Saturday, January 28, 2012

Learning Languages

Learning languages has always been an interest of mine.  When I am going somewhere new, I try to gain at least a rudimentary awareness of the language.  I consider it a gesture of respect to greet people in their own tongue, especially when I am a guest among them. 

The process also feeds my own curiosity about other cultures.  Languages reveal ways of thinking.  In the quest to expand and deepen my understanding of humanity, new vocabulary and syntax provide a window on new points of view.  Learning a fair amount of French, German, and Arabic and a limited sampling of Bengali, Czech, and Turkish have been a fascinating challenge.

When I had to learn organic chemistry and pharmacology, I approached them as language acquisition.  Chemicals are words and reactions that connect them are syntax.  These sentences communicate knowledge and describe relationships.  Behind them, lies a worldview.  Elements form larger, more complex structures.  What goes into a reaction must come out again.  Processes are directional, occur along arrows, and are spurred by catalysts.

In the world of chemistry, there is building, balance, and progress.  There is also inflexibility, little room for the spontaneous or unexpected.  Descriptions are dry and rational, often lacking a creative flare.  However, even these names hold meaning beyond their surface.  Labeling the gain of electrons as “reduction” inspires a mental stretch and must be paired with oxidation in the necessary give-and-take of natural phenomena.

The names of elements evoke a history of achievement, discovery, and myth.  Many are named after places, such as Polonium (Poland), Ytterbium (a town in Sweden), Ruthenium (from the Latin for Russia), Hafnium (from the Latin for Copenhagen).  Others are named after people, such as Curium, Einsteinium, Mendelevium.  My personal favorites evoke characters in Greek mythology, such as Tantalum, Niobium, Titanium.

Consider also the step from chemical names to drug names.  Chemical names describe components and structure.  They suggest certain characteristics, bonds, and acid-base properties.   When marketing gets a hold of them, a transformation takes place that deviates wildly from the straightforward pathway of chemical composition.  Drug names can be trademarked, patented, and claimed for profit.  They are crafted to evoke feelings and associations in consumers.

When I was memorizing hundreds of these names, my main concern was how to tell Clonidine, Clozaril, Klonipin, Clorhexidine, Clonazepam and others apart and recall that two of these are actually the same compound.  Now that they roll off the tongue, I have a chance to step back and think about how they have shaped my own synaptic connections as I have assimilated them.  And to think about the meanings embedded in another new language.

Saturday, January 21, 2012


I have been reflecting on the issue of patient confidentiality in medical writing.  Cases shared for educational or research purposes are de-identified.  The standard approach is to use initials, not names, and change characteristic features, such as age or gender, if they are not directly relevant to the clinical question.

What about fiction set in clinical environments, in which patients and doctors are characters?  All characters bear some connection to the writer’s personal experience.  They are usually designed to feel “real”, in order to make their stories believable and to communicate some element of human truth.  How can a writer achieve this effect without making characters who are too “real”, traceable to the individuals on whom they are based?

Fiction is preceded by the caveat: any relation to actual persons living or dead is purely coincidental.  However, can we say this with confidence when our characters are influenced by actual persons and intentionally crafted to behave like them? 

Is there a higher standard for coincidence when the writer is also a doctor?  Medical professionals have privileged access to the lives of others and a unique perspective on the human condition.  This exposure can enhance our writing and give our novels insight.  However, much of our human contact occurs in confidence, in the context of private doctor-patient relationships.    Patients who tell us of their personal struggles and tragedies do so for therapeutic purposes, not to become the basis for fictional depictions of struggle and tragedy.

In some cases, we know which patients of ours inspired which characters.  If we are successful at de-identification in our writing, we are the only ones who can draw the connection.  In other cases, the link is obscure even to us.  Characters come into being without conscious attribution to someone we know.  They are composites of our experiences, the essence of many people rolled into one.

It is difficult to tell exactly how others will respond to or interpret our work.  I do try to imagine how my patients would feel reading my writing.  Would they see themselves in a universal sense, in the way that any readers identify with characters who are like them?  Or would they feel used, their personal details stolen or taken advantage of, because they see themselves in an individual sense?

If I suspect that a character or a particular scene would cause offense to a patient or family member, I change it.  Yes, I could exercise my freedom of speech and write whatever I want.  But I also take my professional obligations and privileges seriously.  I aim for my clinical and literary lives to complement each other, not conflict.  And even though my sharing of experiences is not for educational purposes, there is an intention to create something positive.

Sunday, January 15, 2012

Rejection and Self-Worth

We have all suffered rejection of various kinds.  I will defer the issue of unrequited love for another time and focus instead on the rejection of work.  I have been wondering which is worse: rejection of scientific work or creative work.

When you submit an original research article for publication, you intentionally aim high.  You choose a journal that is perhaps a little out of your league in the hope that maybe, just maybe, it will deign to include your work (after extensive revisions).  You know that the most likely outcome is rejection, but you tell yourself that it is worth a try.  You may lose a few months waiting for the impending disappointment.  Once you receive it though, you will move on and resubmit to a slightly less high-powered journal.  You attempt to comfort yourself with the objectivity of the process: the editors have considered your sample size, your study design, your statistical techniques, your subject matter and decided it is not quite right for them.  They have rejected your article but they have not rejected you, as a person or as a scholar.

The rejection of creative work can affect you on a very personal level.  You have distilled a part of yourself into a poem, a story, or a piece of art.  It represents you and your world.  It has taken some measure of courage to reveal it to others.  When this work is turned down, it is hard to avoid feeling that you have been rejected.  You can still comfort yourself with rationalizations.  The literary journal must have received thousands of submissions but only had room for a few.  You are equally good; you just didn’t fit this time.

I keep meticulous track of my submissions.  My list of poems is a catalogue of rejections.  I comfort myself on occasion by looking at the accepted ones (they are on the list too) but I assume that they will always be in the minority.  If I don’t keep aiming a little out of my league, I won’t advance.

Despite any efforts to the contrary, I will probably always take rejections personally to some degree.  Both creative and scientific works are a part of myself.  A research study is based on fact rather than experience, but facts still require interpretation.  Study design, conduct and analysis are creative endeavors.  Professional identity is a crucial element of my self-concept, just as artistic identity is.

All rejection is painful.  To move on, we need to cultivate a sense of self-worth that lies somewhere beyond the affirmation of others.  Yes, the journal (literary or scientific) has rejected your work.  You feel that it has rejected you.  But you do not need its permission to exist.  You are your work, but you are also more.

Wednesday, January 11, 2012

Editing and Humility

In the digital age, deleting is easy.  With a single click, you can dispose of a word, a picture, or an entire file.  Deciding what should be deleted is as hard as ever.  The art of editing is threatened on many fronts, as we lose the ability and inclination to restrain ourselves from excessive expression.

Remember when your camera had actual film inside it?  An investment of time and money was required to bring your photos to fruition.  You had an incentive to choose your shots carefully.  Today, there is no cost to taking a hundred pictures of your vacation at the beach and throwing them all on Facebook (or your photo-sharing service of choice).  Does the world really need all hundred pictures?  Even your closest friends would be satisfied with ten well-selected, representative images that convey the essentials of your trip.

Text-messaging and email are widely considered invulnerable to the usual standards of spelling, punctuation and grammar.  I am all in favor of the casual and spontaneous.  However, let us not abandon our standards completely and lose the skills of “correct” writing.  By all means, nurture your children’s self-esteem, but if they cannot spell, please provide them with constructive criticism.

In addition, let us each remember that our every utterance is not perfect, fascinating and indispensable.  We can cut a thousand words out of a manuscript (as I recently struggled to do) without any irreparable harm to the universe.  Those words will not be missed, in the grand scheme of things.  We must have sufficient humility to let go of our words and pictures (and perhaps entire files, on occasion). 

I admit that blogging is, in many ways, a narcissistic exercise and perhaps an odd forum in which to discuss humility.  There is an implicit assumption by bloggers that our words and thoughts are of interest to others, which may or may not be valid.  I will do my best to avoid the trap of typing just to hear myself speak.  If I fail in my editing duties, you are welcome to let me know.  I can take constructive criticism myself.

Saturday, January 7, 2012

Writing By Hand

Though I embrace technology in many ways, there are some realms of life in which I prefer tradition.  I never plan to own any electronic books or reading devices.  I am entirely willing to sacrifice efficiency and space for the sake of feeling paper.  I want to hold books in my hands in what I consider their natural state.  There is an indefinable value in the palpable weight of an intellectual work.  Not to say that shorter works are “lightweight” in content as well as physical form.  As a poet, I would never belittle an achievement that fits on a single sheet of paper or in a few carefully crafted lines.  Even so, I want to hold novels, to smell them.  Old and new books smell different, each in a good way.  Allow me to turn pages with my own fingers, not the impersonal click of a mouse.

My affinity for paper extends to the act of writing as well as reading.  Perhaps I am old-fashioned, but I still write first drafts with a pen and type later.  I can blame (and thank) my British education for this habit.  My English classes involved writing essays longhand in ruled notebooks.  And rewriting them, often several times.  Even my maths and science exams included writing out my work.  My instructors did not believe in multiple-choice bubble-filling as a means of assessment.

As a result, I grew accustomed to expressing myself on paper.  I began writing for fun long before I had a computer.  I filled notebooks with my journaling and fiction.  Now I have a computer and use it every day for work and outside of work.  I take notes on paper for my research but draft the presentations and articles entirely in electronic form.  When the source material is in spreadsheets and statistical software, it seems logical to write it up by typing.  However, I have not lost my connection with the low-tech pen.  I still write my journal, poems, stories and even novels by hand.  I type them up later for editing, preserving and disseminating.

A blank notebook page feels different to me than a blank screen.  It is more inviting, more connected to physical experience.  In the interests of full disclosure, I will admit to typing this post without the intervening step of handwriting.  In the world of blogging (and research), dissemination is the primary goal.  I have come to realize that I type first when I write for others.  The notebook will come first when I write for myself.