Category Archives: Dylan Blacquiere

The Gift of a Different Path

A guest post by Dylan Blacquiere

When I was younger, I dreamed of being a professional author. I dreamed, like many I knew, of seeing my name on placards in the book store announcing my latest signing, of getting invitations to the book talk programs on public radio, of being the next Robertson Davies or Mordecai Richler. An Important Author. The thought comforted me through some difficult times, and for a great part of my life, I thought of my studies and my career as the prelude to my Great Discovery. And I did write; I won some writing contests and managed to enter, and complete, the three-Day Novel Contest twice. A good start.

But there came a time when day-to-day life intruded, as it always does, and writing became just one of the many things that I needed to accomplish in any given day. My wife, who has similar aspirations of making a career as a writer, dealt with this by diving headlong into the Business – she set aside writing time each day, found contests to enter, and ultimately has found some success by getting some publications in anthologies. She knows that this will be her main career, and that with enough success and good fortune, she will be able to make a career as a professional author.

My greatest gift, however, is in learning that my path is different.

I’m struck by how many people start out with dreams like mine and who, like me, find that life gets in the way. It can be an excuse, of course. If the dream is strong enough, then one will find the time and the will to press forward. But sometimes there are extenuating circumstances. Sometimes you realize that a dream is not enough to carry you forward. In my case, I don’t want my writing to be my primary focus. I am also a stroke neurologist, and that demands time and attention if I want to be excellent at that role. Soon I will be dealing with all sorts of responsibilities and duties at work that are as important to me and to my aspirations as the name on the placard ever was. Other people face similar dilemmas, and others fall into the worst of both worlds – they neglect the one in favour of the other, and they end up tainting both. The pursuit of writing as a business takes discipline and focus and time, but so do the other things.

When I realized this, that being truly excellent at either of these goals would require a level of devotion that would harm the other, I knew that I had to make a choice, and I chose medicine. It meant that I had to give up the straightforward path to the dream I had when I was younger, and that I likely won’t be able to devote the time and the focus in the same manner as my wife does; nor will I see the rewards that seemed worth anything. There is a certain grief for that, and I can’t entirely shake the feeling that I’m justifying giving up in some fashion.

However, the more that I think about it, the more that realization seems like the greatest gift that I have received as a writer. Not everyone gets to be top of the charts, after all, and not every creative outlet needs to be in service of a career. Knowing my limits has freed my work to be more personally satisfying; when I do write, I can write knowing that it isn’t carrying my livelihood on its shoulders. I can explore other outlets for my creativity that fall outside of the traditional publishing model. There is a growing field of narrative medicine, studying how the way we tell stories leads to better health care, and I have started to explore this in earnest as part of my work in neurology. As well, health care needs good writing too; being able to write clearly and coherently about how medicine works makes me an ideal person to write things like blogs or newspaper columns that help people navigate the health care world that I know so well. And of course, there is always something to be said about writing for writing’s sake; the gift of just putting words on paper, even if for no one else than one’s self, is sometimes hard to remember when we talk about things like sales margins and promotional materials.

I’ve realized that I, personally, have to let some of those old dreams go. But that’s left me free to find other ways that writing can be a part of my professional and personal lives. I don’t mean to suggest that everyone needs to be a hardcore realist about it; for some people, taking the chance on becoming a professional author is the only way for them to be true to themselves. But for the rest of us, the realization that there are other paths, that the creative urge doesn’t have to lead down only the one road – what else can that lead to but self-awareness and contentment? It can be a gift to learn where your limits are, and it can bring with it another gift – learning where other roads can take you. I’m glad that I learned those lessons when I did. They aren’t for everyone, but for some of us, they are precious beyond compare.

 


DB (1)Dylan Blacquiere Bio:
Dylan Blacquiere is a fellow in stroke neurology at the University of Ottawa, soon to be a full-time stroke neurologist in New Brunswick. He has worked on research projects involving writing, metaphor and medicine, including an examination of how people who have survived cancer treatment use metaphor in telling their stories. He has published short stories in “In Our Hands”, an anthology of medical writing, writes a monthly newspaper column on life in medicine for The
 Northern Star Newspaper in Central Queens, PEI, and twice won the Cynthia Davis Writing Prize in medical school. He does have several writing projects on the go, but suspects they will be done in good time.

 

 

 

 

 

The Cunning Man

dylan2When I was younger, I had the fanciful notion that I would be a writer as well as a physician. Both of these were uncommon pursuits growing up in rural Prince Edward Island, and while both of these were viewed as fine goals, there were not many role models available locally for either of these. There was the kindly old family physician, of course, and he did in a pinch; in fact, it wasn’t until a significant chunk of the way through medical school that I decided upon neurology instead of family practice. But back then, I had an idea that his career would be someday my career. I would set out my shingle close to home and treat the locals. I had the idea that I would incorporate literature somehow into this-this was in the days before anyone had even thought of concepts like narrative medicine and patient stories-but I didn’t know how such a thing could happen. And I knew that I wanted to write things, perhaps even call myself a novelist, but I wasn’t sure how to make the two things fit together.

At the age of fifteen, I went to the local bookstore-I was already a voracious reader and spent my money there instead of on hockey cards, which was a Big Deal. While browsing, one paperback book caught my eye; the cover was a stylized portrait of a well-dressed man, a physician, holding a picture in front of him. But the picture was actually a chest X-ray, and the implication was that the sternum, rubs and clavicles were those of the doctor. Wound around the sternum, coiling between the intercostal spaces of the ribs, were two serpents, staring each other down in a semblance of the staff of Mercury associated with the medical profession.

The book was The Cunning Man, by Robertson Davies. The back cover told me that it was a memoir of a doctor’s life, and promised the story of a doctor who knew his patients’ souls as well as their bodies. This was exactly what the Fifteen-Year-Old Me needed, wanting to find a middle ground between my medical ambition and my interest in literature. I bought the book, and then spent the next several years buying every book by Robertson Davies that I could find. In the years since, I have constantly gone back to reread his novels, his essays, his letters, and they have always had something to say with regard to either-or both-of those worlds.

Many Canadian students know Davies through his Deptford trilogy; Fifth Business is required reading in many high-school English courses, though I was never so fortunate. His writing was very literate; you had to work to understand his stories, but if you did, you would be rewarded with the richness of his language, the depth of his characterization, and the breadth of his interests, everything from small-town theatre to Jungian analysis to academia. He could be wickedly, savagely funny, and he was not always kind, as many of the characters were thinly veiled composites of the pretentious and the stupid. But the writing was never preachy, or awkward; he was a writer who expected the literacy of his readers, and his readers, me included, were proud every time their efforts were rewarded with some sage bit of wisdom or some interesting jewel to share.

I devoured his novels, and even tried to ape his style in my own writing (of course it never worked!) but as I grew older I found more and more inspiration from his essays and his letters. Several books of essays and speeches were published after his death; in one collection, The Merry Heart, he published a speech he had given to medical undergraduates titled Can a Doctor Be a Humanist? This one went right to my heart’s core. He talked of how the truly great doctors didn’t just consult lists of symptoms or mindlessly offer pills, but took the time to listen, to let the patient’s symptoms tell the true story of what was happening. He also spoke of the background of the medical profession, and the mythology behind the staff we use as our symbol, and most of all how we can balance Wisdom with Knowledge to become a truly great humanist physician.

He died shortly after I discovered him-one of life’s many small cruelties-and so I have been left sifting through his writing and the words he left behind, knowing that there won’t be any more, but still finding jewels of inspiration every time I read his work. There have since been many role models, literary and medical, but none have bridged those two worlds so successfully. I am still very early on my path as a physician, and I am still trying to find a way to have literature and writing be a part of that journey, but I can say with conviction that had I not found that book all those years ago, I would not be half as good at either of those things as I am today.

The Art of Writing Medicine – Good Medicine

The trick to writing good medicine is starting from what makes sense. There are all kinds of medical mistakes in fiction that get laughed at by those in the know; these tend to go beyond the big ones, such as people walking away from getting CPR, even in the field. I recently watched a movie where a main character had what was called “heart failure” without so much as a cough or a wheeze; they collapsed quietly to the ground and when a monitor was placed on their chest (without exposing the skin, of course), it showed the heartbeat still in a lovely sinus bradycardia, slowly cycling down to zero with the big flashing green numbers growing ever smaller. What did the paramedics do? Chest compressions. No atropine, no external pacers, nothing. Of course the CPR (and a kiss from a lovely woman) brought him right back, at which point he began chasing the bad guys straightaway without so much as a warning from the paramedics that a trip to the nearest cardiology ward might be a bright idea.

Now I’m not saying that one must be a cardiology expert in order to bring a bit of high stakes medical peril into the story, but you do have to have a vague idea of what you are talking about. To continue the cardiac arrest example, only five to ten percent of out-of-hospital cardiac arrests without external defibrillation survive, and even then, survival involves rapid transport to the nearest emergency room with blasts of epinephrine, a search for the cause of the cardiac arrest, and often times a prolonged hospital stay involving deep sedation and therapeutic hypothermia. You could avoid those things for the sake of your story, perhaps, but it would be nice to at least recognize of the seriousness of the event. In the end, of course, it all boils down to doing research and asking for help, if needed and available.

This rule usually applies most when dealing with fiction that takes place in the early twenty-first century with human patients as characters; the rules become more complicated when dealing with fantasy or science fiction settings. George RR Martin’s A Song of Ice and Fire does a great job of dealing with the nasty complications of unsanitized wounds in a medieval setting, and even obliquely references characters having epileptic seizures and inflammatory conditions such as gout, all in terms that make sense given the feudal setting. Many science fiction authors do amazing work in plotting out the various biological facts and medical needs of various alien species or evolutionary offshoots, usually taking off from known species and medicine that we are familiar with in our day-to-day lives and extrapolating from there. But these different styles and genres have that starting points from the well-established medical canon, and then letting the needs of the story take over. One of my favourite writers, who is also a good friend, has characters in her work with plant-based biology, and every time she talks about chloroplasts and carbon dioxide I start to smile. I also forgive any small errors, being in a much more charitable mood after seeing her work earlier in the story.

By now you may be detecting a theme in these posts, and that’s fair. It all comes down to doing your research, knowing (or having a fair idea of) what would happen medically in any given situation, making adjustments for the time and the place that you’re working with, and then deciding how much license your story needs to take with those elements. These really isn’t much point in trying to be pedantic; example above notwithstanding, most people don’t know the elements of advanced cardiac life support and will overlook or forgive most errors. But you don’t have to be exhaustive in order to have at least a partial grasp, and it’s always better in your research to consciously decide to leave details out than not to be aware that they exist in the first place. Even if you’re going the full-out fantasy route and plan to have your healing be with magic rather than moxifloxacin, it’s still not a bad idea to have an idea of what would happen in the medical realm and then figure out a way to have your healer’s spell do the arcane equivalent.

So, do your research, make your adjustments (if the situation calls for it), and don’t overwhelm readers with details – you’re not trying to write a medical textbook, after all! Keep it plausible and grounded in realism, or at least with realism as a starting-off point, and you should avoid the worst of the errors, such as a kiss doing what atropine could not.

The Art of Writing Medicine – Writing Doctors

Irony of ironies, my series on the art of writing medicine has been unavoidably delayed these past couple of months by having to write my own board exams. I’ve passed, which makes me a fully qualified neurologist. It’s a tremendous thing to be able to say that, after four years of medical school and five years of residency; it also gives me some weight on what a credible physician character can be.

I have talked in past entries about how easy prey physicians are for cliché in fiction. To some extent, that isn’t surprising, as doctors and physicians are stock characters that show up regularly in genre work, often as a simple background fountain of exposition, sometimes as a noble, compassionate hero who starts her day reciting the Hippocratic Oath over her morning coffee. Sometimes the reverse happens, and the doctor is secretly an evil character who conducts unethical experiments or is involved in a vast conspiracy (often with a pharmaceutical company) for no other reason than the money. Take a look at any science fiction story or television show; odds are high that there will be an episode or a segment where the doctor struggles with healing the enemy, or where an unscrupulous physician is called out by a morally sound one on a violation of ethics. Money or research prestige is usually at stake, with justifications about it being for the good of science. It’s usually a surgeon, too, which makes my physician’s heart calcify with jealousy.

That isn’t to say that these tropes are always bad, but they can descend quickly into cliché. They’re easy to fall into as well, and it happens when the medicine takes over from the character.

So how to avoid the slide into cliché? The easiest answer is to write true characters who happen to be doctors, and many other posts have talked about how to write good characters in your story. Here are a few other pointers, though, which may help the next time you have a doctor among your cast.

1. Not every doctor is a bloody surgeon or emergency room specialist. Sorry, that may be my own pet peeve. But pity the poor internist, or family doctor, or geriatrician. It’s been a fond hope of mine to see a physician-hero who happens to be a radiologist someday. But in all seriousness, the practice of medicine is wide and varied, and not every doctor goes to the operating room or runs a trauma code.

2. Do some research into the training. For the most part, it takes at least six years of schooling after an undergraduate degree to become a doctor, yet it’s not uncommon to see preternaturally gifted doctors in fiction that went to medical training straight out of high school. That doesn’t happen, and it strains credulity to have your doctor too young.

3. Not every doctor does everything. The moment House lost its magic for me was when Alison Cameron, nominally an infectious diseases specialist, was the lead on a brain biopsy, which requires years of neurosurgical training. Some doctors are able to do many things in many different fields; these are generalists, like family doctors and general internists. Having your trauma surgeon show a sudden expertise in managing a heart attack or a stroke – that doesn’t happen. If you need your doctor to be able to do a specific thing, then plan that as you create your character – or have them acknowledge that they’re out of their depth if the situation calls for it.

4. There is life outside of the hospital. We do more than see patients; we teach and research, we shop for groceries and mow the lawn, we get flat tires and go to the bathroom. Keep in mind that doctors are human beings and that having sworn the Hippocratic Oath doesn’t take away from all of our other needs and secrets. Write your doctors as human beings, and make them more than just their profession.

5. The same tricks apply even if your physician is just a means for exposition. Having some hint of a back-story can help make the difference between a piece of furniture delivering dialogue and a good minor character that helps to flesh out the world that you’ve built.

6. As with any aspect of medicine that you write, read up on the medical science. If the doctor you write doesn’t know what he’s talking about, it’s going to show.

There actually aren’t many other tricks to writing physicians that don’t apply to writing people from other professions or occupations. The bottom line is that medicine is an occupation, not a character description, so you’re going to need more than that to flesh them out. Done poorly, doctors in fiction can stand out as tired clichés, but done well? Many of the greatest works of fiction have had physicians as strong characters. Maybe yours will be next.