1. So much of medicine depends on maintaining silence. Doctors are told secrets, taught over a period of years how to respond. The expression on a face transforms “stranger” into “patient.” We bear witness, not turning away from any form of suffering, even if it triggers us. This is how we protect patients.
This silence extends to all relationships at work: nurses, counselors, admins, secretaries, other doctors. One of my psychiatrist colleagues, training her residents, uses the phrase “think of yourselves as 50,000 feet above whatever’s happening.” At first, everything in me resisted this idea. By comparison, “down to earth” was an Americanism I found appealing, a testament to having warmth, guts, energy, courage. Closeness is risk; risk, dedication. But quickly I saw how true my colleague’s words were: Cool distance is a soothing thing. This is how we protect ourselves.
When I was younger, I watched as my mother, a pediatrician in a community clinic, came home and immediately flopped down on the couch. Sweaty, annoyed, she’d ruminate silently until the day’s indignities wore off. Eventually, she translated her years of daily practice into pithy advice for me when I neared the end of my medical training: “Never say anything about yourself to anyone you work with at the hospital. Never tell anything to anyone.”
Even without my mother’s instructions, I learned in medical school and residency that so much of being a doctor, even with no patients in the room, would involve obeying a repressive code. We’d be expected to be as neutral as possible so nothing would impede the machinery of care that depends on us yet dominates our lives. We’d be expected to nod silently, always, rather than launching impassioned defenses of any idea that might get in the way of the reality of the patients’ needs before us, of the system’s demand that we simply perform.
A doctor’s friendly, watchful, generous silence is one instance of self-effacement, among many. Another involves keeping your voice and face free of outrage. This, no matter how egregious others’ microaggressions can be, especially for a woman of color in medicine. This, no matter how many times, and by how many different authority figures, we might have been promised that such transgressions, such racist or sexist or intersectional indignities, would not happen again. This, no matter how much we might have invested in ideas such as “equality.” This is how the system protects itself.
2. All day long, I have to write and write. And since words can assuredly do much harm, one form of primum non nocere — the Hippocratic oath of “doing no harm” — is choosing what words you utter with care and then letting them go. Every medical record belongs to a patient, not to me, and there is nothing I write that cannot be transmitted elsewhere, simply by a patient signing off on the request. There’s nothing clinical I could write that will ever be mine. To write, as a doctor, is to publish right away. To give over.
With years of practicing medicine, I’ve come to like the fact that most of what I write isn’t for myself. It makes writing both automatic and highly functional. When I write for medical reasons, I don’t “compose” the words, exactly; I’m thinking about the patient—that’s it—and focusing on each detail of what I need to do for the care. The satisfaction here is the same as when I’m immersed in the craft of fiction writing. The joy comes from doing a job as thoroughly and carefully as humanly possible, holding no effort back. Nothing hurts me. I am not what I’m working on; it is not me. And since my attention is engaged so neutrally, the hours fly by, and I can tolerate much longer periods of clinical writing than I ever could if I were writing about racism, or dystopias, or even a fictionalized version of my life — all of which I do in the interstices of my work as a doctor, during those times when it is just me and the page, no thoughts of patients in between. Personal writing is self-defining. But there’s also a freedom in medical writing, so removed from myself.
3. Writers who’ve become my friends and teachers ask, “How do you find the time to write?” The answer is complex, in part because the “finding” of time is not a conscious choice. The truth is that by writing so much every day — I estimate around 7,000 words per day of clinical notes — the act of writing itself has transformed into something I can do while tuning out any “inner critic.” It has transformed into a form of organic activity, if that makes sense. Like shedding skin.
Now, after 11 years of practicing medicine and writing fiction or personal essays or poetry, I can no longer fetishize or fear the act of sitting down with notebook and pen or in front of my computer. Or sometimes even with my iPhone turned to video, with me talking into it the way I would into a dictaphone. Writing is pared down to an act of survival. I do it without judging myself, truly without expectations. I do it because I know myself well enough to know I have to write. Because I like the familiar feel of shaping words.
Now, on the eve of publishing my first book, a prize-winning collection of stories, I don’t write thinking that it “has to be” something. I write because, like practicing medicine, it’s what I do. I write as a self-defining activity, without judging if what I write is any good. I write because I have seen people whose ability to write was taken away by illness. I write because I am mortal, and know it.
The doctor code, like the white coat, is intended to conceal. To take away my individuality. To make the patient the main point. But what I’ve found, surprisingly, is that obedience to this code has also helped my writing. Writing abundant clinical words helped make it easier for me to submit work: Once I’ve sent it off, I don’t give it a thought. I probably submit some piece of writing (poem, essay, fiction, flash, author interview, book review) every other day. Words move, and I move, grateful to have written them, to have revealed myself.
And counter to traditional teaching about how “writing makes doctors better because it builds our empathy for patients,” writing has helped me, as a doctor, by building empathy for myself. It’s estimated that more than half of all U.S. doctors experience burnout, defined as rage, humiliation, sadness, frustration, helplessness, and the sense of having been cheated — denied respect for all the years poured into training; years of grinding, almost impossible effort, sustained over many sleep-deprived nights. But I have never felt burned out, and I believe that I won’t, because writing, like medicine, keeps no promises. There are no guarantees of basic respect — writers are insulted all the time, dance on the edge of ridicule, joke with each other about how we torture ourselves. Stoicism as a writer has made me more tender to myself as a doctor, and that in turn keeps my heart open and unscarred, eager to care.