Compassion is its Own Art
(Poet, Amatoritsero Ede in conversation with award-winning short story writer and novelist, Vincent Lam)
Amatoritsero Ede: It is a pleasure to have you on MTLS, Vincent, especially since we have been trying to hold this conversation for a while. Coming as this does on the heels of your most recent novel, The Headmaster’s Wager (Doubleday, 2012), it is an opportune moment. First I would like you to give the reader a sense of your writing process. Consider, also your engagement as a medical practitioner. How do you manage the time between writing, touring and the operation table; and you are an emergency Doctor too!?
Vincent Lam: It’s true – I’m a practicing physician, a writer who does sometimes tour, but most importantly I’m a father of three small and wonderful children. Kids have far more impact on time management than either doctoring or writing. As for juggling it all, everything is scheduling, commitment, and prioritized decisions. This is a somewhat prosaic answer, but that’s all there is to say. With multiple things going on in my life, I have to schedule time for writing, just like I have work scheduled at the hospital, and I make sure to put aside time for kids. Then, I have to use the time for the things I’ve scheduled. Commitment means sticking to long-term efforts even when there is no immediate reward, and there may be many frustrating challenges along the way. Those are learning opportunities, but they may not be easy. The capacity for delayed gratification is hugely important. It takes four years of tough work to do medical school, and easily four years of struggle to write a book. Both require commitment. I’m just at the start of being a parent, but I’m told it lasts forever. For me, prioritization is about sensible decisions and accepting certain trade-offs. I live very close to the hospital – ten minutes by bicycle – and I write at home. The kids go to a school within walking distance. We love our home, and it is smaller than a similarly priced home would be elsewhere. We save that commuting time, because the daily time savings is a higher priority to us than a larger home. It sounds like a small thing, but in Toronto, where some people commute 90 minutes each way, that’s 3 hours a day. Over a few years, there’s a novel written right there. We don’t have a TV. This is a great way to prioritize effortlessly, because it means I never have to decide whether to watch TV or do something else. The trade-off is that I don’t know what’s on TV, but am I really missing that much? When I grocery shop, I buy as much of everything as I can, so that I don’t have to go back to the shop sooner than I need to.
A.E.: Literary history is replete with medical-doctor-writers. In the distance we have, for example, Anton Chekhov, Sir Arthur Conan Doyle, William Carlos Williams, Mikhail Bulgakov, Lenri Peters, John Keats, that fine essayist, W. Somerset Maugham and at the present moment, John Murray, Khaled Hosseini, Daniel Mason, Ethan Canin, Abraham Verghese, Rivka Galchen, Austin Ratner, Chris Adrian and, here in Canada, Kevin Patterson and, of course, your good self. What might be the source of this romance between medicine and literature, for you at least?
V.L.: Both medicine and literature involve the exercise of empathy. This is the core act for both types of work. Good doctors and writers wish to participate in a deep and positive way in the lives of others, whether patients, characters, or readers. Then, at the level of work, there’s just the skills and habits required to ‘get things done’, which is the stuff addressed in your first question. I think doctors tend to have those skills. They need them to get to medical school, and they are further developed by medical training and practice.
A.E.: In an article by Andrea Crawford in Poets & Writers (January/February 2009), Ethan Canin is reported to have said that everyone has an expressive urge, but that this urge is greater in medical practitioners because being a doctor is “like being a soldier. You’ve seen great and terrible things.” And of course I understood that to mean that then this soldier in the OP room, by the sickbed, in the pediatrics ward, wants to report from the battlefield of human misery, triumphs, struggles, victory and well, defeat?
V.L.: Yes, I think the soldier analogy is true, and that’s the first part of it. As a doctor, one sees. Then, one participates in the situation in a human way, but also a professionally defined way. This is as it should be. I do not help my patient if I crumble into tears and need to be comforted. Perhaps writing allows a fuller range of speculation and emotional engagement. It is the real of the ‘what if I had said’ or ‘what if she had said.’ Fiction is especially free, because the characters do not exist in real life. I don’t know if doctors in general have a greater expressive urge than people in general. I would poke Canin in the ribs (gently) and ask to see the epidemiological data supporting his claim that doctors as a statistical group have more of this urge. Anyhow, on that score I have no idea, as I basically became an adult while I became a doctor. Meanwhile, I had a very deep urge to write as a teenager – which in many ways led me to medicine as a profession in which I would learn about people.
A.E.: For example in your short story collection, Bloodletting and Other Miraculous Cures, (2006) you did ‘draw blood’ did you not, literarily and metaphorically in the exchange between Toronto’s Dr. Fitzgerald – on rescue mission to Guatemala – and a local doctor: “[…] we talk around the regret of a lost opportunity: the narrow time frame in which an expanding death in the form of a bloody intracranial expansion can perhaps be drained, can sometimes be sucked out like an evil spirit to leave the scintillating brain intact.” That conversation highlights the irony of the half title of the collection, ‘Miraculous Cures.’ The patient dies due to an absent surgeon and the right facility; we are talking Guatemala. And later Dr Fitzgerald, bearer-of-bad-news, compassionately lies – “with the greatest tenderness I have within me” – to the wife, who wants to know if the deceased husband’s life would have been saved had he been closer to more modern facilities. The Bloodletting did not happen, and the miraculous cure is out of reach, and the lie was a necessary evil. Black humour? Is the medic’s life like this all the time, and is there any professional preparation in real life to make sure the doctor does not collapse from emotion in the OP room etc?
V.L.: One works up to these things. It’s like a musician – you learn single notes, then scales, then arpeggios, then etudes, finally a concerto. A medical trainee learns to interview, then to examine, then to diagnose, then to explain, then to treat, then to do all of this in simple routine situations, then to do all of this is complex unusual circumstances, and then deal with multiple problems at the same time, and so on. Yes, of course there is preparation. That is part of what medical training is about. The preparation for emotional competence, meanwhile, is not something that comes in a course with a name like ‘Emotional Competence 101.’ It is a steady accrual of experience and perspective, honed in one’s training, then in one’s practice even after formal training is done.
A.E.: Perri Klass, M.D., Professor of Pediatrics & Journalism NYU, suggest in his online “Literature Arts and Medicine” blog, that the relationship between writing and medicine, for him, is one of restriction and limitation, that writing enabled you free range of self-expression, while writing in medical practice is more utilitarian, you say what you got to say and clearly. It is merely to communicate medical diagnoses, prognoses, explanations etc. What do you think?
V.L.: Hmm… I would reframe the discussion slightly. I might tweak the dichotomy of restriction and limitation and ask whether, instead, it is that both medical and literary writing exist within a frame, but the frame is much bigger in literary writing. In both instances there are frames. In medical writing, the frame is the patient’s circumstances, their information needs, and the information needs of others in the team. In literature, the frame is the reader. The reader is far more difficult to characterize than a patient, because one has not met most of one’s readers, but the reader is nonetheless the frame of literary communication. I think that narrative is very utilitarian in medicine. Often the most useful medical communication is that which communicates diagnosis, prognosis, explanation, and narrative. Medical information is much less useful in a binary format, though sometimes that is appropriate too – the patient either smokes, or they do not. The story of what my patient is experiencing sometimes has huge import for me in what I will suggest next. Of course medical communication is not literature, but I think there is a huge range within which skilful use of narrative makes communication better, and a list of facts is less useful.
A.E.: Bloodletting has been made into a TV series of the same title. What were your initial feelings about moving from page to screen, worries, concerns etc? How is the series doing in terms of ratings?
V.L.: The writer of any book that is adapted can only win. Either people say, ‘oh, what a great adaptation’. Or they say, ‘it was nice, but the book was better’. Or, they say both! The writer cannot lose. I was happy with the adaptation. I felt very free about it – not especially protective. I did want the spirit of my book to be respected, and I think it was. The screen is a different language and the art form is different. The ratings were very good.
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