Compassion is its Own Art

(Poet, Amatortisero Ede in conversation with award-winning short story writer and novelist, Vincent Lam)

Maple Tree Literary Supplement
September 1, 2012

matoritsero Ede: It is a pleasure to have you on MTLS, Vincent, especially since we have been trying to hold this conversation for a while. Coming as this does on the heels of your most recent novel, The Headmaster's Wager (Doubleday, 2012), it is an opportune moment. First I would like you to give the reader a sense of your writing process. Consider, also your engagement as a medical practitioner. How do you manage the time between writing, touring and the operation table; and you are an emergency Doctor too!?

Vincent Lam: It's true – I'm a practicing physician, a writer who does sometimes tour, but most importantly I'm a father of three small and wonderful children. Kids have far more impact on time management than either doctoring or writing. As for juggling it all, everything is scheduling, commitment, and prioritized decisions. This is a somewhat prosaic answer, but that's all there is to say. With multiple things going on in my life, I have to schedule time for writing, just like I have work scheduled at the hospital, and I make sure to put aside time for kids. Then, I have to use the time for the things I've scheduled. Commitment means sticking to long-term efforts even when there is no immediate reward, and there may be many frustrating challenges along the way. Those are learning opportunities, but they may not be easy. The capacity for delayed gratification is hugely important. It takes four years of tough work to do medical school, and easily four years of struggle to write a book. Both require commitment. I'm just at the start of being a parent, but I'm told it lasts forever. For me, prioritization is about sensible decisions and accepting certain trade-offs. I live very close to the hospital – ten minutes by bicycle – and I write at home. The kids go to a school within walking distance. We love our home, and it is smaller than a similarly priced home would be elsewhere. We save that commuting time, because the daily time savings is a higher priority to us than a larger home. It sounds like a small thing, but in Toronto, where some people commute 90 minutes each way, that's 3 hours a day. Over a few years, there's a novel written right there. We don't have a TV. This is a great way to prioritize effortlessly, because it means I never have to decide whether to watch TV or do something else. The trade-off is that I don't know what's on TV, but am I really missing that much? When I grocery shop, I buy as much of everything as I can, so that I don't have to go back to the shop sooner than I need to.

A.E.: Literary history is replete with medical-doctor-writers. In the distance we have, for example, Anton Chekhov, Sir Arthur Conan Doyle, William Carlos Williams, Mikhail Bulgakov, Lenri Peters, John Keats, that fine essayist, W. Somerset Maugham and at the present moment, John Murray, Khaled Hosseini, Daniel Mason, Ethan Canin, Abraham Verghese, Rivka Galchen, Austin Ratner, Chris Adrian and, here in Canada, Kevin Patterson and, of course, your good self. What might be the source of this romance between medicine and literature, for you at least?

V.L.: Both medicine and literature involve the exercise of empathy. This is the core act for both types of work. Good doctors and writers wish to participate in a deep and positive way in the lives of others, whether patients, characters, or readers. Then, at the level of work, there's just the skills and habits required to 'get things done', which is the stuff addressed in your first question. I think doctors tend to have those skills. They need them to get to medical school, and they are further developed by medical training and practice.

A.E.: In an article by Andrea Crawford in Poets & Writers (January/February 2009), Ethan Canin is reported to have said that everyone has an expressive urge, but that this urge is greater in medical practitioners because being a doctor is "like being a soldier. You've seen great and terrible things." And of course I understood that to mean that then this soldier in the OP room, by the sickbed, in the pediatrics ward, wants to report from the battlefield of human misery, triumphs, struggles, victory and well, defeat?

V.L.: Yes, I think the soldier analogy is true, and that's the first part of it. As a doctor, one sees. Then, one participates in the situation in a human way, but also a professionally defined way. This is as it should be. I do not help my patient if I crumble into tears and need to be comforted. Perhaps writing allows a fuller range of speculation and emotional engagement. It is the real of the 'what if I had said' or 'what if she had said.' Fiction is especially free, because the characters do not exist in real life. I don't know if doctors in general have a greater expressive urge than people in general. I would poke Canin in the ribs (gently) and ask to see the epidemiological data supporting his claim that doctors as a statistical group have more of this urge. Anyhow, on that score I have no idea, as I basically became an adult while I became a doctor. Meanwhile, I had a very deep urge to write as a teenager – which in many ways led me to medicine as a profession in which I would learn about people.

A.E.: For example in your short story collection, Bloodletting and Other Miraculous Cures, (2006) you did 'draw blood' did you not, literarily and metaphorically in the exchange between Toronto's Dr. Fitzgerald – on rescue mission to Guatemala – and a local doctor: "[…] we talk around the regret of a lost opportunity: the narrow time frame in which an expanding death in the form of a bloody intracranial expansion can perhaps be drained, can sometimes be sucked out like an evil spirit to leave the scintillating brain intact." That conversation highlights the irony of the half title of the collection, 'Miraculous Cures.' The patient dies due to an absent surgeon and the right facility; we are talking Guatemala. And later Dr Fitzgerald, bearer-of-bad-news, compassionately lies – "with the greatest tenderness I have within me" – to the wife, who wants to know if the deceased husband's life would have been saved had he been closer to more modern facilities. The Bloodletting did not happen, and the miraculous cure is out of reach, and the lie was a necessary evil. Black humour? Is the medic's life like this all the time, and is there any professional preparation in real life to make sure the doctor does not collapse from emotion in the OP room etc?

V.L.: One works up to these things. It's like a musician – you learn single notes, then scales, then arpeggios, then etudes, finally a concerto. A medical trainee learns to interview, then to examine, then to diagnose, then to explain, then to treat, then to do all of this in simple routine situations, then to do all of this is complex unusual circumstances, and then deal with multiple problems at the same time, and so on. Yes, of course there is preparation. That is part of what medical training is about. The preparation for emotional competence, meanwhile, is not something that comes in a course with a name like 'Emotional Competence 101.' It is a steady accrual of experience and perspective, honed in one's training, then in one's practice even after formal training is done.

A.E.: Perri Klass, M.D., Professor of Pediatrics & Journalism NYU, suggest in his online "Literature Arts and Medicine" blog, that the relationship between writing and medicine, for him, is one of restriction and limitation, that writing enabled you free range of self-expression, while writing in medical practice is more utilitarian, you say what you got to say and clearly. It is merely to communicate medical diagnoses, prognoses, explanations etc. What do you think?

V.L.: Hmm… I would reframe the discussion slightly. I might tweak the dichotomy of restriction and limitation and ask whether, instead, it is that both medical and literary writing exist within a frame, but the frame is much bigger in literary writing. In both instances there are frames. In medical writing, the frame is the patient's circumstances, their information needs, and the information needs of others in the team. In literature, the frame is the reader. The reader is far more difficult to characterize than a patient, because one has not met most of one's readers, but the reader is nonetheless the frame of literary communication. I think that narrative is very utilitarian in medicine. Often the most useful medical communication is that which communicates diagnosis, prognosis, explanation, and narrative. Medical information is much less useful in a binary format, though sometimes that is appropriate too – the patient either smokes, or they do not. The story of what my patient is experiencing sometimes has huge import for me in what I will suggest next. Of course medical communication is not literature, but I think there is a huge range within which skilful use of narrative makes communication better, and a list of facts is less useful.

A.E.: Bloodletting has been made into a TV series of the same title. What were your initial feelings about moving from page to screen, worries, concerns etc? How is the series doing in terms of ratings?

V.L.: The writer of any book that is adapted can only win. Either people say, 'oh, what a great adaptation'. Or they say, 'it was nice, but the book was better'. Or, they say both! The writer cannot lose. I was happy with the adaptation. I felt very free about it – not especially protective. I did want the spirit of my book to be respected, and I think it was. The screen is a different language and the art form is different. The ratings were very good.

A.E.: The plot in Headmaster's Wager has strong emphases on male relationships, which can be complex, conflict-ridden or traverse several shades from absence of male figures and nostalgia about 'ancestors' to conflict between fathers and sons. I am thinking specifically of the relationship between Headmaster Percival as a child (Chen Pie Sou) and his own absent father, Chen Kai, Headmaster Percival and his wayward teenage son, Dai Jai, and that between Teacher Mak and the Headmaster. Male 'homosocial' bonding generally seems to be a central underlying plot. But this got me wondering if you had any psychoanalytic intent in the plotting or if you think a psychoanalytic reading is justifiable.

V.L.: I had no psychoanalytic intent, and probably for that exact reason, a psychoanalytic reading might prove fruitful! Isn't that what a Freudian would expect, that I would act unconsciously? The funny thing is that when it comes to novels, I think that any psychoanalytic (that's a really big word, perhaps the reason I rarely use it) effort will always reflect as much about the observer as it does about the art. For instance, an article was published in which it was suggested that the Christian resurrection story is embedded in my work. Well, that certainly never occurred to me, but it doesn't mean it is false. It is true for that reader. That's just part of the amazing thing about literature – the experience is an exchange. The reader is 'lying on the Freudian couch' as much as the writer.

A.E.: Again I am thinking of D.H. Lawrence' Sons and Lovers, which has encouraged many a Freudian reading. This has been due to the convergences between the author's suspect troubled relationship with his father, and closeness to his mother in real life, and a replication of these relationships in Sons and Lovers. I do not presume that Headmaster's Wager has any autobiographical intent beyond, well, the setting, does it?

V.L.: Well, in the sense that autobiography refers to one's actual life – no. Is the setting important for me? Of course, but it is more than setting. It is a character in the story. I have written about the Chinese community in Saigon during the Vietnam War. This is my own family's background, therefore much more than an arbitrary setting that could have been somewhere else. It is essential to my feelings for the book.

A.E.: Please do elaborate about that setting. Was this an excavation of roots for you, a dialogue with self? Was there a physical revisiting of those places or just the mental journey? And did you have to do some research for purposes of verisimilitude?

V.L.: I've never lived in Vietnam, though I'm flattered when people who have read the book assume that I must have lived there. I went to Vietnam twice for research, and read extensively. My family is ethnic Chinese from Vietnam, and the events of the war were integral to my family's historical trajectory – though I should distinguish that they were never integral to my own life or upbringing. So, the book is not a literal excavation of my own individual roots, but it does meditate upon history that is very meaningful to me. Isn't every meaningful book a kind of sketch of a portion of the writer's heart? It is deeply personal, without being autobiography.

A.E.: In your biography of the great and inimitable Tommy Douglas, CBC Greatest Canadian for 2004, you express pride in the fact that Canada's health care system, championed first by Douglas in Saskatchewan and adopted nationally later on, is based on the social democratic premise "that all human lives have equal value." Obvious as it might appear, what was your initial impetus for choosing that "father of Canadian Medicare" as subject?

V.L.: I think we need to remember that when we discuss health care, we are not just discussing a consumer good like breakfast cereal, or a government service like road building. Health care discussions are a discussion of how we, as a society, want to treat our fellow human beings in their most vulnerable moments. When we discuss health care, we are discussing morality and humanity. I'm not saying our system is perfect – we should always strive to improve it. I do think that having a universally insured medical care system is a fantastic starting point for meaningful discussion and work. So, why did I write about Tommy? Well, because in this country Tommy's story is integrally intertwined with these human and moral discussions of how to provide health care, and I think we need to remember how we got here.

A.E.: You have talked more pseudo-scientific prose in The Flu Pandemic and You. By Pseudo-scientific I mean you would not alienate the readers by throwing all the Latinate Jargons at them. What was that experience like compared to writing fiction or the biography of Tommy Douglas?

V.L.: The best scientific writing is very clear. So is the best non-scientific writing. There's nothing special about the way doctors talk to each other. It's just that for the sake of efficiency, we use certain verbal shorthand conventions. Lingo, if you will, or jargon. If I communicate with a patient or a reader who is not a doctor, there is no point in me using those conventions, so I write without them. That's not such a distinctive experience as a writer; it's just a different set of tools. I have found non-fiction and fiction to be quite different. In non-fiction, you don't have to make things up. You just have to get the facts straight, grasp their story, and find a way to express them. In fiction, you have to make it up, but paradoxically you are trying to create a kind of truth out of invention. So, that is another layer of difficulty. A big one!

A.E.: Recently you posted a fan letter on your Facebook wall, which expressed gratitude and satisfaction. Was that letter in respect of Headmaster's Wager? How does this affect you? Compare it to how Dr. Fitzgerald would have felt in "Bloodletting" (the book) had he been able to save the stroke victim's life.

V.L.: It was a letter to do with 'The Headmaster's Wager.' These things are hard to compare: my actual response to an appreciative reader, vs. a fictional character's potential response to saving someone's life? I'm not even sure where I would begin, so I'll move to the next question.

A.E.: You are so versatile going from biography, to factual writing, to the short story and novel that I am suspecting you probably see poetry on in the aesthetics of well-knit and tidy stitching of broken skin. Do you indulge secretly? I mean write poetry – or anything else?

V.L.: I indulge in bicycle riding, which I find very poetic. I do not write poetry.

A.E.: You are an emergency doctor; which means the pace can be fast, the difference between life and death might be a blink of an eye. How do you handle a situation where the patient does not respond to all treatments?

V.L.: Well, first of all, most situations do not unfold in the blink of an eye. Some do, but most develop over a slightly longer period of time. So, what do I do? As a diagnostician, I think laterally. I revisit and reconsider the clinical scenario. As a professional care provider, I communicate with the patient and the family, both to see if there are new perspectives on what is going on, and to make sure that they have as much understanding as possible of what is going on. As part of a team, I turn to colleagues for fresh ideas.

As a human being, I remember that there are often lots of things that can be done to make the journey better, even if a patient is not 'responding' in the way we would hope they might to treatments. Above all, I try to act kindly and usefully. I try to help the person to have dignity and comfort, as well as the best medical treatments. All our journeys will end the same way, and then often the most crucial question is what kind of humanity we offer each other along the way.

A.E.: Finally I will like to thank you on behalf of MTLS for taking the time out of so many demands on your time from different directions.

© Maple Tree Literary Supplement 2012