I was a college sophomore in 1994, when the hit show E.R. debuted. So watching “The Pitt” has piqued some nostalgia, along with sobering reminders of how much the world has changed since then.

Noah Wyle played a significant role in E.R. as Dr. John Carter, who begins as a third-year medical student (1994) and ends as a veteran emergency doctor and philanthropist (2009). For all the grunge and Gen X vibes, the 90s now seem like a buoyant time. College could still change your life, get you out of poverty. Doctors still wanted to change the world.

You could break both of your wrists, as my father did when I was young, and not immediately go broke.

National health care spending doubled between 1993 and 2004. Health spending per capita was roughly $3K per person in 1993 and $16,570 per person in 2025. Employers paid $27K in health insurance premiums per family in 2025, and workers contributed an average of $7K annually from their paychecks. Not to mention the spike in ACA plans after federal subsidies expired last year.

Money is one of the reasons why 2026 feels so different from 1994. “The Pitt” does not bright-side that fact, which is one of the reasons I love the show.

Here are four other reasons why the series is a must-see.

1️⃣ It’s inclusive without feeling smug.

The 90s were all about political correctness and sensitivity training. So were the woke 2010s. But people don’t like being preached at, and the show doesn’t do that. It just shows people living their lives, working as a team, queer and straight, believer and atheist. Decency and mutual respect are the default expectations.

So when Dr. Santos can barely dignify Dr. Langdon after he returns from rehab, it stands out. She tried to cancel him and she failed. The show forces her to live with the messier reality that most of us inhabit, which is that people are more than their worst mistakes. It’s not a flawed person who is insufferable, it’s the person who wants to destroy them because of their singular flaw.

2️⃣ It is comfortable with silence.

One of Dr. Robby’s rituals is to call the ER staff together and observe a moment of silence at the bedside of a patient who has just died. I’ve never seen anything like this on a medical show. Nothing overdramatized, just simple human dignity.

A pause in the relentless hurry and noise.

In one particularly touching scene, an ER regular named Louie finally succumbs to his alcoholism. He’s a happy drunk, kind to all and thankful for the care he receives. But that’s all the doctors and nurses know about him.

When Louie dies of a massive hemorrhage, two nurses clean him up for viewing and Dr. Robby calls everyone in for the customary moment of silence. Louie’s only possession is a wrinkled photograph of a woman. No one knows who she is. But Dr. Robby does.

Turns out that Louie used to be a big-time landscaper, head of groundskeeping at PNC Park. He married, and his wife was expecting their first child when she and the baby were killed in a car crash. Louie never recovered.

He didn’t die of alcoholism. He died of a broken heart. That deeper story is only audible in the silence.

3️⃣ Characters reach believable breaking points.

Ben Percy says that one of the meanest things anyone can say about your book is that it “sounds like writing.” We’re more forgiving with what we watch because shows demand little from us. We just have to ooze a little dopamine.

I like the adrenaline spikes in medical dramas even when I know they are contrived. But it’s easy to lose track of the wall between fiction and real life on “The Pitt.” It doesn’t sound like writing.

When Dana, the head nurse, gets punched in the face by a patient who is fed up with his wait time, she gets right back to work, managing the clinic like she always has. But that punch lingers. She quits temporarily, and when she returns she’s not bulletproof. She snaps at people, she carries an unauthorized syringe filled with sedatives like a frontier cowboy carries a six-shooter, sometimes she can’t focus and has to fight back tears.

The ER takes its toll. Everyone cracks. There’s no sermonizing about it, but the message is clear: the system is asking too much.

Maybe it’s a good thing that the show doesn’t offer solutions. Instead it poses an unsettling question: if we break our ERs through penny pinching and overwork, so that the best people no longer want to (or can sustainably) work there, what implications does that have for our quality of care?

And if this is a problem that disproportionately affects underprivileged urban and rural communities (decidedly *not* the primary viewership of The Pitt), what then?

“The Pitt” doesn’t resolve these tensions. They finish in us long after we’ve clicked off the remote. It’s been two weeks since I saw the last episode. It’s still haunting me. That’s a good thing.

4️⃣ It smashes the myth of the singular calling.

I’ve written about this often since I left academe, how the canard about finding the one thing you love, so you never have to work a day in your life, chews up professors and spits them back out. Fobazi Ettarh, a self-styled radical librarian, coined a good term for it: “vocational awe.”1 When everyone sacralizes the work you do, it moves beyond critique. You’re not supposed to complain any more than a priest is supposed to chafe against his sacrifice.

The doctors and nurses in “The Pitt” are excellent at what they do. The senior doctors move swiftly, perform risky procedures with bravado, and embody the old saw about surgeons: sometimes wrong, never in doubt. The nurses keep the place running, always one step ahead of the hurricane. The residents sometimes compete with each other, showing off their diagnosis chops. Everyone is proud of their craft.

But the show ruthlessly exposes the danger of conflating the personal self and the professional role. Dr. Robby is one of the best, but he reaches a point where the only place he belongs is the ER scrum. He has lost his place in the world as a result. He doesn’t fit anywhere, and his plans for an upcoming sabbatical are shadowed by the risk of suicide.

He’s not much different from Luisa Madrigal in Encanto. Prodigious gifts are like serious mistakes: they can easily become your whole identity. Luisa realizes this in the song “Surface Pressure.”

I'm the strong one, I'm not nervous
I'm as tough as the crust of the Earth is
I move mountains, I move churches
And I glow, 'cause I know what my worth is

I don't ask how hard the work is
Got a rough indestructible surface
Diamonds and platinum, I find 'em, I flatten 'em
I take what I'm handed, I break what's demanded

But under the surface, I feel berserk as a tightrope walker in a three-ring circus
Under the surface, was Hercules ever like, "Yo, I don't wanna fight Cerberus?"
Under the surface, I'm pretty sure I'm worthless if I can't be of service

Encanto offers insightful commentary on our talent-obsessed culture, but The Pitt holds up a mirror that is harder to ignore.

What does it mean that we are exhausting professionals who have devoted their lives to helping others?

Why does there seem to be no viable alternative to the corporate-based model for hospitals (and public schools and universities)?

Dr. Robby is quite clear that his ER “pit” would benefit from hiring more nurses. The Chief Medical Offer, Gloria, is equally clear that the budget is insufficient for that. Capitalism would like us to see this standoff as irrevocable, inevitable.

Everyone seems to accept that protecting the bottom line is defensible. Protecting the greater good? Pretty to think so.

That’s the world we live in. Is it really the best we can do?

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Wreckage has been on my mind a lot lately. Breaking points. The before and after, and how we put ourselves together again.1

Three of my clients are writing books that reckon with the past in an attempt to find surer footing in the future. It’s all over LinkedIn, bold prophecies about the future of work alongside plaintive updates from people who feel they are being replaced. And it’s there in the latest issue of The New Yorker: “Sam Altman May Control Our Future—Can He Be Trusted?” Disruption, distrust, a fog of uncertainty up ahead.2

For me, one of these breaking points has been literary craft. The purpose of literature for generations has been to teach us about ourselves, to hold up a mirror to who we are and who we have been, and to use craft to open up the full(est) truth. That is, you can’t get the whole truth from a war diary. You can’t get it from a news report. Maybe no story can encompass the whole, but a novel or play cuts as close to the bone as is humanly possible.

We bear witness through a character’s limited point of view, through a narrator’s framing, through metaphor and symbolism. These are tools that define a lifelong apprenticeship to craft, and for most of my life I’ve seen them as separating serious art from mere fluff.

I’ve written about the death of craft, how the literary scene that defined my own writing for twenty years is gone. This is the world I wrote about last week in my close reading of Wit, which comes close to telling the whole truth about cancer and corporate medicine, in part through the work of John Donne.

I still believe that craft elevates art, that the best writing transports readers to heights that they could not reach on their own. But I read a book recently that touched me deeply, even though it was self-published, lacks polish, and probably never would have been written if the author hadn’t first become a minor celebrity.

Timber Cleghorn’s Memoir of a Wildman might have changed my thinking about the future of memoir writing. For all its rough edges, the book has a root in the literary past. It’s not a medical book, per se, but it is a book about healing. Like Wit, the narrative is driven by an internal struggle that parallels a physical ordeal.

It’s a story with high stakes, not just for the author, but also for me.

***

I often feel like a holdout for a world that was in a time when everyone is hyping what will be. That makes me suspicious of shiny new things. And it’s made me skeptical of those who gush about the future of unedited personal writing. I could not disagree more with Sam Kahn’s “Everything About How Writing Is Taught it Wrong” or Caleb Caudell’s “Kill the Editor.”

But Timber’s memoir is precisely the kind of story that thrives in a world with fewer gatekeepers, fewer curators.

I ordered it after watching Timber nearly win the 11th season of Alone. If you don’t know the show, it’s a survival competition produced by History (formerly The History Channel). Ten contestants are dropped in a remote area, where they must live off the land as long as they can, shut off from human contact except for occasional medical checkups. They can tap out at any time for any reason. Many otherwise sturdy people can’t endure the mental strain. Doctors can also forcibly remove anyone whose health is at serious risk. The last man or woman standing wins $500K..

There’s some educational value in the series — you can learn how to make fish hooks from bone — but it’s reality TV. Much of the hardship is not historically accurate. People typically do not survive in isolation, especially when they are banished during the start of winter. Nor have hermits of the past enjoyed modern tools like Japanese-made folding saws. So I’ve been inclined to view the series as a diversion, not as a story that teaches me about myself, the way good novels, plays, and memoirs do.

But Timber caught my attention. The setting for Season 11 was the Arctic, and Timber was the only contestant to kill a moose. He had a stash of jerky laid by once the snow flew. He was mentally strong, playful and serious, anchored by faith and gratitude. He was set to win.

But then he started worrying about how winning would change him. He was raised poor and he’d worked as a humanitarian volunteer for most of his adult life. Whatever he had, he gave away. He was the equal of those he served. But if he won, he’d no longer be “just Timber,” he’d be “Timber the rich guy.”

So he quit. 83 days in, with the supplies and health to last another month, maybe more. And he still walked away.

His message was so unusual, so riveting to watch as it unfolded on the show, that I had to buy his book to learn more.

***

Memoir of a Wildman is wordy, has a few typos (“taught” for “taut”), and moves inconsistently through time. It’s an immersion memoir, tracking Timber’s 83 days on Alone, but it’s also the story of his life, told in a series of braided flashbacks.

It’s a story that would never make it out of an MFA workshop intact.

But Timber didn’t want an agent. He didn’t hire a ghostwriter. He wrote the book himself, with the help of his wife, a few close friends, and a copyeditor who has zero followers on LinkedIn.

There is an older prototype for Timber’s book: the conversion narrative. This was a staple for the New England Puritans: a public story about having been brought low, convicted of sin, and transformed by divine grace. No one could know whether anyone (including themselves) had been saved, but stories like this were evidence that the “motion of the heart” had been turned irrevocably from evil to good.

Anne Bradstreet’s letter to her children is one example. Jonathan Edwards’s Personal Narrative is another. Captivity narratives like Mary Rowlandson’s and memoirs like Harriet Jacobs’s Incidents in the Life of a Slave Girl and Frederick Douglass’s Narrative of the Life of Frederick Douglass, an American Slave also show a similar movement from brokenness to redemption.

Memoir of a Wildman has a place in that canon of American autobiography. Timber is a person of faith at the start of his journey into the Arctic, but he’s carrying years of buried trauma and anger, questions about his future, and real confusion about his purpose on earth. He’s given most of his energy, time, and resources to humanitarian work, but he’s still empty at the start of Alone.

Like most of us living in the hurricane of our time, he has no idea what’s next. We’re all living in Timber’s personal wilderness.

His unanswered questions map perfectly onto his external struggles. Did I come to the Arctic to win the grand prize or did I come here to heal? What does real winning look like? How do I keep finding reasons to live in a broken world?

Amateur memoirists usually tell their life stories in a strict chronology, even when using the braided form of flashbacks. But Timber (I can’t call him Cleghorn) doesn’t reveal everything right away. His memories track his emotional progress.

At the beginning he’s guarded, not sharing much, focusing on the drama of catching pike, tracking moose, and saving the meat before it spoils. But as winter descends and silence blankets the frozen land, he has more time to stare into his fire and search his soul. And so it’s fitting that he doesn’t recount his own conversion until the last third of the book.

Timber recalls how much fear governed his family life on the homestead, how his parents taught him to evade the government, how the hardship he endured eroded his self-worth. He lived in terror of death, imprisonment, eternal damnation. The only outcomes he could see from all that were suicide or war. Either he’d kill himself or enlist in the Marines and turn himself into a killing machine.

But before he could enlist, he surprised himself by volunteering for a mission trip to Ukraine. He thought the whole thing was dumb, but he’d given his word, so he went along. Timber saw his own fear and emptiness in the eyes of terrified children. He saw the transformative power of kindness to bring hope to those who had given up. It was more than faith, it was confidence, purpose, and self-love. Pretty much everything that his own anger had hollowed out.

It was a simple but powerful shift: “instead of a perpetually angry God waiting to strike down the fearful and broken like me, I saw a compassionate God longing to raise us up.”

I am not a Christian. I converted to Islam last fall and have been rather quiet about it, even though the daily practice has become the cornerstone of my life. But I hear echoes of my own awakening in Timber’s story. He’s not doctrinaire, he’s a truth seeker. He has a low tolerance for bullshit and is as earthy as he is devout. It’s because he’s so grounded in his body and his survival escapades that the psalms he recites from memory resonate. There’s nothing false or preachy about it.

Tobias Wolff opens This Boy’s Life with an epigraph by Oscar Wilde: “The first duty in life is to assume a pose. What the second is, no one has yet discovered.”3 At least a few generations of memoirists have followed that invitation to stretch the truths of their lives. But such a disclaimer would have been anathema to personal writing before 1900, and I see Timber’s book as a return to those older forms.

When he tells his conversion story late in the book, I know it’s because he’s trying to resolve his internal crisis on Alone. There’s no artifice in it. He’s doing what we all do: recruiting what he’s learned from the past to meet the demands of the moment.

Timber describes two competing voices within his heart. The competitive self, the one that wants to win and could easily gut it out, is Broken Timber. This is who he was as an angry young man, the would-be Marine. But there’s another, quieter voice, who wants to be more than a winner. He wants to be known as an ancestor, not as a wealthy man. He is Timber the Satisfied.

“This show is my legacy,” says the first voice. “I’ll never walk away from this.”

“If you can’t walk away from this, you’ll screw up. You’ll change the path of your life, and it won’t lead you to your heart’s desire.”

“But I’ll never find peace or happiness without winning.”

“Follow me, and I will bring you real peace.”

“But if I don’t have this, I’ve got nothing.”

“You already have everything.”

To read Memoir of a Wildman is to participate imaginatively in Timber’s struggle for peace. Like the best personal writing, the book goes somewhere. And even if he discovered most of the message while he was alone in the Arctic, I’m confident that Timber cried multiple times throughout the writing, that those tears came from fresh insights, new discoveries. You can feel it in the words. They come alive on the page.

It’s hard to write a book this raw without being sloppy. But Timber captures his life in the Arctic more cinematically than any GoPro camera could. It’s a good reminder that we can’t feel touch sensations or smell anything while we’re watching TV. Yet a good book can make us feel, smell, taste, see, and hear everything.

For instance, in one scene Timber forces himself to bathe in the icy river because he can tell the snow is coming. He’s been saving a clean set of clothes for cold snap, but he wants to get good and clean before putting them on. He wrote this scene long after living it, after he’d grown accustomed to daily showers and regular meals. But he’s able to transport us back into his physical and head space quite vividly.

“Aaaaaaah!” I scream as I rush deep into the near-freezing river. I start scrubbing like a mad man. My bristle brush of scratchy spruce tips feels like razors slicing me all over and certain body parts don’t like it at all.

He then recalls other experiences of swimming in cold water, how much he hated those, including a time when his brother shot a deer that they later found floating in a frigid lake. Timber stripped down, swam out to it, and towed it to shore, “shivering, blue, and barely male.”

Then he comes back to reality.

“Graaaaaah!” I yell at the water again and try a kick of protest. Rage helps warm me up. But I’ve sunk into the mud and I’m stuck. The water is up to my chest but most of the depth is mud. The sucking morass has swallowed both of my legs up to the knee or higher. As I try to pull one leg out, my weight makes the other go deeper.

Yanking and thrashing to get my legs free, I race up the bank shaking mud from my legs and feet and soon I’m in the thick alder trees where I left my clothes.

I’m struggling to catch my breath when I glance to my right and nearly jump out of my skin. A huge, green eyeball is staring at my naked self from just four feet away. After the initial shock I see that it’s nothing more than the big pike I caught right before bathing. I had stuck the fish into the crotch of a willow tree so that a mink couldn’t drag it away while I washed. It’s sitting there in the tree at head-level, huge eyeballs just staring me up and down.”

Now, it could be that I love a scene like this because I’m still a Montana boy at heart and have a few adventure stories of my own to tell. Maybe there’s no conclusion to draw from this at all about the state of literature or the future of memoir writing. But I don’t think so.

There’s craft in Timber’s telling. He roots us in the physical experience, breaks it with a memory (the way we dissociate from our bodies when we’re in shock) and then comes back to the sensory particulars. I’m freezing in the river with him, lost in thought, then back in extremis, getting sucked into the mud and desperately trying to escape.

Maybe some readers find the eyeball gratuitous, but the effect on Timber’s story is to punctuate long stretches where he’s fighting boredom and fatigue with bursts of adrenaline and humor. A good song needs dynamics. It grows louder at the chorus, softer in the verse, builds toward crescendoes of feeling. A good story needs that kind of emotional movement, too.

I still believe in craft. I still see writing as a lifelong apprenticeship to art. But Timber’s book has made me wonder whether personal writing might be moving away from more stylized forms back to its older, simpler, roots in autobiography.4

More than anything, I love Memoir of a Wildman because it shows change. Timber walked into the wilderness with an understandable goal: to win life-changing money. He could build a house for his family, finally settle down, figure out his next step without living hand to mouth. But instead he experienced a second conversion, an awakening and healing from wounds that he’d never been forced to confront fully and thus had never been able to fully let go.

Sometimes we choose our futures. Sometimes our futures choose us. We’ll never know for sure whether we made the right choices, but we still have to keep making those decisions with everything at stake, based on reason and evidence, but also based on the inner voice that we’ve most come to trust.

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I’ve been watching a curious trend in the headlines. The very thing that public K-12 and corporate-minded universities have been gutting for at least two decades is not only sorely lacking now, it’s the new frontier of learning.

No one in Big Tech or Big Science is asking “What can you do with an English major?” anymore. They know that critical reasoning, discernment, and advanced literacy are more important than coding. But they still don’t get that these habits of mind are byproducts of close reading, not explicit outcomes.

You don’t study Shakespeare to become a VP at Samsung or a chief attending physician, though reading the Bard could well lead you there.

Take Margaret Edson’s Pulitzer-winning play Wit. It’s long been a staple of medical humanities teaching because it illustrates so well the gaps (and affinities) between scientific and literary thought. Its themes apply equally to medicine and to business.

In the play, Dr. Vivian Bearing is a professor of English Literature, a specialist in the Holy Sonnets of John Donne, when she’s diagnosed with ovarian cancer. Her counterpart, Dr. Harvey Kelekian, is Chief of Medical Oncology at University Hospital. Edson lists them as the same age – 50 – in her cast of characters, along with another intentional pairing. Jason Posner is a clinical fellow working under Dr. Kelekian, and Susie Monahan is the primary nurse at the cancer unit where Dr. Bearing is admitted. Both Jason and Susie are 28 years old, just starting their professional journeys.

Edson evokes discussion questions before we even read a word of the script. Why would she want her cancer patient to be the same age as the senior oncologist? Why would the two junior caregivers also be the same age? And why might their roles be gendered in this way?

There’s no objective way to narrate the story of medicine, not in memoir, fiction, or on the stage. Narrative requires framing. Unlike a scientific experiment, which must be replicated in precisely the same way to confirm the results, a text can sustain multiple and sometimes competing readings.1

Edson stacks the deck by juxtaposing a formerly formidable, now vulnerable, woman with a powerful man. Not only that, Jason Posner, the clinical fellow who contributes to her care, is a former student. Dr. Bearing once made him work for an “A,” but those roles are reversed when Jason gives her a pelvic exam.

What does all of this mean? And why is every character identified in the script by their first name except for the attending physician, who is identified simply as “Kelekian”? As a patient, Vivian Bearing is not Dr. Bearing or even just “Bearing,” she is identified throughout the script as just “Vivian.” So is Jason and so is Susie. That pattern invites close reading.

To read critically is also to picture how each scene would look on the stage, the tone and delivery each line requires, when to accelerate or slow the pacing.

For instance, when Kelekian begins explaining his diagnosis of advanced metastatic ovarian cancer, he and Vivian go back and forth normally until she begins interrupting him to call attention to his phrasing. When Kelekian refers to her tumor as “insidious,” Vivian objects. Insidious doesn’t mean “undetectable,” it means treacherous.

Medical language has a tendency to blame patients for “failing” to respond to treatment or to erase people as human beings altogether by placing disease in the subject of every sentence. But as a literature scholar, Vivian is highly attuned to the story that Kelekian is telling about her condition.

To emphasize the point, Edson turns the script into two columns, mimicking Vivian’s thought process and commentary on Kelekian’s treatment plan. If you were directing actors in a stage performance, how would you set the scene to show how the clinical story and the personal one unfold simultaneously?

No one reads Wit to improve their bedside manner. It’s a story about how no one can outsmart mortality, not even the great Professor Bearing, who thought she could wall herself off in words.

Edson lures us in with what seem like simple binaries between indifferent men and empathic women, the scientific patriarch and the lettered feminist, but then she shows how Dr. Bearing was just as merciless as Dr. Kelekian to her students, how she sacrificed her humanity to scholarship in precisely the same way that her student, Jason, is beginning to do with his clinical research.

In the end, after chemotherapy has reduced Vivian to a childlike state, bald and drooling, she receives a surprise visitor — E.M. Ashford, her old English professor, the mentor who taught her what rigorous scholarship meant. Up until then, Vivian has been seeking solace in Donne’s Holy Sonnet “Death Be Not Proud,” recalling how Ashford taught her the importance of punctuation.

Donne’s sonnet is often preserved with the more dramatic semicolon, but in the original text, the final line has just one comma: “And death shall be no more, Death thou shalt die.”

Ashford explains:

“Nothing but a breath — a comma — separates life from life everlasting…. This way, the uncompromising way, one learns something from this poem, wouldn’t you say? Life, death. Soul, God. Past, present. Not insuperable barriers, not semicolons, just a comma.”

At her dying student’s bedside, Professor Ashford sees that Vivian is in no condition to listen to Donne, so she reads from The Runaway Bunny, a book she’s purchased for her grandson, in which a little bunny tries to escape his mother only to find that she will follow him anywhere.

“A little allegory of the soul,” Ashford muses. “No matter where it hides, God will find it. See, Vivian?”

In Mike Nichols’ film adaptation, this scene draws out the text’s nuances beautifully. Nothing but a breath separates life from life everlasting. Just so, Vivian’s moaning turns to peaceful breathing as Ashford reads The Runaway Bunny. There’s no seizure, no sudden gasp, no death rattle. Just a comma between agony and rest.

Grappling with the meaning of Wit won’t directly improve diagnosis or patient satisfaction surveys, but it teaches medical students about themselves, now and in the years ahead. It holds up a mirror to the profession and asks them to interpret what they see, how medicine has gotten that way, how it might be changed.

It’s not a pretty picture in the final scene. The morning after Ashford’s visit, Jason finds Vivian unresponsive and starts CPR immediately. Susie protests that Vivian is DNR (Do Not Resuscitate). But Jason shouts, “She’s Research!,” and orders a Code Blue. Jason has missed the point. He sees death as a hysterical semicolon, not a quiet passing from one truth to the next, not as a human rite that deserves its own dignity.

The play is a warning. A call for humility. If Jason doesn’t rediscover his humanity, one day he will be the senior scholar with no spouse or children to visit him in his last days.

To read Wit thoughtfully, to engage with its questions and its invitation to complete each scene imaginatively, is to practice all the skills that tech leaders and hospital CEOs now say they need.

But not for the reasons they think.

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“Some things can’t be healed. They just need to be held. Narrative medicine does a great job with this — sometimes the healing is in the holding.”

Kimberly Warner, author of “Unfixed”

Thank you to , , , , and many others who tuned into my live interview with last week.

Kimberly Warner Bio:

Kimberly Warner is a filmmaker, author, and patient advocate whose work explores what it means to live fully in a body that doesn’t always cooperate. After studying pre-med and biology at Colorado College and pursuing graduate training in naturopathic and classical Chinese medicine, she left a clinical path for a creative one. In 2015, a rare neurological condition upended her sense of balance. That experience became the seed of Unfixed Media, a multimedia platform for chronic illness storytelling that has been recognized by PBS, Harvard Medical School, and the Invisible Disabilities Association. Her debut memoir, Unfixed, was serialized on Substack, picked up by Empress Editions, and earned a Publishers Weekly Editor’s Pick and a Kirkus review calling it “genre-defying.”

Kimerly is a member of the Global Advocacy Alliance, the PPAA (Patient and Physician Advocacy Alliance,) and a visiting faculty member with Global Genes. She also serves on the editorial board of the Journal of Health Design and is an ambassador for the Vestibular Disorders Association).

The full transcript of our conversation is available below.

Transcript:

Joshua Doležal:

Welcome back to The Things Not Named. I’m Joshua Doležal, and my series this year is titled for a phrase from Willa Cather. 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?

My guest today is Kimberly Warner. Welcome, Kimberly!

Kimberly Warner:

So great to be here. I love that you are exploring the white space, the unnamed, and that you’re putting that into the realm of clinical care this year. That’s fascinating to me.

Joshua Doležal:

It seems appropriate for illness and especially for your story. So, lots of mouthfuls there in your bio. You’ve been really active, it seems, in medical communities as a patient advocate and also as a storyteller.

Kimberly Warner:

Yeah, it was not intended. I certainly didn’t set out to go that direction. Although I do remember even in high school when I told my parents I’m going to medical school. And my parents said — well, my father was a physician and they said, do you really want to work with patients all day? And what’s the reality of that? And I said, no, I want to be a high school health teacher. And they’re like, how are you going to pay off your school loans? And I’m like, I don’t know, I’ll figure that out. But it’s interesting to look, you know, 35 or 40 years later and see how education has become a really big part of the way that I work with healing. And a lot of that has come through my own personal struggles and personal insights through living with a body that doesn’t always feel great.

Joshua Doležal:

I mean, it’s great that you’re using storytelling as a form of advocacy because I think it’s underutilized. And we were talking before we went live about narrative medicine and how it began at Columbia University. But there’s a long tradition of doctors writing about medical practice and really giving voice to things that can’t be said in the examining room or in the operating room. And I first came to this in graduate school. I was learning about deconstruction theory and this idea that all reality is constructed by language. And I kept wondering, well, what about the body? You know, the body has a kind of grammar. The body has a way of making sense of things and finding balance. So it’s not all relative, as Derrida and others would say. So I got into medical history and wrote a dissertation on the medical humanities and taught for many years courses like illness and health and literature, where I would have loved to have featured your book. It’s nice to be sharing that with folks on Substack this year.

But I want to get back to your memoir, which is the first in this year’s series of illness narratives. I’ve been mostly interviewing doctors who are either in the process of writing a memoir or have written memoirs. My conversation last week with Damon Tweedy centered on his second book about mental illness and integrating mental health care into general medicine. So you’re the first author of an illness narrative. And before we dive into that, could you just give us a brief synopsis of your book for anyone who hasn’t heard of Unfixed or doesn’t know anything about it?

Kimberly Warner:

Yeah, I’d be happy to. I’ve got the little dust jacket summary here, and I can read that to you. But I’ll preface it with — it’s not your classic illness narrative in the sense that it’s a weaving of two different types of narratives, though they are both about identity, because anybody that’s lived with chronic illness knows that that really can crush our identities. There is — it’s not — true in the sense that I have a stack of favorite illness narratives here, and a lot of them are just like, this was the diagnosis, and this is the journey with that, and this is the resolution. And mine is much more complicated, let’s say.

But here’s the dust jacket summary for those that don’t know. Unfixed: A Memoir of Family Mystery and the Currents That Carry You Home, is a haunting exploration of identity, loss, and the unsteady ground of becoming. When a midlife DNA test reveals that the man who raised her isn’t her biological father, Kimberly Warner is drawn into two parallel mysteries — one excavating the silence surrounding her beloved father’s death, the other tracing the absence of a stranger whose blood shapes her very being. As she unravels the secrets hidden beneath her family’s story, another rupture emerges, this time in her body. A mysterious illness takes hold, leaving her adrift in dizziness and a growing awareness that her body knows truths language cannot hold.

Joshua Doležal:

Nice. And I’ve got my copy here, so I’ll put a link in the show notes for anyone who wants to order it. So you are braiding two stories. Why did you not tell them separately?

Kimberly Warner:

Because they were completely linked, to the point where I think that the DNA revelation when I turned 40 was very much a catalyst for the disassembly that was happening in my neurology at the same time. And I think many — anyone listening that knows about vestibular disorders, especially ones that are neurologically related instead of within the ears, can often be heightened or triggered by extreme states of panic. And I was definitely going through a protracted panic attack and a real disorientation to who I was and who I had known myself to be for 40 years. So while I don’t think it was a direct link, I think there are a lot of factors that were happening. It was definitely a piece that pulled the rug out from underneath me and quite literally created the sensation of living on water, which is what this Mal de Débarquement that I have — that is the actual symptom. The experience of it is living on water. So you can’t really disentangle the illness from your life circumstances and it’s all part of the same fabric.

Absolutely. And I don’t know if that’s always the case. I’m not going to say that everyone gets an illness because something psychological shifts in their life story. But for me, it did play a huge role. And I think, unfortunately, because of that, I also wasn’t diagnosed for five, five and a half years. And a lot of that was because of the multifactorial events that were happening. Based on which doctor I saw to try to figure out why I was so dizzy, they were either looking at the psychological issues and doing trauma work and brain spotting and everything under the sun, or concussions on the other end of the spectrum. So it made it very difficult to diagnose what was going on.

Joshua Doležal:

All of the people I’ve interviewed so far are doctors, and in a doctor memoir, doctors write about patients. The patients don’t always have the chance to write back. Your book is coming from the other side of that. When you’re going through your diagnostic journey — years of dizziness with no explanation and so on — I’m wondering if you really struggled with other people’s stories being projected onto you. I know with neurological conditions, it kind of literally is in your head, right? And there’s a kind of condescending form that that takes. So did writing Unfixed feel like you were reclaiming the narrative for yourself instead of being a character in someone else’s story?

Kimberly Warner:

Yes. And I’ll say that when I started writing this, it was 2018. So this was still pre-diagnosis, but it was also right on this precipice of me being so tired of pursuing cures. So I was resting in this place of trying to, like you said, reclaim all of what had just happened to me — including the DNA discovery and the dizziness and all the subsequent things that happened because of that. The loss of job, the loss of friends, nearly the loss of my relationship. And I was trying to just piece it all back together for myself. This was not intended to be something to be read by the world. It was very much just, let’s get this down on paper as much as I possibly can so I can remember the details.

So as you know, when you read this, there’s certainly trauma in this, but there was also so much magic and love that was happening throughout this. And that was a really important part that I didn’t want to forget. And so in the writing, I think I was trying to weave those two together and maybe find a way for them to coexist, because I knew that what I had been doing — which was just chasing cures and living as if I couldn’t be happy unless I was fixed — was not working anymore.

Joshua Doležal:

One of the frustrating parts of your condition is that it’s invisible. I think you’ve even used that word in some of your advocacy. So what you experience is constant dizziness, this sensation of, like you said, being on water. But you don’t look sick. And I don’t know if this is true — correct me if I’m wrong — but when you’re in an examining room, everything has to be kind of reduced to puzzle pieces. So it’s the tests, the clinical signs, lab results, imaging, and so on. So I’m wondering, in your case, what’s lost when a doctor can’t see what’s happening? They can only see what’s measurable. And what did your doctors miss because they were looking for the wrong things or just not able to see?

Kimberly Warner:

Oh, gosh. Well, I actually just finished another illness narrative, and it’s called Dizzy. And of course, I picked it right up because this woman is my age. And I had to email her and say, we have siblings because our stories are so similar. She was dizzy for 18 years. And the parallels between her story and all the other vestibular patients that I’ve talked to around the moment — because there is lab work. There are classic vestibular tests. And you will, first you’ll get the Epley maneuver for the crystals in your ears. Then you’ll go for extensive two-day lab testing in the vestibular lab that’s designed to stress your vestibular system. But so many of us, especially with the central nervous system disorders, will go back to get the results after this hopeful duration after the test and — oh my God, they’re finally going to figure out what’s wrong with me. And the doctor hands you the paperwork and says, congratulations, there’s nothing wrong with you.

And that is the most disheartening experience. And I remember that moment. I had already been living with it at that point — I think it was eight months. And I thought, I mean, I was going day by day thinking, I can’t live another day with this. Counting the days to his answer for me. And then for him to pat me on the back and high-five and, you know, you’re great. What they’re missing is that we’re not. And this was a dizzy specialist — a dizzy neurologist. And unfortunately, a lot of the central disorders are the last to get diagnosed. So when they’re checking the boxes, they’re going for — he eventually diagnosed me with cervicogenic vertigo, which is structural. He was saying it was in my neck. They want the quick fixes and they want to be able to medicate.

And so I know there are so many vestibular patients out there that have to go through 20, 40 doctors before they end up getting to the one that’s going to address the central issues. And those are a little bit more complicated. And it’s tricky because it is in your head.

And often they are treated with SNRIs and SSRIs. But the patient has to be coached enough to know that the doctor’s not saying you’re crazy because he’s giving you an SSRI or an SNRI. He’s not saying, oh, you’re making this up. He’s saying that the world is too much for your brain. Your brain is acting like a scared cat right now. And we need to dim the lights and we need to turn the volume down. If someone had told me that when they handed me the prescription for diazepam, I would have said, yes, that makes sense. But if they hand the diazepam to me and they say, you know, I think you have too much anxiety — well, of course I do right now because I can’t even walk across the street. So I think a lot of it just comes down to how it’s communicated.

Joshua Doležal:

I wonder if you might reframe that phrase. You know, it’s not in your head — it’s in your head and your heart and your nerves. I mean, it’s in your life, basically. And I want to ask you about your training because it’s a little bit non-traditional. You trained in both Western pre-med but then also in classical Chinese medicine before you turned to the arts. So that’s kind of an unusual combo. And in the book you write about the body knowing truths that language can’t hold — which is ironically how I got into medical humanities, right. The body knows things. It’s not all language. So I’m curious how that dual medical training shaped how you think about illness, but then also how you told this particular story.

Kimberly Warner:

Oh, well, instantly — thank you. Classical Chinese medicine is fascinating because so much of it lives in metaphor and symbolism, even down to the elements — categories of illness and any sort of medicine or herb is either earth, fire, metal, water, air. And it makes me think of — so the way that I experience the dizziness, like I said, is as if I’m on water. In Chinese medicine, there are lots of different ways that they might look at this, but let’s look at water simply as a kidney and bladder function — not in the classic organs, as in kidney and bladder, but what those organs represent in the universe. And there’s a lot there to do with death and grief.

And what was happening for me when this experience of being at sea started, I was reliving another big seismic shift in my life around the loss of a father. I had lost my adopted father — the one that raised me, who I thought was my real father — when I was 18. But then here’s this other father that appears through a DNA test and, through some discoveries, he’s no longer available either. So there was something on a cellular level for me that was happening in the realm of grief. And I can’t separate the physiology with the metaphor. And I feel like that is a perfect place where Western and Eastern medicine can come together and can actually be really informative.

And the physicians that are able to bridge that, I think, can penetrate a lot deeper into the true experience of what the patient is going through. Because we can’t separate mind and body. The body certainly does lead the way with symptoms. And I know for myself, my body was leading the way with symptoms. Heightened anxiety — I had never experienced anything like panic attacks before all of this was happening. What my mind was trying to do was to bring certainty into the experience. And the way I was doing that was by manically asking everyone how I should be experiencing this story. I would just tell strangers about what was happening to me in my life. And what my body was telling me was, this is too much and you need to slow down and process this information. I have said I even would have done really well had I been sedated, because I was becoming manic with the information and some gentle sedation so that my nervous system could catch up — this influx of information that was coming into my life that was changing the bedrock of my being — that would have been really, really helpful. So yes, I think there’s a real sweet spot between Western medicine and Eastern medicine that bridges metaphor with physiology.

Joshua Doležal:

And part of the Eastern tradition, as I understand it, is ceremony. So there’s nothing ceremonious about going to the hospital. It’s almost as disembodied, ironically, as it could be. I was speaking last week with Damon Tweedy about what happens when someone who is uninsured or underinsured goes to the ER looking for help. If they took some pills, you know — a cry for help, I need help, I’m a danger to myself. Well, if you don’t have the resources and you’re not in the bourgeois club, then you get escorted in handcuffs to the state hospital. How does that help your mental, spiritual condition? It’s like the worst possible ceremony, the worst ritual that you could undergo.

You’re reminding me of one of my favorite novels, Leslie Marmon Silko’s Ceremony, which is about a war veteran. It’s a classic. I love teaching it. But this half-Laguna, half-white man comes back from the war — World War II — and he’s trying to tell his doctors that he feels like white smoke, and he’s narrating his own story in the third person. So he’s that detached from himself that he’s narrating as if he’s outside of his own body, but he sees his body as white smoke. Which is a perfect way of capturing that kind of shell shock — though it’s not shell shock. It’s not PTSD. It’s a spiritual illness that he’s carrying. It’s the image of himself and the Japanese soldiers, the kind of kinship between indigenous people and other Asians that he’s seeing and wrestling with. And a pill isn’t going to solve that. Four white walls in a hospital are not going to be the right environment for that. So it’s through traditional ceremonies that he finds his way back, and he has to kind of sing his way back. He has to find the story. He has to go to the place where uranium is mined to actually complete the ceremony for himself. And that’s just not how Western medicine thinks at all. So when you’re dealing with grief and you go to the hospital, there’s no ceremony for grief. It’s just sort of like, well, get over yourself — or here’s a pill to sedate you or something. But ceremony activates the body and the spirit traditionally. And I just don’t know that Western medicine has any idea what to do with that.

Kimberly Warner:

No, but it’s interesting. I’m sure you’re familiar with Dr. Rachel Naomi Remen. And she thought when she went into medical school and became a clinician that she could cure everything. And what she realized after years and years of practice is that some things can’t be healed. They just need to be held. And I love that so much. And that’s, to me, connected to what you’re saying around ceremony, because ceremony is a place to hold. And sometimes — and I think narrative medicine does a great job with this too — sometimes the healing is in the holding. It truly is.

And I will say that for myself — I’m still dizzy sometimes. But I have been tremendously healed on this journey because I feel that while I didn’t have physicians that were holding me, I feel like I learned to hold myself in the dizziness. And that is a kind of healing that is lasting. It’s a deeper healing. It’s a spiritual healing. It’s something that allows me to be able to live with this experience of dizziness and still feel quite peaceful and joyful. Is that the role of the doctor? I don’t know. But I think that there are physicians out there that are able to recognize that maybe their greatest power isn’t in finding the physiological cure, but to still be able to hold the patient.

Joshua Doležal:

A commenter noted: healing is not always a lack of symptoms. I mean, really, you have to hurt to heal. That’s true of grief. If you don’t hurt, your love wasn’t real. The more deeply you love, the more deeply you hurt. And that’s something you have to feel, and there’s no way to release it except to feel it. And that’s not something that there’s a lot of patience for in traditional medical contexts either.

Kimberly Warner:

Yeah. And unfortunately not. My father — the one that I write about in the book — he was a heart surgeon. And I think he really was an unusual heart surgeon in the eighties because he wanted to access that deeper energetic healing with his patients. His favorite time wasn’t when he was cutting them open. It was when he was doing rounds. And he was a big, six-foot-six physician, but he would kneel down at the patient’s bedside and just rest his hands on them. And that was his favorite, favorite work. And I remember even as a daughter going around the hospital with him doing his rounds. And I could tell that there was healing happening in just that touch and in just that contact — the wordless contact even. I think some of this healing really happens beyond words.

For me, writing the book was — even though it’s a book of words — I think largely the healing is what was happening in between the words. So much so that the last poem in the book talks mostly about how I am less the words and more the page. And to me, that is often where the real healing comes from. Kind of like what you were saying at the very beginning about the white space and the unnamed. Maybe the unnamed is really where the healing is coming from.

Joshua Doležal:

The thing not named, yeah. Part of what’s complicated about your condition is that it’s not fixable, really. Unfixed is the title of your book. And it’s a little bit unusual in that regard from a typical illness narrative. Because an illness narrative usually has — like the inciting incident, it’s like an episode of House M.D. I know that’s an obsolete show now. I’m dating myself by mentioning it. But in a House M.D. episode, there’s somebody in their normal life, and then they have a seizure, and that’s the beginning of the illness, and then you have to figure out what the diagnosis is. So there’s an onset, there’s a kind of crisis that leads to some kind of diagnosis, whether it’s satisfactory or not. And then it ends kind of one of two ways — either you recover or you don’t. Maybe you learn to accept that you’ll never recover. In some cases, you die, like Christopher Hitchens in Mortality. That’s the end of that illness narrative — death from cancer. But your book kind of resists that arc. And I hear the title, Unfixed, as a kind of defiant — I don’t know if it’s a thesis exactly, but it’s a kind of defiant message.

Kimberly Warner:

Philosophy, yeah.

Joshua Doležal:

Yeah. So I’m wondering if refusing resolution in the book is a craft choice, a philosophical stance as you’re saying, or something your illness forced on you. If you had been cured, would you have written a different book, do you think?

Kimberly Warner:

Yeah, this is a life lesson for me. And I can honestly say I’m glad that I hadn’t been cured because — well, first of all, I love one of my favorite bits of feedback that I get from people that read this book: they sleep really, really well when they finish. And at first I was like, what? Like, is it boring?

Joshua Doležal:

Yeah.

Kimberly Warner:

And there’s a nervous system reset is the way it’s been communicated. And I think our culture, our collective, is needing more of this nervous system reset. I couldn’t have written that nervous system reset had I been cured because then it’s just following that nice linear arc of, you know, the hero needs to get to the resolution. And I finished the one I just mentioned, Dizzy, the memoir. And I was a little bit re-traumatized reading it. And it was fun and it was gripping and when’s she going to get the answer and all of that. But it engaged me physiologically in a way that felt so much more stressful. And the way I had to — and where I was even when I wrote this book was a deeper settling with, and a deeper allowing with, the experiences that I was having. And I did not know that when people read that, that’s what they would be picking up. But it’s really cool to hear that there is kind of like a nervous system reset in people. Finally, they get to let it all go. They get to let down that struggle, that achievement, that self-actualization — all of those things that we are trying to achieve — and they get to just be.

So it wasn’t a choice. I didn’t think that that was going to be an experience that my readers would have. I wasn’t even writing it for readers. But it has been my experience, and that’s lasting no matter what now happens — even this last month, since I’ve had some higher dizzy symptoms. I feel just kind of peaceful in the midst of all of it. So I feel like those are some good lessons for all of us right now in our overstimulated population.

Joshua Doležal:

That’s an interesting effect of the book. And I wonder if you could give us a taste of it. We were talking about — there’s a chapter that we flagged that we could possibly read a bit of. I think this is the diagnosis, or it’s kind of where you understand that there’s no cure.

Kimberly Warner:

Yeah. How much would you like me to read?

Joshua Doležal:

Chapter 29 is the one that you mentioned. Why don’t we start on page 184, beginning of late summer, and kind of on to the middle of 186, so a couple pages.

Kimberly Warner:

Okay. My beginning on Chapter 29 is “Reality Strikes: Damning Red Inks.” Do we have different page numbers?

Joshua Doležal:

Well, on 184, the last full paragraph here begins —

Kimberly Warner:

Oh, late summer. Got it. Yeah, yeah, yeah. Thank you.

Joshua Doležal:

So give us kind of the lead up to this.

Kimberly Warner:

Yeah, so this was the dizzy doc that I was mentioning earlier that eventually diagnosed me with cervicogenic vertigo. So at this point, the early dizziness had started in February just erratically, and then it was consistently dizzy by May. So May, June, July, August, September. And those months were just — hell on earth. I did not know up from down, constantly being pulled in these sensations of being pulled in different directions, like walking in a bouncy castle, the sidewalk dropping out, to the point where I just couldn’t — I didn’t leave the house. So I was desperate.

[Reading from Unfixed, Chapter 29:]

Late summer, I finally meet with a neurologist, Portland’s leading dizzy doc. I enter his office, certain he has an answer. Hope is hard. I’ve been carrying it in my pocket for months. The possibility of this doctor not having answers is inconceivable and crushing.

After listening to me convey, for what feels like the hundredth time, all my bizarre experiences and sensations, he orders two days of extensive testing at Legacy Hospital’s vestibular lab. “It’s not going to be fun, I’ll tell you this right now, but we may get some answers.” I nod obligingly. I’m quick to tell a doctor he’s right or she’s helping me even when I feel like I’m dying inside. I project all my absent father issues on male physicians. Maybe he’ll think I’m so smart and so sweet that he’ll go the extra mile to make sure I get better. He’ll look forward to the day when he sees me out in the world succeeding and think, I helped her. He’ll be proud of me.

But he was right. Two days of vestibular tests designed to put maximum stress on all the visual and auditory connections to one’s inner balance are not fun. He was also right to use the conditional verb may, leaving room for no answers at all.

“Kim, you passed your tests with flying colors. Your vestibular system is working great.”

Ordinarily, this kind of daddy high-five would projectile shoot glitter from my eyes. But instead, I am deflated and in disbelief. So, that’s it? But what do I have? Are you saying nothing is wrong with me? Maybe I haven’t conveyed how dire this is. Maybe I tried too hard to look okay, to be pleasing. I can’t go on like this. Does he think I’m making it all up?

“You may have cervicogenic vertigo.”

Cervic — what? It takes me a moment to realize he’s not talking about my vagina.

“I’ll prescribe you 12 sessions with a great vestibular PT. She’ll work on your neck. And you may feel some improvement. And if that doesn’t work, we can start drug trials. Benzos, anti-seizure drugs, anti-anxiety drugs. They all have side effects that you’re not going to like, though.”

Contempt smolders inside me. You may feel some improvement. You don’t even have a definitive diagnosis. I can barely hear him anymore as he rattles off drug names, possible complications, dependencies. He starts to read my face. I am no longer speaking, only shuddering. With an attempt to comfort me, he says, a tincture of time.

I stand up, the floor trampolines. He reaches out his hand, and my misinterpreting heart leaps towards it — a gesture of warmth and support delivered on a scribbled prescription pad for diazepam.

“The body heals itself, and doctors take the credit,” he chuckles as I walk out the door.

I hate his flippant remark and the kernel of truth that suggests. Time can be the ultimate healer, at least in the most broad sense of healing — the kind of healing, or post-traumatic growth, that may not cure bodies but can sometimes heal spirits. A person becoming more virtuous, more brave, more connected because of illness or tragedy. But I don’t want my spirit to grow. I want to be fixed.

I wobbled home thinking about his parting words. If this is true, are all treatments, protocols, and dollars spent along the way just buying time? Time is also the ultimate killer. What if time makes this worse? Not everyone has access to resources and support. Sometimes time destroys us.

Joshua Doležal:

Thank you so much. So it’s indeterminate. And instead of trying to resolve that or tie it up in a bow, you just kind of leave us in that predicament — which I think is a powerful place. We have to finish that story within ourselves.

Kimberly Warner:

It’s a very true place, too. I’ve been working with Unfixed Media now since 2019, and I’m constantly working with patients and their stories. And most of us don’t have cures. It’s interesting how the medical system is designed to — you know, fix things — it’s emergency care. We’re really, really good at emergencies. And largely, a lot of people are walking around with things that can’t be fixed. And there’s not a lot of narrative around that in media. And so what it does, I think, for patients is it leaves us feeling isolated. And then when we read stories or we watch films that talk about that isolation and that unfixedness, the uncertainty, there’s a settling that happens that’s like — oh, my God. Like I said earlier, maybe I won’t be healed, but there’s a new emergent self that can still live her life within this.

One of my favorite people I’ve worked with over the years — we started in 2019 doing a documentary — and his name is Dylan Shanahan. He wrote Liberation of Being. Lives with ALS, very, very late stage. But even when I met him in 2019, he wasn’t able to communicate with his mouth, only with his eyes. A young person. A beautiful gentleman. And I helped him write his memoir a couple of years ago. And he is quite a shining example of how that life force can continue to thrive and exist within an extremely compromised state.

Joshua Doležal:

You mentioned your films. Maybe we could end there since we’re getting close to our time. So you’ve made films that you screened at Harvard Medical School. You’re doing films as part of your advocacy work, and you’re on advisory boards that really are contributing to that advocacy. Do you think illness narratives like yours actually change how medicine is practiced, or is the power of it mainly for patients to feel solidarity and that nervous system reset that someone gets from reading your book? Is that for other people in your shoes, or is that actually something that you think doctors and other caregivers will absorb and then change?

Kimberly Warner:

Yeah, the goal would be to get these in medical schools. I think patients seek this stuff out. Even with social media, they can find it now. So that’s great. But to me, the real work is getting the films into medical schools, getting them into curriculums, getting them in front of physicians that are already practicing. My episodes are all eight to ten minutes long. It doesn’t take long for a physician to really just grasp a sense of humanity within the voices that I feature in these stories. And I really stay away from, let’s talk about what your treatments are and all of that. It’s more the deeper themes around hope and purpose and meaning.

One of the episodes towards the end of the first docuseries asked the question: would you give up everything you’ve learned since your diagnosis in order to be healed? And there was no right or wrong. I wasn’t looking for some sort of glitter rainbow from people. And it was a wonderful mixed bag. But a resounding no came from a lot of people, including Dylan — this gentleman with ALS — because he had gotten to the point where he felt like ALS had become his ultimate teacher. And he wouldn’t want to take away those lessons.

So I think that kind of level of humanity — when a physician can, in 10 minutes, they’re just looking for bullets and ways to attack what is coming in at them. But if they can hold a little bit more of their patient’s story, I think it just opens the potential for an additional kind of healing if they are unable to heal them with the magic bullet.

Joshua Doležal:

I know from speaking with physicians that some of them are fighting the common enemy of the patient, which is the corporate bureaucracy. So it’s not that they’re unconvinced of the need for more healing. It’s just that they’re not given opportunities to spend that quality time or show anything that’s not a billable hour — or they just can’t, within the system that they operate, perform that way. And that seems especially harmful in the case of chronic illness because it’s the contextual things that make it worse or even spark the onset of it. And so it’s more of the contextual human story that a doctor would need to be able to respond to. And yet the constraints of the 15-minute visit, or if they are running behind all day and they can’t get their 40 patients in because some admin is telling them they have to do that — I think sometimes the culture and the corporate environments that are created within hospitals work against that too.

Kimberly Warner:

Yeah, and I think, to me, there’s a solution to that. If 10 minutes is all they’ve got, have resources for your patients. Give them your time for those 10 minutes and then hand them a resource — with a link to one of the Unfixed docu-series videos or for, you know, my dizzy doc — hand them the pamphlet to the Vestibular Disorders Association that’s literally in the same town so I can connect with support groups and additional physicians that are working within — I mean, have resources. We live in a world where there are so many resources. And I think maybe that’s a lot of extra work for the doctor, but maybe there needs to be an additional staff member that just gathers resources for those patients, because a lot of that time is just going to be taken up by gathering data and writing a prescription. But if the patient’s sick, they’re going to go home and they have got lots of time. I guarantee you they’ve got lots of time. So give them something to do with that time.

Joshua Doležal:

Tell me a little bit about Unfixed Media. So you’re telling other people’s stories — are these oral histories? Are they interviews? What would someone see in your films? Can they go somewhere to watch some of these?

Kimberly Warner:

So there’s a great channel called the Disorder Channel, and that was started actually during the pandemic by two gentlemen that were running a rare disease film festival on the East Coast. And then because the festivals had to be shut down, they started a channel, and it’s accessible through Amazon Fire and Roku. But I also have everything for free on YouTube and on the Unfixed Media website.

It originally began just as a documentary, a feature documentary. But like I said, we started filming in 2019 and the pandemic happened. So I was three subjects down and then we had to shut everything down. So I had 20 individuals that were already signed on and I thought, let’s just use smartphones — I’ll send them equipment and see what we can get done in their living rooms and bedrooms. And it ended up being such a successful model for patient narratives because I found that they were actually even more comfortable than the ones that had the film crew in their living rooms. And very vulnerable. And so we filmed for two years where they, every month, would answer a question I had. And then they were edited into a docuseries, a two-year-long docuseries. And then that snowballed into another vestibular series through the Vestibular Disorders Association. And then another one through Solve M.E., which was all about myalgic encephalomyelitis and long COVID-19. And then I did one through Harvard Medical School and Dr. Annie Brewster that was on all mental health. So it keeps going — every year I sort of respond to what organizations might feel like there’s a need for this type of education. There are always willing ambassadors and patients to participate and support. And it’s really easy. It’s been an easy way to gather these stories.

And I’ve always — I’m very picky about how they’re edited. So they’re beautifully done and staged as well as they possibly can. And ultimately someday — I’ve actually applied for a Guggenheim grant and I’ll find out next month if I got it — but I would like to go back to those original 20 subjects, or at least a smaller pool of those subjects, and finish the feature documentary. A little bit like the 7 Up stories, the films that were done over a period of, God, I don’t even know, 49 years. And see how these subjects are doing seven years later, because chronic illness is chronic. So how are they doing seven years after our first interviews? So I’ll be doing this for the rest of my life.

It feels really satisfying to bring these stories into a little bit more of the general audience. But I’ll tell you, it’s an uphill battle to get people to watch it. I think we have to find our niche populations, and medical schools would be a great place for that. But a lot of the time, as soon as somebody says, here’s chronic illness, they’re like, no, I don’t want to hear it. Sounds sad. And the irony is that so many people, when they watch these, they feel uplifted. They are stories of human resilience, mostly.

Joshua Doležal:

Absolutely. Best of luck with your grant. And we’ll end with a plug for your memoir, Unfixed, which is available from Empress Editions. And I’ll point everyone to your Substack, unfixed.substack.com. I’ll put the links in the show notes.

So that’s the thing not named for today. Thank you, Kimberly, for sharing your time and your book with us.

Kimberly Warner:

Thank you so much, Joshua. Take care, everyone. Bye.

My 2026 series explores medicine and storytelling. Come think with me about how narrative bridges gaps between doctors and patients and the public, and why we need writers like Kimberly now more than ever.

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Damon Tweedy Bio:

Dr. Damon Tweedy, is a psychiatrist, author, and leading voice on race, medicine, and mental health. He’s a professor of psychiatry at Duke University School of Medicine and a staff psychiatrist with the Durham Veterans Affairs Health System, where he co-leads an integrated primary care mental health team. A graduate of Duke School of Medicine, he also earned a law degree from Yale Law School, focusing on health policy and medical ethics before returning to Duke to complete his psychiatric training. Dr. Tweedy is the bestselling author of Black Man in a White Coat, which takes a hard look at racism and American medicine. The book was a New York Times bestseller and was named a top nonfiction book of the year by Time Magazine. His latest book, Facing the Unseen, explores the struggle to center mental health within medicine and was recognized by Nature as one of the best science books of 2024.

The full transcript is available below.

Transcript:

Joshua Dolezal:

Welcome back to The Things Not Named. I’m Joshua Dolezal, and my series this year is based on one of Willa Cather’s famous passages. She said that it’s the presence of the thing not named that gives high quality to fiction, drama, and poetry. And so for my series this year on the medical humanities, I’m applying that principle to how we might 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. Damon Tweedy, psychiatrist, author, and leading voice on race, medicine, and mental health. He’s a professor of psychiatry at Duke University School of Medicine and a staff psychiatrist with the Durham Veterans Affairs Health System, where he co-leads an integrated primary care mental health team. A graduate of Duke School of Medicine, he also earned a law degree from Yale Law School, focusing on health policy and medical ethics before returning to Duke to complete his psychiatric training. Dr. Tweedy is the bestselling author of Black Man in a White Coat, which takes a hard look at racism and American medicine. The book was a New York Times bestseller and was named a top nonfiction book of the year by Time Magazine. His latest book, Facing the Unseen, explores the struggle to center mental health within medicine and was recognized by Nature as one of the best science books of 2024.

So thanks for joining me, Dr. Tweedy.

Damon Tweedy:

Yeah, it’s a pleasure.

Joshua Dolezal:

So Damon, maybe we can start with your family origins. If I’m not mistaken, you and I are both first-gen college students. So it was kind of a long road that you took from where you were born and raised to Duke and then also to Yale.

Damon Tweedy:

Yeah, so, you know, growing up, it didn’t feel that way. But now, looking back — I’m 51, almost 52 — it does feel like, yeah, you know, it was quite a journey. So I grew up in a two-parent home, mom and dad, both of whom traced their families back to America’s origins, right? Back through segregation, even back to slavery — because I have an 1860 census my dad showed me of some of his relatives. And so they grew up from Southern Virginia, grew up during the time of segregation. My parents are still living, they’re elderly now, and literally, you know, the things that we read about in textbooks were their lived experience. The Civil Rights Movement came to them when they were in their early 20s. So their whole first 20 years were in that space. And so that undoubtedly impacted how they experienced the world, see the world.

And so for me, I grew up — so my dad worked in a grocery store, a food store. Mom worked in a sort of government, kind of administrative secretarial type work. And I had an older brother and we were in a community that was all Black, literally 100% Black, a very working-class sort of Black community outside of Washington, D.C.

Back in those days, busing was still around. And so we were bused to a neighboring district that was all white. And so those are probably my first earliest kind of signs of, okay, you’re different. And what do people make of you by being different?

And so for me, that difference was that, you know, I was kind of really into math and numbers — I was sort of an odd kid in that way, really into that. So I excelled in math, but I was also one of the Black kids bused to a school that was all white. And there were a lot of perceptions among teachers there about the Black students not being capable or being somehow, you know, a problem — things that we sort of all hear about. And so for me, I was finding myself in a space where, at the same time, I was a top student. And so people didn’t know what to make of me — the teachers and sometimes my classmates — because there were all these perceptions about what it meant to be a Black person, you know, largely negative, right? And so I experienced that sort of duality at a very early age.

When I got to high school, my middle school was a local Black neighborhood school, but then I tested into a magnet program in high school. Little did I know at the time how powerful a school it was in terms of some of the people who went there and what they achieved. But it was a magnet school that was pretty much all white and Asian within a school that was otherwise Black. And so I was in these magnet classes with white and Asian students, but the rest of the school was mostly Black. And there was always this sort of tension between — where do I fit in in these two worlds?

And so that was sort of a common theme, and it played out in a lot of really kind of crazy ways. One story I can tell real quick that will encapsulate this. In high school, in 10th grade, I was in a chemistry class — literally the only Black student in a class of 30 students. And one day, our school was a school of excellence, and so they brought in several leading politicians to sort of talk about our tech program and how great it was. And so at that time — given my age — this was Governor Bill Clinton before he was president, and several people across both parties. And they sort of took them around our school to the tech programs. So here I am, the only Black student in that class. And before they get to our particular classroom, there’s suddenly four or five other Black kids in the class who are just sort of there, positioned. And then you see where I’m going with this? And then suddenly, as soon as these political people leave, those kids are just kind of told to leave. And so I’m back here as the only Black student in the class. And I’m looking around like, what the hell just happened? And no one had any reaction. It was like no one else seemed to get what had just taken place.

And that sort of in some ways encapsulated my perspective of being different, you know, and having to navigate two worlds. So my first book sort of starts with me being a medical student, but that’s sort of the backdrop to that. And so when you get to medical school at a place like Duke, that’s just accentuated — that whole idea of two worlds. The world of the doctors, you know, mostly white and Asian. Then there’s the world of patients and the community that you’re around, which is largely Black. And how do you navigate those two worlds? And so that was sort of the tension that I experienced at a young age, but it just really was accelerated in a medical setting.

Because for me, you know, part of what attracted me to medicine was the idea that it was objective, that it was concrete. It was data-driven. You know, it doesn’t matter what you look like on the outside. A bone is a bone. A blood vessel is a blood vessel. And so that’s part of what appealed to me. It’s like I could contribute to society, but in a very concrete way. And so it was really kind of a shock to the system to get into medicine and realize that it was sort of in some ways the same old thing in terms of those problems that I’d experienced as a young person.

Joshua Dolezal:

Yeah. One of the philosophers that I used in my dissertation was Helen Longino, whose iconic book is called Science as Social Knowledge, kind of questioning this idea that science is just objective because it always takes place in a context that is social, and that certain questions get privileged and certain research gets funded and all of that.

We’re the same age. So I remember Clinton when I was in high school and all of that.

Two questions came up as you were telling a little bit of that story. One — you said that you tested into this program. I know that recently there’s been some debate about whether standardized tests are actually exclusionary, whether they set arbitrary barriers for diversity in college. And I know during COVID, a lot of those standards were just taken away. And yet I’ve heard other writers talk about this — Thomas Chatterton Williams is another one who felt like standardized testing was the only way that he got noticed at all, that he would have been lost in the cracks if it hadn’t been for some kind of merit-based way of breaking through. So I’m curious what your thoughts are on that, whether standardized testing is actually a way of bringing more diverse voices into medicine or whether it’s been kind of exclusionary.

Damon Tweedy:

I think it’s a mixed picture. I think it depends on how you use it. I think that if it’s used — like, a number in and of itself — it has to be — it’s going to sound crazy to some people, but a number has to almost be contextualized. Like, if you take, let’s say, an SAT score — let’s just say 1,200, right? Now, 1,200, depending on what your background is leading up to that place, that could be a not-so-good score, that could be an exceptional score, depending on what your background is and what you sort of had to overcome and deal with.

So you think about my situation. First, you know, parents did not go to college. Despite my mom’s best efforts, I was sort of like anti — you couldn’t get me to read a book. I was kind of anti-intellectual, because that was sort of what was cool, and that was sort of the internalized message as a Black person — that these books you’re learning about in school, about 18th century England, that’s not for you, so why even bother? And so in some ways you’re kind of — it’s easy to sort of go down that path. And so you think about me getting a score like that. You know, given my background, that score may show a lot of potential. But if you compare it to someone who has had all the tutoring and — I was even told when I was in middle school and early high school that you couldn’t even study for the SAT. Like, I was like, really? I mean, looking back now, I think, really? People told me that? But that’s what I was actually told. Obviously there’s a whole testing industry that would prove otherwise.

And so if you compare people — again, the score in isolation — if you’re comparing someone like me with that score to someone who has had a much more privileged background, and putting us on the same footing, then I would say no, that’s not great. But if you sort of contextualize that person — what is that person’s distance traveled to get to this place? Then I think the scores could be potentially very useful. So again, it’s all about how you choose to use it. But if you just use it as a blanket number and say this is your value, then no, I think it could be more harmful than good.

Joshua Dolezal:

I heard Scott Galloway talking about that — you know, that it used to be that you could be kind of average and then get into an environment where you could become exceptional over time. But a lot of elite universities now seem to screen for these superhumans that are already superhuman at age 17. And yeah, it’s a problem.

The second question from your background — you’d mentioned feeling kind of caught between two worlds. You didn’t know quite where you fit. And there’s a saying about comedians, right? That they’re all damaged people. And I think there’s a similar saying about memoirists, which is that we felt dislocated or marginalized somehow, and that we try to write our way back into normalcy. I don’t know if that is true for you — that the impetus to write your first book came from that sense of wanting to bridge the two worlds. Is that accurate?

Damon Tweedy:

I never heard that exact saying. I heard about comedians, but not about memoirs. But I will say, it was an effort to make sense of what I’d experienced. Like, I would have an experience — it all started — writing not even with the intent that I would one day be writing a book for a public audience. It was more about writing for my own sense of like, how do I make sense of this experience internally. You know, I spent eight weeks in a hospital setting — again, patients often all Black, staff the opposite. I’m the only Black person in it. I would always find myself caught in these two different kinds of spaces and not having — as I put in the book — one foot in both worlds but not two feet in either. A sort of dislocation. And so it was kind of just a way to make sense of what I was experiencing initially. That’s how it all kind of really got started.

And then as I began to write a little bit more, I began to realize that there were aspects of what I was writing about that other people could connect with. And then it just sort of built upon — often Black people, but even beyond that, because in so many ways, as you learn, there are so many ways in which someone can be othered, right? And I was able to feel like I could connect with people in other ways as well. So that’s sort of how it kind of all sort of evolved. But it started as something to make sense for myself.

Joshua Dolezal:

I had the pleasure of teaching Black Man in a White Coat. I used to be an English professor in Iowa before I pivoted to independent writing and podcasting, but I loved teaching it, and students resonated with a lot of your stories and learned a lot. They appreciated the research that you brought to it and the historical perspective. What really struck a lot of them was the opening, so I wanted to talk about that first scene that really hooks the premise. And I’d like to also maybe get into some of your influences — people that shaped you as you were writing this or models that you had for the book — because the book doesn’t come out of nowhere. You join a conversation about what it’s like to be a doctor and there’s a great body of literature on that already.

Damon Tweedy:

Yeah, so, you know, just to quickly start that last point. As I got into medical school and once I was there, I started getting interested in stories. Like, it was fascinating to me that, you know, in some ways a story — like a doctor could write a 750-word essay about an experience in a clinic with a patient, and you could learn so much from that. And it was a sort of way you could connect to that. And I found it ultimately became more interesting in some ways than, say, the latest New England Journal study comparing this drug to this placebo. And it was like, wow, these stories are fascinating.

But what I noticed — and there were many books, many writers who were really successful, and I drew on many of them, I have a whole library of books over here that’s nothing but medical memoirs in one row — what I thought I brought to the table, looking back, is that those stories were set in big cities often, but there wasn’t that dynamic of what is it like to be a Black person, given our country’s history, to be in these same rooms? And what were the tensions between patient and doctor that maybe someone who is not Black and didn’t have my experience growing up could sort of understand? So that’s sort of how the book situates within that literature of medical memoirs.

But as for that opening story — so I’ve already kind of laid out for you some of the dislocation I felt and how medical school would start to be this space in which I could kind of escape that. I initially started medical school thinking I’d become a cardiologist or an orthopedic surgeon — very, from my mind, very concrete, objective enterprises, you know, a blood vessel is a blood vessel, a bone is a bone, right? And that was sort of how I was thinking about medical school when I started.

So in the background, of course, in the mid-90s, Affirmative Action was — there was an earlier attack. There’s always been attacks on it, right? There’s always, you know, history repeats itself. So there was always a sense of, you know, you’re in this place like Duke — man, do I really belong here? You know, my parents didn’t go to college. I’m a Black guy here. This guy next to me, his dad’s the dean of this law school. This guy’s mom owns a company. They’re driving Mercedes to school and like, man, you know, I don’t belong here. Right? And they’ve all gone to Ivy League schools, Princeton and whatnot. And so what am I doing here? So there was always that there.

And then there was this early day, first few weeks of med school, where basically I leave the classroom for a break, come back between lectures, and the professor confronts me in the room and says, “Sir, are you here to fix the lights in the room?” And I’m looking around like, who’s he looking at? He’s looking at me. And I’m like, well, no. And he’s like, “Yeah, but I mean, I called about this last week. Why haven’t you done it?” He sort of got irritable about it. And he really kind of doubled down. I’m like, whoa, what’s happening here? Why is it me? And I’m not someone who wants to just jump to the idea that race is always the reason why someone treats you a certain way. But I couldn’t come to anything else. It’s like, wait, why else — I’m dressed the same, everything’s the same as everyone else except the obvious, right? And so I was like, man. It always comes back to this.

And so how do you deal with that? I’m a really big, tall guy. Am I going to come back with anger? Is that going to — how is it going to be received? Am I going to be some, you know, angry Black guy who’s looking to make everything a problem? And this guy was small — so I could visualize how that could have gone south so quickly. And so what do you do? I mean, just based on life experience, that could have gone south really quickly. And so you kind of retreat and you’re like, man, this guy thinks I don’t belong here, right? So I had to — it was like a test for me. Do I belong here? And so I really kind of internally just — maybe he’s right. Maybe all these things are true. And so I just really kind of tapped into something I didn’t know I necessarily had at that point in my life, where I doubled down and I studied like hours around the clock, basically, almost literally. Ended up at the very end getting one of the highest grades in the class.

And the way it worked back then is that you would meet with the professor at the end of the course. And then it was a weird thing because, you know, I knew that at this point I’d done well. But then the professor — when he saw my score and he saw me — he did this double take and started getting nervous and stumbling. And it was weird because it was like in some ways I vindicated myself. I’d shown him — I stuck it to him, if you will. But at the same time, it was like, you know, I’m different, right? And people are going to see me differently. And no matter how much I just want to be like everyone else, I just want to be a medical student — I have to navigate this reality that people will see me differently. And I have to figure out how to make that work. And so that was sort of the opening salvo to that journey.

Joshua Dolezal:

And he, as I recall from the book, offered you a chance to join his research team, and he wanted to be part of that.

Damon Tweedy:

It was like a patronizing kind of thing, right? Because I think he remembered the first encounter in retrospect, and I think it was just so awkward. And it was like, no, we just need to move forward.

Joshua Dolezal:

What you’re describing — being seen a certain way by professors — it didn’t stop once you started practicing. And one thing I love about memoir writing and your book in particular is that our lives happen to us in chronological order, but we don’t have to tell everything that way in a memoir. We can choose how we’re going to order things. And so sometimes the way you place two stories side by side is enlightening. And in this case, you had a self-admitted white supremacist named Chester, and then in the same chapter you had a Black man named Robert. And neither one of them wanted you as their doctor. That was a really interesting contrast — for both of them, coming from very different backgrounds, to draw the same conclusion. So why did you juxtapose them like that in the same chapter? And what did you learn from that?

Damon Tweedy:

At that point in the book, I’m an intern, a medical intern, which is the — people have probably seen TV shows — busiest year in a doctor’s life, you know, all those stories about interns. And so, yeah, you just want to be dealing with all these other challenges: the 3 a.m. call, you know, the heart attack in the room, whatever. And so you’re dealing with — can you cut it, right? And so that’s the context of every intern. And so in some ways, it’s extremely stressful. And you want to feel like you’re just like every other doctor, but then these things happen and you’re reminded you’re different.

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I keep hoping that a new release will change my mind, but trade books now suffer from a flattened style, as I wrote last week. The risks don’t seem risky, the conclusions feel staged. It doesn’t feel like the writer surprised herself.

That’s because big publishers have eaten up so much of their competition that they take fewer risks of their own. The business model is to sell a new version of what sold last year. We’re living in what calls the “Conglomerate Era,” in which the author is just one worker on the assembly line that spits out a book at the end.1

These are some of the reasons why I love Terence Holt’s Internal Medicine so much. It sets a high bar. It’s hard to classify. It was published by Liveright (A Division of W. W. Norton & Company) in 2014. All of this — the consummate craft, the hybrid genre forms, the overall strangeness of the book — means that Holt beat the conglomerate odds. The book gives me hope.

Holt explains the design in his intro. The book follows the chronology of his own residency, but it is neither a memoir nor a novel.

The hybrid design has moral reasons, Holt explains. The usual method of protecting patients with pseudonyms and a few altered details might hide their true identity from the public. But Holt feels that patients deserve more respect.

As long as there’s an actual, unique individual beneath that disguise, you’re making a spectacle of somebody’s suffering, and that’s a line no one should cross. It’s bad for the patient. It’s not good for the writer, either.

Even so, a good story needs specificity: one character rather than generalized summaries. So Holt chooses a middle way. His patients are not “facts.” Instead, they are “assemblages drawn from a variety of sources, compiled from multiple cases, transformed according to the logic not of journalism but of parable, seeking to capture the essence of something too complex to be understood any other way.”

That same logic applies to Holt’s narrator, who he names Dr. Harper and who is neither a thinly veiled version of himself nor a wholly fictional creation.

[I]n recreating experience as parable, I have watched the narrator of these pieces evolve into someone else. He dealt with patients different from the ones I cared for, and did so, necessarily, in ways I never did. The mistakes he makes were not mine. He sometimes thinks or feels things, or fails to, in ways he would not be proud of were they generally known…. He struggles differently than I did, but in the end he learns things that it took me much longer to figure out. In portraying his inner conflicts I have tried to get at what the hospital teaches us. I have tried, more than anything else, to be faithful to the inner life of medicine.

Novelists like to say that they lie in order to tell the truth. But it seems that Holt sets a higher standard yet. Getting at the truth requires invention, but for Holt the truth is never purely abstract.

He recalls the hubbub in the ER one day, how multiple teams are talking over each other, he’s got three people trying to get his attention at any given moment of his shift, the pager is going nuts, and he’s worrying about a dozen different things all at once. He’s light-headed from hunger, his feet hurt, and he has this nagging feeling that he’s forgetting something important, some life-or-death detail.

The book was born of an epiphany: This is not narratable.

Holt explains:

What I glimpsed that day was that the hospital is too manifold, too layered, too many damn things happening one on top of the other ever to get it down in its entirety. If there was any way of doing justice to it, it would have to be through some kind of condensation: by transforming it into a parable that could somehow imply the whole.

He didn’t know if that could be done. But he desperately wanted to try. He needed to understand what had happened to him both externally and internally throughout his training.

So he started where the best books begin: with what he did not yet understand. He wrote into that darkness in search of the truth.

That’s why Internal Medicine is better than anything I can find on the New Releases shelf. Holt’s parables don’t resolve themselves. They are cryptic by design. To read Internal Medicine is to grapple with mystery for yourself.

The meaning finishes in my own inner life, not on the page, which is why I will carry it with me always.

My 2026 series explores medicine and storytelling. Come think with me about how narrative bridges gaps between doctors and patients, and why we need writers like Terence Holt and Damon Tweedy now more than ever.

Paid members get two in-depth essays each month, on-demand interviews, and full archive access.

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I discovered Damon Tweedy while updating a course on narrative medicine (was it really five years ago?). Some professors like to stick with the same syllabus to minimize prep, but I got bored teaching the same books year after year, so I regularly searched for new titles that grappled with familiar questions about medical training, the doctor-patient relationship, and how social context influences medical practice.

Some years that meant teaching a unit on war trauma with Sand Queen and Here, Bullet. Or indigenous medicine, featuring Ceremony and The Scalpel and the Silver Bear. Or systemic racism, with Black Man in a White Coat.

Black Man in a White Coat

Hazing is almost cliché in doctor memoirs. Atul Gawande recounts how his mentors taught by shaming. Danielle Ofri opens her first book with assault: an old man takes advantage of her compassion to steal a kiss. Tweedy’s debut takes that trope to a different level.

During a mid-class break during his first year at Duke Medical School, Tweedy was hanging out, chatting with friends, when he saw the professor striding toward him. He thought Dr. Gale would keep going, but instead the prof stopped and asked if Tweedy was there to fix the lights. The incident shook him so much that Tweedy studied furiously, earning honors and a surprise invitation from Gale to join his research team. Tweedy said he’d think about it, but he left “with a confused mixture of pride, relief, frustration, and bitterness.” Pariah one moment, prize pupil the next. He had no intention of choosing a mentor like that.

Black Man in a White Coat is packed with similar stories which Tweedy braids with research about historical racism and ongoing inequities in care. But it’s not a one-note excoriation: Tweedy often faces his own prejudices and resentment when patients like Leslie, a crack addict who gives birth to a stillborn, hew to the very stereotypes that bedevil him as a first-generation physician. In one chapter, Tweedy feels almost more flattered when a white supremacist shows him begrudging respect than he does when a Black patient requests him as a primary doctor based on nothing more than the color of their skin.

Some of Tweedy’s experiences are truly dizzying. One day he sought care for aching knees after years of competitive basketball caught up to him. The doctor who saw him sized up a Black man wearing sweatpants, a fleece, and two socks that were slightly mismatched, and did not even conduct an exam.

The doctor would have ended the visit with “You’re fine…just a bruise or a sprain” if Tweedy hadn’t pushed back, explaining that he’d lived with a metacarpal fracture for days before seeking care the previous year. That one word, metacarpal, morphed Tweedy from potentially-homeless-man to medical colleague.

He got a full workup, an X-ray, and a thorough diagnosis.

I couldn’t get out of my mind how I’d been treated as two entirely different patients. Damon Tweedy, the unknown black man, dressed like he was about to mow the lawn, couldn’t get the doctor to look him in the eye or touch him; Damon Tweedy, M.D., was worthy of personal, first-class service.

It wasn’t just better treatment, it was a different class of care. Tweedy traces these systemic problems throughout the book, often finding hope in encounters that other doctors might face with cynicism.

Facing the Unseen

Tweedy's second book, Facing the Unseen: The Struggle to Center Mental Health in Medicine, probes new danger zones. Like most good memoirs, it’s driven by one burning question: Why would an M.D. with an elite law degree, firmly established in a general medical residency, choose…psychiatry?

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Casey Means, Trump’s nominee for Surgeon General, has been testifying before Congress about waning trust in American medicine. I agree with her more than I’d like, which is worrying.

Means holds an M.D. but did not complete her medical training and does not now have an active medical license. I’m a little baffled by how someone who isn’t medically licensed can legitimately supervise a cadre of professionals for whom licensure is a necessity.

Yet she doesn’t spout fluff. I read the full text of Means’s opening testimony.

We are now the most chronically ill high-income nation in the world. We live shorter, sicker lives than peer developed countries. Today’s children are projected to live shorter lifespans than their parents. We spend trillions annually on reactive sick care; nearly 150 million Americans rely on federal healthcare programs; and we invest more than $50 billion each year in research—yet outcomes worsen and disparities widen. Our nation is angry, exhausted, and hurting from preventable disease. Rates of high blood pressure, many cancers, autoimmune conditions, type 2 diabetes, mental health disorders, dementia, neurodevelopmental challenges, and youth suicide have all increased in the past two decades.

I’ve made many of these same points myself in courses on sustainability, where I featured films like King Corn and Jamie Oliver’s Food Revolution.

Authors I admire, such as Bill McKibben, Michael Pollan, and Sandra Steingraber, also draw similar conclusions as these:

Public health leadership must address the evidence-based, modifiable drivers of chronic diseases including ultra-processed diet, industrial chemical exposure, lack of physical activity, chronic stress and loneliness, and overmedicalization.

Steingraber even goes so far as to call for “carcinogen abolition.” It sounds like Means agrees.

I found a lot to admire in her newsletter, too. Take, for instance, this one from last spring, which had me nodding nearly all the way down the list.

Means’s take on the Farm Bill and school lunches is edgy, but true. The sheer tonnage of sugar kids ingest at school, from chocolate milk to the endless stream of teacher-supplied candy to birthday treats is dizzying. Not to mention pizza being counted toward vegetable servings.

It’s generally been conservatives pushing for farm subsidies and food processing. Liberals and moderates have favored sustainable food systems, touting the educational, economic, and health benefits of eating locally. But now those alliances have fractured, seeing the baffling rise of fat liberationists and mukbang influencers, who make bank by eating themselves into early graves.

It used to seem simple: eat a little less (mostly plants), move a little more, make ice cream a treat, not a daily necessity. Now I feel like an eater without a country.

If forced to choose between those extremes, I would choose Dr. Means. But that is a low bar to clear. And the attention economy is designed to reward each extreme, not the common ground where we might meet.

Dr. Means has promised to divest from her many conflicts of interest if appointed as Surgeon General. It’s possible that she could do some good in that role. But the reason that Casey Means cannot restore the public trust in medicine is that she comes to the table not as a scientist, not as a doctor, but as a brand.

It’s a point she’s made repeatedly: brands (like Lunchables) should not get to set federal policy.

What do you think of her testimony?

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If I have a patient who's dying in the hospital, I do try to take a moment to just acknowledge that the person in front of me is a very unique person. There will never be another person like that. Whatever bank of memories that person has with their family, friends, loved ones — that all dies with them.

Istiaq Mian, MD

Thank you , , and many others for tuning into my live video with yesterday.

Istiaq Mian Bio:

Dr. Istiaq Mian is a hospitalist (an internal medicine physician who works exclusively in the hospital) in Madison, Wisconsin. His Substack, , explores narrative medicine through memoir and essays about what it means to care for people at the most vulnerable moments of their lives. His essays have also appeared in the New York Times.

Before medical school, Istiaq spent a year as an AmeriCorps volunteer at Joseph’s House, a hospice in Washington D.C. for homeless men and women dying of HIV/AIDS. That experience shaped everything that came after, and it’s the subject of a memoir he’s been writing for years.

Listen to the audio-only version and read the full transcript below.

Transcript:

Joshua Dolezal:

Welcome back to The Things Not Named. I’m Joshua Dolezal, and this is my series named after a quote from Willa Cather in one of her craft manifestos. Cather famously said that it’s the presence of the thing not named that gives high quality to fiction, drama, and poetry.

And for my series this year, I’m applying that principle to medicine with just a simple question: 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?

So my guest today is Dr. Istiaq Mian. Thanks so much for joining me.

Istiaq is a hospitalist, which is a term for an internal medicine physician who works exclusively in a hospital, in Madison, Wisconsin. His Substack — probably the best title I’ve seen — The Substaq of Istiaq, explores narrative medicine through memoir and essays about what it means to care for people at the most vulnerable moments of their lives. His essays have also appeared in The New York Times. Before med school, Istiaq spent a year as an AmeriCorps volunteer at Joseph’s House, a hospice in Washington, D.C., for homeless men and women dying of HIV AIDS. That experience shaped everything that came after, and it’s the subject of a memoir that he’s been writing for years. We’ll get to that and lots of other things. But first, Istiaq, you’re joining us today from Bangladesh. I understand you’re there on a family sabbatical, so I thought maybe we could start there. How did this come about and why is it so meaningful to you to be spending this year in Bangladesh?

Istiaq Mian:

Yeah, I was born in Bangladesh and I moved to America when I was three years old. Growing up, I never had the chance to really come back here and spend much time. And when I met my wife, she loves to travel, is very adventurous. We talked about at some point, after becoming attending physicians, taking a year-long break and spending some time somewhere. And we decided on Dhaka of all places, because I have a family here. Now that we have kids, it’s a lot more meaningful to spend time here. I still have aunts, uncles, cousins here. And I wanted my kids to have that connection and just know where I come from and where my family came from. Growing up, Bangladesh always felt like a concept and it always felt like something was missing. I could see that in my culture, people dress differently. There are a few different cultural norms and I always just felt kind of out of place. So we chose this location because it would be meaningful for us and for our kids. That’s why we’re here.

Joshua Dolezal:

I’ve been enjoying following your adventures on Instagram and you’ve been writing about some of them on Substack. Is it your youngest son who recently had a kind of cyst or growth on his foot and had to be airlifted to Singapore? That’s been kind of a curveball you’ve been dealing with abroad. How is he doing, and I’m curious how you thought through a medical emergency while living overseas. It seemed like a stressful thing.

Istiaq Mian:

I’ll preface it by saying it wasn’t a true emergency, but it was enough of an issue to want to do something about it right then. He had this foot mass that came off and my wife spotted it — it’s a hard thing to really pinpoint on a four-year-old, but thankfully she found it. We had quite a few discussions going back and forth on how we would approach it. In these types of situations, I don’t like to doctor my children because in the past I didn’t have the best experience doing that — you don’t want your child to be sick and so you can have some blinders on throughout trying to manage your own kids’ problems. And thankfully, we got one foot in the door here in Dhaka by going to a hospital and getting the right imaging. After imaging, we decided that probably the best thing for him was to go to Singapore, after trying to figure out where he could get the best care. So it was a lot of back and forth between us and then with the physician team in Singapore. He got his surgery, no major issues after that, and he’s running around normally having a good time now.

Joshua Dolezal:

That’s great to hear. I was struck in your essay about this by how much vetting was involved, because both you and your wife are physicians, so there’s a lot of inside networking and connections that you can draw on. But also the way that you think through the diagnoses you can trust — it’s not the thought process that a typical parent team would be doing. So I’m glad to hear he’s doing well.

Istiaq Mian:

Thank you.

Joshua Dolezal:

Let’s go back to origins a little bit then. So you’re taking your sabbatical in the place of your birth, essentially. Your parents immigrated from Bangladesh when you were three. Tell me a little bit more about that journey. You were old enough probably to have some memories of that trip, but then you grew up in Wisconsin where you live now?

Istiaq Mian:

Yeah, correct. When I say I moved, it was in reality I was new, because I didn’t really have much memory. I think I had just three memories of my time in Bangladesh as a kid. One of them — I remember being in a backyard walking next to some pails of water and some chickens. And I think that’s why I enjoy the company of chickens so much — it’s like one of my earliest memories of being in Bangladesh. But then I grew up in a small town named Kimberly, Wisconsin for six years, and then grew up in Oshkosh, Wisconsin. Maybe you’ve heard of it — like where the overalls are from. It was kind of an interesting experience growing up there, coming from Dhaka. I grew up with three older siblings, and I think they had it much harder than me in terms of growing up there because there were a lot of expectations on them. They didn’t always feel like they got the support they needed. And then when it came time for me to choose what I wanted to do with a career, they didn’t really pressure me to become a physician. They just said, whatever field you choose, just try to be good in it. So there wasn’t any pressure on me per se.

Joshua Dolezal:

So you didn’t have the kind of stereotypical “be a doctor, lawyer, engineer” pressure.

Istiaq Mian:

Correct. Not on me. I wonder if I asked my older siblings if they felt that, maybe they would say yes. I know I had cousins that certainly felt that pressure — you need to either be a doctor, a lawyer, or an engineer. But I didn’t personally feel that pressure, thankfully.

Joshua Dolezal:

We’re skipping a little bit to college and kind of your medical training, but I imagine in an immigrant family with big dreams and high standards, whatever you chose, you had to be good, you had to be excellent. So you tell the story in your memoir in progress about getting caught plagiarizing — I think it was a biology paper. And I don’t know if that news trickled home, but why did you want to include that story in your memoir? And how did it fly in your family if they learned about it?

Istiaq Mian:

I don’t think my parents know actually to this day that that happened.

Joshua Dolezal:

Oh, I’m sorry for spilling the beans.

Istiaq Mian:

I don’t think it’s a big deal. But yeah, I was a sophomore at the University of Minnesota and I got caught plagiarizing a lab report. I included this in my memoir because I wanted to include low points in the story. Nobody wants to read a book of all your highlights — there has to be some low points. Looking back, it was a good time to refocus for myself. At the time, I was 19. I had a crush on this girl. I spent a lot of time hanging out with her and just thinking about her. Then I started slacking. I cheated on this lab report and I got caught. It was just a good time for me to refocus. I also wanted to show that, in a way, I did put some pressure on myself to do good things and get to medical school. Being an immigrant, I always heard stories of people who would want to be in my position, especially coming from Bangladesh. After living here now, I know that there are quite a few people here who are working really hard to try to move this country forward. If you look at some of the competitive schools, some of those students are trying to get to the UK or Australia or America. And so I did feel like there was some pressure on me to try to uphold some standard that my parents would approve of. So I was trying to show a low point and then maybe some of the pressure that I was feeling to get to medical school.

Joshua Dolezal:

I think it’s important in memoir to be vulnerable, and if we’re critical of others or showing flaws in our parents or friends or whoever it is that we’re representing, we need to be just as hard on ourselves. So that’s one of those human notes, I think, in your story, which I appreciated. Also, and I should say, this is a memoir in progress. I don’t know how superstitious you are about talking about a book before it’s actually done and in the world, but you have been writing some of these essays on Substack. But this is a manuscript you’re working on separately. So a lot of the stories that you tell in that are not things that have appeared publicly before. Is that right?

Istiaq Mian:

Correct. Yep.

Joshua Dolezal:

So the story — before you went to medical school, if I’m getting this correctly, you spent a year working with a hospice called Joseph’s House, which is an interesting choice. I think a lot of pre-med students that I’ve taught over the years would have made a different choice, either angling for some kind of high-profile internship that would leverage the most opportunity or possibly something in a third-world country. And was this in Chicago? Is that right?

Istiaq Mian:

This was in Washington, D.C.

Joshua Dolezal:

Washington, D.C. Tell us about Joseph’s House and how that impacted you.

Istiaq Mian:

I was 22 years old, just graduated from the University of Minnesota. And the timing in which I took the med school entrance exam led me to have a year where I could do something while I was applying to medical school. I looked at AmeriCorps. This position was through AmeriCorps, a program called AIDS United, back in 2009. Through AIDS United, I got placed at this place called Joseph’s House. It’s a hospice home for people primarily dying from HIV-AIDS. Statistically now, there are fewer people dying from HIV-AIDS, but back then in 2009, most of the people who were passing through the hospice were dying from HIV-AIDS. And this was a year that allowed me to spend really good quality time with people. And it was really humbling. When I was an undergrad, I looked at all these different experiences I could have, and I sort of looked at it like, what can I obtain from this experience to add to my resume? I think that’s a very common outlook that med students have — you’re just working really hard to get to this final destination. But then when I went to Joseph’s House and I met all these people who were dying, it really forced me to shift my focus. When someone’s dying in front of you, there’s nothing to gain from that experience. Someone’s dying and you have to be there and have humility and just do what you can to make it a good experience for that person. It forced me to have this outlook of: from then on, I’m not working to get any recognition. That’s not what my interest is. It’s me trying to help someone for the sake of helping. That was monumental from that time.

Joshua Dolezal:

Do you still do that? Do you still sit at the bedside of a dying patient? Is that part of your practice?

Istiaq Mian:

Not commonly, Josh. I would say that I take moments to sort of acknowledge the person who’s dying in front of me in the hospital. I work as a hospitalist now, and so I’m only seeing patients in a hospital setting. My days are — when I drop my kids off to school, the clock is sort of ticking until I have to pick them up. And I see typically 15 to 17 patients in a given day. So it is very busy. But if I have a patient who’s dying in the hospital, I do try to take a moment to just acknowledge that the person in front of me is a very unique person. There will never be another person like that. Whatever bank of memories that that person has with their family, friends, loved ones — that all dies with them. And so I just try to acknowledge that it was a very unique person in front of me. And then having this experience from Joseph’s House has helped me communicate with family members who are also in the room. Usually there’s family there, but if there isn’t, I’ll take a moment to acknowledge that it’s a very unique position.

Joshua Dolezal:

I ask that partly because it seems like you’re unusual in that regard. As you said, days are carved up so efficiently, so the time you have to spend with patients is limited. But also, my sense is that when someone gets moved to hospice care, perhaps it would be out of your rotation — there’s a whole separate area for that. And people who go into medicine, for family medicine or internal medicine, the focus is much more on the cure, and if you can’t cure someone then it’s kind of someone else’s problem, whereas physicians used to attend to someone throughout the full course of an illness — mortality was just part of the deal. I’m not sure if you’re familiar with Terence Holt. He has a book called Internal Medicine, which he calls a collection of parables — they’re short stories but he calls them parables — and in one of them he’s a resident dealing with a patient who can’t breathe and is basically at the end of life, and he continually has this frustration that he can’t do anything to help her. He ends up understanding at the end that the thing he could have done, instead of paying attention to all the machines or getting angry that she’s not complying with the breathing tube, was to actually focus on just being present to her in that moment. It’s a story that I’ve taught in medical settings to first-year med students, but also to pre-health majors — about how you spend so much time focusing on solutions and tech and all these things that are supposed to solve problems. But sometimes there is nothing to solve except misery or fear or dignity. Dying is when you can attend to those things, but it seems to be outsourced to nurses or to other caregivers. I don’t know if you would agree with that, but that’s my impression.

Istiaq Mian:

Yeah, I would agree with you. The current model in which I practice — usually the people who have the most time at the bedside are the nurses, the respiratory therapists. Sometimes volunteers just have more time at the bedside than we do. So I would agree with that assessment.

Joshua Dolezal:

For those that have joined us, we do have the ability to see questions if things come up as we’re talking that you want to throw into the live chat — please do. We’ll try to make some time for that. I do want to get to your writing soon, but it seemed that part of your work at Joseph’s House was not necessarily a representative slice of America. It was a population that skewed less privileged. And a lot of the people that you worked with there were Black, and you wondered if their deaths could have been prevented. I guess I’m curious what you took away from that experience about race and poverty and American medicine.

Istiaq Mian:

So when I worked at Joseph’s House, I saw 31 people die in that year. And I would say about 90% of the people I saw die were Black, even though the population of Washington, D.C. is about 40% Black. And it’s very layered as to why that discrepancy exists. There is a really good book called Urban Injustice, written by the founder of Joseph’s House. His name is David Hilfiker, and he’s a Minnesota physician who moved to D.C. and started Joseph’s House. And I read this book, and it had some really great takeaways as to why that phenomenon exists. He talks about slavery and the systems in place that happened after slavery. So after slaves were freed, there was a system of sharecropping where Black people were free, but they still had to work on white property owners’ land and grow crops. In exchange for growing crops, they would be able to live on the land. Even though they were free, they were not able to really have equity or ownership. And then there were decades of Jim Crow laws. In the book, he talks about how suburbs were made and highways ran through Black neighborhoods and sort of walled them off from other parts of the city. That’s how ghettos formed. And then you had zoning laws that prevented residential buildings from being built in these ghettos. And home loans weren’t offered to Black people at the same rate they were offered to white people. And so when you think about those systems starting from slavery, it’s really hard to have equity, have homeownership, have money to spend on your health. And if someone’s starting out from that, from generations of that, it’s really hard to focus on your health. And when people deal with those things, it leads to early deaths. The people I saw — some of them were as young as 21. I saw someone with HIV AIDS die at the age of 21 in D.C. And it made me think: death can’t be prevented, but early deaths certainly can be prevented. I make an argument in my memoir that universal health care would be really beneficial for this reason. When you’re dealing with so much, health is so important to have. People in America should be able to manage a health scare or a health emergency and not have it send them into debt or really wreck their ability to have an earned livelihood. That’s how I would answer the question — death is not preventable, but early deaths can certainly be preventable.

Joshua Dolezal:

One of the people that you write about is Tony, who was a homeless Black man with heart failure, but really became a close friend. I want to kind of pair this with the question I see from Elizabeth in the comments about how you reconcile your need to tell your story against the need for privacy for family and friends. It’s kind of a perennial challenge in narrative medicine — protecting anonymity for confidential information. I assume Tony’s not his real name. But tell us about Tony and how he impacted you as a friend, but also how you approached this question about writing about other people’s lives.

Istiaq Mian:

Writing in medicine, I go to great lengths to make people anonymous. And in instances where people give me permission to use their identifying details, I’ll certainly use some of those, but I do try to make people as anonymous as I can because I think you can still see the heart of the story whether or not you have the right name or demographics of someone. And as far as Tony goes — in my manuscript, Tony has the biggest chapter in the book because he’s the person that affected me the most. He was homeless. He had heart failure. And even though he knew he was dying, he had a really big presence at the hospice. He would buy music for other people in the house who were dying. He would buy flowers. He just had a really big heart, was very generous. And those are the things that I remember about him. And what I learned from my time with him was how everyone deserves care, regardless of whether they’re rich or poor. I feel like back in the 2010s there was this narrative that — and maybe this narrative has been around much longer — but I have specific memories of people saying, poor people leech off the government. They’re taking advantage of the system. They’re taking more than what they can. And myself, growing up under the poverty line in Wisconsin in the 90s, I know that that’s not true. My mom was a stay-at-home mom. My dad started out as a custodian and then was a data analyst. And I could see how hard they worked. I could see how hard people worked in D.C. They’re not taking more than they can. They’re just trying to make it. They want to have some work-life balance, be able to enjoy time with their family. So that was one of my biggest takeaways from knowing Tony and spending time with him.

Joshua Dolezal:

When you’re talking about the hospice here, I think it’s understandable why that would be universally appealing, why people would want to hear about it. It’s a novel experience. It’s one of the classic themes of literature. There’s a running joke that if you major in English, you major in death, because it’s so prominent as a literary theme. But when you think about your own story — telling Tony’s story makes sense, why that would rise to the level of the universal. I think a lot of memoir writers have to clear the hurdle of “why the story about me?” Why am I writing a memoir? Why does my personal story need to be told? So I’m curious how you answer that for yourself.

Istiaq Mian:

Why are you writing a memoir in particular — what propels that for you as something that needs to be a publicly shared story? That’s a phenomenal question. It’s a hard one to answer. And I think for me it was because I met so many people at this really young age, and they had such a profound impact on me. To this day, 17 years later, I think about them often — very often — even as I’m treating people in the hospital now. And you can’t talk about medicine without talking about the system in which it exists. So I really want to share my story and part of their story as well, because I want to give people some ideas on why universal healthcare is needed. And it’s not a policy book. It’s a memoir. It’s a book of stories. And I think stories can demonstrate a point much more emphatically than a straightforward essay or a policy book. And so that’s why I’m writing this book.

Joshua Dolezal:

And as you’re trying to find time — doctors are busy people, you’re also a parent — how do you find time to do this in the midst of all of those other commitments?

Istiaq Mian:

So I have a really nice schedule, Josh. My schedule is seven days in the hospital, and then I get seven days away from the hospital.

Joshua Dolezal:

Oh, wow.

Istiaq Mian:

I’m not vacationing in my seven days away. I sort of shift to being a house citizen. My wife works in primary care, so she has very full days. I’m doing mostly household tasks during my weeks away from the hospital. But the times when I drop my kids off to school, that’s when I have time to write. I wrote this manuscript in 2020 when the pandemic started, and then I finished it in 2023. And then I had the manuscript read, and then I just shifted to reading books because my brain definitely benefited from reading other people’s writing. I’m relatively new to writing — I didn’t start until 2020, and I didn’t start publicly writing until 2023. So the moments that I have away from kids during the day, that’s when I’m able to squeeze in writing time.

Joshua Dolezal:

I don’t know if I’m projecting this assumption, but you said the main reason you’re writing is to address policy things or the system that you work in. But another reason for writing is to help other people know that they’re not alone. And so having an immigrant story, having a different cultural background, being a practicing Muslim — all those things would, to my mind, give more strength to your story as something that would help build the bridge with other people, or let them know that they’re represented in medicine, or make visible some of the challenges that exist in the system. So if you don’t mind me asking, what’s it like being a Muslim in American medicine? And there are a lot of other priorities in a faith practice that I think compete with American capitalism and the way that the work week operates. How do you navigate those things?

Istiaq Mian:

I sort of move away from the checklist of what a good Muslim needs to do. I realized over years that that’s just not my practice habits. I can’t operate on “I have to do this, this, this,” because it does take a lot of discipline to be a practicing Muslim. So I allow myself to have some agency when it comes to that. I’m more interested in how I go about my business. That to me is more important. In terms of growing up as a Muslim in America, it was definitely isolating. When I think about myself as a kid, there was that confusion aspect of being Muslim but not seeing many people like me around. I definitely see how being in a community is helpful in that regard. It’s definitely more prominent here in Dhaka. I think it’s important for people to have visibility, to see people like you.

One unique aspect I would mention in terms of growing up as a Muslim in America — I grew up in a small town. And so the mosque that I went to was almost like a little UN because there were so many cultures that came together. My best friends growing up were from Pakistan, and I knew people from Syria, Lebanon, Morocco, Somalia. So that was really nice. If you go to bigger cities, you’ll find that certain mosques have a certain demographic that tends to go to one mosque or another. Everyone’s welcome, but sometimes you can get a different vibe when there’s a more prominent majority there. But I felt like that was a really unique experience I got to have. And then I did grow up in a post-9/11 America. I was 14 years old during 9/11. And so after that, I did start to shelter myself in terms of that visibility, because it felt like people’s assumptions of what a Muslim was were based on media perception and geopolitics. And so as I moved through school and medical training, that doesn’t come up as much — that part of my identity. But if it does, usually it’s because patients are opening the door for that kind of discussion. And I do enjoy connecting over that because I want to help people feel less alone, because the hospital is such an isolating place. So if that door is open to have those types of conversations, I certainly welcome it.

Joshua Dolezal:

Since we’re talking about writing — and I’ll just remind folks that have joined us recently, if you have a question, we can see the live chat. We’re aiming for 45 minutes, but we might run a little bit longer. Istiaq, if you have a few minutes extra. So please post a question if you have one, and we’ll try to work that in.

So your Substack tagline is “narrative medicine, essays, and memoir from a perpetually rounding physician.” What do you mean by narrative medicine? That’s familiar to me because my background is medical humanities, which might be a distinct category in some cases, but how do you define narrative medicine? How is it different from just writing about being a doctor?

Istiaq Mian:

To me, narrative, in its simplest terms, is just a story. We hear hundreds of stories in the hospital every week, and a lot of those stories stick with me. I’m meeting people at a particular point in their life, but there’s so much that’s happened before, and then oftentimes, things that happen afterwards. So to me, narrative medicine means a story. You’re thinking about a patient and their life before the hospital — who they are and what they enjoy outside the hospital. And as I come to meet them in the hospital, there are so many stories that stick with me. The best way for me to process these is to write about them. I think there are so many interesting behavioral aspects to medicine that I see. It’s a focal point in my writing. I usually try to analyze some behavioral quirk or tendency that we have, because I think humans are just a really fascinating species. For example, in my last essay, I wrote about my son’s medical evacuation to Singapore. I wanted to highlight some of the privilege and the hypocrisy in me taking my son to Singapore. In the previous essay I wrote, I wrote about Bangladesh, and it was titled “Will Bangladesh Complete Its Revolution?” In that essay, I examined why the government of Bangladesh is so corrupt, and by interviewing people, talking with friends and family, and even someone inside the government, I learned that the bottom line is that people make a ton of money via corruption. So there are so many interesting stories out there. To me, narrative is just the story. I’m trying to collect these stories and share them with people so that we can sort of look at ourselves and see how we behave.

Joshua Dolezal:

Do you write about your chickens or do they just show up on the about page?

Istiaq Mian:

Actually I wrote just one essay that I can recall on my Substack about chickens. It was a night that a raccoon got into my chicken coop in the middle of the night at 3 a.m. I’m in my pajamas trying to get this raccoon out of the coop. It killed two of them, and then it was just hanging out inside with the other two. And trying to rescue the other two was an adrenaline rush, because I had to just grab them by the tail and kind of whip them into a cage. The takeaway from that essay was that I was hurting after my chickens were killed. But then I tried to analyze who was the predator that night. Because if you think about it, humans and deforestation leaving less land for animals — that poor raccoon in Madison, Wisconsin was just looking for some food. Just one essay on my Substack about chickens.

Joshua Dolezal:

You’re more generous than I am. I’ve joked with friends that I don’t have chickens yet. I grew up raising them. My family had a homestead in Montana where we had chickens, lots of them. It was my job to take care of them, but I don’t have them now. I do have a backyard garden, and I’m much less charitable to the raccoons and the hedgehogs and everything else that maraud through there. I’ve joked with friends that I’m much more sympathetic to Mr. McGregor than to Peter Rabbit. But maybe I’ll grow out of that and be more compassionate someday.

I have a couple of writing questions. I don’t see any more in the chat. So all the reasons that you’ve given me for writing — some of them are about helping other people feel less alone, some of them are about policy changes, telling stories for people who maybe don’t have a voice.

Crosstalk:

Sorry, Josh, I think you cut out for like five seconds.

Oh, okay. I’m just doubling back to some of the reasons why you write — to change policy, to help other people feel less alone, to give voice to stories that people don’t have a voice for.

I’m sorry, Josh.

Are we out of time?

No, no, no, no. She was trying to connect to my headphones.

Oh, I see. All good. Sorry. Go ahead.

All right. The pleasures of live technology, right?

Yeah.

Joshua Dolezal:

One of the neglected parts of narrative medicine, I think, is the benefit to the writer, to the physician. And I think Danielle Ofri has an essay about this in her debut collection, Singular Intimacies, about a professor of hers, a professor of medicine, also a doctor, who committed suicide partly because he was so burdened by all the stories that he carried. Every day you’re talking about 15 to 17 patients, and then you have to deal with lots of those patients dying. You do the math on how many that is a year — it’s a lot to carry. And the thing with memories we can’t make sense of or make order of is that they just haunt us. They’re just something that weighs down. Her message, I think, in that essay was that this mentor of hers just couldn’t continue under the weight of that. And writing — sometimes it’s thought of as release or catharsis. But I think in the best sense, narrative medicine allows you to take some of these experiences that are confusing, that are chaotic, give them a shape, give them an order, find meaning in them when perhaps they seemed meaningless at the time. I don’t know if you see a personal benefit in that way — that the cost of doing medicine in the U.S., the burden of all these policy failures, the deaths that come, the stress on patients and all these things that you carry with you — is writing a way of releasing them, but not just in a cathartic way, in a way that actually has meaning? Is that fair to say?

Istiaq Mian:

Yeah, I would say a thousand percent. Just the self-care alone is more than enough reason to write. Now I write and journal every week, and none of that stuff is seen by anyone. I publish one piece a month on Substack, but the rest of the writing is for me. So it helps me clear my head, helps me work through what I’ve seen in the hospital, and I also get to know myself better. It’s not just about medicine — it’s also about me as a person. It helps me really figure out who I am and what I believe. I think physicians and healthcare providers in general do have good outlets. Some people prefer exercise, just getting their heart rate up. I certainly have that aspect of self-care, but I’ve worked into a routine now where I’m just writing, and I notice it does feel like a weight has lifted off my shoulders. That’s a great reason to write in general, even if you’re not writing for an audience or for the public.

Joshua Dolezal:

Maybe good words to live by or advice to take for someone who’s a young physician who thinks they don’t have time in their day for writing. Why don’t we wrap up with just a sense of what’s next with your book? Because I’ve enjoyed reading a draft of it, a beta copy, and I know that writers are protective of these things, so maybe you want to be secretive still — but what are your hopes for your book? When might we look forward to seeing it?

Istiaq Mian:

No, I’m not secretive about it. It took me a while to just write it, and then I’ve spent a good chunk of time reading other books and then trying to come back to it with fresh eyes. So the next step is cutting and trying to strengthen the thesis that readers may take away from the book. I don’t have a timeline on that, Josh, because I was told if you don’t have a deadline, there’s no need to place one on it. And so I’m avoiding a deadline. The next steps are to revise. In my sabbatical year, oddly enough, I haven’t had time to approach it, actually. I’ve been taking Bangla classes and trying to learn this language that I knew at three and four years old. And that’s what I’ve been spending my time on. And then my kids’ school, they get done at 1 p.m., so after that, I’m with my kids, which is great. We wanted to have this time with our kids here. So I don’t have the time right now, but I’m hoping that we’ll get to it in the near future, certainly when I come back to the States.

Joshua Dolezal:

One way that folks could keep up with you and, of course, follow the progress of your book as you have news to share is your Substack, — “Substack” spelled with a Q. I’ll put a link in the show notes to that. So follow Istiaq on Notes or subscribe for more. And I hope everyone will save the date for my next Substack live on Thursday, March 19th, 10 a.m. Eastern. I’ll speak with Dr. Damon Tweedy. He’s a psychiatry professor at Duke and a staff psychiatrist at the Durham VA. And his memoir, Black Man in a White Coat, is about arriving at Duke Medical School expecting to escape his working-class segregated background, only to find race waiting in every lecture hall, every patient encounter, and eventually in his own diagnosis. The second book, Facing the Unseen, explores the collision of mental and physical health in American medicine. So if today’s conversation about race, medicine, and the power of storytelling to bridge our differences resonated with you, you won’t want to miss the next one. So thanks to everyone for tuning into this edition of The Things Not Named. Thank you, Istiaq, for joining me. And until next time.

Istiaq Mian:

Yeah, thanks a lot, Josh.

Joshua Dolezal:

Take care, everyone.

My 2026 series explores medicine and storytelling. Come think with me about how narrative bridges gaps between doctors and patients, and why we need writers like Istiaq now more than ever.

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That’s the opening scene in Danielle Ofri’s Medicine in Translation. She wasn’t there, needless to say. She’s using a technique called “perhapsing,” where a writer imaginatively reconstructs moments they did not witness in service of emotional truth. The idea is that we’ll feel Samuel’s story more deeply, and apprehend more of its truth, if it’s dramatized like this.

Ofri broke into publishing as a memoirist. Translation is her third book and her first to turn the camera from Ofri’s own life to her immigrant patients.

Ofri met Samuel Nwanko at Bellevue Hospital in New York, where she contributed to the Survivors of Torture program. Her colleague, Allen Keller, started the program in the mid-90s, when applications for political asylum spiked.

How do doctors treat torture victims? Typically Ofri did routine medical evaluations, outsourcing emotional or practical concerns to other professionals.

But Samuel had come to her looking for help with career training, hoping to resume his engineering studies at an American university. At first, Ofri demurred, saying that he ought to see a social worker. But all Samuel could say was, “I have waited many months for this visit.”

Ofri asked if he’d like to tell her about his injuries, and the bulk of the chapter picks up the story of how Samuel came to be attacked by members of a Nigerian cult — beaten senseless and forced to drink sulphuric acid — because his father, a minister, had led a cult member to Christianity. Samuel’s esophagus had been burned away by the acid, and his face and eyes had also been scorched. He lay in the hospital for nine months, his head completely covered in gauze, unable to sleep because his eyelids were gone.

Samuel tried to commit suicide four times. Each time the guard posted at his door intervened.

Despite all he had endured, Samuel turned his pain into music. Sales from the CD paid for his passage to New York City.

So what could Dr. Ofri do for him? Just one thing, he kept repeating. “Career training.”

She did all she could within hospital protocol, referring him to an ophthalmology clinic for his burns and to a social worker for his university plans. But she knew Samuel didn’t feel that she’d helped him much.

For the rest of the day, I was edgy. My temper was short, and I could not settle into a smooth groove of work. Whenever I reached for a glass of water, I winced. Even that night, I was restless, unable to find a comfortable position despite my fatigue. When I finally fell into an uneasy sleep, I dreamed of reaching a clear mountain stream after a strenuous hike. The water was clear, menacing. I was too afraid to drink.

In subsequent chapters, Ofri treats Mrs. Liang, a 51-year-old woman with metastatic colon cancer living alone in a walk-up apartment, somehow surviving without a local support system. Then there’s Jade, a patient from New Zealand who copes with paraplegia by using visualization techniques. There are women who have fled rape, patients who insist on dictating their last will and testament before being intubated, and an elderly man whose unintelligible demands turn out to be key symptoms, no matter how frustrating Ofri finds them to be.

Medicine in Translation would be a difficult book to write today. There’s still a lot of Ofri in it, including a lovely account of her daughter’s birth in Costa Rica during a family sabbatical, when it’s her turn to be a foreigner receiving medical care. She takes pains to avoid Western saviorism, fully acknowledging the limits of her power to meaningfully help people whose lives have been scarred forever. Ofri shows us that a good doctor knows how to listen, a better doctor absorbs what they hear, and a great doctor gives back stories in narrative form, capturing the heart of a stranger.

But would it be enough today for Ofri to bear witness to Samuel’s story, then carry that sorrow into her cello lessons and imagine her grief echoed in the largo doloroso notes in Vivaldi’s fifth cello sonata?

“I couldn’t ever know the intimo sentimento of Antonio Vivaldi in the 1730s,” Ofri writes. “But three centuries later, his Baroque lament from Venice exactly captured my sadness about this young Nigerian man.”

Literature and music have always tried to capture the depths of human sorrow in forms that outlast the artist. But I can’t help feeling that much is lost in translation in Ofri’s collection. There are gaps between her experience and her patients’ lives that the narrative cannot bridge.

In Medicine in Translation, torture is something that happens far away. Surviving it seems possible. There are still a few slices left of the American Dream.

I wonder if a doctor could write meaningfully now about the devastation wrought by ICE crackdowns. Are narrative devices like perhapsing enough? Can good storytelling overcome numbness to violence and tragedy? What good is emotional truth in a time when it’s hard enough to apprehend the factual, literal truth?

Don’t miss my conversation next week with , who spent a year caring for terminally ill patients before becoming a physician. Read his latest essay on what it’s like to experience a medical emergency overseas.

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It would have been cold on February 13, 1843, when the Boston Society for Medical Improvement convened. But anyone who heard Oliver Wendell Holmes’s fiery speech about puerperal fever would have forgotten about the chill outside immediately.

Holmes stood just 5’ 3”. And he was young, only 34 years old. But he was hot with moral authority. He was so sure that puerperal fever was contagious that he accused his skeptical colleagues of murder. He knew that in order to make them listen, he had to do more than lay out the facts. He needed a persuasive story.

As I’ll show presently, it was precisely this approach that allowed Holmes to win Nathaniel Hawthorne’s trust as personal physician to the great author near the end of his life. No mean feat, since Hawthorne was terrified by medical science.

The Crowd Puller

In those days, you had to speak well publicly to make a name for yourself. Oratory was required in school. In New England, the rhetorical standard was set in the pulpit, and public discourse followed. So it wasn’t an insult if someone said your speaking or writing felt sermon-like. Good sermons could awaken, convict, inspire, and transform even the most uneducated souls. The best professors and the best doctors fit the ministerial mold.

In New England, good speakers were a dime a dozen. But Holmes stood alone.

One of Holmes’s students recalled how he could hold a crowd:

He always makes people attentive, and I have been told that there is no professor whom the students so much like to listen to. In one of his books he says that every one of us is three persons, and I think that if the statement is true in regard to ordinary men and women, Doctor Holmes himself is at least half a dozen persons. He lectures so well on anatomy that his students never suspect him to be a poet, and he writes verses so well that most people do not suspect him of being an authority among scientific men.

This was also a time when science was retreating from the public sphere. Hawthorne was writing short stories about the terrors of the lab, where Rappaccinis and Chillingworths played God. As Michel Foucault said, it was a time when some doctors took the patient into account “only to place him in parentheses.”

Holmes was a scientist, but he hated how science made some of his peers “think only in single file.” And so he tried to wake his colleagues up on that cold day in Boston with facts, but also with panache and metaphor.

The Case for Contagion

Attention spans were different in 1843. The full text of Holmes’s speech, which he later published in essay form, was over 12,000 words. It would have taken him at least an hour to deliver it. He had to review many cases in depth, not just spin fetching tales.

But that’s why everyone in the Boston Society had gathered that day. They wanted to get better as doctors, for medicine itself to improve. So they listened.

Holmes points out that William Dewees’s A Treatise on the Diseases of Females, published in Philadelphia in 1833, explicitly denies that puerperal fever is contagious and that the Philadelphia Practice of Midwifery (1838) omits mention of the disease entirely.

Unthinkable now, but it was commonplace for a doctor or midwife to deliver one baby and then move to the other without washing their hands. Holmes’s words for such a physician? A “death-carrying attendant.”

He also opens with a logical list, a kind of syllogism, something he’d have learned from his humanities education. If all these things are true, then there’s no room left for opposing views.

1. Not all forms of puerperal fever may be equally contagious. But evidence shows the disease appearing again and again among patients of a single practitioner, even when no epidemic is present. That pattern demands explanation.

2. Whether infection travels through the air a physician carries into the sick-chamber or passes directly from his unwashed hands, the practical result is the same. We need not settle the question to act on it.

3. Contagion does not guarantee infection. Even the smallpox vaccine, fresh and carefully administered, sometimes fails. Same for scarlet fever. But no one doubts those diseases are contagious.

4. Seasonal and regional influences may trigger or worsen the disease. But smallpox follows the same patterns of rise and fall, and no one doubts it spreads by contagion. Why should puerperal fever be different?

5. If physicians can be shown to carry death instead of health, no excuse will absolve them. “[W]henever and wherever they can be shown to carry disease and death instead of health and safety, the common instincts of humanity will silence every attempt to explain away their responsibility.”

It made Holmes angry that colleagues could explain the deaths of new mothers as Providence, using God’s will as an excuse for their own failures to stop preventable deaths.

We do not deny that the God of battles decides the fate of nations; but we […] are particular that our soldiers should not only say their prayers, but also keep their powder dry. We do not deny the agency of Providence in the disaster at Norwalk, but we turn off the engineer, and charge the Company five thousand dollars apiece for every life that is sacrificed. Why a grand jury should not bring in a bill against a physician who switches off a score of women one after the other along his private track, when he knows that there is a black gulf at the end of it, down which they are to plunge, while the great highway is clear, is more than I can answer.

I’ll not reprise Holmes’s full review of cases (he painstakingly covers more than half a dozen). You can read the full text that he reprinted in Medical Essays here.

What I want to emphasize is how storytelling was much more than a way to “sell” science for Holmes. He knew that story piqued an emotional understanding of science, which was how doctors could be persuaded to act, and also how public trust could be earned and held.

Here’s his passionate conclusion in full:

It is as a lesson rather than as a reproach that I call up the memory of these irreparable errors and wrongs. No tongue can tell the heart-breaking calamity they have caused; they have closed the eyes just opened upon a new world of love and happiness; they have bowed the strength of manhood into the dust; they have cast the helplessness of infancy into the stranger’s arms, or bequeathed it, with less cruelty, the death of its dying parent. There is no tone deep enough for regret, and no voice loud enough for warning. The woman about to become a mother, or with her new-born infant upon her bosom, should be the object of trembling care and sympathy wherever she bears her tender burden or stretches her aching limbs. The very outcast of the streets has pity upon her sister in degradation when the seal of promised maternity is impressed upon her. The remorseless vengeance of the law, brought down upon its victim by a machinery as sure as destiny, is arrested in its fall at a word which reveals her transient claim for mercy. The solemn prayer of the liturgy singles out her sorrows from the multiplied trials of life, to plead for her in the hour of peril. God forbid that any member of the profession to which she trusts her life, doubly precious at that eventful period, should hazard it negligently, unadvisedly, or selfishly!

I read recently that we respond much more powerfully to troubled characters in fiction than we do to stock types who move from one adrenaline-spiked obstacle to the next. That’s because our deepest emotional responses are driven by three chemicals (dopamine, cortisol, and oxytocin). These brain responses are strongest when we truly care about someone else.

Holmes was trying to do something similar by creating a moral dilemma within the physicians he addressed. The doctor who cared nothing about exposing his patients to risk had no soul. But the doctor who could imagine a family’s grief and wrestle with his own culpability was more complex, more colorful, more worthy of trust.

If you’d been listening to Holmes on that February day, you know which doctor you’d have wanted to be.

Converting the Chief Skeptic

Despite his charms, it took time for Holmes to push his reforms. People thought he looked too young. One woman ordered him out of her house when he accompanied a senior physician during his medical training. “Take him away!” she cried. “This is no place for boys.”

Holmes’s colleagues respected his medical skill, but thought him “impaired” for writing poetry. And not all readers of The Atlantic loved him. To some he was a “tiresome little man.”

As one biographer explains, Holmes “disarmed criticism…by courageously persisting in the same method which had originally produced it, namely, by the most fearless intimacy with his audience, never keeping back any jest or any expression of confidence.” In a word, he was not afraid to make himself vulnerable in his writing.

Holmes and Hawthorne shared pages in The Atlantic Monthly and also knew each other through the Saturday Club, a gathering of literary celebrities that included Ralph Waldo Emerson, Henry Wadsworth Longfellow, and Harriet Beecher Stowe hosted by the publisher James T. Fields. Hawthorne was quiet and shy, brooding around the edges, but Holmes loved to regale the group. As Annie Fields recalled, “with Dr. Holmes sunshine and gayety came into the room.”

The two writers developed a close intellectual relationship, commenting on each other’s manuscripts and commiserating with one another over the dangers of pseudoscience and careless experimentation. So it was no surprise that when he grew ill in 1864, Holmes was the only doctor that Hawthorne would see. Hawthorne had watched a friend die of pneumonia while a quack prescribed a variety of ineffective drugs, poultices, even cupping and blistering, to no avail.

As the two men walked the Boston streets, Holmes conducted a “talking exam,” listening while Hawthorne reported his symptoms of indigestion and fatigue. Holmes recognized that Hawthorne suffered from a profound sense of despondency which signaled imminent death, that there was no cure but compassion. This was an intimate moment—as vulnerable as the introverted Hawthorne had ever allowed himself to be with anyone—and it illustrates Holmes’s ability to reassure even this great skeptic of his good intentions.

Hawthorne’s simultaneous fear of alternative medicine and medical science left him nowhere to turn as his own death approached. On the one hand were the mesmerists who sought to control the individual through pseudoscientific means. On the other were the Rappaccinis whose misappropriation of science was equally hostile to the privacy of the soul.

Only Holmes could rescue Hawthorne from those two nightmares. He did it as a man of science, as an indefatigable optimist, as a caring friend, and, yes, as a storyteller who knew that passion is one form of understanding.

explores the intersections of medicine, culture, and storytelling. Paid members get two in-depth essays each month, on-demand interviews, and full archive access.

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Whooping cough is on the rise. It doesn’t have to be.

The CDC reported nearly 28,000 cases in the U.S. last year, including thirteen deaths. The U.S. is also seeing 30-year highs in preventable diseases like measles. Even influenza is hitting kids harder than it has since 2004.1

Here’s the CDC:

The 280 pediatric flu deaths [in 2024-2025] are the highest number reported in the United States since the 2009-10 H1N1 pandemic and the highest for a non-pandemic flu season since child deaths became nationally notifiable in 2004.

But I’ve probably lost you already. Most of us aren’t numbers people. We’re story people. We anchor into stories that we live by, regardless of what the facts say.

Kurt Tucholsky, the German satirist, illustrates the point: “The death of one man: that is a catastrophe. A hundred thousand deaths: that is a statistic!”

Numbers need a human face. The death of one man reduces epidemic disease to an emotional level that people can absorb. It’s a comprehensible story.

But chances are good that if you don’t already believe the science behind recommended vaccines, you won’t believe it until you experience the death of someone close to you. Even then you might explain it away.

I was born in 1975, when whooping cough fell to record lows. I did not get the Diphtheria, Tetanus, Pertussis (DPT) vaccine as an infant or toddler, in part, because of bad public storytelling. Around the time I was born, DPT had sparked an international controversy. As is often the case, one report did great harm.

The year before my birth, three physicians at the Hospital for Sick Children in London, published a paper, “Neurological complications of pertussis inoculation.” The paper is a call for further study – more of an elaborate hypothesis, really – not at all a denunciation of DPT. But newspapers and TV journalists exaggerated the questions raised in the studies, and in 1982 an Emmy-winning documentary, “DPT: Vaccine Roulette,” sowed panic in the United States.

The film’s claims were later proven false, but it takes time to do rigorous studies, so it wasn’t until 2001 that facts caught up with feelings. But by then public suspicion had taken deep root. There were thousands of lawsuits filed against vaccine manufacturers in the 1980s, activism by concerned parents, and plenty of family physicians who hedged their bets by replacing recommendations with free choice. My parents really thought they were saving me from brain damage by letting me go jab-free. I can see why they were swept up in that fear. And there wasn’t much of a price to pay then because of herd immunity.2

But in 1994, we gave a friend a ride to church when I was home from college. He happened to be carrying pertussis, and I wasn’t immune. So I caught what was then thought to be a Third World disease.

It took me six months to fully recover from that cough. And it fundamentally changed the story I lived by. (Read the full story here.)

I’ve been trying to imagine the stories that parents in Texas are telling themselves about vaccines. Maybe some of them are bewildered by their information streams, thinking that nature running its course is safer for their children than trusting scientific medicine. Maybe some trust “Bobby” over all the elitist PhDs.

Some are living by a story about freedom and privacy. The government doesn’t get to tell me what to do. That’s not liberty. That’s not democracy.

We once believed that public health was part of the American Dream. The Mother of Exiles still stands in New York Harbor for the “homeless” and “tempest-tost.”3 Our public health campaigns have all been driven by anthems of justice and equality.

But those beliefs were rooted in a story: one that doctors told more skillfully in the early twentieth century.

Doctors were heralded as heroes then because they knew how to frame their numbers with a human face. It’s why Jonas Salk was once a household name. Salk gained celebrity as a public savior in a white coat because his name became synonymous with the polio vaccine.

By contrast, his contemporary, Maurice Hilleman, developed 40 vaccines that have since saved millions of children from preventable deaths. Hilleman preferred to work behind the scenes, so most Americans still don’t know the power of his story.

Winning back the public trust requires a return to Salk-style storytelling, combined with moral and scientific authority. Next week I’ll dig even farther back to an 1843 essay by Oliver Wendell Holmes that changed medicine and public attitudes about medical science, even though it took time for his message to sink in. At that time, the evidence was clear that puerperal fever was contagious and that better sanitation would save thousands of lives, not to mention sparing newborns from immediate orphaning.

No one would listen to facts, so Dr. Holmes used storytelling as a sugar pill to deliver science and sincere advocacy.

We think we’re living in the future, but 2026 looks an awful lot like 1843. I wonder: will it take 40-year, 50-year, 100-year highs to change the story about preventable disease?

My 2026 series explores medicine and storytelling. Come think with me about how narrative bridges gaps between doctors and patients, and why we need writers like Oliver Wendell Holmes now more than ever.

Paid members get two in-depth essays each month, on-demand interviews, and full archive access.

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Later this month, will join me to talk about medicine, storytelling, and his book-in-progress.

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“The health of our healers is an indicator species for the health of our culture. A thriving medical humanities that allows us to be emotionally healthier is beneficial for everyone.”

Dr. Amy Walsh

Tha…

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Christopher Hitchens woke up one morning “shackled to [his] own corpse.” His chest felt like it had filled with “slow-drying cement,” and he could scarcely drag himself across his hotel room to call 911.

When the ambulance arrived, it didn’t feel like a rescue:

I had the time to wonder why they needed so many boots and helmets and so much heavy backup equipment, but now that I view the scene in retrospect I see it as a very gentle and firm deportation, taking me from the country of the well across the stark frontier that marks off the land of malady.

Why would medical help feel like forced custody?

Illness narratives often frame the body’s betrayal as the inciting incident, launching both writer and reader toward recovery or death. No matter our politics, we want to know whether Hitchens lives or dies. It’s the ultimate suspense, the highest stakes imaginable, one of the few universal storylines.

But we come to illness narratives for more than plot. We expect to learn something from those who have toed the threshold between living and dying. In Hitchens’ case, it’s a deportation metaphor that he later extends to two symbolic communities: Tumortown and Wellville. His memoir Mortality is, in part, an attempt to break down the language barriers between the sick and the well, to help us communicate more truthfully.

I don’t invoke the deportation metaphor lightly. Masked ICE agents weren’t raiding our streets when Hitchens published his book in 2012, but he still felt more menace than mercy in the hands of ER personnel. If anything, our crumbling democracy has only amplified the feeling that once you enter a hospital’s custody, you’ve surrendered a great deal of your agency.

One night, eight years ago now, I woke with dull abdominal pain that I took for bloating. But I could find no relief. Massaging my belly didn’t help – when I released pressure, the pain just increased. So I drove myself to the clinic, waited painfully, endured an enema (I think for better imaging), and then, early the next morning, was told I needed an appendectomy.

It’s hard to reconstruct those events from memory. I’m an unreliable witness. I was scared, in pain, and fatigued. But I was a borderline case. If I went home, it was possible the inflammation would subside. It wasn’t (yet) an emergency. But the surgeon was adamant: the smart choice was the appendectomy.

I was alone — my ex was at home with our girls — so I had to make the decision myself. There was no time to research anything. It seemed ambiguous. Was the risk of a rupture greater than complications from surgery? I was in no position to say. I agreed to go under the knife.

I remember lying there, just before being wheeled into the OR, listening to the anesthesiologist run through the list of what could go wrong. It didn’t feel like a choice, but I signed the form anyway. As I rolled through the door and gazed up at the blinding lights, I thought, This could be it.

I tried to focus on my family, but the last thing I heard was the nurse (or was it me?) laughing about my hairy chest.

These things feel important, even in retrospect, because we want relief when we are in distress, but we also want dignity. And that applies just as equally to a routine case like mine as it does to Hitchens’ cancer. An illness narrative tries to help us see what standard procedures miss. It flips the power script.

Sometimes those procedures come with master narratives that a writer tries to resist. Barbara Ehrenreich takes this approach in “Welcome to Cancerland,” where a routine mammogram makes her bristle at a “cult of pink kitsch.”

Ehrenreich tries her best to ignore all the sentimental content in the waiting room, but she finds that she can’t escape it, not even in the local news:

I read the New York Times right down to the personally irrelevant sections like theater and real estate, eschewing the stack of women’s magazines provided for me, much as I ordinarily enjoy a quick read about sweatproof eyeliners and “fabulous sex tonight,” because I have picked up this warning vibe in the changing room, which, in my increasingly anxious state, translates into: femininity is death. Finally there is nothing left to read but one of the free local weekly newspapers, where I find, buried deep in the classifieds, something even more unsettling than the growing prospect of major disease— a classified ad for a “breast cancer teddy bear” with a pink ribbon stitched to its chest.

Ehrenreich shows how cancer branding shapes everything, distracting us with palliatives and pink-themed 5Ks (or NFL games) and mandatory optimism when we should be asking how a company like AstraZeneca can possibly be allowed to manufacture both carcinogenic pesticides and chemotherapy drugs.

I’ll have more to say in the weeks ahead about the master narrative of survivorship and how that story gets written in different ways for women and for men. We’ll think about the limits of war metaphors in narrating disease, the default assumptions baked into medical terminology, and how illness is a touchstone for nearly every marker of identity and belief.

For now I want to introduce the illness narrative as a distinct kind of medical humanities text. It’s most often told in essay form, as in the examples above, and part of its power lies in its amplification of the individual voice, often from a position of marginality or powerlessness. Many poems about illness achieve a similar effect. But there are fictional versions, too, such as Tolstoy’s “The Death of Ivan Ilyich” or Leslie Marmon Silko’s Ceremony. And Margaret Edson shows how the form can be adapted for the stage.

In all their iterations, illness narratives offer much more than empathy. They are unique forms of truth telling. They help us resist the social pressure to see the bright side of everything (in Audre Lorde’s case, the prosthetic breast). They help us reject identities that have been chosen for us. They help us find loved ones who have been transported to Tumortown. And they help us, if we find ourselves there, to find our way back to the living, even if only by reclaiming the meaning of illness with our very last words.

As it happens, my appendix didn’t burst. I woke up in my hospital room. I went home the next day, and even though it took several weeks for me to even think about doing leg lifts, it is a mercy that the story ended there.

But I still remember what it felt like to drive to the hospital alone and in pain, to sign the consent form just after hearing that I might never wake up, and to surrender my body to strangers. All these years later it’s their laughter I remember most vividly. It wasn’t comforting, not even with the drugs pulling me into oblivion.

We all deserve to be treated like more than specimens.

Join us here: https://open.substack.com/live-stream/99781

My 2026 series explores medicine and storytelling. Come think with me about how narrative bridges gaps between doctors and patients, and why we need writers like Hitchens and Ehrenreich now more than ever.

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Nathaniel Hawthorne wrote “Rappaccini’s Daughter” as a parable for the mid-1800s, when the Industrial Revolution was giving way to the first Big Tech wave. Tech back then meant infrastructure and communications. Telegraph (later telephones), railroad, electrical grids. It also meant scientific discoveries by controversial means, such as vivisection, autopsy, and Louis Pasteur’s lab-produced vaccines — all precursors of modernity.

But as many comforts as science offered, it often seemed like a menace. Railroads meant bloodshed and noise, the machine rumbling through Eden. The telegraph aided Western conquests. And a fearful public did not trust that scientists probing the depths of the body or psyche cared as much about humanity as they did about their own discoveries.

Hawthorne felt all this deeply. He expressed his fears in the most timeless form he knew: the allegory.

The story opens like a fairy tale, “very long ago” in Italy. But Hawthorne gives his mad scientist, Giacomo Rappaccini, the enormous power that he saw in the nexus of science and industry.

Hawthorne’s fears have become our own. There are now many Rappaccinis promoting AI in medicine, placing more faith in technology or pharmacology than in human connection, all in the name of profit or efficiency. Some of them are physicians, some are hospital administrators, and some are tech or Big Pharma bros.

All are driven by utopian fantasies that could just as easily spell disaster for humanity.1

But let’s return to the story.

Read more

“I spy on my patients.” So begins Richard Selzer’s 1977 essay, “The Discus Thrower.”1

It’s a short piece, scarcely more than 1,000 words. I cannot imagine anything like it being published today. Undergraduates would struggle with its subtleties. Making meaning of it requires close reading and critical thinking: two hallmarks of advanced literacy that are fast disappearing.

That’s why “The Discus Thrower” represents, more than any other work I know, medicine’s dire need of the humanities, and the public’s need of more writers like Richard Selzer.2

The premise is this: Selzer’s patient is dying. The man has gone blind and lost both of his legs, which continue to rot away. Selzer’s skill as a surgeon is useless: the best he can do is trim and redress the man’s wounds. And watch and wait.

The head nurse hates the dying man, whom she calls “room 542,” because he orders scrambled eggs for breakfast each morning but refuses to eat them. Instead, he smashes the plate against the wall.

When Selzer hears of this, he stands in the doorway the next morning to observe.

In this time, which he has somehow identified as morning, the man reaches to find the rim of the tray, then on to find the dome of the covered dish. He lifts off the cover and places it on the stand. He fingers across the plate until he probes the eggs. He lifts the plate in both of his hands, sets it on the palm of his right hand, centers it, balances it. He hefts it up and down slightly, getting the feel of it. Abruptly, he draws back his right arm as far as he can.

There is a crack of the plate breaking against the wall at the foot of his bed and the small wet sound of the scrambled eggs dropping to the floor. Just so does this man break his fast.

And then he laughs. It is a sound you have never heard. It is something new under the sun.

That evening, Selzer learns that his patient has died. The head nurse says it is a blessing. Selzer visits his room, “a spy looking for secrets,” and gazes upon the man he could not help. As he turns to leave, Selzer notices the place on the wall where the man has aimed his plate of eggs: “the place where it has been repeatedly washed, where the wall looks very clean and very white in contrast to the rest, which is dirty and gray.”

And so “The Discus Thrower” ends.

An essay like this would not be published today because it is not a polemic or a memoir aspiring to “authenticity.” It doesn’t fit neatly into an identity category and contains no rage bait that I can see. It sustains multiple interpretations. It appeals to no tribal sensibility.

Instead it sparks questions.

Why might Selzer characterize himself as a “spy”? What do we make of the contrast between his perception of the man in room 542 and the head nurse’s view? What does the essay’s title mean?

Selzer requires us to finish the essay within ourselves, imaginatively completing its emotional impact, wrestling with its multiple meanings.

He styles himself as a compassionate narrator, a doctor who sees his patient as a complete human being, but the essay is driven by much more than empathy. It’s an invitation to participate in mystery. A challenge to remain curious about one another, to think critically, to accept uncomfortable ambiguities.

Selzer, like many doctor writers before him and some of those that have followed his lead, saw literary craft as a way to bear witness to the eternal in the everyday. Many surgeons wash their hands of a patient once they can no longer fix anything. But Selzer shows humility. His education is not complete; there’s more to learn about himself as a healer even when the best he can do, despite his prodigious skills, is change wound dressings.3

The medical humanities encompasses many disciplines, many ways of knowing, many ways of seeing and understanding humanity. It’s a big tent. Religious history, sociology, visual art, fiction, memoir, and poetry all have a place here. In 2026 I’ll focus on the intersection between medicine and storytelling, the ways that narrative bridges gaps between doctors and patients, allowing both healers and people suffering from illness to tell their sides of the story.

Selzer and other writers like him offer a corrective to the clinical gaze, which sees people as bodies and illness as no more than a puzzle to solve. Literature allows doctors to release grief, guilt, and confusion about the limits of their power to save. Literature allows people to narrate their own illnesses, to coin new terms that help us reimagine old realities, to resist false identities.4

That’s what Selzer tries to do by reimagining the man that the head nurse calls “nasty.” He is more than that. He is an athlete. A discus thrower. A man with dignity who, even on the day of his death, refuses to give up his last smolder of strength and agility.

It’s become unfashionable to speak of “serious” literature or “high” art or sophistication in craft. But Selzer knew that irony was more than a fancy technique. The purpose of “The Discus Thrower” is not to impress readers with writing that seems “dazzling” or “deep.”

The purpose is to capture what it means to be a surgeon caring for a patient he cannot save, what it means to be a man who has lost his sight and his legs, what it means to hold that murky space between living and dying — with compassion, yes, but also with curiosity, wonder, and humility.

When approached as an art, rather than personal brand building, literature has enormous power to build trust between doctors and their colleagues, between doctors and patients, between government health programs and a fearful public.

That’s a taste of what I’ll be exploring in my 2026 series. I hope you’ll join me.

This is the first post in my 2026 series on medicine and storytelling. Come think with me about how narrative bridges gaps between doctors and patients and why we need writers like Richard Selzer now more than ever.

• Free subscribers enjoy two short essays a month and Substack Live interviews.

• Paying members enjoy all this plus two longer posts each month: original research, in-depth reviews, and on-demand replays of interviews.

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Friends,

When I wrote to you at this time last year, I was celebrating the publication of Someday Johnson Creek. That was a hard-fought victory after a year of rebuilding.

My next big goal was finishing my fatherhood book. I made a fancy writing calendar to help me draft one new chapter a month while pacing myself with craft essays and interviews.

But I got too confident about how that book would end while I was still experiencing big changes in myself and my family. If you’re just tuning in now or weren’t paying attention before, those included renewing a faith journey that lay dormant for twenty years. I would have scoffed if you’d told me this time last year that I’d be explaining why so many atheists are becoming converts these days. Indeed I’ve *not* written about much of that search because it’s still fresh and precious.

It was presumptuous to think that one year of solo parenting would show that I had it all under control. Doing passably well with meal planning, Daddy Ubering, and laundry meant nothing when my eldest officially became a teen. Some weeks have been lovely and some weeks we’ve survived one white-knuckled day at a time.

Perhaps one day I’ll have the distance (and permission) to write about all that, but increasingly I’ve felt that writing honestly about parenting would require me to lie, pick political fights, or betray someone I loved — all while still discovering what I truly believe.

2025 in Review

Even if I can’t say that my book is done, I still have a lot to show for the year. Here is the updated chapter list.

There’s value in writing forward, through the fog and unknowns, even when inspiration feels miles away. I’ll need to rethink the design, the whole premise, really, if this book ever sees print, but I’ve written twenty-one chapters in all, more than 60,000 words, which I’m prepared to call a first draft.

I’ve also written over 30 craft essays. I expect that these will also turn into a book, though I’ll house them all under one tab for now.

Craft Resources

I wrote three reviews this year and produced eight interviews.

Reviews and Interviews

So that planning calendar served me well, I must say. It gave each month a shape, helped me schedule in advance, and kept you from guessing what you’d see from me each week.

And now I’m excited to share my 2026 theme.

Paywalls vs. Piracy

When I launched this series in March, 2022, Substack founders preached a simple gospel. Paywall a little, but share your best work for free. That mostly jived with my open access philosophy as a professor. Real teachers don’t try to monetize everything.

I’ve shared nearly all of my intellectual property over the years for free. Discussion questions and teaching resources on two WordPress blogs, lesson plans and assignments for informal writing and formal essays, dozens of detailed syllabi.

But it dawned on me earlier this year that every time someone prompts Claude, Chat, or Gemini, it’s not just copyrighted work that gets snatched, it’s everything that I’ve placed on the web, including this series. Those bots have to train on something.1 And I would bet that most of what I once shared with colleagues has now been fed without my consent into AI machines.

Don’t let the lightning-fast apps fool you. These really are energy-guzzling machines. AI runs on gigantic data centers that drive electricity prices up, create industrial noise, consume huge quantities of water for cooling, and pollute the air with diesel exhaust plumes.2

There are now 4303 data centers in the U.S.

102 of those reside in PA. I drive by one of them in State College every day.

There’s no escape from AI that I can see. Tech giants have a stranglehold on our economy, massive war chests to fight copyright suits, and Goliath-scale leverage over zoning and development in our local communities. In a few years they have completely upended universities.

But even a flimsy defense is better than nothing. I’ve tried prompting Claude and Chat with links to my own posts, and both tell me they can’t “see” behind paywalls. That feels like shooting arrows at a tank, but it’s the best protection I have against outright piracy.

Consequently, I’ll be taking a few measures in January.

• I’ll return to my original policy of publishing free content just twice monthly. Half free, half paid, alternating weekly.

• I’ll automatically paywall everything — including my whole archive, 400+ posts by now — after two weeks.

• I’ll spend some time thinking about how to package chunks of that backlog in ways that full members can navigate easily. For instance, you might not know that I have a page just for poetry. Or 22 interviews specifically devoted to PhDs transitioning from academe to industry. Or 60 thought pieces on higher ed.

What does this mean? In part, I want to fend off more digital thieves. But the core reason is that I intend to lean more purposefully into my research expertise.

A Preview of 2026

Ever since I launched The Recovering Academic, I’ve been thinking about how my writing might meet an urgent need. At first I did that by chronicling my own journey out of academe, interviewing others who had made similar pivots, and writing op-eds about the crumbling university. I’ve sometimes narrated my life in real time, published poetry, even organized a Willa Cather Read Along.

But really the throughline for this series has been me.

That changes in 2026. While I’ll still write personally, I’m shifting to my core expertise: the medical humanities.

The medical humanities is interdisciplinary. I think of it as a corrective to the biomedical mindset, which reduces disease to mere biology or chemistry. When we explore illness and health through the biopsychosocial method or through art and history, we resist the indifference that pure science seems to breed. We fight that objectifying tendency to “atomize” life, suppress nuance, and push us all into tidy spreadsheets.

My research began with literature and medical history. I wanted to explain why science-minded doctors in nineteenth century texts are nearly all villains or monsters, like Shelley’s Frankenstein or Hawthorne’s Rappaccini, but works from the early twentieth century reimagine physicians heroically. Sinclair Lewis’s Martin Arrowsmith, who comes of age in the Roaring Twenties, even has aspirations to become a Great Man, in part because of his scientific discoveries. Public fear and distrust turned to reverence in just a few decades. How could this be?

Over the past twenty years I’ve published on the doctor-patient relationship, on medical and literary history, and on more recent affinities between neuroscience and older explanations of creativity, imagination, and epiphany.

During that time I’ve watched the public view of physicians warp back into the fear and distrust of the late 1800s. The bridge between medical science and laypeople has been washed away by arrogance, political attacks, and corporate greed. And now AI threatens to widen that gap by further distancing medicine from humanity.

We need that bridge of understanding again, and rebuilding trust is a task uniquely suited to writing. People are more like poems than like puzzles. The best literature asks us to get comfortable with ambiguity, with nuances more sensed than seen.

That’s a taste of what I’ll be exploring in 2026.

I’ve simplified my calendar somewhat, but I’ll still be pacing myself with shorter posts in the first and third weeks and more in-depth analysis or interviews every other week. So far I’ve received commitments from Substack doctors and , and I’m hoping to firm up a live interview with Damon Tweedy, author of Black Man in a White Coat and Facing the Unseen.

Here’s a preview of January.

What free subscribers will get:

• Commentary connecting medical news to literary history

• Short reviews of illness narratives or medical memoirs

• Substack Lives and replay previews

Paid subscribers will enjoy all this plus:

• 2x monthly: deep-dive research, in-depth reviews, on-demand interviews

• Quarterly live Q&A sessions or workshops (as well as replays)

• Full archive access (even after the auto-paywall at two weeks)

Founding members will also receive:

• Signed copies of my memoir and poetry collection

• One 60-min coaching session

• A bottle of Dr. Josh’s homemade hot sauce

The monthly rate will remain $5/month, annual memberships will be $50, and founding membership will stay at $150/year.

As usual, I’m running my holiday sale: 20% off annual memberships through December 31.

With All My Gratitude

To all the readers who have stuck with me from the start: thank you. We began at zero four years ago, and we are now 3,500+ strong. I write just as much for my kindergarten teacher and Montana family as I do for bibliophiles and colleagues. What a privilege that is.

This year my memoir writing group disbanded after publishing collaborative series consistently. , , , , and , it was a pleasure sharing pages with you. and — thanks for co-hosting with me.

I’m especially grateful to my podcast guests, , , , , , , , and . Special thanks to for interviewing me about my poetry debut, to Carrie Frey and the Kentucky Library Association for inviting me as a featured speaker, and to , , and for sharing my work in broader venues.

It is a blessing that my coaching clients are too numerous to name, but I hope you’ll help me celebrate Dr. ’s book, Navigating the P.I.V.O.T., an indispensable playbook for Ph.D.s moving from academe to industry. Gee knows her methods work, because she lost one medical communications job and landed another while we were reviewing her manuscript. See Gee’s case study here and buy the book if you or someone you know needs a career reboot.

I hope you’ll stay tuned for another client’s exciting news about a serialized memoir featuring Tall Ships, a voyage into his past, and an international scandal that you won’t believe.

My warmest thanks to , my soulmate and friend, for believing all things and teaching me how to love again, and to the Preserver, Protector, and Sustainer who brought us together.

For the first time in so long, I can’t wait to see what’s next.

Faithfully yours,

Josh

I used to hold a memorization contest on the last day of my American literature survey. After devoting the last two weeks to Walt Whitman and Emily Dickinson, I challenged the class to memorize a complete poem or a portion of a longer one.

Dickinson’s “I’m Nobody! Who Are You?” was far and away the most popular choice. Not just because it was short but because my students were exhausted trying to be Somebody on Facebook, Instagram, or X. The Business majors were already building profiles on LinkedIn, faking it until they made it. Everyone else knew that even if they could never hope to gain influencer fame, they were nothing without their personal brands.

Dickinson reminded them that they could love small, beautiful things without needing to splash their personal lives across everyone else’s feeds. They didn’t need to be constantly staring in the mirror of their own selfies to justify their existence.

I’ve come to appreciate Dickinson’s poem more of late. After years of striving to be Somebody, I’m learning to embrace the quiet and unseen. My friend Bob Leonard tells me that once you reach a certain age, you’re invisible, and the more white I’ve seen in my beard, the more I feel what he means.

I’m Nobody when I’m reading Grumpy Monkey and The Vanderbeekers to my kids. I like the anonymity of the gym, where no one needs to know my latest PR, except a handful of friends. Most of the time the Almighty Algorithm reminds me that I’m not in control, especially when I’m announcing myself to the virtual bog.

The basic idea of authority has changed. It’s as if credentials have an inverse relationship to influence. The more expertise you claim, the less anyone seems to want it. Say “I’m Nobody!” loudly enough, and you’re sure to become Somebody. The stage belongs to the stooge, not the sage.

No one understands the authority crisis more than doctors. In the West, physicians are trained to be superhuman, enduring boot camp conditions throughout their residencies, only to emerge with an M.D. that no one seems to trust. Indeed, public distrust of medical experts has reached levels last seen in the nineteenth century, when autopsy was banned outright and physicians who wanted to study disease had to go overseas or resort to more sordid means. Accordingly, Ambrose Bierce’s Devil’s Dictionary (1881) defines the grave as “a place in which the dead are laid to await the coming of the medical student.” I can only imagine what Bierce could do with a term like “vaccine” today.

It’s worth noting that many doctors who tried to be Somebody through research alone were either ignored in the 1800s or remembered as Frankensteins. But the physicians who showed that in their private moments they were Nobody, just like everyone else, changed history. It wasn’t heroic cures, but writing — poems, short stories, and essays — that brought out doctors’ humanity. That was how a skeptical public came to accept empirical reasoning. That is how trust could be won once again.

I’ll say more about this in my year-end post next week, but after focusing on memoir in 2025, I’ll be shifting my focus to the medical humanities. It’s the area where my research expertise can best serve an urgent need. But I’ll be reminding myself as I go that disinformation spreads because it’s written stridently.

It’s just as apt now as it was in 1850. The truth only advances when it is expressed humbly. Modestly. Quietly.

Don’t tell!

Working on a medical narrative—memoir, fiction, or creative nonfiction about medicine, illness, or healing? I help writers craft stories with authority and depth.

Book a free consultation to learn more

Want more on medical humanities? In 2026, I’m shifting my focus from memoir to medical humanities—exploring how literature reveals (and shapes) our relationship with medicine. Starting in January, paid subscribers will get two in-depth essays per month (deep-dive research, book reviews, or exclusive author interviews), plus quarterly live Q&A sessions.

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I’m trying something new with today’s interview. Instead of recording my guest separately on Zoom, then painstakingly trimming the audio and editing the transcript before uploading both to Substack, I’m sharing a replay of my live interview with .

If you prefer to read the transcript, that should still be available at the link above. Captions are also available (click “CC”). Hopefully you don’t miss the theme music and voiceover intro/outro too much.

Since this is an experiment, I’d love to hear your feedback, privately or in the comments. I plan to use this format, or something similar, for my podcast in 2026, so suggestions or requests are welcome.

Thanks, as always, for supporting my work.

Josh

Holly Starley Bio:

Holly is the author of , which she writes from her DIY van, AKA Vivian. She’s got solar panels on the roof, steadily changing views out the window, and community wherever she lands. But before Holly was roaming the countryside she was an award-winning journalist in West Virginia and the managing editor of a cycling magazine. She’s founded a radio station, taught courses in person and online, and rebuilt a van with her own two hands.

Holly has also been a freelance editor for twenty years. When she’s not chronicling her van life, Holly works one-on-one with authors as a “self-editing coach.” She is a co-founder of the , where you can find on-demand courses, write-ins, and many other resources for your writing practice.

Keep my poetry collection, Someday Johnson Creek, in mind as a holiday gift. It’s available on Amazon and Barnes and Noble, or you can support a local bookstore by ordering at the link below.

Buy the book

I appreciate the support of readers who make my writing life possible. Monthly installments of my memoir-in-progress are only available to full members. For access, please consider upgrading your subscription. I’m also proud to be a Give Back Stack. 5% of my earnings in Q4 will go to Centre County PAWS, a no-kill shelter focusing on adoption, education, and community assistance.

See my accountability page, with receipts for Q1, Q2, and Q3 here.

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Some twenty years ago, after playing with a new digital camera, I posted a photo of the American flag to my Facebook page. It was February, and a storm had just hammered Iowa. The flag hung fossilized in ice, its frayed edges splayed as if windblown.

A friend asked what statement I was trying to make. I asked, “Does it have to be a statement?”

He replied, “You’re such an English professor!”

I’ve never studied photography, so cannot claim sophistication in composition, depth of field, or any other element of that craft. My method is simply to capture images with nuance, the way I try to do in poetry and prose. A scenic sunset isn’t interesting to me. But a sunset that casts a blush over tree branches encased in ice, creating the illusion that they’ve just bloomed? That picture makes me think.

My photographs aren’t statements about anything. They don’t contain fixed meanings. They are, I now realize, much like the discussion questions I posed in literature classes: invitations to meaning making, rather than answers in themselves.

So my friend was right. I don’t just snap photos like an English professor, I try to open up a conversation about them, too. In literary studies we call that technique “problem posing.” In creative writing it’s the notion of seeing.

The innovative scholar doesn’t record what they already know, they are driven to explain a gap, an error, or an inconsistency in what has been previously thought or said. The precursors to epiphany are thoughts like That’s weird or What do these discrepancies mean? Similarly, the essayist learns to locate story-worthy memories, which do not resolve easily into homilies but instead delve deeper into fissures or ambiguities.

In both cases, the question is everything. Good writing is driven by good thinking, which begins with perplexities. Which is why the best metaphors are epiphanies.

I was thinking about this recently while mulling “AI atrophy,” a new phrase that has been circulating among educators and business people on LinkedIn. The idea is that the more dependent people become on Claude, Chat, or Gemini to solve everything for them, the less capable they are of independent reasoning. The secret to AI is supposed to be prompting, but prompting is a directive, not an invitation to explore meaning. And so one of the first intellectual muscles to go might be the thing that exasperated my friend: my old habits of problem posing and seeing.

AI is eroding this skill by pirating artifacts of human reasoning. Many of my former colleagues developed web archives for authors, such as this fine collection of Sarah Orne Jewett’s texts. The Willa Cather Archive and Walt Whitman Archive are even more comprehensive. Paul Reuben’s Perspectives on American Literature is one of many teaching-oriented sites, and I created versions of my own for my American Literature I and American Literature II surveys.1

If you were to prompt Claude to generate a 15-week American Literature syllabus or a series of discussion questions for Emily Dickinson, Anthropic’s data centers will siphon up these free resources to satisfy your command. You might have saved time with teaching prep by doing so, but you will not have exercised the critical muscles for teaching, which require you to develop the questions yourself from your deep understanding of the text, from your personal teaching philosophy, and from your desire to know more than you already do. Similarly, students who use AI to write their essays bypass problem posing altogether, skipping the reason why writing assignments exist in the first place.2

There’s no learning without the perplexities.

I haven’t taught in a classroom for nearly four years. But I’m still fighting AI atrophy with my clients. We begin with the questions, not the answers. What are the essential problems this memoir needs to resolve? What shape might we pull from these disparate memories? How might this life story tap into a larger human conversation, inviting readers to make meaning of their own personal histories?

Show me the wreckage of your divorce, the triumph of your business story, or a photograph of a flag, frozen and torn. There’s only one answer worth giving. And it is no answer at all.

What does it mean?

Most of my content in 2025 is free, but monthly installments of my memoir-in-progress are only available to full members. For access, or just to support quality writing, please consider upgrading your subscription. I’m also proud to be a Give Back Stack. 5% of my earnings in Q4 will go to Centre County PAWS, a no-kill shelter focusing on adoption, education, and community assistance.

See my accountability page, with receipts for Q1, Q2, and Q3 here.

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