Danielle Ofri is an attending physician at Bellevue Hospital in New York and a faculty member at the affiliated New York University department of medicine. She knows Bellevue well, having cut her teeth as a medical student and trained as a medical resident there. Besides her MD, she has a degree in physiology and a PhD in biochemistry. Now she divides her time between seeing patients, teaching, editing and writing. The Bellevue Literary Review was launched in October 2001 and is published twice yearly. Ofri鈥檚 book of essays, Singular Intimacies: Becoming a doctor at Bellevue, will be published in April by Beacon Press
You are a doctor. Where did you get the inspiration to start a literary journal?
It was not in my career plan at all. I had spent 10 years at Bellevue and I needed a break. A very close friend of mine died without warning while I was an intern and I suddenly found that I needed to re-examine the priorities in my life. I did locum tenens, which is essentially temping for doctors. I鈥檇 spend a month or two in, say, a clinic in the Southwest, and then I鈥檇 travel in South and Central America, as far as my money would take me. Over the two years I spent doing that, all these stories from my time in Bellevue were building up. I started writing them down.
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I returned to Bellevue in a three-day-a-week position as an attending physician, both seeing patients and teaching students, and during my free time I kept working on these stories and started taking writing classes. I wanted to incorporate writing into my medical teaching. My students had to write up their patients鈥� histories as part of their course, so I instituted a policy whereby they had to do one write-up as a narrative 鈥� to tell the patient鈥檚 story from the patient鈥檚 point of view. Our new chairman, Martin Blaser, was also getting his students to write essays, and an astute colleague suggested we sit down and talk. We thought about what to do with our collection of student writings 鈥� perhaps publish them in an in-house journal. Then we thought we should do something broader, more national, as there might be a larger interest in this. So the Bellevue Literary Review was born.
Why do you think it鈥檚 so important for doctors to write about their patients?
A patient鈥檚 story is so much richer than the standard medical write-up. I felt the students could learn so much by taking the time to ask about it. We often miss the boat, the social context. For example, if a patient has diabetes we say, no big deal, we鈥檒l give them a couple of insulin shots. Meanwhile the patient is thinking, 鈥淭hey鈥檙e going to think I鈥檓 a drug-user at work if I have needles in my bag.鈥� If you ask a patient what their real concern is, it can be a very long way from what鈥檚 on the doctor鈥檚 mind. Often you can nip the problem in the bud if you ask them, but we rarely do. If the patient lives on the street, you can鈥檛 send them home with dressings that need changing every day; if they鈥檙e in a shelter it鈥檚 very hard for them to take six medications a day. All these things become a critical part of medical care.
It seems remarkable that doctors aren鈥檛 taught to do this in medical school.
There is a section in their education about taking a patient鈥檚 social history, but that usually involves only asking them about drugs, alcohol or tobacco. That is very limited. Medical language is so standardised, and students are taught to follow it. Medical students all went to university, probably all graduated at the top of their class, but by the time they finish their medical school residency they can barely put a sentence together. If you read a patient鈥檚 history in the medical chart it is all abbreviations, acronyms, shorthand 鈥� the language is all so strangely removed. It will say something like, 鈥淭he patient denied chest pains but admitted shortness of breath,鈥� which sounds so accusatory. Why can鈥檛 we say, 鈥淭he patient did not have chest pains but did have shortness of breath.鈥� You read sentences like, 鈥淭he spleen was palpated.鈥� But who palpated the spleen? Then there are sentences that begin, 鈥淭he X-ray showed鈥︹��, or 鈥淭he biopsy revealed鈥︹��. They sound like revelations from Mount Sinai. This is standard medical language that doctors use to write patients鈥� histories. Students strive to imitate it, and we encourage them.
A classic example was when I had a patient presented to me whose name was something like Jacques Strauss 鈥� French first name, Jewish-sounding last name. I was intrigued, so I asked for the social history. All I heard was 鈥渘o drugs, alcohol or tobacco鈥�. I said, this patient has got to have a more interesting history. So we went to his bedside and it turned out he was from a French-Jewish family who had escaped the war and ended up in Shanghai, where he grew up speaking Chinese. He鈥檇 then come to New York and worked as a French chef, but he didn鈥檛 have health insurance, which is why he ended up at Bellevue. That鈥檚 an important part of his story.
Do you think science education in general should pay more attention to how language is used?
Absolutely. Everything is about language. The scientific literature is so dull to read. There鈥檚 never a human element, there鈥檚 never an 鈥淚鈥� or a 鈥渨e鈥�. It鈥檚 always 鈥淭he experiment revealed that鈥� 鈥� you never learn about the person who did the experiment.
What do other scientists and doctors at Bellevue think of your views?
People think it鈥檚 reasonable. Some of them think I鈥檓 a little odd. The students and medical residents are still a little perplexed. When I go around the wards talking to the students and ask them what books they鈥檝e read recently, I usually get a blank stare. Some of them haven鈥檛 read a novel since college. Yet it鈥檚 so important. You can read medical journals until the cows come home, but at some point you鈥檙e going to need to read something literary to keep your brain alive.
Some researchers worry that using personal language would undermine the science they are trying to present.
It seems you can combine both. You can still get the same point across even if you use language that is slightly more 鈥渟ubjective鈥�.
You studied physiology and biochemistry. Yet your literary activities seem to have more to do with psychology鈥�
The psychology really came from listening to the patients鈥� stories and realising that you cannot deal with the patients adequately without knowing who they are. Malaria is malaria, but the interesting thing is that the guy suffering from it just stepped off the boat from Beijing. Or the Tibetan monk who was a haemophiliac and who was tortured in a Chinese prison. This whole place is teeming with stories.
Does the story-telling help the patients?
The major complaint we encounter in our clinic is physical pain. The majority of our patients are middle-aged Hispanic women 鈥� first-generation immigrants 鈥� who have had very painful lives. A lot of them are raising their grandchildren because their children have been arrested or have AIDS, or their husband is alcoholic. And it all comes out somatically, as pain. They tend to switch doctors very frequently, because the doctors cannot find any physical source of the pain and often end up saying there鈥檚 nothing wrong with them. I find a lot of my patients of this type stick with me now, because I accept that their pain is real, even if I know there is no underlying medical cause. I ask them about their lives, and they feel they are at least being listened to.
You have a long literary tradition at Bellevue鈥�
We have always had doctors who write, and many writers have been institutionalised at Bellevue, particularly beat poets. William Burroughs was here. Eugene O鈥橬eill, Malcolm Lowry and Norman Mailer spent time here. Stephen Foster, who wrote Oh, Susannah! and other popular songs, died penniless at Bellevue. The Mississippi writer Walker Percy was an intern at Bellevue until he contracted tuberculosis during an autopsy. We鈥檝e had probably just about every top jazz musician 鈥� Charlie Parker, Bud Powell, Charles Mingus, Dizzy Gillespie. Many artists have spent time here. William Burroughs鈥檚 wife, Joan Vollmer Adams, ended up in Bellevue addicted to speed before he accidentally shot her in a failed 鈥淲illiam Tell鈥� stunt.
Is there any conflict in being both a doctor and a writer 鈥� a scientist and an artist?
I鈥檓 hoping I can do both. Will I get promoted as quickly? I don鈥檛 think so, because I鈥檓 not doing high-end research. Will I publish many books? Probably not. But if I get one book out, I鈥檒l die happy, and if I have a good experience with my patients and with teaching, I鈥檒l be satisfied.
You also dance. Do you dance and write because you need to express yourself in ways that you can鈥檛 in medicine?
These are all different ways of expression. I am definitely able to find expression in medicine because I enjoy my connection with my patients. When a patient walks out feeling better or feeling somehow fulfilled, that is expression. Writing and dance are just different ways of doing it. Sometimes even words are strangling, and to dance is a blessed relief.
What are you trying to achieve with the Review?
We subtitle it 鈥渁 journal of humanity and human experience鈥�. That鈥檚 what I see in the hallways of Bellevue. We鈥檙e looking for things that examine the human experience through the prism of health and healing, illness and disease. I want people to interpret this creatively. But first, it has to be great writing. Good writing is always about getting at the underbelly of human experience. Being ill opens up the seam, the crevice of vulnerability. I think that鈥檚 a similar spot to the one where creativity comes from. That鈥檚 not to say you have to be ill or in pain to be a good writer, but a lot of inspiration for great works comes from vulnerability.
I read an account you wrote about an American Indian woman with acne, and how you wanted to treat all her problems and not just the acne, and your frustration at not being able to. Was writing about it a way of addressing that helplessness?
Absolutely. It was at a clinic in New Mexico. Sometimes in science and medicine you鈥檙e overwhelmed and can鈥檛 properly help someone. A hundred acne doctors would not be able to heal what was really causing her pain. Her husband had hanged himself two months before and their son had discovered his body. I needed to articulate that frustration, the thought that this woman鈥檚 life was falling apart and I could do nothing to catch it. And maybe with my next patient I鈥檒l be better prepared and stronger when that whole other side comes in.