A prescription for creative writing

Hearing the phrase “What do you make of her headache?” within the walls of a medical school, you might think you are listening in on a class on, say, how to take a medical history. But in a small, brightly lit classroom at the Harvard Medical School every Tuesday night this fall, 10 medical students (give or take two or three who are out on call) tackle questions like that on a literary rather than a physical level.

In a single evening of Susanne Klingenstein’s “Creative Writing for Physicians and Medical Scientists,” an elective offered through the Harvard-M.I.T. Division of Health Sciences and Technology (HST), students engage in probing analyses of classic works of literature in the setting of an intense writing workshop that has all the makings of an afternoon at the Bread Loaf Writers Conference. There’s talk of pacing, character development, and foreshadowing. The virtues of various narrative techniques, such as flashbacks, stream of consciousness, and time compression are compared.

“If you’re writing an essay on a serious ethical problem, your style should have a certain gravitas. Adjusting your style to your topic and releasing technical and scientific information gradually is the key to good fiction and nonfiction on tricky medical issues,” Klingenstein says to one student, whose latest installment of a novel set in Nigeria was up for discussion one mid-November evening. He looks attentive as Klingenstein launches into a short but thorough catalog of authors who demonstrate her point.

Another student, a lanky young man with tortoise-frame spectacles and an overstuffed day planner in front of him, pipes in, contrasting his colleague’s style from chapter to chapter. The writer looks at his paper, his eyelids fluttering a bit as he takes in all the feedback. “Oh, but I’m not a minimalist,” he says with conviction. The other students giggle in acknowledgement of the obvious fact.

Apart from leading the seminar, Klingenstein, an associate professor at the Program of Writing and Humanistic Studies at the Massachusetts Institute of Technology (M.I.T.) until June 2001 when she moved to HST as a lecturer, has pioneered a campaign to raise awareness of the importance of training doctors in the clear, concise and sophisticated use of language. Since she initiated the HST writing course in the fall of 2000, she said, “It has very quickly become an underground cult class of sorts.”

“[Doctors] need a handle on language to think and communicate clearly. When you enter a life of medical research, you enter the life of a writer. HST students’ language skills will deteriorate if they don’t get practice,” said Klingenstein, a native German with finely chiseled features and crisp speech. She holds a Ph.D. in American studies and American literature from the University of Heidelberg.

Practice is critical, but so is instruction, and Klingenstein’s instructions are clear: To produce writing about medicine that is accessible – let alone interesting – to the general public involves striking a delicate balance between communicating scientific and social complexities and establishing an engaging voice and style.

Writing research papers, a highly specialized genre intended for experts by experts, is hardly a physician’s exclusive linguistic responsibility, affirms Klingenstein. Her class is predicated on the principle that a “sophisticated use of language” is critical for physicians to communicate effectively to individual patients or translate technical minutiae into language the public at large can understand.

It’s been 30 years since Harvard and M.I.T. pooled resources to establish HST. Classes take place at the Medical School on Longwood Avenue yet much of the administrative work is done at M.I.T. Most of the students are in a dual-degree track studying for an M.D. and Ph.D. or M.P.H. They take a heavy course load that entails medical classes at Harvard and time-intensive research at M.I.T. or medical labs in the Boston area.

The partnership, however, is still considered “experimental.” And Klingenstein is poised to play a role as a humanist as the program evolves. Her vision is that in addition to research and clinical training, guidance in the sophisticated use of language will become an essential part of a medical science education. Issues such as human genome manipulation and patients’ fears of dying hooked up to equipment demand the consequences of medical research be thought through in public by the physicians involved in them. Language is the medium for conveying their perspectives.

“What is going on today in science is, in an almost religious sense, awesome. But the general public knows very little about it. To give the public information on scientific issues that are ethically contested, we must have writers, public intellectuals, who are skilled in presentation and have a thorough knowledge of medicine,” she said. Those who best fit that profile are doctors themselves, Klingenstein says.

If there are better institutions to support the endeavor than Harvard and M.I.T., you’d be hard pressed to find them. After all, many leading voices in medical writing today are Harvard Medical School-educated or -affiliated physicians, such as New Yorker contributors Jerome Groopman, Recanati Professor of Medicine at HMS, and Atul Gawande, research fellow in surgery at Harvard-affiliated Brigham and Women’s Hospital.

Also nestled among the ranks is acclaimed journalist and novelist Perri Klass ’78, M.D. ’86, whose views on doctors and the written word echo Klingenstein’s. Klass said doctors are given to miscommunication because their writing tends to be so jargon-laden that it’s impenetrable even for professionals.

“It’s true that for many doctors the ability to communicate is lost outside the profession. Doctors are bound by jargon both in person and on the page. As technology, knowledge, and science get more complicated, it’s important to have people in the know who can explain decision making, thought processes, and how it looks from the inside,” said Klass, who runs a pediatric practice at Dorchester House and teaches at the Boston University School of Medicine. She notes that many more doctors are writing now than when she started, so she happily concedes that the standards are higher.

Few of the students in the HST course, however, write about medical issues. Maybe that’s because they see the course as a respite from the nitty gritty scientific grind.

“Of all the classes I’ve taken since coming to med school, this is the most enjoyable. I enjoyed other parts of med school. But sometimes I think I’d just like to write,” said Mark Ghaly, who’s in his last year of earning an M.D./M.P.H. degree. He already knows his medical career will include writing about his experiences with patients.

“In order to make people understand the work I do with different marginalized, underserved populations, it’s important to write stories convincingly, persuasively, and with a lot of emotion,” he said.

In class, the students present their assignments: parts of novels, memoirs, satires, and reflections on medical culture. The weekly reading assignments cover cultural approaches to medicine, illness and death. They range from fiction by Kafka to narratives by practicing doctors.

“Some pieces we do involve literature and medicine, so that meshes extremely well [with other classes]. It made sure I’m aware of the patient’s side,” said Alvan Ikoku, a third year student. When he recalls his recent grueling pediatric surgery rotation, he realizes the class made him more sensitive to the people he was treating. Recalling Chekhov’s comment that medicine was his wife and writing his mistress, Ikoku said he’s lately found new meaning in the words.

“[The hard science classes and the writing class] may seem like separate things, but one can’t help feeding on the other. It’s almost as if doctors need something else besides medicine to ensure they are complete doctors. Sick patients undergoing treatments need that. Med school doesn’t teach you how to be a complete human being. But this class does that. Imagination is provoked by assignments, and reading and imagination are important conduits to empathy,” said Ikoku.

During the discussion of the piece by the would-be minimalist, an exchange arose that illuminated the chasm Klingenstein seeks to straddle between rigorous, methodical scientific practice and creative writing. A slightly flummoxed, bedraggled first-year asked if flashbacks should be uniform in length and tense within a story.

“It makes no difference, as long as it works. There’s no rule. What works, works,” said Klingenstein.

And that’s the science of it.