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 Natalie Lago, Michelle Ray, and many others for tuning into my live video with Istiaq Mian, MD 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, 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 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, The Substaq of Istiaq — “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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