I am often asked how a doctor gets to write fiction. Isn’t being a writer a completely different profession than being a caregiver ? Isn’t there any confidentiality problem involved with writing people’s stories ? How close to reality are my books ?
These questions are deceptively simple, and there is no easy answer. One doesn’t just start writing out of the blue. I have been writing for many years. I started writing when I was a child, long before I became a doctor, and have continued writing throughout the years. I was also a compulsive reader, then. Very early on, I made up stories based on the stories I had read. Some of them impressed me more than others. Usually, they had to do with love and death and time travel. Don’t all the stories that patient tell have something to do with those same topics ? (Yes, patients do speak about time travel... Their mind is a time machine.)
My earliest memories of writing go back to the age of 12 or 13, when I kept a diary. I also wrote down recollections of things I had done (one of them was the fortnight I had spent in a British high school with thirty fellow French classmates. We were on vacation during the summer and spent a lot of time playing pranks and other silly things. It sounded worth writing all it down and making it into some kind of epic. I rewrote some of the short stories and/or comic-book stories I had read, to give them another ending, or bring some psychological depth to a seemingly-superficial character, or bring meaning to an apparently meaningless event.
This is what writing is for : to bring meaning to things events, people, places that seem to lack meaning.
Now, being a doctor is a different story. A doctor is not someone who writes fiction or non-fiction, even though he is asked to write innumerable papers. A doctor is, in reality, very much in the position of being a reader, not a writer. A doctor listens to people’s words. A doctor examines people’s bodies. A doctor reads people’s symptoms. (Some would claim that doctors read people’s minds but that is a fantasy...). A doctor’s position requests that he look and listen more than he actually talks. I know that most doctors in France don’t see things that way, but I believe that, when you are a doctor, attention is much more important than action. Attention is what will help you choose whatever appropriate action is needed.
On the other hand, a patient is a storyteller. He or she comes into the examination room and starts telling a tale, something with sound and fury - but this time, signifying something, and tears and sighs. He or she enacts the story. And the doctor listens and reacts to it.
The important point here is that whether the story is actually true is not the issue. The issue lies in what the story (the pain, the symptoms, the feelings) actually mean for the doctor and the patient, regardless of how true or accurate the story is. This process reminds me very much of the way the Sherlock Holmes stories worked.
Looking down from their Baker Street bow-window, Watson would point at some man standing in the street and Holmes would say " Oh, you mean that retired Sergeant who fought in Afghanistan ? " and Watson would wonder : " Now, Holmes, how in the world would you know that ? " and Holmes would give a perfectly logical explanation that would reveal itself to be true to fact after the man was shown in by Mrs Hudson, their tenant.
The readers of this article may remember that Arthur Conan Doyle, creator of Sherlock Holmes, was a doctor. And some of them may know that he actually based his world famous character on one of his teachers, Professor Joseph Bell, whose deductive abilities were extraordinary.
I do believe that in many ways, the patient-doctor relationship works like the encounters Holmes had with his clients : someone would bring him some extraordinary story and Holmes would think about it, and react, and ask questions, and finally come up with an explanation. In fact, Holmes was an expert in seeing things that other people didn’t see - which is what a doctor does. In all instances, he would start reading and/or reviewing the " story " he was told. Later on, he would go visit the house of his client to find other evidence (don’t doctors learn a lot from people’s interiors ?). Holmes - like a doctor - would also be very keen in identifying bruises and wounds and drugs. Only at the last resort would he propose a " treatment " that would help the client solve the problem.
When I was a young boy, I lived with a doctor. He was my father. I would come back from school and if his door was open (he had his office on the ground floor of the house) I would knock and go in and sit on the couch, a few feet away from his desk. He’d be reading some newspaper before leaving for his house calls. We’d start talking about life and death and time travel - actually, world history, but isn’t this just the same ? After a while, he’d ask if I had any homework and I’d always answer No. And he’d say " Why don’t you come along with me and we’ll chat in the car ". And we would.
In a way, my father taught me how to be a patient : he took care of my childhood and teenage diseases and vaccines and pains. He taught me that no pain is too insignificant for the doctor to care about. He taught me that any pain or suffering or anxiety is worth the doctor’s attention. He taught me that a patient’s pain or symptoms is not, as too many French doctors think, a thing that challenges the doctor’s knowledge and authority, but that it is a thing that the patient brings to the doctor so they can find a way to ease it together. He taught me that every good doctor is like Holmes : he cares for what people tell him, however extraordinary or unbelievable it may seem. He doesn’t stop searching and looking and thinking until he’s found what’s wrong. He never lets people down, however desperate they may seem. He is there. And, like Holmes, a good doctor learns from each and every person he meets.
When a doctor starts working on a new case, he is Sherlock Holmes.
Now, in the Holmes stories, the other character is worth examining. John H. Watson is both a doctor and a writer. He is the one who brings the Holmes cases to literature. He is not a secondary character, even though he stays in the background. He is the witness and the scribe. He is the conscience and humanity of the investigator that every doctor is.
My father also taught me how to be a listener : I would spend hours listening to him and the anecdotes he told me. Some of them went into the very first short pieces I wrote as an adult. He, himself, didn’t write. But he told me many stories. I learned a lot from what he shared with me, and I enjoyed them thoroughly because of all the emotion it conveyed. Later, each time a new patient would come into my surgery, I would have the same feeling. Their tales might seem funny, or frightening or sad, the important thing was : they had come to tell me about it.
When a doctor starts writing about his experience, he is John H. Watson.
Writing a fictional account of people’s stories isn’t a breach of confidentiality. You turn one patient into several characters, or make several real events happen to one fictional character while no real person could have experienced all of them. You build your storyline in order to end up with a satisfying tale, something that will enlighten the reader, any reader - not just doctors. And the most important thing in writing is to give some kind of closure, some kind of meaning to stories which, in life, often lack either.
I believe writing fiction based on my medical experience is, if anything, a way of sharing thoughts and beliefs and feelings I cannot share as a doctor. I would never sit down at some dinner table and tell friends stories about patients I’ve seen during the day. But I do feel the urge to share my thoughts and doubts about these stories - and writing fiction is a way of doing that without being indiscreet. In fiction, as in a doctor-patient relationship, the important thing is not the authenticity of the facts that are told (beauty lies in the eyes of the beholder ; which might also mean that beauty is a lie).
In storytelling, the important thing is the depth of the feelings you share.
(c) Martin Winckler, 2001