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Pull the Thread: A Perspective from Hematology-Oncology Attending and Writer

The following manuscript was submitted to the April 2017 Arts in Medicine Themed Writing Contest.

Writing is the greatest self-excavation tool I have found. It was always something I enjoyed, but during my medical training it became something much more important than that.

When I was younger, probably seven or eight, my mom (a daily journaler) bought me a blue Mead spiral notebook and told me I could write anything I wanted in it. Entries were an occasional event: a few lines describing something that happened on a vacation or documentation of some great oppression like when I wasn’t allowed to stay up and watch Family Ties after The Cosby Show was over on Thursday night.

In college, writing became something else for me. When I signed up for my first semester of classes, I had an idea that I would head for medicine eventually, so I devoted large chunks of time to the pre-med prerequisites. I spent much of freshman year in lab or lecture, and grades-wise I fared squarely okay, but not good enough for medical school. 

When sophomore year started, slightly behind the eight ball from a GPA-standpoint, I signed up for an English class to meet a liberal arts requirement. In that class, I met Anne.

Anne was unlike other professor I’d met at college. Each class was a conversation about whichever classic novel we were working through, and our grades were based on the thoughtfulness of our written responses to the reading. Occasionally, there would be a grammatical correction or a circle around a misplaced bit of punctuation, but I don’t think they factored in to our grades at all.  Anne walked us through Crime and Punishment first, and her love for narrative was infectious. She graded with a black pen, not red. The majority of the comments written in the margins were affirmations rather than corrections. When she disagreed with a point, her response was objective, never punitive.

I didn’t know I had a writer in me until I sat in that class, but when the semester was over, I knew it was the writer who would get me through everything else. Amazingly, my inorganic chemistry final was four essay questions, and it was the first time I scored 100% on an exam since arriving to college.

I signed up for a total of three classes with Anne, and grew through each one. As she got to know me, her guidance became more challenging but she never strayed from the priority of building up over breaking down. Her favorite metaphor for teaching was that she was training gardeners, not soldiers.

Time marched, I graduated, worked in industry for a few years, and then started my MD/PhD program. After that, residency, then heme/onc fellowship. My entire medical training was overcast by my dad’s death from cancer a year before starting medical school. The whole time, there was a stretching push from inside, a restlessness that wouldn’t settle. I couldn’t exorcise it.

Fellowship proved emotionally difficult. Cancer, the home wrecker, the great destabilizer, and now it was around me all the time, even at home now that I was taking call overnight. It was confusing: I should be elated because I was becoming a cancer doctor, the endpoint to which I had devoted so many years. It should have felt better, but there were things about it that felt bad. I just couldn’t put my finger on what they were.

Then, on New Years Eve, halfway through fellowship, I sat with my iPad on my lap and worked up the courage to start letting all of those pressurized thoughts out. I filled a page with stream-of-consciousness writing, allowing myself to tap out complete nonsense if that’s what showed up. Then I went back over it, nudged, tweaked, refined, and it was as if Anne’s black pen was there on the page for me, picking which ideas to expand and which ones didn’t serve. I ended up with a “piece of writing,” and I loved it.

I would never characterize it as great writing (nor would I characterize anything I’ve ever written as great) but it felt great to me. My soul perked up a little, like a few PSI of steam had been released from an over-filled tank. I stopped blaming medicine for not filling that need, because I made the mistake of forgetting my own history. Science was never soul-feeding for me. Story is.

Now I’ve been writing (irregularly) for two years, and I remember and forget and remember again that when that restlessness starts to emerge, when the tank starts to overfill, it’s not the most recent NEJM, and it’s not a heavy patient census that are going to let that steam back out.

It’s sitting and filling a page. Sometimes that page is nonsense, and I throw it away. You’re allowed to do that! Sometimes something interesting comes out and I keep it. The best times are when a connection pops out that I’d never recognized before, and never would have made had I not started pulling the thread of one story and ended at the conclusion of another.

There will be times during your medical training when the training process feels wrong, or seems unfair. You’re probably going to be more tired than you have ever been. You will experience new stressors and responsibilities, and there will be times when you will ask yourself why you ever chose to put yourself through this.

You might find that if you write something down, you’ll find new motivation, or new meaning in what’s happening to you and around you. Pull the thread. You’ll be amazed at what’s tangled up in it, and what you’ll be able to untie.

Ken Bishop, MD, PhD Ken Bishop, MD, PhD (1 Posts)

Attending Physician Guest Writer

The Warren Alpert Medical School of Brown University

Ken Bishop is a hematology/oncology attending at Brown University, where he also completed his internal medicine and hematology/oncology training. He has a strong interest in palliative care and the role of narrative in cancer and end-of-life care. Working with trainees is the best part of his job. He can be found on Twitter at @kenbishop and on his blog