Frequently Asked Questions
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I’ve always written some, but it was becoming and then being a doctor that made me into a writer.
In medical school, now and again I would be struck by something—the young schizophrenic on 1000 milligrams of Thorazine, for instance. “Look what the tree is doing!” she told me, when we went out of the locked ward one spring morning, and stood together in front of a plum tree just bursting into blossom.
I would write an occasional poem or piece about something like that. To distract myself from the hospital, I also began translating the poems of Renee Vivien, some of which were published. Still, I wouldn’t say I was a writer.
But doctoring, especially the “workup”—the written account and summary of the history, the physical examination, and the test results—requires a lot of writing, and the more I wrote those workups the better writer I became. Nowadays what with electronic medical records, young doctors can simply cut and paste everyone else’s words, and they do, but the traditional workup is handwritten and, at best, a work of observation, intelligence and good storytelling. Especially the History of Present Illness, which should really be called the story of the illness, because it sums up all the facts and conveys, by what it puts in and leaves out, the probable diagnosis. I wrote many of these, and enjoyed writing them. How concise could I be? How clear? How subtle in leading the reader down the path I wanted him to take?
Doctoring, too, is similar to writing in that it—again at best—requires the keen observing of physical details, intuiting a back story by what is “not there,” reading emotions, and finding the thread of logic in a bunch of different impressions, thoughts, feelings, and facts.
It was only when I decided to get a PhD in Medical History—studying the medicine of the twelfth-century nun, Hildegard of Bingen, and through her, learning about pre-modern medicine—that I began thinking about writing.
It started in our seminar on historiography, whose structure was that each week we would read a book and write a review in the style of that author. I hadn’t realized before that it was as possible to imitate a writing style as to mimic an accent, and that exercise gave me a whole bag of new tricks. I could choose a style, I learned; I could change my style; I could have a style, by what words I chose, how I punctuated, paragraphed, used quotations, and composed my cadence.
The second experience that turned me into a writer was the first major essay for my PhD. I outlined it and I wrote, rewrote, and edited it, rearranged it, and puzzled over it. But no matter what I did, I couldn’t get it right. What was wrong or how to fix it. The essay was on Hildegard of Bingen, the star-to-be of my PhD, and I had so much to say! I knew all the threads I wanted to weave together, but it just wouldn’t come out. Finally I went over to the library with scissors, tape, and paper, and I took that essay apart. I rewrote it, in simple sentences, one after another, clear and clean. Then I put it back together like a mathematics proof. Then it worked. After that, I had the basics of writing.
As for becoming a writer, that happened when I realized the depth and breadth of what, unbeknownst to me, I’d been learning for years at Laguna Honda. Since the hospital was soon to be destroyed, I decided to see if I could capture its essence on paper. I wasn’t sure I could. But as I started out on the pilgrimage, my patients—the important ones, the ones who had changed my practice of medicine, the ones who had changed me—began to surface in my mind. I started to take notes, and when I got back home I spent a year writing the first draft of God’s Hotel. It wasn’t perfect—it took me seven years to get it the way it wanted to be—but when I’d finished, I knew I could be the writer I wanted to be: the writer that captured God’s Hotel’s essence, on paper.
I can only say what works for me.
I do not write every day. In fact I deliberately write—not every day. I don’t write when I don’t want to; I don’t keep a journal. When something wants to be written, I don’t think about it much, until I write it. I let it bat around; I let it smoke and smolder, then I catch it when it starts to flicker.
I don’t compose on a computer. Its quivering screen, its ready eagerness, make me nervous. I feel like I should apologize to it for making it wait when I can’t think of the right word. Instead I use a fountain pen, which makes the most satisfying scratch, like a chicken scratching in the dirt for worms, on the paper of my notebooks, which are numbered and dated and always have purple covers.
I write twice as much as I need, then I edit. Editing is the key to writing, or to my writing, and the other key is selective reading. Reading the best writers, the cleanest, the smartest, the most elegant, the most truthful. And not reading much else.
Being truthful. That’s the hardest. Not just not-lying but choosing the right word is truthful, and choosing the wrong word, isn’t. Words have images within them, and the image needs to match, to express the truth, just like the word, “true,” itself. When something is true, it fits perfectly; it does not deviate or curve away; it is straight.