December 13, 2012 0 Comments

In Defense of Fiction

It is widely known and well documented that third year medical students – future doctors thrown for the first time into daily patient care – are raw, awed, frustrated, exhilarated, confused, astonished, angry, eager and exhausted. Suddenly, they are members of teams of health professionals responsible for the ongoing care of sick patients.

To help them through this experience, I teach a longitudinal course called Public Medical Writing: Exploring the Clinical Experience in which they discuss readings by doctors, write, and workshop what they’ve written.

The readings introduce them to several key forms of Public Medical Communication: Op-Eds, narrative journal articles, blog posts, medical fiction, and essays. For one session, the assigned readings were the first chapter of Abraham Verghese’s literary memoir My Own Country: A Doctor’s Story and a short story called “A Child’s Book of Sickness and Death” by Chris Adrian from A Better Angel.

“What did you think of the readings?” I asked. In typical UCSF medical student fashion, they quickly decided which reading they’d discuss first and how long they had for each discussion, then launched in.

“I want to meet her!” exclaimed one student, referring to Chris Adrian’s narrator, a 16 year old girl who has been in and out of the hospital her whole life.

“Incredible voice,” echoed another, detailing the edginess and intelligence of the voice.

I interrupted sooner than I should have. “It’s fiction.”

All head’s turned my direction. Several sets of lips fell open in silent, cartoon-like gasps. Then they all started speaking at once.

They felt deceived. Manipulated. Now they didn’t like the story. Now they thought the narrator had more insight than any sixteen year old could. Worse, they were interested in real stories, stories like the ones they were seeing every day in the hospital. They didn’t have time for fiction. They wanted facts and guidance and insight.

I should have maneuvered them into detailing the magnificence of the voice and story, summarized their discussion, and then – only then – revealed that it was fiction. Perhaps with that approach I could have made a better case for fiction: that good fiction always reveals Truth, while non-fiction, limited by actual events and conversations, too often can only give us facts.

As it turns out, medical student rotations schedules being the random things they are, none of my students had done Pediatrics for their first clerkship. But sometime this year, they will. And then maybe they will see that although chronically ill children often have unusual medical knowledge and behave differently than healthy kids, the genius of “A Child’s Book of Sickness and Death” comes from the writer channeling not only the peculiar precociousness of the sick child but also the insights of the physician who has cared for hundreds or thousands of such children.

In Adrian’s story, as in all great fiction, Truth trumps truth.

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