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, 2023Information
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.