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The first patient I ever wrote about wasn’t really my patient; as a first-year medical student, “my patient” hadn’t yet entered my vocabulary. In any case, he was long gone by the time we met. I followed my classmates into the medical examiner’s office just north of Bellevue Hospital, past the quiet rooms of unclaimed bodies and into the noisy autopsy area. There he was, a boy, maybe twelve years old, barely taking up space on a metal table.
His T-shirt was pulled up, revealing a smooth teenage chest. His immaculate basketball shoes stood out in a room that had since faded into the shadows of my memories. I barely realized the narrowness of the gap between our ages, as I was shocked by how tiny the bullet hole was. I had no words to express how something so small could cause such devastation.
It was ten years before I was able to write about this episode. By then, I had completed medical school and residency, having spent years in direct contact with such suffering that, against the advice of my academic mentors, I went on to work as an itinerant physician for eighteen months, filling health-care shortages in small towns, then traveled across Central America to improve my Spanish. In lonely malls and dusty markets, I began jotting down thoughts in notebooks. The boy on the metal table was the first ghost to appear. I didn’t realize then that I was slipping into a time-honored role: that of doctor-writer. Yet, all these years later, I still struggle to determine why doctors write.
In a sense, physicians have always been writers, compiling accounts of disease since ancient times. Physicians’ writing is a more modern phenomenon. Anton Chekhov and Oliver Wendell Holmes Sr. were both physicians, but their writing was largely independent of their day-to-day clinical practice; the term “physician-writer” usually refers to a working physician whose writing is directly related to patient care. This model took shape in the late twentieth century with the neurologist Oliver Sacks and several Yale surgeons, Sherwin B. Nuland and Richard Seltzer. When I was a student, reading Sacks’s The Man Who Mistook His Wife for a Hat was a revelation. “Biologically and physiologically we are not so different from one another,” Sacks wrote. “Historically, as narratives, each of us is unique.” He demonstrated that medicine could be a path to those narratives and thus to that uniqueness.
There was plenty of literature in medicine throughout my training, but it all felt purely transactional—I memorized facts to advance my learning. Sacks, Nuland, and Seltzer made me realize that there was somewhere to go with all those facts. They wrote about medicine, exploring the layered resonances of disease and the intricacies of medical practice. Nothing could have prepared me better for my surgical rotation than Seltzer’s explanation of how to handle a scalpel in his memoir Down from Troy: “Hold the knife like you would a cello bow,” he wrote. “A knife is not meant to be pressed. It is meant to be drawn across the surface of the skin.” In these works, the doctor was the central character. Readers could feel his experience—it could be uncomfortable, at times disgusting, but it was certainly eye-opening.
These authors created a generation of physician-writers. Today, it can seem like every doctor leaves residency with a book bubbling inside them. This is not surprising, since medical training thrusts ordinary people into extraordinary circumstances, where the stakes of life and death are not just metaphors. If many medical memoirs share certain similarities—the first birth, the first death, the first resuscitation, the first realization that medicine cannot always help—that does not necessarily diminish reader interest. Books by physician-writers are charged with a special energy, thanks to the truthful nature of the drama. But it should not be so, or such works can be exploitative. I can describe it as a sense of awe, rekindled daily as we treat our patients, for the human condition and its incessant suffering. Where else can we wrestle with something at once so majestic and so brutal as on the page?
During my training, I devoured every medical literary work I could find, desperate to understand “the anatomy and physiology of a hospital,” as pediatrician Perry Klass put it in her memoir, A Not-So-Benign Procedure. That book and its preceding magazine columns were my crash course in “the terrifying evidence of how thin the barrier between normal life and disaster is.” Abraham Verghese’s debut, A Country of My Own, came out during my residency, and found me in the Stygian pit that marks her
Sourse: newyorker.com
