By Christy Duan, MD
Dr. Sandeep Jauhar is a cardiologist and director of the Heart Failure Program at Long Island Jewish Medical Center. He graduated from University of California, Berkeley with a PhD in physics before completing a medical doctorate at Washington University in St. Louis. He is a contributing writer for The New York Times and his work has been featured in TIME, The Wall Street Journal, and the New England Journal of Medicine. He has also appeared on National Public Radio, CNN, and MSNBC. Dr. Jauhar has written three books published by Farrar, Straus, and Giroux. His first medical memoir, Intern: A Doctor’s Initiation, was published in 2009 and his second medical memoir, Doctored: The Disillusionment of an American Physician, was published in 2015. His newest book, Heart: A History, is out today. I dropped by Dr. Jauhar’s office to gain insight into his writing process and learn more about his new book. This interview has been edited and condensed.
Can you tell me a little more about how you got involved and interested in writing?
I grew up in southern California in a place called Riverside. And I grew up in a household that was very science oriented, like many immigrant Indian families that we socialized with [where] the fathers were doctors or professors. And so my parents wanted their kids to become doctors. I was interested in many different things, so I kind of rebelled. I sort of thought about and entertained different careers and my father’s response was always “non-science is nonsense.” It was that kind of cultural situation. [Laughs] So I ended up deciding to study physics because I was fascinated by the mysteries of the universe and I went to Berkeley, never thinking I was going to do any writing. I figured I would become a professor.
Mid-way through my graduate training at Berkeley, my girlfriend got sick with lupus and I got interested in medicine because of her illness. I’d visit with doctors [and] mostly spoke with them on the phone. I went to the library and I read up on various aspects of this disease and I came to understand that there’s a lot in medicine that’s just unknown. And that was a huge contrast to what I was experiencing in the physics lab, which is that it was very iterative. I’d seen that a lot of things had been figured out. So in the course of all that, I decided to switch out of physics and go to medical school.
Now, how did writing come up? Well, the summer before I went to med school, I applied – really, on a lark – for a science journalism fellowship called the AAAS Mass Media Fellowship. I wrote an essay, filled out an application, and they picked roughly 15 or 20 applicants out of a pool of maybe 300 or 200 or something applicants that had an advanced degree in science. So it was basically designed for people like me who sort of liked writing, but had a science background. I applied and fortunately I got it and I also got one of the plum assignments, which was to work at TIME magazine. So I went to TIME in Washington, D.C. and I spent the summer there.
When I left, I asked the bureau chief to give me some names of people I could call on in the future if I ever decided to do some writing about medicine. He gave me some names and I said, “Well, what about the New York Times?” And he gave me a name there. I eventually called up this guy… and we sort of hit it off because I was actually in St. Louis—I went to Washington University for medical school—and it turns out that this guy was from St. Louis, the guy from the New York Times. So I went and I met with him and then he introduced me to one of the science writers there and we sort of stayed in touch. She encouraged me to apply for a science writing internship at the St. Louis Post-Dispatch, [based] where I was living. And so I got a few clips and I sent them to her. Sometimes I’d get a reply and sometimes I wouldn’t. But in any case, after I was done with medical school, I moved to New York for an internship. And it happened to be the same time when the New York Times Science section had a new editor. And, you know, new people come in and they sort of want to bring in their own people. So the editor reached out to me and said, “Do you want to do some writing?” And I said, “Yes.” She’d liked one of the pieces I’d written and she encouraged me to write about my internship. I started writing for a column called Cases and my first piece came out in maybe November of my internship. By the time internship was over, I had already written four other pieces. And then the following year, I wrote ten. And I just became a regular contributor to the New York Times. So that was a very nice avocational pursuit during my training.
Was there one moment you could point to that you could say, “This was my big break”?
One of my early pieces was on a patient who had a mysterious fever. I spent a lot of time on it. It was probably 1200 words. And I got a call from a literary agent saying, “I read your piece and we should meet. And have you ever thought about writing books?” I never thought about writing books and he said, “Well, I could still be your agent and we’ll see what happens.” And I said, “Sure, why not?” Because who doesn’t want an agent, you know? Then about maybe two or three years later, I had enough pieces. We started talking about maybe stapling them together and having a collection of essays. Maybe writing some new stuff. Maybe writing some connective tissue between the pieces. My agent reached out to… several editors. An editor from Farrar, Strauss and Giroux said, “We’re not really interested in this book but we are interested in Dr. Jauhar writing a bildungsroman,” you know, a memoir of his education, “and would he be interested?” My agent said, “You better be interested because this is your big break.” I said, “Well, I don’t know if I can do this.” And he said, “You’ll do it.” In any case, I ended up signing a contract. Once you sign a contract, then it kind of lights a fire to get it done. So that’s what happened and I ended up writing my first book, Intern.
Writing takes such a significant portion of time to have just fallen into it. I’m kind of curious about what kept you going and what kept the spark alive for you.
I would get honestly a rush out of writing a piece and having it come together. But I think the biggest motivation was that I found writing a way to process my experiences. And it wasn’t until I had written about what I had gone through that I was able to make sense of it. Before, it was nebulous. There were things that bothered me about something—you know, a patient interaction or whatever that didn’t quite gel in my mind until I put some kind of structure to it on paper. And it wasn’t for publication necessarily. I mean, I kept a journal during internship when I never thought about writing a book. And that journal actually came in quite handy when I wrote my first book in turn.
So I found and I have always found that writing is a way for me to process what I am experiencing. I would usually early on write about things that bothered me or things that were surprising. I remember one guy, a patient of mine, who couldn’t swallow and they were planning on putting in a feeding tube. But he didn’t want a feeding tube because one of the great pleasures of his life was the taste of food. He even liked the hospital food. So I started asking, “Why are we doing this?” And in the course of that sort of moral conundrum that I experienced, I wrote a piece about that. It helped me understand what was the problem, why I was bothered by this. And in the course of this, I investigated research on feeding tubes and patients with dementia, and whether they were helpful or harmful. These things helped to form my clinical life also, so it ended up being a nice two way interaction.
And so you’ve done a lot of personal writing, you’ve done a lot of memoir work with Intern and also with Doctored. In your new book out in September, Heart: A History, would you say that’s a significant departure from what you’ve done before?
I think it’s a departure, but it still has a lot of personal writing in it. It’s a scientific and cultural and emotional history of the human heart. But it’s also a personal story. It’s a story of my development as a cardiologist, it’s a story of my fellowship, it’s a story of my own work in cardiology as well as being a family member of patients with heart disease—and in some ways, being a patient myself. So there are a lot of personal strands that I think readers will find familiar from their readings possibly of my other books.
But then there’s this fascinating story about the heart. And as interested as I am in the heart, I didn’t realize what an incredible story it was until I started investigating it. One thing I think that will come as a surprise to most general readers is that the heart had never really been operated on until almost the beginning of the 20th century. For millennia, the heart was the only organ that was considered immune to manipulation. The brain had been operated on, the liver, the kidney—I mean, all vital organs. But the heart was left alone.
I think part of that was because of scientific obstacles. Obviously, the heart is filled with blood. If you cut it open, you bleed. The heart supplies blood and nourishment to every organ. So if you stop it, then you get organ damage quickly within a few minutes. So it seemed like an almost unsurpassable obstacle. And the book, in part, is about how we overcame those obstacles.
But it wasn’t just the scientific obstacles. There were, I’d say, cultural obstacles also. The heart had symbolic meanings that were not present for other vital organs. The heart was the locus of the emotions, it was the driver of the affections, it was the seat of the soul. How can you operate on something like that? So there were cultural as well as scientific prohibitions that delayed the development of heart science for a very long time… The book is a multiple sort of facets where I try to weave the defining discoveries of the past with my own experiences.
At what point in the development of this idea… about the history of the heart would you say, “I really need to write a book about this?” Because there are plenty of people who go read the history of medicine and do these things on an individual basis. But why write a book about it?
I like to write and I wanted to put my own imprint on this fascinating story. Again, it’s not just a biography of the heart, but it’s really a history that’s comingled with personal history as well. It’s an intimate story.
Were there any surprising insights that you developed or challenges you faced in writing this that surprised you in some way?
One of the themes of the book is that we are probably nearing the end of what I would call is this golden era of cardiology where heart disease was so effectively treated and survival from heart disease increased substantially over the past half century or so. This was a half century that was defined, at least from the cardiac standpoint, by the heart-lung machine, by cardiac catheterization, by coronary care units, by defibrillators, by pacemakers—all the things that we sort of take for granted were all figured out in the last 50 to 75 years. So in that sense, it was a golden era. But if you look at survival from heart disease, it’s no longer decreasing at the same rate as it was in the past. And I think part of that is we are nearing the limits of what current science can do to prolong life from heart disease.
One of the themes of the book is that we’re going to have to figure out new ways and to help people live better and longer with their hearts. And one of those ways is to pay more attention to the emotional life that is ironically the emotional life that the heart was supposed to contain for so many thousands of years. There’s a lot of evidence that psychosocial disruption is very damaging to the heart. Acute disruption can cause broken heart syndrome, where the heart’s acutely weakened without any obvious cause. But chronic psychosocial stress is also heavily implicated in cardiovascular disease—stroke, hypertension. So I think that one of the messages is that that it’s not just about the devices and the procedures, it’s really about how we live that’s going to define this next era of cardiac advances.
Definitely—I see strains of how that would relate to that case with the man with the feeding tube. Exactly what’s the purpose of the intervention? How is it going to help people live more meaningful lives? And I think that’s [what] we should really be focusing on as physicians or people in the medical field.
I wanted to get some last thoughts from you in terms of what advice you would give to trainees or medical students who are interested in incorporating writing more into their careers? What words of wisdom do you have?
Keep a journal, because what we go through is so full of human drama and mystery and oddities that it’s sometimes easy to take it for granted. But we have really an incredible viewpoint and lens into the human condition. I think medicine was an incredible career to nurture one’s writing life and it’s an incredible career in so many ways… you can do good and it’s intellectually stimulating, but it also just provides so many interesting experiences that one can explore in one’s writing.
One of the best pieces of advice I got when I was starting my internship was to keep a journal. I did that and it actually came in handy. And I kept it not… with thoughts I’d write a book one day, but that I didn’t want to forget those experiences because it’s so easy to do that. I wanted to have something to talk to my children about. So that to me is the most important piece of advice I can give—not to lose those experiences, to put them down in paper. Think about them. Struggle with them. It’s just essential for your development as a writer.
People often ask me, “How do I start writing?” Well, it’s a different question than “How do I start publishing?” Publishing relies on the actions of other people. But writing doesn’t. Sometimes I’m reminded of that crazy guy who wrote seven novels before his first one was published. But the seventh novel was published and they retroactively published all six of his…[Chuckles]. So you know you can write and you can develop your craft and you can get better and you can show your writing to other people without it being published necessarily.
I think we also are in an era where people are fascinated by how doctors think, what doctors’ lives are about. I think that’s been true for a long time, but now I think there are so many opportunities for medical narrative writing. Most of the major medical journals have columns devoted to that. Most major newspapers love to get opinion pieces from doctors. Magazines love medical pieces. So it’s a great time to develop one’s craft.
About the Author
Christy Duan, MD is an award-winning writer and a psychiatry resident physician at Zucker Hillside Hospital in New York City. Read more of her work at www.christyduan.com.