Just the other day the Wall Street Journal sent a big notice to writers, the gist of which was, “Don’t quit your day job.” According to the article, I could sell not only my first and second novels, but also my fifth, twelfth and seventeenth and still have better luck covering the rent by collecting bottle deposits on my neighbors recyclables. Imagine my disappointment when I had to put the letter to my boss — written in moment of euphoria upon completing the first draft of my novel (“Dear Jeffrey, Soon I will be a rich and famous writer, and the demands on my time and creative energy may no longer permit me to show up for work…”) — back in the drawer. Again.
So this is my feeling: If I have to continue having two occupations, writer and doctor, I need to find ways for each to feed the other. I’ve always been interested in the connections between writing and medicine — the role of stories, the detective work, the observation — but now that I know I’ll be talking low cholesterol diets and checking for hernias right through the blue-hair years, finding these connections seems more important than ever.
Today’s topic: a look at some of the “golden rules” of medicine to see how they apply to writing. (I promise, by the way, that hemorrhoids will not be discussed. No sputum or fungal rashes either.)
Rule #1: “First, do no harm.”
Okay, not to start off on the wrong foot, but this one just gets thrown out. A great rule for doctoring but writing . . . well, it demands some boldness and you can’t be worrying about things like doing harm.
Next.
Rule #2: “The patient is the best teacher.”
Not the text books, not the CME courses, not the genius who discovered Weird Rare Disease X. The patient.
To me this translates to: “It’s the work itself that teaches best.” It’s the writing. It’s the thinking. It’s struggling with the characters who do not behave the way you intend, the ending that does not deliver the sense of completion you’d hoped for. It’s fiddling with the words and the paragraphs and the chapters. Workshops can be a lifesaver (sign me up), probing the minds of great writers can uncover gems, reading good stuff is a must – but it’s the actual work of writing that teaches best.
Rule #3 (corollary to Rule #2): “When all else fails, go back to the patient.”
When the diagnosis isn’t there or the treatment doesn’t work, go back and see the patient. Take it from the top, hear the story from the beginning, examine all over again. Translation to writing: I don’t think this means to start your novel or story again, but I do think this means go back to the basics. Do you know your characters well enough? Do you understand their motivations? Is your plot consistent with what your characters would say and do?
Rule #4: “If you think of it, you’d better look for it.”
A little explanation on this one. A pulmonary embolus (blood clot to the lung) is a life threatening event and the early signs can be all too easy to miss. The golden rule for doctors on pulmonary emboli: if the possibility even crosses your mind, no matter how UNLIKELY, you’d better go ahead and make sure the patient doesn’t have one. That’s because sometimes you are picking up on hard-to-define elements of the whole picture and, in the back of your mind, another kind of thought process is at work.
My translation for writers: Don’t ignore your subconscious. There’s good stuff in there. Sometimes a flash comes along seemingly out of left field, but you sense that this is a key part of that odd puzzle of writing powerful fiction. You’re probably right or, at the very least, it’s worth exploring.
Rule #5 (variant of Rule #4): “Broaden your differential.”
Differential diagnosis, that is. The list of problems or diagnoses that could explain the patient’s condition. Keep trying, keep your mind open, step back and reconsider options you may have thrown out.
Here’s a quote from a great and wise physician who understands the puzzle-like quality of diagnosis, a woman named Faith Fitzgerald who teaches medicine at the University of California in San Diego. She describes an evening she once spent with a room full of Nobel Laureates. Her observations:
“They did not have an orderly, disciplined thought process… what these people did was less linear than it was mosaic. They had an uninhibited cascade of — to my mind — unconnected ideas, all of which appeared in their minds and somehow seemed to hold equal pre-eminence. I thought initially, ‘They are all crazy!’ What was fascinating was that they’d all throw up these little ideas as if they were the bright bits of a mosaic, look at how they fell, see if it satisfied and if it didn’t, they’d throw them up again and try again. It’s the synthesis of that combined order and discipline and chaos that is the diagnostic thought process.”
Similarly with writing fiction — you need the order and discipline, but you need the chaos, too.
So keep thinking, keep throwing things up there, keep trying again.
Oh, and Rule #6?
Quit smoking.
And eat your vegetables.
And get some exercise, wouldja?
P.S. For anyone who didn’t know this, the character of Sherlock Holmes was based on Joseph Bell, one of Arthur Conan Doyle’s instructors in medical school.
Kathy Crowley’s short stories have appeared in Ontario Review, Fish Stories, The Literary Review, New Millenium Writings and The Marlboro Review. Her stories have been short-listed for Best American Short Stories, nominated for a Pushcart Prize and anthologized. In 2006 she was awarded a Massachusetts Cultural Council Grant. She recently finished her first novel, On Locust Street. When she’s not busy preparing for her future literary fame and fortune, she provides care and feeding to her three children and works as a physician at Boston Medical Center. Kathy can be found on Twitter at @Kathy_Crowley.
