■
>>MARCIA DAY CHILDRESS:
Hello, and welcome to Medical
Center Hour, the University of
Virginia's weekly public forum
on medicine, healthcare, and
society.
I'm Marcia Day Childress, from
the Center for Health
Humanities
and Ethics in the School of
Medicine.
It's great that you've joined
us
today -- indeed, please do
come
every Wednesday.
The slides that open and close
this program offer resources,
information about continuing
health professional education
credit, and bookstore links.
There's also a link to our
Center's website, with
information about today's
presenters, our spring program
lineup, and Medical Center
Hour
videos on our YouTube channel.
This program is being recorded
and closed-captioned and will
be
posted to YouTube.
On Zoom, we handle audience
contributions using the Q&A
function. Write your questions
and comments there.
We'll monitor questions as
they
come in and make them the
focus
of my conversation with our
presenters at the end of the
hour.
Today's program, WHY DOCTORS
WRITE: IN THEIR OWN WORDS,
features three University of
Virginia physician-writers.
-- doctors who writ write and
give us a chance to focus on
what has become a flourishing
subspecies, the doctor who
writes. Across history, there
have been doctors who write,
even some who became more
famous for their literary
output, think Arthur Conan
Doyle on modernist poet,
William Carlos. Or as a past
time, and medical schools like
UVA are encouraging doctors to
write, even connecting writing
with the core clinical skills
of reflection and
self-reflection, and with
improved clinical practice.
But why really, do doctors
write? In their own words,
what physicians say about why
it gets them early in the
morning and keeps them away
late, how it anchors this.
Three University of Virginia
physician writes, two
internists and a pediatrician.
Two internists and a
pediatrician, two poets and a
prose-writer, two assistant
professors and a professor
emeritus -- however you parse
them, they're a dynamic trio.
Besides practicing medicine
and
writing, they all teach,
including with and about their
writing. Our three presenters
are Dr. Daniel Becker,
professor
emeritus of medicine and
author
of 2ND Chance, a newly
published, prizewinning
collection of poems; Dr. Ben
Martin, assistant professor of
medicine and a UVA hospitalist
who's at work on a novel; and
Dr. Irene Mathieu, assistant
professor of pediatrics and
author of three books of
poetry.
Resides in the UVA medical
alumni association and we're
grateful for the alumni
association's partnership with
medical center hour, and thus,
their celebration of doctors
who write. And again, we'll
start with Dr. Becker.
>>DANIEL M. BECKER, MD: Good
afternoon, everyone, when
Marcia invited me to speak
today, I agreed under one
condition. Only if Tony Fauci
was not available for a return
performance on medical center
hour, and I hope that everyone
watching and listening is
either vaccinated or has an
appointment for vaccine or
planning to make an
appointment, is my slide up?
By the way? There it is.
Okay. You can see a phone
number on that slide. And
also, my e-mail address and
you're welcome to e-mail me
because I'm a self-a pointed
vaccine ambassador and I'll
try to be helpful. And as for
the right half of this slide,
that really is a bear on the
driveway to the building where
I have been seeing patients
since 1985. Funny things
happen on the way to work. On
the way home and at home. By
funny, I mean, worthy of
reinvention. Writing for some
of us and reading good writing
for most of us, works the way
a vaccine does. It deflects
the slings and arrows of
outrageous fortune, it
protects us, it can make us a
little more happy or a little
less sad. Moreover, it can
make that sadness or happiness
a little more interesting.
And speaking of happy, I'm
really happy to share a Zoom
podium with Ben and Irene, our
orbits keep intersecting and I
hope that that continues. Ben
and Irene and I are different
kinds of doctors and different
kinds of writers and just as
ten doctors in a room will
have a 100 clinical opinions
on an interesting clinical
problem, three doctors in a
virtually space will comp I
Kate and elaborate the
question that today's medical
center hour poses. In
considering the question, why
doctors write, we should limit
the discussion to legible
doctors writing. So why do
doctors write? Some of us
can't not write. It's a
habit. A habit of the heart.
As much as of the mind. Let's
start with what we write.
Clinic notes, memos, grants,
scientific articles, budget
justifications, and results
letters, letters of
recommendation, pleas to third
parties for prior
authorization, memos, e-mail,
text messages, textbooks,
chapters in textbooks, grocery
lists, kitchen table notes,
explaining why we're working
late. Essays, novels, and on
occasion, a handwritten thank
you or condolence note. As a
division chief, I enjoyed
writing holiday and birthday
poems to staff. Thus, roses
are red, violets are thirsty,
I almost forgot, today is your
birthday. Some of my results
notes to patients were in
rhyming and I'll save those
for the Q & A. Lots of
doctors write poems and
stories, some lawyers also
write poems and stories. Some
insurance adjusters, Stephens
in mind, write mind boggle
poetry, there's a plumber poet
who I know, there's many good
nurse poets, as there are good
doctor poets. And trouble
times, there are never enough
first responders or good
poets, William Carlos
Williams, a great poet and a
great doctor, reminds us that
we don't get the poems, but
people die every day for lack
of what we find in poems. If
you wonder about the inspiring
effect of poetry, check out
the YouTube video of young
poet Amanda Gorman, reading
the hill we climb, at
president Biden's
inauguration. While all good
poets and essayists and
fiction writers know how to
build and enjoy a good
sentence, so doctor doctors,
some of my most soaring
sentences occurring in
strongly worded letters to
insurance or durable medical
equipment purveyors who do
read and respond when you
capture their attention. Most
of my writing has been in
clinic notes, every once in a
while, the clinical history
mentions that a patient walks
a dog for exercise and the
dog's name is padlock, a
doctor who knows the dog's
name is a doctor who listens,
and pays close attention, the
doctor who asks the patient,
by the way, what's your dog's
name. I could spend the rest
of my allotted time on dogs,
mine, my patients, dogs that
come to clinic and wander in
and out of my poems, when I
mention the dog's name in my
note, that's a note to self, a
reminder to me and anyone
reading the note that this
patient, like all patients,
has a particular story to
share and more than the sum of
medical problems and
medications. A bad writer can
be a good doctor or scientist
but a great doctor or
scientist needs to be at least
a good writer. As an above
average doctor on a good day
and a struggling scientists
back in the dies when my
career and research, I woke up
one morning and learned I had
700 new patients, the PCP era
had begun. While UVA
employees had to change a PCP,
and there weren't that many of
us at that time at UVA. My
grant writing days were over.
No time to gather and analyze
data, no more carefully
crafted research abstracts
that use every word the
abstract form allowed. By
then, I had a pretty serious
writing habit. I woke up
every morning, way before
sunrise, while the house was
quiet, and rather than writing
grants and papers, I started
making up stories. Most of
those stories don't need a
clinic or a hospital or a
doctor. They often make the
case that tragedy is failed
comedy. They all benefit from
a doctor's ear. They're
written to be heard and on the
page, they look like poems.
They're also fictions, or
fictions in their most
complicating details. If
inspired by a real family, or
person, the final version is
either unrecognizable or a
gift that person or family has
acknowledged. As an above
average doctor, on a good day,
I'm a good listener all the
time. I'm not talking about
my stethoscope. I listened
for the story and the accent
that goes with the story and
the origins of the, assent and
the unique syntax that make
the story worth reinventing
and sharing. And I also
listen to the body language,
the snap of two fingers, the
shrug, the look out the window
or down at the floor. And the
emblem on the hat, the name,
the tattooed on the neck, the
silence that out lasts my need
to keep asking questions.
These are stories that make me
a better listener and as I
became a better listener, I
became a better doctor. And I
also became eager to make home
visits, if there are stories
in clinic visits, there are
novels in home visits. The
first poem I'm reading today
is the first poem I published,
it's called home visit, and it
was published in the journal
of the American medical
association, in 2001. So can
we -- I hope you folks can
read this. Home visit.
We follow a blue Ford tractor
pulling a wagon and moving
slowly, scattering straw like
exhaust, south side Virginia
in July. Still haying season,
so hot that the hay shimmies
on the asphalt, June bugs
stray at the windshield, the
afternoon breeze a warm
sponge. The nurses, telling
me how to greet other drivers,
lift two fingers from the
steering wheel, only two, show
some restraint. Where to
park, watch out for the dog,
stretching a yawn, scored ribs
settling on a minor chord.
Who's who as we edge through
the home front porch to back,
generations ungapped, no work,
no school, no AC, fans whir,
TV promises a better life. We
reach the kitchen, and in the
pantry, an old woman with
electric hair and petrified
eyes hums a gospel. She looks
straight through us. She's
expecting Jesus, sweet Jesus.
The next poem is also a
moment, about swimming laps.
What I miss most of the
prepandemic days, with was
swimming at UVA's north ground
pool. There are few phrases
in this poem with melody and
you'll have to imagine the
melody, I can hear a tune but
I can't carry it. Swimming
with John's ghost.
During the memorial service
after the acclamation and
before the sermon size
metaphor that started with the
tree then lost me, a comrade
from the morning shift at
college, they shared a lecture
hall and the appreciation that
all sleepy students are each
sleepy in different ways,
quoted John bragging about
having the north grounds pool
all to himself at sunrise.
Morning people brag about
their mornings. This morning
the life guards, proving they
do pay attention to the lives
they guard, have the music
turned to oldies, Sam Cooke
crooning, you send me as Sam's
fans adjust their goggles.
John, easy to spot in that
deep blue bathing cap, he
claimed helped part the
waters, takes the lane next to
me. We're standing there
praying the water isn't as
cold as it is and waiting for
one of us to acknowledge our
existence, bummer about that
service; I say, hoping to
sound too relieved he doesn't
want to share my lane. Total,
he says. Then we submerge.
Strange how dying helped us
stroke, he doesn't have to
breathe but does. Old habits
die hard. I'm a little choked
up in the locker room, and he
suggests doing something about
that cough. He would know.
Since it is a locker room, I
share some look locker room
wisdom, when the going gets
going, the tough get going.
John takes his cue, practice
doesn't make perfect. Perfect
practice makes perfect. We
allow a moment of silence but
before any hymns erupt, I
share my favorite hymn fact.
Emily dickens can be tuned to
the tune of amazing Grace.
Almost on key. And then I
asked if he can borrow my
brush, get real, I answer.
Who wants to catch someone
else's static? We complain
about chlorine and dry itchy
skin, and we put our pants on
one leg at a time, and act of
faith that grounds, see you
later, he promises and like
anyone, walks out the door.
The last poem is a listening
poem, and this is a pound poem
because parts of it, I just
found in a day, of paying
attention, it's about a newly
retired doctor auditing a
music class at UVA.
Called among the deep
listeners in deep listening
101.
Among the deep listening in
deep listening 101, are music
majors taking the class for
credit and an auditor on
social security who can only
hum one note and that's the
note he hums. Overtones, find
a major chord. Then we march
off and find a place to sit
and list the sounds while
building castles out of sound,
listening as the hardest thing
a brain does, according to
listening psychologists,
soliciting grants and
donations. It is now possible
to sound into the brainstem
and into the attic some sounds
turn on the -- human ears fly
like bats from one echo to the
other. The bats returning to
my attic don't trigger the
motion detector in my
driveway, it takes poetic
license to claim that motion
detectors listen. Unless the
motion detector is a sleeping
dog who wakes up to announce
the UPS truck in the driveway.
Look around, listen up, there
are worlds beyond our
threshold. During the field
trip, outside of the sound
free chamber, those strangers
pounding at the door, heart
beats. Added 20% gratuity, if
anyone in the audience is
interested, there's a book,
second chance, as Marcia
mentioned, and I hope you --
if you're going to buy it, buy
it, at an independent
bookstore on the downtown mall
or the UVA bookstore, and
independent bookstores and
small poetry presses need the
support. Thank you and next.
>>BENJAMIN MARTIN, MD: I'm
so honored to share this time
with Danny and Irene, swimming
with John's ghost, one of the
things I keep coming back to,
thinking about why doctors
write is sometimes doctors
write as a way of making peace
with patients who haunt us.
And so, with that, in the
front of our minds, what I
want to do is take this time
and the next 14 minutes to
read an essay that I have
written. And the essay is
really about two things. One,
is the relationship that I
developed with a patient I
took care of last year. And
the other is one of my
favorite books, which is the
novel, life and times with
Michael Kay. And the title of
the essay is Michael Kay.
In life and times of Michael
Kay, an unnamed military
medical officer over his
patient, the Michael Kay.
Quote, you are like a stick
insect, Michaels, whose sole
defense against the predators
is the bizarre shape. Like a
stick insect that has landed,
God knows how in the middle of
a concrete plane. You raise
your slow fragile stick legs
one at a time and inch about
looking for something to merge
with and there's nothing. The
officer, a pharmacist by
training, has been deployed as
a bedside clinician in a
makeshift hospital. He works
for the Government carrying
out the forced migration and
imprisonment of all nonwhite
people in the quasi fictional
South Africa. The officer is
one of attempts to make sense
of the man he is charged with
treating. Life and times of
Michael Kay a story of the
protagonist survival, on his
journey, Michael Kay squats on
the family farm, hides in the
mountain, escaped a labor gang
and a prison camp and lives on
pumpkins he grows by seed.
The narrator write, the only
sound he could hear is the
trouser legs whipping
together. From horizon to
horizon, the landscape was
empty. It is near the end of
the novel when soldiers
apprehend Michael,
malnourished and relinquish
him to the medical officer.
Michael is one of the great
characters of modern
literature, who knows
solitude. Solitude has been
on my mind. I recently
reopened the book hoping to
learn something about one of
my patients who seemed
impossibly alone. Last March,
I assumed care of a man I will
call Mr. S. A 64-year-old who
first presented to the
emergency department with
confusion and recurring falls.
At that time, months before I
met him, he had been treated
for a cute alcohol withdrawal.
His electro lights returned to
normal, cultures of his blood
and urine grew nothing, but
his confusion did not improve.
He saw rats running across the
floor, he heard whispered
voices about the end of the
world. He seemed to have no
reliable short-term memory.
And each time someone asked
him what he did yesterday, he
offered a different response.
Shopping for a jacket.
Clearing out brush from the
woods. Working on the frame
of the house. When asked if
he knew where he was, he
responded, keyboard. Brain
imaging didn't turn up an
explanation, the consultant
agreed that Mr. S's
presentation was consistent
with permanent memory loss and
psychosis due to vitamin B1.
If you asked someone with the
syndrome, what they did last
night, they can't remember.
So their brain involuntarily
offers up fabricated event.
The region of Mr. S's brain
that regulates emotion and
memory had been irreparable
damaged. Mr. S ate his meals
and exercised with physical
therapists, his a
hallucinations improved. He
couldn't remember when to take
them. He had difficulty
getting dressed by himself, he
was better, but was he ready
to leave the hospital? He had
no spouse or living relatives.
He had had some old friends
who were reluctant to help and
had stopped answering the
phone. He had nowhere to go.
One rainy afternoon, he
vanished, it took hours for
the police to track him down
on the median strip of a
highway. Hair matted,
desperately searching for a
pair of boots that didn't
exist. Without protest, he
let the officers return him to
the hospital. Mr. S. Needed a
so called memory, a facility
where patients with cognitive
disease and unpredictable
behavior received care under
strict supervision. Beds are
hard to come by. Weeks added
up on the time line. When I
met Mr. S., he had been in the
hospital for months, but there
was little for me to do as his
doctor. We spent our time
exchanging pleasantries, how
do you feel, I asked him each
day? I'm healing. He would
tell me. Eyeing my
stethoscope. When I asked if
he had shortness of breath or
chest main pain, there was
some variety in his responses,
a mild display, but the spirit
was the same. The bronchitis
is getting better, or the
pneumonia is all gone. He
passed afternoon stretched out
in bed, sitting in a chair by
the window, sport coat on. A
Bible in his lap. One day, I
found him writing scripture on
the walls white board. He
made no mention of my face
mask and goggle, now mandatory
protective equipment when
examining any patient. The
pandemic had made its way
across the globe, but for
Mr. S. Nothing had changed in
his inner reality or nothing I
could detect. What was his
life like before he came to
us? In a decade-old note in
the virtual bottom of his
electronic file, I found a
passing reference to a year he
spent in sobriety at the faith
and healing farm stead.
Nowhere else in the chart was
his this part of his life
mentioned. It is easy for me
to fill in the gaps, imagining
him performing the activities
his mind now offers as
confabulation, chopping wood,
knocking fences together,
rolling cigarettes. But the
stories of his chart do not
reveal the answers to my real
questions. Where do you
belong? What do your stories
and their gaps mean?
As with Mr. S., Michael Kay
comes under medical care in an
advanced state of medical
nutrition. Michael either
ignored the medical office's
questions or offered invasive
responses. The office calls
him Michaels, even after
Michael corrects him. The
officer doesn't trust Michael
to know his own name. You're
like a stick insect, the
officer tells him. It is one
of many attempts to assign
meaning to Michael with animal
imagery, the officer compares
Michael to a pet duckling, the
runt of a cat's letter and a
fledgling expelled from the
nest, like a bunny rabbit SEWN
up. Clucking like -- the
medical officer speculate that
providing Michael with
physical rehabilitation would
be like trying to teach a rat
or a mouse or a lizard to bark
and beg and catch a ball.
The narrator, the reader
learned that Michael, too,
attempts to understand himself
through animal metaphor,
quote, when he tried to
explain himself, to himself,
there remained a gap, a hole,
a darkness before which his
understanding balked. At the
limits of self-knowledge,
Michael cast himself as a
snail without a shell, an
earth worm, a mole, he does
not consider soaring kites or
stocking panthers. Animals
with which he identifies are
small, subterranean, the kind
that seek the vital protection
a physical form cannot supply.
At one point ply lying on
ground, I'm like a ant that
does not know where his hole
is. Solitude in the loneliest
form. The reader is drawn
into a patch work of animal
imagery as an instrument of
explication. But neither
Michael nor the officer seem
convinced by their effort.
Forgive me, Michaels, the
author imagines telling his
patient, I only want to tell
you what you mean to me, then
I will be through. It is a
plea originating from
self-interest, once he can
explicate Michael, the officer
will be one step closer to
understanding his own role in
a tragic history, one step
closer to making sense of the
chaos around him. How did the
novel's come to pass? The
reader is never given the
origin story. The indifferent
cruelty, a guard at a work
camp tells Michael, you
climbed the fence and I'll
shoot you dead, Mr. No hard
feelings. Stopping Michael at
a check point, a motorcyclist
warns, do you want to stop on
the expressway, you go 50
meters off the road side,
that's a regulation, anything
near you can get shot, no
warning. No questions asked.
The phrase, no questions
asked, seems to summarize the
spirit of the militarized
state, in exchange, Michael
adopts a rejoiner, no answers
offered.
So Michael's solitude is a
shield, he has no reason to
trust the medical officer. He
foregoes durable friendship
with other prisoners. He
managed to be solitary, even
when crammed into a train car.
But his shield is an imperfect
defense against the ubiquitous
-- no fresh water in sight.
At times the only decision to
make the whether to walk
through expelled dizziness or
lie down.
If I can explicate Michael
where the officer comes up
short, I have less luck with
Mr. S. During my 7-days as
his doctor, my other patients
had changed course. My
patient with pneumonia went
home with an oxygen tank, the
my patient with the kidney
injury went home with hospice
care. Mr. S. Slept in through
noon, and he flipped through
the Bible. Talking about
whatever came to mind. He
spent most of his day alone.
On the morning he deviated
from our normal pleasant
exchange, he looked me up and
down, and this is a wicked
town, he told me. Anything
bothering you physically, I
asked? I'd be better if I was
left the hell alone, he said.
Fair enough, I said, backing
away. I can come by later.
Fair enough, he repeat.
That's right. No papers, no
money, the medical officer
muses on Michael. No family,
no friends, no sense of who
you are. Obscured of the
obscure. Michael K, Michael
S, both alone, both obscure,
is this why I feel compelled
to draw a link between them.
If Mr. S is like Michael, am I
like the medical officer? By
all measurements, he is my
fiction of shade. Like him, I
view my patient with a gaze
distort by the desire for
meaning. Like him, I forced
symbolism on I person who
never asked to be symbolized.
Instead of filling in the gaps
in Mr. S's chart, I should
follow Michael's example and
try to explain myself to
myself. What kind of animal
am I? Am I like a wandering
ant? Are my goggles like the
compound eyes of a fly? Does
my prowling in the hallways,
leaving and returning to the
patient's -- like a wolf. If
Mr. S is both like and unlike
Michael K, if I'm like and
unlike the medical officer,
what about the representative
environments? As COVID spread
through the U.S. last spring,
studies revealed
disproportionately high rates
of morbidity and mortality of
persons of color, at the same
time, nationwide protests
filled the streets. In May,
the NAACP called for the
United Nations to classify
U.S. police violence against
black Americans as a human
rights violation. Some cities
condemned the violence.
Others issued curfews, and
enforced by the police. And
the headlines, lootings,
beatings, gas canisters. A
friend sent me a photo of a
burning car, taken from a
window in the COVID unit of
his hospital. In the footage
of George Floyd's murder, the
crime is partially hidden by
the police car. But the
killer's face occasionally
emerges into view, a crease in
his brow, eye brows raised as
if to say, no hard feelings.
At the end of life and times,
Michael manages to climb the
fence and flee the hospital,
he walks the landscape and
imagines quenching his thirst
by tying a teaspoon into a
stringer and lowering it into
I a well. One can drink from
a teaspoon, maybe, but a cup
is not too much to ask for.
Over half a year from the
night of his admission, months
after we parted ways, Mr. S.
Left the hospital, discharged
to a memory facility. And in
a different kind of story, in
a different environment, along
lost friend might track him
down. Pay him a visit from
time to time. But if a
solitude changes character, I
will never know about it.
Probably for the best, best
not to think of Mr. S like one
thing or as something else.
Best to resist the temptation
to wring out meaning from
unyielding sources. And
instead, I cling to my
understanding of Michael like
a fist around the spoon.
Thank you.
>>IRENE MATHIEW, MD: Good
afternoon, everyone. I'm
really pleased to be here with
Ben and Danny, and I will be
reading a section of an essay
as well and just a few poems.
When Marcia asked us to
consider the request of why
doctors write, I wanted to
turn the question on its head,
why this writer became a
doctor. So I'll go ahead and
start with my essay.
I grew up with a language of
medicine, my mother, a
pathologist, and my father, an
internist turned
dermatologist, who I should
mention, trained under Danny
Becker, made laboratory talk
at the dinner table. Sarcoma,
specimen, histiocyte, mitosis,
they talked cases, of course
with patient's names redacted,
over red beans and rice, and
in this way, the vocabulary of
medicine became mundane to me.
The first little girl I
startled with my presence had
just arrived to the hospital.
She and her mother were
settling down in her room. I
was wearing a new dress, I
told them I would be her
doctor. The girl and her
mother and I had the same
color of skin. They looked at
me, as if I were foreign to
them. You can't be my doctor.
Proclaimed the girl. Why not,
I asked? Because doctors
don't wear dresses. I mean,
stammered the mother, you're
so young. How can you
possibly be old enough to be a
doctor? Harvard university
has created a series of tests,
with them, anyone who has
access to the Internet and
relative dexterity of the
fingers can diagnose herself
with homophobia, fat phobia,
anti-blackness and a range of
other social biases. I once
took the test that tells
whether you that think women
are emotional and associated
with the humanities and men
are pragmatic and science
oriented, the common social
assumption, my results were,
women strongly associated with
pragmatism and science. Men,
strongly associated with
emotion and the humanities. I
was not surprised. My father
regularly weeped over
Beethoven, my male partner is
a humanities profession.
My mother, when I read her a
new poem of mine, says, why
don't you just say what you
mean? I have seen her cry
once. People still card my
mother when she buys alcohol,
I won't tell you her age. She
is a young woman. But to me,
she has always been a doctor.
This is important. Let me say
it again. To me, my mother
has always been a doctor. If
you don't see it, you don't
know it.
But there are things -- are
there things that we know
without being able to see
them? There have been times I
have a feeling about a
patient, how her asthma may
flair over the next few hours
or extra fluids and I'm right.
And in medicine, we have a
plethora of data, some would
argue too much, there are many
ways to measure what we know
about the body and all of the
ways it might turn on us.
Yet, we still have yawning
gaps and health outcomes based
on gender, race and a host of
other social categories. We
spend astronomical amounts on
healthcare, but life
expectancy in United States
does not reflect this. And
there are some things we
cannot measure. But don't
know how to predict. This is
where the unsayable knowing
takes over. Perhaps it is
intuition, sharpened by
experience. This is the art
of medicine. No one ever
taught it to me, but the best
physicians I know have
obtained, honed, the finest of
arts, the most human of
humanities, some people
predict that doctors will be
replaced by robots capable of
synthesizing data and agent
algorithms. I do not think we
can teach its art, which is
the result of deep and
multidimensional listening.
The kind of listening a robot
can never replicate.
For a long time, I had no
interest in the profession. I
did not want to become a
doctor because I liked reading
and writing, and I did not
think that these had had
anything to do with medicine.
Further more, medicine felt
like an inheritance, hand me
down clothes, and I did not
want to become my parents by
default. In high school, I
wrote a long and strangely
specific poem about how I
would never study
neuroscience, declaring my
independence from the medical
sciences as a whole, and
swearing to a life of the
humanities. I rejected the
arrogance I sensed, the
know-it-allness, although I
didn't consciously know what
alternatives to compliments
might exist. I did know that
I loved the feeling of finding
words for an emotion or
sculpting a thought into
something beautiful and
transplantable when I wrote
stories and poems I loved the
deep sense of peace and
connectedness that settled
over me when I spent hours
mucking around in the woods or
swimming in just about any
body of water. Surely, these
knowledges meant something,
too. I challenged my mother
one day in high school. I
think there are many ways to
know things and human beings
are limited by the five very
not good sense, I hate how
arrogant people are about the
science. That's it's not the
only thing. That's why I'm
not going to be a doctor. My
mother, given my implicit bias
test results, returned, yes,
but it works. I had to admit,
she was right. Antibiotics
saved lives. Vaccines prevent
fatal diseases, technology can
be used to buy time for a body
working to heal itself. The
advances of modern medicine I
had to admit are real and
important. When we were kids,
my siblings and I would spend
our trips to the local hippie
grocery store, when incense,
candles, and essential oils,
Crystals and fragrant soaps,
found. We would touch and
smell the items, occasionally
imploring my apartments to by
us something. We called this
the magic section, I found
myself particularly attracted
to amethyst, years later,
amethyst is associated with
healing. And I think that
those items were appealing to
us because we sensed in them
something that wasn't present
in our daily lives. There was
an inexplicable energy, a deep
vibration that appealed to us.
These objects represented
another way of knowing the
world for us kids surrounded
by biomedicine. And that
foreign knowledge felt
powerful. My years of
practice have only solidified
my conviction that spiritual
and scientific understandings
compliment one another, that
there is no separation between
the mind and body and that
some things we can never fully
understand. And I've come to
love that uncertainty.
Perhaps this is the core of
my own spirituality my faith
in the universe that functions
beyond my comprehension and
long before and after the last
of us lives. I am
fundamentally a healer, for
me, western biomedicine
provides one limited set of
tools for effective healing.
It's wonderful. But it isn't
everything. I started
journalling before I could
physically write, demanding
that my mother take down my
dictations, later I delved
into writing popes, poetry
dependents on uncertainty, my
best poems are nebulous
thought feelings -- the
language sorts the muck in my
brain until a pattern is
created, synapses are linked
and a narrative has bloomed.
But within this muck and
invisible sources pull words
this way and that, like
threads controlled by an
unnamed puppeteer. The dean
of my medical school remarked
that medicine is the ultimate
of the humanities and I found
myself agreeing. Medicine
reveals how the invisible
forces all around us shape
people's very bodies.
You can't be what you can't
see, but seeing is
insufficient. There are so
many forces that change our
bodies, they change the DNA
shut the floor of blood. Maya
Angelou said someday we'll be
able to measure the power of
words, I think they are
things, they get on the walls,
this get in your Paul --
wallpaper and finally into
you. Think about it like
this. The financial system
relies on our belief and the
value of money, racism relies
on a collective belief of a
critical mass of people in
white supremacy, the political
nation state relies on a --
male dominance is possible
because of collective -- these
invisible forces are created
and shaped. And like those
forces, it has measurable
power. Stories convey
emotional where medical
language fail us. They offer
a way to more viscerally
experience a person's
perspective in a power dynamic
that is different than
clinician patients, the reader
becomes the listener, and the
one who has given an
experience, and the narrator
retains the power. In this
shift, fleeting though it may
be, is an opportunity to push
healthcare provider outside of
our comfort zones as knowledge
keeper, instead stories
suggest, there are ways of
knowing we can never dream of.
It's important, I think, for
doctors to feel this on a
cellular level every once in a
while. As a physician and
writer, I'm constantly
hovering around this these
questions, what silences in
our collect i conversation are
manifested in and through our
bodies? What are the secrets
we refuse to speak that come
out any way in my exam room
every day? What happens if I
train the microscope of
language on myself? Through
writing, I've been developing
-- I've been training my eye
on myself instead of only on
my patients and thus have
developed a language for
things, vague tugs at the
ended of my consciousness.
Intuition inherited from
unknown places, other
dimensions. My poetry, essays
and fiction represent my
attempt to create a language
for these other kinds of
knowledges. And I use them to
better understand how I came
to be, and what has shaped
this world into the place
where we live.
Now, I'll share a few of my
poems with you. The forest
fire of family trees.
The problem is, we don't know
that many ways of doing
things. For instance, neither
of us can fry an egg without
public radio chattering in our
ears. And there are worst
blueprints for a home, like
what my grandfather taught my
uncle. We think we know
people until we see the way
they eat a banana. Totally
unlike how we peel and devour
the fruit. Only instead of
eating a banana, it's
something way bigger. Like
loving another person. As the
snowflakes get thicker, I hear
myself say exactly what my
mother would say when faced
with the same situation, and I
say it in her voice. It's not
that I'm ashamed to share my
DNA and most of my life with
these people, I worry, it's
not easy to recognize the odor
of toxins you release, day
after day, which rearranged
spells door. You cross the
threshold, and think it's just
the cologne of the world, not
the smoke in your blood, not
grass burning from the little
fires ignited by your feet.
Origin story.
After all of this, it's the
miracle of what took, blood
vessels knotting their fingers
into the red room at the
center of me. The cure that
worked, the vaccine that won.
Today, I explained to a mother
and her furrowed brow that the
pro teen is nothing that tries
to bureau into us, with a tip
tap water, heavy metals and
chemical residues, the whole
sticky swirl of waste humans
leave in our wake. We ought
to be amazed at what the body
fights off and what it opens
to hold. Like the child who
shifts against the curve of my
spine. Subs its thumb a
little in the fluid dream its
had for months. I could claim
to be the dream maker, but the
truth is, I have no idea how
this tiny world came to be in
me. Some passing comment or
well-positioned thunder cloud
must have opened this portal.
Prepared the threshold.
Loosed the song that started
it all.
Lull buy.
Scrape a baby's white tongue
and if crumble off, it's milk.
If the tongue bleeds, it's
thrush. Let the baby thrash,
looking for food. If I find a
well-spring, let me drink.
This is called responsive
parenting. Don't rush to
console me, let the baby cry.
This is sleep training. Let
me palm the dark edges of my
own vision when the light goes
out, let me taste what grows
in my mouth. Follow the
little spine to where it ends
in the feathered tail,
whipping in a bone's straw
intervating my wrists, I can
tell myself, reach for that,
or grab that, and it is done.
I smell food, I drink. I
cannot tell from here if my
tongue is overgrown or simply
overfed. The room is full of
shuttering. Milk tongue, milk
tongue, your song is getting
sour. I haven't slept well
since I was born. As a bird,
thrush doesn't is much sing as
insist. Look, blood, the baby
assumes that everything in the
room has an explanation. Milk
here, blood there and why? If
a baby is sick, take blood
from the wrist. Ask it why.
I'll never be nursed this way
again. My mother says when I
cried my father always came
running. This explains the
color of my feathers. It's
hard to tell if the baby is
getting bigger or the room is
shrinking but some things
arise, symbiotically, a
warming ballad. Tell the
baby, even birds drink milk.
I can't tell what's inside of
the room and what's out. I
give up blood to know. The
baby's cried too long again.
I'll turn out the light, place
her face up, hush the rooting
mouth still in training. I
won't ask questions of my
tongue. Thank you.
>>MARCIA DAY CHILDRESS:
Thank you, Danny and Ben and
Irene, you've given us such
strong and specific examples
of your writing. And of what
-- how it works. And what it
does. And you've allowed it
to work on us which is
powerfully. And what we would
like to do now is to turn to
some questions, I think that
you have -- you've certainly
struck a chord with our
audience. But they seem a
little wordless. At this
point. Except for words of
praise. So I think that what
we will do is have a
conversation around some
things, some points that you
made. And mentioned. And let
the words that you have
brought to us and the thoughts
with that combine into a
conversation.
So first of all, I'm struck
for each one of you, your
mastery, with words. In the
forms that you've chosen to
write in. And I'd just like
to hear you talk a little bit
about what is the significance
of word play? For each of
you? Start with Danny,
putting him on the spot. You
know, you're all acute
listeners, but you all know
and it seems to sort of seep
through the writing that you
really enjoy word play, what
would you say to that?
>>DANIEL M. BECKER, MD:
Well, true enough, I -- I
enjoy pons and word play, I
think that in my remarks, I
make the point that tragedy
can be failed comedy, and it's
no doubt, there's some degree
of self-dense, I'm trying to
lighten up a little bit. One
of my associates who teaches
poetry in prison was told by
his students, professor, you
need to lighten up. So
there's that. But also, you
know, diction is one of these
tools that, you know, you play
around with different words,
and at a different point in a
line, and the right word will
deepen the meaning and
complicate the meaning, I
mean, I'm after being as
complicated as I can without
making my readers run out of
the room. And, you know, and
sort of finding the right word
is -- it's pleasurable. It's
fun to do that.
>>MARCIA DAY CHILDRESS:
Yeah. Ben, thank you.
>>BENJAMIN MARTIN, MD: Yeah,
echoing everything that Danny
said. I think there's a
genuine joy, for me, writing
and reading are so closely
intertwined, when you have
that experience of
encountering an idea that's
been framed in a different
way, never thought about it
before, by the language
choice, there's something
inspiring about that, too,
where you think, well, can I
actually change the way I
think about the world by
simply deciding what words to
use? So there's -- there's an
excitement there. But yeah,
for me, it just comes out of a
wealth of language and the joy
of discovery.
>>MARCIA DAY CHILDRESS:
Irene?
>>IRENE MATHIEW, MD: Well,
think that for me I have a
pediatric perspective on this
and I was thinking how play is
so important developmentally
for children. And when we
think about how young children
learn the world, they learn it
through play. And it's an
essential part of development.
And I think that it's the same
for me. I think that play
with language, is a way that I
improve and deepen my
relationship to language and
learn more about language's
capacity to express various
things so it's a natural part
of the development of my place
as a writer and that seems to
mirror the way that play
functions for all of us in our
development as human beings.
>>MARCIA DAY CHILDRESS:
Great. So we have several
questions here that have to do
with your writing practice.
But this -- this one starts
with an interesting question.
What is the rhythm of your
writing like? When are the
sort of overflows, where you
have to get this out? And
when do you take time to craft
your words a bit more? And
particularly, and this was a
question that echos some other
questions, where in the world
in a busy life of medical
practice where you find the
time? But back to what is,
what is the rhythm of your
writing like? Anybody who
wants to grab it.
>>DANIEL M. BECKER, MD:
Well, you know, poets start
out writing iambic pentameter,
I started out writing and
sounding like Dr. Seuss than
Milton. So I think poetry is
supposed to be musical. And I
think that the prose writers,
mostly fiction writes whom I
admire have very musical
language, think of Faulkner.
The -- so the -- and then you
go back to it again and again
and again until it sounds
right. And something we
haven't mentioned is syntax,
just sort of the construction
of the sentence, you know, and
a lot of sentences have a
subject, a verb and an object.
And once you learn how to vary
that and to complicate that,
and sort of bring the sentence
all the way down the page,
it's a way of entrapping the
reader, so that they want to
find out, you know, how this
almost sort of gravity defying
sentence can ever sort of come
to an end. So as my writing
developed, I wrote longer and
longer poems. You know? And
more complicated sentences,
and, you know, it kind of felt
like the guy on the unicycles
and someone tosses him a
chainsaw that's running and
being able to do that. That
would be my goal as a writer.
To juggle on -- being able to
ride a unicycle and juggle.
>>MARCIA DAY CHILDRESS:
Also, what you mentioned,
Danny was something that
actually enlists the reader,
almost as the play mate, as
you're working with words in
the way that Irene was talking
about. Yeah.
So who were your -- who your
models or your mentors? As
writers and maybe they weren't
even writers, but, you know,
where was your inspiration to
move into writing and to call
yourself a writer?
>>IRENE MATHIEW, MD: I can
jump in on this, and also, to
piggy-back off of the last
question, I would say that my
rhythm is title, sort of comes
and -- tidal, sort of comes
and goes in waves, depending
on what I'm writing, there's
different times of day or
times in my life where it
makes more sense to focus on
it. I tend to write poetry
late at night, it works if I
have a schedule the next day
where I can sleep in a little
bit, so for me, as an academic
physician, one of the nice
things is flexibility. And so
not every day is the same.
Which allows me to have later
evenings, some days and other
days I can't do that. So I
definitely don't have a daily
writing practice. I wrote a
novel in residency on a series
of night shifts. As a third
year resident because I really
didn't like going to sleep at
night if I had to sleep during
the day. So while the interns
were sort of running the
floor, and I was there
supervising them, I was kind
of sitting in the background
of the work room working on
this novel, for me, it depends
on the type of writing, but I
guess my first model was
actually my father, because he
-- maybe this comes from
having trained under Danny
Becker, I don't know, but he
had a strong interest in the
arts and literature and when I
was a child, I remember him
working on a novel late at
night, nothing really came of
that, but I just remember him
as this model, this person who
could be a physician and be
very serious about his medical
practice, and then also, you
know, in the hours of the
evening, very seriously work
on a literary practice, and he
was the one who sort of
encouraged me to consider both
as viable careers. So I guess
that he would be my first role
model. But going forward, I
think more of my role models
have been poets who have no
connection to medicine, but
have been artistic role models
in terms of craft.
>>MARCIA DAY CHILDRESS:
Others of you about your
models?
>>BENJAMIN MARTIN, MD: I
read -- a lot of people read
it and read about Chekhov, his
personal life was so
interesting, and so, reading a
short story and I remember
this one detail where the
protagonist is at a dinner
party and one of the guests
knocks over a cup of gravy
with his wrist, and no one
notices except the protagonist
and it bothers the protagonist
so much, it is like a Larry
David moment of new row seize,
but then going from that story
to learning that Chekhov
really valued observation in
his medical practice and
writing, very early on, I
learned that there is a, you
know, this fusion between the
two practices, a close
observation and again, the
joyful observation, where it's
really funny when someone
knocks over a cup of gravy and
no one notices but I think
that Chekhov continues to loom
as a giant in my mind, he was
so good at writing, too.
>>MARCIA DAY CHILDRESS:
Uh-huh. So Irene, you
mentioned at one point, poetry
depends on certainty. It
strikes me that medicine is
Wright with uncertainty. That
uncertainty is there every
time you meet a patient. Any
comments that you have about
writing and uncertainty, for
you as a medical practitioner?
>>DANIEL M. BECKER, MD:
Yeah, I mean, I would -- my
first small book of poems was
called chance. And my current
book is called "second chance"
and I think that chance -- I
used to teach statistics, and
I have had memorable failures
teaching statistics to medical
students who once compared my
lectures to listening,
watching paint dry. Or
watching grass grow. And of
course, that raised the
question, for me, well, isn't
-- aren't those two absolutely
different experiences?
Watching grass grow and paint
dry? And I've kind of been
stuck at that question. But,
yeah, chance. It allows, you
know, it is -- it triggers
imagination and wonder. What
if.
>>MARCIA DAY CHILDRESS:
Uh-huh.
>>DANIEL M. BECKER, MD: Once
upon a time, is really asking
about chance.
>>MARCIA DAY CHILDRESS:
Anyone else on uncertainty?
One of the things that struck
me, Ben, if your essay, your
wonderful essay, with the ways
you moved in and out of
different kinds of possible
certainties, when you were
exploring the various animal
metaphors, that, you know,
both what was being done in
the novel that you were
referring to, but also, in
your attempts to get a sense
of who might Mr. S be. And
finally, coming to terms, that
he was not really capturable.
In a metaphor, animalistic or
otherwise and you had to learn
to let him be, in all of his
uncertainty. Which was
powerful.
>>BENJAMIN MARTIN, MD: Thank
you. Yeah, that's the one
thing I'll add, the hospital
of medicine, we talk about
inhabiting uncertainty. A big
part of clinical care in the
hospital is defined by
uncertainty, both clinical
uncertainty and more emotional
spiritual uncertainty, so the
process of inhabiting
uncertainty can oftentimes be
painful and not feel that
comfortable, so I think that
you get that both in writing
and in clinical practice.
Thank you for your nice words.
>>MARCIA DAY CHILDRESS: So
we have come to the end of our
short hour, I want to thank
Irene Mathieu and Ben Martin
and Daniel Becker into the
looks into your understandings
of why you write, why other
doctors might write and we
hope that this is inspiring
for some in our audience to
try their hands as well.
Please join us next week for a
program with Louise Aronson
from USF San Francisco, she'll
be talking about elderhood,
redefining aging, transforming
medicine and reimagining life
and we'll also be joined by
Justin Mutter, a UVA
geriatrician. Thank you all
and we'll see you next week.