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My business card introduces me as a physician and a novelist. This presented a design quandary, given that I can’t separate one from the other and still comprehend who and what I am. But as the two nouns can’t be merged, even by the best Scrabble player, one must come first. I decided to go with the more easily defined of my two professions: Anesthesiologist, M.D., Board Certified, Malpractice Insured. The Doctor You Meet Ten Minutes Before Your Operation. By comparison, a writer’s job description is uncomfortably nebulous. If you ask 50 writers what their working day is like, you will get 50 different answers—often from the same person.
It surprises me when people are surprised. After all, there is a long and storied history of doctors who have been novelists, playwrights, or poets, from Anton Chekov and Arthur Conan Doyle to William Carlos Williams and Khaled Hosseini, and all of us would confirm that writing and medicine are synergistic. Without question, we do relish hard data—what’s the patient’s serum sodium? Cardiac output? We even try to quantify the unquantifiable experience of pain on a scale of one to ten. “How high is your pain level?” the doctor asks. “Ten,” the patient answers. “Ten is a root canal without Novocain.” “Three!” adjusts the alarmed patient. Yet I’ve never come across any attempt to calculate a number for hopelessness or grief.
Hopelessness and grief won’t heal without empathy, some insight into the secret places my patient and I share because we have both been loved and rejected, celebrated and defeated, often by our own insecurities. That isn’t much of a leap when he or she could be a member of my book club, but I also take care of meth addicts and tech wizards, abused children and professional athletes, not to mention patients who don’t speak my language, nor I theirs. It isn’t easy to identify with a man twice my size, handcuffed and guarded because he’s a convicted murderer. But also, not hard. Because I’ve met him inside a book, where I had the mental time and space to understand how he got to here. And I write hoping to add flesh to the skeleton of what I know, allowed the luxury to invent and illustrate my character’s unspoken traumas and dreams.
I meet my patients in novels. Pick up Dorothy Allison’s Bastard Out of Carolina if you want to better understand the drug abuser who will never tell you what happened to her at age 13. If you want a better idea of what the world looks like to an autistic child, read Mark Haddon’s The Curious Incident of the Dog in the Nigh-Time. The course of an illness is the quintessential hero’s journey. We meander through our uneventful lives until we find a lump in our breast, we’re hit by a car, slip on the ice—and thus starts our trajectory into a series of challenges that will change us forever.
Both doctors and writers are close observers, examining, asking, and probing, but all the while listening for the unstated story. To quote Abraham Verghese: “Medicine and writing are very parallel disciplines. When you take a patient’s clinical history, what is that but a story? What makes a good doctor is that he or she takes the story down well, sees the links and makes the connections toward a diagnosis. That’s also what writing is about.”
Writing is a compulsion quite different from my medical work, but they were both born from a conviction that healing people starts with understanding them. Despite that, I publish under my married name but use my maiden name in the hospital—given that someone dies under anesthesia in Oxygen, my first novel, I’d rather avoid explaining that it’s purely fiction, not a memoir. But at least 80 percent of my novel is my personal truth, an insider’s reflection on an anesthesiologist’s job, which involves a fascinating braid of human physiology and tender care, tailored to each unique patient. I rarely have time to discuss that—it’s hard enough to articulate to myself. So I put it into the safe zone of a novel, one step removed.
If all of my patients were consummate readers, I would give them a copy of Oxygen and donate the money to research. Maybe, hopefully, they would realize they are a participant, not a captive, when I hold the mask over their faces. Maybe, despite the unknowable outcome of any surgery, the mystifying component of anesthesia would be one less thing to worry about before they have to take that leap of faith and believe that we will keep them safe.Carol Cassella is a practicing physician and the national bestselling author of three novels, Gemini (2014), Healer (2010), Oxygen (2008). Her work has also appeared in the New York Times, Wall Street Journal, Huffington Post, and other web and print sites.
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