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It wasn’t until my mid-forties that I began to write about the world of medicine. Before that, I was busy building a career as a hematologist-oncologist: caring for patients with blood diseases, cancer, and, later, AIDS; establishing a research laboratory; publishing papers; training junior physicians. A doctor’s workload tends to crowd out everything but the most immediate concerns. But, as the years pass, the things you’ve pushed to the back of your mind start to pile up, demanding to be addressed. For two decades, I had seen my patients and their loved ones face some of life’s most uncertain moments, and I now felt driven to bear witness to their stories.
After writing and revising three chapters of what I envisioned as my first book, I showed a draft to my wife, an endocrinologist. She read them, and then looked at me squarely. “They’re awful,” she said. I was taken aback. I’d felt pretty good about what I had produced. “They’re overwritten, with run-on sentences, filled with fancy words,” she explained. I stayed silent, absorbing her criticism. “I can’t really figure out what you’re trying to say here.”
I reread my words and concluded that she was right. What’s more, I realized that many of the problems with my draft reflected the conditioning that occurs during medical training. I had used technical jargon, as if communicating with colleagues, rather than addressing a general reader. And I had removed myself from the stories, a result of the psychological distancing needed to remain steady while helping a patient coping with a life-threatening disease. Finally, I’d focussed on the clinical details of the cases, instead of exploring patients’ emotional and spiritual dilemmas—the very thing that had moved me to write in the first place.
What I needed was a new kind of training, analogous to my medical training but very different. So I reread some of the physician writers whom I most admired: Oliver Sacks, Richard Selzer, Sherwin Nuland, William Carlos Williams, Anton Chekhov. I started to appreciate how they used their individual perspectives and styles to illuminate the experiences of those struggling with illness. They made their own reactions part of the story and, in doing so, immersed the reader in a fundamental struggle of the profession: balancing the ego required to take responsibility for another person’s life with the humility to acknowledge our capacity for catastrophic error.
Today, my library shelves are filled with books by doctors, spanning the whole arc of a medical career—from “A Not Entirely Benign Procedure,” a memoir of medical-student life by the N.Y.U. pediatrician Perri Klass, to the self-lacerating retrospect of the British surgeon Henry Marsh’s “Do No Harm,” which broods on mistakes made during a long and outwardly illustrious career. Somewhere between these, I can now slot in Jay Wellons’s vivid mid-career memoir, “All That Moves Us” (Random House). Wellons is the chief of pediatric neurosurgery at the Vanderbilt University Medical Center, in Nashville, and has begun to write, as I did, after some twenty years in medicine.
His book unfolds in a harrowing series of operating-room vignettes, explaining the work of his hands while also evoking the tension in his mind and his heart. Before his medical training, Wellons was an English major at the University of Mississippi, where he took writing classes with the novelist Barry Hannah and the poet Ellen Douglas. It shows, both in his narrative control and in the freshness of his descriptive touches. Here he is on the first glimpse of a brain—with its tissues and blood vessels and crevices—once the skull is opened:
Wellons’s journey into medicine was influenced by his father, who had wanted to be a doctor, but whose family couldn’t afford the training. Instead, he became a businessman, and his early ambitions were transferred to his son. Then, just as the younger Wellons was graduating from medical school, his father received a diagnosis of the neurodegenerative disease A.L.S. “For all my uncertainty about how I would spend my life in medicine, it is but one irony that I would spend my days trying to understand the mysteries of the anatomical system that had failed my father,” he writes. “I know now that I would come to see him in the patients that I cared for, and also see myself in the families’ grief.”
Wellons writes unsparingly of his chosen specialty, and “the nearly unbearable pain that we must at times unleash upon our patients.” For parents, merely hearing him introduce himself as a pediatric neurosurgeon can be traumatic. (“As I did, his chin dropped to his chest,” Wellons writes of one father.) He recalls acquaintances who implored him to avoid this line of work, citing stereotypes of neurosurgeons as grouchy, egotistical workaholics whose patients usually die. But he persisted, inspired by a series of charismatic and contrarian mentors. Eventually, he came to see the severity of the situations he confronts in a positive light, as an opportunity to prevent the direst outcomes—“not always, but most of the time.” The extraordinary plasticity of the juvenile brain, its ability to recover and adapt, offers hope. He rejoices in seeing young patients grow into adults and reflects that his field offers “the opportunity to fundamentally improve, or even bring back, a child who is pure potential, for whom nothing is truly determined and all possibilities exist.” In the moments when he decides that surgery is necessary and feasible, he writes, he “can see just the haziest version of a life to be lived.”
We see Wellons operate on patients with tumors, blood-vessel malformations, brain swelling, developmental problems, and damage from trauma, including gunshot wounds. He also works on the peripheral nervous system, sewing and grafting damaged nerves, and closes up the exposed spinal cords of infants with spina bifida. Although most of his patients range from neonates to teen-agers, he has also become a specialist in a new medical frontier: operating on fetuses in utero. In one chapter, he and his Vanderbilt colleagues travel to Australia to teach a team at the Mater Mothers’ Hospital in Brisbane how to operate on fetuses with spina bifida. The challenge for the surgeon is to work in a biological dimension never encountered before, he writes: “The tissue was entirely different at twenty-three weeks of gestation, akin to sewing wet tissue paper. The slightest wrong move would tear the fragile skin.”
In Richard Selzer’s short story “Imelda,” an American plastic surgeon named Hugh Franciscus, a cold and imperious perfectionist, goes on a charity mission to Honduras. There he prepares to operate on a young girl, Imelda, with a cleft palate. But Imelda suffers a complication from anesthesia, dying before Franciscus even makes an incision. That night, he sneaks into the hospital morgue and performs the planned surgery on Imelda’s corpse, so that her mother can bury a repaired child. He has saved face, in more ways than one, but he is shattered by the experience, unable to recover from an imperfect outcome.
Wellons tells a number of stories in which he takes responsibility for irreparable mistakes. He relates a case in which he had to operate on a pair of conjoined twins, who were connected at the back of the head and had been born very prematurely. The intestines of one twin were becoming necrotic, as sometimes happens after extremely premature birth, and toxins were spreading through shared circulatory systems to the other twin. Normally, separating conjoined twins involves weeks of preparation and planning, but here the infection necessitated emergency measures—“a Hail Mary if ever there was one.” The operation starts off well: “Through the skin exposure and the craniotomy and then the dural opening, we’d lost less than a thimbleful of blood.” But suddenly, more than three hours into the operation, heavy bleeding issues from deep within the two brains. Attempts to stanch the flow don’t work, and Wellons finds himself “cutting the joined skull with scissors, all hope of delicacy abandoned, trying to get them separated so that my partner and I could each take one and stop the bleeding.” There is a moment of relief when the bleeding stops, then a terrible realization:
Like Selzer’s Dr. Franciscus, Wellons ends up producing, postmortem, a poignant approximation of the hoped-for result. But he is more fortunate: rather than becoming isolated by perfectionism and imperiousness, he has mentors and colleagues who help him through the agony and reconcile him to human imperfection. Indeed, he is skeptical of our tendency to heroize surgeons, and he specifically rejects the “testosterone-driven” culture that has long typified the field. Noting that, among pediatric neurosurgeons in the U.S., a higher proportion are women—twenty per cent—than in any other subspecialty of neurosurgery, he writes, “That number continues to grow, and we are clearly better off for it.”