Cover Story: The Physician-Writer: Good doctors are good storytellers; some make it a second career | By Debra L. Beck
Want a writer intimately attuned to living and dying? See a doctor. Their life expertise alone makes physicians great sources, but that’s just part of the equation: long before journals made knowledge transfer much easier, good doctors had to be good story tellers.
For centuries, select physicians have chosen to write creatively (or just non-academically), taking up pen (or keyboard) alongside their practice of medicine. An unusual choice, but actually not an uncommon one. This might be a surprise to many people, but today, many such physicians are now far better remembered for their prose than their medical credentials. The list of great physician-writers of ages past includes the medieval philosopher and physician, Maimonides, and such notables as John Locke in the 17th century; John Keats, Edward Jenner, and Tobias George Smollett in the 18th century; and Anton Chekov, Sir Arthur Conan Doyle, Oliver Wendell Holmes, Sr., W. Somerset Maugham, Sir William Osler, and William Carlos Williams in the 19th century.
Besides being one of history’s greatest short story writers, the Russian writer, playwright (and physician), Anton Chekhov famously characterized his dual career as “medicine is my lawful wife and literature is my mistress.” Less often quoted is the continuation of that letter: “When I get tired of one, I spend the night with the other. Though it’s disorderly, it’s not so dull; and besides neither of them loses anything from my infidelity.”
You think it’s hard to make money in today’s health care environment? Chekov started writing strictly for financial gain, but later grew more attached and devoted to his ‘mistress.’ In a letter written in 1899, he said that while he picked medicine more or less randomly, he did not regret his first choice:
“I have no doubt that the study of medicine has had an important influence on my literary work; it has considerably enlarged the sphere of my observation, has enriched me with knowledge the true value of which for me as a writer can only be understood by one who is himself a doctor.”
The Modern Hyphenate
Like Hollywood and other creative fields dominated by star power hyphenates, the red carpet, best seller lists, and book award winners have contained many recognizable names in this and the last century to add to the physician-writer list (though, again, you may not have realized all of them are physicians): Michael Crichton, Robin Cook, Atul Gawande, Siddhartha Mukherjee, Tess Gerritsen, Khaled Hosseini, and Abraham Verghese.
The term physician-writer (or physician-author) is most often used to describe doctors who write creatively. (Think fiction.) Nevertheless, considering that health is perennially one of the most popular topics among the public, many physicians have taken pen to paper to write the history of medicine or explain, elaborate, or opine about the practice or future of medicine.
Of late there have been an abundance of books written for the general public about different diseases and conditions. This is to the immense gain of the reading public, as some of these books and articles represent the best consumer health information available.
The (Incomplete) Reading List
If you’re looking for some light or not so light reading this summer, there are a number of great options in physician-written literature. This list is far from complete, but it’s a reasonable start.
Abraham Verghese (Stanford University) was an early over-achiever, board certified in internal medicine, pulmonary diseases, and infectious diseases. You may have seen him when he gave the Simon Dack lecture at the opening session of ACC.15. His novel, Cutting for Stone, set in Ethiopia and New York City, is rich in medical detail and human emotion. It spent more than 2 years on the New York Times bestseller list and was on President Obama’s summer reading list in 2011. He has also penned two memoirs: My Own Country (detailing his experiences as a young doctor in rural Tennessee at the beginning of the AIDS epidemic) and The Tennis Partner (tracing his friendship with a medical student dogged by drug addiction). Both were critically acclaimed and the former became a TV movie.
Physician burnout continues unabated. When it hit Dr. Verghese, he realized, it was now time for something completely different. He wanted to write an “epic medical novel,” so, Dr. Verghese put his career on hold to attend the prestigious Iowa Writers’ Workshop at the University of Iowa. He earned a Masters of Fine Arts in English there in 1991. When writing Cutting for Stone, he poured all of his passions into it. As Dr. Verghese noted, “It shows that a career in medicine can both save you and lose you.” Maybe his experience explains the allure for physician-writers: “Illness is a story.”
After his initial success with The Kite Runner (2003), Khaled Hosseini wrote A Thousand Splendid Suns, which debuted as the #1 book in the nation and hit the top of nearly every national bestseller list. Together with The Kite Runner, it has sold more than 38 million copies worldwide. Dr. Hosseini practiced internal medicine for more than 10 years, until shortly after the release of The Kite Runner. In 2013, he published And The Mountains Echoed.
Of his two crafts, Dr. Hosseini said, “Writers and doctors alike need to understand the motivation behind the things people say and do, and their fears, their hopes and aspirations. In both professions, one needs to appreciate how socioeconomic background, family, culture, language, religion, and other factors shape a person, whether it is a patient in an exam room or a character in a story.”
Mysteries, Sci-Fi, Thrillers
Somehow, medicine, mystery, and murder just—well—go together. Dame Agatha Christie was an apothecary. So accurate was her description of thallium poisoning that on at least one occasion, it helped solve a case that was baffling doctors. Of course, Sir Arthur Conan Doyle, the creator of Sherlock Holmes and Dr. Watson, was himself a doctor. His writing had very practical origins: he started penning fiction while waiting for patients to discover his newly opened private practice. His future life as a mystery writer may have been foreshadowed when he drew a humorous sketch of himself receiving his medical diploma, with the caption: “Licensed to Kill.”
Doyle continued to practice medicine even after achieving literary success but in 1891, after a near-death experience with influenza, he decided to abandon his medical career “with a wild rush of joy.”
Not all writers of medical mysteries/thrillers are physicians, but several notable ones are, including, arguably, the King of the Medical Mystery, Robert Brian “Robin” Cook. Until Dr. Cook, medical doctors in fiction tended to ‘practice’ perched atop a pedestal. (Paging Drs. Casey, Kildare, and Welby.) All of Dr. Cook’s novels have a grittier medical slant, starting with his first books, The Year of the Intern (1972) and Coma (1977), all the way to his most recent, Death Benefit (2011), Nano (2013), Cell (2014), and Host (2015). An ophthalmologist by training, Dr. Cook has written 33 worldwide bestsellers to date. In each, Dr. Cook tries to elucidate various medical/biotech ethical issues. According to his website, Dr. Cook “chose to write thrillers as a way to use entertainment as a method of exposing the public to public policy conundrums such as genetic engineering, medical economics, in vitro fertilization, research funding, managed care, drug research, organ transplantation, stem cell research, concierge medicine, and M.D.-owned specialty hospitals.” (Managed care as entertainment. Think about that for a moment.)
Michael Crichton, Tess Gerritsen, and Michael Palmer also achieved chart-topping hits as physician-writers in the mystery, thriller, sci-fi arenas.
Dr. Crichton (1942–2008) trained at Harvard Medical School but never obtained a licence to practice medicine, instead becoming a best-selling author (Jurassic Park, 1990, among others), producer, director, and screenwriter.
Dr. Gerritsen (Vanish  among others) started writing during a maternity leave from her job as an internist. She is now retired from medicine, but has used her knowledge and fame to help raise money for Alzheimer’s research. Many, but not all, of her books fall under the medical thriller category. You may know her best as the creator of pathologist Dr. Maura Isles and her colleague and close friend, Detective Jane Rizzoli, who live both in the pages Dr. Gerritsen has penned and on the small screen in the television series, Rizzoli and Isles.
Dr. Palmer (1942-2013) never wanted to be a writer, but did believe he had “some sort of creative streak hidden inside me.” He was inspired to try writing after reading Robin Cook’s Coma; his deeply analytical approach to his second career went something like this: “If Robin can do it, why can’t I?” Dr. Palmer (Extreme Measures  among others) spent 20 years as a full-time practitioner of internal and emergency medicine, and served as an associate director of the Massachusetts Medical Society’s physician health program, along the way writing 19 novels, several of which were bestsellers.
Beyond these superstars, there are several physician-writers who have published a book of fiction or two, whilst keeping their day jobs. In our own world of cardiology, two names stand out: Douglas Zipes and Peter R. Kowey (Jefferson Medical College and Lankenau Institute for Medical Research).
Dr. Zipes is “Douglas P.” when writing as a physician and just “Doug” when writing creatively. (See the sidebar: “Two (and Too) All-consuming Professions.”) He just published his third mystery, entitled Not Just a Game. The release of the novel is timely in that the story takes place, in part, during the 2016 Rio Olympics. The book tells the stories of three generations of Olympians from the same Jewish family.
The reviews have been resoundingly positive: “Doug Zipes, undoubtedly one of this genre’s rising stars, masterfully weaves romance, intrigue, and suspense into an intoxicating journey through history including WWII, Nazi Germany, South America and culminates on one of the world’s grandest stages- the Olympics!” said an Amazon reviewer.
Dr. Kowey has published two books: Lethal Rhythm (2010) and Deadly Rhythm (2012). His principal area of interest is, as you might guess, cardiac rhythm disturbances.
On Living and Dying
Death and illness (not taxes) are obvious topics for physician-writers and some (if not most) of the seminal works on death have been penned by physicians. Sherwin B. Nuland’s How We Die: Reflections on Life’s Final Chapter (1994) won a National Book Award and is considered one of the most important books on the topic. Dr. Nuland was an American surgeon.
Also on this list: Elizabeth Kübler-Ross, who wrote the 1969 ground-breaking classic On Death and Dying, which massively reshaped the way we talk about mourning, the process of moving from anger to acceptance. It remains basic reading for those interested in life and living as well as death and dying. Many of Kubler-Ross’s observations on living and dying are so much a part of popular parlance, that their origin has been forgotten. For example:
“The opinion which other people have of you is their problem, not yours.”
“There are no mistakes, no coincidences. All events are blessings given to us to learn from.”
“It’s only when we truly know and understand that we have a limited time on earth—and that we have no way of knowing when our time is up—that we will begin to live each day to the fullest, as if it was the only one we had.”
Some of the most impactful and even haunting writing to arise from the physician world is from physicians who have written about their own fatal diseases. The response to this kind of expanded autobiographical case history can be profound.
When Breath Becomes Air (2016) is by Paul Kalanithi, a budding neurosurgeon struck down by lung cancer at the age of 37. In this profoundly moving memoir, Dr. Kalanithi (formerly of Stanford Medical School) writes about reading his own CT scan, seeing a new tumor, scrubbing for his last case, his last day practicing medicine. The response to the book has been huge. The New York Times called it “a great, indelible book” that, once read, will never be forgotten.
“If you asked me at the age of 17 what I’d be doing with my life, I’d have said I would definitely be a writer,” said Dr. Kalanithi in an interview shortly before his death. “For me, literature was always a powerful, reflective tool for thinking about life.”
After finishing his undergraduate studies, however, which, included an M.A. in English Literature, he decided what he was most passionate about was medicine. His motivation for writing his memoir was summed up simply by a short sentence that appeared in an essay he wrote for Stanford Medicine magazine entitled, “Before I go.” He wrote: “Words have a longevity I do not.”
With a foreword by Dr. Verghese and an epilogue by Kalanithi’s internist wife, Lucy Kalanithi, When Breath Becomes Air, is a poignant and life-affirming must read. As Eric Topol put it (in an email exchange), “I loved the book and it fully deserved to be the #1 book (non-fiction) in the world. I feel it immortalized Paul.”
Just down the list from Dr. Kalanithi’s book at #4 on The New York Times hardcover nonfiction bestseller list (as of May 15, 2016), is Atul Gawande’s Being Mortal (2014), at #11, which considers “the modern experience of mortality” and how medicine is failing the test of assisting patients to a good death. Alongside his success as a surgeon, Dr. Gawande has received international renown for his insightful, honest, and sometimes highly critical looks at the practice of modern medicine. He has written four books and dozens of articles that reveal and evaluate the practice of medicine today.
And, of course, there is the late Oliver Sacks, the poet laureate of contemporary medicine. Dr. Sacks wrote in 1984 about his experience recovering from muscle surgery and then, in 2006, about the loss of stereoscopic vision after radiation therapy for uveal melanoma. Then, in Dec 2014, in a New York Times op-ed piece, he shared the news that he was dying from metastatic cancer. When he died in August 2015, Dr. Sacks was and is remembered not just as a gifted neurologist, but as one who was able to chronicle death and illness from the cool intellectual perspective of a physician and scientist, yet with profound sympathy. In his own words, he “bore witness” to the wealth of emotion felt by the sick and dying.
Dr. Sacks’ valedictory essay was not about death but about what makes life most worth living and what is meant by a “good and worthwhile life.” It is an impactful effort from anyone facing death, but made more so by one who had so successfully brought science and medicine to the night tables of the world.
About Medicine or Disease
The Emperor of All Maladies: A Biography of Cancer (2010) details the evolution of diagnosis and treatment of cancer from ancient Egypt to the latest breakthroughs. A large book detailing an exhaustive account, Emperor won a Pulitzer Prize in 2011 before becoming the basis of a PBS miniseries. It would be reasonable to feel surprise that a 600+ page book on cancer could be a bestseller. As The New Yorker said of the book, “It’s hard to think of many books for a general audience that have rendered any area of modern science and technology with such intelligence, accessibility, and compassion[…]An extraordinary achievement.”
Dr. Mukherjee’s second book, The Laws of Medicine: Field Notes from an Uncertain Science (2015), was shorter, addressing the issue of whether medicine is indeed a science. His third, just released effort (The Gene: An Intimate History) “weaves science, social history, and personal narrative to tell us the story of one of the most important conceptual breakthroughs of modern times.”
Dr. Topol, director of the Scripps Translational Science Institute in La Jolla, CA, has long been considered one of America’s most influential physicians. He wrote The Creative Destruction of Medicine (2012) and The Patient Will See You Now (2015). The latter attempts to democratize and digitize—and thereby improve—medicine. The book was heralded by The New York Times, as a “must-read manifesto for patients who feel helpless.”
In his well-received memoir Intern: A Doctor’s Initiation (2007), Dr. Jauhar chronicled the harrowing, formative years of his residency. In Doctored: The Disillusionment of an American Physician (2014), he presents the crisis of American medicine through the life of an attending cardiologist.
History of Medicine
Not surprisingly, many of the most important books tackling the history of medicine have been written by physicians. We mention just a few here, written by cardiologists.
W. Bruce Fye
Caring for the Heart: Mayo Clinic and the Rise of Specialization (2015) describes major developments in the diagnosis and treatment of heart disease in the 20th century and details how the Mayo Clinic evolved into one of the world’s leading medical centers. The book also describes how scientific advances and technological innovations—along with national and international societies—helped create contemporary heart care and stimulate subspecialization. Speaking of those societies, Dr. Frye also wrote American Cardiology: The History of a Specialty and its College (1996).An emeritus cardiologist at Mayo Clinic in Rochester, Minnesota, Dr. Frye also is a past president of the American Association for the History of Medicine and the American Osler Institute.
Serving at both Cedar-Sinai Medical Center and UCLA, Dr. Forrester has written a historical memoir of his personal relationships with the pioneers who created cardiac surgery, defibrillators, pacemakers, cardiac care units, cardiovascular imaging, and percutaneous coronary intervention. The Heart Healers: The Misfits, Mavericks, and Rebels Who Created the Greatest Medical Breakthrough of Our Lives (2015) tells the tales and backstories to illuminate this golden era of cardiology for the masses.
William L. Winters, Jr.
The star of Dr. Winters’ book, Houston Hearts: A History of Cardiovascular Surgery and Medicine and the Methodist DeBakey Heart and Vascular Center at Houston Methodist Hospital (2014) is Michael DeBakey, MD, who came to Houston in 1948 to chair the department of surgery at Baylor University School of Medicine. His 6-decade relationship with Houston resulted in the establishment of the Methodist DeBakey Heart and Vascular Center in 2001. Dr. Winters himself moved to Houston in 1968 to join a private cardiology practice and has shared his experience as a witness to the rise of Houston as a center of excellence in cardiothoracic surgery and medicine. n
|Read the full June issue of CardioSource WorldNews at ACC.org/CSWN|
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