Holt, a professor of social medicine and geriatric medicine, uses a fictionalized narrator and composite patients to “make sense of medicine through storytelling” in Internal Medicine: A Doctor’s Stories.
What was the idea behind creating composite characters, rather than writing straight nonfiction?
Ethically, it’s impossible for me to write nonfiction about a patient I’ve taken care of. I created the characters in these stories to represent something that was important to me at a certain stage in my training. I hope they’re convincing as characters, but these stories couldn’t be about the patients anyway: their stories don’t belong to me. These are the stories I have to tell about what it was like for me to become a doctor and about making sense of medicine through storytelling.
Medical residencies are grueling. Did you construct these portraits during or after your own residency?
When I was in my medical training, I thought I had given up writing. I had no intention of writing these stories. When residency was over, these things just started coming out. I write when confronted by what I don’t understand. Some of the things I found puzzling I think I have a clearer grasp of now, having written about them.
Do you think writing is a worthwhile pursuit for doctors in training?
I’ve been teaching writing workshops for interns and the demand is strong. It’s the most rewarding teaching I’ve ever done. [Medical students] have a strong sense of what matters and [which stories] need to be told; their ability to home in on that is breathtaking. And they tell me it’s invaluable—the insight into their own responses. The attempt to write about your own experiences is an extremely valuable tool, [revealing] yourself and what you’ve done in as clear a light as possible.
Are you ever inclined to write about the difficult politics of medicine?
I have tried. It breaks my heart... I see people desperately sick with illnesses that could have been prevented by primary care. And the conflict of interest for insurance companies... We don’t have a rational system of care. Instead, it’s a cruel system for denying adequate care.
You write that our bodies “remain the essential mystery we keep trying to solve.” How does that inform your relationship with your patients?
We’re all mortal, we’re all headed to the same end, and part of mortality is completely incomprehensible. That’s humbling, especially in a profession that prides itself on its knowledge. It also helps me to care for people; it’s a way not to judge and to get some sense of how it feels to be in someone else’s shoes. I don’t really know what empathy means, but I do understand sympathy and compassion. I think those are really an important part of what I bring to any medical encounter.