Writing and an emergency medicine life

I’m an emergency physician and a writer of fiction, and there is an inherent paradox in these two activities. When writing, I work with words on a page to create lives that readers will hopefully care deeply about. Meanwhile, when I’m working in the emergency department, there are moments when I’m faced with real people experiencing real suffering and I wonder why I don’t care more.

The great writer Tobias Wolff once said, “When I sit down to write, I discover things that I have, for one reason or another, not admitted, not seen, not reflected on sufficiently.”

And that’s the essence and beauty of writing, whether it’s writing fiction, an essay, or random notebook scribbling. By laying down words into sentences and sentences into paragraphs, I find myself thinking differently, making previously unseen connections, and discovering untended fears and blemishes.

Emergency medicine can be an emotional contact sport. Writing offers a process, and serves as an interpretive filter, for making meaning out of the incomprehensible parade of experiences that constitute a typically ‘normal’ shift, especially those encounters that eat at my stomach and test my identity and purpose.

I also find myself pinning to the page moments that remind me of why I chose a career in emergency medicine, precious butterflies that might otherwise fly away unnoticed.

However, the very treasured values and habits that make us excellent emergency physicians can serve as impediments, if not outright obstacles, to a creative writing practice.

For example, in emergency care, the idea of purposely taking risks, pursuing mistakes, and welcoming failure may feel unnatural, and even painful. We function in a system designed by necessity to mitigate mistakes and manage risks. In contrast, happy mistakes are essential to the creative process. Only by playing with ideas, form, character, point of view and language can you push yourself to discover what you’re trying to understand, make sense of, and put into words.

Similarly, our relationship between time and efficiency requires reconsideration. Speed is a valued trait when maximizing productivity. But writing doesn’t obey these algorithms. There are times I produce a page or two of garbage that contains a hint, a word, or a phrase that on some later date catches my attention like a found coin. Sometimes I purposely need to get lost to learn what I’m searching for.

So what does it mean to be an expert writer or artist? For medical professionals, the process is well-mapped. Those who successfully meet the requirements of schooling, exams, and training earn the privilege to wear the credentials of an expert. The arts require similar rigor and commitment to craft, but the journey itself challenges our traditional and formal notions of training and expertise.

I’m reminded of this lovely observation from the novelist Jenny Offill. One of the odd things about being a writer is that you never reach a point of certainty, a point of mastery where you can say, Right. Now I understand how this is done. That is why so many talented people stop writing. It’s hard to tolerate this not-knowing. It’s hard to tolerate feeling like an idiot or an imposter, and it gets harder as the years tick by.”

That imposter feeling, the feeling that there’s too much to know and so much beyond my grasp, is familiar emotional territory, whether I’m writing or caring for patients. It serves as a healthy reminder that emergency medicine and creative writing (or other creative pursuits) also share common features as well. This includes creating order out of chaos, a tendency to focus on worst outcomes, and of course, the need for empathy.

In both creative writing and emergency medicine, what passes for talent is often grit, persistence and a work ethic. Show up everyday, even if it’s only for fifteen minutes. The process is the product. And whether you’re rushing about the ED or facing a blank page, please remember the importance of self-forgiveness, especially in the early drafts.

I couldn’t be an emergency physician without writing. When I’m not writing, I become an inadequate version of myself. But I couldn’t be a writer without emergency medicine either. I need to get out of myself and take care of patients. Difficulty with a story, or a paragraph, or a word, seems so insignificant when compared with the broken lives of many of my patients. I often feel guilty that through the disrepair in their lives, I often find balance in mine.

Jay Baruch (@JBaruchMD) is Associate Professor, Department of Emergency Medicine at Alpert Medical School of Brown University, as well as a writer, baffled participant in healthcare, and shameless advocate for more creativity in medicine. What’s Left Out is his latest fiction collection.

One response to “Writing and an emergency medicine life”

  1. libby nestor says:

    like the idea of writing acting as a pin, to fix the memory or case in place. Nice essay, Jay.