I met Dr. Suzanne Koven several years ago at Harvard Medical School’s CME publishing course before her writing career took off. I was thrilled to hear from Dr. Koven years later, and to learn that she’d written a book, Letter to a Young Female Physician, being published by W.W. Norton & Company.
Lisa: Can you share a bit about how you started writing about your experiences in medicine and then publishing your writing in short form?
Dr. Koven: For many years, and I mean many, I knew I wanted to write about the moving, funny, fascinating, frustrating, sad, joyful experience of being a doctor. I also knew that the personal essay was the writing form that felt most like my own voice. But it took me a long time to figure out how to actually write and get published. I just couldn’t do it alone. For me, the first breakthrough came when I started taking night courses in writing in Harvard Extension, the University’s adult ed program. Next, I completed an MFA in nonfiction writing at Bennington—in my fifties. I started writing professionally around then; a monthly column in the Boston Globe, and book reviews and essays there and elsewhere. I’m now publishing my first essay collection in my sixties. So writing-wise, I’m kind of a late bloomer.
From Essay to Published Book
Lisa: How did the idea of Letter to a Young Female Physician come about? What sparked this book, writing about medicine and being a doctor?
Dr. Koven: This was not the book I thought I was writing. I actually wrote the essay, “Letter to a Young Female Physician” almost as an act of procrastination while working on what I thought would be a memoir. One of my early readers of the memoir draft told me that I was an essayist, not a memoirist. I was taken aback, but she was right. When an editor read my “Letter” essay and asked if I wanted to write a collection of similar essays I said no: I was writing a memoir! A year later I realized that this “memoir” was really a collection of essays about my life in medicine, from childhood as the daughter of a doctor, to the present, as I near the end of my career.
Lisa: Did the book begin as a letter or how did it take shape and morph over time?
Dr. Koven: I knew the “Letter” essay would be included in the book but I gradually understood that the whole book was, in effect, a letter to a young female physician, to my younger self, to all young—or formerly young—people.
Lisa: Did you picture anyone as you wrote the letter? Did you have a specific real person in mind or your younger self, for example, each time you sat down to write?
Dr. Koven: Mostly I was writing to my younger self, or, really to my current self, trying to make sense of the seemingly chaotic narrative of my life. But I was also thinking of the many people who contacted me after reading my original “Letter”; young and not-so-young people, men and women, physicians and non-physicians all of whom had struggled with self-doubt or wondered if they had a distinct identity. I wanted to assure them that these feelings are normal and common and even surmountable.
Writing is Work of the Heart
Lisa: You write “I never became fluent in science, never dreamed in its language.” I found that such a beautiful way to say that your heart was elsewhere. How does it feel to be doing the work of your heart, this creative work as a writer?
Dr. Koven: It feels wonderful. Don’t get me wrong: writing is hard and writing a book, a sustained effort over several years was really hard. I wanted to quit a million times. But it is a thrill and a privilege to arrive at this point in life and feel that in writing and in medicine I’m doing exactly what I was meant to do.
Lisa: You write about alleged plagiarism over an oral presentation because the teacher thought your ideas were too creative and brilliant (my words, not yours) to be your own. That happened to a friend and classmate of mine in college at MIT, a beautiful young woman who was a physics major and an extremely talented writer, who later earned an MFA elsewhere. Her MIT professor told her, “I don’t know where you got this from but I know it has to be plagiarized” and he gave her a low grade for the paper. How common do you think this is in science and medicine, women whose work is not accepted as their own simply because it’s brilliant? And how do we combat that old school, old (white) boys bias?
Dr. Koven: I don’t know how commonly it happens to women but I’m pretty sure it rarely happens to men. The status of women in medicine is a good news/bad news situation. The good news is that there are more of us now than ever. The majority of entering medical students are women and the majority of trainees in several specialties including OB-GYN, pediatrics, and psychiatry are now women. The bad news is almost everything else. A gender pay gap, workplace harassment, fewer opportunities for promotion and research funding and other obstacles thwart women’s medical careers and drive women out of medicine. The same is true in the sciences. We won’t be truly equal until more women are in positions of leadership and more institutions address the structural sexism that allows these inequities to persist.
Writing as Training for Clinical Medicine
Dr. Koven: Reading and writing are excellent training for clinical medicine. The discipline of narrative medicine is based on this idea. Storytelling is an essential element of medicine. Patients come to us with their stories and we help interpret them and use them in, hopefully, therapeutic ways. Reading novels and other forms of literature hones our ability to imagine and make sense of someone’s suffering, important aspects of healing.
Lisa: And the flipside, when you think about your skills as a doctor, which of those has helped you be a better writer (and helped you in writing about medicine) and how have those ways of thinking and other skills contributed to writing Letter to a Young Female Physician?
Dr. Koven: Every doctor has a rich collection of stories, one reason why there have been so many doctor-writers. Clinicians have a unique opportunity to observe other people closely: their bodies, behaviors, and life stories. Details are important in medicine—and in writing, too. Also, doctors undergo a long training and work long hours—we’re used to deferred gratification and hard work, which come in handy in writing.
Advice for a Young Woman who Wants to Write Nonfiction (who may or may not be writing about medicine)
Lisa: In Letter to a Young Female Physician you offer hard won advice to women beginning in the field of medicine and presumably what you would have said to the younger you starting out in this field. If you were to write a letter to a young woman who wants to write nonfiction narrative, or specifically memoir, what advice would you give her?
Dr. Koven: Great question! First is to ignore any “rules” about how to get writing done. For some people writing a certain number of words works well. Not for me. I needed to take courses, have deadlines. Second, don’t assume that you have to write in a certain way or about certain things just because of your age, background, occupation, or whatever. “Write about what obsesses you” is good advice I was once given. I’d add: write about the thing you think you can’t or shouldn’t write about. That weird, idiosyncratic thought you have that you think no one else could possibly understand is probably writing gold. If you feel something deeply, find something deeply fascinating, then it’s certain others will too. Don’t write what you think you’re supposed to write.
Lisa: At what point did you search for a publisher and what was that process? Did you work with a literary agent?
Dr. Koven: The editor who contacted me about my “Letter” essay ended up being the editor I worked with on the book. After I spoke with her, I contacted a literary agent to whom another doctor-writer referred me.
Tips for Writing a Book Proposal
Lisa: Any tips about writing a book proposal?
Dr. Koven: Take your time. It took nine months from the time I signed with a literary agent until we sent the proposal to editors. This may sound slow but the work put into the proposal was well worth it. By the time the book went to market it was pretty well defined. And then it only took six months to complete the first draft. So the proposal took more time to write than the draft, in fact.
Lisa: Did you need to do any specific activities to create an author platform that would be enticing to agents and publishers? If so, what did you do?
Dr. Koven: I had been writing for several years and published a number of essays. Plus, through the informal community of doctor-writers (which, like many writing sub-communities, is easily accessed via social media) I had participated in many panels and other events and done some media. For the kind of writing I do—personal writing—I’m not sure platform is as important as for say, writing for patient education.
Working with a Publisher
Lisa: Can you describe the process of working with your publisher, W.W. Norton & Company? Did the acquisitions editor require or suggest changes to the book before or after signing a contract, for example?
Dr. Koven: The book was bought in a “pre-empt,” meaning the publisher makes an attractive offer with the condition that you accept it quickly (48 hours in my case) without considering other offers. So there was no time for changes before the book was sold. After reading my first draft of the whole book my editor had a clearer sense of what shape the book might take and suggested cutting out certain essays, revising others, and adding additional material. Specifically, she urged me to omit anything in the book that wasn’t about medicine in some way. The result is that I wrote about my childhood, my family relationships, and even my reading and writing through the lens of medicine—hence the book’s subtitle: “Noted from a Medical Life.” It turned out to be excellent advice, giving the book a cohesion and narrative arc it might not have had otherwise.
Promoting a Book in a Pandemic
Lisa: Gone are the days of bookstore events, at least for now. What activities are you doing to promote the book?
Dr. Koven: Bookstore events aren’t entirely gone—I’ll be doing some virtually. Also: book festivals, lectures to medical audiences, library events, interviews, podcasts, and more.
Lisa: Your memoir demonstrates the ways that our medical residency system is broken. How would you change medicine and redesign the system if you could (or how would you start)?
Dr. Koven: I wrote about residency over thirty years ago and, sadly, there is still much that is broken. Women, people of color, and LGBTQ physicians still often face bias, harassment, and pay inequity. Depression and suicide rates among medical trainees are appallingly high. There have been some improvements in residency training—most notably more humane work hours—but until those in positions of leadership fully commit to the idea that learning to be a healer shouldn’t be harmful we’ll have a long way to go.
Memoir as a Device for Social Change
Lisa: In what ways do you see memoir as a powerful device for social and systemic change?
Dr. Koven: No opinion piece, policy statement, or statistic is more compelling and convincing than a story. I co-direct a program at Harvard Medical School called Media and Medicine based on this principle. We encourage participants to use storytelling to advance public health.
Lisa: What kind of change do you hope comes out of this book?
Dr. Koven: Nothing would make me happier than if readers experience for themselves the realization that I ultimately came to: that we are not imposters, simply imperfect human beings, and that day-by-day, year-by-year, with love and patience, we go about the messy work of becoming who we need to be.
Suzanne Koven was born and raised in New York City. She received her B.A. in English literature from Yale and her M.D. from Johns Hopkins. She also holds an M.F.A. in nonfiction from the Bennington Writing Seminars. After her residency training at Johns Hopkins Hospital she joined the faculty of Harvard Medical School and has practiced primary care internal medicine at Massachusetts General Hospital in Boston for over 25 years. In 2019 she was named inaugural Writer in Residence at Mass General. Her essays, articles, blogs, and reviews have appeared in The Boston Globe, The New England Journal of Medicine, The Lancet, The New Yorker.com, Psychology Today, The L.A. Review of Books, The Virginia Quarterly, STAT, and other publications. Her monthly column “In Practice” appeared in the Boston Globe and won the Will Solimene Award for Excellence in Medical Writing from the American Medical Writers Association in 2012. Suzanne’s essay collection, Letter to a Young Female Physician, was published by W.W. Norton & Co. on May 4!