“When faced with the opportunity to read a book by someone who isn’t by profession a writer, I always go for the doctor.” —Stephen J Dubner
(And can I just say here, Mr. Dubner, doctor-writers everywhere – and their publishers — thank you.)
I write fiction, most of the time, because that’s what I like to write, but also because writing about my work raises all kinds of complications. Every once in a while, though, I am so moved by my experience with a patient, that his or her story becomes my story, too. Several years back I wrote a piece about a patient of mine. Mr. Z. was an elderly man who bragged about his Nazi past but otherwise kept lots of secrets. He had a family he had driven away from him, a house he wouldn’t leave, a dog he couldn’t care for, and a loaded gun on his kitchen table. (Perhaps because this is real life, Dr. Chekhov, and not one of your carefully crafted stories, the gun was never fired.)
I had been Mr. Z’s primary care doctor for years and had tried unsuccessfully to help as dementia overtook his life. One day he came into clinic saying he planned to destroy everything in his home of value, then kill his wife and himself. He was very calm as he related this to me. I contacted his family, told them of his threats, then escorted him to the ER. After evaluation by a psychiatrist, he was “sectioned” (admitted to the hospital against his will) and confined to his bed with elephant doses of haldol and soft restraints. When I went to see him that evening, he raised his head, spit at me, and turned away.
Of course there was the high drama of his war crimes, dementia-induced paranoia, a loaded gun. But that was his ugly and unfortunate story. For me there was this: his hatred toward me, his complete sense of betrayal, my professional certainty — and personal discomfort – with the the role I had played. It felt important to me. It changed me as a physician. I was a writer long before I was a physician, so I did what writers do — I wrote it down. His story, my story, the whole thing. And then put it away. (Actually, it was on my computer – but you get the idea.)
A year or two later, I was asked to give a reading, and I pulled out the story of Mr. Z. I could have chosen one of the stories I had published or an excerpt from my novel-in-progress, but instead, I picked Mr. Z. Afterward, a member of the crowd approached me to ask, “Have you published that yet? It’s a wonderful piece.”
I hadn’t published it, of course, and even had second thoughts about reading it in front of a small crowd. It felt like a violation. I protected his privacy in a superficial sense – changed names, locations, etc. – but still, writing this story of betrayal felt like more betrayal. The complication – or the loss — for me was that it felt like my story, too. I wanted not just to WRITE the story, but to have someone read it, hear it, share it.
Which brings me to my closing thought. We all want to own, or at least share, the narrative. It has power. We see it in politics. We see it with husbands and wives, between siblings and among friends. And, of course, between doctors and patients.
Robert Coles, in his book The Call of Stories, talks about the importance of giving patients the opportunity to tell their story. The book came out when I was a medical student. I read it and took the message to heart. (It continues to cost me an awful lot of time in clinic, but still may be the best doctoring advice I’ve ever gotten.) He also advocates for doctor’s sharing their stories with patients, because storytelling, he suggests, is how we enter each other’s lives.
As unlikely as it seems, Mr. Z’s story had a not-so-bad ending. He was transferred to a psychiatric hospital, did well with medication and therapy, and moved away to live with one of his children. I never got to tell him my story – to let him know how the experience had affected me. It would never have occurred to me at the time, but maybe I should have. Maybe that’s something doctors should do more often.
As one of Dr. Coles’ patients instructed him: “You tell me your story, and I’ll tell you mine.”