So I've been reading Richard Selzer's Letters to a Young Physician. One of the essays spoke to me. It got me thinking about a particular challenge in my life and my career, and I started writing about it last night.
That piece isn't finished yet, but that's not why it's not making an appearance in this blog. I won't post that piece here because it deals with aspects of my personal history that I don't want to put into the ether of the internet, from which, I must assume, everyone that I ever meet could discover them. I'm not talking about secrets per say. Nobody that knows me well would be surprised by the foundations of my essay. The challenge here is surrounding the personal details of our lives that our friends know but that that we don't necessarily want potential future employers to discover at the speed of google.
But I'm also proud of this piece, even just in the first draft. This makes me want to put it somewhere that will allow readers to get their hands on it. Otherwise all the effort seems a little wasted. Second draft? Third? Instead of sleep? Studying? Writing something else?
I've been a journal writer all my life, and I am certainly not claiming that writing without an audience other than yourself serves no purpose. Writing for myself and the page that I write on has been essential to my sanity for long periods of my life. But that writing has not had the polish of the things that I've been working on lately. That writing was about processing emotions as opposed to being a writer. As a journaler I want to be left to myself, but as I writer, I am not satisfied with this audience of one.
And perhaps that long history of journal-writing is why I am struggling with this issue now... not just in this case, but more broadly. I turn to words when I am emotionally raw and ethically challenged. The ideas and events that have moved me to actually put pen to paper or fingers to keyboard in the last couple months have been powerful ones, but ones that I'm either not free or not willing to give to the world. The intimate challenging moments involving my friends and family, personal ethical questions, and stories of patients that would make no sense without details that blow HIPPA to oblivion can't pass freely from my hands.
And so I've been asking myself the question: which of these things are my stories to tell? It's obvious (I hope) that I would never post or publish something that violated the privacy and confidentiality of my relationship with a patient or research subject. But what about the privacy and confidentiality of one of my siblings? My husband? My friends? I am not alone in the emotional moments of my life, there are other players. Is it for me to paint the saddest moments in the history of my family and then give them to the world? They are part of my story, but they are not mine alone, and they can't be separated in narrative or emotion from the people I love. When I write a poem about my life, do I give everyone involved veto power before I try to publish? Do I even ask? Surely there needs to be a line.
Because the writing is mine. The work is mine. The moments and the emotions are mine as well. But not just mine. These things are shared, and belong as much to my loved ones as to me. Who am I that I can give away another person's story for the sake of telling my own?
So lately I find myself unsure about what to do with that second draft. Whether to push through a third one at all. How do you tell your story when so little of your story is yours alone to tell?
Wednesday, September 15, 2010
Sunday, August 1, 2010
The Most Prestigious Disease
Kevin MD, a blogger for medpagetoday.com pointed out an interesting, troubling study earlier this week. The study, performed in Norway, attempts to rank the prestige of both medical specialties, and less conventionally, of diseases themselves. If you want to read more about it, here’s an article and the abstract. Basically, they mailed a survey to a bunch of physicians and medical students that had a list of diseases and asked them to rank how prestigious each one was.
Now, there are a number of things about this that are appalling. I am totally fine with the fact that there are differing levels of perceived prestige for different medical specialties. I am also aware that I am planning to select one, psychiatry, that is not often near the top. However, I think that attempting to rank diseases themselves is disgusting. It’s more prestigious to have leukemia than thyroid cancer?! Where does that even come from? It just doesn't make sense conceptually to me.
The study only ranks 38 diseases, so obviously a lot of the biggies are left out. There's probably something to criticize in the methodology of a survey that includes ankylosing spondylitis (very rare) and not diabetes (very common)… but what I really want to talk about are the diseases that come in last on the prestige scale. Because it is not the top of this list, but the bottom that tells me what this survey was all about.
Of the four psychiatric diagnoses included in the survey, none are above the bottom six. The only two diseases that rank lower than any psychiatric condition are cirrhosis of the liver and fibromyalgia. Despite this outcome, the study authors make the claim that diseases located in vital organs in the upper parts of the body have high prestige. Really?
Come on folks. Name the highest up and most vital of all the organs.
The brain perhaps?
Are we really still so deep in the stone age that we can’t admit that someone with schizophrenia, depression or chronic anxiety has a brain problem? How about someone with cerebral palsy, which is only 8th from last?
My reading of these results points to a rather different conclusion. What we have here is the reverse social stigma scale. Diseases that nobody holds against you are near the top. No one tells you to buck up and get back to work if you have a heart attack or a brain tumor. Most of the things in the middle are kind of neutral: not as serious, but no way to assign any blame to the patient either. (It is notable that testicular cancer #5, while ovarian cancer is #12 and breast and cervical cancers are not even important enough for inclusion on the list. Men's reproductive organs are far more prestigious than women's.)
And down at the bottom of the list we find exactly those people that likely don’t need to be told that they’re not at the top of the social status scale. Patients with diseases that are psychiatric (anorexia, depression, anxiety and schizophrenia), poorly understood (fibromyalgia), or associated with culturally unaccepted behaviors or groups (cirrhosis, AIDS).
So I have to ask, what was the point? How could a scientist convince themselves that they had learned something about prestige as opposed to something about prejudice? Does this work really need to be done? Resources were used to conduct this study. Resources that could have been used to try to better understand some of those chronic and terrible diseases at the bottom. Resources that could have paid for antiretrovirals for someone with AIDS or some of the long term care that is so often needed by a patient with cerebral palsy.
The journal Social Sciences and Medicine decided to publish this study. I challenge any self-respecting social scientist to tell me that these rankings don’t have more to do with prejudice against people with the diseases near the bottom than the prestige of the diseases near the top.
Now, there are a number of things about this that are appalling. I am totally fine with the fact that there are differing levels of perceived prestige for different medical specialties. I am also aware that I am planning to select one, psychiatry, that is not often near the top. However, I think that attempting to rank diseases themselves is disgusting. It’s more prestigious to have leukemia than thyroid cancer?! Where does that even come from? It just doesn't make sense conceptually to me.
The study only ranks 38 diseases, so obviously a lot of the biggies are left out. There's probably something to criticize in the methodology of a survey that includes ankylosing spondylitis (very rare) and not diabetes (very common)… but what I really want to talk about are the diseases that come in last on the prestige scale. Because it is not the top of this list, but the bottom that tells me what this survey was all about.
Of the four psychiatric diagnoses included in the survey, none are above the bottom six. The only two diseases that rank lower than any psychiatric condition are cirrhosis of the liver and fibromyalgia. Despite this outcome, the study authors make the claim that diseases located in vital organs in the upper parts of the body have high prestige. Really?
Come on folks. Name the highest up and most vital of all the organs.
The brain perhaps?
Are we really still so deep in the stone age that we can’t admit that someone with schizophrenia, depression or chronic anxiety has a brain problem? How about someone with cerebral palsy, which is only 8th from last?
My reading of these results points to a rather different conclusion. What we have here is the reverse social stigma scale. Diseases that nobody holds against you are near the top. No one tells you to buck up and get back to work if you have a heart attack or a brain tumor. Most of the things in the middle are kind of neutral: not as serious, but no way to assign any blame to the patient either. (It is notable that testicular cancer #5, while ovarian cancer is #12 and breast and cervical cancers are not even important enough for inclusion on the list. Men's reproductive organs are far more prestigious than women's.)
And down at the bottom of the list we find exactly those people that likely don’t need to be told that they’re not at the top of the social status scale. Patients with diseases that are psychiatric (anorexia, depression, anxiety and schizophrenia), poorly understood (fibromyalgia), or associated with culturally unaccepted behaviors or groups (cirrhosis, AIDS).
So I have to ask, what was the point? How could a scientist convince themselves that they had learned something about prestige as opposed to something about prejudice? Does this work really need to be done? Resources were used to conduct this study. Resources that could have been used to try to better understand some of those chronic and terrible diseases at the bottom. Resources that could have paid for antiretrovirals for someone with AIDS or some of the long term care that is so often needed by a patient with cerebral palsy.
The journal Social Sciences and Medicine decided to publish this study. I challenge any self-respecting social scientist to tell me that these rankings don’t have more to do with prejudice against people with the diseases near the bottom than the prestige of the diseases near the top.
Wednesday, July 28, 2010
On Being A Writer
About 18 months ago, I wrote a piece for bookworming (my other, occasionally updated, blog) after I attended a reading by Lauren Groff. During that reading, Groff asked the crowd if anyone was a writer, and I noticed that the majority of the people in the audience had raised their hands, although I had not. That got me started on what it would take for me to feel as if I could raise my hand in response to that question, and you can find some of my thoughts, if you’re interested, in the original post.
If you choose not to read it (and that’s fine by me) here’s the summary: I did not feel like a writer, but I was sure that I wanted to become one. I thought of myself in some limbo of becoming, but I was optimistic about that, planning to commit some time to the process, and reading Stephen’s King’s On Writing to help me get started.
I’m not all that ashamed to say that I didn’t find as much time as I had hoped. The pressures of medical school can be overwhelming, and Andrew moved here. I did write a couple of pieces last year, but I didn’t commit to it the way that I had intended to when I was writing that blog entry. Such is life. There’s nothing to do but move forward.
This past weekend, I did a whole bunch of moving forward. At the AMSA Writer’s Institute, I had that fire lit under my ass again. It’s a much more powerful flame this time because it came stoked by a community of other talented and inspired people who, like me, want to find a way to fit writing into a medical career. I was ready, once again, to commit to figuring it out, to think about becoming a writer. I wrote the beginnings of a couple pieces that I think might come to something. I had great conversations with a couple of physician writers about how they have made it work in their lives and how to develop my craft. I met some amazing colleagues whose writing I’m sure we’ll all be reading for years into the future. By the third full day, I was totally sold. I was inspired and excited and motivated as I have never been before. This was it, I thought, I am really going to become a writer.
Then there was a moment when Dr. Sayantani DasGupta challenged that idea of becoming. She stood in front of the room, beautiful and passionate, and told us all that we were already writers. I’m paraphrasing here, but she assured us that we were not baby writers, nor apprentice writers, not people that wanted to become writers at some point in the future, but writers. Certainly we could and should develop in the craft, but that development was the development of a writer, not the development into a writer. She told us that we had to claim the title, all the better to be able to use it.
It took me right back to that blog entry from so long ago, and it blew all those ideas about the process of becoming right out of my mind. And for the best I think, because now I have no more excuses. I have, as one of the other participants wrote in his blog on MedScape this week, crossed from “should” to “will.” There is no more, “If I want to be a writer I should find more time to work.” That sentence doesn’t make sense anymore. There is a new imperative.
I am a writer. There is nothing left to do but write.
And damn, doesn’t that feel good?
If you choose not to read it (and that’s fine by me) here’s the summary: I did not feel like a writer, but I was sure that I wanted to become one. I thought of myself in some limbo of becoming, but I was optimistic about that, planning to commit some time to the process, and reading Stephen’s King’s On Writing to help me get started.
I’m not all that ashamed to say that I didn’t find as much time as I had hoped. The pressures of medical school can be overwhelming, and Andrew moved here. I did write a couple of pieces last year, but I didn’t commit to it the way that I had intended to when I was writing that blog entry. Such is life. There’s nothing to do but move forward.
This past weekend, I did a whole bunch of moving forward. At the AMSA Writer’s Institute, I had that fire lit under my ass again. It’s a much more powerful flame this time because it came stoked by a community of other talented and inspired people who, like me, want to find a way to fit writing into a medical career. I was ready, once again, to commit to figuring it out, to think about becoming a writer. I wrote the beginnings of a couple pieces that I think might come to something. I had great conversations with a couple of physician writers about how they have made it work in their lives and how to develop my craft. I met some amazing colleagues whose writing I’m sure we’ll all be reading for years into the future. By the third full day, I was totally sold. I was inspired and excited and motivated as I have never been before. This was it, I thought, I am really going to become a writer.
Then there was a moment when Dr. Sayantani DasGupta challenged that idea of becoming. She stood in front of the room, beautiful and passionate, and told us all that we were already writers. I’m paraphrasing here, but she assured us that we were not baby writers, nor apprentice writers, not people that wanted to become writers at some point in the future, but writers. Certainly we could and should develop in the craft, but that development was the development of a writer, not the development into a writer. She told us that we had to claim the title, all the better to be able to use it.
It took me right back to that blog entry from so long ago, and it blew all those ideas about the process of becoming right out of my mind. And for the best I think, because now I have no more excuses. I have, as one of the other participants wrote in his blog on MedScape this week, crossed from “should” to “will.” There is no more, “If I want to be a writer I should find more time to work.” That sentence doesn’t make sense anymore. There is a new imperative.
I am a writer. There is nothing left to do but write.
And damn, doesn’t that feel good?
On Blogging Anew
Well, here it goes.
I was thinking about it before this weekend, which was spent in DC at the AMSA Writer's Institute, and now there is nothing to do but jump in, I am actually going to be updating this blog.
In the spirit of keeping myself honest... I'll tell you all right now, I'm committing to writing three posts every two weeks. You should expect something new every five days or so. You should not expect me to blog the week of the wedding, because I am trying to be ambitious, but I am not dilusional. It would make me excited to have followers, so feel free to link up.
It's going to be about medicine, and research, medical school and writing, and who knows what else. I'll try to make everything readable to a general audience. I'll probably double post some book review type things here and in bookworming. I am always open to questions, comments, and ideas for things that you think I should be writing about or responding to. The email link works if you don't want to post it for the world to see. Let's make this interactive. Sweet.
I've taken down just about everything that I had posted here before when this was a more personal and experimental space, except for the post below on "The Neverending Reading Train" because, while we're being honest, I just plain like that one.
And with that, we're off.
I was thinking about it before this weekend, which was spent in DC at the AMSA Writer's Institute, and now there is nothing to do but jump in, I am actually going to be updating this blog.
In the spirit of keeping myself honest... I'll tell you all right now, I'm committing to writing three posts every two weeks. You should expect something new every five days or so. You should not expect me to blog the week of the wedding, because I am trying to be ambitious, but I am not dilusional. It would make me excited to have followers, so feel free to link up.
It's going to be about medicine, and research, medical school and writing, and who knows what else. I'll try to make everything readable to a general audience. I'll probably double post some book review type things here and in bookworming. I am always open to questions, comments, and ideas for things that you think I should be writing about or responding to. The email link works if you don't want to post it for the world to see. Let's make this interactive. Sweet.
I've taken down just about everything that I had posted here before when this was a more personal and experimental space, except for the post below on "The Neverending Reading Train" because, while we're being honest, I just plain like that one.
And with that, we're off.
Subscribe to:
Posts (Atom)