Essays and creative nonfiction
Creative nonfiction, which includes the memoir and the personal essay, uses the tools of fiction while staying truthful to real lives and events, and writing about oneself brings difficulties of its own. A personal essay in a professional journal lets a scene, an anecdote or one relationship carry its reflection and its professional point, and the professional boundary itself can be its subject. An essay can also argue rather than report: a literary essay on a poet can address a profession's readers as one of their own, and a discursive essay can argue outward from one observed scene.
Creative nonfiction as a genre
Lee Gutkind, the writer and founding editor of the journal Creative Nonfiction, defined creative nonfiction as a genre that uses scenes, dialogue, description, first-person points of view and all the other tools available to the fiction writer, while consistently attempting to be truthful and factual, and one writer of the genre approaches real lives and events with skills adopted from fiction. Memoirs, personal essays and profiles can all be types of it. Creative nonfiction can be an outlet for medical writers who want to express themselves in a different way.
A memoir is a personal story, a reflection on past events, and writing one brings its own challenges: deciding how much of one's private life to reveal, writing about oneself, identifying who will care about the memoir and focusing on everything essential to that story, deciding on the tone, attending to word choice, tone of voice and speech patterns when writing dialogue, and telling the "truth" given the reputations involved and the availability of accurate sources. A memoirist's advice to writers is to take up fiction or creative nonfiction: "Don't let life happen to you. In your art—make your life happen."
Ways into autobiographical writing
Writing a memoir or any piece of creative nonfiction involves writing about what one knows. One creative writing workshop exercise gives writers about ten minutes to write down their favourite childhood memory in as much detail as comes to mind, then invites them to share it. An important aspect of that workshop was that no member was allowed to comment negatively on what the others had written. One writer recommends exploring creative nonfiction on websites and blogs, especially the Brevity site, which features works of creative nonfiction of 750 words or fewer. Memoirs one writer of creative nonfiction has enjoyed include Augusten Burroughs's Dry and Magical Thinking, Dave Eggers's A Heartbreaking Work of Staggering Genius, Art Spiegelman's Maus, Alison Bechdel's Fun Home: A Family Tragicomic and Phil Dusenberry's Then We Set His Hair on Fire.
Janet Roseman's The Way of the Woman Writer blends personal commentary and practical exercises for women who wish to develop creative autobiographical pieces. It holds that women face challenges of their own in finding the courage to write pieces reflecting their own life experiences, particularly because many undervalue their own intuition and so need novel tools to invoke the creative spirit. Each chapter centres on a spiritual topic, from maternal relationships to grappling with fear, and ends with exercises meant to generate material for an autobiographical essay, followed by sample essays using those techniques that the author collected from her workshops. Nearly all of the exercises are rooted in visualisation: the writer imagines abstract scenarios, sketches them roughly in colour and texture, and then writes by describing the drawings. The book holds that every woman writer has her own personal mythology to relate.
Reflection carried by a scene
An essay on balancing work and home life can be built from scenes rather than tips: the AMWA Journal's Page Break column promised no bullet lists, no outlines and no references cited, but scenes that illustrate how medical communicators honour commitments to their jobs, their families and themselves. In "Wasting Time", a manuscript deadline for a new client the writer would like to work with in future competes with her toddler's invitation to swing. The client wants the work good, fast and within budget, and although she has always delivered on past assignments, she wonders whether she can again. The essay is told through sensory detail, a groaning swing, a leaf blower on a neighbouring street and the smell of motor oil, and through the child's repeated "Swing", and it ends with her staying: the deadline will come and go, as will the day and her son, and she gives him a push and sits back down beside him.
"By When?" sets a novel the writer began in 2003 and has twice fully drafted against the paid work whose contracted delivery dates set her schedule. The paid work is real because there is a date. The novel is the project that is not running her life: it is sometimes written after yoga, with the email turned off, at a pace that lets its characters linger at a locker after school, hear traffic on the next street and anticipate a first kiss. It closes on the novel's main character, a girl who takes comfort in rules, whom the writer has often wanted to tell that a little uncertainty is all right; perhaps the character would say the same to her, and the writer concludes that she does have to finish, she just does not have to know when.
"Mending" opens on a repair, the writer's four-year-old son's teddy bear needing stitches, and returns to it only after telling two other stories: the bear's arrival two years earlier as a prayer bear given to the boy's grandfather after surgery for colon cancer, and a last visit to the writer's grandfather, dying of prostate cancer that had spread to his bones. Its details include a grandfather clock chiming eleven times at four o'clock, the boy tightening his grip on the bear at the sound of a croaked greeting, the dying man asking where the child was while the child stood close to the bed, and then asking to be put in his wheelchair and wheeling over to turn on the light with a shaky, outstretched hand.
The writer's work appears once: six weeks later, her grief gone from numb to tender, she was editing a book about cancer and working after dinner to finish it when her son ran into her office with the torn bear. The essay closes on the repair, which takes ten minutes against the months her quilts once took yet seems just as big a job, and she goes to bed relieved "that some things can be mended—and granted to stay with us through the night".
"Socks and Shoes" is built from one ordinary morning, getting a five-year-old to preschool. Its scene holds a warning of fifteen minutes that becomes ten and then five, a child absorbed in his action figures, a threat to confiscate the toy, socks and shoes that come in unattached pairs and hide separately, and a reward chart that had been going reasonably well until that morning.
The writer reports her own conduct: she had lost her cool before they were out of the door, and her son told her she was a mad mom that morning. On the way to school the child says that he takes so long because he wants to spend time with her, and the essay turns from the scene to what being a working mother seems on some days to consist of. By the time she dropped him off she was calm enough to realise that half his classmates have stay-at-home mothers, and with that perspective it became almost easy to tell him that they would play in the afternoon and that right now it was time for school.
"Unruly Critters" tells of a family holiday at a lake cottage in Maine with a two-year-old, a broken routine, three mice in a week and a chipmunk on the kitchen counter. In its middle the writer names what she is missing: not the house so much as her routine of spending a few hours a day moving words around a page, the satisfaction of putting a manuscript in order (making a neat title page, trimming an abstract, formatting references) and making it flow from one idea to the next, whereas with her son there are days when nothing seems linear. Faced with the chipmunk, she had no reference book or style guide with a rule on convincing a rodent to go outside. She lays a trail of broken animal crackers from the sink around the counter and out the door, and when no chipmunk comes she adds a whole peanut butter cracker at its start for its stronger smell and waits in a chair with a book.
"My Inheritance" is about the writer's father, who has dementia. Its scenes are short exchanges with him: she reminds him that he is about to turn ninety-one, and he replies "I am?" and then that it is amazing; she tells him she has turned sixty-three and he says she does not look it, and she answers that he does not look a day over eighty-five, and he laughs. After the second exchange she writes that she can still make her father laugh, which brings her joy and a measure of hope for her own old age. His dementia has made him a kinder, gentler man, and he no longer knows his age or the date but still recognises her voice in their weekly phone calls.
The essay cites a geriatric psychiatrist's characterisation of resilient people by seven traits (commitment, dynamism, humour in the face of adversity, patience, optimism, faith and altruism) and applies it to her father: he was naturally gifted with six of the seven, and his physical and mental limitations have forced the seventh, patience, upon him. It asks how a man who smoked two packs of cigarettes a day until he was sixty-two, ate hot fudge sundaes and beef stroganoff, never exercised, kept the irregular hours of a professional actor into his mid-seventies and whose parents both died young defies the odds, answers in one word, resilience, and gives the psychologists' term for it, adaptive coping. He survived colon cancer surgery in his late eighties and a broken hip a year later.
The writer says she is not one to sugarcoat the challenges of ageing, but she looks for the bright spots. The essay ends on what she has inherited: her father has no money to leave his children, and what she has received from him is an ability to bounce back and a firm conviction that hot fudge cannot be bad for her.
In "A New Credential for My CV: Zoom Concierge", an outpatient neurologist writes about video visits during the coronavirus pandemic. She had been an early user of her hospital's prepandemic virtual platform, which did not work well: every third patient was missing from the virtual waiting room, the novelty distracted, patients struggled to position their cameras and family members walked in and out. With the pandemic her hospital converted overnight to phone visits and eventually to video visits, mainly on Zoom, and much of her clinical time is now spent on Zoom, which is as draining and exhausting as anything in her thirty years of practice.
Much of the essay is the search for the patient: an empty waiting room; a call through an app that hides her number, to patients who do not answer unknown numbers; "Dr Bernstein! How are you?" answered with "I'm looking for you in my Zoom waiting room"; patients who never opened the instructions, did not know they had to download the program, had computers without cameras, or feared the data cost of joining by smartphone; an index card reading "Turn on the mic" held up to the camera; a family member helping at the cost of privacy; a log-in named only "iPhone". Before the medical visit begins, each patient asks how she is, and she reassures them that she is okay and genuinely happy to see them. The visit itself follows, with the patient minimised at the top of the screen while she reviews notes, updates medications and looks at imaging, and with drawings of neural pathways, a string of mala beads for explaining the twists of DNA and a demonstration injector ready as visuals, until, for the discussion, she maximises the patient's image to recreate pushing the chair back and talking as two human beings. The essay's admission follows: "I'm explaining, I'm listening, I'm metabolizing, I'm trying to de-Zoomify and be as present and stabilizing as I can possibly be. But it's not the same."
The ending explains the title. A concierge, by the dictionary definition she quotes, is an employee of a hotel who assists guests, which in the broadest sense is what she and her colleagues do in looking for patients, getting them onto a safe virtual site and supporting them through the pandemic; the search is an epic quest, and if she can meet her patients wherever they need her to be, she is content to add the credential to her CV.
A professional point reached through an anecdote
An essay on sitting a three-hour editing certification examination opens on the arrival at Princeton, the pencils that slipped under the passenger seat and the cooling coffee, and turns where the writer notices that the skill tested most thoroughly was one she had not used much since college: sitting in one place and concentrating on the rules of language for three uninterrupted hours. Its conclusion is a professional one, about the place of distraction in an office workday.
An essay on turning sixty sets the writer's birth, on the same day as the state of Israel, against the countries, social movements, pop fads and diseases she has watched wax and wane since, and reaches a conclusion about work: she has always worked, work is central to her identity, and yet work-life balance has never mattered more to her than now. Working "until I drop", she supposes, depends on what is meant by work: she wants no more of the old grind in a cubicle, but writing novels, painting pictures, starting new ventures or volunteering for favourite causes is a vision she would share.
A shared predicament anchored in one relationship
An essay on caring for an ageing parent while working opens on the general scale, with estimates of how many Americans would be sixty-five or older and how many American workers were caring for parents or loved ones, then moves into one household, one father and one hospital bedside.
The private side is told in specific detail: the father's booming voice and hearty laugh in a body weighing less than half what it did in his prime, the Saturday night baths and an invented verse, the hidden figure in a newspaper cartoon, the search for a Christmas tree with three children breaking through snow crust. The hospital scene is just as concrete: ginger ale through a straw, the latest Harry Potter book read aloud, hospital jelly and chicken broth, and the moments of becoming hard-nosed advocates when the nursing staff would not answer the call button. The essay's general claim, that the workings of the human heart cannot be tallied on a spreadsheet, follows the admission that none of the siblings could afford New York hotel bills for more than a week.
The essay attributes its figures on the value of informal care and on caregivers' health to the organisations that produced them. It offers no answers: "I don't have any answers. You find balance where and when you can." The writer calls herself lucky to work for a company with a generous family leave policy. It closes by addressing readers who do the double shift of caring for their work and for the ones they love: find a way to keep your health and your sanity, keep daily pleasures in your life, and know that there are a lot of others out there, caring.
Another essay by the same writer opens on the health education department where she works, in a high-rise office of the largest combined medical group and health plan in the United States, and imagines the interconnected grey cubicles seen from above as an ant farm: the buzz of low phone conversations and tapping keys, and a team creating materials on the web, in print and by podcast or CD that help people live healthier lives, laying down a trail of information for others to follow. She then sets the comparison against real ants: worker ants practise kin altruism, most being sisters more closely related to each other than to offspring they will never have, and she concedes that comparing workers in a vast health care bureaucracy to ants is perhaps not quite parallel, since they are not sacrificing their reproductive independence to preserve a colony, but holds that they are altruistic.
Her daughter's engagement brings pride, terror and awe; the colleagues three cubicles away and in her manager's office, who have married off children of their own, bring help: advice on bridal stores and on paying and tipping vendors, and an offer to help with goody bags for out-of-town guests. Her daughter's horror stories are concrete: wedding cupcakes at four dollars each, a hotel computer system losing reservations, and an alterations firm whose customers say the seamstress wrecked their dresses. The essay's professional point is that friendships built on hard-won life and work experience make achieving work-life balance happier and easier, and that sharing the stress as well as the joy of the wedding with coworkers helps her be more present in her daily work.
An essay on becoming a grandmother opens at half past four on a Friday afternoon, most of the cubicles around the writer deserted, as she dashes into her manager's office to show a thirty-second three-dimensional ultrasound video her pregnant daughter has emailed. It closes on the writer and her sister puffing and panting as they wrestle her sister's squirming thirteen-month-old granddaughter during a nappy change. Between the two scenes it states that issues of work-life balance seem to persist at every stage of life.
In that essay, the writer and her daughter face work-life balance from different vantage points. The writer and her manager, mothers of the same generation, always worked, juggling children and careers, and now wonder how they did it. Her daughter is already planning her own juggling act: a work-at-home schedule, back-up babysitting and networking with other mothers-to-be. The writer herself, at sixty-one and too young to stop working, wonders how to balance the new grandchild with a full-time job, and counts herself one of the lucky ones, since lots of working grandparents raise their grandchildren while she has only to juggle occasional babysitting with trips to the zoo.
The professional boundary as the subject
In one personal essay, a writer whose company prepares manuscripts, continuing medical education materials and summaries of advisory board meetings opens by predicting the reader's reaction to the fact that she has been a bellydancer for about seven years, and names the four reactions she usually gets from women and from men. Those reactions are why she rarely tells people, especially colleagues in medical writing; in professional settings it is often inappropriate for her to talk about any personal hobby, and she sometimes deflects even a direct question because she is tired of the assumptions people have about bellydancing. An essay gives her the chance to explain herself without enduring strange looks or nervous laughter.
Told she does not look like a bellydancer, she says she could not describe what one looks like and lists her last class: a physician, two editors, a nurse, an accountant, a classics professor and a network administrator, from their early twenties to their early sixties, with body shapes and motives as varied, some wanting to get in shape, some to learn something new, some to escape putting the children to bed one night a week. She sets the dance's history against its seductive reputation: arguably the oldest dance form, native to North Africa and the Middle East, historically a social dance performed in groups segregated by sex, and seen as seductive in the United States after its introduction at the 1893 World's Fair in Chicago, when rapid hip movements and uncorseted bodies were considered shocking. She recalls dancing seven months pregnant on a Christmas parade float, cheered by women and blushed at by police officers, then calling in under her stage name to the morning radio programme that discussed it. The essay ends with the stage name staying off her CV, although next time she may answer that actually, she does look like one.
A literary essay addressed to colleagues
A 2009 essay in the AMWA Journal on Emily Dickinson's surgical imagery addresses its readers in its abstract and again in its opening: medical writers and editors who love poetry might be interested in the musings, not meant for a hardcore literary journal, of one of their own, about a poet most physicians and patients have heard of but may know little about. It gives its author's standing: an English PhD who works amid a sea of MDs and has critiqued surgeon-scientists' manuscripts for more than twenty years at two research universities. Against the common view that Dickinson was obsessed with death, its thesis is that she wrote numerous life-affirming poems that foreground medical, anatomic and scientific concerns. The allusions to surgery she inserted into these poems and into a few of her letters, it argues, offer a multi-layered critique of the objectification of patients as silenced, numbed specimens for surgeons to perform on and physicians to exert sterile power over.
The essay quotes a Lancet essay that Apollo was the god of poetry and also the father of the god of medicine, and that poetry moves away from rational thought while modern medicine attempts to approach it, in conflicting directions. It acknowledges, in a quotation, that there is no single way to read a work of literature, medical or poetic, and it gives its primary purpose as sharing its author's appreciation of Dickinson's range by showcasing some of her medically pertinent imagery. Its author is drawn again and again to one four-line poem that addresses surgeons exclusively, which the essay reads closely, down to the etymology of a word and the poem's metre. It dates the poem to around 1859 or early 1860, and later places its writing at the start of the Civil War, adding that civilian surgery had arrived, to a degree, before the war, especially after the 1846 demonstration of anaesthesia in Boston. It turns from that poem to the briefer mentions of surgeons and surgery in her other poems.
The essay's conclusion states that, as her surgical and medical allusions show, Dickinson was both fascinated by and fiercely protective of the body, in all its anatomic splendour and animated familiarity. It suggests that the methodical making of Dickinson's homemade fascicles might even be seen as a very careful operation, offering surgical words in parentheses as questions: she folded sheets of stationery (layers of skin, surgical drapes), made holes through them (lanced, punch-biopsied) and tied them (ligated, sutured) with string (catgut, polypropylene). It ends on the line of the poem its title quotes, that underneath her fine incisions, the words she handwrote, still stirs the Culprit- Life.
A discursive essay argued outward from one scene
A discursive essay in EMWA's journal Medical Writing in 2012 opens its abstract on what it calls widely acknowledged, that resolutions of difficulties tend to engender new problems, and suggests that the most promising discoveries, innovations and inventions are impuissant to obviate once and for all the need for vigilance. Its vocabulary includes impuissant, obviate and insinuate themselves. In its body, an inconsistency its author observed in how surgery clinic nurses disinfected a room, gloved while they cleaned and later turning the room's contaminated door handle without gloves, leads to the conclusion that futility cannot be banished completely and there will never be absolute safety. It traces the rituals now displayed to protect people from each other's pathogens to the emergence of HIV and AIDS, and counts the result costly, economically and environmentally. It goes on to list the burdens of what it calls a not unfounded but perhaps inflated fear of contagion.
The list sets out the economic and environmental costs of contemporary Western approaches to the potential of infection: people in work with frequent public contact adopting disposable gloves unnecessarily and in a copycat manner, even where their work does not require it; the increase in latex allergy that increased glove use produced, and the industry that grew up to supply latex-free gloves; the disposal of gloves as waste; the public's increasing, often unnecessary use of facemasks, which in turn require disposal; paper towels used to grab lavatory door handles, made from trees and becoming trash; the chemicals in disinfectants and hand cleansers used institutionally and now increasingly by individuals, entering the environment with as-yet-unknown effects; the imminence of pathogens resistant to those compounds and of human allergy to them; and the costs of determining the magnitude of a threat, drawing up policy for it and implementing preventive measures, including education. The essay marks the list as informal and non-exhaustive, and sidesteps the politically loaded notion that fears and needs have been opportunities for industries to emerge and thrive.
In the essay's reading, that the incidence of infections is not higher speaks not for the efficiency and efficacy of safety procedures but for the resilience of the human body and its capacity, though not inexhaustible, to fight off pathogens. It ends on questions: whither safety goes, at what cost, and whether the safety net is safe.