two stories

Last week I got to talk writing with a dozen smart medical students, all with writerly inclinations. I’m a believer that writers learn best from what they read, so I’d asked the students to look at two short narratives, “The Unknown Assailant” by Frank Huyler*, and “Sudden Death,” by Emily Transue**, both of which describe the inner life of young physicians.

Huyler, an emergency physician, grapples with the discovery that he’s taking care of an accused murderer. Among the students there was much appreciation for Huyler’s storytelling skill — spare sentences and images, effective use of minor characters — and though he never overtly tells you what he feels, you’re sure of it by the end.

Transue’s story, about an elderly man who codes and dies unexpectedly, explores the moment a physician comes to understand she can’t always exert perfect control over a patient’s outcome, that people may still die regardless of how well she does her job. In contrast to Huyler, she tells you exactly what she’s feeling. And the writing is just as effective because it’s so clean, unaffected and honest — she doesn’t try to sound like a writer.

For those who write medical narrative, there’s lots to learn from these two very fine stories.

*from The Blood of Strangers, Holt, 2000.
**from On Call, St Martin’s Press, 2004.

onwards

Health care bills are slowly making their way through both chambers of Congress. Last night the House passed a $1.1 trillion bill that would insure an additional 35 million Americans. Importantly, the bill makes it illegal for insurance companies to deny health insurance to those with pre-existing conditions, or to cancel your policy if you develop an expensive disease.

The House bill also calls for a ‘public option’, or government-sponsored health plan available for individual purchase. This isn’t thought likely to survive a Senate vote.

While I was being interviewed on XM Satellite’s Book Radio last week, a caller expressed dismay at the proposed level of government intervention in health care. I sympathized with his point of view. While writing House of Hope and Fear I learned that Seattle’s public hospital, Harborview, remained financially healthy in spite of very little government funding. How? Partly because the hospital needs to compete for business with every other hospital in town. Public hospitals operating primarily on the dole don’t do nearly as well.

But the free market isn’t a cure-all. Private sector success has increasingly come from excluding sick people from needed health care. Nearly one in six Americans is now inadequately insured, or not insured at all, and the problem is only growing worse. No doubt health care reform will be expensive. But doing nothing could cost even more. We pay for universal health care now, and in the priciest way possible — through our Emergency Rooms. This year’s health care bills won’t solve all of our problems, but they look to be a reasonable start.

a local review

Check out this latest review of House of Hope and Fear: Life in a Big City Hospital, which was published in today’s Bellingham Herald.

homeless in alaska

Dan Sullivan, Republican mayor of Anchorage, Alaska, recently announced that he’s hiring an executive staff member to reduce chronic homelessness. Check out my editorial supporting his plan, which was published in today’s Anchorage Daily News.

what obama wants

During last night’s speech, President Obama finally proposed a few concrete ideas for health care reform:

-Insurance companies could no longer exclude certain individuals from obtaining coverage; lifetime maximums would become illegal.

-Small businesses and other uninsured individuals could obtain insurance at reasonable cost through co-ops or exchanges.

-Individuals would be required to obtain health insurance or face a penalty. Businesses would be required to provide insurance for employees or pay a fee.

-A public insurance option could be used to spur competition in markets dominated by a few insurers, but is not a requirement for the final bill.

-There would be a cap on health care spending. Excessive spending would trigger automatic Medicare cuts.

-The $900 billion price tag would be paid for by savings gleaned from reducing waste in the current health care system. The final bill would be deficit neutral.

the speech

President Obama gives his big health care speech tonight. Be there.

reading at elliott bay books

I love author readings at Elliott Bay Books. The reading space is on the lower level, behind the cafe, and when I was a medical student I would take a break from studying and head down there to listen to writers read from their new books. Among those I heard read was Ethan Canin, whose marvelous book The Palace Thief had just come out. Canin is a physician who writes full time now and teaches at the Iowa Writer’s Workshop.

While signing my books, he talked about how the intensity of medical practice could inhibit creativity, and he advised me to take long stretches of time away from medicine to write. “The imagination is such a fragile thing,” he said. Partly because of his advice, I took a year off after finishing medical school. That’s when wrote my first book, What Patients Taught Me. I’ve also incorporated his advice into career choices; it’s one reason I opted to practice medicine as a part-time hospitalist.

So, no surprise, I feel a strong connection with the author space at Elliott Bay Books, and I had a wonderful time at my own reading there last week. It was terrific to see familiar faces not only from Harborview, several of whom figure prominently in the book, but also from other times and places in my life.

In case you missed it, the reading aired on KUOW 94.9 FM on August 27, 2009. Here’s the audio archive.

the week in review

Yesterday, driving through Seattle’s Eastside, we spotted a minivan with this scrawled across the rear window: “No Government Health Care!” And that’s fairly civil when compared to the general tone that has infected health care reform efforts of late. Extremists have ignited rumors about government- sponsored “death panels” and are showing up at town hall meetings packing heat. People are comparing the government’s efforts to expand health care benefits with Nazism.

The level of confusion and misinformation truly amazes me. For one thing, it’s about forty years too late for no government health care; the government insurance programs Medicare and Medicaid now cover about 1 in 3 Americans. The question is how to manage the unsustainable growth of these programs; Medicare may go bankrupt in the next dozen years without serious intervention.

And we desperately need serious public dialogue on end-of-life care, not sound bites about ‘death panels’. Most of the patients I take care of — and believe me, they’re not all liberals — desire dignity and comfort at the end of life and not the intensive, life-prolonging efforts that are the current default. The latter are incredibly expensive, generally futile, and not very pretty to watch. That’s why you’ll often hear providers describe such efforts as ‘floggings’.

As for Nazi health care, Robert Proctor’s Nazi War on Cancer (Princeton University Press, 2000) describes Hitler’s efforts to provide superior health care in the service of a superior race. If parallels can be drawn to our current situation, I’m not entirely sure how.

the bestseller list

Good news — the House of Hope and Fear debuted at #12 on this week’s Pacific Northwest Indie Bestseller List!

book news and events

It’s been a busy seven days. Last Friday just as House of Hope and Fear was arriving in stores, I drove to Olympia, Wash., for an appearance at the Barnes & Noble there. I read from several stories, including one about a woman who delayed medical attention because she lacked health insurance, and became extremely ill. This ignited a terrific discussion with the audience about health care reform.

This past Tuesday I went on the local NPR affiliate, KUOW 90.3, where the advertised topic was life in a big city hospital, but what we really talked about for most of the hour was — yup — health care reform. Also on the show were an ER physician and an ER nurse, who see firsthand how bad it is for patients with no health insurance.

Tonight I’ll be reading at my favorite bookstore on the planet, Elliott Bay Books, where House of Hope and Fear has been selected as a staff pick. KUOW radio will be taping the event to air at a later date. I’ll tell a few stories, then open up the floor for Q & A. Got something to say about health care reform? I’m ready. Bring it on.