October 1, 2014 0 Comments

Facts & Fictions, Or How I Tell the Truth with Lies

It happens at every reading. so I’ve begun to think of it as The Question.

3d human with a red question mark

Indeed, the predictability of The Question is such that I’ve not only given it its own moniker, I’ve made a game of trying to guess where it will come from: Will it be the vaguely familiar, distinguished looking woman at the back, intelligence apparent not only in her gaze but in the set of her lips (a writer, I suspect, but who…)?

Or will it be that bearded, middle-aged man in an oxford button-down shirt (one of many in his closet, or so I imagine…) and likely a doctor of some humanist, generalist slant, an internist like me perhaps, or a pediatrician, or a psychiatrist?

Wait for it, I tell myself, wait for it.

When The Question comes, the words vary but the intent is the same. “You call this fiction,” they might say, “but the stories are true, right?” Or, “Which parts actually happened, and which did you make up?”

It’s tempting to answer: yes, few, and most, respectively. In other words, yes the stories are true, though few of the events actually happened, and I made most of it up, imaginary events and people being the essence of fiction.

I know I’m not the only fiction writer who gets The Question, though I might get it with more regularity than some since I write fiction and non-fiction and because my writing is often inspired by my doctoring.

 Screen Shot 2015-01-01 at 10.04.42 AM

But with A History of the Present Illness, I wanted to represent the world, not transcribe it. I wanted to see life and people, health and illness, love and parenting, medicine and writing from new perspectives. And I wanted to learn what I could do with language and take readers into lives and worlds unlike their own. But the people in the book don’t live in San Francisco, and never have, because they don’t exist, even if they now feel as – or more – real to me (and, I hope, to my readers) than some people I actually have known.

So are the stories true?

No and yes. Or, rather, they are True, but not true.

Fiction, I believe, offers Truth with a capital ‘T’, while non-fiction in all its myriad and often entertaining and educational manifestations offers fact, or truth, small ‘t’.


Capital ‘T’ truths are universals, impervious to time period, geography and culture. They include life, death, loss, love, guilt, heroism, suffering, friendship, adventure and terror. Truth with a capital ‘T’ is the stuff that matters most to most of us most of the time. It’s our humanity distilled. It’s what endures.

Which brings me to the most honest answer I can give to The Question: A History of the Present Illness is a work of fiction that’s 100% true.

For a longer version of this post, please see The Story Prize blog. And for more of my thoughts – and an accompanying playlist of songs (!), please see my post on the LargeheartedBoy blog.

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