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Perri Klass, Physicians on Writing: An Interview with Perri Klass
A pediatrician in Boston, Dr. Perri Klass, five-time O.Henry Award winner, is a prolific author of fiction and non-fiction, which includes two collections of essays about medicine, A Not Entirely Benign Procedure: Four Years as a Medical Student and Baby Doctor: A Pediatrician’s Education. She also serves as medical director of the national literacy program Reach Out and Read.
Dr.Klass met with the editors of The Healing Muse after reading from her recent collection of award-winning stories, Love and Modern Medicine. She was visiting Upstate as invited Keynoter Speaker for Elizabeth Blackwell Day, an annual celebration in remembrance of Upstate’s having graduated the first fully accredited female MD in 1849.
EDS. What do you think of the growing emphasis on literature and narrative in the medical curriculum?
KLASS I applaud it; it gives students official permission to use the other sides of their brains. Knowing how to listen and how to assess what you are hearing and seeing is an essential skill for a physician; such knowing is also of great value to a writer. I see the arts and humanities as a refreshing influence in the curriculum; students are so drenched in science that they may lose the art of reflection. For me, writing has always helped nurture and sustain that art.
EDS. Did you keep a journal during your medical school years?
KLASS Oh yes, through all my training too; I have what I call ‘boxes of misery’ stored somewhere at home. I saw in ICM that one could do a patient write-up as simply an intellectual exercise, or one could become quite skilled at it, could see him/herself as entering the chaos of a person’s life and creating a structured and orderly response to it that would benefit the patient. I also tell students that writing can be the best revenge for some of the atrocities they undergo during their education.
EDS. How do you find the time to maintain a practice, a family, and still write?
KLASS I’ve always agreed with William Carlos Williams who insisted there was no real competition between the practice of medicine and the art of writing. He found that one nourished the other, and I do too. People are starved for plot; in a doctor’s office, plot just keeps spilling in and spilling out. HMOs mean a story comes to us in pieces over time, but even these little bits of life are intriguing and get me thinking later in the day about the whole story behind the piece I witnessed.
EDS. Do you show the stories to your patients?
KLASS I try very hard not to use my patients in a particular story; I change everything in order to hide the facts of a case. If, however, some aspect of a story seems identifiable or connected to a patient, I will always ask that patient or family to read the story and give me permission to publish it.
EDS. How has writing contributed to your medical career?
KLASS Everybody in this job has to learn empathy and projection; writing has helped me by allowing me to imagine myself inside other people’s stories. I’ve learned some lessons about life from being a physician who writes stories. For example, in medical school no one talked to us about liking a patient or not liking a patient, and it’s amazing when you discover that someone you are treating can make you angry. Creating a character like that and then creating an ending to that encounter can make me think differently or feel better.
EDS. How do your colleagues react to your success as a writer?
KLASS I think mostly positively. I’m seen as someone who genuinely likes our profession and the medical community.
EDS. Who are your literary influences?
KLASS I’m very old-fashioned: I love nineteenth century fiction, Eliot is my all time favorite, Middlemarch the book I can reread forever; I love Dickens and Shirley Jackson, Dorothy Parker, Jill McCorkle. The more I read, the more I want to write. As a mother, I also found myself wanting to write the kinds of stories my children would want to read. Everything feeds the creative impulse.
EDS. Your stories often beautifully illustrate the conflicts faced by physicians who are also parents when they have to deliver bad news about their patients.
KLASS Pediatricians especially, I think, engage in a form of sophisticated denial when catastrophic illness presents in a young patient. ‘If I treat this patient, I will insure that my own child need never suffer such a horror.’ We make deals in our minds with the Lord, with fate, with ourselves. I think I do that in my writing as well; if I can write about it, I can prevent it. Silly but nonetheless real.
EDS. You were invited today to celebrate the presence of women in the medical profession. Your stories, too, celebrate women; any thoughts you’d like to share about being a woman physician?
KLASS As I told the students today, I am really no pioneer; I so admire Elizabeth Blackwell and Sarah Loguen Fraser, women who had to face the hostility and cruelty of their colleagues all alone. I’m grateful to them, and I hope others now see that women in the profession have made enormous contributions to it. In my own experience, I have to say that my male colleagues and professors in medical school were welcoming and supportive. I try to be that for all the students I meet now as well. In my fiction, yes, you will mostly find female characters being supportive of each other. This too comes from my experience; women are strong, capable, funny, smart. Some of the women med students here were telling me how it’s difficult at times to go home and be in the weddings of their friends who seem to be getting their lives underway while those in med school can see only several more long years ahead of them. The cohort effect. I tell them to relax; everything comes in its own time.
Jack Coulehan, Phrenology: A Villanelle
Concavities and lumps above my ear
tell narratives I never would have known
before relentless loss of all my hair
turned the truth about my scalp so baldly clear-
the story of my life is in the bone.
Convexities and slumps above my ear
identify the site of passion: here.
Like tenacity and hope, it’s in a zone
invisible before the loss of hair
writ large the heady script of character.
Depression, fancy, awkwardness intone
a complexity that’s bunched above my ear
for you to read. Your gentle fingers, dear,
interpret my desire, and mine alone.
My scalp is blessed to have no trace of hair.
And I am blessed to know how much you care
unsettling perhaps, for you are young
and concavities and bumps above the ear
are lost in transient waves of lustrous hair.
Deborah Bradshaw, The Woman in the Next Room
I awake at 4:00 a.m. For a few seconds I am only aware of the heat, of sweating. Too hot. That is why I have wakened. Throw off the extra blanket, turn and settle like a dog circling. Find just the right shape to fold into to pass back through the door to peace. No fit. This way, that way. There is still the tension in my bones of unspoken sorrow, of unshared grief. For an hour or two I work at resting. This way, that way. As I wrestle in the dark in my bedclothes, the day dawns upon me. The day past. The day ahead. The endless struggle of days. The memories come creeping, howling at my window, causing my heart to beat fast and alone. Alone in the dark, regret bays at my window.
This business of doctoring, of diagnosing and treating illness seems to be a two-fold trial. Take the history, examine the patient, know your anatomy: slowly progressive equals tumor, acute onset equals stroke, relapsing remitting equals inflammatory/autoimmune. Fill out the requisition; shake the patient’s hand. Answer the phone call.
“Mrs. Smith, your MRI was normal. No, I’m not sure why you are having numbness, but it can’t be serious.”
Questions hang in the space between you. Fill it with empty assurances; bridge the gap with platitudes. Struggle to find, to touch, to grasp the cause of imperfection. To name it, then to repair it. This is our goal, and yet it is so often out of reach. So much to know. So much to do. Listen, think, look, read, review, think again. Search, speak, wonder, worry. So much to do and still the patient is sick.
I live beside this life of work, study, thought, and analysis. I live in another room where the sounds of my work ring clear and cold, where I can hear them but not touch them. The voices in the next room march interminably on. I listen to the spoken sorrows, back pain, breathlessness, paralysis, palpitation. I listen to the sorrow spoken and the unsatisfactory answers. As I sit alone in the next room, my heart aches with the lonely distance between those two in the next room.
The physician removes herself, keeps a cool professional distance. The woman in the next room wraps herself around the anguished patient, touches him, holds him, suffers. The physician knows the condition is terminal, knows the only course of action. The woman looks into the patient’s eyes begging forgiveness. The physician states the prognosis, offers alternatives, and advises. The woman prays, "Dear God, take him, hold him, comfort him. Open his eyes to paradise. Touch and heal him, touch and heal. Let him live." The physician notes little hope for recovery. The woman falls on her knees and weeps.
The day has finally dawned gray. Snow falls. I throw back my blankets; they are sleepier than I. The children are still asleep, just murmuring their last minute dreams before the day bursts upon them. I shuffle to the shower, looking forward to its caress. A moment’s warmth. All too soon this counterfeit day begins. The children hurried to the bus, the physician dressed, the march begun. The physician dressed in white and full of authority. The woman in the next room, alone and listening.
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