As a teenager, I tried to journal, and I’d get off to a good start. But invariably after a week of recording the dramatic events that herald passage into adulthood, I’d read what I wrote and think to myself how inane it all was, and I would lose interest. It would be much later in life, after my divorce, when a good friend bought me “The Artist’s Way,” that I’d begin to write every day. The book provided explicit and concrete instructions for reclaiming one’s lost creativity. Eager to do something to fill in the void left by the absence of my husband, and my desire to be distracted from the grief I felt for something lost forever, I embraced the task of journaling every day. I followed the book’s author Julia Cameron’s strong advice not to read what I had written for 90 days. Finally! I was able to write and write, and I filled notebook after notebook with the free-floating thoughts that are easily accessible right after awakening each day.
As my 50th birthday neared, I assembled a bucket list of sorts, like those of many middle-aged people who have become fully aware that they’ve traversed the hump, where enough people and opportunities have been lost, leading to the stunning realization that: life doesn’t last forever, and anything can change in an instant. My desire to write something good enough to be published figured highly on that list, and I realized that it was time to stop thinking about it, and to take action.
Ironically, it was during one of the most challenging periods of my mother’s life when she was diagnosed with an aggressive brain tumor, and consequently for me, where time became even more precious, that I became fully committed to the process of writing on a regular basis. My role was to shepherd my mother through the medical system and help her navigate the myriad sectors of her life. I found solace during those quiet afternoons together, while she drifted in and out of sleep in a warm room, because she always felt cold, arranging my words in surprisingly decent fashion.
As a medical educator, I teach my medical students to be terse, to omit all superfluous details from the history and physical note. I counsel them that a good observer who has elicited a wealth of patient information needs to learn how to distill all of the details into a succinct and organized note. However, what makes that patient a person is not intuitively obvious in the medical note, and those of us who are happy in our profession know it is that permission to enter into the intersection between our patients’ medical, psychological, cultural and personal lives that make the practice of medicine so fulfilling. The medical narrative allows for the filling in of those details missing in the medical note as well as the fleshing out of who our patients are beyond the core of their entry ticket into the consultation room.
I have found that writing helps me make sense out of messy and impossible situations and offers the opportunity to fully clarify my perceptions and feelings. It takes a lot of audacity and courage to be a writer. You have to believe and be confident that people are interested in what you have to say. My mother, a bridge player, has always told me that I underplay my hand and that I need to recognize my assets. It took a long time to rebuild the confidence and joy I had as a child, and to reclaim the courage to “live out loud.” After all, writing is about exposure and leaving oneself open to the barrage (hopefully) of opinions about what you’re trying to convey. Writing requires a willingness to be vulnerable. I like too that I can bring to life the dignified and interesting lives of patients and the contemporary practice of medicine to serve as an impetus for necessary change and to educate in more global fashion; I have always liked translating medical information into fully digestible and understandable form. So, writing allows me to do what I like.
When I was in college, I belonged to an organization called House Plan Association. Its official events and activities were all designed to help its members live up to its motto, “Let people know who you are.” I am happy to be at a stage in life where I think that my perceptions about my personal life and my patients and my work have value. I find that I am comfortable with the idea of exposing my thoughts for all to see, and letting “people know who I am.”
Maria Maldonado is a primary care physician who has been engaged in medical education for over a decade. Her interests include the intersection of medical education and primary care for underserved populations and health concerns of undocumented immigrants. She has written for KevinMD.com and recently had an essay published in the “A Piece of My Mind” section of JAMA, and she contributes to a blog on perspectives of program directors of internal & family medicine. She is working on several personal essays as well as medical narratives highlighting the challenges of the contemporary practice of medicine. She can be followed on MMaldonadoMD on twitter.