Jerome Groopman's "The Scalpel and the Pen"

Jerome Groopman (Illustration by Joe Clardiello)

Jerome Groopman, in his recent “The Scalpel and the Pen” (The New Yorker, July 25, 2022), claims that storytelling is part of being a good doctor. He says, “By writing stories, we as doctors aim to teach others about our patients while learning about ourselves.” This statement seems innocuous enough, yet I find myself balking at it. Why? It’s that vexed word “stories.” It smacks of fiction, of narrative purposely shaped to convey message or moral. Is that what Groopman means? If so, I disagree. Why fabricate? Why not just say what actually happens?  

A few years ago, Groopman wrote a great review, “When Doctors Admit They Went Wrong” (The New York Review of Books, November 6, 2014), in which he faulted Terrance Holt for writing medical “parables.” He says of Holt’s work, 

His stories, though, do not recount recollections of exact events. Rather, Holt offers what he terms “parables.” The patients are not really individuals whom he cared for, but rather composites. 

He further says,

I was taken aback by Holt’s assertion that only the form of parable can “capture the essence of something too complex to be understood any other way.” Tolstoy’s “The Death of Ivan Ilych” is an illuminating parable, as are the medical tales of Chekhov, Turgenev, and Kafka. But the nonfiction stories of Oliver Sacks, Robert Coles, Richard Selzer, and Sherwin Nuland, as well as potent new voices of young doctors like Danielle Ofri, Leah Kaminsky, and Christine Montross, certainly capture the essence and complexity of the clinical world.

I agree. If you want to “capture the essence and complexity of the clinical world,” or any world for that matter, write fact not fiction. 

May 18, 2015 Issue

The piece in this week’s issue that most absorbed me is Joshua Rothman’s "Anatomy of Error." It’s a review of neurosurgeon Henry Marsh’s memoir, Do No Harm. Medical writing is, for me, a relatively new interest. I trace my appetite for it to a quartet of elegant Jerome Groopman pieces that appeared last year: “How Memory Works” (The New York Review of Books, May 22, 2014); “The Transformation” (The New Yorker, September 15, 2014); “When Doctors Admit They Went Wrong” (The New York Review of Books, November 6, 2014); “Print Thyself” (The New Yorker, November 24, 2014). Groopman writes a graceful, plain-English-style prose. Judging from the quotations in Rothman’s piece, it seems that Marsh’s style is similar – plainspoken, eloquent. Rothman calls Marsh “the Knausgaard of neurosurgery: he writes about his errors because he wants to confess them, and because he’s interested in his inner life and how it’s been changed, over time, by the making of mistakes.” I find Marsh’s willingness to confess and explore his errors fascinating. I applaud his factuality. Groopman, in his excellent “When Doctors Admit They Went Wrong,” a review of Terrence Holt’s Internal Medicine: A Doctor’s Stories, criticizes Holt for not recounting recollections of exact events. Holt offered “parables,” i.e., “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” (Holt’s words). Groopman says,

I was taken aback by Holt’s assertion that only the form of parable can “capture the essence to something too complex to be understood any other way.” Tolstoy’s “The Death of Ivan Ilych” is an illuminating parable, as are the medical tales of Chekhov, Turgenev, and Kafka. But the nonfiction stories of Oliver Sacks, Robert Coles, Richard Selzer, and Sherwin Nuland, as well as potent new voices of young doctors like Danielle Ofri, Leah Kaminsky, and Christine Montross, certainly capture the essence and complexity of the clinical world.

Add Henry Marsh to the list. Rothman says, “Do No Harm is an act of atonement, an anatomy of error, and an attempt to answer, from the inside, a startling question: How can someone spend decades cutting into people’s brains and emerge whole?”      

December 1, 2014 Issue

Recently, I’ve read some amazing New Yorker medical pieces – Jerome Groopman’s “Print Thyself” and “The Transformation,” Richard Preston’s “The Ebola Wars” – but Emily Eakin’s “The Excrement Experiment,” in this week’s issue, is one of the damnedest things I’ve ever read. It’s about treating disease with fecal microbiota transplants (FMT). It’s the type of subject that’s so novel and arresting that the reporter is well advised to just get out of the way and let the facts speak for themselves. That’s what Eakin does. Along the way, she generates interesting, slightly surreal sentences such as, “In September, Leach gave himself a fecal transplant with the aid of a turkey baster and a bemused Hadza man, who served as his donor.” Eakin’s “Celluloid Hero” (The New Yorker, October 31, 2011) made my “Best of 2011” list. “The Excrement Experiment” may well be a “Best of 2014” contender.

Another piece in this week’s issue that I enjoyed immensely is Joseph Mitchell’s “A Day in the Branch,” a fragment of a memoir found in his papers after he died in 1996. It’s a reminiscence of his time growing up in North Carolina when he spent many of his days roaming a wild swamp river called the Pittman Mill Branch. He says of the river, “I would walk slowly and keep looking into the water, studying it. The water mesmerized me….” Reading that brought to mind the great opening paragraph of his classic “The Rivermen” (The New Yorker, April 4, 1959; included in his 1992 collection Up in the Old Hotel), in which he says, “I often feel drawn to the Hudson River, and I have spent a lot of time through the years poking around the part of it that flows past the city. I never get tired of looking at it; it hypnotizes me.” “A Day in the Branch” shows the roots of Mitchell’s deep appreciation of the Hudson – the youthful days he spent pleasurably hanging around the Pittman Mill Branch, walking it, smelling it, fishing it, swimming in it, climbing its trees, sometimes pretending he was a bobcat.    

November 24, 2014 Issue

Pleasures abound in this week’s issue (“The Tech Issue”): “the easy, cheesy thrills of the appetizers” at Upland (“Amelia Lester, “Tables For Two”); the “in-process” feel of Bryan Graf’s photograms, “as if the fabric were still moving, refracting and layering gossamer passages of magenta, rose, and acid green” (“Goings On About Town: Art”); the “razor-sharp pulp efficacy” of the action scenes in Rainer Werner Fassbinder’s The Third Generation (Richard Brody, “Goings On About Town: Movies”); the “subtle but staggeringly delicious truffle pasta with grated yak cheese” at Aldo Sohm Wine Bar (“Sarah Larson, “Bar Tab”); the “heavy, golden, fan-shaped leaves” of New York City’s ginkgoes (Oliver Sacks, “Night of the Ginkgo”); the 10xers on the roof of Altay Guvench’s “hacker mansion,” finishing their drinks in the fog (Lizzie Widdicombe, “The Programmer’s Price”); Sean Parker, in his Plaza Hotel apartment, “dressed in jeans and rust-colored high tops, drinking tea from a white china cup” (John Seabrook, “Revenue Streams”); the sound of a Wyss Institute 3-D printer “clacking and clattering like a busy riveting machine” (Jerome Groopman, “Print Thyself”); the roar of the crowd in Lincoln Theatre, “as it saw Scarlett plant a hatchery – a pulsing, cloudy blue blob – down in the corner, next to PartinG’s home base” (Ben McGrath, “Good Game”); the “jagged music” of Penelope Fitzgerald’s prose – “each sentence is a little different from its predecessor; nothing is allowed to settle into the familiar” (James Wood, “Late Bloom”). I enjoyed it immensely. 

September 15, 2014 Issue

I’m a latecomer to Jerome Groopman’s writing. Earlier this summer, I read my first Groopman – “How Memory Works” (The New York Review of Books, May 22, 2014). I was surprised to find myself enjoying it – “surprised” because I’m not used to seeing science written about from the “I” perspective. Science is generally a third-person discourse. But Groopman writes gloriously in the “I.” His “The Transformation,” in this week’s issue, exemplifies his personal approach. It’s about an experimental new drug that causes leukemic cells to mature into healthier ones. In it, he visits the laboratory where the new drug, AG-221, was developed. He writes,

That afternoon, I examined microscope images of the bone marrow of a patient who had not been treated with the drug. As a hematologist, I often dread taking in this view. Up close, healthy marrow looks like an Impressionist painting—a variegated landscape of cell types and colors. Leukemic marrow is a monotonous canvas of cancer cells; the images I was looking at showed hardly any normal blood cells being made. Then I examined images from a patient who had received the Agios drug. Typically, when a patient with A.M.L. is treated with high doses of chemotherapy, the marrow is emptied of all living cells; what’s left is a moonscape of fat globules and fibrous tissue. The images at Agios showed robust marrow: the leukemic cells had been forced to mature and had reverted to functioning white blood cells, red blood cells, and platelets. They were transformed.

That “moonscape of fat globules and fibrous tissue” is very fine. Groopman’s words call up pictures. He makes medical science vivid.

Postscript: William Finnegan’s “Dignity,” in this week’s issue, is one of the most moving, brilliant, effective pieces on economic inequality that I’ve read in a long time. I say “effective” because it not only describes the workers’ predicament (miserable pay); it suggests a powerful remedy – labor activism. The piece reports on the growing campaign to unionize fast-food workers. Finnegan immerses himself in the life of Arisleyda Tapia, a worker at a New York City McDonald’s. He describes her workplace (“the deep fryer and the meat freezer, the clamshell grill and the egg station, the order screens and the endless hospital-like beeping of timers”); he accompanies her on a bus to a national conference of the fast-food workers’ movement in Chicago (“Shantel Walker, who works at a Papa John’s in Brooklyn, jumped up as the bus approached Chicago. She wore a gold-billed cap and a big crucifix. She had a microphone. ‘I work too hard,’ she chanted, ‘for a little income.’ The bus erupted, workers chanting the lyrics after her. ‘Your story is an inspiration / People are with you / New York is proud of you, HEY’ ’’); he talks to the conference-goers (“Jorel Ware worked at a McDonald’s in midtown. He was thirty-one. He still made minimum wage, after two years. ‘They say the franchisee is just a small man in the middle,’ he said. ‘If that’s true, then who am I? I’m just a dot on the wall. I just want to be able to get an unlimited MetroCard. I can’t afford nothing’ ”); he observes a sit-in outside a McDonald’s (Some of the marchers wore their McDonald’s uniforms. Tapia was in civilian clothes. It was midday, hot. She and the rest of the protesters were steered by police into a containment pen, built of interlocking metal barricades, on the east side of Eighth”); he describes the arrest of some of the demonstrators (“The police used disposable restraints—white plastic ‘flexicuffs.’ They led their captives toward two large white vans, herded them inside, and shut the doors”). Anyone frustrated (as I am) by the lack of political response to the recent surge in inequality will find “Dignity” inspiring. It shows workers bravely taking matters into their own hands, using collective action as a means of reform.