With the publication of Isthmus today, Christmas 2014, I am now scheduled to tour the book and present it at a number of gatherings. Likely, as I have in the past with Widow Walk, I will discuss the creation of the cover art as a way to bring forward the entire story and the inspiration for the new novel. Book readings are always interesting experiences. Another physician-writer friend, Richard Selzer MD, once warned me that the audiences were unpredictable. Sometimes his audiences were huge but at other times he would find only a few folks attending. Sometimes he would be asked profound questions from folks who had read his work, and other times he would be asked practical questions like “…do you prefer to write with a pencil or pen?” That has been my experience as well.
I have been asked several times during these sessions about my transition from physician/educator into a different career – that of historical fiction author. Was it difficult to make the change? Is writing fiction easier than practicing medicine? Why did I choose to write historical fiction instead of non-fiction? What similarities do I see in the respective disciplines? Is writing as fulfilling to me as my clinical practice and teaching career? Each of these questions indicate to me that readers are curious about why an established professional would invest himself in a new career that seems to be so very different from the one in which he had been a participant for decades.
First of all, I really haven’t left the medical profession and likely never will. I continue to volunteer my clinical services in free clinics indigent patients and also teach Emergency Medicine residents and faculty about leadership, as well as the business of medicine at Cornell-Columbia and the University of Washington. I guest lecture about the same “survival” topics at many other university medicine residency teaching programs. These pursuits are a giving back, as it were, after a long wonderful career in the private and academic settings, and I consider them a welcome fulfillment for an important obligation I have incurred by accepting the license to practice medicine. And I will never truly retire. There is too much to do and too many magnificent things to see, taste and relish in this life. I refuse to replace my mind with a remote control.
I also do not believe that my approach to writing historical fiction is much of a departure from how I have always participated in my practice of medicine. In fact, irrespective of the differences in “end-product” that one pursues, whether it be saving a patient’s life or creating informative, responsible popular “entertainment”, I have always believed there is a valuable cross-fertilization that occurs when one discipline meets another and their respective vocabularies and experiential bases are exchanged. New metaphors, meanings, and connotations can thus be discovered for the words that are used by the practitioners of each métier to solve the problems they face. And the expansion of ambiguities that thus develops, in turn serves to enrich our poetry.
I have always believed that patients benefit when their physicians learn new words and new languages. And I have found that the process of successfully assimilating new information for a profession, whether it be patient care or filmmaking requires the same amount of vigor, attitude and attentiveness. Writing fiction is just as difficult as practicing medicine. It pays monetarily far less but the fulfillment is similar for me, because I am given the chance to communicate with other souls, just as I have when I take a patient’s history and render a diagnosis.
When I entered pre-med studies in college, I decided that I would always keep both sides of my brain open, so to speak. I felt that would make me a better physician for my patients. Thus, when I was in medical school at Cornell, I taught an acting class and took time to learn to sculpt. And I think the acting helped my bedside manner. The anatomy classes helped me sculpt betterand sculpting gave me a better appreciation for plastic surgery concepts like symmetry and aesthetics. After my internship, I worked part time as an untrained ER doc while I completed my MFA studies at CalArts. My MFA thesis, “Diary of a Moonlighter” was the first documentary ever on the new specialty of Emergency Medicine. The film and video linear editing process taught me to conceptualize, construct and complete a project, which later helped me understand the fundamentals of project management in business. As the national Chief Medical Officer and a co-founder of a major national health care organization, I produced and directed 26 “Patient Safety Fables” videos that we used to teach physicians and nurses about a diverse array of important topics like “bedside manner,’ risk reduction, and the safe management of the violent patient. Each of them were shot “from the gurney”, to emphasize the patient’s perspective. When we taught our medical directors to be effective leaders, we utilized a wide array of atypical teaching tools such as simulation, acting and role-play. We pushed on the edge and the innovation was refreshing and memorable.
For me, writing historical fiction is just as rigorous an endeavor as writing non-fiction history, or scientific prose. When I write historical fiction, I apply the same research principles that I learned in writing scientific and business papers. I read extensively from a variety of sources, verify the information I glean as best I can, and integrate the story line into a well-informed historical context, so that the end-result will be less likely to be dismissed. Frankly, I find that writing historical fiction, at least how I try to do it, is in many ways more difficult than writing non-fiction, because in my writing I am attempting to find themes that resonate and create plausible characters. Thus, the historical context must be accurately depicted and the motivations of the characters must be consistent with what I believe is inherent in human nature. If I write about fictional protagonists and villains, their actions have to be driven by needs and worries that most people can truly understand. If my writing is to endure, the people I invent must be palpably human with all the vulnerability that defines much of the human spirit.
Perhaps that is where the notion of learning about and practicing medicine with empathy plays such an important role in honing the skills of a physician. In my medical school and residency training years such notions were diminished, if not overtly, then by the examples we were given by some of the most famous and well-published of our teachers. As students and young physicians, we had to fight to preserve and inculcate empathy into our practices, and it was difficult at times, because it is so easy to slip into self-pity and treat patients as outsiders, particularly when we worked so hard in difficult conditions. We often resorted to gallows humor to get past the worst of things. I truly believe the process of empathizing with our patients was considered by many medical “scientists” a non-measurable component to health care, and therefore was an unaffordable vanity to be minimized. But great medical authors like Lewis Thomas and Richard Selzer certainly understood the importance of empathy and, as evidenced by their writing, they defied the prevalent philosophies and norms of the time in which they wrote. They were non-fiction writers, and their work is rich and beautiful because of what was imbued as an underpinning to the stories they created.
My responsibility as a historical fiction writer is to apply the same ethos and pathos to the characters I invent. Perhaps that is where keeping my eyes and heart wide open in the practice of medicine has given me an advantage for which I am very grateful.