By the time I sit down to write in my office, I’ve typically gone through several internal cycles of remission and relapse. I’ve probably finished my rounds in the cancer ward. Perhaps I’ve taught the red-eyed, exhausted overnight intern to recognise the difference between the drug rash from Amoxicillin (bright, angry, often harmless) and the innocuous-looking rash of immune rejection after a transplant (dusky, hazy, often deadly). Perhaps it’s eight in the morning now. I’ve had two shots of espresso. I might have written orders for chemo for a young woman with breast cancer, and – since her babysitter had to cancel this morning – I may have asked one of the nurses to distract a three-year-old daughter while another nurse puts an IV line into Mom’s arm. Then I may have scooted down to the pathology lab to look at the bone marrow biopsies that I did last week. There’s one man whose marrow shows a spectacular response to the drug that is on trial. Another patient has definitely relapsed. It’s barely midday, and my pulse has stopped, started and stopped about four times.
Why do I write? Or why, for that matter, do some doctors write? Some of us write to bear witness. Some of us tell stories. Zadie Smith once said that the very reason she writes is so that she “might not sleepwalk through my entire life”. On some particularly grim days, I think that I write to induce sleepwalking.
There’s a red suede couch in my office. It might have a pile of patient notes on it. Or it might bear a pile of books: Oliver Sacks, Henry Marsh, Ian McEwan (whose Nutshell, a Hamletian saga, I raved about) and Atul Gawande but also – I’m looking around the room, picking titles at random – a new biography of Jonas Salk, George Orwell’s essays, Pankaj Mishra’s An End to Suffering and James Gleick’s Chaos. Or the couch might have a pile of gene sequences – a string of A,C,T and G; another language with its own lexicon and semiotics – from the latest cancer genetics project that’s going on in the lab.
Perhaps I’ve written for two hours, uninterrupted, when a post-doctoral researcher in my lab jabs on the door with a pipette. She’s found something that, um, “doesn’t quite fit”. The three most beautiful words in the language. My interest piqued, I follow her down the corridor to her bench where she shows me a Petri dish. The cells should have been killed by a drug, but she’s made a deliberate genetic change in them, and they’ve turned miraculously resistant. I think of the man who has relapsed in the clinic: could this genetic change have occurred in his marrow?
And then I am back on my red couch. My single rule for writing is the same as my rule for science. You cannot know the answer if you don’t know the question. Before I write anything, I ask myself: what is the question that I am trying to answer? When I read a novel, or encounter a poem, or a painting, I will ask myself: what question is the painting, or the novel, trying to answer? This drives my wife and children mad – there are days when the kids refuse to go to museums with me – but it works as a guide to my writing practice. Orwell? He’s trying to answer whether we can build a moral world out of fundamentally immoral people. Sacks: can you inhabit the minds of others who are extraordinarily different from you?
After the post-doctoral visit, if it’s a good day, I’ll have four or five quiet hours of thinking and writing. Now I will lock out all sound, turn off the phone and dim the lamp; any stimulus off the page becomes a terrifying distraction. I’ll make myself another coffee, and I’ll type out an essay or a paper using my painstakingly slow pigeon-pecking way of typing (never took lessons in school). About two hours later, I’ll turn to reading. I work methodically through books, scientific articles and medical papers. And then I might read what I’ve just written, gleefully trashing much of what I’ve produced through the day.
The last hour of work is dedicated to patients and my lab. I return phone calls, and then check with the nurses on the ward. Then I am back at the lab bench. My particular, secret love is cell culture: I like looking at cells under a microscope with the obsessive pleasure of a hothouse gardener inspecting his orchids. Good cell biologists have an animal instinct for the health of a cell in culture, and I try to teach my students how to hone that instinct. I might have a group of graduates gather around the scope. “Look at the borders of that cell,” I might say, “and ask if they are just a little bit ruffled. Ask the cell a question: how are you feeling in this culture today?” Sometimes I might end the day by asking myself the same question.
In brief
Hours: 8-9 (includes time spent on scientific articles, reviews, medical notes)
Words: 2,000 (but as above)
Time on internet/Twitter: 1 hour total
Tea/coffee/gin: 2 cups of espresso, 1 cup of tea, a glass of wine around dinnertime (if still in office, no gin, thanks)
