HOW TO BECOME A DOCTOR-WRITER
by David Hellerstein, MD
How did you get interested in being a doctor and writer?
For me it was hardly a matter of choice. Becoming a doctor was something
almost necessary in my family, in which both of my parents were doctors as
were my grandfather, great-grandfather and many others. In college, I rebelled
against my apparent destiny and became passionate about writing. I left school
and began a sort of literary apprenticeship. And yet the life of the writer
seemed insufficient, and I decided that I wanted to become a doctor as well.
My model was William Carlos Williams, the poet who was also a practicing
doctor in New Jersey. Many of my premed friends were also interested in
literature, but I found that they almost all stopped writing during the first
few years of medical school. I kept writing, though: it was something I had
How did you learn to write?
From reading, reading incessantly from the time I was eight or nine years
old. In high school I read the works of Saul Bellow and Gunter Grass and
many nineteenth century novels, in college I read the English and American
novelists from 1800 to the present, in medical school I kept reading, mostly
short story writers including IB Singer, Isaac Babel, Flannery O'Connor,
Frank O'Connor, VS Pritchett, Cynthia Ozick, and others. I was trying to
write seriously as well, beginning in college. During college I left school
for a year and focused on trying to become a writer. (That is a whole story
in itself). Then, after going back to medical school, I was fortunate enough
to be admitted to the graduate fiction writing workshop at Stanford, where
I met writers such as Alan Gurganus, Tobias Wolff, Vikram Seth, Ron Hansen,
and many others.
They were all serious, at times frighteningly so, about their craft. I read
their work, and occasionally dared to submit my own works to the writing
workshop. There was always the humbling moment when one realized the vast
gulf between what one had intended and what one had achieved.
It goes without saying that the most important things I learned from my
fellow-writers in California was that rewriting is critical. That and reading
one's own work aloud. To take what you had written and then to read it out
loud was the best way, as far as I could tell, to find one's own voice. If
you couldn't read it, if you couldn't breathe the phrases, then there was
something wrong with it. It was repetitive, or boring, or it didn't sound
like you. And every writer wants to find his or her voice--that is the beginning
How did you get published?
I kept writing throughout medical school. I wrote stories, novels, essays,
and kept a voluminous journal. The experience of attending medical lectures
and then beginning to see patients--and at the same time having the wonderful
opportunity to reflect on and write about becoming a doctor--was wonderful.
To many of my writing colleagues, my medical experiences seemed "too real"--and
to many of my medical school colleagues, the day to day pressures of learning
biochemistry or anatomy may have made literary reflection impossible or seemingly
foolish. But to me the hectic life of the hospital and the quiet of the writer's
study were synergistic. I began taking materials from my medical school journals
and trying to make sense of them--the death of a patient with leukemia, the
hospital stay of an immigrant's baby, the exam-room conversations in gynecology
clinic. They seemed remarkable to me. I submitted one essay, "A Death in
the Glitter Palace," to Harper's, an essay about a patient with Hodgkin's
Disease who developed leukemia as a result of her chemotherapy. And the editor
there suggested that I try the North American Review, which was known for
publishing literary nonfiction.
A miraculous event--the North American Review's editor, Robley Wilson, agreed
to publish that essay. Not only that, he asked me to write for his magazine
on a regular basis, to contribute a column. By that time I was finishing
medical school and had accepted a position as intern at a hospital in New
York. I was ecstatic. Arriving in New York, I began writing more articles,
and submitted them to other magazines, including Harper's, Esquire, and Ms.,
and was amazed--I kept getting published.
How did you get an agent?
My agent contacted me on the basis of my first published work, the essay
"A Death in the Glitter Palace," which additionally won a prize as best essay
in the Pushcart Press anthology of 1980-1981. My agent convinced me that
I should not merely write one essay after another but that I should think
of trying something larger
perhaps a series of essays for a collection,
or a nonfiction book. (In general, among writers there is a debate about
the benefit of having an agent. For magazine work, the economics aren't favorable
for agents to even be involved, but once you have a book idea, agents can
be helpful in a number of ways, including working with you to structure your
book proposal, and figuring out which editors might be most receptive, not
to mention negotiating contracts. There are other writers who do it on their
own, and perhaps hire a publishing lawyer to help with the contract. In my
own case, having an agent who was actively involved in shaping my work was
How did you put your books together?
The first book, Battles of Life and Death, evolved as I went through medical
school and residency training. My journal was an invaluable source of material,
often containing experiences and impressions which had entirely disappeared
from my mind. The intensity of day-to-day experience as a medical student
and resident can be paradoxical, in that they may be so intense as to practically
preclude their recording. I kept writing, and after a while I had a dozen
or more "good" essays. I put them in a logical order, and wrote a brief proposal,
and sent them on to my agent.
How did you sell your book to a publisher?
My agent did all the work. The only input I had at this point was that I
had also started a novel, and I asked him whether we might do a two-book
deal, that is, sell both the essay book and my first novel at once time.
Again amazingly enough, this worked: Houghton Mifflin was interested in
publishing not only Battles of Life and Death but also Loving Touches, my
first novel, a black comedy set in a psychiatric hospital in New York City.
How do you find time to write? When do you write?
As a busy doctor who has always worked full time, and yet who has been able
to publish several books, along with essays, stories, and professional articles,
I am always asked that question, and I never have a good answer. Of course
it is best for any writer if he or she can find a regular time to write.
The people who ask this question with most urgency are fellow physicians,
or physicians-in-training, medical students or residents. How could any doctor
find a regular time to write? At some phases of my career, I have indeed
had regular times to write. On some rotations there is "library time," and
who knows if you are reading a medical journal or writing a short story?
Other times, there is practically no free time in which one is not exhausted
or overwhelmed. And yet, there is always some down time--between cases, waiting
for the patient who hasn't shown up, during a particularly dull medical lecture
at weekly Grand Rounds. For a doctor, there is often no extended time to
write, but there is practically never "no time" to jot some notes. And notes
can be the start of an essay or a story, and eventually a book.
One other thing of note is that doctors are fabulously hard workers, and
many doctors juggle research, practice, teaching, administration, and writing.
Perhaps not creative writing, but some sort of writing nonetheless.
How do you "switch gears" from doctoring to writing?
Many people assume that this is difficult, but to me it is no more difficult
than the scientist who is also a classical musician coming home and sitting
down at the piano. If you do it enough, writing is something that you do.
Also, in some way, I think a writer is constantly writing, day and night.
It is just that there is only so much time in which the typewriter is at
hand. I often have "written" much of an essay in my mind during a car ride
or while listening to the latest scientific update on some medical or psychiatric
disorder; only later am I able to put it down on paper.
Look at William Carlos Williams's Autobiography. He was an inspiration to
me as a doctor-writer, although there are so many others. He has a great
section about this:
"Five minutes, ten minutes, can always be found. I had my typewriter in
my office desk. All I needed to do was pull up the leaf to which it was fashioned
and I was ready to go. I worked at top speed. If a patient came in at the
door while I was in the middle of a sentence, bang would go the machine--I
was a physician. When the patient left, up would come the machine. My head
developed a technique: something growing inside me demanded reaping. It had
to be attended to. Finally, after eleven at night, when the last patient
had been put to bed, I could always find the time to bang out ten or twelve
pages. In fact, I couldn't rest until I had freed my mind from the obsessions
which had been tormenting me all day. Cleansed of that torment, having scribbled,
I could rest."
These days, with computers and word-processing programs that keep several
documents open at once, this is not so difficult to do, mechanically at least.
What have you learned about how other MD-writers do it?
Over the years I have met and talked to and sometimes interviewed many
doctor-writers. I have interviewed Robert Coles and Lewis Thomas and Oliver
Sacks, and talked at length with other doctor writers. We all are very different.
Some of us practice medicine, others do research or hospital administration,
others are "non-practicing" doctors. Abraham Verghese, for instance, writes
for Talk magazine and works half-time on a medical school faculty, and writes
books as well. We doctor-writers tend, still, to work in isolation even more
than most writers, who have contacts in English or creative writing departments.
Usually a town or hospital has at most one of us.
There is only now just becoming a critical mass of doctor-writers, so that
for instance at Columbia College of Physicians and Surgeons, where I hold
an appointment, there are half a dozen of us. What we have in common, despite
our differences, is a fierce dedication to a dual craft, and an admirable
instinct for survival.
What is the importance (if any) of being a doctor-writer?
When I was in medical school, in the late '70s, my writing made me a rather
unique creature in medical school class. I knew a few other would-be
doctor-writers, and only occasionally met one of these strange zebras, at
a conference, or a book-signing. Now, though, there seem to be doctor-writers
everywhere. Not only Sacks and Richard Selzer and Robert Coles and the late
Lewis Thomas, but Verghese and Ethan Canin and Perri Klass and a host of
There are medical humanities classes in the curricula of many medical schools.
There is a growing realization of the value of reflection upon what doctors
do. Doctors (and other health care providers, and patients as well) have
unique access to new types of experience. The miraculous advances of medicine
in the past fifty years have introduced us to new worlds that were never
imagined before. New dilemmas and problems and complications emerge at a
baffling pace. The doctor, who lives in this world, these worlds, has the
opportunity to report back from the frontier, to say what it is that is coming
to our lives. This is not an indulgence, in my view, it is not a luxury.
I view reflection as a necessity. In order to be a good doctor, I believe
it is essential to be able to reflect upon what you do. To be able to imagine
what your patients experience, and to think about the larger consequences
of your work.
One of the great mistakes American medicine made in the 1960s and 70s was
to over-enthusiastically embrace the scientific model of medicine. Science
is essential to medicine, but it is not all of medicine, and catastrophes
and problems of all sorts have emerged as a result of the too-narrow education
of a whole generation of doctors. For instance, major problems in health
economics and the distribution of care in this country. For instance, doctors
who are cold and seemingly unable to communicate with patients. For instance,
doctors who have ignored patient preferences about death and dying, or who
are unable to properly treat their patients' serious pain. For instance,
researchers who have abused and exploited patients in the course of pursuing
medical progress. There is no shortage of examples of such things, and no
shortage of topics for literary-minded doctors (and patients) to explore
and to write about. And that is why I think we are in for a renaissance of
doctor-writers, something that the world has never before seen.
Any other advice?
Literary-minded pre-meds and medical students, and practicing doctors as
well, often approach me, confiding their ambitions to write books. How do
you get published? I am asked. Should I get an agent? How do I write a book
proposal? I try to be polite, but really I think they've got it wrong.
I think that the place to start, as much as there is one, is with an observation,
a thought or two written into a journal, whether in a notebook or some hard
drive, and to continue this or weeks and months and years. And a stack of
books closely read, and perhaps a writing group, a circle of disinterested
but honest colleagues. And then perhaps a small magazine or newspaper, somewhere.
And if you are lucky, a few readers. And then more small appearances. Between
the first jotting and the end-product of a book lies an odyssey of the sort
described above, a sort of internship or residency in letters. A book is
an end-product of an evolution, of the development of a writer; it can't
be forced. First become a writer, then the books will come.