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Physician Novelists: At the Intersection of Writing and Healing

William Pomidor, M.D., credits his medical training for enabling him to create nearly untraceable murders that confound even the most assiduous homicide investigators. It was when the physician-turned-author first tried his hand in the murder mystery genre that he says he realized he had a "real talent for bumping people off."

Dr. Pomidor is the author of a series of mystery novels in which the physician husband/wife team of Plato and Calista Marley, he a geriatrician and she a forensic pathologist, are thrown into the midst of homicide investigations that require their medical know-how to solve.

Bill Pomidor, M.D., wroted a series of mystery novels starring a husband-and-wife team of physician/sleuths.

"There is a real parallel between mysteries and medicine," says Dr. Pomidor, "between the solving of a murder mystery and the clinical problem-solving process. So it didn't seem like too much of a stretch for a pair of doctors to use their medical skills to solve mysteries."

With a "write what you know" philosophy, Dr. Pomidor has published five "Cal and Plato Marley" mystery novels since 1995, in addition to numerous short stories. It didn't take long after his own medical training for Dr. Pomidor to discover that he was more cut out to be a novelist than a family physician.

While serving his family practice residency, he became disillusioned with what he perceived as the increasing inability of physicians to maintain their own independence, career direction, and self-determination. The sheer amount of paperwork that accompanied managed care also seemed to Dr. Pomidor to take away from the physician-patient relationship.

"I was afraid I would be spending half of my time conducting the business of medicine rather than actually spending time with patients," he explains. And so in 1987 Dr. Pomidor made the decision to trade in his stethoscope for a writer's pen. "I think having a medical degree in some strange way gave me the confidence to try something different," he says.

"I also had the advantage of having a very wise, older, experienced sage of a residency director. He really counseled me about what I wanted to do with my life and how I should pursue my dreams. Leaving medicine was a tough decision, but I never really regretted it."

Making the switch

Dr. Pomidor's medical training has served him well in his newly chosen profession. He frequently calls on his days as a student and resident to bring attention to both the plight of economically threatened academic medical centers and the physicians who work in them. Both Plato and Cal are department heads at the Cleveland Medical School, where they wrestle with a lot of the issues that Dr. Pomidor says were factors in his decision not to pursue a medical career.

Dr. Pomidor's real-life geriatrician wife also adds to the authenticity of his novels, in which Cal Marley wrestles with the multiple demands of being a woman academic physician. "Putting my wife and me not literally into mysteries, but into a couple of characters who are physicians, has allowed me to incorporate my concerns about modern medicine into my stories," Dr. Pomidor says.

The mystery author explains that he often attempts to dispel many of the "myths and misconceptions" about doctors that his largely non-medical audience holds. "Something that struck me during my training is that the mere putting on of that white coat engenders feelings of respect in a lot of people, but also some hostilities, some envy, and some misunderstanding," explains the author.

"There are an awful lot of myths about doctors being these snobby, wealthy people who live half their lives on golf courses, and I wanted to dispel that." To do so, Dr. Pomidor cast his two main characters as "a pair of struggling young doctors saddled with gargantuan student loan debt, and not making a ton of money in their practices. They live the middle-class lifestyle; they're ordinary people."

In his novel Ten Little Medicine Men, Dr. Pomidor takes on the plight of the struggling academic medicine center, torn between the pressures of profitability and competition on one hand and its responsibility to care for indigent and non-paying patients on the other.

"So the novel has doctors and nurses and some administrators facing off against a somewhat hostile takeover by one of these healthcare group mega-corporations that is trying to 'streamline' the delivery of patient care to make it more profitable," Dr. Pomidor explains. "This is a dangerous concept, because once you introduce the profit incentive, the prime motivation is no longer optimal health care."

Writing as catharsis

Dr. Pomidor is one of several physician authors who use their art to address misconceptions about and abuses within the medical profession. Perhaps the most notorious is Samuel Shem, whose 1978 novel, The House of God, has become a cult classic among medical students who are alternately amused and horrified at the abuses of power witnessed and endured by the novel's six interns fresh out of medical school and in their first year of training.

Stephen Bergman, M.D., Ph.D., pen name "Samuel Shem," made waves in the academic medicine community with his first novel, The House of God.

Although these abuses of power more often than not border on the outrageous and have thus been characterized by many readers as satire, Shem, the pen name for psychiatrist Stephen Bergman, M.D., Ph.D., resists that classification.

"I write my novels in an attempt to be authentic to my experience," explains Dr. Bergman. "If people want to call them hyperbole and satire, that's putting a label on them that I don't use. A lot of the situations that people think are either fictional or stylistically insane are actually in fact what happened. I think people underestimate the inhumanity and farce that happens in some medical training. Some of the most appalling things in The House of God and Mount Misery [The House of God's sequel] are actually autobiographical."

Dr. Bergman, who says he partly chose psychiatry as his specialty because it gave him his mornings free for writing, has authored several other novels, plays, and some nonfiction in his writing career. But it is The House of God, which has sold over two million copies and has been translated into 20 different languages, and, to a lesser extent, Mount Misery, which follows HOG's protagonist over the course of his first year of a psychiatric residency, that have made Shem/ Bergman an instantly recognizable name among many medical students and practicing psychiatrists.

Dr. Bergman says he began writing The House of God as a kind of "catharsis" to get over his own intern year. When the novel was published, the author had grave misgivings about its reception. "I thought, 'Oh my God, what have I done?' " Dr. Bergman recalls. "It was pretty strong stuff; it's still pretty strong stuff. So I was really scared at that point. But in time I was pleased with the way it came out. I wouldn't change anything about it."

The success of The House of God emboldened Dr. Bergman to continue to use fiction as a vehicle to depict what he perceived as substantial abuses within the practice of psychiatry. "I never expected anyone to pay attention to The House of God, but they did," he says. "So I went into Mount Misery saying, look, I have a bit of a forum now, people might really read this book, so I'm going to lay it out the way it really is. And I did."

The author explains that he wrote Mount Misery and much of his other fiction to capture what he calls "hey, wait a second" moments. "These are the moments we all have every day when we think, 'Hey, wait a second. Why am I doing this? What's going on here?' " explains Dr. Bergman. "When those moments pile up to a certain threshold, I get really motivated and think, well, somebody's got to write about this. So why not me? This was especially true for Mount Misery, which I wrote to address the pitiful state of psychiatry in America at that time."

Dr. Bergman says that medical training has improved since the days of The House of God and Mount Misery in that there is now a better appreciation of the "humanistic" side of medicine. He also cites the entrance of more women into the profession as having changed many of the sexist attitudes depicted in the two novels and credits women with helping usher in the practice of patient-centered care.

On the other hand, says Dr. Bergman, the "worst" thing that's happened to medicine within the past 20 years is the domination of the "managed care" model, under which, Dr. Bergman says, patients do not receive optimal treatment.

Now at work on two new novels that Dr. Bergman says are his first departures from the subject matter of medicine, the author says that the "shabby treatment" he endured from colleagues after the publication of The House of God has abated.

"In general, my colleagues reacted with a resounding silence, which is typical of psychiatrists," Dr. Bergman recalls wryly. "But they would often convey their attitudes about the book by canceling commencement and other speeches that students would ask me to deliver - although by now I have given something like 70 commencement speeches at medical schools over the years."

Other people's stories

While Drs. Pomidor and Bergman were inspired by their medical training and practice to take up the pen, Perri Klass, M.D., recalls writing "as far back as I can remember, certainly since elementary school." It was when she became a medical student that her subject matter began to reflect her medical training and, later, pediatric practice.

The author of short stories, novels, nonfiction, and personal autobiography, Dr. Klass has made a name for herself both within and outside of medical circles. A five-time O. Henry Award winner, her stories have reached large audiences in publications including the New York Times Magazine, the Washington Post, the Boston Globe, Parenting, Vogue, Ms., and others. In addition to her writing career, Dr. Klass practices pediatrics at a Boston health center called the Dorchester House, is an assistant professor of pediatrics at Boston University School of Medicine, and is the medical director of "Reach Out and Read," a program dedicated to making books and literacy promotion part of routine pediatric care. She is also the mother of three young children.

"For me, part of the motivation of writing is the squeezing it in and using it therapeutically to help cope with the other things I am doing," says Dr. Klass. She admits that she would be an even more prolific writer without her other professional and personal responsibilities, but she says she is the type who is happy having a full plate. "If I only had one thing to do, then I would start cluttering it up by saying, 'Oh, if I've only got this to do, then there's also room for this, that, and the other thing.'"

Dr. Klass believes that both writing and doctoring attract individuals with an "intense curiosity" about other people's lives. "I think there's a lot of overlap between the type of curiosity that draws people into medicine and the kind of curiosity that makes a writer," she says. This curiosity, maintains the physician author, involves a desire to know people's stories and the details that make up their lives.

"In medical school, you actually spend time learning how to ask personal questions or questions that would be offensive in another context, questions that aren't anybody's business most of the time," Dr. Klass explains. "I think that desire to ask those questions of perfect strangers and know the answers is probably a link between many doctors and many writers. Like doctors, writers are curious about how people got to be where they are and what their real stories are."

Dr. Klass maintains that it is her inherent curiosity to know other people's stories that, as a doctor, has helped her learn to put herself into different patients' situations, and thus to better empathize with them. "The way I learned to accommodate lives very different from my own without being judgmental has to do with being a writer of fiction," says the pediatrician. "That is not the only way to learn, but it has been my way."

In Love and Modern Medicine, Dr. Klass' latest collection of short stories, many of her characters, who are physicians or work in related healthcare fields, struggle with modern domestic life, the travails of which their professional expertise does little to prepare them for. An anesthesiologist struggles with the prospect of spending two weeks alone with her four-year-old daughter; an obstetrician in her third pregnancy struggles to find common ground with an old college friend; a geneticist and her attorney husband are floored when their daughter's kindergarten teacher suggests the child attend therapy.

It is as if the author is assuring her audience that it's possible to juggle multiple life roles; it just may take some inner work to do so.

By Barbara A. Gabriel

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