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Writer-in-Residence at a Hospital

koven_suzanne_9864_550w-1Suzanne Koven, MD, MFA is a primary care physician at Massachusetts General Hospital (MGH) and writer-in-residence for its division of general internal medicine. She received her B.A. in English literature from Yale and her M.D. from Johns Hopkins, as well as her M.F.A. in nonfiction from the Bennington Writing Seminars. She has written for many publications including the Boston Globe, The New England Journal of Medicine, and The Los Angeles Review of Books. She also contributes an interview column, “The Big Idea,” at The Rumpus.

I sat down with Dr. Koven to discuss her career path as a physician-writer, what it’s like being the inaugural writer-in-residence for MGH’s division of general internal medicine, and what advice she has for budding physician-writers:

V: What was medical school like for you, as someone who had majored in English in college?

Dr. Koven: I was recently doing a narrative workshop with a group of students who were about to start medical school or dental school, and I was telling them that it brought back some painful memories to be with them because the first two years of medical school were very hard for me. Virtually everybody else in my class had been science majors, and it was a snap for them. They were taking biochemistry for the second or third time, and I didn’t even know what it was. But I had this feeling that if I could dog it through those first two years and get to seeing patients, it would get better. In fact, not only did it get better, but I found that my background in the humanities really served me well. I was very comfortable communicating with people, I knew how to establish rapport, and those things came in very handy. This was years before the term “narrative medicine” was invented, and I think hearing a complicated story and plucking out the important themes in a way that I could communicate to someone else, the skills that you learn as an English major, really served me very well.

V: Did you expect that you were also going to be a writer as well as a doctor? How did that transition happen?

Dr. Koven: As I got into my late 30s, early 40s, and my kids were growing up, I started thinking about revisiting writing. My assumption was that writing was going to have to be on a parallel track to my career, that it wouldn’t really be part of my career. As I did more and more of it, I found that I really wanted to write about medicine, and I wanted to write about my patients. I wanted to write about the thorny issues that came up that made me uncomfortable. More and more, the lines between my clinical work and my writing work felt like they were blurring. For example, I would write something and I would be getting emails from advocacy groups for patients. Then a few years ago, one of my mentors here at MGH suggested that I might want to start running a literature and medicine monthly discussion group for staff, and now that’s grown into a really wonderful and robust program. There’s a tendency in these kinds of groups to try to stick with readings that are strictly about healthcare, but as the years have gone on, I’ve found out you can stray pretty far, because if something is great literature, it means it has something fundamental to say about human experience. And if it has something fundamental to say about human experience, it’s going to be of great relevance to healthcare workers.

V: While you were going through medical school or residency, did you keep a journal or keep up writing in some way? Or did you just kind of ignore that part of yourself until later?

Dr. Koven: I’ve never kept a journal, and no, I wasn’t writing, at all. But I have to say, I always enjoyed writing chart notes, probably more than most people. I wasn’t writing otherwise. That was the reason why in my late 30s, I started taking writing courses, because I knew if I didn’t have a deadline I wasn’t going to write. I started taking writing and literature courses at the Harvard Extension School in about 2000, and I got an ALM degree in 2008. Then I got an MFA at Bennington, where I was working with professional writers and people interested in writing or teaching professionally. From there, I was lucky enough to get into a position where I got regular enough writing assignments that I had a lot of deadlines—I highly recommend deadlines.

V: Did you have a community of medical writers?

Dr. Koven: I didn’t, but I’m growing one. There are wonderful medical writers all over the country and around the world, and social media has been a great way to connect with them. It’s not an enormous community, so I think mostly people have heard of each other and connected with each other. I do have a fantasy of creating a more cohesive community and having conferences and so forth. The other community I helped develop was at Harvard Medical School, where there was a gradual gathering of faculty interested in the arts and humanities: musician-doctors, writer-doctors, and artist-doctors. We all started meeting, first very informally, and then it grew and grew. We included medical students and started holding events. The dean just designated us as an initiative and so now we’re a formal entity. I don’t have a regular writing group, because that somehow feels overwhelming to me, but I do have a writing partner, who’s a biographer. She and I meet regularly and we exchange work, and we make deadlines for each other.

V: When you write a piece that mentions some of your patients, do you have a protocol of how to talk to them about it?

Dr. Koven: This is the number one question that gets asked of clinician-writers, and my policy is that I never write about a patient, even if it’s anonymous or even if I can change the details, without asking their permission. Often I show them what I’ve written before it’s published, because the idea of somebody seeing their personal story in print as a surprise is horrifying to me. Virtually 100 percent of the time, people are not only very cooperative, but in some cases they encourage me to write. Generally speaking, people want their suffering to mean something, and when I ask someone if I can write about their situation, they’ll say, “If it’ll help someone, I want to do it.” I think it does help people, since illness can be incredibly isolating, and I get all these interesting emails from other people who are going through the same things.

V: What do you think is the value of the literature sessions you lead for healthcare workers?

Dr. Koven: As I was telling this group that was about to start medical and dental school, they will quickly become exposed to something that’s called the “hidden curriculum.” The basic tenet of the hidden curriculum is a lie, and the lie is that we are somehow of a different species than our patients: we are less vulnerable, less emotional, less subjective, less influenced by our own personal histories and experiences. It’s true that we are professionals and have skills and knowledge that our patients don’t have, of course we do, that’s why they’re coming to us for help. But what comes out in these literature sessions is a tremendous sense of relief that it really is okay as a clinician to have human feelings, to get angry, to get frustrated, to get sad, or to feel joy. As I’ve said elsewhere, the magic of literature is that it has a way of creating a safe space. If you’re talking about a poem or a novel, that just provides an entry point that wouldn’t exist.

V: What advice do you have to current medical students or residents who are interested in some creative passion like writing, art, and want to follow that in addition to or part of their medical career?

Dr. Koven: Because this is a relatively untrodden path, there is no well-defined way to make this kind of career. There is no particular fellowship or specialty that leads you to this, so I think you kind of have to work from within and do what you want to do. The bad news is that there’s no prescription, but the good news is there’s enormous need, and the field is wide open.