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Geriatrician, Writer, and Patient Advocate

Louise Aronson, MD, MFA is Professor of Medicine at the University of California San Francisco (UCSF) where she cares for frail older adults in the Care at Home Program and directs the Northern California Geriatrics Education Center and UCSF Medical Humanities. A geriatrician, Louise received her medical degree from Harvard Medical School and completed an internal medicine residency and geriatrics fellowship at UCSF. She also holds an M.F.A. from the Warren Wilson Program for Writers. Her writing has appeared in the New York Times, Narrative Magazine, the Bellevue Literary Review, the Lancet, the New England Journal of Medicine, and the San Francisco Chronicle, among other publications. Her first book, A History of the Present Illness, was a finalist for the Chautauqua Prize and the PEN America Bingham award for best debut fiction.

After reading Dr. Aronson’s book and following some of her insightful pieces online and commentary on twitter, I reached out to her to hear more about her path to being a physician-writer, why she chose geriatrics, and what advice she has for students and residents.

Vidya: What was your career path to writing and medicine?

Dr. Aronson: I think I was always interested in writing, I just loved stories—my mother had me reading from a very early age. In high school, I actually felt like I wasn’t good at math, and I wasn’t interested in science. I really spent a lot of my early years trying to create workarounds to math and science, which at the time I thought were completely irrelevant to my life and my interests. And then I went on to college at Brown, and I thought I might do English or literature or something like that, but there were all these very confident New York people wearing black and who completely scared little California me, so I ended up doing history and an independent major. During college I started working with refugees in Providence and then on the Thai-Cambodian border, and I thought, I could be a teacher, I could be a social worker. In the group I worked in, with social workers and nurses, once a month for two hours the doctor would come in, and he would get to make all the big decisions. And so I thought I should be a doctor so I can do the essential day-to-day work and make the big decisions. So I went back to school, and started taking all the math and science courses I’d been avoiding for a long, long time.

Vidya: Did you do a post-bacc or were you able to fit it into your undergrad courseload?

Dr. Aronson: I came around to this realization at the end of undergrad, and I signed up for a physics course and on the first exam got 4 points out of 40! I went to the premed advisor and he said, well, you can go to extension schools to take more preliminary math and science classes. And then he said, “If you can get into the Bryn Mawr Post-bacc program that’s a really good program.” So I ended up doing algebra at Rhode Island College, and then I went to Bryn Mawr.

Vidya: When you made the decision to go into medicine, were you thinking at the time that you would be able to keep writing?

Dr. Aronson: Writing felt really risky in undergrad. Medicine is hard, but the next 12 years of your life are basically determined, and you can get a job with a good salary with health insurance and all these things, and you can do good work for people. And it just seemed so much more straightforward, and so I kind of just let writing go. There were people who wrote—I was co-residents with the poet writer-physician Rafael Campo, so I had daily evidence that a person could be a fantastic writer and a resident. For me, it was hard just trying to get through residency, and be a good doctor, and that was really about all I could handle at the time. As I came to the end of my training, I realized these parts of me that were so important to me, defining who I thought I was in the world and what I valued most, had just atrophied. And yes, I had acquired some incredible skills and experience along the way, and I don’t want to slight that in any way, but I missed these parts. As soon as I finished fellowship, I went on a vacation, I adopted a dog, and I signed up for a writing class through the University of California extension school. That just started me writing, and as I started to do it I remembered how much I loved it. I realized how bad I was at it, at the time, after not working on it all those years, but also that I was filled up with incredible stories from all these years of being in really intimate relationships with people who I would not have otherwise known, at such a key moment in their lives. If medicine is me one-on-one in a room with a patient, then my writing might be more akin to public health, where it will tackle the bigger issues and the population in a larger way.

Vidya: I know a lot of physician-writers who write differ in how they find the time to write, and the format in which they write. Do you have a specific schedule? Do you keep a journal with you?

Dr. Aronson: I have to say it varies, and I think there’s probably not one strategy that will work all the time. We’re busy people doing hopefully important work, and sometimes you don’t get to write. For me, I sometimes have phases where I’ll get up early and write. I’m more of a morning person than a night person, and I love writing then in the quiet. Doing it that way, an hour here and there, can take a long time. I’m currently writing a new book, and taking some time off actually to just focus on doing that, which is amazing, because if it’s a longer work, it’s hard to get your head into the piece in little snippets of time and so much easier if writing is your job, at least for a while.

Vidya: What is your new book about?

Dr. Aronson: My new book is about aging. It’s nonfiction, but what I’m hoping is that it will read like a really good novel, that it will do for aging what Atul Gawande did for discussing death, in Being Mortal. I hope that people will enjoy reading it and then put it down and realize that they’re thinking and feeling differently about aging than they ever have before.

Vidya: What made you most interested in geriatrics?

Dr. Aronson: If you’re interested in stories, or if you’re interested in medicine primarily because of people, it’s one of the great specialty choices for that, for two reasons. One, these people have been around for a while, and have a long history full of great stories. The other is, as a patient grows into very old age, you really have to know who they are and who their family or other support is, and what they value, to make their treatment decisions. You can’t just treat the disease, you really have to treat the person. Finding out and forging those relationships really becomes as important as knowing the science, and I really like both. The other thing is, I could see how we were sort of routinely and systematically harming old people, and that ageism was so widely accepted. There was this structural prejudice that I rebelled against, and because it exists, there was – an still is – a lot of opportunity to make change. Geriatricians are so happy and enthusiastic to do what they do, so I thought, why wouldn’t I want to be happy and hang out with people who are enthusiastic?

Vidya: What’s your advice to residents or students?

Dr. Aronson: I would say two things. One is, whatever you can do to manage your life that makes your life better, not worse, do it and let it be enough. The most important thing is to learn how to be a good doctor, be happy, healthy and have a life, and to do as much creative stuff as you need for sustenance. Know that eventually, life will open up and give you more breathing room. I think people need to cut themselves some slack if they don’t write as religiously as they used to before medicine and certainly while they are doing the very hard thing that is medical training. But also, especially for the writers, if you spend even five minutes a day writing down what happened, especially in third year, and residency, that will help you later because how you think and feel changes so much. You think you’ll be able to remember how you felt then, but you won’t. So just write some of that down, and it’s okay if you don’t even look at it. It could sit there for years, but then you will have this treasure trove, this window of yourself into the past, that will be really helpful and interesting.