Creativity

There’s only so much creativity we want in our physicians, right? After all, shouldn’t one stick to  generally accepted rules when writing prescriptions? We don’t sign our name where the date should be and we don’t leave the dosing up to our patients. We employ checklists in the operating room and reminders in the clinic so that even the slightest swerve toward negligence can be quickly corrected. Early in my training, with the starch still stiffening my white coat, I collected thick stacks of notecards to remind me of all the right ways to practice medicine. And practice I did. During the first year of my medical apprenticeship, I quietly hid the creativity of my liberal arts education. Ignoring the advice of my English teachers, I liberally plagiarized the chart notes of my mentors, creating an eerie similarity between infant and elderly patients as I learned the proper way to record my findings. “Fat feet” translated into “lower extremity edema” while “crusty scabs” became “eczematous lesions.” My transformation from a history major to a history taker clipped along, and by Christmas, I could report the narrative of a hospitalized patient as fluently as I could retell childhood stories. Soon my terse prescriptions and taught presentations mimicked my mentors. I completed my intern year as a well-trained clerk, able to track down labs in the most remote corner of the hospital. I knew I must be ready for the next step of becoming a doctor. What I did not know, or at least did not appreciate, was that with experience came responsibility. With responsibility came decision making. And when charged with making those decisions, I stumbled, wilting under the white-hot expectations of those who called me their doctor. I knew my medical facts when the road was wide and the questions were clear. Complaints of chest pain meant heart attacks. Broken ribs. Sometimes hear burn. But how could I tell when complaints of chest pain meant pneumonia. Or kidney infections. Or cancer. While my vocabulary couldn’t articulate the answer then, I now know that those are the medical situations that cry out for creativity. Not in the process. Those fundamentals don’t change. But creativity in the problem solving. Creativity in the consideration. Creativity in the communication. We all do this. Approaching familiar situations in new ways is the essence of creativity. It allows us to weigh what works in our...
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A 2013 Reader’s Guide for Writers

In his delightful book My Reading Life, Pat Conroy explains with velvet prose how good reading undergirds good writing. His well-supported argument is that effective writers are first avid readers. Conroy’s personal goal of consuming two-hundred pages a day seems straight from Mount Olympus, and accomplishing that daily feat is an act of almost mythologic proportions. Near the end of his trekker’s guide for writers, though, he explains that, “reading is the most rewarding form of exile and the necessary discipline for a novelist who burns with the ambition to get better.” I find myself strolling through the meadows at the foot of this mountain, burning to get better but reading less frequently than I wish. Still, with the help of a monthly book club and the periodic recommendations of friends, I have completed twenty-nine books this past year. Some are high-carb fuel for the road, inspiring me to be a better writer. Others are the sugar-sweetened equivalent of an afternoon snack, quickly consumed but lacking in sustenance. One wasn’t even worth a second bite. But that’s how reading is for me, trail mix for the writing road that feeds my next writing project. Below is a sample from my 2013 menu, categorized not by what I enjoyed but what I learned. The Most Fitting End to a Story: The Catcher in the Rye by J.D. Salinger On an uncommonly cold day this fall, best described in Alabama as “football weather,” I stumbled across Salinger’s book in the local library. Impulsively checking it out and then reading it again for the first time since high school, I soon recalled why this sixty-year-old book still speaks to readers today. Of all the bold characters I read about this year, few had the naked honesty of Holden Caulfield. For me, Salinger found the perfect way to end the tale of this audacious character when we learn that throughout the book, Holden was retelling his story from the comfort of a mental ward. The Most Consistent Point of View: The Good Lord Bird by James McBride I’m sure I’m near the back of the line of those waiting to praise this National Book Award winning novel, but what I learned most from it was the consistency of creating a witty character with a rich backstory. McBride’s protagonist, Onion, is as fresh at the end of the novel as he is with his...
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Two Months and Counting

Two months and counting before Blood Money will be published. The road to publication of this book, though, began over five years ago. On a warm Santa Barbara afternoon in June 2008, my writing mentor held up a bound copy of a soon-to-be-published novel  “You want one of these,” she told me. “It’s an ARC.” That term didn’t mean much to me at the time, but if my mentor said an ARC was what I needed, then it was my job to find out how to get it. Only later did I realize that an ARC—an Advanced Reader Copy—represented one of the last stops on the road to publication. Not the end of the road, though. I had attended conferences to improve my writing. I spent my early mornings back at home practicing that craft, revising each draft, and writing some more. Sometimes on this road, the novel in my mind butted up against an embankment of real words on a page. When that happened, I left the manuscript on the side of the road for a few months. Afterwards, I came back to the book with eyes fresh, seeing the flaws hidden there all along. In 2008, I thought the ARC represented the destination. In 2013, Blood Money has taught me that the ARC is just one more stop in this writer’s journey. Last month, the ARC of Blood Money arrived at my house to the jubilant fanfare of my kids. The cover of “Daddy’s book” perfectly captured in an image what I could hardly articulate in a query. I basked in the book’s glow for a few day before sitting down to read it, quickly realizing I had more miles to go on this road. For the last month, I’ve re-read the book. Suffered the tyranny of typos. Smoothed unpaved sentences. Erased obvious errors. Each read-through brings me closer to a goal I had five years ago when the idea first bubbled up from my subconscious of a tainted blood substitute and a dead body. Now, as I finish my final edit of the ARC, I’ve noticed other distant vistas from this initial mountain top. So the journey continues. To the book release. The marketing. The next book idea. Then, to the next...
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Hubris and Humility

My wife is a seasoned pediatrician. Through a decade of private practice and parenting, she has honed a skill set in primary care that is as impressive as it is nuanced. In many ways, she is a cartographer of kids, able to read the topography of toddlers and the fault lines of adolescents with equal skill. But like any professional ten years into a dedicated career, the visible skills spring from nurtured talent. Many providers-in-training, though, cannot appreciate the terrain at the beginning of their journey. Last week, a student approached her about a shadowing opportunity. This young professional, still lacking a year of formal education, wanted to invest one hundred and twenty hours in my wife’s office learning to practice pediatrics. Fifteen days of a dedicated rotation to the clinical care of kids, learning to track their progress and map the road ahead. When my wife asked about the student’s expectations, the trainee’s confident response exposed either a lack of self awareness or an under-appreciation of the complexities of the field. “I think I’ll shadow you for the first few days. You know, to learn the ropes,” responded the student. “After that, I’ll just see patients independently. I’m really good with kids.” Clowns are good with kids, too. To be fair, a decade pursuing any endeavor tends to level the peaks of unearned confidence and the valleys of insecurity. In 2003, I began to write my first novel after reading a book that I interpreted to be a hardbound copy of inelegant writing describing two-dimensional characters suffocating under a limp plot. I can write better than this, I thought. I really like books. My path seemed simple enough: I would re-read a favorite novel to see how good writing is done. I got this, I thought, so I embarked on a ninety-day first draft. With minimal preparation, I pecked out a hundred-thousand words of under-researched prose, uninteresting characters, and an unimaginative plot. What’s worse, at the end of my three-month sprint, I thought I had created a book for the ages. I mailed out thirty-seven queries to agents and editors. A universal chorus of literary rejection sang an unambiguous tune to me that year. Whatever writing talent I may have had was not enough. Whatever enjoyment I may have had reading books could not supplant the need for practice. So I read more. I wrote more. And my...
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Remembering Kennedy, Considering Character

Young clinicians are taught that most of what is needed to make an accurate diagnosis is obtained in the history. That assumes, of course, that the novice scribe knows not only what to ask but also what to do with that information. With so much historical significance packed into this past week, I took the opportunity to expand my own history taking skills, asking a question at the end of each office visit: do you remember where you were when you found out that President Kennedy was shot? For those old enough to remember, the question elicited a pause, then a story: One man, at his office in Chicago. learned about JFK’s death from Walter Cronkite’s television announcement His wife heard the news on the radio while waiting in the carpool line to pick up their kindergartener A young Navy officer on night watch in peace-time Guam also received the news on the radio, hearing it in the early morning hours of the Pacific. He soon found himself waking his fellow sailors to tell them the news. A fifth grade boy in rural Georgia heard about the shooting from his teacher. His class spent the rest of the day crowded around the school’s only television set All of my patients-turned-historical-sources recalled the palpable sense of loss in Kennedy’s death. Not one had trouble remembering what they felt and where they were when the news came through. Neither did they have trouble reeling me in to emotions of fifty years ago. Their stories were natural. Unforced. And they flowed easily, as all good stories do. Why, then, is it so hard to replicate natural emotions in fictional characters? After completing my first book-length manuscript in 2004, I solicited representation from any number of literary agents. While all of them ultimately passed on the work, some took the time to provide feedback. One agent’s written assessment simply stated the book “does have a surface readability and some tension too, but I just didn’t get involved with the characters.” At the time, no amount of manuscript massage could revive the work, which led me to shelve that book and begin again. Fast forward nine years. This past summer, I spent two months re-editing and re-polishing the manuscript for Blood Money. My publisher, an early champion of the Mackie McKay series, continued to press me with typed comments about my main character’s soul....
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