By Kwei J. Quartey, M.D.
The other day, I was talking to someone about how I combine my writing and medical careers. “Being a doctor and a writer seems such a strange combination,” she commented. I’m not sure what she meant by “strange,” but the existence of physician-writers is hardly unprecedented. In fact, there is a long list of them, dating from antiquity through every century up to the present.
Sir Arthur Conan Doyle, prolific author and creator of Sherlock Holmes, arguably the most famous character in fiction, was only a couple years into his studies at medical school when he wrote the short story, The Mystery of Sasassa Valley. Evocative of the works of Edgar Allan Poe, it was accepted and published by an Edinburgh magazine. It was while he was struggling to get his medical practice off the ground in 1886 that Sir Arthur began the Sherlock Holmes novel that would catapult him to fame, A Study in Scarlet. In this story, Holmes utters a memorable declaration: "There's the scarlet thread of murder running through the colorless skein of life, and our duty is to unravel it, and isolate it, and expose every inch of it."
During the same period as Sir Arthur’s work, the great Russian writer Anton Chekov, was writing the short stories for which he is so recognized, but many do not know that he was also a full-time physician who continued to practice medicine throughout most of his literary career. He is quoted as having once said, “Medicine is my lawful wife, and literature is my mistress.”
Moving forward a couple centuries, we have many present-day examples of physician-writers: phenomenally successful Robin Cook, author of Coma, Shock and many other works; the late Michael Crichton (The Andromeda Strain, State of Fear, and of course, Jurassic Park); Khaled Hosseini, a contemporary of mine who once worked in the same medical group (The Kite Runner and A Thousand Splendid Suns.)
Some doctor-authors write primarily about medical matters and do so in a way that engages the layperson. A good example is Oliver Sacks (Awakenings), whose explorations of patients’ experiences tell stories in the framework of what might be called “romantic science.” But it is the physician who writes fiction who interests us the most. What makes a doctor want to turn away from the often very tough realities of practicing medicine to creating stories for publication?
In fact, the two vocations are not as different as one might think. Much of medical practice is about stories. In medical school, I was taught that as much as 70 percent of the diagnosis comes from the patient’s history of present illness (HPI), the narrative that forms the reason for which the patient is seeking medical treatment. A substantial chunk of my medical training was spent in schooling us students in how to “take” a medical history, and how to “present” it. In the electronic age, some of this curricular emphasis may have been lost, but the importance of the HPI hasn’t gone away, even if people think it has.
At teaching hospitals all over the world, bedside rounds are the venue in which the HPI takes center stage. Nowadays, much of teaching rounds has been replaced by time spent consulting laptops and smartphones. This electronic shift notwithstanding, the responsibility of narrating the HPI still falls traditionally upon the intern, who “presents the case” to the senior physician along with a substantial and sometimes intimidating audience of other doctors. Invariably the history begins with, “This is an x-year-old man/woman/girl/boy who was well until yesterday when he/she began to experience abdominal/chest/pelvic pain…” and so on. That introductory form is so standard as to be almost sacred. After the body of the HPI, other elements are added: the past medical history and the family and the social histories. The most admired presenters are those who describe the case so well that the audience immediately gains a clear picture of what is going on. It is gratifying when a senior physician praises a junior one for “giving a good history.”
But think about it: all the presenting physician has done, really, is tell a story. Sometimes the tale is so interesting, it holds the audience in rapt attention. The best medical histories are like good thrillers or mysteries, and the best case-presenters tell them that way. So, although you have probably never thought of your doctor in this way, he or she is actually a trained storyteller. Perhaps out of some deep-seated need, the physician-writer adapts this training to the pages of a novel.
Another aspect of the physician’s experience that equips him or her to write is called the clinical gaze. It is the opportunity and privilege afforded a doctor to observe a wide variety of people on an intimate physical, psychological and emotional level, particularly in the setting of the most universal component of human suffering: pain. This interaction provides the physician-writer with a wellspring of characters from which he or she can draw in the writing of a novel. The incorporation of some of these characters in the physician’s novel is not always conscious. It may be a subconscious synthesis of several patients he or she has encountered in the practice.
Of course, direct medical knowledge and expertise come in handy as well: in my own works, there is always a prominent medical component, whether it’s a detailed autopsy report, or an account of the heart disease of one of my most favorite characters, seven-year-old Hosiah. It comes as second nature.
The genre that parallels medicine most is the murder mystery. Indeed, it was Joseph Bell, a mentor of Sir Arthur Conan Doyle’s and a physician with particularly brilliant powers of observation, who was the inspiration for Sherlock Holmes’s extraordinary deductive powers. By extension, it is quite evident how a medical case and a murder mystery are analogous to each other. The doctor is the detective who “solves” the illness; the patient is both the victim and the scene of the crime; and the culprit is the causative organism or pathological process. Doctors look for clues in the patient’s appearance, the history, the physical exam and the lab tests. There is no fundamental difference between a physician eliciting a history from a patient and a detective interviewing a witness or suspect.
There may be one more reason why some doctors are drawn to writing, and here, I mean fiction in particular. We physicians have a driving desire to combat and overcome the chaos of illness, and in many ways, redirect the course of life and death. Some of us never give up, and in the crushing defeat that must invariably befall us at some juncture, we may be thrown into the abyss of depression. It is true: we don’t like to make a mistake or miss a diagnosis. After all, a patient’s life may be at stake. Yet despite all our training and the wonders of modern medicine, we remain woefully mortal and vulnerable to defeat.
But in fiction, physician-writers can turn the tables on life and be in complete, godlike control. In the murder mystery especially, we create the setup—the heinous crime for which justice must be done—and set our intrepid detective on the perpetrator’s trail. Our detective does not rest until the murderer is identified in the delicious denouement, by which time we have also managed to tie up the loose ends in our character’s lives. What could be more gratifying?
But despite medicine informing the process of writing, there can still be an unsustainable tension between the two careers. Both take time, and sometimes there aren’t enough hours in a day to accommodate them both. Dr. Hosseini, for example, simply has no time to practice medicine anymore, what with forty-city book tours.
Is that tension affecting me as well, and if so, how much? Let me put it this way: in 2014, being a doctor will by necessity gradually cede to the burgeoning sovereignty of my writing, and in the very near future be forced to genuflect in submission.
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About Dr. Quartey
Kwei Quartey is a crime fiction writer and physician living in Pasadena, California. Having practiced medicine for more than 20 years while simultaneously working as a writer, he has attained noteworthy achievements in both fields. Dr. Quartey balances the two professions by dedicating the early morning hours to writing before beginning a day in his clinic.
Kwei Quartey attended medical school at Howard University in Washington, D.C. In 1990, he began practicing medicine in California with HealthCare Partners. Dr. Quartey later founded the facility’s wound care center while working as an urgent care physician.
As a crime fiction writer, Kwei Quartey made the Los Angeles Times Bestseller List in 2009. The following year, the G.O.G. National Book Club awarded him the title of Best Male Author. Having published Wife of the Gods and Children of the Street, he is anticipating the release of a third novel in the series, Murder at Cape Three Points, in March 2014. Death at the Voyager Hotel, a mystery e-novella not belonging to the series, was published July 2013. Dr. Quartey is also a member of the Los Angeles chapter of Sisters in Crime, a fiction writers’ organization.
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