For Writers, the Doctor’s Definitely In

Andrea Crawford
From the January/February 2009 issue of
Poets & Writers Magazine

The literary lineage of those who pursue medicine and also write is long and well known, with Anton Chekhov, Sir Arthur Conan Doyle, William Carlos Williams, Mikhail Bulgakov, John Keats, and W. Somerset Maugham as standouts through history. But even among contemporary writers of fiction, doctors continue to hold their own. Today's most celebrated examples include Khaled Hosseini and Daniel Mason—who followed up his best-selling debut novel, The Piano Tuner (Knopf, 2002), published while he was still in medical school, with A Far Country (Knopf, 2007).

Ethan Canin, who stopped practicing as a doctor after his third book was published and is now on the faculty of the Iowa Writers' Workshop, says everyone has an expressive urge, but it's particularly pronounced in those who pursue medicine.

Ethan Canin, whose sixth book, America America, was published by Random House last June, is perhaps the most admired among his literary peers, while others gaining prominence include Chris Adrian, a pediatric hematology/oncology fellow best known for The Children's Hospital (McSweeney's Books, 2006) who published his third book, the short story collection A Better Angel (Farrar, Straus and Giroux), last August; Vincent Lam, an emergency physician whose story collection, Bloodletting and Miraculous Cures (Weinstein, 2007), was the first debut work to win Canada's Giller Prize; John Murray, an Australian whose collection, A Few Short Notes on Tropical Butterflies (HarperCollins, 2003), drew on his medical work in Africa; and Kevin Patterson, another Canadian writer, who followed his debut memoir, The Water in Between (Nan A. Talese, 2000), a New York Times Notable Book, with a story collection in 2003 and a novel, Consumption (Nan A. Talese), in 2007.

Last summer Rivka Galchen, a graduate of Mount Sinai medical school, appeared on the scene with Atmospheric Disturbances (Farrar, Straus and Giroux), and in February, Abraham Verghese, known for his nonfiction, including a memoir about his work with AIDS patients in the South, will publish his first novel, Cutting for Stone (Knopf). Later in the spring, Austin Ratner, a first-year MFA student and graduate of Johns Hopkins medical school, will debut with his novel, The Jump Artist (Bellevue Literary Press).

As the list of physicians writing fiction today grows longer, one can't help but wonder if it's just a coincidence or if there is a strong connection between the two professions. Canin, who stopped practicing as a doctor after his third book was published and is now on the faculty of the Iowa Writers' Workshop, says everyone has an expressive urge, but it's particularly pronounced in those who pursue medicine. "It's like being a soldier. You've seen great and terrible things."

Of the ten new students in his workshop last fall, Canin notes, two have medical backgrounds (and he adds that more and more physicians are contacting him for advice about pursuing writing). To Ratner, one of Canin's students, who graduated from med school ten years ago but never practiced, the two professions have always seemed connected. For as long as he can remember, he wanted to do both. "They're both what are sometimes described as callings," he says. "They were both ways of meaningfully addressing myself to human experience and suffering."

For those who were writers first, however, the motivation to enter medicine is often pragmatic: Canin calls his decision to enroll in medical school following his MFA a response to the typical adult panic of realizing he had no prospects for employment. Lam, who had wanted to be a writer since childhood, faced the same hard truth: "I had become reasonably aware that many Canadian writers had difficulty eating," he says. "This seemed concerning to me." Josh Bazell, who left a PhD program in literature to study psychiatry and whose first book, a crime novel, is forthcoming from Little, Brown this month, adds: "Writing scared is not a good idea. It's good to know that you're not writing to save your own life every single day."

Pursuing medicine often goes hand in hand with acquiring worldly experience, which—following the example of authors such as Ernest Hemingway—can feed one's creative work. Lam and Murray, for instance, have traveled extensively as working physicians. "It sounds ridiculous, certainly it was very naive," Lam says, noting there are far easier ways to seek adventure, but "the life histories of the writers I was reading seemed to suggest I should find some way to be involved in the world." It didn't occur to him until much later—after he graduated from medical school, returned to writing, and took a break from his novel to attempt a story about a young resident—that medicine itself could provide him with subject matter for his fiction. The piece became part of Lam's collection, a series of linked stories inspired by his medical experience, including his work as a medevac physician flying to remote corners of the world and in the emergency department during Toronto's outbreak of SARS.

Beyond providing security or subject matter, medical experience has other values for writers. Practitioners learn to work under less than ideal circumstances, become adept at time management, and develop a thick skin. Medical training, like writing, requires a long view of life; and learning to always be aware of—and separate from—one's emotions helps to sharpen observational skills. While Canin says that mastering medical jargon can be hard on one's prose, Galchen found it a lesson in aesthetics. "The vocabulary is estranging in a nice way," she says. "There's that old poetic trick where if you can describe something in a way that makes it unfamiliar when it's familiar, then you achieve an aesthetic sensation. Medicine is great for that, in making things you take for granted seem as strange and unsettling as they are."

Physicians actually write all the time too; as Bazell noted, on a page-by-page basis, he produces more on a day he practices medicine than on a day he writes fiction. The case history, or progress note, is the basic unit of medical practice; it's something doctors work on constantly, and students learn from the first year to see a patient, hear her story, distill it into a chief complaint or main narrative, and write it down. It's not unlike the process of writing fiction, Lam says: "The art of figuring out the medical narrative is, on one hand, to be very intuitive, instinctual, open, and expansive, and, on the other hand, to be very reductionist."

While practicing medicine may help the aspiring author gain greater writing skills, the act of writing may help the doctor become a better one. Adrian, who set out first to study medicine and says he discovered writing as a detour along the way, thinks it's good for physicians to spend time in other people's heads "even if it's in a deranged, imaginative way." For him, writing developed as a way to process what he experienced as a doctor. "You witness all sorts of extraordinary stuff...and you get repeatedly presented with extraordinary injustices. Everybody has a different way of ultimately putting that in order, which lets them come back to work every day. For me, part of that has been writing about it."

The psychiatrist Bazell turns his clinician's eye upon the question of whether physicians are drawn to writing in order to process the emotions they experience as doctors. "Writing is a large component of current post-traumatic stress disorder treatment, and it may be that some aspect of intensity is best dealt with by writing," he says. "But I know that what intensity tends to engender in myself is the desire to sit and watch cable."

Andrea Crawford is a contributing editor of Poets & Writers Magazine.