The Kenneth and Georgia Barwick lecture Clinical Fiction, Doctors’ Families: Can Creative Writing about Medicine Predict the Future of Healthcare? with Marie Myung-Ok Lee

May 31, 2023

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The Kenneth and Georgia Barwick lecture

Clinical Fiction, Doctors’ Families: Can Creative Writing about Medicine Predict the Future of Healthcare?

Marie Myung-Ok Lee

April 13, 2023

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00:00Hello, everybody. Thank you so
00:02much for joining the 2023 Barwick
00:06Lecture featuring Marie Young Oakley.
00:08I'm going to say a few words about
00:10the Barwick Lecture and then I will introduce
00:16Marie. So the Kenneth and Georgia
00:18Barwick Endowment Fund was established
00:20by friends and former colleagues of
00:22Ken and Georgia Barwick and provides
00:23funding for this lecture as well as
00:26other initiatives and activities.
00:28Including the books we are able to
00:30provide to some of you tonight.
00:31Ken Barwick was a gastrointestinal
00:33pathologist here at Yale in
00:36the 1970s and 80s.
00:37He also loved the humanities and
00:39was committed to sharing the value
00:40of the humanities in medicine.
00:42And in 1986 he received the Leo
00:45Lowenstein Award for promoting humane
00:47and egalitarian medical education.
00:50I didn't know Ken Barwick myself,
00:52but I have gotten to know his wife.
00:54Georgia Barwick and really appreciate
00:56that Georgia also has a deep regard
00:58for the absolute necessity of the
01:00humanities in the health professions.
01:01And so I'm glad to say welcome to Georgia,
01:04who I believe is here on the zoom tonight,
01:07and any other Barwick family,
01:10former colleagues and friends,
01:11very you are very,
01:13very welcome and we are happy
01:14that you were here.
01:15And thank you for again for your generosity.
01:18So Marie Munovli is an acclaimed Korean
01:21American writer and author of several novels,
01:23most recently The Evening Hero,
01:25which was published last year,
01:27and really covers all sorts of fascinating
01:29themes that you'll hear a lot about,
01:31including the future of medicine,
01:33immigration, racism, North Korea,
01:35family, dynamic secrets,
01:36and much, much more.
01:38Marie graduated from Brown and was
01:40a writer in residence there before
01:41she began teaching at Columbia.
01:43She is one of the few journalists
01:45who have been allowed to travel to
01:47North Korea since the Korean War,
01:49and her stories and essays
01:50have been published widely in
01:52such places as The Atlantic,
01:54New York Times, Slate, Salon,
01:57Garnica, The Emancipator,
01:58and The Guardian, among others.
02:01She was the first Fulbright scholar
02:02to Korea and creative writing,
02:04and has received many honors for her work,
02:06including an O Henry Honorable Mention,
02:08the Best Book Award from the
02:10Friends of American Writers.
02:11As well as several other fellowships
02:14including Yatto and McDowell Colony,
02:17and she has also served as a judge for
02:19the National Book Award and the Penn EO
02:22Wilson Literary Science Writing Award.
02:24And she is also a founder of the
02:26Asian American Writers Workshop and
02:27was an R Word writer in residence
02:30for the Columbia MFA program.
02:34We have closed captioning and
02:36a SL interpretation available.
02:37Thank you so much.
02:38And thank you to Karen Cole,
02:41program Manager for all you do.
02:43Marie, welcome.
02:56Thank you so much. This is great.
02:58Is this sound good here? Okay, great.
03:03So. Thank you for the wonderful introduction.
03:07And I want to say thank you to the Yale
03:09School of Medicines program in Humanities,
03:11especially its director,
03:12Doctor Anna Reisman, and to the Barwick
03:15family for sponsoring this lecture.
03:17And to the late Doctor Duffy.
03:20I actually presented in this series
03:23over a decade ago when this novel,
03:26The Evening Hero, was in its infancy.
03:28And actually, since it's taken me 18 years
03:30to write and get this novel published,
03:32actually 10 years is more like it's.
03:35Adolescence, I guess, but in any case,
03:37it just feels like a real
03:39homecoming to be back here at Yale.
03:43So a little bit about me.
03:45I'm a novelist,
03:46and the evening hero is somewhat of a
03:50critique of forprofit medicine as seen
03:53through the eyes of a retirement age.
03:56OBGYN Yongman Kuak.
03:57And I know there are some famous novelists
04:00like Abraham Vergazzi who are also doctors,
04:03or like my friend and Columbia
04:06Yale colleague Dr.
04:07Mandy Hutter Epstein,
04:09who also is a doctor but and an author.
04:12And in fact we became friends when I
04:14contacted her a really long time ago
04:16about her fabulous book Get Me Out,
04:18A History of Childbirth and the
04:20From the Garden of Eden to the
04:21Sperm Bank as my main character,
04:23being an OBGONI was just starting
04:25to do research and I've always
04:27appreciated her generosity.
04:28As well as that of so many people in
04:31medicine and academia and more studies.
04:33And the list goes on.
04:34Because for some people,
04:36writing is a very solitary endeavor,
04:38and for me, the introvert, it is as well.
04:40But it is also a highly
04:42collaborative enterprise.
04:44And so,
04:45as you probably figured out by now,
04:47I'm not a doctor and so nothing I say here,
04:51now or ever should be taken as
04:54medical advice.
04:55But I did grow up in a doctor's family,
04:57and so I am very interested in
04:59doctory things.
05:00My father was an anesthesiologist
05:02and a pain specialist,
05:04and we lived in an extremely isolated
05:06rural area in northern Minnesota.
05:09But in high school I often helped
05:11him with preparing his articles
05:12for journals like Neurology,
05:14and thus I was always
05:17working with clinical data.
05:19And so at one point I thought I
05:20was going to be a doctor and I
05:22dropped out of premed in college.
05:24But I did go on to major in a STEM subject,
05:27economics,
05:27and that helped me prepare
05:29for my side hustle,
05:31which has always been science writing.
05:34I published several articles in the
05:35New York Times and other places,
05:37articles that have actually changed
05:40clinical practice in some cases.
05:42First one was one being using cannabis
05:45in a pediatric setting to to treat
05:48our artistic son's gut disease and
05:50anxiety instead of using antipsychotics.
05:52And that actually eventually
05:54got autism added to the list of
05:56qualifying conditions in two states.
05:58And I also read a piece on the
06:00effectiveness of fecal microbiotic
06:02transplant for C difficile
06:04infections and also the long history
06:07in Asian medicine of nurturing
06:09the gut Biome. And that piece
06:12actually helped popularize the
06:15treatment. And I also wrote
06:19Why I never got a mammogram, which.
06:23Where I talked about how I looked at
06:25rates of false positives in mammography,
06:27especially for stage 0 cancers,
06:29as well as looking at longitudinal
06:32numinal mortality rates from breast
06:33cancer comparing women who got
06:35mammograms versus those who didn't.
06:37And I chose for myself
06:38what I was going to do.
06:40I will note, not for anybody else,
06:42but in this article I wanted
06:44to explain my thought processes
06:46and how I got to this place.
06:47And I initially received a lot of really
06:50angry letters from primary care physicians.
06:52But once they looked at the actual data,
06:54including the Cochrane data,
06:56which is mostly what I looked at,
06:57they actually wrote me follow up
06:59emails to apologize and said they're
07:01actually rethinking the age at
07:02which they might start recommending
07:04mammography for their patients.
07:05And as a writer, I don't need
07:07their apologies or their censure.
07:09Actually, I feel like as a writer,
07:11it's my job to.
07:13Digest enormous amounts of observational
07:16data and try to make sense,
07:18if not art, out of it.
07:21So I'm going to tell you a little
07:23bit in a bit about my father,
07:24William Lee,
07:25MD,
07:26who had a really interesting
07:28career besides migrating from
07:29North Korea during the Korean War,
07:32but unlike the character of
07:34young man in my novel.
07:35You Mine is an OBGYN who was more
07:37or less contentedly been at a
07:39small rural hospital for his entire
07:41career until a private equity move
07:43puts his hospital out of business.
07:45My father actually had a stellar
07:48career as a young man that was cut off
07:51by US immigration law and policies.
07:54So novelists are are often this
07:57sensitive antennae of society to the
07:59extent that even they can seem prophetic.
08:02For instance,
08:03speculative writer Octavia Butler,
08:05in her dystopia novel Parable of
08:08the Talents had America electing A
08:10dictator named Andrew Steele Jarrett
08:13who campaigned on can you guess a slogan,
08:16Make America Great Again?
08:18And this was in 1998.
08:19But so I'm also going to be talking
08:21about how their aspects of fiction
08:23that can be useful to physicians and
08:25others in healthcare because there is
08:27an aspect of medicine that is also an art.
08:30So my late father was a doctor.
08:32And so is the character in the novel.
08:34And one of the the pitfalls of
08:36being an ethnic writer is the
08:38usual false assumption that the
08:40novel is pure autobiography.
08:42So my father and the character,
08:43Yong Man, yes, they're both doctors.
08:45Yes,
08:46they're both Korean War refugees to America.
08:48It's reasonable to think of
08:50writing my father's story,
08:51but I'll talk a little bit more about
08:53the mysteries of the art process first.
08:58So this is my father.
09:00And he's with one of the colonels that
09:02he worked with during the Korean War.
09:04During the war, he was already
09:06a doctor and he was at the very
09:09prestigious still National University,
09:10which is the Harvard of Korea.
09:11And so when the US Army set
09:14up camp at on his campus,
09:16they took the top five people from his class
09:18and my father became a liaison officer.
09:20And so he was the person that
09:23whenever the top level generals,
09:24people like Matthew Ridgway,
09:25when they came to look at the mass
09:27units or the floating hospitals,
09:28my father was the one who took.
09:30Them around,
09:30and also from some connections he made
09:33with the World Health Organization,
09:35some executives from there were the people
09:38who helped him immigrate right after the war.
09:41And sort of characteristically,
09:43Korean immigrant doctors habitually
09:46cluster in the same specialties.
09:49They do it so much in these specialties
09:51that are high paying and need less
09:53English that there's actually,
09:54it's on acronym road for radiology,
09:57ophthalmology,
09:57anesthesiology, dermatology.
09:58So my father just fits in there, right?
10:02Exactly.
10:02And in my research,
10:04when I was starting to write the novel,
10:05I had never met a Korean American OBGYN.
10:09So that made me a little bit nervous
10:11about writing about it in fiction.
10:13And I have to say at one
10:15point I was really almost.
10:16Attempted to make Young Man and
10:18Anesthesiologist because when I felt
10:20like I could use some of what I knew
10:22about my father for my fictional world,
10:24but for some reason I just really
10:26wanted him to be an OBGGYN for
10:29whatever intuitive reasons.
10:30I just decided to go with that.
10:32And then the other thing about my father,
10:34my father's Korean name is Cheshi,
10:36which is a very classic and
10:39legible Korean name.
10:40They're just two very
10:42common Chinese characters.
10:43The name Yong Man came to me out of the blue,
10:46and I was never ever sure that
10:49that those are actual 2 legitimate
10:52syllables that you could put together.
10:54But I've always kept it.
10:56And then it wasn't until later when
10:58I was working with someone who
10:59speaks like sort of a sinophilic
11:02Korean and knows ancient Korean
11:04a lot better than I do,
11:05that he was the one who told me
11:07that it could be translated as
11:08Evening Hero and that's how after.
11:10Trying to go through thousands
11:12of titles the 18 years.
11:14That's how the evening hero came up.
11:16And then he the other really cool
11:17thing is that he said that a month
11:19after we had this discussion he
11:21was looking at these Oracle bones
11:23and so this Asian like,
11:24I don't know like to you Mancy.
11:25They actually will put like symbols on bones.
11:27And the symbol he saw for one of the
11:30characters in Yuleman was of a woman
11:33and she'd ex in her abdomen and he
11:35said that could also be translated as OBGYN.
11:38So I just had this very weird moment of
11:40you know sometimes. When you're just
11:42when you're working with fiction,
11:43just kind of going with what you're doing,
11:46even though it doesn't seem right or
11:48you don't know what you're doing is kind
11:51of what what you have to do in art.
11:53So the other thing that's
11:55different is so as you saw,
11:57my father was already a doctor and
11:59he's fairly established.
12:00And in the book,
12:01young man is an orphan who survives
12:03his migration from North Korea to Seoul
12:06as a houseboy on a US Air Force base.
12:10And so the gentleman to the right
12:14is actually my cousin's father.
12:17And this wasn't until I'd already written
12:19most of the book and I'd mentioned that
12:22I had a houseboy character and she said,
12:24oh, my dad was a houseboy.
12:26And so using this,
12:27she dug up this picture from Ray And then.
12:31That helped me this picture basically
12:32helped me kind of imagine what
12:34his life would have been like,
12:36but sort of also the the real
12:38similarities and there because what
12:40happened to my uncle is he ended up
12:42going to law school and he stayed
12:44in Korea unlike young man and he
12:46became a banker and he became a
12:48very successful president of a bank.
12:50So this,
12:50the similarities just ended right there.
12:56And then here too you can see.
12:58So my father's the fancy doctor.
13:00On the left, and my uncle is
13:02the houseboy on the right.
13:08And I also wanted to mention,
13:09I'll be getting into this little bit more.
13:11But there are some incredibly
13:13fantastical elements of my father's
13:16story that incredibly novelistic
13:19and I did not utilize them because
13:21that's his story and yeoman's
13:24story is completely different.
13:30Okay for medical history types.
13:32This is C Walton Lilly High,
13:34who is considered to be the father of
13:37open heart surgery because he's he
13:39did some of the earliest successful,
13:42that's important successful open heart
13:44surgeries and he used cross circulation
13:47and heart lung bypass in order to do that.
13:50There were other doctors working at the
13:51time and normally the patients just died.
13:54During one of those first surgeries,
13:56I believe it's in 1956.
13:57My father was at the University
13:59of Minnesota and was Doctor Lilly
14:01highs anesthesiologist for that
14:03particular landmark surgery.
14:06But what happened to my father?
14:10Is that you would you would imagine that he
14:11would have had an amazing career after that.
14:13But because of the anti Asian immigration
14:15laws at the time which stipulated
14:18that Asians could not become citizens,
14:20it was under the same laws that the
14:23Japanese Americans were incarcerated
14:25basically unlawfully during World War Two.
14:28My father,
14:28well basically my parents got their their
14:31deportation notice the day I was born.
14:33I was the third of their three children,
14:36eventually 4 and so my father had always.
14:39Wanted to have a very large career,
14:41and that was what had kind of
14:42prepared him when he was in Korea.
14:44But because the only thing he could do
14:46to survive and stay in the US was take
14:49a job in a rural town where they were
14:51so desperate that they were willing to
14:54have a Doctor Who didn't have papers.
14:56Because the anesthesiologist is
14:57generally the one person who's always
15:00on call for anything for surgery,
15:02childbirth, emergencies.
15:03And so my father took that job at this.
15:08The Hipping General Hospital actually found
15:11this in the National Library of Medicine.
15:14This this was also historically is
15:17very interesting because Hipping
15:19is the site of the largest open pit
15:21mine in the world and apparently in
15:24the early 1900s they established
15:26this hospital to treat the miners
15:28because mining is very dangerous.
15:30And the miners all had to contribute a
15:33dollar so they could have their care.
15:35So this is kind of the first sort of
15:38employer sponsored healthcare here
15:40at this hospital.
15:41I'm not sure if that's why it's in
15:44the database, but in general,
15:46so you can see my father that I I kind
15:50of see this expression in his face.
15:52He had a much quieter career than
15:54he would have liked to.
15:56Because he was very thwarted in all
15:58areas and also the the reason he wasn't
16:00deported is they ended the town ended
16:02up having to have this big petition
16:04that they took to the State Department.
16:06It actually was rejected several
16:09times but it it ended up they ended up
16:11being able to stay his deportation,
16:13although he was never given even
16:14a green card.
16:15But he always felt so beholden to the
16:18town that even though the laws change,
16:20Lyndon Johnson admitted it was very
16:22racist in 1965 with the Hart Seller Act.
16:24They changed the laws,
16:25but even though my my parents
16:27could have left at that point,
16:28my father just felt very loyal
16:29to the town and what sort of
16:31contented himself with having a much
16:33lesser career than he would have,
16:35than he would have liked.
16:37So now that you know a little
16:38bit about my background,
16:39I'm just going to read 2 brief
16:41sections from the book about young man.
16:45I'm
16:49just going to start.
16:50The two brief sections are I'm
16:51going to start at the beginning,
16:52which is the typical day for young
16:55man working at his General Hospital.
16:58He loves his work.
16:59What he doesn't realize this is
17:01he thinks it's a regular day,
17:02but he doesn't realize the
17:03hospital has already gone back
17:05up because of the private equity
17:06play that the hospital is closing.
17:12Horses breath. Young Man's office was
17:15strategically placed between the surgical
17:17suites and the labor and delivery rooms.
17:20You walked by the imaging room whose
17:22door had a sign that said please do
17:24not smoke during your ultrasound.
17:26And through a door with a sign that
17:29said maternity ward and push, push,
17:32push above its automatic opener.
17:35This heavy door kept the noise of
17:37the ambulances out, but young man was
17:40always imagining he heard sirens.
17:42Young man waved with Secretary Rose,
17:44who's half sized office was
17:46umbilically connected to his.
17:47She had left his white coat
17:49on its hanger behind the door,
17:50pressed and cleaned and sheathed
17:52in protective plastic.
17:53He had to deal with his shoes first.
17:56The unseasonable winter rain had left
17:58the physician's parking lot flooded
18:00and he had picked his way across
18:02archipelagos of dryish asphalt,
18:04stepped lightly into what he
18:05thought was an inch deep puddle,
18:06and then been so shocked when his foot
18:09disappeared up to the ankle that he put
18:11his other foot down into a different lake.
18:13From his desk he took out his
18:15package of emergency socks,
18:16crisp in their cellophane and with the
18:19stuffers drug price tag still on it for 1989.
18:22Both shoes were damp,
18:24so while he hit them under his desk to dry,
18:26he transferred his feet into a
18:28squishy white surgical clogs.
18:29Even though it wasn't a surgery day,
18:33he checked the ER whiteboard.
18:34His longtime patient, Misses Mackey,
18:36had called him at home this morning,
18:38complaining of indigestion.
18:39She wasn't due for two more weeks,
18:42but she tended to deliver fast.
18:45Three children each labor faster than
18:47the previous, so he told her to come in.
18:50Better safe in the hospital than sorry,
18:52especially since recent cuts meant
18:54fewer ambulances were available.
18:56Of course, this could add to his workload.
18:58Normally, Maude,
18:59his nurse midwife,
19:00could do the work up in monitoring,
19:02but there'd been sporadic layoffs for months.
19:04It it seemed there was no more flesh to cut.
19:06But she had been a casualty of last
19:09week's Friday night massacre,
19:10along with Kate Javarina,
19:12the hospital's social worker.
19:14Into this vacuum,
19:15the hospital hadn't come up with
19:16a better system than having all
19:18OBGYN cases come to the ER and wait
19:21for him in bed #5.
19:22Young man didn't feel comfortable
19:24with emergency mixing,
19:25emergency and nonemergency.
19:26It was also a systems problem,
19:29deciding for, say,
19:30a vehicular accident with a pregnant victim,
19:33whether the person needed Doctor Rasmussen,
19:36the ER doctor, or him.
19:38If I'm busy with another patient
19:40without Mod to assess it,
19:41it could be dangerous,
19:43he challenged Odin Tinklenberg,
19:45the young hospital president,
19:47with the curiously old Norris canine.
19:49We all have to do more with less,
19:51Doctor Kwok,
19:52he'd said.
19:53If we're going to keep horses breath
19:55general viable in this market market,
19:58Young man scoffed to himself.
20:00They were talking human beings,
20:02not rubber balls or boxes of cereal.
20:05Tinklenburg's predecessor,
20:06who'd been with the hospital more than 20
20:08years, had been an MD with a
20:10master's in public health.
20:11Odin was an MB A brought in two
20:13years ago by the private management
20:16company Synergistic Action Network.
20:18US Health Systems,
20:19which had made the tantalizing
20:21promise to the board of trustees that
20:23Horse's Breath General would be debt
20:25free in a mere two to five years.
20:27The hospital could regain its former
20:29stability if they gave Tinklenburg
20:31free reign to do his magic.
20:33But all they'd seen so far was fewer staff,
20:35fewer supplies.
20:36Even basics like IV saline and Tylenol
20:39were troublingly often in short supply.
20:42Telephone problems,
20:43which used to get fixed right
20:45away now languished for days.
20:46Also, their ER had been downgraded.
20:481 trauma level, then another.
20:51The new sign at the entrance read
20:53minor injury only, not 24 hour.
20:56For emergency,
20:57please dial 911.
21:03Okay for the second part.
21:05Now young man is out of a job and he
21:08still wants to work and help people.
21:11So his adult son Einstein,
21:14who is also an OBGYN and a Harvard
21:16Medical School graduate has joined
21:18a bro type startup at the Mall of
21:20America doing forprofit luxury births.
21:22And as part of his company there's
21:25a more down market retail scene with
21:27mall based medical retail outlets,
21:29otherwise known as Ambrose.
21:31So he gets his father a gig job.
21:33The only problem in this piece that
21:35I'm going to read is young man thinks
21:37he's going to be administering vaccines
21:43in the very back of the place
21:45with a small storeroom.
21:46It shows piled with inventory.
21:48In the middle, on a folding table,
21:50a woman lay naked from the from the
21:53waist down in lithotomy position,
21:55her head propped up with one hand
21:56so she could check her phone.
21:58Young man tried not to stare.
22:00Hi, she chirped from the table.
22:03Hello, young man said.
22:05Nice to see you.
22:07This is Jenny, our standardized customer.
22:09They get one free treatment for volunteering.
22:12Why do we need a standardized patient?
22:14He asked. True,
22:16normally Maude administered the flu vaccines,
22:18but intramuscular injection was hardly
22:20something he could forget how to do.
22:23You have run a laser defaliculator #2 before?
22:27She said with surprise.
22:29No young man said.
22:31Now they're using lasers for vaccines.
22:33She handed him a white coat that said
22:36Santa's mall based medicine on the pocket.
22:38It's $10 a day to rent.
22:40I have one back at home,
22:42he said, paying for coat.
22:45Consistency across the brand, she said.
22:47We really have to hurry up.
22:49Young man sighed as she left to
22:50go make a copy of his credit card.
22:52While the trainer was gone,
22:53young man didn't know where to put his eyes,
22:55so he picked up a brochure from the pile.
22:58Make my medical grand.
22:59Opening Specialized Medical Retail
23:01puts the trees back into treatments,
23:04Speedy dialysis, In and out, Chemo USA,
23:08Cancer Care, Depalation Nation,
23:11For Eyes, LASIK and vision testing.
23:14Quick view MRI imaging Barry's Bariatric
23:17now with Barry's Junior lap bands Dome Depot,
23:21Neurology and Psychopharmaceuticals.
23:23Faster than the ER.
23:25Vaccines are us. Keep this.
23:29It's your only receipt.
23:30White coat deposit plus $500
23:33incidentals at Depilation Nation.
23:36Depilation Nation, he said, looking up.
23:39We really need to start your training.
23:40The store opens.
23:41She checked her gadgety Sanis
23:43watch in 15 minutes.
23:44Young man wanted to correct her gently.
23:47I'm actually supposed to
23:48be administering vaccines?
23:49That vaccines are us.
23:50No, you're not.
23:52Yes, I am not according to your ID.
23:56Welcome to Devolation Nation,
23:58where unwanted hair comes to dye,
24:00a Sanis Medical retail outlet.
24:02Laser mustache pubic hair depilation is
24:05less painful than waxing or tweezing.
24:07No annoying stubble.
24:08No cleaner skin with less chance
24:10of infection.
24:11Physician administered for
24:13high safety standards,
24:15perfect smoothness and permanent results.
24:17Asterisk financing available.
24:18Asterisk your results may vary.
24:24OBG wins work here, she said.
24:28I don't mean to stop flippant, he said.
24:30The depolation is even less of a
24:32medical procedure than vaccines.
24:34This is the exclusive FDA approved machine
24:38for pubic hair depolation and it requires
24:41a doctor to operate it. Pubic hair.
24:44Why would anyone want to depulate that?
24:47It's an elective health therapeutic.
24:49Young man wanted to clutch his head.
24:51Health pubic hair cushioned and
24:53protected the sensitive skin of the area.
24:55Depolation was unhealthy.
24:58Folliculitis, various infections.
25:00How did he end up in this absurd situation?
25:03Yes, it was Einstein Doctor
25:06shouldn't disease monitor.
25:08He said Pubic hair is not a
25:09pathology and should be left alone.
25:11Here's your code back.
25:12He could sit in a cafe somewhere and
25:14have a pretzel until the day was done.
25:17The store needs to open.
25:18She looked at him.
25:19It's Black Friday,
25:20you know.
25:29So I guess I'll talk a little bit
25:32about how I constructed this book
25:35and me doing things included like
25:36being I was embedded with a bunch
25:39of medical school students in their
25:40third year OB GYN clerkship at Albert
25:42Medical School at Brown and I also had
25:45part of the 18 year journey of this
25:48also was me trying to get into North
25:51Korea to do some research there and
25:55a lot of a lot of times when people.
25:58Think about novels.
25:58You think, oh, I'm going to write about this.
26:00So I do all this research,
26:01but at least for how I did this,
26:03I just let me,
26:04I just let the research take me
26:06where it would.
26:07And I just tried to keep my eyes
26:09open rather than trying to force
26:10anything into this story.
26:12And so one of the funniest things
26:14was because for this clerkship,
26:16I was given an ID that said instructor
26:18on it at Brown Medical School.
26:20I started getting these solicitations on my
26:22in my university e-mail saying Doctor Lee,
26:24learn how to monetize your GYN practice.
26:27Which led me to some seminars.
26:29I had to get on the plane immediately to
26:31go to Las Vegas where I stumbled onto
26:34the weird world of aesthetic vagina surgery.
26:37So and just besides like this sort
26:40of novelistic flamboyance of and
26:42kind of grosses of the issue of
26:45actual vagina plastic surgery,
26:48what I what struck me more deeply was,
26:51and then I felt was worth highlighting,
26:53was what happens when primary care
26:55physicians like. Migrate on mass.
26:57The couple seminars I attended were
26:59these Tony Robbins type seminars
27:01where they were really just trying
27:03to convince people that it's so much
27:05better lifestyle and you can make
27:07so much more money and you don't
27:08have to have liability insurance.
27:10So for me the bigger story besides
27:12just the idea of the vaginal
27:15plastic surgery was about.
27:16What happens when all these primary
27:18care physicians like individually,
27:20when I talk to them,
27:21I understood when they say,
27:22well, I have a family,
27:23like my kids are going to college.
27:25But then on a on a larger sense.
27:27So I started writing about this in the novel,
27:30but then I was realizing the way
27:32I was writing about it because I
27:34felt like I had to tell somebody
27:35about it is that it just became,
27:38it became so much more polemical.
27:40And I could kind of feel myself
27:42like shoehorning.
27:42And then also the fact that,
27:44you know, one of the conferences,
27:45you know, I never lied.
27:46I never said I was.
27:47I never said I was a doctor.
27:48So a couple of them,
27:49when I said I'm not a doctor,
27:50I actually got physically,
27:52like in Bugs Bunnyish,
27:53I got physically out.
27:54Except the weird thing is they
27:56actually threw out this other guy
27:58who was one of their competitors.
28:00And so because we've been thrown out
28:02at the same time, I was kind of like,
28:03I wasn't crying. I was just saying,
28:04like, I flew all the way out
28:06here and look what happened.
28:07And he said, oh,
28:08I'm doing anything at The Four Seasons.
28:10In Tucson in like 4 weeks.
28:12So you could come see this one.
28:13So that's why I was able to go to several
28:16of these vagina surgeries seminars.
28:19But what happened basically was finally
28:22sort of the idea of imagination
28:24and narrative of the story is I
28:26realized I'm going to have to give
28:28up like all this work that I did.
28:29But at the same time I found
28:31a way to scratch that itch.
28:34So I wrote a piece for the
28:35Atlantic on perversive incentive.
28:37It's and it was basically.
28:39What I was talking about when primary
28:41care physicians are lured away into the
28:44the world of business and elective medicine.
28:47And so in that way,
28:48it was almost like I could just unload it
28:50and then feel OK because it was out there,
28:52and then concentrate more on
28:54on what belonged to the novel.
28:56And so from the piece that I just read,
28:57you could see a little bit there's
28:59vestiges of like this silly,
29:00this silly zany experience that I had
29:04in the world of aesthetic vagina surgery.
29:07But. The bulk of it has been left behind,
29:10and in this article and that, you know,
29:14that's what fiction writing is.
29:15It's all about.
29:16You're starting at 0,
29:17and you are literally not
29:19knowing what you were doing.
29:20When I started,
29:21I had a vague idea that I wanted to write
29:23about a Doctor Who does the right thing,
29:26but it somehow turns out wrong.
29:28And this was actually a plot for Middlemarch,
29:30where there's this Doctor Who's this very.
29:34Up and up doctor.
29:35And then he accidentally ends up
29:37murdering this homeless person
29:38that ever is trying to murder.
29:39But he's doing it for the right reason.
29:41And so I just had this idea it was going
29:43to be about medical malpractice and so
29:46that's why I just started writing it and so.
29:51Most,
29:51most writers that I know do start with this.
29:53Like you don't want.
29:54No one ever really says I'm going to write.
29:56It was the best of time.
29:57It was the worst of times.
29:58I'm going to write about,
29:59you know, I don't know this issue.
30:01Most people start with a puzzle
30:03that or a question that they had.
30:06And for me that was my question.
30:07Like,
30:07what happens when you're a doctor and
30:09you really try to do the right thing
30:11and inadvertently something weird happens,
30:16but. It through the 18 years,
30:18that's when it started sort of morphing into.
30:21I became more interested probably
30:22because I saw so much of how when
30:24my father was practicing at Hibbing
30:26General Hospital and you know,
30:27we never saw money change hands.
30:29My son is very medically fragile.
30:31And now like there's a C in
30:33the book where when young man
30:34first goes to the medical mall,
30:36the first thing he sees is an ATM.
30:38And my son,
30:39when he had to have an epilepsy study done,
30:41when we went to the fancy hospital,
30:43that was the first thing we saw was an ATM.
30:45And I was so used to growing up in an area
30:47where like money was never discussed.
30:49And now you know, for me,
30:50for my generation that that's kind of
30:53like the first thing we have to discuss.
30:55And so I kind of also wanted to look at,
30:57and having worked as an investment
30:59banker in my early career,
31:00I really want to look at how
31:01things like private equity,
31:02we're just worming their way into medicine.
31:05Because I think having grown up with,
31:08you know, sort of reverence for medicine,
31:10but then now understanding that.
31:13Medicine is a market and it is actually
31:15the largest consumer market in the US
31:17and we don't think of it that way.
31:20But you know sort of economist me is,
31:22is realizing that is why so
31:23many decisions get made.
31:24They're made on economic reasons and not
31:27necessarily patient centered reasons.
31:29But I also wanted to talk about how like
31:32in in fiction so many things happen
31:33that are just so completely serendipitous.
31:35Because actually when I was here like
31:39over 10 years ago when Doctor Duffy.
31:42Was at A at a dinner and we
31:44were just chatting.
31:44He just had a really funny story
31:48about how Pfizer was going to
31:50head approach to medical school,
31:51about donating some very expensive,
31:54superfluous equipment.
31:55I believe it was a PET scanner and part
31:58of it was going to be so, you know,
32:00Yale Hospital already had a PET scanner,
32:01but their idea was that they're
32:03going to get another pet scanner,
32:04except it was going to be in a really like,
32:06sort of, I don't know,
32:08distinctive position.
32:08It was going to have a big logo on it.
32:11And he,
32:11I think he was on an ethics board
32:13and he said that the ethics board had
32:15actually said no to accepting the gift.
32:17But I'm not sure what happened.
32:18But somebody else accepted the gift.
32:20And so from that conversation,
32:21like just that small conversation
32:23and you know,
32:23it's just like a throwaway thing
32:25that that encouraged me that.
32:27So there's a thing in the novel where.
32:29In the new, in the new for profit hospital,
32:31there's just like logos everywhere.
32:33But so even something as you know,
32:35as small and fleeting as this kind
32:38of discussion is,
32:39is some is things that make its
32:40way into fiction.
32:48But I also wanted to talk about
32:51how creativity really depends on.
32:54Being comfortable with the unknown and
32:57I I teach writing and for my Columbia
33:00students because they got into Columbia by
33:03learning how to do everything correctly.
33:05That is some of the most difficult
33:07things for me to help them get over.
33:09Is is kind of understanding the mysteries of
33:12creativity and being okay with the unknown.
33:15But what's really interesting,
33:16I recently came across an
33:18article in Medscape about.
33:20How they found out that if they
33:22can teach medical students to be
33:24better about tolerating ambiguity,
33:26that that is one of the reason
33:28that is one of the things that can
33:31help them through medical school.
33:32Because they have so much anxiety.
33:35Because so much of what they
33:37do is directly much of their.
33:38So much of their self worth is directly
33:40tied to like how well that they do.
33:43And then being able to make some room
33:45for ambiguity or not necessarily knowing
33:47what's happening is important and not just.
33:50Like in medical school.
33:51But you know,
33:51we can just see from the past three years,
33:53like nobody really expected the
33:54pandemic to be the way it was.
33:56So for people who are unable to
33:58adapt to the idea that things change
34:00or things can change abruptly,
34:02not being able to tolerate the unknown
34:04is something that you can see and we
34:07have seen like on the ground immediately
34:09leads to burnout for practitioners.
34:13And so, but I'm going back to fiction,
34:17You know, a lot of people ask me like,
34:18well then. What? Why? Why Fiction.
34:21Like what is value in the real
34:24world of actual pandemics?
34:25And so, like when I was working at Goldman,
34:27I had never met a single person who would
34:29waste any of their time on fiction.
34:31Because the ROI,
34:32the return on investment, was not there.
34:34Because why waste your time on
34:36something that is not showing you
34:38how to become a richer person?
34:39And then when I was,
34:41I was researching an article actually on
34:42Alpha Waves for Smithsonian magazine.
34:44And I don't know how I ended up doing this.
34:46I was interviewing a guy from the NSA
34:48because they are trying to use Alpha Wave,
34:51They're trying to use direct current
34:52stimulation to try to create super soldiers.
34:54And the NSA guy is like, what do you do?
34:57And as soon as I told him I was a novelist,
34:58he just, he just like rolled his
35:01eyes and I kind of couldn't go.
35:05Is there a problem? And he said.
35:08You know, fiction is so stupid.
35:11And I said, well study,
35:12show that fiction helps create
35:14empathy in people.
35:16And he said, Oh no, yeah, that's true.
35:18And empathy is the last thing you want.
35:20You do not want to have empathy.
35:21It opens you up to spies and blah blah.
35:24And at the NSA, and this is just one guy,
35:26so I can't tell if he would just
35:28be asking me. We don't let anyone.
35:30We need fiction because it leaves
35:32them vulnerable.
35:33So that's what he claimed.
35:35And then,
35:35But it just really made me sad,
35:37because empathy is really the touch
35:39point where narrative and emotion need.
35:42As a novelist,
35:43I'm always just like the reason it took
35:45me 18 years is always just writing
35:46and rewriting until I could feel the text.
35:48Like A2 dimensional text, like reach,
35:50emotion and you know what?
35:52But it's almost it's always also
35:53exactly where art and medicine need.
35:55Because as a practitioner.
35:57Of course you need like these proper.
35:59You need proper mental and
36:00emotional boundaries.
36:01But in all my time,
36:02which has been quite abundant in hospitals,
36:05not just for the book but watching
36:07my father sit at patients bedsides
36:09every night before their surgeries.
36:11And also as mentioned,
36:12because my son is medically fragile,
36:14I have seen so completely when the
36:16pendulum swings the other way,
36:17how sometimes the overemphasis
36:19on clinical detachment.
36:21Literally puts doctors into this kind
36:23of heuristic where they are the healers,
36:25the fixers, the technicians,
36:27the professionals,
36:28and then the patients become this
36:30kind of subaltered species for them.
36:32More like subjects that they're
36:34that they're working on.
36:35And one one other thing that my
36:37novel sort of gently investigates
36:38is the idea of doctor suicides,
36:40which doctor suicides tend to be higher
36:42than that of the general population.
36:44And one of the suggestions is
36:46when people get in
36:48this kind of less empathetic state that
36:50when they too, when they become patients
36:52especially for something serious,
36:53it just becomes a sort of it,
36:55it becomes a mental crisis and
36:58that is and that is one of the
37:00things that maybe think about how.
37:03How can you, how can you have,
37:04like a certain amount of clinical
37:05detachment and be a healer,
37:06but then also like open yourself
37:09up to empathy and particularly for,
37:11you know, it's it's.
37:14Where doctors and novelists are so
37:15similar is when they recently did an
37:18article like a study on depression.
37:20They actually went to the Iowa
37:21Writers Workshop because it turned
37:22out that I don't know if you
37:23want to find depressive people,
37:25they would look at writers.
37:26But one of the things is,
37:27is because when we're writing,
37:28we're also getting in the same,
37:30like, sort of vibe as the.
37:33As our characters and that
37:35can be extremely depressing.
37:36And similarly for doctors you
37:37know you're working like with
37:38you you're generally like unless
37:40you're an obese sometimes,
37:41you're generally working with
37:42people you know with pathology and
37:44their worst times in their lives.
37:45And so you're in a similar state
37:48where having empathy too can
37:50just be really stressful and
37:52and something that can that can.
37:54I can just be wearing on you as a person.
37:56So in terms of like the balance in
37:58like in how I try to live my life,
38:00but then also like kind of
38:02understand because I do tend to.
38:03I think that's why I write satires,
38:04because of a very depressive
38:06worldview and satires kind of because
38:07the novel is also about genocide.
38:09And I kind of felt like I can
38:10only write about genocide.
38:11I guess I can have some like
38:13yin Yang like humor about it.
38:16And I think as practitioners
38:17you also have to find a way to
38:20have that balance as well.
38:21Oh, you know,
38:22I want to.
38:22So I'm going to just stop here
38:24because I want to leave some
38:25time so I can have wonderful
38:27conversation with Doctor Reisman.
38:28And so I'm going to move over here.
38:48Okay. Thank you so much,
38:49Marie. That was fantastic.
38:53Trying to pick which
38:55question to ask you about.
38:57I'm going to ask you about.
38:59I'm going to ask you the
39:00predictable question, which is?
39:03We are in a medical humanity setting.
39:07This is a medical school.
39:11Mostly medical people are here
39:12in person and on the zoom.
39:14So what is it?
39:15What is it that you want them to
39:16take away from this book that
39:17touches on all of these aspects
39:19of medicine that you described?
39:24I think particularly when I was,
39:26when I do some of when I hear
39:29from doctors, I really appreciate.
39:34Even when they are angry at me,
39:37at my portrayal of medicine,
39:39and I have to, I may refresh your memory.
39:41There were some when I did a reading
39:43of the early there were some people
39:45who are very upset about what I read,
39:47but they did not question the
39:50accuracy of what I of what I did.
39:52I think it was mostly they
39:53didn't like sort of well what I
39:55portrayed from what I had seen.
39:57But I also feel that what the novelist does.
40:02Is that I have more, I have again,
40:04I get, I get to digest everything
40:06and people who are practitioners,
40:08they are very busy practicing And then
40:10you end up getting siloed because you're,
40:12you know, you have your training
40:14and you're working every day.
40:16And I kind of think I don't feel like,
40:17Oh my not going to teach people
40:19about medicine, but I do.
40:20I do like the idea that
40:25that it has shown.
40:27It has shown some practitioners.
40:30Different ways of looking at
40:32how they practice and how
40:35patient centered work can be.
40:37And also what I what I loved about it is
40:41I also felt that you know me, the person,
40:45sort of the progressive whatever.
40:46I thought young man was going to
40:48open up his own clinic and it
40:50was going to be free so people
40:51could still have their babies.
40:53But you know,
40:54but it was just interesting because.
40:56Finally having to carry everything
40:58and then seeing so much of how
41:01private equity really has gotten
41:05its tendrils into everything.
41:06And one thing I didn't show is
41:08that one of that last slides is
41:10in my town now this company called
41:13Essentia has taken over all the
41:15hospitals and put it almost exactly
41:17like has happened in the book.
41:19And when I googled, who's the OBGYN?
41:22It came up nobody that there was no person.
41:26So literally for local people there's no OB,
41:28GYN.
41:29And there's one guy who's in Wisconsin
41:30and he comes like once a week.
41:32So when I when I broaden the search
41:34and he's an Asian immigrant because
41:36clearly no white person wants to do this job.
41:39And so in a weird way, I don't think,
41:42I don't feel like novels can be
41:44prophetic about like healthcare,
41:46you know,
41:46which is kind of like the title of this talk.
41:48But at the same time is I think
41:50because we're so sensitive and
41:51see the different signs.
41:53That when I made an MPR interview
41:55someone said,
41:55Oh well,
41:56I want to interview you because
41:57we predicted this was going to
41:58happen 10 years ago and your book
41:59is what exactly what we predicted.
42:01And it's not like I'm magic.
42:02I think it's just more that because
42:04I have a wider range lens,
42:06I I can see some of that.
42:07And so I would hope, I don't know.
42:09I do hope like a lot of doctors would
42:13would read this and other people.
42:15I have heard from a lot of people
42:17who are from doctors families to who
42:19really it's really resonated with them.
42:21Yeah, I definitely.
42:25I am, I definitely.
42:26I'm going to come back
42:27to families in a second.
42:28But yeah, I agree with what you said.
42:30Also, I think issues that you
42:32have in your book that are so,
42:35so vividly presented, so racism,
42:37which is something that we in
42:39medicine think more about now than we
42:40used to think about as as a whole.
42:42So I think that captures that.
42:43And also the other thing I was
42:45thinking is just that people have
42:47really complicated lives and that the
42:48way that they respond to our advice.
42:51May seem like they don't get
42:53it or they're being difficult,
42:55but I don't know like your
42:58characters are young.
42:59One is just such a well developed
43:02rich nuanced character.
43:03It just is a great way.
43:04I was thinking it's a great
43:06way for people to think people.
43:07I mean it sounds dumb but people
43:09are complicated but we don't we
43:10kind of forget that and we see
43:12people as two-dimensional,
43:13right? I mean young as kid.
43:16You know, some of it comes
43:17from like war trauma too.
43:19So we have secrets.
43:20So I want to talk to you about
43:22yeoman's wife, Young A who
43:25for those people who
43:27haven't read the book,
43:28she also went to medical school.
43:30That's where they met.
43:31And she got pregnant and
43:37wanted to have an abortion so
43:38she could continue on in her
43:40training and become a doctor.
43:41But. Even coming to America,
43:44she was not able to get the abortion as
43:46she thought that she would be able to,
43:47and so she gives up that whole dream.
43:50So I thought that was really
43:52sad and very real,
43:53and I wondered if you could
43:55talk a little bit about her.
43:57I am so glad that you mentioned
43:59that and you were the only person
44:00so far who's even brought that up.
44:02Because, well, you know,
44:03when this got picked for Good
44:04Morning America and this is when
44:06the Dobbs decision to come down.
44:07And you know, I'd always realized this
44:09is like in some ways like a forced
44:11birth story because they're come,
44:12they're coming because this is pretty
44:13row and they think, oh, I'm an abortion.
44:15Oh, but, you know, young man's in Alabama,
44:17You know, they don't understand as Koreans.
44:19They don't understand what's going on.
44:21And so this is sort of a forced birth.
44:22So I kind of want to talk about that.
44:24And they were just like, you cannot say this,
44:26it's Good Morning America.
44:27And I was like we used to watch
44:29Good Morning America all the time.
44:30And no one.
44:31I I so appreciate it because.
44:32And then I to some degree,
44:34as you're talking about like,
44:36I don't know why I made young man at NOBGYN,
44:38but this was partly why.
44:40Just because looking at all these
44:42these other issues and there,
44:44this is an issue,
44:45Forced birth is an issue and it
44:48has completely ruined her life.
44:50It has, it has affected every single thing.
44:52It's affected everything in their marriage.
44:54And in the end, there is some, you know,
44:56sort of redemption to some degree,
44:58but it has, it hasn't changed the fact
45:00that she never wanted to have a child.
45:02And the empathy part,
45:03when,
45:03you know,
45:04I have a child who's very difficult
45:05and maybe to some degree that
45:07helped me sort of write her parts
45:08about how she want to nurse,
45:10was completely uninterested.
45:11But I really appreciate that because I
45:13feel like nobody ever picks up on that.
45:15And I feel like that is such like the
45:17one of the major things in the book.
45:21And
45:24what about thank you for that. Yeah,
45:26I'm so glad that that
45:28is there and that it is.
45:29Very much flavoring the whole thing.
45:31Even though you're, as you're saying,
45:33people don't really think about it.
45:34They just kind of think,
45:35well, she's the mother.
45:36Yeah, it'll work out. Yeah.
45:39And so how about Einstein, who has a long,
45:43wonderful name, which I can't,
45:44I I should have written it down.
45:45But it's like Einstein,
45:47Albert Schweitzer, Nobel.
45:49Nobel. Yeah.
45:52And he is also kind
45:53of a tragic figure,
45:54aside from being an unwanted child,
45:57at least. Until he was born.
45:59Can you talk about him a little bit?
46:00Sure. I think part one of the things that
46:02when I started going to the hospitals and
46:05interviewing Korean American doctors,
46:07one of the things that most surprised
46:08me was when I said, well, why?
46:10You know, why do you want to become a
46:12doctor after the I want to help people.
46:14They would literally say I don't know.
46:18And then they'd say it's
46:20too late for me to change.
46:21And they were almost always
46:24anesthesiologists and.
46:25So it made me feel also because I was
46:28there's four children in our family
46:30and I was the designated doctor.
46:32I think I mentioned the last
46:33when I was five years old,
46:34my dad gave me this giant thing of
46:36the size is drawings like that,
46:38those dissections like who gives a
46:395 year old a book of dissections.
46:41You know what? I was so into it.
46:42I had a visible woman and I was so.
46:44But then I realized I was doing
46:45this for my parents.
46:46I was doing this because it I
46:47would get positive feedback for
46:48my parents and I still, you know,
46:50as you see I still have an interest
46:51in science, but you know in in.
46:53In college,
46:54I just realized taking in organic chemistry,
46:56this is not for me.
46:57You know, I had that much self-awareness,
46:59but I really feel like I couldn't
47:00have been one of those doctors.
47:02I could have literally forced
47:03myself to do it.
47:04And Einstein is pretty much the filial,
47:06slightly dull child who just
47:07really wants to please his parent.
47:09And some of it is like the
47:10there's always like the dad's son.
47:12You know, the son can never live
47:13up to the what the dad wants.
47:15And then for young man,
47:16he's got the secret ways he
47:17wants Einstein to be,
47:18but he doesn't know.
47:19Just like when there's a different Korean
47:21family and his son's a neurologist.
47:23And stuff.
47:23And you know,
47:24young man's and he speaks Korean,
47:26but young man actually didn't
47:28let Einstein speak Korean because
47:29he didn't want to get an accent.
47:30But then young men secretly going like,
47:32why can't my son speak Korean?
47:33Like there's just so many
47:35like conflicts like that.
47:36And poor Einstein becomes.
47:37I think Einstein feels like
47:38he's got this big car and he's
47:40making all this money and why is
47:41his father still not satisfied?
47:43And a lot of that was just
47:44and a lot of this was.
47:45Part of the comedy part that
47:46I want to tell more comedy.
47:48So this sort of father son,
47:49like not ever seeing anything
47:51together with part of it.
47:53And it's really like a tragic comedy too.
47:56I'm going to ask our people here
47:58if they have any questions. Hold
48:03on, let me give the time.
48:10Thank you, Doctor Lee.
48:12I'm so interested in.
48:15What you said about tolerating
48:16ambiguity in both fiction,
48:19creative writing and in medicine,
48:22But as not a doctor,
48:24I'm wondering how can,
48:26or maybe the doctors
48:27here can doctor reason?
48:29Maybe you can answer this.
48:31How can you project authority,
48:33which is what a patient wants?
48:34They want reassurance,
48:36They want certainty,
48:37while also sort of living with your own,
48:41your own uncertainty and
48:42and your own sort of.
48:47Knowing that the unknown is okay,
48:49that's a great question and but one
48:53example I would have for you is one
48:56of the closest relationships that
48:58I have with my son's neurologist
49:00and we're kind of a similar age and
49:03he was at Brown is is one time I
49:05asked him a kind of I don't know
49:08esoteric question about something
49:10and he he just said I don't know.
49:13Because he said, I don't know,
49:14I just thought, yeah,
49:18do you see what I'm saying?
49:19Like he had that kind of humility
49:21and openness and honesty so that I
49:24felt so later he was the person who
49:27was very instrumental in helping us
49:29get our son his cannabis license,
49:31which was very complex because this
49:33is 20 years ago when no one was using
49:35cannabis in a pediatric setting,
49:37but because we had because he.
49:40He was able to kind of project that
49:42so in a in a weird way that gives me
49:45that gave me more of a feeling of
49:47authority than someone who would just say,
49:50Oh well, must be blah blah, blah.
49:52So yeah, in its own way,
50:02I'm so interested in the
50:04process of writing fiction.
50:06I've never written fiction.
50:08I write other things.
50:10What Where did you where did you start?
50:13What was the first thing
50:15you wrote in this novel?
50:16Do you remember? Yes, I do.
50:18I found it the other day in my desk.
50:19I should have.
50:20I have a three by five thing where it
50:23says Doctor tries to do the right thing
50:25but something happens and he screws up.
50:28I still have this and
50:29it has a date from 2005.
50:32Wow, it has a date.
50:34And so I what I thought I
50:37thought it was going to be.
50:39Someone who tries to save the plot
50:41I came up with is some an OBGON
50:44tries to save a woman who has
50:46placenta privia and he saves her,
50:48but he has to give her a hysterectomy.
50:50But because he gave her a hysterectomy,
50:52because he's Asian,
50:53they managed to like have a
50:55malpractice case where he's this
50:56butcher and she's only she's
50:58young and so he like butchered her
51:00and like killed her fertility.
51:01And so I spent a whole year watching these,
51:03like Mahokumar practice cases
51:05to get the courthouse.
51:06And so I read a whole novel on that.
51:10And then it just as I was talking earlier,
51:11it just didn't,
51:12the emotion did not meet the text.
51:15And then it was kind of weird
51:16because I kind of felt I saw this,
51:17but I saw this little bead in my
51:19head just like writing towards it
51:21about a Doctor Who's trying to do
51:23something that that part like never changed.
51:26And so I just so I just kind of
51:28went back to that and and what's
51:30funny is originally Einstein,
51:31the son was the center of it.
51:33I think I had more of an idea of, you know.
51:35Yeah, I'm a woman, so I want to have more.
51:37I want to be like,
51:38Jonathan Brandon had to do like a,
51:39you know, real social novel.
51:40It's be a novel of ideas and so forth.
51:42And so it was more of the Einstein.
51:43There were little bits of,
51:44like, Yeoman in the interstices.
51:46But one of the things that changed the
51:49novel drastically was the 2016 election.
51:50Part of it was in order to write satire,
51:52you do need excess.
51:53And then kind of excess sort of
51:55went out the window at that point.
51:57And then, weirdly,
51:58there is a scene in the novel that is
52:01taken from real life because when?
52:03Trump was making a lot of noises
52:05about North Korea and so forth.
52:08So in my very small, rural,
52:09all white town in the Facebook
52:11group that I'm in,
52:13somebody very proudly posted
52:14their pickup truck with their new
52:16bumper sticker that says every
52:18day 150 species go extinct.
52:21North Korean should be next,
52:23for which I thought okay.
52:25So every single person in this town
52:27has been touched by my father,
52:28the anesthesiologist.
52:29And you're saying you should,
52:31you want to kill my family?
52:33You know just this whole disconnect
52:34or just like the anti immigration you
52:37know my parents being undocumented not
52:39because they there's some sneaky extra
52:42legal things because they're Asian and
52:45the US banned Asians until 1916 five.
52:47So seeing that I just suddenly felt
52:52I just suddenly wanted to not I've always
52:54all my whole life like not want to write
52:56the immigrant story because I sort of
52:58feel like it's kind of I don't know.
53:02I'm very egotistical.
53:03And my pride, I kind of felt like, you know,
53:05I want to do a male kind of story of ideas.
53:07But then I just decided, you know what?
53:09I want to take this one guy and just
53:11humanize him. That's all I want.
53:13I just want people to know he's human
53:15so that they will not want to kill him.
53:17That was it. And then the weird thing too,
53:19is that, you know,
53:20we're talking about like the unknown.
53:21But because I had written the young man
53:23pieces like in the interstices, I wasn't all.
53:25This is gonna be a Great American novel.
53:28So in some ways,
53:29those pieces are like really engaging.
53:30So I just kind of let those
53:31just kind of expand.
53:32And then Einstein just got
53:34kind of pushed to the side.
53:35And then in a weird way,
53:38once young Man's voice took over,
53:40it was like these gears.
53:41And then he there's all these,
53:43like really weird jokes that he
53:45would tell and he just always
53:47mishearing all these lyrics.
53:48And so in a weird way,
53:50yeah, that he just,
53:51it just became this really funny.
53:53I just love spending time with him.
53:55So it just, you know what?
53:57It's terrible.
53:58It really is just like bang your
54:00head against the wall until one day,
54:02if you do it long enough,
54:03the gears just start turning.
54:04And you know what I mean?
54:05If I knew this was going to take
54:07me 18 years and almost not sell,
54:08I lost an agent in the process.
54:10She hated the novel so much.
54:12Well, it was 800 pages, but it was,
54:15it was finally worth it.
54:16Because that's why I'm like so pleased
54:19that you're here and listening to it
54:20because this is 18 years of me just
54:22kind of toiling in this salt mine, but.
54:25But this guy, like, he's mine.
54:27You know what I mean?
54:28I feel like I finally did it
54:30long enough that it worked.
54:31And so, you know, as a fiction writer,
54:33that's, you know,
54:34that's all you can do is like,
54:36you write a bunch of bad stuff and
54:37then maybe one day, magically,
54:38like the monkey and a typewriter,
54:40there's something that pleases you.
54:42And then it just goes.
54:44And I have to say, you know,
54:46even just walking over here like
54:47in the train, I just thought,
54:48I don't know what I'm working on next.
54:50And it's a very weird feeling in limbo.
54:52Like, I feel like I've just,
54:53I'm back to zero.
54:53Like,
54:54I don't,
54:54I don't have an index card where
54:56I have my next thing that's
54:57going to take me for 18 years.
54:58And it's a little,
55:00it's a little disconcerting right now.
55:02That was going to be my
55:03last question for you, Lisa.
55:07Let me just say that for Zoom people,
55:10just how did you know that you were finished?
55:16You know, sometimes it's just like
55:17these weird signs from the universe,
55:19because there is this weird Yoman and yogay.
55:23I have this scene where they're
55:24watching The Great Escape,
55:26and because I do so much research,
55:27I want to always make sure that
55:29anything that's in the book I I know
55:31is part of it that could really happen.
55:33And so I did research and it turned
55:35out that they did play that Clint
55:36Eastwood movie, The Great Escape.
55:38And so when he would have
55:39been in medical school,
55:40so I included that there.
55:41And then I had this other idea,
55:42like I want to end it with his Great
55:44Escape type thing because he's bringing
55:46his ashes back to his family and
55:47he's trying to like in North Korea,
55:49trying to like.
55:50To get past the authorities And
55:53then when I was writing that
55:54scene it there's such a weird
55:55not like feeling of completion.
55:57But the mystical part of it was that
56:00I'm a big bong Joon Ho fan and that's
56:02this is even before like Parasite
56:03and everything came out and I was
56:05reading an article just as I was like
56:07finishing it and feeling very settled.
56:09I was reading this article and I still
56:10have the clipping and it said Bong
56:12Joon Ho is like sort of err movie
56:13that make him want to be a movie.
56:15Maker was the great escape
56:17that he sounds old.
56:18And I just had this moment where I,
56:20you know what I'm saying?
56:20Like,
56:21I just felt like the novel is actually alive.
56:23Like somehow, like my antenna were up enough,
56:26got in there, and that was it.
56:28Because no,
56:29you're it's like it's like baking.
56:31You just never keep sticking
56:32the toothpick in.
56:33And it just never felt right.
56:34But then finally I was like, yeah,
56:36it just finally I was like, God,
56:38And it's, you know what I mean?
56:40It's been 500 pages,
56:41so yeah.
56:45Here at time. So thank you so much.
56:48That was a wonderful conversation. Thank
56:49you. This is so much fun.
56:50Thank you all for coming,
56:51everybody. Thank you,
56:52Zoom audience. Thank you.