If you attended the inaugural UnCon in Salem, this post is an attempt to recreate a bit of its inherent magic. If you couldn’t attend, this is one explanation of why you’ll read reviews like this paraphrased quote: “What have you people done to me? I’m forever changed and so is my writing.”
Several decades ago, an excessively young, naïve, and nervous version of myself began working as a first year medical resident in the Cardiac Care Unit (CCU) of a major city hospital. It promised to be a grueling month, in part because there were only two of us to share the call schedule. I’d be working for 24 hours on as the sole resident attached to the Unit, then I’d remain long enough to transfer my patients to the other resident. In the roughly 22 hours of free time remaining, I would commute, shower, eat, sleep, study up on whatever had arisen in the previous night, whereupon I’d return to the hospital and begin the cycle anew.
My duties meant I’d be the first one called to handle admissions through the emergency room. I’d be the first on-scene “doctor” if a patient crashed in the Unit, and if a Code Blue  was called anywhere in the hospital, it would be my sorry ass expected to run the resuscitation protocol. (Doesn’t that make you feel safe?) To be sure, the experienced nurses would help and if the staff cardiologists happened to be around they’d back me up, but the primary responsibility would be mine.
How did I handle this, you ask? I neither was nor am a religious person but during my first shift on the CCU, I located the hospital chapel and began to memorize the Psalms.
Your Voice in the Workplace
We have a voice in any vocation we pursue and, as with writing, it’s a critical component of our success or failure. Consider, for instance, two social studies teachers’ approach to a standardized curriculum. Were you to scramble their students – have them attend the alternate classroom for a few sessions – do you believe they could mistake one instructor for the other?
The same principle applies to doctors. Each time you meet a physician you absorb their professional voice – their way of being in the world – from minute details such as whether they invite you to address them by their first name, whether they wear a lab coat, their office’s decor. In their presence will you be permitted to laugh at your own cancer? Will you feel foolish if you cry at the birth of a baby?
At the CCU stage of my life, if you had pressed me to describe the story of my medical career, I would have said it was about the struggle to survive information overwhelm, sleep deficits, and responsibility, not to develop an independent physician-voice.
That changed the morning I met “Jim.”
A Paradigm Change
He’d arrived overnight, been admitted by my colleague for a heart attack, and in the transfer meeting was said to be recovering uneventfully. But as I began rounds on the CCU, Jim developed a known complication – intermittent heart block, meaning that he went through periods when the top and bottom parts of his hearts were not communicating. He hadn’t passed out yet, but his EKG was deteriorating.
This is not the kind of problem which can be fixed with medication. Should Jim progress to complete heart block, depriving his brain and vital organs of oxygen, his life could only be saved by the emergency placement of a pacemaker.
Now I’d never inserted a central line before, never mind a pacemaker, so it was fortunate that a new-to-me cardiologist was on the unit at the time. As we collectively wheeled Jim into the attached OR and as we donned our sterile gowns and gloves, I became Dr. H’s assistant, more bystander than participant. I watched him prep the patient’s skin, make an incision, and prepare to thread the pacemaker through a vein into Jim’s heart.
That’s when things got interesting.
If you’d been told that your life hung in the balance while a team attempted to float a delicate mechanism into your chest, do you suppose you would remain motionless when specifically asked? While I’d personally be doing my best Hans Solo impression, Jim, who was a great shaggy beast of a man, wasn’t cooperating. No sooner would we get close to stabilizing his heart than he’d shift his body and we’d have to begin anew.
It took us a while to twig to the nature of the problem, but eventually someone plowed through his chart and confirmed a vital piece of information which had been lost during the staff changeover: Jim was mentally handicapped, with an intellectual age of four. He was incapable of understanding the seriousness of his condition, couldn’t provide informed consent, and there was a strong possibility he’d die before we could locate his absentee guardian or caregiver.
In such situations, Canadian law allows physicians to perform life-saving activities first and sort out the legalities later. While the options we had were limited, we could:
- Sedate him, though this could easily precipitate the danger we were trying to avoid.
- Have him physically restrained, although there was no way to fit six security guards into the OR suite, and Jim’s size meant he’d require nothing less than a full contingent. Also, this would place a huge strain on his heart.
- Wait until he was too ill to resist, which would almost certainly result in his death.
- Win Jim’s cooperation by speaking to him in terms he could understand.
That fourth option is a no-brainer, yes? For reasons I’ll explain, on a personal level it felt the riskiest of all.
In the era under discussion, the city’s hospital-based specialties were unabashedly patriarchal. Most clinical preceptors were male and the rules of belonging were clear. Thus, surgeons could scream and throw instruments at the then all-female nursing staff without fear of being censured. One obstetrician — easily the best technician in the city — was known for delivering this line to attending fathers. “A daughter?” he would say when announcing the baby’s sex. “Maybe the next one will count.”
I could go on, but you get the idea.
When you become a medical student, you don’t just ditch 100,000 years of evolution.
Human beings are hard-wired to seek the safety of a community, even if the price is assimilation. In the culture of healthcare, I’d already come to understand I was bottom of the heap. I was young (23 or 24) and planned to be a family doctor (seen by many specialists as the refuge of the unintelligent, incapable and unambitious).
The price of being discounted was steep, ranging far beyond hurt feelings or a sense of unfairness. If you had a chance to get a few hours sleep during a 36-hour shift, nurses would think nothing of disturbing you for laxative orders that could have waited until the morning. Senior residents would cut you out of critical learning opportunities, meaning your entire future practice would suffer. Most distressing of all, if you knew you were in over your head and asked for help, your back-up crew would be just a little slower to respond.
So there I was, Jim’s health deteriorating and me in a known bastion of conventional, masculine thinking. The CCU nurses had a reputation for cliquishness. Dr. H was an unknown quantity and this would be his first impression of me. No one — not one single person among the intelligent, experienced, senior professionals — mentioned the obvious fourth choice to comfort Jim.
Was that because they didn’t see it, because it was unacceptable for a reason I didn’t grasp, or was it a cultural taboo? If I became the consummate symbol of femaleness by turning into Jim’s comforter and surrogate caregiver, would I be forever written off by the team?
I don’t know how long I vacillated before a particular feeling of knowing washed over me, but inexplicably my choices narrowed to one option. I moved to the head of the stretcher and started to talk to Jim like I might a younger brother. You know: nothing brilliant, nothing insightful. Just basic explanations of what the medical staff were doing and why he had to stay still. We talked about pets, favorite animals, favorite foods.
From time to time I would look up to see how this was going over with my colleagues. I’d catch them staring at me but in the half-hour that followed — which ultimately resulted in the successful placement of the pacemaker, thank goodness — their surgical caps and masks made it impossible to determine if they were disgusted, relieved or both. No one said anything to me. No one flashed me a thumbs-up sign. It felt like we inhabited two different realities — me and Jim on the dark side of the planet formerly known as Pluto, the rest of them on Earth, close to the Mediterranean.
Because I can give you closure on this anecdote, unlike the last time , here are the results of this incident:
- As Jim recovered from his heart attack, his heart block disappeared so that he didn’t have to have a permanent pacemaker. He would return to his group home and undergo successful cardiac rehabilitation.
- Far from being disgusted with me, Dr. H asked me to switch my specialty to cardiology before reluctantly agreeing that my skillset would be a better match for family medicine. During the remainder of my time in practice, we would maintain a cherished mentor-mentee relationship.
- The medical culture began to shift slowly, one sign of that being Dr. H’s ascendancy. His brand of clinical acumen and humanity would be recognized when the hospital named its future cardiac wing after him.
- Through similar, repeat incidences, I would come to understand the reason for the staff’s silence: shame in the face of powerlessness. They wanted nothing more than to have someone — anyone — reveal the path to a place of healing.
- As for me, the incident with Jim wasn’t the last time I’d be forced to pick a side in the battle between the desire for prestige and the desire to be a good clinician.
- And that somatic sensation I described above? Physiologically, it’s almost certainly a sign of neurotransmitter activity in certain regions of my brain. In practical terms, I came to trust it as a sign of deep wisdom that superseded my medical, textbook-based education. I’m certain that it helped me save a baby’s life and was responsible for some of the best moments in my career.
The UnCon’s Legacy: Why I’m Ready to be Naked
If you believed that these dramatic and powerful learnings would help me in my writing, you would be wrong. I am as yet unpublished, and in good part this is because I am a serial non-finisher and chronic self-doubter. I have allowed myself to be sidetracked. I ask myself questions such as these: Who am I to write? What could I possibly have to say that others haven’t said before me and in more poetic terms?
In the UnConference however, I got “it.” I got the answers to these questions and as in the paraphrased quote waaay above, I hope to be forever changed.
Why there? Why in Salem?
I believe it was the consistency of the message delivered by a multitude of people. For example:
1. In Meg Rosoff’s classes, she spoke of the state of Throughness — a sort of effortless writing which comes from what she believes to be the subconscious mind. When she writes from this deep place, whatever fiction she produces will tend to resonate with readers and be quoted by reviewers. In her description of Throughness, I recognized the state of knowing I tapped into with Jim, and which I’ve felt occasionally in my writing, yet shut down all-too-often when things became weird.
In the future, I’ll stop shutting things down.
2. In his teaching, Donald Maass makes use of the Socratic Method in which we are taught to mine our own emotional life as a means to build worlds, characters and stories with authenticity and texture. If there was one overarching message I took from his classes, it would be that the medium of writing is oneself.
Happily, I have a self with which to work, which happens to be no more nor less than any other writer.
3. John Vorhaus talked of the need to see the writer as educator in service of a bigger truth.
I can use this. The truest moments of my life have come when I bury my ego and do the right thing by other people.
4. Finally, and perhaps biggest of all, there was the cumulative realness of being among ninety kindred spirits for five days in a row. For when you are in a group in which bravery and exposure is the norm, it no longer seems frightening to be vulnerable, naked.
And so, Unboxeders, I finally feel integrated – and full of integrity – around the obsessions and concerns and wisdoms which preoccupied my medical career, and which pervade my fiction. Thanks to the sessions on craft, I feel more empowered to tackle them.
If I can distill one message of the UnConference for you it would be this: Take off your gloves. Strip off your surgical mask. Creep up next to your reader’s ear. Begin by murmuring, if you must, but begin. And in that nascent voice, trust yourself to bear a critical message. Though it may seem weird and freakish and unwelcome to the bulk of the world, you offer a nourishing and necessary kind of medicine. And chances are, in the doing, you’ll have the Writer Unboxed community at your back. Because we know you. We see you. You are our kind of people.
And you don’t need to have come to Salem to know this, though it definitely helps.
Unboxeders, have you learned lessons about Voice in your non-writing capacities? What are they? If you attended the UnCon, how has it changed you? Please share.