Outside the bounds of polite conversation

Perri Klass, M.D., the physician-writer, thinks it’s no coincidence that many doctors are passionate about writing and medicine. As professor of both pediatrics and journalism at NYU, she has noticed connections between the professions. “These are fields that draw people who have what might be in other settings a sort of inappropriate busybody curiosity, people who like the idea of asking questions that, shall we say, are outside the bounds of polite conversation,” she said.

Klass discussed these connections in a recent internal medicine grand rounds called “Doctors as Readers, Doctors as Writers, Doctors as Characters.” She comes from a family of writers—her mother is a novelist, her late father an anthropologist—and she “grew up with the very strong message that a writer needs a day job. So I went to medical school.” There, she found that physicians’ training shapes them as both writers and readers. (As for being characters, doctors often show up in pulpy novels, which she collects; a slideshow of their covers had the audience hooting with laughter over titles like Girl Intern and Spanish Doctor, Pregnant Nurse.)

Most doctors must write in the course of their practice, and Klass thinks they learn better interviewing skills than journalists do. “We are taught a framework for telling stories, a framework for narrative, a specialized locution.” Some begin to develop an almost reportorial instinct for the untold story, one that can lead them to take up the pen or even influence their medical judgment. Klass read an essay about a patient, a child with vomiting who seemed to have an ear infection. Just as his mother was leaving with his antibiotic prescription, she told Klass that the boy had fallen and hit his head. Shaken at nearly missing this information, Klass nonetheless decided the fall was minor and sent the boy home. But soon a half-forgotten short story was haunting her. Raymond Carver’s “A Small, Good Thing” is about a boy who succumbs to a seemingly minor injury. Its moral about the nearness of misfortune led Klass to second-guess herself. (Happily, the real boy did fine.) That sense of a connection between life and literature has for generations inspired doctors like Klass to write. As she quoted poet William Carlos Williams on writing and medicine: “It’s no strain. In fact, the one [medicine] nourishes the other [writing], even if at times I’ve groaned to the contrary.”

Yale’s internal medicine program allows residents to explore the connection in its annual Writers’ Workshop, led by Anna B. Reisman, M.D., associate professor of medicine, and Lisa Sanders, M.D. ’97, HS ’00, assistant clinical professor of medicine. Klass met with the resident writers at their annual reading, held at lunchtime in a packed conference room on the ninth floor of Yale-New Haven Hospital. The young doctors stood at the front of the room, essays in hand, sandwiches left behind on their seats, and surrendered their usual authoritative body language. They bowed their heads to the pages. They scratched their noses. They committed spoonerisms. And they read aloud the kinds of thoughts they seldom voice while wearing their white coats.

Lakshman Subrahmanyan, M.D., who was formerly a statistician, read a chilling account of a night on call, lamenting how he must forgo “undirected exploration [and] excessive analysis” now that he spends his time rushing through hospital wards. “There is no time to delve into the details I once treasured,” he wrote. Nitin Kapur, M.D., related his fantasy about forming a team weight-loss effort with a patient whose body mass index was only a few points higher than his own. “Our story would be the fodder for a New Yorker article: ‘Annals of Obesity….’ ” Boback Ziaeian, M.D., wrote from within the mind of a patient waiting for a heart transplant, “alive in this purgatory, tallying the days leading up to someone else’s misfortune.”

When asked to deliver a final word, Klass smiled. “Concentrating on the stories amidst the distractions and the work in the constantly distracting setting of clinical medicine is really an exercise in watching and learning and paying attention,” she said. These, she said, were “reminders of how many ways there are of being inside the stories that we write about … I’m very impressed.”