Doctors who write; It all began with Ctesius of Cnidus

A question I am often asked about my first novel, A Little Piece of Me, is: why did you write it? This is usually followed by: how long did it take? I also get asked if it is based on something in my life. I did study a liver biopsy with the same condition affecting the little boy in the book and, as I called the pediatrician to relay the diagnosis, I wondered about the effect of this condition on a family about whom I knew nothing. The rest is all fiction; as soon as I had an idea of the main characters they, to a considerable degree, wrote the story for me.

The why question is neither easily nor succinctly answered.

I was a voracious reader for as long as I can remember. My mother introduced me to Brooklyn’s Park Slope Library, on 6th Avenue between 8th and 9th streets, when I was 6 years old. Pete Hamill, the renowned newspaper man and novelist, who, as a child, lived in the same neighborhood as I did and went to the same library, described it as “the place where most of the things I came to value as an adult had their beginnings.”

I started out reading mostly fiction – the Hardy Boys, the Black Stallion, the Lloyd C. Douglas books about Christ (not because I was in any way religious but likely because the neighborhood of my childhood was mostly Catholic), and so many more. I also read a lot of biographies and autobiographies; one that I remember best was by Edward Beach, the acclaimed commander of a WW II submarine. Needless, to say I wanted to be a submariner after that. As a seven-year-old I would walk the dozen streets from the Park Slope library to our home carrying six books at a time, usually twice a week. I would have carried more but that was the maximum allowed at the time. Each book had a little open envelope pasted to the inside back cover, with a card stamped with the date due. My books were never overdue because I always wanted new ones to read.

Back to the “why?” question.

I’m not sure.

It once seemed to me that anyone who reads a lot must, at one time or another, want to write. That’s often true but not always.

My first attempts at creative writing were when I was at Walt Whitman Junior High School #246 in Brooklyn. They continued at Manhattan’s Stuyvesant High School where I wrote short stories and poetry, and was encouraged by Irving Astrachan, the advisor to The Caliper, our high school literary magazine. I was co-editor of The Caliper, along with my classmate, Bruce Young, who would become a leading obstetrician-gynecologist at NYU. Astrachan, an inspiring figure, had a curmudgeonly manner that did not obscure his powerful commitment to excellence. The key to high quality writing, he exhorted us, was, “Write about what you know.” I’ve learned that this should not be taken too literally.

Now that I have written one novel and am at work on others, I understand something I don’t recall Mr. Astrachan telling us: writing is very hard work, taking much time and effort rewriting and rewriting and rewriting and rewriting.

And rewriting.

I suppose the answer to “why?” can be best answered by other writers.

In A.S. Byatt’s absorbing novel, Possession, Blanche Glover says, “Nothing endures for certain, but good art endures for a time, and I have wanted to be understood by those not yet born.”

This lovely, hope-filled goal might, however, soon be achieved with new, highly sophisticated technology. The Shoah Foundation and the University of Southern California Institute for Visual History and Education are developing a hologram (http://sfi.usc.edu/tags/hologram) that will potentially inform those in the future about you and your thoughts. The highly detailed three-dimensional images are taken with a full circle of cameras as the subject responds to hundreds of prepared questions. At some time, even in the distant future, the recording can respond to almost unlimited new questions. Currently being applied for holocaust survivors, it could eventually be made available to almost anyone who wants “to be understood by those not yet born.”

Perhaps Paul Auster, the marvelous Brooklyn-based writer, best explained why people write: “Becoming a writer is not a ‘career decision’ like becoming a doctor or a policeman. You don’t choose it so much as get chosen, and once you accept the fact that you’re not fit for anything else, you have to be prepared to walk a long, hard road for the rest of your days.”

Auster’s view is well-expressed in a highly thoughtful and decidedly accurate David Sipress New Yorker cartoon, reprinted with permission of the magazine:

Of course, Hippocrates, himself a physician and writer, expressed it in his aphorism, “Ars longa, vita brevis” (art is long, life is short).

How long did it take to write A Little Piece of Me?

The short answer is: six or seven years, even longer if you consider when I first thought of writing it after sending out the report for that liver biopsy.

The long answer is the title of this article, perhaps reflecting Auster’s view: It all began with Ctesias of Cnidus.

Ctesias, a 5th century BCE Greek physician, served the Persian King Atarxerxes II Mnemon. Ctesias is the first physician known to have a second career as a writer. His History of the Persians was in twenty-four books.All of his books are lost but we know about them because they were quoted by various authors of the time. Cnidus, or Knidos, the Greek community in which Ctesias lived and practiced is in what is now southwest Turkey and was well know for its doctors who were called Asclepiads. Aretaeus of Cappadocia, regarded as second only to Hippocrates, also came from that region.

The next writer-physician we know about is Luke the Evangelist (St. Luke), also a Greek physician, born in the first century. Luke lived in the Syrian city of Antioch. Paul’s epistle describes Luke as a Hellenic Jew. Universally regarded as a great historian he is also thought to be the first painter of icons.

There are no known physician-writers of note between Luke and three Middle Ages figures: Avicenna (980-1037), a Persian thought to have been born in Uzbekistan, Yehuda Halevi (?1075-1141), a Jewish-Spanish philosopher and poet, and Moses Montefiore (1138-1204), a rabbi, physician, mathematician and philosopher in Andalusia, Morocco and Egypt. The flavor of those years is vividly captured in the highly informative and enjoyable novel, The Physician, by the non-physician Noah Gordon who often writes historical novels with medical themes.

Many physicians in the Renaissance and the 16th-18th centuries gained fame as writers of medical and non-medical science, but also as poets and novelists. Giovanni Batista Morgagni (1682-1771) was one of the most important figures in the history of medicine. His great work, De sedibus et causis morborum per anatomen indagatis (The sites and causes of disease by anatomic investigations), firmly established the autopsy as the most important and productive tool, until the current age of molecular medicine, for the understanding of diseases. Morgagni was a highly regarded and prolific poet as well as the foremost physician of his time.

As another example, John Keats (1795-1821) graduated with a license from Guy’s Hospital, London, qualifying him to be apothecary, physician and surgeon, but he was consumed by the desire to write poetry and never practiced. In his tragically short life he wrote some of the greatest poems of the English language, the best known being Ode on a Grecian Urn. He died in Rome of tuberculosis. Oliver Goldsmith (1728-1774), who wrote The Vicar of Wakefield, was a physician, as was Peter Mark Roget (1779-1869) the compiler of Roget’s Thesaurus.

Anton Chekhov (1860-1904), the brilliant Russian short-story writer and playwright, advised young writers “Don’t tell me the moon is shining; show me the glint of light on broken glass.” Many of his plays, such as The Cherry Orchard and Uncle Vanya, are regularly performed in theaters throughout the world. Chekhov also died too young of tuberculosis.

Oliver Wendell Holmes, Sr. (1809-1894), close friend of Ralph Waldo Emerson (1803-1882), Henry Wadsworth Longfellow (1807-1882) and James Russell Lowell (1819-1891), was one of the best regarded poets of the 19th century and a founder of the literary magazine The Atlantic Monthly, as well as distinguished physician and surgeon, and eventually dean, at Harvard Medical School. He was the first physician in the United States to promote the concepts of Ignaz Semmelweiss (1818-1865), who discovered that puerperal fever, generally fatal maternal sepsis following the delivery of a baby, resulted from physicians not washing their hands before delivery. Holmes’ son, Oliver Wendell Homes, Jr. (1841-1935), became a distinguished jurist and was Associate Justice of the Supreme Court.

One of the best known figures in all of literature is Sherlock Holmes, created by Arthur Conan Doyle (1859-1930) when his ophthalmology practice failed to fill either his time or his pocketbook. Holmes is modeled after Doyle’s University of Edinburgh medical school professor, Joseph Bell, acclaimed for his diagnostic skills. Bell served as Queen Victoria’s physician whenever she visited Scotland. The Holmes stories remain as entertaining as they were when written. Each year I have recommended the Holmes stories to new pathology residents to introduce them to deductive reasoning and problem solving.

A.J. Cronin’s inspirational novel about a young physician committed to research, The Citadel, has been read by generations of young people. The Citadel  is also one of the first books to openly discuss medical ethics. The physician António Agostinho Neto (1922-1979) was the first President of Angola and a celebrated poet. Han Suyin (1917-2012) was the pen name for Dr. Elizabeth Comber. She was born in Xinyang, China, as Elizabeth Rosalie Chou, of a Chinese father and a Flemish mother. Comber graduated with honors from London’s Royal Free Hospital medical school. Her semi-autobiographical and best-known novel, A Many-Splendoured Thing, was turned into a highly successful film in 1955.

Mikhail Bulgakov (1891-1940), Ukrainian-Russian novelist and playwright, wrote The Master and Margarita, one of the great novels of the 20th century, first published 26 years after his death. The novel is critical of Soviet society and its literary establishment. Bulgakov was born in Kiev, graduating with special commendation from the Medical Faculty of Kiev University. After suffering serious wounds as a physician at the front in World War I, he became addicted to morphine. Morphine, a book published in 1926, is the tale of his experiences, including his freeing himself from the habit. After the war he devoted himself completely to his writing. Many of his stories, plays and novels were severely criticized and about to be  banned until Josef Stalin came to his defense. Louis-Ferdinand Céline, pen name of Louis-Ferdinand Destouches (1894-1961), created a new style of writing that modernized French and world literature. His novel, Journey to the End of the Night, won wide praise but he remains a controversial figure because of his outspoken support of Nazi Germany during the World War II Paris occupation, his virulent anti-semitism and Holocaust denial. Céline’s medical school thesis was The Life and Work of Ignaz Semmelweiss (1811-1865), mentioned above, whose fascinating life story was told in the wonderful and highly readable 1949 novel, The Cry and the Covenant, by Morton Thompson, also not a physician.

Arthur Schnitzler (1862-1931), a prominent Hungarian-Viennese laryngologist, personally familiar with Sigmund Freud as well as his work, wrote novels, short stories and plays. His works were highly controversial, both for their frank descriptions of sexuality and their strong stand opposing anti-semitism. Hitler referred to his work as “Jewish filth.” His autobiography, Youth in Vienna (Jugend in Wien), was published posthumously in 1968. The highly regarded 1999 film, Eyes Wide Shut, by the brilliant film-maker Stanley Kubrick (1928-1999), is based on Schnitzler’s 1926 novella, Rhapsod. The books and stories of Sigmund Freud (1856-1939)  describe in great detail patients he cared for without disclosing their real name (e.g. Dora) and have been highly praised for their literary quality.

The Rutherford, New Jersey, pediatrician, William Carlos Williams (1883-1963) was one of the most important and influential American poets of the 20th century. A student and friend of Ezra Pound (1885-1972), Williams is also considered a revolutionary poet despite living a remarkably conventional life as a small town physician.

W. Somerset Maugham (1874-1965) was the most popular writer of his time. He went to St. Thomas Hospital medical school but gave up his beginning practive when his first novel, partly based on medical school experiences in delivering babies in a South London slum, Liza of Lambeth, was a wild success. Phillip Carey, the protagonist of his semi-autobiographical masterpiece, Of Human Bondage, is Maugham’s alter ego, but with a club foot as the disability substituting for Maugham’s own stammer. In World War I he worked in Switzerland for British intelligence. His spying experiences led to a book of short stories, Ashenden: Or the British Agent, which is thought to have inspired Ian Fleming to create James Bond. He was also a highly regarded travel writer. There have been more than 30 films based on Maugham’s works, including three versions of Of Human Bondage (1934, with Bette Davis and Leslie Howard, 1946 with Eleanor Parker and Paul Henreid of Casablanca fame, and 1964 with Kim Novak and Laurence Harvey), four versions of his short story Miss Thompson, two versions of his novel of cholera in China, The Painted Veil, one starring Greta Garbo, and two versions of The Razor’s Edge.

In the 20th century many physicians achieved renown for their writing. Indeed, it would be relatively easy to amass a list of more than 200 physician-writers, fiction and non-fiction, since the end of the 19th century, with at least 50 Americans including, but not limited to, Ethan Canin, Robert Coles, Robin Cook, Michael Crichton, Atul Gawande, Tess Gerritsen, Frank Huyler, Sherwin Nuland, Danielle Ofri, Walker Percy, Theodore Isaac Rubin, Oliver Sacks, Richard Selzer, Samuel Shem (Stephen Joseph Bergman), Frank Slaughter, Lewis Thomas, Abraham Verghese, and Irvin Yalom.

When I was an intern I often told myself that it was a great privilege to be a physician. When I became a pathologist, and considered all the pathologists who had gone before me who contributed so much to humanity, I realized that was an even greater privilege. Now, when I think of the physicians who have also contributed to the world’s literature I am very happy to be a new addition to that illustrious group.

As Charles Aznavour, the great French singer, not a physician, wrote, “I have so many songs in me that won’t be sung.”

Back to working on one of those songs, my next novel …