From Hippocrates to Walker Percy : Doctors Still Not Cured of the Writing Habit

Unless the name on the door is “Richard M. Ratzan MD,” patients flipping through the available reading matter in a doctor’s waiting room would hardly expect to have their traumas soothed by applications of medicinal literary trivia.

Ratzan is fascinated by doctors who write, and here are some symptoms of what now may be diagnosed as Ratzan’s syndrome:

Hippocrates, the 4th-Century BC Greek practitioner who wrote the physician’s oath, prescribed barley gruel, a precursor of chicken soup, as a remedy for the common cold.

St. Luke, that “dear and glorious” physician, alone among the Gospel authors tells the story of the Good Samaritan.

“Yankee Doodle Dandy” was written by British army surgeon Richard Schuckburg to poke fun at raw colonial recruits in the French and Indian War.

Temperance Supporter

Dr. Benjamin Rush, a signer of the Declaration of Independence and an ardent advocate of bloodletting, wrote tracts on temperance.

Tobias Smollett, creator of “Peregrine Pickle,” Sir Arthur Conan Doyle, creator of Sherlock Holmes, and A.J. Cronin, whose “The Citadel” was recently revived as a TV series, all sailed as ship’s surgeons.

Sir Thomas Browne, Francois Rabelais and Anton Chekhov were practicing physicians. Poet Oliver Wendell Holmes and lexicographer Peter Roget of thesaurus fame taught anatomy. John Keats and Henrik Ibsen practiced pharmacy. Viennese playwright Arthur Schnitzler was a psychiatrist and friend of Sigmund Freud.

Like W. Somerset Maugham, novelist Walker Percy, now on the best-seller list with “The Thanatos Syndrome,” took degrees in medicine but never practiced.

Surgeon Mariano Azuela rode with Pancho Villa and wrote novels by the campfire.

Poet and pediatrician William Carlos Williams delivered 3,000 babies.

Waiting on a Novel?

This conjures up the thought that patients may be waiting so long in a waiting room not because the doctor is tending to another case but because the doctor is hunched over his word processor rejiggering the second chapter of a novel or getting a second opinion from the nurse on the dialogue of a torrid love scene.

Richard Ratzan is himself a doctor who writes. In fact, he is in the final editing stages of a book on doctors who write, the outgrowth of a medical congress he staged at the University of Connecticut Health Center two years ago. It drew 400 participants, including a dozen author-physicians, from 27 states and Canada.

“My book is primarily about the relationship between medicine and writing,” says Ratzan, on a short break from his duties in the emergency room at the university hospital. “Why do doctors write? When do they write? And how do they or should they handle the ethical implications of using patients as source material?”

Ratzan, an internist specializing in emergency medicine, majored in Greek, Latin and the classics as an undergraduate. He conducts a weekly seminar in literature for medical students. He has four children, ranging in age from 4 to 12, and a wife who is a pediatrician at the same hospital. A prolific essayist with a novel buzzing in his head, he ponders late at night over his word processor the ethical questions raised at the conference about writing taking valuable time away from research, patients and family.

“Are we all selfish brigands, robbing wives, partners, hospitals and patients of their rightful time and care?” he asks.

Doctors, Ratzan has found, write for a number of reasons. Ego gratification. Escape from the grim realities of the operating table. As an outlet for the human dramas enacted in their consulting rooms. Self-therapy for the pain and frustration at being unable to help someone reaching out to them in trust and hope. And, perhaps in the case of the ship’s surgeons, a release from boredom.

Some agree with Dr. Johnson Some agree with Dr. Johnson Some agree with Dr. Johnson Some agree with Dr. Johnson Some agree with Dr. Johnson that “no man but a blockhead ever wrote except for money.” Some follow St. Luke’s advice: “Physician, heal thyself.”

A.J. Cronin had a prosperous London practice until a duodenal ulcer forced a rest of six months in the Highlands of Scotland, where one day he announced to family and friends that he was about to give birth to a novel.

Walker Percy turned to fiction while recuperating from tuberculosis, which he contracted by cutting up cadavers in pathology class at New York’s Bellevue Hospital.

Motivations vary with the amazing variety of their output. Dr. Mary Lake Polan, an obstetrician-gynecologist at Yale University medical school, has just written her second murder mystery as an escape from “the very realistic, often sad and tough profession of medicine.” Michael Crichton and Alan Nourse write science fiction.

Adventure Vein

In the adventure vein, Ratzan points to Marshall Goldberg, a Minnesota surgeon whose second thriller, “Anatomy Class,” is about a medical student who sets out to learn the identity of the young, healthy body he has been assigned to dissect, instead of the usual wino.

Psychiatrist Michael Robert Coles won the Pulitzer Prize in non-fiction for “Children of Crisis.” Immunologist Lewis Thomas, whose idol is Montaigne, won a National Book award in 1974 for his essays.

These days, Ratzan observes, physician-authors tend to be more serious--”almost angry”--writers than their Victorian counterparts. “Their primary motivation is to create serious works of art. Writing for them is not so much an expiation of guilt as the need to create.”

On the question of violating the confidentiality between doctor and patient, Ratzan finds that most writing doctors “tend to blenderize their materials. There are any number of stories you acquire, either on your own or from colleagues, that with a little modification can be used legitimately. Their fiction characters are composites.”

Writing may make doctors more compassionate, Ratzan suggests. “They may be poorer in the knowledge of bretyllium tosylate or understanding nuclear magnetic resonance but probably richer in understanding why a patient would rather not be told a diagnosis and why that decision should be respected.”

‘The Decision’

Sooner or later, every author-physician faces what Ratzan calls “the decision,” whether to pursue art or science as a career or to continue “leading this demanding double life.”

“Medicine is my lawful wife; literature is my mistress,” confessed Chekhov, who remained remarkably faithful to both.

“One occupation complements the other,” insisted poet-pediatrician William Carlos Williams. “They are two parts of the whole and not two jobs at all. One rests the man when the other fatigues him.” Poetry was “the thing which gained me entrance to the secret gardens of the self.”

Ratzan’s favorite case study is James Gates Percival, a highly praised contemporary of poets Longfellow and Lowell, who quit medicine when five children in one family and five other patients died in a fever epidemic. Unhappy with writing, he resumed practice in Charleston, S.C., after several suicide attempts but found that “when a person is really ill, he will not send for a poet.”

William Carlos Williams also lost patients because of his poetry.

Two Masters

“I love the camaraderie of surgery and the solitude of writing,” said Richard Seltzer, the author of “Confessions of a Knife” who eventually gave up medicine.

Still others, like immunologist Thomas, Atlanta’s poet-cardiologist John Stone, California playwright-internist Larry Snyderman and essayist Gerald Weissmann, chief of rheumatology at New York University, thrive in both worlds. Weissmann in fact urges his students to read Sherlock Holmes for clues to the art of diagnosis.

Similarly, Ratzan thinks Mary Shelley’s “Frankenstein” is a great text to teach medical students ethics.

As to whether medicine or literature is the higher calling, the jury is still out.

Years after Somerset Maugham became a millionaire with a yacht and villa on the Riviera, an eminent surgeon at St. Thomas’ hospital was asked if he remembered the author as an intern. “Ah yes, poor Willie,” he replied. “One of our failures, I’m afraid.”