The Things Not Named

Joshua Doležal
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Conversations about literary craft and the things not named that bring high quality to fiction, memoir, and poetry. Hosted by Joshua Doležal, creator of THE RECOVERING ACADEMIC. joshuadolezal.substack.com

  1. Oct 20

    Rita Charon On What Gets Left Out Of Your Medical Record

    Now, I’m not saying that your internist should be asking you about your intimate relationships, necessarily, but the relationships and the meaning and the identity, and even more practical things like “I can’t afford this anymore. Who’s going to pay my rent?” Even those things need to be, not addressed by the doctor, but understood, or at least recognized, yes? Otherwise, the person is alone in their illness, and they will die. — Dr. Rita Charon, co-founder of narrative medicine Today, on “The Things Not Named,” I speak with Dr. Rita Charon, general internist, literary scholar, and founding chair of the Department of Medical Humanities and Ethics at Columbia University, where she helped launch the field of narrative medicine. Below is an edited transcript of our conversation on Substack Live. Transcript Joshua Dolezal: Welcome back to The Things Not Named. I’m Joshua Dolezal. Willa Cather said that the presence of the thing not named gives high quality to literature. This year, I’m applying that idea to medicine, asking how we might be more attentive to what goes unsaid in the clinic, in popular culture, and in the experience of illness from the patient’s side. My guest today is Dr. Rita Charon. Dr. Charon is a general internist and literary scholar who helped found the field of narrative medicine at Columbia University. She’s Professor of Medicine and Founding Chair in the Department of Medical Humanities and Ethics at Columbia, where she launched the Master of Science in Narrative Medicine, and directs training programs across ten health professions. Dr. Charon earned her MD at Harvard, and later a PhD in English at Columbia, where she studied narrative theory and the works of Henry James. Her research is funded by the NIH, the NEH, and many other organizations, and it examines what narrative practice changes in clinical care, including its contributions to equity in healthcare. She’s published in the New England Journal of Medicine, The Lancet, and JAMA, as well as in literary journals, and in 2018, she delivered the National Endowment for the Humanities Jefferson Lecture, the federal government’s highest honor for achievement in the humanities. So welcome, Dr. Charon. So nice to talk with you. Rita Charon: Thank you, and thank you for introducing me to this audience of people who want to learn something about it. Wendell Berry and Narrative Medicine Joshua Dolezal: Dr. Charon, I wanted to start with the Jefferson Lecture, because I’ve often taught and written about Wendell Berry’s lecture, “It All Turns on Affection,” where he goes through the history of James B. Duke and this kind of predatory capitalism, which really works against a loyalty to home places and the care that goes with that. And you told me you’re reading one of his early novels, Hannah Coulter. You share this honor with Wendell Berry. What’s your opinion of him as a writer? Rita Charon: So I recently met Wendell Berry, I mean, in print. One of my reading groups has been reading his poetry, which is so exquisitely plain and intimate. And so I needed to start reading his novels also. I don’t know how many of you know these works. Hannah Coulter is an unvarnished outpouring of self from the protagonist, and she speaks so directly to the reader, as if we’re sitting across from her in her living room, or even better, in her kitchen. And Joshua, I don’t know if you thought about Wendell Berry as an icon for us in narrative medicine, but that exact intimacy, informality, and being at home that we get from Hannah Coulter is what narrative medicine tries to help patients get when they are with their doctor, nurse, social worker, chaplain. That sense of, you’re sitting here at my kitchen table, and I can tell you things that are on my mind, which is what Hannah does in the novel. So anyone who thinks that it’s a leap from medicine to literature, go read Wendell Berry. Joshua Dolezal: Oh, that’s a lovely connection. And I know that you’ve done some creative writing yourself, although I’m less familiar with that than I am with your research, which is how I discovered your work. What have you written that’s been published in literary journals? Rita Charon: No, I write essays. I’m not a creative writer. I teach creative writing. I mentor lots of creative writers, but I’m not a fiction writer. I’m not a poetry writer. I write essays. They tend to be not necessarily factual essays. They tend to have humor and fantasy, as I’m talking about Henry James or as I’m writing about what doctors write about their patients. So I certainly am committed to style, to form. This is why any of us write, is to find out what we know. So I’m very committed to form and style in my own writing as well as in the writing of my students or learners. But I would be misleading you if I told you I was a creative writer. Joshua Dolezal: Well, I’m a memoirist and also came of age during the burgeoning field of creative nonfiction. So my sense of the essay is that it has many creative possibilities, and part of what narrative medicine is trying to do is break down those binaries between the fine arts over here and science writing over there. So I see your work as a kind of hybrid of the two. I don’t know if you would accept that. Rita Charon: Well, of course. I mean, even if I’m writing about the cellular membrane and how the calcium ion enters the cell, I’m still writing, and I’m still using all the affordances of language, which is the metaphors and the temporal shifts, and the ways in which you can help people visualize things that they can’t see. I just don’t characterize that as creative writing. But maybe you do. I was recently at a conference for autoethnographers. Do you know that field, the autoethnographers? They certainly have a hybrid approach, where they’re essentially talking about themselves or writing about themselves in a memoir-ish way, at the same time being very attuned to the culture in which they’re writing, to the social powers that be that may be impinging on even what it is they’re allowed to write about. So there’s a hybrid form maybe along the lines of what you’re talking about. Joshua Dolezal: Absolutely. Well, I don’t want to talk about me so much, but I do work with clients as a book coach and editor now, and many of them are trained to write trade books about how to be a better public speaker or a better executive. And in a lot of cases, what I’m trying to help them do is incorporate literary elements into the trade format. So that would be characters that have contradictions, and case studies that feel colorful and real and not like cardboard cutouts. Rita Charon: Right on. How Narrative Medicine Got Its Name Joshua Dolezal: But that’s enough about me. When I was talking with some friends about our conversation, one of my earlier guests this year, an internist in Wisconsin, a younger physician, learned of you as the founder of narrative medicine. I don’t know if you accept that title. Do you consider yourself to have founded this discipline, or are you part of a larger movement? Rita Charon: Well, I started it only because I finally finished my PhD in English, and I already had my MD for decades before that. And I said, “Okay, Rita, what are you going to do now?” I had already been writing about the contributions that a literary capacity will give to the physician. I’d been writing about that for years. What happened in the year 2000 or thereabouts is that I found a name for it. And I was going to call it the narrative hemisphere of medicine. I was writing a piece for, I don’t remember what journal it was. It could’ve been Academic Medicine or general internal medicine. And I said, “No, Rita, you can’t do that, because that’s giving away fully half of it, and that’s not fair.” And that’s how I found my way to just calling it narrative medicine. And that, in my mind, rang true. Although if you ask my colleagues in nursing or social work, they’ll say, “Rita, why did you call it narrative medicine? Why couldn’t you call it narrative… This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit joshuadolezal.substack.com/subscribe

  2. Sep 22

    Doctors Face Mental Illness Stigma Too

    “The fact that we don't trust the word of a physician with mental illness the same way we do one with a chronic physical health condition speaks volumes about embedded stigma.” — Dr. Devika Bhushan Today, on “The Things Not Named,” I speak with Dr. Devika Bhushan, former Acting Surgeon General of California, pediatrician, and author on a mission to drive greater health innovation and equity. You can subscribe to her Substack at Spread the Light with Dr. Devika B. Below is an edited transcript of our conversation on Substack Live. Transcript: Joshua Dolezal: Welcome back to The Things Not Named. I’m Joshua Dolezal. Willa Cather said that the presence of the thing not named gives high quality to literature. This year, I’m applying that idea to medicine, asking how we might be more attentive to what goes unsaid in the clinic and popular culture and in the experience of illness from the patient’s side. My guest today is Dr. Devika Bhushan. Dr. Bhushan is a pediatrician, public health leader, and author who served as California’s acting surgeon general in 2022 after three years as the office’s inaugural chief health officer. In that role, she advised the governor on public health and helped build the ACEs Aware initiative, which focuses on healing from childhood trauma. She now teaches as adjunct faculty at Stanford, serves on the national board of the National Alliance on Mental Illness (NAMI), and advises organizations working at the intersection of mental health and innovation. She’s also writing a children’s book series on stress and resilience with Dr. Bruce Perry. Dr. Bhushan trained at Harvard Medical School and Johns Hopkins and has spoken publicly about her own experience of bipolar disorder, work that has made her an award-winning mental health advocate. She lives in the Bay Area with her husband and child. Welcome, Dr. Bhushan. So nice to talk to you today. Devika Bhushan: Thanks so much for having me, Josh. It’s really good to be here. Joshua Dolezal: So you’re in the Bay Area, and you were telling me it’s foggy there. What do you like about San Francisco? Because I know you’re from the East Coast originally. Devika Bhushan: Yeah. I spent a lot of years on the East Coast and actually grew up all over the world, so India and the Philippines mostly. What drew us here to the Bay Area is that both my husband and I have had really good fortune, in a way, because a lot of our friends from different parts of our lives have ended up in and around the Bay for different reasons. So from a community perspective, it felt like the best place for us to land, and we came here almost a decade ago now. It’s also just very rich with cultural experiences, nature, a lot of incredible communities and neighborhoods. So it’s been a really nice place for us to land. Joshua Dolezal: I was an academic for 16 years, 20 years counting grad school, and one of the things professors say is they can’t pick where they live. So it seems like that’s one of the benefits of medicine, that you can make that choice to move closer to your friends, your people. Is that fairly consistent, or do doctors also get boxed into certain places? Devika Bhushan: I would say that in the early phases of training, where you go to medical school, where you go to graduate school, and where you go to residency are largely outside your own control. You can apply to the places that you’d be willing to go, but especially for residency, you are given one option through this arcane system known as the Match, where each applicant and each program are optimally matched by an algorithm, and you end up with a letter that says where you’re going to be living for three, six, seven, eight years. So in the early phases of my career, no, there wasn’t very much choice. But once there was, this is where we came to be. And you’re in Pennsylvania, right? Joshua Dolezal: Yeah, Central PA. I’m from Montana originally and did my grad work at Nebraska, and I think my whole adult life I’ve been trying to get back out West. Academic life is just different in that regard. Devika Bhushan: And you bill yourself as a recovering academic, right? Joshua Dolezal: I do. I left higher ed in 2021, so I built a coaching practice and started this Substack in 2022. So four years strong, I guess, fifth year total on Substack, but it’s definitely a second chapter for me. Devika Bhushan: Nice. Joshua Dolezal: Thanks for asking. I want to get into your mental health work shortly, but first, can we go back to your desire to become a doctor? Because for some people, that’s a childhood dream. I’m wondering when that started for you. Did you always know you wanted to go into medicine, or is that something that happened later for you? Devika Bhushan: I think through grade school, middle school, and high school, I always really enjoyed learning about how things work, so all of the sciences really called to me. Once I started to take biology and psychology, I was really hooked, because how we do what we do in the world, how we think about ourselves and about the people around us, and how the cellular and molecular processes in our bodies and brains work to either set us up for risk or resilience were really fascinating topics for me. In undergrad I was a neuroscience major, and my undergrad thesis was about how women who were majoring in the STEM fields were either differentially susceptible to or resilient to something called stereotype threat. You may know what that is, and many of our viewers and listeners may too, but for those who haven’t heard the term before, it’s essentially the concept that when you belong to a group about which there’s some kind of negative stereotype in a specific domain, that identity can be activated for you as you’re doing something within that domain. For example, you’re a woman taking a standardized math test, and you’re asked to check off your sex at the beginning of the experience. That will actually activate implicitly all of the negative stereotypes that abound about women’s abilities in math, and women will underperform relative to men when their sex or gender identity has been activated before the task. However, if you don’t ask that question, women persist as individuals rather than as members of their group, and you don’t see a difference in scores. I was really interested in this concept because we know that there is a leaky pipeline effect, right? At every stage, whether undergrad, graduate school, medical school, or different levels of professorship, women are falling out of the pipeline at disproportionate rates, and this is true across all kinds of underrepresented groups. But I was really interested in which women are specifically susceptible to stereotype threat, so we designed a paradigm to study that. That’s a long way of saying that what called me to medicine was a deep interest in understanding how the brain works and how our social context influences our health and health outcomes, as well as our achievement and opportunities. Joshua Dolezal: So you were a researcher first and then a doctor after that? Devika Bhushan: I would say so, yeah. I’ve always had a research bent to my career. Joshua Dolezal: Part of your journey has included public advocacy for mental health, and this came after or alongside your diagnosis with bipolar disorder. Now, diagnosis is tricky, because sometimes it can be a label or a box, and it can be wrong. A lot of friends of mine, people I’ve had on the show even, have talked about how they were misdiagnosed for years before they got the autism diagnosis or the one that fits, and then that’s a game changer. So what was that like for you when you were first diagnosed with bipolar disorder? Was it liberating? Was it limiting? How did you respond to it? Devika Bhushan: You’re absolutely right. In the mental health field, going from having symptoms of any kind to getting the right diagnosis and then the right treatment plan often spans decades. In my case, I was relatively lucky: my diagnosis and the start of the right kind of treatment for bipolar disorder took only … This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit joshuadolezal.substack.com/subscribe

  3. Aug 25

    A Lit Mag Born Into Rubble, Still Standing

    “Where do you go with the unspeakable? From time immemorial, in moments of communal grief we turn to music, to art.” Dr. Danielle Ofri, author and founder of Bellevue Literary Review Today, on "The Things Not Named," I speak with Dr. Danielle Ofri, a primary care internist at Bellevue Hospital, founder of the Bellevue Literary Review, and the author of seven books, including Singular Intimacies, What Patients Say, What Doctors Hear, and When We Do Harm. Below is an edited transcript of our conversation on Substack Live. Transcript: Joshua Doležal: Welcome back to “The Things Not Named.” I’m Joshua Doležal. Willa Cather said that the presence of the thing not named gives high quality to literature, and this year I’m applying that idea to medicine, asking how we might be more attentive to what goes unsaid in the clinic, in popular culture, and in the experience of illness from the patient side. My guest today is Dr. Danielle Ofri. Dr. Ofri is the founder and editor-in-chief of Bellevue Literary Review, the first literary journal to arise from a medical setting, now an award-winning independent nonprofit literary arts organization that’s celebrating its twenty-fifth anniversary this year. So we’ll get into that in a bit. She’s also a primary care internist at Bellevue Hospital and a clinical professor of medicine at New York University. She’s the author of seven books, all nonfiction. My favorites are Singular Intimacies, about her medical residency, Incidental Findings, which frames patient stories with her own experience as a maternity patient, and Medicine in Translation, about her work with immigrants and their complicated personal and medical histories. Her essays have been selected for Best American Essays twice and also for Best American Science Writing. Dr. Ofri has won many awards, including a 2023 Guggenheim, the 2022 National Humanism in Medicine Medal from the Gold Foundation, and an Honorary Doctorate of Humane Letters. As an ever-struggling student of the cello, she’s also hoping to someday complete the ever-uphill slog through all thirty-six movements of the Bach Cello Suites. So Danielle, welcome, and nice to see you again. Danielle Ofri: Thank you. It’s great to be here. Joshua Doležal: So did I get that right, all seven of your books are nonfiction? Danielle Ofri: That is correct. In fact, I just got in the mail this week the simplified Chinese version of What Patients Say, What Doctors Hear. So it’s always fun to see the new translations. Yes, all nonfiction. Joshua Doležal: Very nice. And you just told me that you have a new book coming out, so can you tell us just briefly about that and when to watch for it? Danielle Ofri: Yeah. It’s due out in April. It’s called The Body Knows How to Die, and it is about facing our fears of death. And it’s been really an exciting book to write, both talking to my patients, but talking to other people in healthcare and hospice, people who are facing death themselves or have accompanied someone, a child, a parent. And it feels like it’s one of the things that nobody wants to talk about, but of course, we all have to talk about it and how to get past those fears so the body knows how to die. Joshua Doležal: So that’s taken mostly from your patients’ stories. Danielle Ofri: It’s actually somewhat, but it’s more reported, so following someone through their illness, talking to caregivers. So it’s been writing. It’s a little bit if you think of, you mentioned Singular Intimacies, when I have little narrative, separate stories. It’s been that thing, but going out into the community and talking to someone in India and talking to someone in California, and it’s been really interesting to see what people are struggling with and what prevents them from being able to think about how they might plan their death and help themselves through the death and grief of others. Joshua Doležal: Well, I can’t wait to read it. I was struck, getting ready for our call, that it’s been... So Bellevue Literary Review is 25 years old, and I think you and I connected shortly after that had started. I was first aware of your work, I think because of your essay, “Merced,” which was chosen for the 2002 volume edited by Stephen J. Gould. And it seemed like that launched your career. Is that fair to say, that essay? Danielle Ofri: It’s hard to say what is a launch, but that certainly was one of the first early recognitions. Yeah, it was quite exciting. Joshua Doležal: What was it like to be chosen for the Best American for the first time? Danielle Ofri: I guess you don’t expect it. Mostly I was sending out my pieces to literary magazines who have circulations that were smaller than my medical school class. So you don’t think anyone actually reads any of them. So it was quite a surprise. And it also restores the faith. You’re slogging your way home. You’re trying to put these stories together, and then, wow, someone not only read it, but thought it was worthy to be included in an anthology that I’ve always admired. So it was just really both inspiring and encouraging and helped me move on and pull those essays together to a book. Joshua Doležal: Well, I’m asking about this partly because we’ll talk about the journal you started, but literary journals have really become increasingly embattled, and that whole scene has changed a lot. So around the time that we met, I was also launching my own writing life and publishing in places like Gettysburg Review and Kenyon Review. I think Merced appeared in the Missouri Review. Is that right? Danielle Ofri: Correct. Missouri Review. Joshua Doležal: Yeah. So the model was that there’s somebody who’s a curator who edits that, who has this sophisticated taste, and that you satisfy that gatekeeper, and that’s how you prove your legitimacy as a writer. And so you get accepted, and it’s a big accomplishment, and then an agent discovers you, and you’re off and running. I’m wondering how you make sense of that now because that’s not at all how publication works now. Everyone, like, I started the Substack. Everybody’s doing their own thing online. It’s much more like self-publishing has been normalized. Danielle Ofri: Right. It’s funny because when you describe that paradigm, I don’t quite think of it as a gatekeeper because as editor of BLR, we now get five thousand submissions a year, more than that. And so we’re reading through them. So I don’t see ourselves as gatekeepers at all. I see ourselves as reaching into this pile and community of writers and trying to find new voices to bring through. I don’t feel like we’re closing the gate to others, but trying to bring new people in, and it’s such an exciting thing to do and to watch writers launch. We published an early story of Celeste Ng, Abraham Verghese. And in fact, Celeste Ng, when she was interviewed in The New York Times, apparently, and I had not realized this, but had gone into a postpartum depression, and she said, “I didn’t think I could write again.” And then her story in BLR won a Pushcart, and that sort of parted the clouds and helped her keep going. And as a journal that we write about health, illness, and healing, it’s nice to be involved in a writer’s healing process as well. But I do think of it as an opening of the gate, not a closing of the gate at all. And you’re right. We have our tastes, but that’s why there’s so many literary journals out there of many different tastes. So if it doesn’t fit for our piece, it will find a home elsewhere. So I look at it as a way of widening the lanes. Obviously anyone can self-publish, and many people self-publish wonderful things. I will say that at BLR, one thing we do do is we work very closely with authors on revising pieces. We almost never take something and just plop it in the journal. We work 20, 30 hours, multiple revisions, and many writers have said it was the most intense editing experience they ever had. And so when it finally gets on the page, it’s really hopefully at its best, but we are excited to help people bring a piece… This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit joshuadolezal.substack.com/subscribe

  4. Jul 28

    She Woke Up Dizzy. It Lasted 18 Years.

    You’re two people in a situation, and you don’t know each other, so you don’t know the best way to communicate yet. You always hear those blanket statements like, “If you see a bear, do this,” but every bear interaction is different. The bear is different. It’s not a blanket thing. We don’t have that doctor that we have this lifelong relationship with, and so we don’t know them as people, and how to communicate with them is so hard.” —Rachel Weaver, author of Dizzy Today, on “The Things Not Named,” I speak with Rachel Weaver, author of two novels and a memoir, Dizzy, about living with undiagnosed vertigo for nearly two decades. Below is an edited transcript of our conversation on Substack Live. Transcript: Joshua Dolezal: Welcome back to The Things Not Named. I’m Joshua Dolezal. Willa Cather said that the presence of the thing not named gives high quality to literature, and this year I’m applying that idea to medicine, asking how we might be more attentive to what goes unsaid in the clinic and popular culture, and in the experience of illness from the patient’s side. My guest today is Rachel Weaver. Rachel is the author of three books, a novel, Point of Direction, which Oprah Magazine named as a Top Ten Book to Pick Up Now. Another novel, The Last Run, about a struggling single mother who risks everything to save her father’s fishing boat. And the memoir, Dizzy, which is our main topic today, about a debilitating illness that went undiagnosed for 18 years, even after seeing 40 different specialists. So that book is part medical mystery, part cautionary tale about American healthcare, and it’s an inspiring story about perseverance and learning to live with life’s uncertainty. A fun side note. Rachel and I both worked for the Forest Service. I was a firefighter and wilderness ranger, and she was a field tech in Alaska studying bears, raptors, and songbirds. She now teaches at Wilkes University’s low-residency MFA program and at Lighthouse Writers Workshop. I became aware of Rachel’s work because of her connection to Columbia University’s Narrative Medicine program, and if you caught my conversation with Kimberly Warner, Rachel also came highly recommended from Kim. So Rachel, thanks for joining me today, and welcome. Rachel Weaver: Thank you. Thanks for having me. Joshua Dolezal: So you’ve done a lot of interviews about this book. Is it your most recent project then? Rachel Weaver: Yes. I wrote Dizzy as I was also sporadically working on the novel, and happened to finish them each within the same year, and then they sold to two different publishers within the same month. So last fall, I was working on the final revisions for both. So in my mind, they’re sort of both equally my most recent project, but Dizzy is the book that I started most recently. Joshua Dolezal: I didn’t mean it to be a trick question, but I know most writers are working on multiple things at once. Rachel Weaver: Yeah. I do have another book outlined over here on my wall, my next novel. I’m about 100 pages into that one, but it’s pretty messed up currently. Joshua Dolezal: Are you superstitious about that? You don’t want to talk about it till it’s done, or can you share anything about it? Rachel Weaver: Yeah, it’s something I’ve never done before. It’s not placed in Alaska, first of all. And it’s just about a group of women that are doing all sorts of fun things. I don’t really know what it’s about yet. I’m in that phase of writing where I just am sort of seeing where it goes and what catches my attention and what’s viable for a full-length novel and what’s just, like, me having fun and maybe won’t turn into a novel. So it’s super early stages with that one. Joshua Dolezal: Sounds fun. I can’t help asking about this because I think we both do a little bit of book coaching or teaching. I know you teach in a couple of these programs. And so I’m always curious how people design books, because people hire me to help them do it. I’m of the school that if you’re just a pantser, unless you’re a special kind of person, you’re gonna get stuck or get lost at some point. And I have really no appetite for the plotters, like the James Patterson types who outline everything down to the... You know, I sometimes wonder what he is discovering when he actually writes the thing, because it’s so minutely outlined. So I prefer a middle space where there are some broad strokes, or there’s some big turning points that are outlined. I know I gotta get to here and there and finally to this big all-hands-on-deck moment, and there are some problems to wrestle with along the way. But how do you do that? It sounds like you’re more of a pantser. Is that fair? Rachel Weaver: I talk about this a lot in my teaching because I feel like there’s actually a lot of animosity between people that identify as pantsers and people that identify as plotters, and I think that all of us have... instead of fighting about which one’s better or worse, I think it’s actually important to develop both those muscles, or both those parts of our writing brain, right? The process of discovering what our own individual process is, is figuring out when to invite one of those, either the pantser or the plotter part of yourself, to the party, and when to kick that one out and invite the other one back, right? So I think it’s really a matter of embracing that just sit down and write to discover part of our writing brains for a period of time. But now 100 pages in, I’m like, “Oh, what is this?” Right? What am I doing? So now it’s time for me to embrace that plotter part of my mind, not necessarily to plot out the whole thing, but to consider some of those big picture questions like, what am I really writing about? What are all these people trying to do? What are their obstacles? What’s at stake? How can I shift things around to amplify those core storytelling elements? And then make some of those decisions, take those decisions back over to the pantser part of me, and then have fun from there, right? But then come back, and I have found that balance for myself. But I think some people like to spend more time in one versus the other. But whichever one you kinda want to avoid, I feel like that’s probably the one to embrace a little bit more. Joshua Dolezal: That’s fair. Yeah, I tend to find a middle path that works for me that has both a plan but also room for discovery, but I like your idea. Maybe I’m too hostile to the extremes. Rachel Weaver: Yeah. The most important thing always is just to figure out what works for you. How does your brain want to work, and then how do you corral it into being the most productive? So I think it looks a little different for everybody, but I do think that everybody has both those parts. I think both those parts are important in writing a book. So it doesn’t get prescriptive, but it also doesn’t get super unwieldy and overwhelming, and then you just don’t work on it because it’s too overwhelming. Joshua Dolezal: For sure. Well, I gave everybody just the briefest synopsis of your book, so I’m curious if you would just fill in some of those gaps. If someone hasn’t read Dizzy, what’s it about? Why should they read your memoir? Rachel Weaver: Yeah, it’s a braided memoir of my time working for the Forest Service before I was sick, working in the backcountry. I was mostly working on a big statewide project, or I should say a Tongass-wide project, in Southeast Alaska to determine appropriate bear tag limits. So the first step in that process was figuring out what is the bear population size on all of these remote islands. So I was working on that study along with lots of other random studies that the Forest Service had going on in the time that I was there. And so there was a lot of interactions between me and the natural world, me and bears, all that stuff. So that’s one thread of the story. And then the other thread is my time as a pretty average person trying to navigate the medical system. One thing that I’ve noticed over my time reading a lot of illness memoirs i… This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit joshuadolezal.substack.com/subscribe

  5. Jun 30

    Some Things You Remember Best Never Happened At All

    "A lot of what makes [memoir] good is what you leave out. You can’t interpret things for the reader." Dr. Sandeep Jauhar, author of “My Father’s Brain” Today, on “The Things Not Named,” I speak with Dr. Sandeep Jauhar, a cardiologist and the author of several books, including Intern, Doctored, Heart: A History, and My Father’s Brain: Life in the Shadow of Alzheimer’s. Below is an edited transcript of our conversation on Substack Live. Transcript: Joshua Doležal: Welcome back to The Things Not Named. I’m Joshua Doležal. Willa Cather said that the presence of the thing not named gives high quality to literature, and this year I’m applying that idea to medicine, asking how we might be more attentive to what goes unsaid in the clinic, in popular culture, and in the experience of illness on the patient’s side. I’m excited to have Dr. Sandeep Jauhar here today as my guest. Dr. Jauhar is a cardiologist and the author of four books: Intern, Doctored, and Heart: A History, as well as My Father’s Brain: Life in the Shadow of Alzheimer’s, which we’ll focus on today. My Father’s Brain takes an unflinching look at the toll that caregiving takes on families. It also delves into what happens in the brain as we age, how memory gives meaning to our lives and even changes with time, and how dementia complicates our understanding of what it means to have a self. In addition to his clinical work, Dr. Jauhar is a contributing opinion editor for The New York Times. He’s also appeared frequently on NPR, CNN, and MSNBC to discuss medical issues. And his essays have been published in The Wall Street Journal, Time, and Slate. You can follow him on X at @sjauhar and learn more at his website, sandeepjauhar.com. Dr. Jauhar, welcome and thanks for joining me today. Sandeep Jauhar: Yeah, thanks for having me. Joshua Doležal: So this is your latest book. Have you done a book tour? Are you currently making the rounds with it? Sandeep Jauhar: Yeah, well, the book came out in twenty twenty-three, so I’m sort of done with that part of it. But yeah, I mean, I sort of miss it. But yeah, no, it was a nice tour. I went to, you know, I don’t know, maybe seven cities and, yeah, it was fun. Joshua Doležal: So what’s that like? Do you have to take time off work to make the book launch happen? Is it kind of all-consuming for a bit? Sandeep Jauhar: Yeah, I think, you know, the first couple of months tend to be a lot of interviews, and, you know, talks, book talks. It takes some time out of my schedule, but, you know, it can be scheduled. So like I know when the book’s coming out, and I know how much vacation I have, and so it all tends to work out. Joshua Doležal: Why do you do it? I’ve asked this question of a lot of people. You know, doctors are busy people, and, you know, I assume there aren’t financial demands that require you to write books, and it’s hard to do with a family, as I know. I have three kids. Sandeep Jauhar: Yeah. Joshua Doležal: So when you work a job that typically has a high burnout rate already and then you’re writing on top of it, it seems like kind of a lot. So why do you stick with it? Sandeep Jauhar: Yeah. That’s a good question. It’s really a miserable hobby. No, writing, you know, as I’m sure you know, is really hard. It’s probably the hardest thing I do day to day. You know, harder than my medical practice really, which can get a little bit algorithmic, whereas writing demands a sort of creative impulse, and that’s why I do it, because I always wanted to make art, you know, in whatever way I could. I had that creative impulse, and I didn’t find really an adequate outlet for it within clinical medicine. And so I found a lot of aspects of medicine were fascinating, troubling, you know, sparked a lot of thought and created a lot of dilemmas in my mind. And I found writing was the way to try to help resolve some of those dilemmas. I mean, I do some writing as just pure advocacy. You know, I’ve written many, many op-eds in The New York Times about aging, ethics in medicine, and, you know, other aspects of public health and clinical medicine that, you know, I just want to bring out some point of view that I would like to be debated or I want to advocate for. But that’s really not my main impulse, especially when it comes to books. With books, you know, it’s just I really focus on creating the best art that I’m able to. Joshua Doležal: Well, it’s nicely said. I have kind of made a name for myself for being grumpy about the quality of new releases. You know, most of the craft touchstones that I look to for my own memoir writing and for fiction are ten years old now. Tobias Wolff, Mary Karr, some of the authors in your genre, Atul Gawande, Danielle Ofri, they were writing earlier, right? So the latest wave seems to be much more grievance-driven. The craft emphasis seems to be lightened. And so I was so refreshed by your book because I was drawn into it with the questions it raised and, you know, the story it was telling. But there are these touches that really showed a high level of nuance and art, as you’re saying. So how did you learn the craft? Is that something you credit your editors with, or did you study it? How did you become an artist? Sandeep Jauhar: Well, I mean, I studied it in the sense that I read a lot of really good memoirs, you know. And, you know, I think to be a good writer, you have to be a good reader. And some of the names that you mentioned, you know, I’ve read their whole oeuvre. Tobias Wolff, you know, This Boy’s Life, one of my favorites. And there’s another book called Stop-Time, which is really one of the great memoirs, I think, in American literature. And I think it was an inspiration for This Boy’s Life. Great book. So I spent a lot of time, you know, before I started writing books. My first book was called Intern. I got the contract for Intern without a proposal, which tells you how much things have changed. But it was just an offer from my publisher, my still publisher, Farrar, Straus and Giroux. And I remember I was a cardiology fellow, and I just threw myself into... I didn’t know I was going to be able to do it, to write a book. I had never even thought of writing a book. And so I just kind of dived into reading great books for several months, you know. And you sort of know what resonates with you and the kind of style that resonates with you. And yeah, that’s how I studied it. I didn’t take a creative writing workshop and I didn’t get an MFA. But it was, I was sort of largely self-taught, I guess. Joshua Doležal: Yeah. Well, I think we learn language by imitation when we’re young. We mimic sounds. You know, the term for that is canonical babble. And, you know, it doesn’t mean anything, but it sounds like the things that mean something, and then eventually it becomes coherent. So I feel like with writing, imitation is kind of where we start, and then slowly we find our own voice and it becomes more coherent and meaningful. So we all have to be self-taught in that way, I think. One example real quick, and then I want to shift to some of the bigger claims and troubling questions that the book raises. Just as a kind of example, at the end of chapter three, you’re at a luncheon, or it’s an award banquet for your father. He’s featured and he gets the award, but then he gets anxious and wants to leave. And so in this book about his slow decline and progression through dementia, this is one of those painful examples of how far he’s come from the researcher that he was. But his inability to even, you know, really care about social cues anymore, he just, he got his award, so he wants to leave. And you have this kind of exchange where you’re irritated, you’re kind of embarrassed because it would look bad to everyone else if you left. You’re even a little bit cruel because he wants to take a taxi, and you remind him he doesn’t even know where he is. But then it ends with a kind of exchange that’s more affirming. I’m curious if you could kind of talk us through how you designed the end of that … This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit joshuadolezal.substack.com/subscribe

  6. Jun 23

    If You're Dying, I'm The Person You Want In The Room

    "I can’t tell you the number of times I’ve walked into a patient’s room and their chart tells me they should be dead and they’re not, and I don’t know why. And I can’t tell you the number of times I’ve walked into a patient’s room where the chart says they should be fine, and they are very, very much not fine, and you have to figure out why. And I don’t know that I would have ever really been able to figure any of that out without humanities education." — Shelley DeWeerdt Hintz, RN, BSN Today, on “The Things Not Named,” I speak with Shelley DeWeerdt Hintz, a critical care nurse, English major, and one of the best writers I ever taught, on what a nurse sees that doctors don't, why the humanities prepared her for the clinic, and what living with autism taught her about high-stakes care. Below is an edited transcript of our conversation on Substack Live. Transcript: Joshua Doležal: Welcome back to “The Things Not Named.” I’m Joshua Doležal. Willa Cather famously said it’s the presence of the thing not named that gives high quality to literature. This year I’m asking that question of medicine. How might we all be more attentive to what goes unsaid in the clinic, in popular culture, and in the experience of illness from the patient’s side? My guest today is Shelley DeWeerdt Hintz. Shelley’s a former student, one of the best writers I had the honor of teaching, so this is going to be a special episode for me. Shelley’s both an RN and a BSN, both nursing degrees, and also holds a master’s in public administration from Drake University in Des Moines. She’s had to recreate herself multiple times since graduating with a BA in English and writing from Central College in 2007. She graduated just a couple years after I started teaching there. And her path really goes to show how much you can do with an English major. Today, Shelley’s an adult critical care float RN, and a day that begins as a cardiology nurse may switch to ED trauma and then to surgical charge nurse all in a 12-hour shift. It sounds to me like she’s living a real-life episode of The Pitt. Shelley lives in Iowa with her spouse, Damon, two stepsons, and several spoiled animals, including her horse, Vinny, who’s taught her everything she knows about being a human. So welcome, Shelley. Shelley DeWeerdt Hintz: Hi. Long time no see. Joshua Doležal: Yep, yep. So The Pitt, that rings true? Or is it not like it seems? Shelley DeWeerdt Hintz: I haven’t actually watched it yet. I need to, but I don’t get an awful lot of downtime. I’m a very outdoors person when I’m not at work. So downtime, I’m usually trying to power down, so I usually read. I know people have talked to me about it, but I’ve seen clips, enough to know that it’s more familiar to what my day looks like than maybe other medical shows. Definitely, we’re not Grey’s Anatomy, but The Pitt is more familiar from what I’ve seen. Joshua Doležal: So you work three 12-hour shifts or four 12-hour shifts? Shelley DeWeerdt Hintz: I am weekend package, so I work every Friday, Saturday, Sunday, 12 hours. Our shifts usually start 7:00 AM and they end at 7:00 PM, but then we have a half hour we stay for a report to the ongoing team, and then the team that comes on for overnight is from 7:00 to 7:00 AM, so we basically split the day right in the middle. Joshua Doležal: Wow. That’s a long workday. Shelley DeWeerdt Hintz: It’s like three days, but then you get four days off, and there’s trade-offs. You get used to it. It’s definitely a culture shock when you first start it when you’re in nursing school, but you get used to it. Joshua Doležal: I have to tease you a little because the reason we’re speaking is a text I got from you after, I think, another one of these interviews where you were saying, oh, you’re talking to doctors and we nurses are the ones who really see what’s happening in the trenches. So I was paying attention, so hopefully we can hear a few of those war stories today. Shelley DeWeerdt Hintz: Yeah. I mean, we wouldn’t function without the doctors and they are the marching orders. They give us the list of things to do. Obviously, they’ve spent a great deal of time in practice learning, and when all else fails, we have to defer to them. But generally with rounds, especially in med-surg, they will come around, and they’ll hang out with the patient for maybe 10 minutes. They’ll give me the list of instructions for the day, and then we won’t see them again until that time tomorrow. And then everything else that happens to the patient is up to me. And so it’s up to me to notice, to change things, come up with ideas. I can message them when things are not looking okay, when I have concerns. But basically, the rest of the day is, I have to figure it out and then include them if I need help. So as much as patients believe their doctor is just, like, right there, they’re not. Joshua Doležal: Do you think the average person just doesn’t understand how much of the actual care is done by people like you? Shelley DeWeerdt Hintz: Yeah. I have most... Probably every week, I’ll have at least one patient who has a lot of anxiety, and so, you know, will question everything that we’re doing. Like, did the doctor want this? Did the doctor want that? Who are you? Why am I not... Or they’ll sleep through their doctor rounding, and the doctor won’t want to wake them up, and they’re going entirely off what I’ve told them and charted. And then they’ll be mad because they haven’t seen their doctor, but their doctor has gone through the chart. So there’s, every week you’ll have somebody just not quite understanding how the system operates in a hospital. It’s a little bit different in critical care. Doctors are more accessible, and they’re more frequent. But once you go to, like, a step-down unit or a med-surg unit, you won’t see them nearly as much, and they’re much less involved. Joshua Doležal: I want to get back to that, but maybe we can kind of double back to the beginning. So you got a degree in English, and I have actually forgotten what you were planning on doing with that initially. You were thinking about a career in writing, I believe, at the time. So help us understand how you went from the English degree to nursing. Shelley DeWeerdt Hintz: So I started out... As a kid, my mom was a pediatric nurse, and she let me play with her textbooks. I did all her CEUs. She brought home stethoscopes. And so I grew up in a medical family. We were always talking about it. And I had originally thought maybe I’d go to school to be a veterinarian or a nurse, but then I, I was 18 from a small town, and I was anxious, and I was far away from home, and the first semester of college as a bio major was just hard. And so I picked up an English class, which writing had always been just something I loved to do, and then I fell in love with it in school. And that was the time, you know, where everything was different in college than it is today. You were very encouraged to just follow your passion, and you would be able to find something to do, and it was going to be no big deal, and that, you know, a BA would open doors for you. So, you know, sure, go switch to English and writing. I loved it. Had a great time. Towards the end of it, the housing crisis happened. So I was going to have to get creative, but I had originally wanted to move to Des Moines with my ex-husband, and he was in pharmacy school, and I love politics and history, and I really wanted to write grants and work at downtown Des Moines, and that’s where the MPA came from. And then the housing bubble broke. So my first job, I was a collector team lead for Wells Fargo. It was... Joshua Doležal: I remember that. Shelley DeWeerdt Hintz: ...not writing at all. And did that for a couple years because you got what you could get a job doing at the moment, and then moved quite a bit with my husband. Eventually ended up purchasing a pharmacy in small town Iowa. So not anything to do with writing, but it was a very, you could either teach, like, elementary school, middle school in t… This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit joshuadolezal.substack.com/subscribe

  7. May 26

    Why This Doctor Reads Detective Fiction

    “What we now consider modern diagnosis, and the literary genre of detective fiction, arose around the same time and mutually influenced each other. We cannot understand the way we do diagnosis today without tracing this prehistory.” — Dr. Lakshmi Krishnan Today, on “The Things Not Named,” I speak with Dr. Lakshmi Krishnan, physician, scholar, and director of medical humanities at Georgetown University, on why diagnosis and detective fiction grew up together, and what doctors and patients lose when humanities is stripped from medical education. Below is an edited transcript of our conversation on Substack Live. Transcript: Joshua Doležal: Welcome back to The Things Not Named. I’m Joshua Doležal, and my series this year is based on a famous phrase from Willa Cather, who said that it’s the presence of the thing not named that gives high quality to literature. So this year I’m asking that question of medicine. How might we all be more attentive to what goes unsaid in the clinic, in popular culture, and in the experience of illness from the patient’s side? My guest today is Dr. Lakshmi Krishnan, and she’s the first in the series to talk about teaching, so that’s going to be a real treat. Lakshmi is an assistant professor of medicine and director of medical humanities at Georgetown University. Her work spans history of medicine, literary studies, and clinical research. She writes about how doctors know, how they think they know, and what impact those stories have on patients’ diagnosis and research. Her scholarship appears in journals such as JAMA, The Lancet, and BMJ Medical Humanities. She’s also been featured in STAT News, The History Channel, and Voice of America. She publishes The Workup with Dr. Lakshmi Krishnan, a Substack on medicine and culture, and is writing a book for Johns Hopkins University Press, which we’ll definitely talk about, titled The Doctor and the Detective: A Cultural History of Diagnosis. Lakshmi was born in Bombay, India, and is a proud immigrant. Her childhood was spent in England and most of her young adulthood in the southern United States, quite a few different regions there, and she adores all things theater, swimming, curating playlists, and weekly trips to the DC Public Library. So welcome, Lakshmi. Lakshmi Krishnan: Thanks so much for having me. This is great. Joshua Doležal: I can’t wait to dig into all of this. I’m fascinated by all of your personal interests, but I wanted to start with your origin story. So fascinating. I grew up in Montana, went to college in Tennessee in the South, did my graduate work in the Midwest, in Nebraska. I spent some time in South America. I’ve also been to Prague a few times. So I don’t know that I’ve been shaped by all those places quite the same way as you, because these were formative years for you. But I’d like to know more about your story. You’re from Mumbai originally, but you grew up in the UK and the southern US. So how have each of those places contributed to who you are now and how you think today? Lakshmi Krishnan: I think it’s interesting, because at first glance, these are places that don’t necessarily have much in common. So yes, I was born in Bombay, now Mumbai, but I still have the pre-90s, very colonial name in my head. But that was really formative. I was born there and was raised for a good chunk of my young childhood, and then actually went back to part of elementary school there in a joint family. So there’s a lot of storytelling. There’s a lot of trading health stories. That’s very much in our culture. I think the things that you observe when you’re a small child and are embedded in are at work often subconsciously. But I still have very strong memories of our family doctor who paid house calls and would come over with this beaten-up leather bag, and lived down the way in this particular neighborhood in Bombay. He was very much a local character, very much a pillar of that neighborhood. He’d come over and do all the checkups, like the young kids — it was a joint family, so cousins, aunts and uncles, parents, then the grandparents. The grandparent visits usually took longer because they had more things going on in terms of health conditions, and he would get plied with cups of tea. I just remember the storytelling that was such a big part of that. And then we moved to the UK and lived in four or five different places in the span of about four years. So even within the UK, broad regional variation, like London to Salford, which is just outside of Manchester, in the north, and then back down to Nottingham, which is in the south of the country, or kind of the Midlands, I suppose. And when you’re the kid who’s always new in school, who’s always finding their footing, I think that part of my experience was very lonely in a lot of ways. I was an only child at the time. My sister was born later, so I’m no longer an only child. But books were a huge — they were a constant and an anchor. And so I think that kind of reading habit, and reading as a source of solace and comfort, and knowing that I wasn’t the only person who had been an outsider in different places, was really big. And then we moved to the US, and we moved to East Tennessee, actually, which was new again. So I guess, as such retrospective narratives go, if I have to assign some coherence to this — my interest was always in connecting across these experiences, even if on a surface level they seemed, southern England to the southern United States to a huge, densely populated city in India. Finding points of connection and commonality was, I think, very important for my internal coherence as a person. And I guess that translated in some way to the work that I do, or to the paths that I followed. Things that seem on the surface disconnected might not be, and you might actually find really surprising connections. So yeah. I could go on, but I’ll stop there. Joshua Doležal: I went to college in Tennessee, in East Tennessee actually. So I’m curious — I was in Bristol, the birthplace of country music. In fact, not Nashville, but Bristol. And so I had a crash course in barbecue and NASCAR and all kinds of things there. But where were you? Lakshmi Krishnan: Johnson City. Joshua Doležal: Johnson City. Wow. Pretty close. What years? Lakshmi Krishnan: We were there from 1995 to — my folks moved to North Carolina in 2021, so a significant — I mean, I went to middle school and high school in Johnson City. Then I left. I went to North Carolina for college. But that was, and is still, home in a lot of ways. Joshua Doležal: How interesting. I’m sure much older than you. I was in college there at that time. I started college in ‘94 and graduated in ‘97, so we overlapped, very close proximity, for two years without knowing. So interesting. I don’t know if you believe in coincidences, or plans, but that’s pretty remarkable. Lakshmi Krishnan: So interesting. The Tri-Cities. Joshua Doležal: Yeah. I played baseball there, and in those days funding for athletics was a different thing, especially at a small school. So we did fundraisers like go clean the NASCAR raceway after the Bristol 500. Lots of character-building experiences like that. So, Lakshmi, you have an MD and a PhD in English, which is kind of an unusual combination. So I want to talk about those two degrees. I’m sure you had lots of people telling you not to get the PhD in English. Maybe I’m wrong about that. But one of them is the degree that everyone pushes for down the STEM path, right? Go be a doctor. The PhD in English is the one that everybody’s like, well, what can you do with that? It’s not practical. So when did you know you wanted both? And what was the through line that connected them for you? And am I right or wrong that people questioned the second one? Lakshmi Krishnan: You’re absolutely right that people questioned the second one. I’ll answer the first question first. So it was kind of an odd and winding road. In undergrad, I was an English major and I was pre-med. I went to Wake Forest for college, and it was a very liberal-arts-heav… This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit joshuadolezal.substack.com/subscribe

    Why This Doctor Reads Detective Fiction

  8. Apr 28

    What's Named And What's Withheld

    “That's what a storyteller's job is. What do you relay and what do you withhold? And frankly, that's the chronic illness storyteller's mode as well. What am I going to tell this doctor in front of me and what am I going to withhold?” Dr. Michael Stein, author of “A Living: Working-Class Americans Talk to Their Doctor” Michael Stein is a physician, a health policy researcher, and author of 15 books — six novels and nine books of nonfiction. He’s currently Chair and Professor of health law, policy, and management at the Boston University School of Public Health and has also taught at Brown University. Michael is a frequent contributor to The Washington Post, The Boston Globe, and the New York Times. He’s also been featured on NPR’s Fresh Air and in O Magazine. In his spare time, he is Executive Editor of the Public Health Post. Below is an edited transcript of our conversation on Substack Live. Transcript: Joshua Dolezal: Welcome back to The Things Not Named. I’m Joshua Dolezal, and my guest today is Dr. Michael Stein. Willa Cather famously said that it’s the presence of the thing not named that gives high quality to fiction, drama, and poetry. So this year I’m asking that question of medicine. How might we all be more attentive to what goes unsaid in the clinic, in popular culture, and in the experience of illness from the patient’s side? Michael’s recent book addresses that question because he’s giving voice to a lot of people who normally don’t get to tell their story in popular culture or in medicine, so that’ll be a treat today. Michael is a physician, a health policy researcher, and author of 15 books — six novels and nine books of nonfiction. He’s currently Chair and Professor of health law, policy, and management at the Boston University School of Public Health and has also taught at Brown University. Michael is a frequent contributor to The Washington Post, The Boston Globe, and the New York Times. And he’s also been featured on NPR’s Fresh Air and in O Magazine. In his spare time, he’s also the executive editor of the Public Health Post. Welcome, Michael. Thanks for joining me today. Michael Stein: Josh, thanks for having me. This is great. Joshua Dolezal: I want to get to your latest book, A Living, which you’ve modeled after Studs Terkel’s classic, Working. But first, I’ve talked with almost everyone on this series about craft and how they think of themselves as a writer. And I’d kind of like to start with when you first started thinking of yourself as a writer, what some of your formative influences were, any significant mentors you had that shaped you as a writer. What’s your origin story? Michael Stein: Right, great. Thanks again for having me. So my origin story is — I think the first book that influenced me as a quasi-adult was in my 20s when I read a biography of Robert Lowell. And I thought that was just a fascinating life. And he was obviously a poet primarily, and I was writing poems at that point. And I spent many years doing poetry, which I published all over the place, and came into contact with the famous editor Gordon Lish, who had reached out to me and asked me to send things to his magazine. So I started to send some things to a journal that he was running called The Quarterly. And so I wrote a lot of poems early on. At the same time, around then I had done some work as a journalist, which was not creative writing but an important kind of writing. I had done that in college and I thought of doing a career — I sort of reached the fork of do I do medicine or do I do journalism? And so, of course, being who I am, I chose both. I ended up going to medical school and was still sort of writing journalism pretty much through medical school. I paid for medical school working as a journalist for Nature magazine and went to occasional medical school classes. And I was writing a lot of poetry. Then years passed and I had children, and I started one night — when I was up feeding children in the middle of the night — to write fiction. I wrote six novels, published six novels over the next number of years. And then along the way, I just decided to come and try to start writing about medicine directly. So I went back to writing nonfiction about medicine. My writings have gone all over the place since then. As you said, I’ve written a lot of books — six novels, eight books of nonfiction — and they range from my recent book, A Living, to more straightforward essays, to public health arguments. I wrote a book called Me Versus Us, which explains to people the difference between public health and practicing medicine, because I now work in a public health school. So I’ve flittered. Joshua Dolezal: Well, so coming back to nonfiction is actually coming back to your roots. And I think I had it wrong — I thought you’d started as a fiction writer and then sort of came to nonfiction later. But it sounds like the essay form, personal form, and your journalistic training was really the foundation. Michael Stein: Yes, I think so. But very different, obviously, from journalism. I’ve always taken my nonfiction to be — having gotten to it really through fiction — a more creative form than I ever considered journalism, which I considered a public service as opposed to my personal writing. So a little different. Joshua Dolezal: Here’s an unfair question, and it probably differs because I know you’ve published 400 scholarly articles too, and all these modes are very different. But when you’re thinking more in the literary sense in nonfiction, or perhaps even in fiction, how do you know good writing when you see it? When you hear about craft, what does that mean to you when you’re making decisions in your writing process? Michael Stein: Well, I would have to say it’s a great question, and I probably see what you’re calling good writing differently at different times in my life. I think what I’ve considered good or enjoyable or meaningful to me — I’ve read different things at different times where, when I went back to reread, they didn’t appeal to me in the ways that they had the first time, which is telling me that I probably have a bit of a shifting view. Having written novels, I became much less interested, for instance, in writing — and therefore stopped writing — naturalistic literary fiction. It just wasn’t so interesting to me as a form anymore. It’s not to say that I don’t like stories, but for the moment, I’ve probably read over the past 10 years, when I pretty much stopped writing fiction, fewer novels than I read in the first 20 years when I was writing fiction. It would take a lot unless the fiction I was reading had something experimental or interesting to me. So technical format changes interest me. But I think what’s a satisfying read — which is sort of what you’re asking me at the moment — depends on my goal of what I’m reading it for. Is it just pleasure or is it something that I’m interested in because it’s a subject I’m thinking of writing about and I want to see the lay of the land? But in general, I think like everybody else, I’m interested in tension. I’m interested in pathos. I’m interested in some investment in a character or in solving a mystery. I’m interested in the theme, which is probably what’s going to draw me to something in the first place. And I’m interested in variation. And as I said, usually these days I’ve been interested in technical questions. So all of my books, as you’ve read, have slightly different forms. I try to ask myself different technical questions, which I think I did when I was writing fiction as well. Can I write a mystery and can I write it from backward to forward? I would ask myself these things and then try to set out to do them. So I think I’ve bounced around both in what I consider satisfying and therefore what I consider good. I don’t know that there is a single “good” for me. Joshua Dolezal: Well, I guess we’re all hopefully evolving — we’re not stuck in our sensibility. But so the book we’re talking about today, A Living: Working… This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit joshuadolezal.substack.com/subscribe

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About

Conversations about literary craft and the things not named that bring high quality to fiction, memoir, and poetry. Hosted by Joshua Doležal, creator of THE RECOVERING ACADEMIC. joshuadolezal.substack.com

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  • Creator
    Joshua Doležal
  • Years Active
    2025 - 2026
  • Episodes
    44
  • Rating
    Clean
  • Copyright
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