Literature, Doctoring, and the Art of Medicine

After several years of working in emergency medicine, I realized that my career was becoming increasingly difficult to deal with. The medical challenges and satisfaction were still there, and the job paid rather well, affording us a wonderful loft in Soho and a country home in upstate New York. But the political mishegass at my hospital, the increasing influx of uninsured patients, the troublesome way healthcare was going in the country, and how that impacted our ability to provide adequate care in the ER were causing me tremendous distress.

I had been very active with Physicians for a National Health Program (PNHP) for many years, hoping to rectify this situation. I had even been the featured introduction on a Keith Olbermann show, videoed as we led a White Coat rally up Broadway after treating patients at Occupy Wall Street. But I was frustrated and disheartened. I had learned that trying to get Universal Health Care instituted in this country was (and continues to be) a very difficult endeavor, and I could only expect things in my job to get more difficult.

It was then that I became involved with the Program in Narrative Medicine. It couldn’t have happened at a better time.

I met with Dr. Oli Fein, the chair of our New York chapter of PNHP, to discuss my frustrations. As a dean at Weill Cornell, Oli was very insightful and knowledgeable about the opportunities available to those of us already many years into the world of medicine. I talked with him about the writing I’d been doing, and Oli told me I should meet Dr. Rita Charon. Rita, an internist with a Ph.D. in English literature, had recently started the Program in Narrative Medicine at Columbia’s College of Physicians and Surgeons. Oli sensed that connecting with her could be fruitful for us both.

Rita had thought a lot about the interface between medicine and literature and realized that when patients developed an illness, they often told themselves a story about it. She realized, as well, that when practitioners wrote stories about their patient encounters and shared them (anonymously) with colleagues, it provided us the ability to get outside of those encounters and look at and understand them from other perspectives.

Rita and I met, and soon I was involved in the program, teaching Narrative Medicine to the Pediatric Oncology nurses there and meeting for Literature at Lunch, where a varied group of professionals from the medical school and Columbia University would convene and discuss great literature. I joined the Adult Oncology Narrative Medicine group, where we’d bring in stories we’d written to be shared, critiqued, and analyzed. And I began attending Narrative Medicine Grand Rounds, evenings where well-known and emerging authors who had published works explored the interface of literature and medicine with provocative discussions afterward.

Around this time, I read an article Dr. Lewis Goldfrank had written in one of our Emergency Medicine journals about how literature had affected his career as a physician. I reached out to Lewis, and he subsequently gave a Grand Rounds. He spoke to an appreciative and overflowing crowd, and I most remember him showing slides of Van Gogh’s work. He convincingly (as a world-renowned toxicologist) made the case that Van Gogh was not crazy at all but cadmium toxic due to his excessive use of cadmium yellow in his paintings.

It was also during this time I submitted a story to the New York Times, which was subsequently published, a story about the events surrounding the death of my physician father.

There is a well-known history of doctors as writers, and I began to reflect deeply on the connection between words and medicine; the rich, many thousand-year multicultural language physicians have evolved to describe organs and disease processes (globus pallidus, consumption, lumbago, delirium tremens); how we grasp at words to convey our understanding of these bodily processes; and how, somehow, the healing we do attracts many of us to literature and writing.

Several years ago, I read a Letter to the Editor of the New York Times by an astrophysicist. He tried to explain how his mind was constantly mulling over concepts in particle mechanics—but in its own language, a language that math could only try to approximate, and words barely touched.

I often wonder if the whole concept and understanding of medicine, in its own way, is like that, if I or any of my colleagues are doing the same thing as we approach a patient with a complicated disease. I certainly wrestle with understanding certain bodily processes and am Intrigued by the words we use to describe them. Plus, I enjoy bringing Yiddishisms like schmutz, kvetch, and chronic meshuginosis to medical conversations. (In fact, one of my colleagues once remarked that she thought there’d be a Nobel Prize given to the doctor who could find the cure for acute meshuginitis!)

I am increasingly fascinated by what is actually going on in that interface of M.D.s’ brains, between having a sense of what is happening with a patient and being able to articulate it and how that affects the healing interaction.

In 2009, I traveled to Cambodia and Vietnam. While in Hanoi, I went to the 1,000-year-old medical school there and spent a wonderful afternoon getting a taste of the Vietnamese approach to illness, capped off by learning that the school was called The Palace of Wisdom.

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Recently, after the events of October 7 in Israel, trying to make sense of where I, as an agnostic, nonobservant Jew, fit into the sociopolitical turmoil surrounding us, I began reading Tales of Love and Darkness by Amos Oz. Set in Jerusalem in the 1930s,40s, and 50s, Oz talks about his parents, both scholars: a father who spoke 16 languages and a mother who spoke six. The family often talked about the origins and interconnectedness of words.

Oddly, I now find myself going to the local shul Upstate. I’m not going for the religious services but for the community and the reading of the Haftorah, the biblical stories, and their interpretation. Here, too, there is a provocative discussion of the Hebrew and Yiddish roots of words and the interpretation of their meaning. I find it an intriguing parallel to my own explorations of words in the context of the world of medicine.

While I am no longer in the ER, I find that my love of language and literature, the attention it makes me pay to patients’ words and the stories they seem to be telling in our encounters, enhances my ability to connect with them. I understand them in more profound ways, whether they are suffering from consumption, delirium tremens, or tic douloureux.

And I say that always keeping in mind what a wise colleague once said to me, “There are no diseases; there are only patients.”