At the Writers’ Workshop, “medicine as a human act”

Between his internal medicine residency and his fellowship in geriatric medicine, Terrence Holt, M.D., Ph.D., began writing stories to “identify what remained mysterious, and often troubling, about the process of becoming a doctor.” The resulting parables emerged in the form of his 2014 book Internal Medicine: A Doctor’s Stories.

At the Department of Internal Medicine’s 13th Annual Writers Workshop lecture in January, Holt read “The Grand Inquisitor,” the book’s last entry. The workshop, which began in 2004 with a reading by Cutting for Stone author Abraham Verghese, M.D., takes place over a weekend in the fall during which residents recollect and write stories stripped from their lives, often inspired by patients they’ve encountered or dilemmas they’ve faced. Led by Anna Reisman, M.D., associate professor of medicine (general medicine) and Lisa Sanders, M.D. ’97, HS ’01, associate professor of medicine (general medicine), the workshop culminates in a grand rounds lecture by a physician-writer.

Holt’s tale of expiation was inspired by the parable of the same name in Dostoevsky’s The Brothers Karamazov, which addresses whether it would be acceptable to torture an infant in order to rid the world of its suffering. In his story, Holt tells of an oncologist in the early 1960s who, in search of a greater good, relentlessly and fruitlessly conducts questionable clinical research involving children, and the outraged pediatrician who confronts him. Holt wrote the story in response to discussion about explaining survival statistics at a Schwartz Center Rounds about a 37-year-old woman with three small children who blamed her doctor for her failed cancer treatment. (The rounds are held to allow cancer clinicians to explore the emotional side of care giving.) Holt wanted to explore what bothered him about the tendency to emphasize “winners” in cancer treatment.

Unlike many previous speakers at the workshop, who became doctors before they became writers, medicine is a second career for Holt. Before attending medical school at the University of North Carolina at Chapel Hill, where he now teaches, for more than a decade he was an English professor at Rutgers University and taught writing at Swarthmore College. Although he thought he would never write another word after medical school, he wrote Internal Medicine over a 10-year period following residency.

“One of the things that moves me to write is the way it helps us to understand medicine as a human act,” Holt said at a lunchtime gathering at which residents read their stories. While the residents’ essays varied in their points of view, focus, and experiences, most touched upon what Holt calls the “existential complexity” of practicing medicine. An essay about an addict’s pain by Michael Kaplan, M.D., explored the central problem of suffering while acknowledging his own vulnerability while a piece by Kaly Cyrus, M.D., focused on her experience being on the other side of a diagnosis. “What all this comes down to is the recognition that the line separating patient and doctor is a comforting illusion that we try to maintain but may do better without,” Holt said.

The residents’ essays, published in a booklet called Capsules, like Holt’s stories, attempt to capture the essence of a complex and chaotic experience. “While they acknowledge a wish to be better,” he said, “they recognize that it’s an ongoing struggle.”