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Medicine and Literature

Anesthesiology, Ethics, Medicine and Literature

“Write what you know”: Anesthesiologist-author Rick Novak discusses his debut novel

419jAUWZsYLThe Doctor and Mr. Dylan is a murder mystery, a medical puzzler and a tale about love and parenting. And, it stars Bob Dylan, who may, or may not be, the real Bob Dylan. It’s also the debut novel by Rick Novak, MD, an adjunct clinical associate professor of anesthesiology, perioperative and pain medicine at Stanford.

Novak took the time recently to answer a few questions about the book, writing and his work as a doctor.

How did you become interested in writing?

I’ve enjoyed creative writing since my high-school English classes. My college essay for a successful Harvard application was a short story in which God revealed himself to the patrons of a Minnesota tavern. For the past three years I’ve authored a website called, which receives 250,000 hits per year from both anesthesia professionals and laypeople interested in the nuances of my specialty.

Why did you choose to write about an anesthesiologist – and do you have much in common with Nico, the primary character, who is also an anesthesiologist?

Wise advice to authors is, “Write what you know.” I’ve been an anesthesiologist for three decades, so I know a great deal about the practice and malpractice of anesthesia. The science and art of anesthesia are fascinating. We enter patients’ lives abruptly, at short notice, and have immense power to save lives and to do harm. The unequal nature of this relationship is fertile ground for storytelling.

The Doctor and Mr. Dylan is fiction, but yes, I do have a lot in common with Nico. I grew up in Hibbing, Minnesota, graduated from Hibbing High School, migrated to Stanford, and became a clinical faculty member here. I grew up 5 blocks from Bob Dylan’s home, am a huge fan of his music, and knew several members of his family. I’m the single father to three boys, and I’ve dealt with the highs and lows of the father-son relationship such as Nico has with Johnny, and the stressors of a failed marriage just as Nico does.

What motivated the plot of your story?

Anesthesiologists have control of dozens of powerful medications, and if misused, they can be lethal. One day I heard someone describe his significant other by saying, “I don’t want to pray that a bus runs her over, but my life would be a lot simpler if one did.” Combining these two ideas led to a plot where a physician seemingly makes use of an anesthetic as a tool to eliminate his troublesome wife. I have an active medical-legal practice of expert witness work, and this experience led me to set the second half of the novel in the courtroom, where tension runs high and mysteries can be posed and solved.

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Events, Medical Education, Medicine and Literature, Medicine and Society, Stanford News

Stanford’s Medicine & the Muse event mixes music, dance and pediatrics

Stanford's Medicine & the Muse event mixes music, dance and pediatrics

The annual Medicine & the Muse symposium is one of senior associate dean Charles Prober’s favorite events of the year, and now it’s one of mine too. Prober, MD, the senior associate dean of medical education, kicked off the evening with introduction of this year’s theme, “transformation and triumph.”

It’s a talent show Stanford Medicine style, with medical students providing the singing (ranging from an Italian opera duet to a foot-tapping mariachi tune), dancing (a group modern piece), film (gritty images from the aftermath of Typhoon Haiyan) and readings (a children’s book replete with illustrations of a mop-headed kindergartner who lost her teddy bear in the hospital and a witty novel excerpt about an incoming medical student leaving her plush Upper East Side existence).

Then, throw in chief communications officer Paul Costello’s thought-provoking interview with author and pediatrician Perri Klass, MD, and you have a full evening of entertainment. Klass has written novels, non-fiction books, and numerous essays and journalism articles.

“Transformation and triumph” is a message that captures both the transition of medical students into full-fledged doctors and many aspects of pediatrics, Klass said. She went on to discuss her drive to write; the urge that keeps her at her computer late in the night, spilling out her reflections on that day’s cases. And she explained her work as the national medical director of Reach Out and Read, a non-profit that provides books to low-income children.

The goal as a pediatrician is to get illnesses and other afflictions out of the way so children can blossom and reach their potential, she said. For some families, that means quite literally providing a book, which can serve of the basis for parents to develop an interactive, close relationship with their children.

Klass also offered advice for physicians hoping to hone their writing chops: “Just read good stuff, and write good stuff.”

Previously: A lesson in voice and anatomy from an opera singer, Stanford Medicine Music Network brings together healers, musicians and music lovers and Stanford’s Medicine and the Muse symposium features author of “The Kite Runner”
Photos by Norbert von der Groeben

AHCJ15, Events, Medicine and Literature, Palliative Care, Patient Care, Stanford News

Physician-author Abraham Verghese encourages journalists to tell the powerful stories of medicine

Physician-author Abraham Verghese encourages journalists to tell the powerful stories of medicine

P1080715Stanford’s Abraham Verghese, MD, greeted hundreds of journalists at the Association of Health Care Journalists 2015 conference last evening with a talk centered on the power of stories and of medicine.

The conference, held this year in Santa Clara, Calif., and co-hosted by Stanford Medicine, brings together journalists from a variety of outlets to solidify their scientific knowledge, enhance their journalism skills and network with colleagues. (As a reminder, we’ll be live tweeting from the conference today and tomorrow; you can follow us at @StanfordMed.)

Verghese is a physician and educator, born in Ethiopia to Indian parents. But he’s also an established writer, author of numerous essays and several books, including Cutting for Stone and My Own Country. In that way, he is “really one of us,” said Karl Stark, president of the AHCJ.

Like journalists, Verghese has an abiding interest in storytelling. But his stories stray from the researchers-made-this-discovery narratives that often occupy health-care journalists. Verghese’s stories are tales of lost loves and the act of toasting death with a glass of champagne. They’re the stories of people, of patients, and of the importance of listening and being present.

There are many types of stories that need to be told, Verghese encouraged his audience. Tell about the company that dominates medical-record keeping, of families who can’t allow their loved ones to pass away peacefully, of young physicians and students who are determined to place patients first, despite the dominance of technology.

And perhaps most importantly, writers should tell the story of medicine itself: of what it can and cannot do, of where it has been and where it is going.

In that vein, Verghese shared a story with his rapt audience. As a physician in rural Tennessee in the 1980s, he cared for many patients with HIV/AIDS. At the time, doctors had no drugs, nothing that could thwart the disease’s progress. Yet when one patient’s mother called the clinic one day, saying her son was too sick to come in, Verghese said he felt compelled to visit the family in their rural trailer home. He wasn’t ready for the patient to die without seeing him again. “My visit had a profound effect on him and the family. It helped them come to terms and that I wouldn’t abandon them,” Verghese said.

This was a revelation, he admitted. This is what doctors did before antibiotics and sterile operating rooms and medical devices galore. “They were able to heal, even when they could not cure.” And that is a power that today’s doctors should never forget that attests to the power of the patient-physician relationship, he said.

Medicine has other stories to share as well. In the past, metaphors abounded in medicine: the strawberry tongue of scarlet fever, the apple-core lesion of tuberculosis, the saber shin of the tibia, Verghese said. Yet now, despite the abundance of new conditions, metaphors are achingly absent, signifying a growing gap between the doctor as data scientist and the patient.

And then there’s the story of the body itself, one that future physicians may not know how to read, Verghese said. He said he jokes that if a patient came in with a missing limb, doctors wouldn’t be able to confirm the diagnosis without a variety of tests. “We really have stopped looking at the patient,” he said.

And that is one reason why journalists, as storytellers, are important. “Stories are the units of life; they’re how we extract meaning,” he said.

Previously: Live tweeting from Association of Health Care Journalists conference, A “grand romp through medicine and metaphor” with Abraham Verghese, Abraham Verghese: “A saintliness in so many of my patients”, Abraham Verghese discusses stealing metaphors and the language of medicine at TEDMED, Abraham Verghese urges Stanford grads to always remember the heritage and rituals of medicine and Stanford’s Abraham Verghese honored as both author and healer
Photo courtesy of Abraham Verghese

Events, Medicine and Literature, Stanford News

Remembering the strange vigils of war through poetry and dance

Remembering the strange vigils of war through poetry and dance

A performance of Dance and Poetry exploring war trauma and recovery Honoring the Ghosts on Saturday, April 11, 2015, at the Stanford University Dinkelspiel Auditorium. ( Norbert von der Groeben /In his Civil War-era poem, “Vigil Strange I Kept on the Field,” Walt Whitman describes watching over a soldier dying on the battlefield as a “vigil of silence, love and death.” That phrase may still ring true for soldiers fighting around the world; it may also feel familiar to medical professionals, whether imbedded in combat or in the ordinary rooms of a medical center. Yet this common experience is one that doctors and nurses reluctantly discuss and one that many soldiers and veterans feel lies beyond their powers of expression. A recent event held at StanfordHonoring the Ghosts – provided an exploration of such strange vigils through poetry and dance.

Alexander Nemerov, PhD, a Stanford art and art history professor, began the evening with a lecture, “Walt Whitman’s Moment.” During his talk he linked Whitman’s imagery of lamplight, starlight and shadow to contemporaneous art and popular depictions of the body, discussing the ways art freezes the human body and history freezes memory. Nemerov recalled the April 14 anniversary of the day Abraham Lincoln was shot in Ford’s Theatre. He quoted another Whitman poem, “When Lilacs Last in the Dooryard Bloom’d,” which commemorates Lincoln, and explained how poetry can simultaneously express private grief and offer public opportunities to honor and remember.

A performance of Dance and Poetry exploring war trauma and recovery Honoring the Ghosts on Saturday, April 11, 2015, at the Stanford University Dinkelspiel Auditorium. ( Norbert von der Groeben /The longer portion of the evening consisted of dance performances by U.S. Marine Veteran Roman Baca’s Exit 12 Dance Company. The program notes explained that after serving as a Marine in the Iraq war, Baca felt “angry, depressed and aggressive.” With his wife and fellow ballet dancer Lisa Fitzgerald, Baca formed Exit 12 as a way to help him, and other veterans, tell their stories. Sunday’s performance at Stanford (the company’s West Coast debut) included seven dances that communicated a wide range of war experiences: a mother’s love and anxiety as her sons enlist; a soldier’s confusion as the demands of battle conflicted with fears for his family in Egypt. Two pieces, performed by solo dancers, were set to music and texts created by a veteran who teaches other vets to write poetry about their experiences; the impression of mental disintegration was terrifying.

My favorite piece was a solo in which the dancer stepped out of a camouflage uniform and performed an extended parting from the pile of clothes on the floor – the dance intimated for me both a soldier’s ambivalence about leaving the military and a human soul vacating a dead body on the battlefield.

A performance of Dance and Poetry exploring war trauma and recovery Honoring the Ghosts on Saturday, April 11, 2015, at the Stanford University Dinkelspiel Auditorium. ( Norbert von der Groeben /The evening ended with the company dancing in front of a large video screen which depicted Iraqi teenagers from different sects performing a dance they created under Baca’s guidance. The teens met in Arbil, Iraq, where Baca returned to share the gift of healing he had found in dance. The live dancers on the Dinkelspiel Auditorium stage repeated the movements of the Iraqi kids dancing on the screen, creating an effect of simultaneous action and memory, both in time and place, a performance both intensely personal and socially connected. The aspects of witness and healing shared between the performers and audience both honored the ghosts of the dead and acknowledged hopeful possibilities.

The event was sponsored by the Stanford Arts Institute, Stanford’s Medicine & the Muse Program in Medical Humanities and the Arts, and Stanford’s Department of Art & Art History.

Jennifer Swanton Brown, RN, MLA (’12) is manager of regulatory services and education, in Spectrum, the Stanford Center for Clinical & Translational Research & Education. She published her first poem in the Palo Alto Times when she was a fifth grader at Escondido Elementary School. Having served as a poet-teacher with California Poets in the Schools since 2001, she is currently serving as the second poet laureate for the City of Cupertino.

Previously: Prescribing a story? Medicine meets literature in “narrative medicine” and “Deconstructed Pain:” Medicine meets fine arts
Photos by by Norbert von der Groeben

In the News, Medicine and Literature, NIH, Research, Science

The value of exploring jellyfish eyes: Scientist-penned book supports “curiosity-driven” research

The value of exploring jellyfish eyes: Scientist-penned book supports "curiosity-driven" research


As an academic, I often encounter variations of the question “And so… what are you going to do with that?” In other words, why should anyone care about insights, experiments, and questions that serve no obvious functional purpose?

A PNAS release published earlier this week spotlights a novel that tackles just this issue. Joram Piatigorsky, PhD, a retired scientist from the NIH’s National Eye Institute who now devotes his time to his passion for art and literature, went through the arduous process of writing and publishing a novel because he sees literature as an important way to make statements about society. And the statement that he wants to get across loud and clear is that basic research matters, and needs to be funded.

The book, called Jellyfish Have Eyes, is set in the near future and follows a scientist who gets into serious legal and professional trouble because he departs from research that is clearly related to a human disease in favor of researching jellyfish, and in a mix-up uses government funding to do so. Piatigorsky laments how in today’s tight funding environment, students who would otherwise pursue basic questions – such as whether jellyfish have eyes – are forced to do more routine, translational research that doesn’t make use of their creativity.

And when creativity gets stymied, important breakthroughs are simply missed. The release quotes the book’s main character, who is modeled after Piatigorsky:

I justify my research on delving into the mysteries of Nature because generally the experiments yield new insights that benefit people. There’s penicillin, recombinant DNA, genetic engineering… Bacteria provided the first models for gene regulation, which set the stage for gene therapy. Sea slugs—snails without shells—revealed mysteries of memory. Birds have taught us that it’s possible to rest half the brain at a time. Think how useful it would be if we could be asleep and active at the same time.

Piatigorsky worries about the current research climate, where “anti-science politicians” force cuts to basic research and pundits and the public insist on knowing what “cure” a research project aims to find, says the release. But Piatigorsky is optimistic about the power of storytelling: “I have a very strong feeling that science is not a collection of facts. You have to make the facts into a story of communication… The narrative aspect of science is very compelling.”

And, in case you were wondering, jellyfish do have eyes – “magnificent eyes. It depends on the species. They have lenses, corneas, retinas,” says Piatigorsky in the release. No one knows what they can see or how vision might affect their behavior, but such impractical questions might lead to the next breakthrough. In the meantime, they promote curiosity and wonder about our world.

Previously: Research in medical school: the need to align incentives with value, Can science journals have beautiful prose? and Science is like an ongoing mystery novel, says Stanford neurobiologist Carla Shatz
Photo by Lassi Kurkijarvi

Medical Education, Medicine and Literature, Medicine and Society, Mental Health, Patient Care

Using graphic art to understand the emotional aspects of disease

Using graphic art to understand the emotional aspects of disease


When it comes to describing the feelings of hopelessness of depression, the fear and anxiety of having an operation or the unrelenting pain of a chronic condition, sometimes words are not enough. But, as some patients have discovered, art can be a powerful medium for portraying and translating these complex emotional experiences. Cartoons can also help future medical professionals empathize with patients and consider their experience from more than a clinical perspective.

An article published last week on the anthropology blog Teaching Culture explores the use of graphic art in medical anthropology courses. It takes its inspiration from Allie Brosh’s comic Hyperbole and a Half, in which she uses a crudely drawn figure to transport readers through the painful inertia and numbness of her depression. I stumbled upon this comic a few years ago when a dear friend was depressed. At the time, I didn’t understand how that could be or what that meant. Brosh’s bizarre, raw, and yes funny, comic resonated not only with what I saw my friend going through, but with my own experience, even though I was not depressed. It enabled me to empathize and to offer her support that was more relevant.

The article also describes a curriculum that incorporates “graphic pathographies” – graphic novels and comics about experiencing illness – into a course for pre-med students. The coursework “examines the multifaceted relations between biomedicine, culture, and the art of care, and places a special emphasis on how creative and humanistic approaches to illness and healing might enrich clinical practice.”

When I asked for his thoughts, Errol Ozdalga, MD, a professor of general medicine involved with the bedside medicine Stanford 25 initiative, commented:

Graphic art is an expression that is probably under-utilized. At Stanford, our guest services offers patients the chance to do guided imagery by expressing their feelings via drawing. Many physicians are unaware this service exists. It’s an opportunity to better understand our patients’ perspectives and promote the importance of connecting to patients among our students.

Previously: Engaging with art to improve clinical skills, Image of the week: a medical-focused manga comic and Stanford nurse’s whiteboard artistry brings cheer to patients, co-workers
Photo by Krystal T

Medicine and Literature, Patient Care, Podcasts, Stanford News

Abraham Verghese: “A saintliness in so many of my patients”

Abraham Verghese: "A saintliness in so many of my patients"

Verghese lookingThere’s a quiet dignity that envelopes Abraham Verghese, MD. You can imagine other authors whose books have scaled to the top to be taken with themselves, hardly humble, but that’s not the case here. When you get to know him, you realize he’s a man of great depth, with a wonderful soul and a deeply felt sense of humanity. When he talks about treating patients it’s with reverence (“There’s a saintliness I saw in so many of my patients,” he told me) – as if each time he crosses the threshold into a patient’s room he’s entering hallowed ground.

Verghese has written two searing works of nonfiction: My Own Country, a paean to the young men he treated for HIV-AIDS when it was just emerging as a human scourge, and The Tennis Partner, a loving eulogy to a best buddy whose life went off the rails. Then the blockbuster novel Cutting for Stone: atop the New York Times best seller list for two years and selling more than one million copies. It’s a sweeping tale of how time transforms family – jolting the reader from the first page, where a Roman Catholic nun gives birth to twins boys and dies on the operating table. I read it during the height of the global economic chaos in 2009 and was transported each evening, thankfully, to another world outside of monetary meltdowns and fiscal maelstrom.

In this 1:2:1 podcast, Verghese and I talk about time’s impact on medicine, novels and life. (Time is the theme of the current issue of Stanford Medicine magazine.) About life, he tells me, “There’s a poignancy to living because we won’t live forever… As John Irving says in one of his books, ‘Life is a terminal condition. It’s about to run out on all of us…’ There’s no exception to that. And I think, in a way, that’s what makes life so beautiful.”

This podcast is accompanied by a Q&A with Verghese in the magazine.

Previously: Stanford Medicine magazine reports on time’s intersection with health, Abraham Verghese discusses stealing metaphors and the language of medicine at TEDMED, Stanford’s Abraham Verghese honored as both author and healer, Abraham Verghese’s Cutting for Stone: Two years as a New York Times best seller and Abraham Verghese at Work: A New York Times profile
Photo by Jason Henry

Humor, Medicine and Literature, Research, Science

Can science journals have beautiful prose?

Can science journals have beautiful prose?

5331998702_2e6ab9e5e8_zScientific journals are not known for being scintillating or inspiring reading. But could they be? A recent article in Nature elaborated on an online discussion started by Stephen Heard, an ecologist at the University of New Brunswick.

In a guest post on the Tree of Life science blog, Heard argued that snappier, livelier writing could attract and retain more readers. “Style and beauty are not incompatible with scientific writing,” he wrote. Papers could appeal to undergraduates, science writers, politicians, and the public.

But is a journal really an appropriate outlet for such writing? Blogs and commentaries might be better mediums for creativity and literary flair, as research articles often must adhere to a more rigid format and provide detailed descriptions of materials, methods and results. Participants in the online discussion have pointed out that clarity and order have a beauty in themselves, the inexorable logic on display in the progression from hypothesis to data to results. Others worried that stylishness would make science research less accessible to non-native speakers of English. Some mentioned (and critiqued) the conventional idea that whimsy and humor cover up flawed science and detract from clarity. And many others praised the idea of incorporating pleasure along with function.

In the original piece, Heard suggested three reasons scientists don’t write beautifully more often:

It could be that writing beautifully in scientific papers is a bad idea, and we know it. Perhaps readers don’t respect scientists who resist the conventional turgidity of our writing form. I don’t think this is true, although I’m aware of no formal analysis.

Or it could be that beauty is a good idea, but well-meaning reviewers and editors squash it. In my paper I argue that beauty (like humour) can recruit readers to a paper and retain them as they read; but that reviewers and editors tend to resist its use. But again, there’s no formal analysis, so I was forced to make both halves of that argument via anecdote.

Or it could be we just don’t have a culture of appreciating, and working to produce, beauty in our writing. I think this is most of the explanation: it’s not that we are opposed to beauty as much as it doesn’t occur to us that scientific writing could aspire to it.

He sees three ways this could change: scientists can add some whimsy to their own writing, leave it in others’ writing when editing, and praise it when they see it. He exclaims:

Wouldn’t it be great if there was an award for the best scientific writing of the year? I don’t mean the best science – we have plenty of awards for that – but the best writing to appear in our primary literature. Such awards exist for lay science writing; if one existed for technical writing I’d be thrilled to make nominations and I’d volunteer to judge.

Heard keeps his own science blog, Scientist Sees Squirrel.

Photo by Ashley Campbell

Cardiovascular Medicine, Immunology, Medicine and Literature, Stanford News, Surgery

Stanford Medicine magazine’s big reads of 2014

Stanford Medicine magazine's big reads of 2014

brain attackThis year’s most-read Stanford Medicine magazine stories were all about the heart, surgery and the immune system – the themes of this year’s three issues. The top 10 (as determined by pageviews on our website):

Previously: Stanford Medicine magazine’s big reads of 2013 and Stanford Medicine magazine’s big reads of 2012
Illustration, from the article “Brain attack” in the Fall 2014 magazine issue, by Jeffrey Decoster

Medical Education, Medicine and Literature, Patient Care

Prescribing a story? Medicine meets literature in "narrative medicine"

Prescribing a story? Medicine meets literature in "narrative medicine"

woman reading bookIn the November issue of The Lancet, Chris Adrian, MD, postulates about what might be called “narrative medicine.” How do stories and poems alter our experience of caregiving, illness, and suffering? Does literature “help”?

Adrian, who is trained in both creative writing and medicine, thinks that artistic expressions of experience do bring something to clinical care, whether care is experienced on the giving or the receiving end. He also finds these benefits ineffable, impossible to quantify, study, or prove, and all the more powerful for it. He writes:

Lately I feel a strong, anxious conviction that writing and reading fiction and poetry might in fact execute some kind of alleviating change upon our suffering, even in the world of the hospital, upon that portion of our suffering related to illness and death. I can’t begin to argue logically or systematically how it actually does this. Accidentally or miraculously is about as far as I get when I try.

The reason literature, or perhaps art more generally, complements clinical practice is because it communicates in an entirely different language that speaks to different aspects of the human experience. Adrian ponders a line from W.H. Auden’s  “In Memory of W.B. Yeats,” which reads, “For poetry makes nothing happen…” and speculates:

…which is not by any means actually nothing, but instead a domain of activity so estranged from our degraded understanding of what human beings can do in the world that [Auden] had to call it Nothing to say what he meant.

Adrian, who is on faculty at the Columbia University Medical Center and an accomplished author, feels that medicine doesn’t train doctors how to interact with the less-scientific aspects of humans experiencing illness, injury, and suffering. There’s a gap or an absence in most medical care, and that’s where storytelling can step in. Columbia’s Program in Narrative Medicine, which originated in 2000, is dedicated to this idea. It draws participants from a vast array of fields, and inspired the International Network of Narrative Medicine. As its website states, “The care of the sick unfolds in stories. The effective practice of healthcare requires the ability to recognize, absorb, interpret, and act on the stories and plights of others. Medicine practiced with narrative competence is a model for humane and effective medical practice.”

Storytelling in medicine isn’t just for medical practitioners to engage in. Adrian’s musing was inspired by a new book by Carol Levine, Living in the Land of Limbo: Fiction and Poetry about Family Caregiving, which collects the stories of family members who dedicate uncountable resources to caring for sick loved ones. Consider also the longstanding role of the hospital chaplain, and the recent proliferation of doulas, both of whom are specialized professionals who work “next-to” medicine, absorbing emotions, anxieties, and fears, and providing nurturance. And then, of course, there are the patients themselves, who in Adrian’s words might benefit from “art as a considered clinical intervention… very nearly like prescribing a story.”

Previously: Intersection of arts and medicine a benefit to both, report finds, Literature and medicine at life’s end, Thoughts on the arts and humanities in shaping a medical career and Physicians turn to books to better understand patients, selves
Photo by Alex

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