What does writing fiction and being a doctor have in common?

I have been asked a lot lately, owing to the release of my novel Altamont Augie, what writing fiction and being a doctor could possibly have in common? Patients and colleagues seem shocked that the rational, left-brain doctor they have come to know and depend on to deliver technologically complex medical care to patients with kidney failure could produce such a right-brain thing as a novel. Where did this come from? they ask. What does writing a novel have to do with giving medical care?

Well, everything.

Writing fiction and the practice of medicine are paired callings that require remarkably similar skill sets. And the act of performing these two seemingly disparate activities affects me in exactly the same manner.

When I return from a vacation or long weekend and begin making rounds in the dialysis clinic at 7:00 a.m. on a Monday morning, there is a restlessness inside me that is hard to understand, an anxiousness verging on a state of unease—or dis-ease, if you will. Yet nothing has happened to cause such unease—no personal crisis, no professional calamity. Nothing.

This mysterious, discomfiting anxiety reliably and predictably dissolves shortly after greeting the first patient I see. Simply by asking them how they are doing. And I realize my anxiousness is a withdrawal symptom—withdrawal from attending to the needs of another human being. Like an alcoholic needing a drink or an addict needing a fix, I am addicted to patient care, because the act of placing myself in the service of another human being makes me blissful.

Attending to the needs of others gets me outside myself and leaves me feeling selfless—a good thing, as the Marine Corps drill instructor Westbrook tells his young recruits in my novel: “For to be selfless is to be free of one’s self. And dwellin’ on one’s self is the root of the problem, thinkin’ you deserve this or that … Only selflessness will protect you …”

Medicine allows me to achieve a virtuous state of selflessness through the active process of empathy—vicariously experiencing the lives of others, and in so doing, transcending my own selfishness. And better yet, since I have the technical skills to do so, medicine allows me to help preserve the lives of others. Feeding my addiction to selflessness by saving lives—heady stuff, this ministering to the human condition.

And so it is with writing fiction.

It is not possible to limn a complex literary character without becoming, if only for a while, that character. The same neuronal connections that allow me to empathize with patients—the same empathic connections, putatively located in the anterior cingulate cortex and amygdala—are required to create characters in a novel. And if these characters are believable and seem real, readers will experience a stimulation of their empathic connections, and be moved and profoundly affected by the story the characters participate in. This all-important sense of verisimilitude is the lifeblood of fiction, and when achieved, has the potential to influence the lives of others in a positive and lasting way by illuminating the human condition rather than by ministering to it, as the practice of medicine does.

But the intent is no less profound: to alter and improve a human life. And that is why writing fiction places me in the same blissful state that practicing medicine does, making me redivivus and new by achieving selflessness through empathy—in this case for my characters rather than for my patients. Empathy leads to selflessness, a virtue that feels good—a feeling to which I am addicted.

Medicine and fiction, feeding my addiction.

Richard Barager is a nephrologist who blogs at his self-titled site, Richard Barager.

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  • Anthony_Bautista

    Thought provoking!

  • http://briarcroft.wordpress.com/ Emily Gibson


    I can identify with what you describe on the Monday morning return to clinical work.  I too am restless, uneasy and anxious until I walk into the first exam room, sit down and look a patient in the eyes and ask them to tell me what brings them in.  Then I’m lost in their story for as long as I’m with them, and lost in 35 more stories over the course of the day.  I write all day long, documenting those stories. Adding in my own role in the story, I send each patient a copy of what I have written, what I thought and what I recommend.

    Each clinic day, several dozen short stories.  So why, when I come home, transitioning back into my own personal story, do I write more non-fiction–prose and poems?  I feel the same restlessness and unease until I do so–I need to record my story too.

    We physicians are writers, whether we intend to be or not from the beginning.  Some of us just simply aren’t done after we go home.  We are compelled to keep creating.
    Emily Gibson,  M.D.

    • http://www.facebook.com/people/Richard-Barager/100001588962579 Richard Barager

      Thanks for your comment, Emily. This notion of physicians as writers is why the field of narrative medicine, as taught for example at the Columbia School of Medicine, has become an integral part of the American medical school curriculum. 

  • http://www.facebook.com/janice.mancuso Janice Mancuso

    As a layperson who has created a CME conference exclusively devoted to the well-being and health of doctors, I am grateful for your essay. You and balanced and caring doctors like yourself inspire and give hope to those of your colleagures who are burned out and contemplate leaving their profession. Beautiful post. Thank you.

    janice mancuso

  • http://www.facebook.com/people/Richard-Barager/100001588962579 Richard Barager

    Thanks for commenting, Janice. I hope the healing power of literature finds its way into your conference’s curriculum.

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