Disease is the stuff of most internal medicine grand rounds. But for the 10-year anniversary of the Yale Internal Medicine Residency Writers’ Workshop, the doctors heard a folk tale. To explain her own journey into the writing life, keynote speaker Pauline Chen, M.D., HS ’98, a transplant surgeon and writer, narrated a Japanese legend her father used to tell her at bedtime. A fisherman releases a fish prince and is rewarded by a fête in the fish’s undersea kingdom, then is given a box he is told never to open. When he returns to his village, he learns he is 300 years in the future, his wife long dead. In despair, he opens the box—and instantly ages 300 years. In telling her own children the story, Chen confessed, she would make up a happier ending.
Though storytelling was the currency of her household, Chen herself avoided the practice for a long time, in part because a “mishmash” of languages at home—her parents were immigrants from Taiwan—had left its imprint on her speech (she once told a colleague an operation was “a slice of pie”). After residency, though, Chen found that stories about her patients began “pouring out.” She took writing classes, published the bestseller Final Exam: A Surgeon’s Reflections on Mortality in 2008, and began a parallel career as a New York Times columnist.
Far from being unrelated, Chen said, writing and medicine can go hand-in-hand. Physicians who write gain “one of the most powerful ways to fend off the temptation to step back and disappear and ignore,” she said. “Writing forces us to remember the patients, to articulate the issues, and to take a stand. ... It forces us out of the anonymity of the sideline and into the responsibility of the byline.” The relationship between the two vocations came into sharper focus when twelve Writers’ Workshop participants held their annual reading in January. Before a standing-room-only luncheon audience in the Beaumont Room, they read essays revealing emotions doctors seldom publicly disclose. Jennifer Pan, M.D., described the short-lived euphoria of reviving a patient who soon dies, while Jorge Moreno, M.D., recalled the “terrible responsibility” of giving orders to withdraw life support. Paul Fiorilli, M.D., wrote of his rage upon discovering that a manipulative patient had lied to him.
The workshop has worked much the same way since 2003, when physician-author Abraham Verghese, M.D., led it in the style of the Iowa Writers’ Workshop. Each participant submits a short piece of prose; after it circulates among the other writers, it undergoes two days of intensive group critique and constructive feedback. More than a month of revisions follow before the completed essays are compiled into a book called Capsules.
Though intended as a one-off, said Anna Reisman, M.D., associate professor of internal medicine, and a widely published writer, the 2003 workshop was so inspiring that she and others determined to continue it. Reisman recruited surgeon and author Richard Selzer, M.D., HS ’60, to lead the workshop in 2004; for a few years they taught together, then Reisman took over; in 2009 Lisa Sanders, M.D. ’97, HS ’00, author of Every Patient Tells a Story: Medical Mysteries and The Art of Diagnosis, joined her as co-director. The annual reading has become a much-anticipated event; past speakers have included Sherwin Nuland M.D. ’55, HS ’61, Perri Klass, M.D., and Samuel Shem, M.D.
Holding one’s work up for such scrutiny sounds daunting. But when Reisman conducted a study of the workshop in its first year, she found that the doctors felt a sense of camaraderie. “All the hierarchies of medicine, at least within the residency program, vanished—people were just talking to each other, writer to writer,” she said.
Does learning to write make a better doctor? Reisman believes it does. The craft not only sharpens the powers of observation, she said, but it also teaches empathy. And medical students may sense this. “When I speak to applicants,” said Mark Siegel, M.D., program director of the traditional internal medicine residency, “the Writers’ Workshop is very high on the list of features that attract them to the Yale program.” Participants Megan LeMay, M.D., and Fiorilli both recall looking forward to it since their interview seasons. Many residents return for a second or third year, and many go on to publish in medical and mainstream journals.
LeMay, whose essay imagined a deceased patient living and thriving under her care, said the work had helped her encapsulate what his death had meant to her—and changed the way she thought about other patients. A single sentence from a patient like “I had cancer last year” or “I was in pain all night long,” she noted, takes on far more meaning once she puts herself in that patient’s shoes to write about him or her. Echoing Sanders’ book, she added, “Patients are always telling us a story.”
Jason Ackerman, M.D., explained it another way. Writing, he said, “keeps the patients human.”