The emergency room physician explains how storytelling brings humanity into the doctor/patient relationship
Rachel Kowalsky’s work made it into a prestigious medical journal last month, and she’s proud to say that she made it all up.
Kowalsky, M03, MG03 (MPH), a children’s emergency room physician in New York City, won the New England Journal of Medicine’s inaugural fiction contest. Her short story, The Billboard, about a pediatrician who longs to be in an advertisement for the hospital he works at, was chosen from more than 300 entries.
Kowalsky’s protagonist is a medical hero, even though he doesn’t perform life-saving surgeries or treat COVID patients in the ICU. “It doesn’t always look like that,” Kowalsky said. “Sometimes it’s just something ordinary, like you pick up a murmur in the newborn nursery, or an ear infection that will never turn into meningitis because you prescribed the right antibiotic, or you treated a kid’s eczema so they could stop being ashamed of their skin and stay focused in school.”
Submissions were reviewed by journal staff and three professional writers known for their medical fiction. Debra Malina, the journal’s Perspective editor, said the judges responded to the story’s subject matter and the quality of the writing. Plus, she said, it’s funny, particularly when the main character’s attempts to do something billboard-worthy, like performing the Heimlich on a choking man at a lunch counter, are repeatedly dismissed by the hospital’s communications officer. (“I don’t think the deli counts.”)
Kowalsky is an assistant professor of clinical emergency medicine and clinical pediatrics at Weill Cornell Medicine, but has been a writer her whole life, even during medical school at Tufts, when she would take a bus from Boston to New York for a weekly writer’s class. Her short stories and essays have been published in literary magazines, writing blogs, and anthologies. Many of her stories, including two she published this year about a hospital pianist and an emergency room clerk, are inspired by the people who work throughout a hospital.
She views her day job through a writer’s lens. “I’ve always seen medicine in terms of stories—the patient’s story, my story, how they intersect,” she said.
The first thing a patient says in the exam room may be just as meaningful as the opening lines of a story, she explained. The parent of a baby with a fever, for example, might start the conversation with, “I just don’t think I ate a proper diet when I was pregnant,” hinting at the heart of her concern.
“The words that patients will use to describe things, the repetition of words, the things that they keep coming back to, it helps you understand what they’re really there for,” Kowalsky said.
How can an E.R. doctor and a mother of two fit writing into her life? A supportive husband (Marc Kowalsky, M03) and department chair (Rahul Sharma, M01) are part of it, along with being disciplined enough to set aside two-hour blocks of time just for writing. “I schedule it into my calendar, like a meeting,” she said.
She also takes time to introduce new doctors to the connection between medicine and the arts. She directs the humanities component of the hospital’s emergency medicine residency program, where she runs a narrative medicine workshop for residents.
“Learning about storytelling and reading poetry helps us to be better, more empathic physicians, because it makes you imagine the perspective of another person,” Kowalsky said. “You become more flexible in your way of thinking.”
Malina, the journal editor, said the idea for the fiction contest came from Editor-in-Chief Eric Rubin, M90, GBS90, and it met the craving many people had for something lighthearted after a difficult year. “I think it was partly the pandemic and the need for an escape, both for the writers and physician readers,” she said.
Kowalsky said she hopes the contest will continue, because it recognizes that the arts have value in medicine.
“More and more, medicine has looked for ways to keep the humanity in the interaction between doctor and patient,” she said. “So much gets in between us, from the medical electronic records to time constraints to PPE that keeps us from seeing our facial expressions.” Thinking more about the stories everyone has to tell may be one way to foster the connection both patients and doctors want.
Julie Flaherty can be reached at firstname.lastname@example.org.