“I like your writing,” a patient said. “Just don’t ever write about me.”
I assured him that even when I don’t use names, I never write about patients without their permission. Most grant it readily. When I ask if I may write about them, patients usually respond with something like: “Sure, if it helps someone else, why not?”
And my mail indicates that such stories do help people. Many readers have told me that they feel better informed, more validated, and less alone after reading about someone else’s medical problems.
But helping people isn’t the only reason doctors write about their patients. Other motivations, less clearly within a doctor’s traditional role, inspire some of us to write. We write to better understand the complex ethical and emotional challenges of medical practice. We write to break up the sometimes exhausting routine of seeing patient after patient. And we write because we love language and good stories.
Not everyone agrees that medicine and writing are perfectly complementary professions, though.
In 1886, a 64-year-old novelist, Dimitry V. Grigorovich, advised Anton Chekhov, then 26, that he would never fulfill his potential as a writer if he continued practicing medicine. “One hound can’t chase two hares,” Grigorovich warned. And in 1968, a young neurologist named Oliver Sacks was told something similar by his boss at the hospital where he worked: If Sacks followed through with his plans to write a literary book about migraines, he’d never find another decent job in medicine.
Sacks proved his boss wrong. He’s been successfully “chasing two hares” for nearly half a century. A professor of neurology at NYU who, for decades, had a busy clinical practice, Sacks, now 80, still sees the occasional patient in consultation and regularly checks up on several nursing home patients. He is also the author of 12 books and dozens of essays for publications including The New Yorker and The New York Review of Books. In almost all of his writing, Sacks has made extensive use of patient anecdotes.
I visited Sacks not long ago in the cheerfully cluttered Greenwich Village apartment that serves as his office. We spoke about many of the subjects which enthrall him: marine biology, chocolate, phantom limbs, ferns, swimming, rubber, and neuroscience, to name just a few. But after 50 years, no topic seems to animate Sacks more than the fruitful and sometimes troubled relationship between his twin professions: writing and medicine. Below is a portion of our conversation:
Q. Have you ever felt ambivalent about using patients as “material”?
A. I hope this is not the reverse of empathy: the desire to see a story, to make a story. I hope it doesn’t divert me from the person’s suffering — though I have sometimes wondered if it does. I’ve always felt myself on a sort of moral knife edge with some of this publishing.
When I wrote “Awakenings,” I thought: My patients are here in New York. I’ll just have it published in England, and they’ll never know about it. Yes, that was long before the Internet!
But one of the patients got wind of this and got in touch with my publisher and got a copy of the book. She was very distressed by a piece of physical description in which I called her “hirsute,” “bearded” — something like this. But in later editions I expatiated on her good mind and all sorts of other qualities. I was in some way trying to compensate for what I had said. Maybe it was a moral compromise. But, in fact, the good qualities were there.
More recently, I’ve always shown what I’ve written to my patients or subjects before I publish it. I give them another chance to say, “I’ve changed my mind. I don’t like it.” Or to revise any way they want. For the most part, though, they rarely change anything.
Q. Is your writing about patients in medical charts very different from literary writing?
A. When I wrote “The Lost Mariner,” [which later appeared in “The Man Who Mistook His Wife for a Hat”] I took the manuscript to the editor of The New York Review of Books. He asked, “Could I see your notes on the patient?” I brought them in and he read through them and said, “Your notes are often better than the piece you gave me. Can we incorporate some of them?”
I think he felt sometimes the notes were more direct and maybe the emotion was clearer. But what I’m also saying is there’s not that much difference between the very long notes I write on patients and what I might write later. I’m already partly in the narrative mode when I write my clinical notes.
Q. It’s often said that the taking of detailed clinical histories is a lost art. Do you feel clinical writing has declined as well?
A. I feel that it has. I know that [A.R. Luria, the Soviet neuropsychologist and Sacks’s mentor] felt this as well. In a letter he wrote to me he said something like: “The art of observation and description so common to the great neurologists and psychiatrists of the 19th century is almost gone now.” And he wondered whether this was due to the rise of technology. He wrote that to me in 1973.
Q. Unlike medicine, writing is a profession from which one need never retire, in theory. At 80, do you have any plans to retire from writing?
A. I still do all my writing by hand. I’m delighted when it’s going and flowing and I use bottle after bottle of ink. When I can write — which is not always — I’m happy.
As we said goodbye, Sacks held my hand an extra moment and offered one last bit of wisdom about writing and medicine: “Don’t quit your practice,” he told me. Never stop being a doctor.”
Dr. Suzanne Koven is a primary care internist at Massachusetts General Hospital. Read her blog at www.boston
.com/inpractice. She can be reached at firstname.lastname@example.org.