By Amy MacKinnon
I first learned of Dr. Pauline Chen and her book Final Exam: A Surgeon's Reflections on Mortality (Knopf, 2007) a couple of months before her book was actually published. I was in my local independent bookstore when the owner told me of a publisher-hosted luncheon she had recently attended. It was held in honor of a brilliant new voice in literature and her debut about the medical profession's attitudes toward death. Of course it was Pauline Chen. The owner, a grand dame in bookselling circles, predicted Dr. Chen's book would be a magnificent success -- if I recall correctly, she herself read it in one night. I took a bit longer, but like the New York Times, Final Exam is one of favorite picks from 2007. In honor of good books and the paperback release, may I present author Pauline Chen...
Amy MacKinnon: A lot of writers complain that they don’t have enough time to actually write. One of my favorite stories is that of National Book Award recipient Julia Glass who completed Three Junes in bursts of fifteen minutes stolen here and there from her job and family. But you’re a surgeon, mother of twins, and active in the greater world, you must be more present than most of us. How do you create the time?
Pauline Chen: I’m flattered by your comments, but I know of many people with bigger daily challenges than mine who manage to get everything done. They are amazing!
In terms of writing, I think Julia Glass is right on target. Soon after my twin daughters were born, I read an article in The Atlantic Monthly about Alice Munro. The article discussed how Munro had written during her children’s naps. After reading that piece, I realized that I had to take advantage of every chance I had, even if that chance was fifteen minutes.
That was generally how I worked – writing in small spurts -- until the last couple of years when my relationship with writing itself changed. I used to think of myself as someone just trying to write, someone for whom writing was a hobby. Thus, writing was an “extra piece” I needed to fit into my day. But the more I began to think of myself as a writer, the more writing became an inherent part of my life. I now cannot imagine not writing; it would be like not brushing my teeth or turning away from my family.
I sometimes think of the advice I used to give new surgical interns. I would tell them to list the most important things in their life. Then, I would have them cross out everything except for the top two or three items because that would be all they would have time for during internship. While my present life is not like an intern’s or even a resident’s, I still do a lot of juggling every day. But writing is not the “extra piece” at the bottom of the list. It’s right up there near the top.
AM: Many writers say they knew they always wanted to write. Given how beautifully crafted Final Exam is, I imagine the same is true of you. Did you always write? At what point in your life did you do it with the intention of getting published?
PC: I’ve always been drawn to writing and to stories. Many of my childhood memories revolve around stories, stories that my father, a gifted storyteller, told my siblings and me.
But publishing always seemed impossible when I was growing up. My parents were immigrants and English was very much a third and fourth language for them. Writing in English, even simple thank you notes, was a terrible struggle, so publishing was as far from their reality (and their reality for their children) as you could possibly imagine.
During high school and college, a few of my writing teachers suggested I try to publish, but I still couldn’t imagine it. And then during medical school and residency training, I rarely wrote. I was too busy trying to catch up on lost sleep and meals.
After I finished my surgical training, I found myself drawn again to writing and took a couple of writing courses. One of my teachers encouraged me to continue writing about my experiences in medicine, perhaps put together a book. I remember the first time I mentioned this to my father. “Are you nuts?” he said to me. “Every English major in the country wants to write a book! To publish you need more than perfect English — you need the best English. How could you possibly think that you could write a book that might be published? That might matter to people?”
It was a devastating conversation. But in a funny way, it was also inspiring. I now had something to prove.
These days, my father is my biggest fan. He eats up every review of my writing; and if there’s a hint of criticism, he’ll first fret -- they are like daggers to his heart – then will rail against the critic. My father calls me up in advance to remind me not to be late to my own events, and my hardcover publicist even gave my father the ultimate Stage Dad compliment – that his work on behalf of Final Exam was so good he could consider himself an official Knopf publicist. My father reminds me of that one often.
AM: Being a surgeon, you must have a dimension to your personality that's fairly analytical. I saw you at a workshop last year given by Michael Lowenthal and, even though your book was already published, you were listening as attentively as the rest. Have you taken many writing classes? What’s your approach to craft?
PC: I tend to believe that people who start their professional lives doing things other than writing – doctoring, parenting, teaching, you name it -- actually have an advantage when it comes to becoming writers. They have the benefit of experience and the confidence that comes with having already successfully become whatever those other jobs required them to be. They can apply those experiences – learning to become a doctor, parent, teacher, etc -- to the process of becoming a writer. In terms of writing, I still feel like I have so much to learn about the craft. But the approach I use is pretty much the same one I used as an undergraduate interested in academic research and as a resident interested in surgery.
As an undergraduate, I was lucky enough to have a mentor who was devoted to the intellectual development of his students. Early on, he told me that before I began any paper or project, I needed to read everything I could get my hands on for that particular topic. “Reading up on the literature” would not only give me a solid grounding but would also help me to push the field forward in some way and create new work. That advice is invaluable for writing. I think that writers have a responsibility to know what has come before them and to push their genre forward.
In my surgical training, I learned that only with frequent practice could one liberate the art. As a medical student and surgical resident, you learn to operate by first learning to tie knots and wash your hands. You keep tying knots and washing your hands until you can throw those sutures and scrub up in your sleep. After that, you begin to cut. And then you start operating. And you practice and practice and practice until one day you find that operating is the most natural of actions. When that operating becomes natural, you discover something. You suddenly go from being wholly focused on every one of your actions -- how to hold the knife, how to hold the needle driver, where to place the stitch -- to thinking about the larger picture -- how the operation as a whole is preceding, how the patient is or will tolerate certain maneuvers, how even to coordinate the relative strengths and weaknesses of your current operating team such that the operation proceeds most smoothly. You see certain shortcuts, refine ways of moving, cutting, suturing, all of which make your operating look more like a well choreographed ballet than a step-by-step technical procedure. What you have done, after practicing technique over and over again, is you have liberated the art. I guess then that my approach boils down to those two lessons: read as much and as widely as possible and practice the craft constantly.
Classes and seminars did have a very important role in my development as a writer. I don’t think I would have ever started pursuing writing seriously if I hadn’t taken writing courses. And I still find places like Grub Street to be terrific sources of inspiration.
AM: Tell us about your road to publication: how you came upon your agent, how long before she submitted your manuscript and it sold to Knopf.
PC: In finding my agent, I did pretty much what all the books and magazines advise you to do: I sent queries to agents who represented work similar to mine. One of them wrote back and said that although she liked my work, she worried about a conflict of interest with her current client. She then suggested I pass my work along to one of her colleagues at the agency. That colleague is now my agent.
For the first month, my agent helped me fine-tune my proposal. We went through at least five drafts; the introduction was the hardest part to get right. When the proposal was finally in its best possible form, my agent sent it to about a dozen editors at different publishing houses. I think we heard back from Knopf a couple of days later.
I feel pretty lucky because I have a wonderful relationship with my agent, my editor at Knopf, and my editor at Vintage (Knopf did the hardcover; Vintage the paperback).
AM: Since this is the Writers’ Group, we’d like to know if you have a writers’ group or trusted readers.
PC: Writing is such a lonely pursuit, so I think writers’ groups are really wonderful. When I first moved to this area, I joined a local writers' group. Being with people who were struggling in similar ways and who wanted nothing more than to do good work provided me with great inspiration. Unfortunately, I had to drop out after about a year because of time constraints. But I still consider several of them to be close friends.
I do have a few trusted readers and feel pretty lucky to be able to get their advice. I think their sensibilities in my particular genre are exquisite, and I really appreciate the fact that they are absolutely honest with me.
But one thing I have learned over the last few years is that there are also bad times to share your work. A promising piece can be crushed if you share it too early on or to too many people. There’s an art to knowing when to solicit comments, even from your most trusted readers.
AM: There’s a passage in Final Exam where you reflect eloquently on Dr. Hacib Aoun’s advice on treating patients. You write, “I want to cry for those in whose bellies I find disseminated tumors, but cannot for fear of being unable to see clearly enough to sew them closed.” I hope I don’t sound insensitive, but it felt a bit like a metaphor for writing. When we see what’s wrong with our manuscript, something we feel passionately about, we must maintain some distance so as to treat it appropriately. Were you able to be as sanguine about your writing when the time came?
PC: I think when my husband watches me revise, he thinks a lot about Faulkner’s line about killing your “darlings.” I’ve heard him tell friends that he cannot understand how his beloved wife could be so detached about her own work. I suppose it’s understandable that he of all people would find this troubling to a certain degree, but I think it has more to do with my medical background than any inherent ruthlessness.
I do feel a sense of disappointment when a favorite phrase or paragraph seems out of place in an essay, but I also feel a kind of wonderful freedom that I can never have in medicine. If you make a mistake in your writing or cut something out of an essay, nobody gets hurt or suffers. For a surgeon, it is absolutely thrilling to be able to cut with such abandon, without any kind of life-or-death repercussions. The only casualty in this type of cutting is my particular attachment to a phrase or sentence or paragraph. And that’s pretty minor in the scheme of things.
Plus with computers there’s that wonderful “Cut and Paste” function where one can save everything that has been deleted. In medicine, we don’t always get those kinds of second chances. Do you know how many files I have squirreled away of “ruthlessly” deleted sentences and paragraphs that I’m actually hoping to use one day?
AM: What has been your most touching experience from sharing Final Exam with the world?
PC: I think what has touched me the most from sharing FINAL EXAM has been the courage of other people. People at readings, lectures, or in letters have shared some of their experiences of loss. Doctors and other health care professionals have told me stories about patients they cared for 10, 20, 30 or more years ago. All of these stories are not the kind that people usually share with one another or even acknowledge in public. I am profoundly honored and touched to be witness to this kind of sharing of stories.
AM: Care to share what you’re working on now?
PC: I’m working on a new book, some new essays, and a talk. I’m also getting back into clinical work again. And of course, I’m trying to be as present as I can for my family.
AM: What three bits of advice would you most like to share with other writers?
PC: Read a lot. Write a lot. And believe that you have a story worth telling. It all seems pretty straightforward, but I think accomplishing these three things well is very difficult. I think that last one in particular is the biggest hurdle for anyone who is starting to write. One of my UCLA writing teachers put it best. “Every one of us has a unique journey,” he said to me a year ago when I visited him in Los Angeles. “These journeys may not be the stuff of mainstream interest or even of commercial interests, but each is interesting, important, and relevant. And all of our journeys, no matter what they are, deserve a voice.”
AM: Final thoughts?
PC: I love your blog!
AM: And we love your book. Thanks so much for stopping by the Writers' Group. Readers, any questions for Dr. Chen?