Clinical Advances in Hematology & Oncology
March 2016, Volume 14, Issue 3
Bruce D. Cheson, MD
I write what I write. —Umberto Eco (1932-2016)
A few years ago, I contributed to a study in which we aimed to learn about the effects of writing on patients with leukemia or lymphoma at our cancer center. The study involved a baseline assessment, a 20-minute expressive writing task, an assessment after writing, and another evaluation at 3 weeks (Morgan NP et al. Oncologist. 2008;13(2):196-204). The findings suggested that about half of the patients experienced changes in their thoughts about their disease immediately after writing, a sentiment that persisted at 3 weeks in the majority of cases. For example, patients reported that writing helped them stand back and reflect on their illness, or made them feel calmer. Perhaps maintaining a diary would lead to longer lasting benefit.
On our recent trip to the Galápagos Islands, I encountered a splendid chap, Dr Peter Acker, a pediatrician from Westchester County, New York, who is (also) a writer. Not only has he published a medical thriller novel (Blood Brain Barrier) that has received laudatory reviews on Amazon.com (buy it!), he has also written epistles in his county medical society newsletter. After the trip he sent me 3 notable examples, and I was impressed by how similar his style was to mine. In one letter he described his experiences body surfing off the coast of El Salvador and viewing the waves a bit too cavalierly, for which he paid a physical price. He finished with a quote from Dante: “And as he, who with laboring breath has escaped from the deep to the shore, turns to the perilous waters and gazes.” (In contrast to my usual quotes from rock and roll songs, Oscar Wilde, or Groucho Marx.) In another letter he took a heroic stand against the National Rifle Association. The third letter focused on the supplement industry, notably a drug purported to improve cognitive function that was marketed with ill-supported hyperbole. I sent him a link to my past letters (http://bit.ly/ChesonLetters) and am curious to hear his reviews; I hope my writing makes him chortle.
This coincidence compelled me to reflect on why doctors write. I recalled that during my training years, I was entertained by a series of topical letters in the New England Journal of Medicine by Dr John Lister entitled “By The London Post.” Subjects included nursing, tobacco and cancer, consultants’ salaries, grateful patients, and Beatlemania. (Little did I know that decades later I would become a good friend of his son, Dr Andrew Lister, now retired from St Bartholomew’s Hospital in London.) The senior Dr Lister convinced Joseph Garland, the editor of the New England Journal of Medicine, that a peripatetic column from London paying special attention to the evolution of the fledgling National Health Service might be a good idea. The result was 339 monthly columns with just 1 missed month, thus ensuring Dr Lister a free lifetime subscription to the journal.
I asked for some insights about writing and health from Nancy Morgan, former director of the Arts and Humanities Program at our cancer center and lead author of the abovementioned manuscript. She referred me to decades of research showing that writing may improve physiological and psychological health. I don’t think we need to use this as the reason to put finger to keyboard, however (or, in my case, fountain pen with ink from a bottle to paper). There are those who feel they have something to contribute to educate a targeted audience (which may produce considerable secondary gain, of course: both an ego boost and financial rewards). This would include celebrated physician authors such as Siddhartha Mukherjee, Atul Gawande, and Jerome Groopman. Others use writing simply as a release, a way to ward off burnout. There is a body of evidence to suggest that keeping it all in has a detrimental effect on personal well-being. Clearly, exercise is one way to counteract this, but it is more restricted than writing by location, clothing, and physical condition, among other factors. Writing can be private, and may be saved in a secret drawer; password-protected in a computer file; or destroyed, if need be, to leave no incriminating evidence.
That leaves the obvious question: why do I do it? First of all, it is one of my responsibilities as medical editor of Clinical Advances in Hematology & Oncology. Second, it does make me examine my rather mundane world and come up with something that stands out as somewhat interesting. Third, it keeps my mind working. But, most importantly, it is because, after 14 years of generating monthly letters, it still makes me feel good that readers actually derive enjoyment from the ongoing musings of an eccentric hematologist.
Until next month…
Bruce D. Cheson, MD