September 26, 2019 § 9 Comments
“Just the facts Ma’am” was the theme of my writing for 30 years. Not as a detective, like Sgt. Joe Friday; I spent my time looking for medical clues. If I acted as a reporter, it was not the human-interest type, but the anchor speaking into the camera without strong emotion or personal comment.
My 30 years as a doctor were spent reporting “facts”—honing the skill of writing notes on medical charts, using a method called S.O.A.P. charting.
Subjective: what the patient tells you.
Objective: your “objective” findings.
Assessment: your diagnostic conclusion.
Plan: what you’re going to do about it.
My writing was analytical; I did not allow emotion to cloud my judgement. When I started practice, the notes had more information. I hoped to capture the whole person on paper. With insurance changes came pressure to see more patients, and my notes grew briefer. As the “physician-patient” relationship evolved into a liaison with the computer in the 2000s, the format (with more typing and tabs and new windows to open, all to be completed in non-increasing time slots) necessitated getting directly to the point, no embellishment. The human being I had just seen got lost in rapid finger movements noting recalled “facts.”
S: Mr. Jones is a 62yo man who appears older than his stated age. Patient states he has been drinking over a pint of vodka daily since his wife died six months ago. He was found on the floor by a niece, who went to his house when she couldn’t reach him by phone, and brought to the Emergency Department.
O: Past Medical History is positive only for hypertension. Family history noncontributory. Blood pressure elevated, pulse thready.
Heart: Regular rate and rhythm, S1, S2, no murmur.
Abdomen: Distended, with spider veins and a fluid wave. Liver two finger breadths below the right costal margin.
A: Alcoholic liver disease
When I began to write creative nonfiction, readers said I sounded cold and clinical. I had mastered writing without feeling, observing from a distance, to describe what I saw. Where was I in the story, a reader asked? I realized I was the remote watcher. I had to learn a new skill: to show up in my writing. Not as the clinical observer, reporting another’s pain, but as someone who felt it. The medical barrier between myself and the other had to come down; I had to turn the “patient” back into a person.
Mr. Jones was unmoored when his wife died suddenly six months ago. He had relied on her to fulfill his daily needs—cooking, cleaning, laundry—while he built his business empire. It was she who arranged outings with friends, bought theater tickets and kept track of his work socializing. She filled the house with conversation and music. He had planned to retire next year, and use the wealth he had spent his life accumulating to show her the world.
Now she was gone, and he didn’t know how to do anything. He pretended to cook for a while, then gave up. He stopped doing laundry when his white shirts streaked blue, instead wearing the same clothes for days at a time. Not sure how to arrange time with friends, he didn’t. He missed her laugh, her smell, her warmth in bed at night. One day he stopped going to work, just didn’t show up; his manager knew how to do it anyway, he rationalized.
A glass of wine with his improvised dinner turned to two, then three, then the bottle. When that no longer satisfied his need for oblivion, he turned to vodka, more each day. He had lain in bed drinking for the past week, and this morning couldn’t make it as far as the bathroom. When he collapsed, he wasn’t sure he would bother to get up again. If his niece hadn’t found him, he might have chosen to stay on the floor.
To write about a whole person, I needed to be vulnerable—to understand how I felt about a heart, an abdomen, the life of a person on the floor. Without feeling, I was describing events, not capturing life. Life has meaning; cold facts do not. Without meaning, the story is empty.
Breaking out of the old skill set takes practice. I needed to recognize that “objectivity” and emotion-free analysis are myths the medical profession tells itself. They provide a mask of clinical words to hide behind, keeping the real story untold.
It should be obvious that it takes emotion to write emotion. But I had to acknowledge my own feelings before I could write with empathy—about myself or anyone else. Adding that missing piece can transform a narrow skill into art. Which is, of course, the goal of all good writing. It’s like going from sketching to painting with oil. Writing as a doctor, I sketched the bare outline of the patient. As a creative nonfiction writer, I have to fill in the details, the nuances of a person, add the brush strokes that paint a complete story of a person and a life.
Sandra Hager Eliason is a recently retired Family Practice physician, now writing full time. She has published creative nonfiction in Minnesota Physician, Student Health Spectrum, and was the winner of Minnesota Medicine magazine’s 2016 writing contest for her essay “The Vacation.” She lives with her husband in New Brighton, Minnesota, where she writes about the interactions of patients with the medical system, and is working on a memoir about her years in medicine. Find her on Twitter at @SandraHEliason1.