Just The Facts

September 26, 2019 § 9 Comments

By Sandra Hagar Eliason

“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.

Ankles edematous.

A: Alcoholic liver disease

P: Admit

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.

Listen Up!

July 28, 2014 § 6 Comments

RadioI started listening to podcasts because I was commuting from Kalamazoo, Michigan to Waynesville, Ohio every weekend. Five hours each way, and Beyoncé’s a boss but there’s only so many times in a row I can belt out Single Ladies before my passengers start to complain (twice). Enter This American Life, Wait Wait Don’t Tell Me, and the skull-pounding nightmare delightful folksiness of Prairie Home Companion.

As I’ve become a radio storyteller and producer, I’ve started listening to podcasts more carefully. Radio producers thrive on making a signature sound for their own shows, a unique style that’s the equivalent of “voice” in written work. If you’re looking for inspirational approaches to structure, viewpoint and story, check out these listens. The links below take you right to the episodes, or click on the podcast title to get to their homepage, where you can subscribe in the audio service of your choice.

If you’re writing hybrid or braided essays:

Radiolab mixes anecdote, conjecture, expert testimony, historical fact and contemporary experiments to tell the stories behind science. Their narrative style is a great example of mixed genres coming together to tell a single story.

Episodes to start with: Rodney vs Death, Colors, and Are You Sure? (This one is a three-story episode. Be aware that the third story–which is one of the most incredible stories I’ve ever heard–is not kid- or work-safe)

If you’re having trouble plotting, or want to amp up your humor:

Snap Judgment has a young, quirky feel, and weaves sound design into storytelling that’s often live. They’re a great listen for sequential stories with surprising endings. If you’re trying to nail down an “…and I learned that…” ending without sounding trite, Snap’s stories can help. If you’re trying to up your humor, they’re often very funny, too.

Start with: The California Confederacy, Like a Virgin, and Seeking Asian Female

If you can’t figure out whether an incident is a story, or are struggling with finding dramatic movement in a reflective essay:

Third Coast International Audio Festival has its own podcast series, but something that’s served me well is the recordings of workshops and panels at their biannual convention. In particular, check out the “Pitch Perfect” and “Pitch Panel” sessions. After listening to several in a row, I was able to start distinguishing what was a story and what was a vignette or an observation even before the panel responded to the pitcher.

Start with: Pitch Perfect Session 2 from the 2012 Conference

If you’re approaching a difficult topic:

Love+Radio producer Nik Van der Kolk is a master of revealing a nonfiction story like a mystery. His use of low-fi sound and recordings that would be considered “flawed” by other shows is fascinating. Listen to the way information is slowly revealed to suck the listener right in before they shy away from the topic.

One to start with: Jack and Ellen (Most of Love+Radio is not kid- or work-safe. Again, incredible story, put in your earbuds or have grown-up passengers)

Happy listening–and if you’ve got a favorite podcast or episode, post a link in the comments–I’m always on the lookout for a good listen!

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