemed endless. I began to feel burnt out, scorched. It was time for a change. I needed a hobby.
Around this time, I read Frank McCourt’s memoir, Angela’s Ashes. The author described it as a story about a miserable Irish Catholic childhood. Ah-hah, I thought, I had a miserable Irish-American Catholic childhood; I’ll write a memoir. The old medical student adage fueled my thinking: see one, do one, teach one. I had read several memoirs. I believed I could sit down and pen one of my own. It would become an immediate bestseller, a movie would be made, and I would be rich enough to fund my own research.
I was quickly disavowed of this dream. My first feeble attempt fell flat, as in flat on the office floor of my previous book’s agent. “Writing that must have been cathartic,” she said. I realized I needed help. Next, I enrolled in a year-long class in memoir writing. The teacher critiqued my work. The other students critiqued my work. They loved this section, didn’t understand that one. They ripped apart my favorite character description, the one about my bald, five foot two-inch tall granduncle, leaning on his shillelagh stick at his brother’s funeral. Painfully and slowly, I began to learn the art of writing memoir. During this process, I realized that there are several similarities between becoming a healer and learning to be a communicator.
Just as it takes years of concentrated medical training to make a doctor, the path to authorship is long and arduous. Both require patience, persistence, and practice.
In medicine, without the wisdom, teaching, and support of mentors, fellow doctors, and other health experts, you will fail, and your patients will suffer. The same is true of writing. The teaching, mentoring, and feedback from other writers is critical to producing work that will resonate with readers. In my case, help came from teachers, editors, writing group members, other students, my agent, and my publisher.
“The patient comes first,” we learn early in medical school. First before meals, first before sleep, and, all too often, first before family. Similarly, when writing, it is critical to think about what the reader will gain from your work. It is not just your story; it is what your story will mean to your readers. You need to entertain, enlighten, encourage, and energize the person who has made the financial and time commitment to read your work.
As a student-writer, I learned that memoir demands a narrative arc. One common model is the heroine’s journey as described by Joseph Campbell and Valerie Frankel. The protagonist has a problem. She needs to search for an answer, but is reluctant to enter the world where she can find the solution. Finally, she is convinced to embark, and several people help her along her journey. Similarly, physicians communicate story as they think about and share information about their patients. This might take the form of student presentations on morning hospital rounds, a consult request to a colleague, or, less commonly now, a chart note. In the patient narrative, the physician follows the trajectory of a patient’s illness experience. The story begins with the patient’s primary problem. It includes backstory. There is a narrative arc with progressive escalation of the condition, a climax occurs, and, finally, resolution.
Over the centuries, many physicians have contributed to popular literature. Modern examples include novelists (Tess Gerritsen, Robin Cook), essayists (Danielle Ofri, the late Oliver Sacks), nonfiction authors (Atul Gawande, Siddhartha Mukherjee), and several who write across genres (Perri Klass, Louise Aronson). These doctors bring the art and science of medicine to a general audience, giving readers insight into the otherwise mysterious world of patients, illness, medical personnel, and treatments. Drs. Gerritsen and Cook frighten us with stories of the dark sides of human nature. Drs. Ofri, Aronson, and Sacks help us recognize the complexities of doctor-patient relationships and the intricate effects of biology on our patients’ lives. Drs. Mukherjee and Gawande enlighten us about modern medicine.
As electronic records replace written medical charts, the improvements in diagnostic documentation will be counterbalanced by the loss of patients’ stories. Hopefully, more physicians will fill the void by writing medical stories, so that this aspect of the art of medicine is not lost.