Writing medical fiction
Thoughts about Samuel Shem--why do I write medical fiction?
Samuel Shem's book "The House of God" was considered by physicians at Harvard to be one of the three most important books to read, ranked between "Harrison's Textbook of Internal Medicine" and the Bible. That said a lot for the status of medical satire, and for a wider category of fiction called "medical fiction".
Why is medical fiction important? Samuel Shem said that there is nothing more important than staying human in healthcare. One of the things that disturbed him is the devastating effect of isolation. To counter isolation, we have to promote the healing powers of human connection. Genuine human connection is mutual, and it involves a topic we don't like to address—suffering. Suffering is unavoidable—is universal and something we all have—what differs between people is how we walk through it. We should talk about it more directly.
According to Sameul Shem, American culture and power is too much about the 'I', the 'self'. What is preferable is the 'we'. When we walk through suffering alone, it will worsen and spread in the world. But we can choose to walk through it by caring for others, while caring for others. And this is one thing we as health-carers can do, one thing that we can embrace and talk about.
"If it weren't for your book, I would have killed myself." A doctor told Samuel after reading "The House of God". Clearly, writing is more than catharsis for a physician, and has far reaching benefits for the community. In that book, Samuel has written about the abuses that doctors have been subjected to. After his internship, he 'laughed and laughed' with the other doctors because he said 'riding on the humor' is the only way to deal with it. In fact, many of the 'horrible things' described in "The House of Gods" are indeed true. Because Samuel fought the system, and made the book a kind of resistance at work, the people in the older generation of the hospital hated the book. But the writer felt strongly about the subject matter, and so he had to write it. He said to himself, "Somebody has to write about it. I guess it's you." The answer to the question, "Medical practice is hard enough. Why write?" was simple, "I couldn't not write."
Many of these things that Samuel said resonates with me. Like Samuel, I feel that "If you're walking around without a sense of something spiritual greater than you, you're in trouble." As a physician, writing fiction also teaches me so many important things. Because fiction is living vicariously in a point-of-view character, it forges empathy. I wrote a coming-of-age novel about a doctor from Singapore who tries to compete in dance in an unfamiliar world of British cities. Writing this book teaches me about forging human connections, and how this process increases a person's self-worth. My second novel is about the struggles of a physician-scientist in a fictional south Asian country in the post-COVID world. This story is about how family connection can be subverted by ambition and human desires.
To write well, one has to be, in Samuel's words, constantly living on the edge. This is what we physicians do on a daily basis. Doctors in my country, like those in the US, are also living in state of stress and tension. This is true even before the COVID-19 pandemic. We are constantly striving for a balance between technology and human connection. We need to 'take the money out of the data', so to speak, avoiding a for-profit system where the doctors' responsibility is to bill as much as possible and the insurers, to pay as little as possible. We as physicians are also struggling to be more united. The system should aim to include voices of doctors, other health-carers, patients, regulators, and the third party payers (like the insurers). The challenging healthcare scenarios that we work in make great conflict, and awesome fiction. And very contemporary, relevant fiction.
Writing fiction also means stepping out to take a different perspective. We physicians tend to be trapped in this world where we follow best practice protocols for each diagnosis, regardless of the great diversity of our patients and how they can react to such standard management. In many ways, this efficiency of care has made us blind to the core meaning of what we do. If not for the Rhode Scholarship to Oxford to do his DPhil—Samuel said in an interview—he would not have those views of Vietnam War and American culture from the outside. When the choice given to him was between 'return to Harvard' or 'be conscripted', Samuel made the decision to be a physician and a psychiatrist. He felt that such a move was more enabling for writing compared to other career moves. Many years later, someone in Australia called him the "Dylan of Medicine", after Bob Dylan, who won the Nobel prize in literature. I agree that if we are only doing the activities that are internal to our professions, we can become terribly biased in our thinking. Writing fiction is such a different type of activity, and to me, is a refreshing way to examine our professional and personal lives.
Different people have given advice on how to write medical fiction. Writers of medical fiction are not limited to physicians. Such advice can be found on this video. Dr Antonio Gomes, author of Have a Heart, has emphasised the importance of doing research to get the facts right, and obtaining feedback. He also mentioned that the work should be targeted to lay reader and not the experts.
I have something to add: it is difficult to be loved by many readers. But it is harder to write heart-felt fiction when you're unwilling to embrace human suffering and voice the injustice you've seen.
