I’m a great believer in geography being destiny.
Rituals, anthropologists will tell us, are about transformation. The rituals we use for marriage, baptism or inaugurating a president are as elaborate as they are because we associate the ritual with a major life passage, the crossing of a critical threshold, or in other words, with transformation.
Though I am fascinated by knowledge, I am even more fascinated by wisdom.
My writing flows out of my doctorhood. They are not separate things. They are one. I think the foremost connection between being a doctor and being a writer is the great privilege of having an intimate view of one’s fellow humans, the privilege of being there and helping other people at their most vulnerable moments.
I was taking care of people my age who were dying. The constant feeling, hearing from them, was that life is transient and can end very quickly, so don’t postpone your dreams.
I’ve never bought this idea of taking a therapeutic distance. If I see a student or house staff cry, I take great faith in that. That’s a great person; they’re going to be a great doctor.
There is that lovely feeling of one reader telling another, ‘You must read this.’ I’ve always wanted to write a book like that, with the sense that you are contributing to the discourse in middle America, a discourse that begins at a book club in a living room, but then spreads. That is meaningful to me.
What we need in medical schools is not to teach empathy, as much as to preserve it – the process of learning huge volumes of information about disease, of learning a specialized language, can ironically make one lose sight of the patient one came to serve; empathy can be replaced by cynicism.
I think we learn from medicine everywhere that it is, at its heart, a human endeavor, requiring good science but also a limitless curiosity and interest in your fellow human being, and that the physician-patient relationship is key; all else follows from it.
The flip side of suicide is that it leaves a lingering question in the minds of the people who survived. It’s like a cancer that’s metastasized. The suicide is the cancer and the metastasis is all these people saying, Why? Why? Why?
We’re now able to show that the words of comfort trigger biological reactions which are the very things that you want, and you can use drugs to get there, or you can use words of comfort to get there, which would make your drugs so much more effective.
Medicine, you see, is my first love; whether I write fiction or nonfiction, and even when it has nothing to do with medicine, it’s still about medicine. After all, what is medicine but life plus? So I write about life.
By visiting patients in their home, by helping them come to terms with their illness, I could heal when I could not cure.
I think legislation needs to put an end to doctors profiting on businesses to which they can funnel patients – that is business, not medicine. If you try to call it medicine, then it is corruption. Without legislation, it will keep happening.
My deceased patients have taught me over the years to believe in the glass half full, to make good use of the time we have, to be generous – that was their lesson for the Uber-mind, and it was free. ‘Do that,’ they said, ‘and then perhaps death shall have no dominion.’
I think we can see how blessed we are in America to have access to the kind of health care we do if we are insured, and even if uninsured, how there is a safety net. Now, as to the problem of how much health care costs and how we reform health care … it is another story altogether.
The bottom line: health care reform is about the patient, not about the physician.
Patients know in a heartbeat if they’re getting a clumsy exam.
Lest it sound as if I resent my day job, I have to say that my day job is the reason I write, and it has been the best thing for me as a writer.
I write by stealing time. The hours in the day have never felt as if they belonged to me. The greatest number has belonged to my day job as a physician and professor of medicine – eight to 12 hours, and even more in the early days.
When you have a natural genetic tan developed over centuries and many generations, the idea of soaking up rays by the pool has never made sense.
Students undergo a conversion in the third year of medical school – not pre-clinical to clinical, but pre-cynical to cynical.
Medicine may be the lens through which I see the world, but since I think of medicine as ‘life +’, a place where life is exaggerated and seen at its most vital and poignant, I’ll be writing about life more than I will be writing about medicine.
My advice for writers is to get a good day job. It takes the pressure off writing if you have a job that pays the bills.
I still find the best way to understand a hospitalized patient whose care I am taking over is not by staring at the computer screen but by going to see the patient; it’s only at the bedside that I can figure out what is important.
There’s something universal about illness… Whether you like it, at some level all patients are saying, ‘Daddy, Mommy, help me, tell me it’s going to be alright.’
I joke, but only half joke, that if you show up in an American hospital missing a finger, no one will believe you until they get a CAT scan, MRI and orthopedic consult.
In America, we have always taken it as an article of faith that we ‘battle’ cancer; we attack it with knives, we poison it with chemotherapy or we blast it with radiation. If we are fortunate, we ‘beat’ the cancer. If not, we are posthumously praised for having ‘succumbed after a long battle.’
Certainly when I got to medical school, I had role models of the kind of physicians I wanted to be. I had an uncle who, looking back, was probably not the most-educated physician around, but he carried it off so well.
My sense is that the wonderful technology that we have to visualize the inside of the body often leaves physicians feeling that the exam is a waste of time and so they may shortchange the ritual.
I’m a proud American – becoming a citizen in 1988 was one of the most profoundly moving occasions in my life; I’m a former Texan and a recent Californian.
I love to read poetry but I haven’t written anything that I’m willing to show anybody.
You can’t show up at the bedside and then turn on your skills. You have to keep your game sharp all the time.
As a young physician in the mid-’80s, caring for people who had contracted H.I.V., I lost two of my patients to suicide at a time when the virus was doing very little harm to them. I have always thought of them as having been killed by a metaphor, by the burden of secrecy and shame associated with the disease.
When I use the word ‘healing,’ by that I mean that every disease has a physical element that we’re very good at handling, but there’s always a sense of the violation. ‘Why me?’ ‘Why is my leg broken on the ski trip and not anyone else’s?’ And I think that medicine has done a terrible job of addressing that spiritual violation.
My desire to be a physician had a lot to do with that sense of medicine as a ministry of healing, not just a science. And not even just a science and an art, but also a calling, also a ministry.
The incredible cinematography makes ‘A Walk to Beautiful’ almost like a poem; there is a tenderness on display that seems to emanate from the camera. There is also great sensitivity to the women whose stories are being told – never did I have a sense of the subjects being exploited.
Lets take away the incentives to do ‘to’ patients and instead create incentives to do ‘for’ patients, to be ‘with’ patients. We don’t need to do comparative effectiveness trials to see if that works; we can just ask patients.
There are moments as a teacher when I’m conscious that I’m trotting out the same exact phrase my professor used with me years ago. It’s an eerie feeling, as if my old mentor is not just in the room, but in my shoes, using me as his mouthpiece.
For one who has an interest in the body as text, airports are treasure troves of information. It seems almost un-American to enjoy delays, and perhaps enjoy is not the best word, but certainly a delayed flight, if it does nothing else, allows one the opportunity to make prolonged observations about one’s fellow travelers.
So I consider myself a dog person. Kind of. Had dogs when I was a kid, but my parents would never have dreamed of having them in the house.
Modern society has evolved to the point where we counter the old-fashioned fatalism surrounding the word ‘cancer’ by embracing the idea of the Uber-mind – that our will possesses nearly supernatural powers.
Literature is a beautiful way of keeping the imagination alive, of visiting worlds you would never have time to in your day-to-day life. It keeps you abreast of a wider spectrum of human activities.
We have the sense that medical students come to medicine with a great capacity to understand the suffering of patients. And then by the end of the third year they completely lose that ability, partly because we teach them the specialized language of medicine.
I’m the first to admit that the resolution of a hand feeling the belly doesn’t compare with the resolution of a CAT scan scanning the belly, but only my hand can say that it hurts at this spot and not at this spot. Only my hand can say that.
I think America is really in denial about the degree to which residents, particularly foreign medical graduates, man the county hospitals of this country, and but for their services, I’m not sure how exactly we could manage.
In writing, as in medicine, there are no short cuts. You need stamina.