Writing is the Least Squeaky Wheel
Christine Montross, MD, MFA is Assistant Professor of Psychiatry and Human Behavior and the Director of Counseling Resources at the Warren Alpert Medical School of Brown University, and a staff psychiatrist at Butler Hospital. She received her undergraduate degree and her MFA in poetry from the University of Michigan, where she also taught writing classes as a lecturer. Once she decided to go into medicine, she took post-baccalaureate pre-medical classes, then attended Brown University for medical school and residency training. In addition to writing poetry and writing for national publications, Dr. Montross has published two books and is working on a third. She wrote her first book, Body of Work, while in medical school. Body of Work explores the experience and emotions of anatomy lab dissection. Dr. Montross received funding from her school to conduct summer and year-out research on anatomical theaters in Italy and the history of anatomical dissection in Europe. She has also written a book exploring patient encounters she had in her early years as a psychiatrist, called Falling Into the Fire. Now, Dr. Montross is working on a book about mental illness and the criminal justice system. She is a 2015 Guggenheim Fellow in Nonfiction.
I was able to meet with Dr. Montross when she attended the University of Pennsylvania to give a lecture to my doctoring class. She also led a writers’ group session with the Penn Med Writers, where we discussed writing and wrote freely in response to a serious of prompts allowing us to reflect on various experiences in medicine. Dr. Montross and I spoke about her path to writing and medicine, how she has molded a unique career for herself, and how to find time and energy to write even when it’s the “least squeaky wheel.”
V: What were the things that made you want to be a writer, and after that, what made you want to be a doctor?
Dr. Montross: I had been a writer as long as I can remember. I can’t remember a time when I didn’t love to write and when I didn’t use writing to try to make sense of the world. I did an MFA in creative writing after college, and that part of my identity was very established. It actually surprised me when I decided I wanted to go to medical school. I had been teaching high school English in the San Francisco Bay area and had been working with a group of very troubled kids, and dealing with many of the psychosocial stressors that the students were experiencing. I found that I was much more interested in that than in the English teaching work that I was doing. So that really prompted the decision to go into psychiatry, but I had done no pre-medical classes. I started taking chemistry at night after my teaching job, and then I did a post-bac year. To me, writing was always there, and medicine joined that path, but there were many years when I never would have dreamed that medicine was in my future. What I underestimated was that there’s so much in medicine that really needs to be written about, and I was going to need to write about it to make sense of too.
V: In your book, Body of Work, you write that you used to write a lot after anatomy lab, when you’d come home in the evening and that was how you would unwind. Was that intentional—was it something you decided would be therapeutic for you?
Dr. Montross: I think it was honestly just more reflexive. When something is gnawing at me or when I am troubled by something, that is just what I’ve always done to try to make sense of it. Some nights I would come home from anatomy lab and write just a couple of words or a couple of lines, it might be something like “head pulled out of a bucket,” you know, something I just really needed to get down. Other days, I would have the time, inclination, or need to write pages and pages. And some nights not at all. It wasn’t that I had a routine practice where I would come home and write methodically, it was just that the journal became a receptacle for me for what I was thinking about.
V: I know you took a year off between your third and fourth years of medical school in Europe doing research for the book. What was that like?
Dr. Montross: My wife is a playwright and she had received a Fulbright scholarship to go to the Abbey Theatre in Dublin. In retrospect it seems so clear, but at the time I kind of panicked. I thought, “I can’t take a year off in medical school, what about my clinical knowledge, what about the path, how is this going to be viewed by residency programs?” I had this nervous response, but the reality was it was so wonderful. That year really became a year in which I had time and space to do the bulk of the historical research on Body of Work, so it was personally fulfilling, intellectually engaging, and restorative. I came back refreshed for my fourth year, and it gave me an opportunity when I was asked about my year off during residency interviews to talk about the scholarly work I was doing. I think they got excited by what I was doing that differentiated me from other applicants.
V: I also thought it was interesting in the book you say your wife had thought she was marrying a poet, and didn’t bargain for being married to a medical student and eventual doctor. I thought that was so funny, and I was wondering if you could talk about whether you felt your identity, or at least how others perceived your identity, was changing?
Dr. Montross: Definitely. I had previously done an MFA program in creative writing, and people make certain assumptions about that. You’re a poet, so everyone assumes you wear a beret and have a long cigarette. I went from feeling perceived that way to feeling perceived as highly conventional, and also smart. It sort of made me mad about how people view poets, because suddenly people viewed me as smart, even though I’ve always been the same person. It’s interesting that just the shift in career makes people assign intelligence differently. There’s also a culture in medicine that’s different. Deb and I always laugh because she’s a playwright and she teaches in the MFA theater program at Brown, so when we go to each other’s events, the rooms are full of really different kinds of people.
V: I know you had mentioned yesterday at the writers’ group the pressure to produce academic work, and the variable respect the medical community has for writing aimed at the greater public, like opinion pieces in the popular press. How have you managed to retain your core of what you want to do and still be in the academic setting?
Dr. Montross: I’ve been fortunate that Brown values the work that I do, though it’s taken some conversations because I don’t fit neatly into a category. I think what they really care about at the end of the day is quality and the rigor of the work, and less about it being exactly what other people are doing. I also think truly from a priority standpoint, it’s more important to me to do the writing that I want to do than to fit neatly into an academic trajectory. I’m fortunate that it has not come down to choosing one over the other, but I think it’s been really clear to me all along that I’m most committed to writing the things that I want to write about. I think there are schools that would have said, forget it then, we need you to meet these criteria, and I think I wouldn’t have been a great fit for those schools, but fortunately Brown has not given me that ultimatum.
V: What is your greatest challenge in writing?
Dr. Montross: This has probably changed over the years, today I would say email. I think that writing, for me, requires space and attention, and its hard. So when there are interruptions, writing is the least squeaky wheel, and there are all these other things that need to be done, people who are waiting to hear from you, and things that you need to respond to. Not only are those squeaky wheels, but they’re also often easier to deal with than sitting down to a blank page and writing. I think that I’m constantly trying to find ways to push back against other squeaky wheels, and instead really give myself the time and the space that’s necessary for writing.
V: What advice do you have for people who are trying to balance a creative pursuit with medicine?
Dr. Montross: I really think that medicine in general is a perfect example of that most squeaky wheel. Medicine constantly places demands upon you and really takes everything that you’re willing to give to it. I think you have to take the long view and look at the kind of physician that you want to be. If you want to be a physician who composes music, is in a dance class, writes, or paints, I think you really have to start practicing being the medical student who does those things. Because when you kick that stone down the road, it becomes really easy to continue to kick it down the road. And then suddenly you haven’t painted in ten years and then you’re bad at it again, and it’s hard to have the incentive to get back into it. One of the major educational goals of medical school should be learning how to be the physician who you want to be, the one who cooks meals for yourself and attends family weddings and still knows enough medicine to be a really responsible doctor.