By ABIGAIL ZUGER, M.D.
Like the racket of dozens of birds on a clothesline, the sound of doctors is filling the air.
The strongest voices at the moment belong to Dr. Jerome Groopman and Dr. Atul Gawande, both clinicians at Harvard and writers for The New Yorker, both with articulate new books garnering impressive reviews and climbing in parallel to best-sellerdom. But they are only two of many doctors holding forth these days, in escalating volume.
The last six months alone have seen the publication of a half-dozen volumes of memoir and opinion by doctors at every stage of professional life, from newbie (“M.D.: A Four-Year Journey Through Medical School” by Shani Stein-Ratzker) to emeritus (“Galileo’s Gout: Science in an Age of Endarkenment” by Gerald Weissmann).
Some books promise to educate and inspire (“The Man With the Iron Tattoo and Other True Tales of Uncommon Wisdom: What Our Patients Have Taught Us About Love, Faith and Healing,” by John E. Castaldo and Lawrence P. Levitt). Some books promise social critique instead (“The Corrosion of Medicine: Can the Profession Reclaim Its Moral Legacy?” by John Geyman, due out at the end of the month).
Doctors are also filling up newspaper columns (like this one), blogging, submitting work to literary journals and signing up for courses designed to help them break into print.
It all prompts the same questions as a sudden swooping, squawking murmuration of starlings: where are they all coming from? And what in the world are they trying to say?
Some listeners hear a set of new variations on very old songs.
“Doctors are storytellers,” said Kathryn Montgomery, a professor of literature who directs the medical humanities and bioethics program at Northwestern University’s Feinberg School of Medicine in Chicago. “They spend all day long listening to stories and telling stories.”
They tell stories, she went on, even when no one is around to listen — to clarify their own thoughts, to teach and to stimulate research. “It’s not surprising they write,” she said.
Reflecting the literary tastes of our age, Ms. Montgomery suggested, the fiction and poetry of doctors like Anton Chekhov, William Somerset Maugham and William Carlos Williams, among others, are being replaced by memoirs.
The current television schedule may also influence the speeding of modern doctors’ work into print. With every second actor now wearing scrubs and saving lives, publishers undoubtedly sense a public appetite for the words of real doctors who are ready to spill all.
But any reader anticipating a good, light read is likely to be disappointed. On television, the frenetic energy of the hospital may spell entertainment, but on the page it has become food for the increasingly sober existential thought.
A look back at The New Yorker’s articles about medicine during the last few decades reveals the darkening mood of medical writing.
For decades, the magazine’s medical beat belonged to Berton Roueché, a journalist who stumbled in the late 1940s onto the great unmined literary lode of medical practice. With no medical background himself, Mr. Roueché (who died in 1994) carefully constructed his dozens of stories about medicine to give the doctors he interviewed the primary narrative voice.
Mr. Roueché’s contributions to The New Yorker’s Annals of Medicine were as addictive and as predictable as any detective fiction: a patient developed mysterious symptoms (a man grew breasts, a woman lost all her strength), and an astute doctor figured out why (the man’s wife used an estrogen-containing cream; the woman had the paralytic condition myasthenia gravis, but an operation let her dance again).
Dr. Groopman and Dr. Gawande have assumed the Roueché mantle, but their cautionary fables could not be more different from his neatly packaged stories of medical success.
Dr. Groopman made his New Yorker debut 10 years ago with the story of a patient dying of cancer, who came to him asking for “magic.” The patient had heard that Dr. Groopman was “a medical genius, a wizard,” and liked to address him as “St. Jerome.”
On television, this character might have gotten his magic. In reality, Dr. Groopman struggled to get him a few months of remission, only to find the man more miserable in health than he ever was in his fight against disease.
Dr. Groopman has made it clear, in his writings since then, that medicine has no magic, wizards or geniuses, and very few saints. Instead, there is only uncertainty in an endless spectrum of grays, with doctors whose skills promote an illusion of magic and others who stumble.
In his latest book, “How Doctors Think,” Dr. Groopman looks at when the sleight-of-hand goes wrong. Why should an emergency room doctor misdiagnose a heart attack, or a pediatrician fail to recognize a malnourished infant, or a highly pedigreed surgeon mistake the problem crippling Dr. Groopman’s right wrist? The flawed thinking is broken down, step by step, like the diagrams in a manual of how to palm cards.
“I wrote this book because I was dissatisfied,” Dr. Groopman said in an interview. “In general there’s a high level of dissatisfaction among physicians. Some doctors look to systems analysis to start to fix things. Maybe I’m a dinosaur; I go for narrative instead.”
Dr. Gawande is also in the fix-it business. He too began his writing career debunking the idea of magic in medicine. “The whole edifice of medical training is based on subterfuge,” he wrote in the online magazine Slate while a second-year surgical resident 10 years ago, going on to deconstruct the surreptitious manipulations that conspire to camouflage medicine’s inexperienced trainees.
In his new book, “Better: A Surgeon’s Notes on Performance,” Dr. Gawande is still tracing the near-invisible maneuvers required to sustain the gigantic ambitions of the medical system. His book celebrates some of the most routine parts of medicine — the washing of hands, the inoculation of children — and explains how, should these actions be omitted, the structure of the enterprise begins to teeter.
What a difference from the glib confusion that passes for medicine on television, or the comforting linear narratives of Mr. Roueché. Instead of speeding along in double time, Dr. Groopman and Dr. Gawande, like the frustrated coaches of a losing team, are slowing the motion of medicine down to half-speed, examining each play, then each frame and image, trying to figure out where the glitches lie.
It is prose with a mission, to find and to fix. And they are not the only ones who have come to the written word as a way to fix medicine, rather than simply to celebrate it.
Humanists have long argued that when doctors cultivate the skills involved in constructing a written narrative — an ear for plot, images and elisions — they become abler, more humane doctors.
Almost all medical schools now ask students to read writing by doctors, and some now require students to write about their own experiences.
Older doctors may turn instead to short courses like “Writing the Medical Experience,” offered at Sarah Lawrence College’s summer school, or the short workshops in narrative medicine offered by the faculty of the Columbia University College of Physicians and Surgeons in New York.
Unfortunately, an appreciation of the written word and its power does not always correlate with talent. The doctors and nurses who submit writing to The Bellevue Literary Review, a publication devoted to health-related poetry and prose, “are heartfelt and have a lot to say, but aren’t necessarily fine writers,” said Dr. Danielle Ofri, the editor. “Most are of mediocre quality. Their writing, that is. I’m sure they’re fine clinicians.”
In other words, the birds on the clothesline are likely to be singing loudly, passionately — and, some of them, completely out of tune — for quite some time to come.
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