Writers have long had a fascination with the topic of medicine. In The Iliad Homer details the nature and treatment of injuries with impressive anatomical accuracy. Shakespeare was also a fan, with references to doctors, diseases and treatments occurring in almost all of his plays. Today there are novels that focus on medicine specifically and are marketed as ‘medical fiction’, while many more contain subtle hints of the topic: a minor character with cancer for example, or a visit to a hospital.
As a reader and a doctor, there are two main reasons why I enjoy fiction that incorporates medicine (aside from the gripping stories). Firstly, fiction is an engaging and palatable way to learn about medical topics. I enjoyed reading Dawn Barker’s Fractured (a novel about the impact of puerperal psychosis) far more than any medical textbook, and Ian McEwan’s descriptions of neurosurgery in Saturday are beyond perfect. More importantly however, reading fiction provides opportunities to exercise empathy. With fiction, you don’t need to have experienced a medical condition or situation firsthand. By giving you a temporary set of shoes to fill, you can learn what motivates a person and what they must be experiencing, which really does help when you have a patient in front of you.
I can understand why writers with a medical background are drawn to this topic; it’s writing what they know. But I have a real admiration for those who tackle medical themes well without first-hand experience in the field. Those for whom the ins and outs of hospitals, pathology and medical procedures are not second nature.
Natasha Lester is one of these writers.
Starting her career in marketing and working for the likes of Harlequin UK and L’Oreal, Natasha is now an award winning and best selling author. Her second novel If I Should Lose You explores the lives of Alix, a talented heart transplant surgeon, and her daughter Camille, an organ donor coordinator with a critically ill child. Making the switch from literary to historical fiction, her third and latest novel A Kiss From Mr Fitzgerald centres on Evie Lockhart, a young woman living in jazz age New York trying to juggle love, her desire to become one of the first female doctors and dancing in the infamous Ziegfeld Follies.
Despite having addressed medical issues in her two latest books, Natasha insists that on both occasions this was entirely accidental. Or, to paraphrase Elizabeth Gilbert: ‘some lovely force gives you the ideas that you need at the time that you need them.’ ‘I just happened to read an article in the Financial Review newspaper,’ she says while discussing If I Should Lose You, ‘and it was about ‘procurement coordinators’ in America, these people who are responsible for ‘procuring’ organs. I was just gripped by the idea of having a job where you had to care for a brain dead patient in an ICU who you know is never going to live, and yet they need so much care to keep their body in a state where their organs are stable and transplantable. You would also have to talk to their family about the possibility of organ donation, and the family is clearly going to be so upset and grieving. What kind of person would be able to do that job?’
For A Kiss From Mr Fitzgerald, it was attending a session at the Perth Writers Festival that planted the seed. ‘Lyndall Gordon was speaking about her biography of Emily Dickenson. I hadn’t planned to go, and I only went to it because it was in between sessions, but she was so engaging that I bought the biography and read it, even though I never read biographies. You kind of always know that women weren’t allowed to go to university, but you don’t really think about it because now it’s such a normal thing to do. The Dickenson’s were very liberal, and the book talked about how shocking and unusual it was for women of Emily Dickenson’s class to go to university. That was when I really started thinking about it, and thought it would be something I’d like to write about.’
It wasn’t long before medicine wandered into the picture. ‘When I was doing my initial research I discovered that medicine was one of the last specialties to admit women – medicine and law – and so because when you’re writing characters you want to make things as hard as possible for them, I thought ‘I’m going to choose medicine’. And I suppose from having done all the research and the writing for If I Should Lose You I knew I was interested in [medicine] and enjoyed writing about it, so it seemed like a natural progression to pick it back up again.’
Having chosen 1920’s New York as her setting and not wanting to do things by halves, Natasha decided to visit the archives of Columbia University Medical Center, one of the first medical schools to allow female students. ‘I was aware that there was little point in me studying current obstetric practices because I imagined things must have been different back in the twenties. So I wanted to go to the Columbia medical school archives and look and see what they had about medical practices at that time. Looking through the finding guide on their website, I realised they had the lecture notes a woman called Leoni Neumann Claman who was a medical student at the college in 1923. These lecture notes are all beautifully hand written and she recorded everything meticulously, so it was literally like being in the lecture as she would have been. All of the stuff I had about obstetric deliveries came from her handwritten notes, and she also had an extensive section on obstetric complications.’
Another resource Natasha found to be of particular use was the memoir of Emily Dunning Barringer, the first female ambulance surgeon in New York. ‘She talked about her experience of going to Cornell University, of starting work as an intern and being put out on the ambulance service and the bullying. That was where I got a lot of the bullying stuff in A Kiss From Mr Fitzgerald from, what she went though. And she just kept going and persevering and I thought you’d have to be so committed to be able to put up with all of that stuff.’
‘The more I read about the experiences of those early female medical students the more I thought ‘I have to write this book’. These women did so much for us to now have this incredible freedom, but no one really knows about what they went through and what they did. I can’t believe that no one’s written about them!’
Being set in the present day, the research for If I Should Lose You involved far less archive trawling and a lot more chatting. ‘I was a little bit nervous because I’d only had one book published and I wasn’t that confident in asking people to give me time. But I got in touch with St Vincent’s hospital in Sydney, and managed to find through the contacts page a person who worked in the cardiac research branch. She was just so in love with the idea that an author wanted to come and talk to people about heart transplants that she set up a whole day of interviews for me. I spent an hour with female heart transplant surgeon Emily Granger, and she talked me through the whole procedure of how to do a heart transplant and how to look after the patients who are awaiting transplants. She also directed me to a couple of videos on the Internet of her conducting a transplant so I could see what actually happened. I also spoke to a cardiologist who looked after patients post-transplant, and that’s where I learned that they literally go and snip off a piece of the patient’s heart every few days at first, then every week, then fortnight, then every month. That’s just so overwhelmingly amazing! And then I spoke to the donor coordinator (the nurse who had the job my character Camille had in the book), and I also spoke to some of the guys doing research into how to preserve hearts for longer so that they could get more hearts to more people. These people took me through a heart transplant from go to woe from all their different perspectives. I think that if I’d only got the heart surgeon’s perspective I would have been missing things, so it was good to see it from all angles.’
Although organising the interviews was nerve wracking, Natasha believes it was an invaluable experience and encourages her writing students to follow suit. ‘I try to encourage my students as much as possible and say ‘I know how it feels because I was absolutely as scared as you when I emailed St Vincent’s hospital but it was the best thing I ever did and so you have to push yourself outside of your comfort zone and do it. It makes the book better.’ Plus if you say to people you’re a writer, they believe you, and people love talking about themselves, and here’s you wanting to listen to them talking about themselves for an hour and they love it! That’s been my experience.’
Aside from time and setting, one of the key differences between the two novels is that the character of Camille in If I Should Lose You is not just working in medicine, but is experiencing it personally: her daughter Addie has biliary atresia and is awaiting a liver transplant. ‘The reason I wanted Camille to have a sick daughter was because [as mentioned earlier] you want to make things as hard as possible for your characters. I didn’t just want her to be the professional with the job, which was complicated enough. Having this extra layer of complications where it was actually a personal experience for her was something that was important to me.’
‘The more difficulties you can throw at your character the more nuanced you can make them, and the more opportunity you give for them to show the reader what their made of and to rise to the occasion by throwing these things at them.’
‘The first thing I wanted to find out was what is the most difficult organ to find, and for a child that was the liver. Then I needed to find out why you would need a liver transplant, and the first thing that came up was biliary atresia. [Coincidentally], as I was writing the book my middle daughter started pre-kindy, and one of the mums there had a daughter with biliary atresia who had had a liver transplant! So she was amazing, very useful to talk to, and she read the book afterwards and said that it was like I had written her mind, even though I’d done most of the writing before I met her, and I’d just confirmed a few details with her.’
Since delving into the world of medicine and fiction, Natasha has found that her views on both medical practice and medical ethics have changed. ‘Organ donation wasn’t really something I had thought about before, but in doing the research it made it so clear to me that more people needed to be aware of how much you can actually help somebody by becoming an organ donor, and that by not knowing enough about it and therefore never making a decision and prevaricating (which I think is what most people do, it seems too hard so they don’t think about it) your actually doing a lot of people a huge disservice. It made me much more aware of the fact that I needed to be responsible for making a decision, committing to it and then doing what I could to talk to people about that. When the book came out I spent a lot of time directing people to websites where they could find more information and sharing articles about organ donation and transplantation.’
Her research has also provided her with a greater understanding of not only sexism in medicine in the 1920’s, but the often more subtle variety that still pervades many medical disciplines today. ‘Emily Granger, the heart transplant surgeon I spoke to, told me all about learning to be a surgeon as a woman and how male dominated the field was (of the approximately one hundred cardiac surgeons in Australia, only eight are female). I also read a memoir of a female heart transplant surgeon in America that described the bullying she’d suffered. My awareness of [sexism in medicine] as an issue was really heightened by writing both of those books, and made me even more determined to write A Kiss From Mr Fitzgerald, to say that even though it’s historical fiction it’s still so relevant today because women are still facing things like this; a lot of the prejudices and the bullying are prevalent today. That made me more confident in the book as I felt it was relevant to people now as well.’
Our conversation turns to the idea of fiction as a way of teaching medicine, and Natasha agrees that it is ‘the perfect way to do it.’ ‘For me the interesting thing about fiction is the way it can allow you to unpick issues. If you were to read a non-fiction account it would seem dry and uninteresting, but suddenly add people with their different perspectives and put the tension and drama of fiction around it and it becomes a whole lot more interesting.’
‘There’s a lot more issues-based fiction these days. Lisa Genova did it so well with Still Alice, and the success of that book just goes to show that fiction is a really accessible way for people to learn. I strongly believe that. Still Alice was a huge and fundamental shift for people in the way they thought about Alzheimer’s disease. I think she’s done a great job of getting those issues out there.’
‘Fiction makes the issues become real,’ Natasha continues. ‘When you read them in fiction you imagine the character as a real person, and people can connect to that and start to consider things like ‘What do I think about that?’ ‘What’s my position on that?’ ‘How does that make me feel now about the people I know who have been through that?’ Writing about these issues in fiction helps people be more empathetic towards people who might be going through those things.’
Finding the line between making fiction enjoyably educational and becoming bogged down in medical detail is something that Natasha is particularly conscious of. ‘You can never set out to write a book didactically and think ‘I want to teach people something by writing this book.’’ We discuss the example of a confronting scene in A Kiss From Mr Fitzgerald where Evie has to perform a craniotomy (opening the skull to remove the brain) on a dead fetus during an obstructed labour. ‘The craniotomy: I knew I had to write that, but I also had to pare it back. My publisher gave me some perspective and said, ‘You don’t want to turn people off the scene’. That was good to know.’
Getting this balance right was also the reason Natasha chose to omit Evie’s medical school years and her own experience of giving birth. ‘When I was writing the book I was nervous about writing historical fiction for the first time, and wanting to have a more commercial feel to it, so I knew that pace was a key thing for me to get right. So the reason I primarily [omitted those scenes] was for pacing and wanting to make sure that the reader moved through the book quickly enough that they felt like there was never a dull moment. I also had a large time span to cover and if I went through it all in detail it would just take too long. I’d written about Evie’s time at summer school, so I knew that seeing her going through medical school would be a little too repetitive. There was nothing really new that her being at medical school could add to the story; we’d already seen that it had been difficult. I did have a very brief birthing scene for Evie initially, but when we looked at the book there were so many birthing scenes, so I lost two other birthing scenes plus Evie’s. Even though she was an obstetrician there’s such as thing as an overload of births, so we lost that deliberately.’
As the interview draws to a conclusion, I’m interested to learn whether Natasha is a fan of medicine in fiction herself, and why she thinks people find it entertaining (particularly when it’s on television). ‘I don’t mind a bit of it on television. I watched Chicago Hope and House, and ER. I loved ER!’ she laughs. ‘I honestly think people like it because your body is so important, but many of us know so little about it. Plus the whole concept of death and dying is one of the very few intangibles of our lives. We know so much about everything these days, but we don’t really know much about death and I think that’s why people are interested: it allows them to think about it a little bit and contemplate these things. I think the idea that your body is so much but it could fail you at any time plays on most people’s minds. These are really quite deep and scary issues, and I don’t think people talk about them because they are so scary and difficult. But when people read about them in a book or watch them on television, it’s somehow a more quieter and personal way to think about them.’ She pauses for a moment, before continuing. ‘I think there’s also that idea still that medicine as a profession is a bit God-like. Fiction gives people access to looking at doctors as humans, as well as these god-like people who can help you to live.’
It takes a little while for Natasha to think of a specific novel with medical themes she has enjoyed, before we both realise that the last two books she has read fit the bill. We groan over the fate of Will Traynor in Me Before You, and get a little teary when remembering the tragic story of Jude St. Francis and the support of his doctor friend Andy in A Little Life. As we do so, it confirms for me even more acutely that medicine in fiction is both important and everywhere, engaging our minds and fuelling our empathy.
Do any of your favourite books have a medical theme? If so, I’d love to hear about them!
Here’s a few I recommend…