Acting God

Is it what Doctors and Writers have in common?

Photo by Behzad Azandaryan Malayeri on Unsplash

This week, MG - a retired gynaecologist living in Australia – was in touch with me on Substack to ask why I think so many doctors turn to writing. And, perhaps because I was in the middle of reading Elizabeth Strout’s The Things We Never Say, a novel which engages profoundly with the idea of free will, I found myself wondering: Is it a control thing? Is part of what connects writers and doctors that we’re both unusually motivated by the desire to shape human stories.

Five years ago, I set off on a mission save my own life. It was a sweltering July like this one and I was exactly where I am now, looking out to sea from the old English beach house where we spend our summers. With its sky-blue A-frame and cosy bedrooms, wild mint in the garden and view out on the great, not-London emptiness of water and sky, there’s no place I love more. But I was stir-crazy that day, standing at the front gate, stiff overnight bag in one hand, car key in the other, reflexly flicking it in and out as I waited for my husband to get home and take charge of the kids, so that I could make haste to Liverpool. Never mind that it would be a six-hour drive in a car with no air-conditioning on a boiling hot day. In my mind, this was a journey towards my destiny, one I was determined to remain in charge of.

A few weeks earlier, I had received the alarming news that a previously benign heart condition I was almost certainly born with, had suddenly got worse. I’d had an inkling something was up, worsening palpitations and fatigue prompting me to a cardiology assessment outside of my usual annual routine. I guess I was hoping to be laughed off. What I didn’t expect was an echocardiogram report to land in my email inbox one afternoon, with no accompanying note of reassurance, stating baldly that the backflow of blood through my mitral valve was now ‘moderate to severe’ and that my previously normal-sized left atrium had become ‘severely dilated’. A phone call from one of the cardiology nurses a fortnight later was more cursory fact-dump than conversation: my case had been discussed in the multidisciplinary meeting, she informed me, and the verdict was that I’d probably need heart surgery in the next few years. In the meantime, I should get on with my life.

I interpreted her advice according to my nature. First, I read extensively on the pathophysiology of mitral valve disease and delved, as far as my non-cardiologist brain would allow, into the arcane guidelines on valve surgery. Next, I put my imagination to work: I imagined dropping dead suddenly versus perishing slowly from heart failure. I envisaged a future in which my four kids had to survive without their highly strung, nutcase mother. Finally, I conducted a quick audit of UK heart surgeons, narrowing my search until I landed on the one man I convinced myself had the right props in robotic and minimally invasive techniques to save my life.

I had no doubt my project was urgent. So when, having sent my clinical information to the heart surgeon’s secretary, she called to say a space had opened up in his clinic the following morning, I saw my chance. I would go to Liverpool, look this surgeon in the eye, and persuade him to fix my valve. Whole cities flashed past me that day as I drove the scorched ribbon of motorway towards my fate.

The next morning, a gentle middle-aged man welcomed me into his clinic room in Liverpool. He perused my scans and notes, and listened to me speak. He examined me thoroughly – how chuffed I was to be declared an ideal candidate for surgery! He acknowledged our shared clinical temperament and, in a manner which made me think the deal was as good as done, said he understood exactly why I wanted to be in charge. Then, calmly and kindly, he told me that he would not do what I had driven the whole way up there to ask of him.

In that moment, it was all I could do not to burst into tears, so abjectly did I feel my own powerlessness. But then something odd happened. As I listened to his rationale, the risk-benefit profile that didn’t yet favour cracking my chest open, and the standardised threshold for surgery which the guidelines insisted on, my heart-rate slowed. And when he reassured me that he’d be happy to be in charge when the time came, to reach his hands into my chest, stop my heart, and mend my valve, I felt myself accepting what had previously seemed intolerable. It was as if, by handing over to the desire to act God, I had become appropriately mortal again, a little abashed at how I’d just behaved for sure, telling this eminent cardiothoracic surgeon how to do his job, but also at peace for the first time in weeks.

Quite far through The Things We Never Say, Elizabeth Strout does something extraordinary. There we are as readers, totally immersed in her fictional universe, entranced by characters she’s painted so beautifully they feel like friends. And then, bam, in she steps with her authorial omniscience, dispensing a shocking set of flash-forwards which inform us exactly how and when her characters will die.

As doctors, we enjoy something of this mirage of superhuman power too. Multiple times in a clinical day, as we diagnose and treat, comfort and advise, breaking news bad and good, we find ourselves profoundly involved in other people’s dramas. But living inside a body is a completely different kind of reckoning. To be at the heart of our own story, ego constrained by its ineffable attachment to flesh that is vulnerable and mortal, is a constant, shocking reminder that, when it comes to the primary narrative of our own lives, we have surprisingly little control over what happens to us.

Sometimes this feels terrifying. But today, staring out to sea again, at a view made familiar by so many days and seasons they’re fast becoming a lifetime, I am calm. Nab tower blinks on the horizon, and my faulty, uncorrected heart beats steadily in my chest. I believe that the human ability to make meaning, over and over, is the best defence we have against the great unknown. And this magical faculty doesn’t belong just to the author ruling over her fictive world, or the doctor shutting down his computer after a day enmeshed in other people’s stories. It’s available to each of us, everywhere, and all the time. In a novel that changes the way we think, a new connection with a colleague on the other side of the world, the sound of a single note warming into a chord.