Midwestern Gothic staffer Audrey Meyers talks with author Brian Volck about his book Attending Others, finding beauty in the ordinary, juggling a career in medicine with one in writing, and more.
Audrey Meyers: What’s your connection to the Midwest?
Brian Volck: The Midwest is my home, or was until very recently. I was born in Cincinnati, left for St. Louis to attend college and medical school, and did my pediatric residency in Cleveland. After residency, my wife and I lived and worked for five years in Tuba City, Arizona, a town on the Navajo Reservation. We loved the work, the people, and the place, but we also wanted our kids to see their grandparents more than once a year. That’s why we eventually moved back to Cincinnati. That was a real homecoming: our Cincinnati house was less than two miles from the hospital where I was born. We stayed put for twenty years, but life takes strange turns. We currently live in Baltimore, Maryland, because of my wife’s job and to be near my aging in-laws. Family trumps place once again. Well, not entirely. All three of our children still live in Cincinnati, and I return often to work at the Children’s Hospital, visit family and friends, and attend writing-related events.
Living in Baltimore and still working, however irregularly, in Cincinnati makes for a complicated life. I also return often to the Southwest to work on Native American child health issues. For now, however, Maryland is my current physical home, the Southwestern desert is the landscape of my heart, and the Midwest is my true homeland.
AM: You’ve spent a lot of time with diverse communities from all over the country, what aspects/values of the Midwest do you carry with you to these places?
BV: I like to think I carry a Midwestern ordinariness with me. I have a bad habit of taking myself too seriously, so it helps to remember the plainness of my origins. There are more powerful and cosmopolitan cities, more astonishing and beautiful landscapes, more eventful and consequential histories to be found elsewhere. But that’s not all bad. It gives Midwesterners a sense of place, however apologetic we may be about it. We have to look harder to find beauty or worldly consequence in what others call “flyover country.” In a land of moderate terrain, second-growth forests, and cultivated fields, or where bland, lookalike suburbs sprawl from aging cities, one either develops a practice of attention or fails to see the subtler beauties and quiet suffering around them.
Karin Bergquist and Linford Detweiler, the couple who make up the band Over the Rhine, moved some years ago from Cincinnati to a farm in Highland County, Ohio. The songs that have grown out of that experience name the beauty and suffering lurking in the ordinary: clouds at sunset, a tupelo tree set against the ironweed, scarred mountainsides, stray dogs on an urban street. Karin and Linford are lifelong Midwesterners who pay attention to the ordinary and find it wonderful. I try to carry some of that with me wherever I go: rural Honduras, a hospital room, a barren hillside on the Navajo Nation.
There are, to be sure, other ways of understanding Midwestern ordinariness. To other regions in the US, our part of the world looks rather homogeneous, and it’s easy to misconstrue the Midwestern “ordinary” as grim demographic uniformity. Some of that talk resurfaced in the wake of the recent presidential election. There are parts of the Midwest where that may well be true, but there’s nothing uniquely Midwestern about that. And if change comes more slowly to the heartland than the coasts, change has always been coming.
In Attending Others, I explore several lessons I learned growing up in an all-white suburb. Some of those lessons needed to be unlearned. I hope attentive readers can see that happening in my encounters with people whose circumstances are very different: an African-American boy in Cleveland, a Navajo girl, children in rural Honduras. This unlearning may take a lifetime, but I can see things changing in something as simple as a family photo: my daughter was born in Guatemala, my sister in law’s grandparents came from China, and my sister’s children are Indian-American. The suburb I grew up in is no longer exclusively white. I hear languages spoken at the Children’s Hospital that my younger self didn’t know existed. The ordinary is, as always, being redefined.
AM: How has the Midwest impacted your extensive list of passions, from teaching medicine to advocating for children and families in poverty?
BV: That’s an interesting question. While the Midwest didn’t create my passions, it certainly shaped them. I come from a family riddled with visual artists, musicians, and even a few medical professionals. I grew up in a house full of books. Though my father was in business, he sang in various choirs and taught night courses at a local university. My mother also sang, played piano and organ, and was a grade school teacher. They showed – rather than told – me not to limit my interests and goals to one part of life.
I’ve had many wonderful teachers whose passion for their subject made me passionate as well. To riff on Mark Twain, the difference between a great teacher and an adequate one is the difference between lightning and a lightning bug. Many of those teachers, especially in college, medical school, and residency, were committed to working with and for families – and especially children – in poverty. Our shared interests drew me to them.
Many had a Midwestern sensibility. They never imagined they would save or transform the entire world, but they saw a particular need and responded to it with all the effort and resources they could bring. Some traveled to developing countries. Others worked in the inner city. All remained rooted to the place they still called home. Fidelity outweighed flashiness or fame. It’s not that they were doing unimportant things. Their motivation came less from personal ambition than from a sense of right action. I like to think of my time with them as an apprenticeship, watching how they worked, trying to the best of my ability to do the same. I hope to never forget where I come from, the privileges I have, and the mentors who showed me how to engage the world from a particular place.
AM: How has your profession as a doctor influenced your work as an author? In other words, how does medicine and writing coincide in your life?
BV: It turns out that medicine and writing are both jealous lovers. Each demands a lot of undivided attention and lets you know when they’re not getting it. I wanted to be a doctor and a writer for as long as I can remember, and I had examples of doctors who pulled the thing off: William Carlos Williams, Robert Coles, Richard Selzer, and Lewis Thomas. Today, I’d add Abraham Verghese, Atul Gawande, and the late Oliver Sacks. They made the combination look easy. Maybe it is for them.
For me, medicine is the easier of the two. I do what I’ve learned from long years of training and watch as my patient gets better – or not. I can reassess, rethink, and adjust my diagnosis and therapy in so-called “real time.” Doctors often hear a small voice of self-doubt after a patient they encounter, a lingering worry they may have overlooked something important, that they should have done something more. When doctors lose that entirely, they grow cocky, dangerous. Lives are, after all, in the balance, and if I miss something important, however hidden it may have been, I feel personally responsible. There’s no certainty in medicine except for the final diagnosis, the one everyone gets in the end. A lingering uncertainty – calibrated somewhere between frisson and paralyzing dread – keeps me focused on the patient, makes me return to the basics of history taking and physical exams.
There’s a similar uncertainty, frequently bordering on dread, in staring at the blank page. I tell myself to just put words down, one after another, that I’ll revise later. Each new writing project brings its own little voice, saying “You don’t know how to do this.” The truth is, you don’t, but you go ahead and do it anyway. And if you’re determined enough to write, revise as many times as necessary, and find it sufficiently crafted to share, there remains the uncertainty of how your work will be received. When I publish something, it’s like sending a child out into the world. I want my babies to be loved, but it will be awhile before I know if anyone even notices, much less likes them. All that’s beyond my control. For too long, I let the short-term rewards of medicine outweigh the uncertain outcome of writing. I needed to write, but I had to overcome my fear of failure. It still takes longer to finish writing anything – short or long – than I’d like, but I’ve learned how to distract the inner critic long enough to get words, however inadequate, on the page.
That said, there are deep similarities in the practices of medicine and writing. Doctors listen to a patient’s story, from which they fashion yet another story: the “history and physical.” Good clinicians and writers attend to the telling detail: the tremor in a lip or hand, the stain on a sleeve, the uncomfortable silence between a question and its answer. The best in both professions look for the story beneath the story: not just a diagnosis, but the measure of the person before you, not just a narrative, but an insight into the human experience. Maybe that’s why there are so many doctor-writers, despite all the difficulties.
AM: Your book includes the experiences of your patients and your own personal experiences. In regards to ethics, do you find yourself struggling between these two aspects? Is it difficult being a doctor and writer in order to write personally about your professional life? How do you decide on what to include and leave out from your experiences?
BV: If I understand your question, you’re getting at one of the most contested matters in creative nonfiction: what particulars must go into a nonfiction piece and what should be left out, whether out of propriety, compassion, or fear of litigation. Sharing doctor-patient stories complicates matters. First of all, there’s HIPAA, the federal law that appropriately restricts the sharing of personal health information. That’s not really a problem, as I change the names of patients and family members or alter personal details to protect their privacy. If I write at length about a particular patient, I let the family read and comment on it before making anything public.
Second, there’s the necessity for confidentiality and trust between doctor and patient, given the intimate nature of the relationship. Patients tell me things they haven’t shared with their parents, spouses, pastors, or therapists. Third, there’s the need to respect the dignity of others, including their custody over their own stories. Anne Lamott says something like, “You own everything that happened to you. Tell your stories,” but that’s not really true for doctors. I don’t own my patients’ stories, yet they are an essential part of my life.
In Attending Others, it’s precisely those stories that I wanted to share with the reader: stories about what comes from paying attention – “attending to” – patients and families whose lives are noting like mine, who are distinctly “other.” As a physician, I’m privileged to enter those stories, to discover where that otherness can be bridged and sometimes where it can’t. Early in the book, I quote the philosopher, Emmanuel Levinas, as saying, “The encounter with the Other calls the self into being.” I learned a great deal about Navajo and Hopi culture in the five years we lived on the Navajo nation. I learned far more about myself, the most important lesson being “I’m not Indian.” In realizing that, I felt compelled to find out who I was, where I came from, what inherited habits and assumptions I took for granted. I hope that ongoing search opens me up to richer encounters with otherness, though I leave it to the reader to decide if I’ve made any headway.
Here’s how I see the challenge. I write my story by showing the reader what I experienced, thought, felt, and did with as much sensory specificity as possible. I also share telling details of my patients to the degree the story demands. To do less is to deprive them of their human complexity. The goal is to make the experience, including my experience of the patient, available without stripping away anyone’s dignity. I hope I come down in that narrow swath of narrative territory where the demands of the story and the dignity of the person overlap.
AM: Who do you write for?
BV: I hope Attending Others is accessible to a broad public, from health care professionals to fans of memoir, but I rarely start anything with a readership is mind. Obvious exceptions would be pieces written at someone else’s request, whether for a specific occasion or periodical. Most of the time, I write because I’m conscious of words or experiences that won’t let me go until I write them. In the past, when fear of failure outweighed my need to write, I let words wither and die, unwritten and mostly forgotten, though they went on haunting me. Unwritten stories, essays, and poems linger in memory and desire, like roads not taken.
When I sit down to write, I hope to discover something I didn’t yet know how to say. If I knew exactly what I was going to say before putting the words on the page, I’m not sure I’d do it. Even if I have the last sentence of a poem or story in mind, I still need to find a way to get there, and in improvising that path, the conclusion itself may change. If I don’t discover something in the writing, why should I expect the reader to do better?
Yet it helps immensely to have someone to whom my writing is accountable, someone to say, “Where’s the work you promised me?” It’s not as though the world would notice something missing if I’d never published a word, but an editor or mentor will. The earliest-written section of Attending Others came some years ago at the request of Robert Coles for the late, great magazine, DoubleTake. A significantly revised version of that essay became the chapter on paying attention. The remaining skeleton of the memoir grew during my MFA. Once I found a publisher, I fleshed out that skeleton with more chapters. Each addition changed the story as a whole, leaving chapters I thought finished in need of revision. With each step, the story grew clearer, like a figure emerging from a slab of marble beneath the sculptor’s chisel. No one ever mistakes someone as clumsy as me for a sculptor, but I’ll stick with the analogy. The surprise was in discovering the real story hidden in the mess of words.
AM: What inspired you to write Attending Others? And what gave the book a sense of purpose for you?
BV: Inspiration isn’t the right word. It was more a matter of awareness, of recognizing the as yet unfinished book forming out of the independently conceived pieces I wrote in the course of my MFA. I didn’t start with a book in mind, but as an MFA student in creative nonfiction, I hoped to find a narrative arc in the episodes from my life rendered on the page. I had previously resisted writing about my life as a doctor – it almost never shows up in my poetry – but once I started, the stories kept coming.
As stories accumulated, I glimpsed a unity I hadn’t seen before: my most important lessons about medicine came after my formal education. More often than not, they came from non-professionals: patients, mothers, grandparents. Once I saw the story beneath the individual stories, the sense of purpose followed. I realized the enormity of my debt to my patients, my family, my mentors, and the students and residents I teach. Children – my own and my many patients – remain my best and most humbling teachers. Maybe that’s true for every medical professional’s relationship with patients, regardless of age, but I’m at my best with kids, mostly because they accept you as you are and can detect phoniness in seconds. Their lack of pretension, their transparent motives and desires helped me see what I was doing as a physician. Those essential practices of history-taking and physical exam I learned in medical school and honed in residency are practices of attentive presence. They were calling me to a heightened attention, not just to the making the diagnosis and prescribing therapy, but to the complex wholeness of the person in front of me.
There were further discoveries as I wrote that kept me going. The final two chapters came after I imagined the book had reached a conclusion. I realized rather late that I was wrong. The story hadn’t even reached a stopping place. True stories about living people can reach a stopping place, but that’s not the same as reaching a conclusion. As life goes on, the past continues to be reinterpreted through the lens of lived experience. Stories, though, need a stopping place, however tentative. The best stopping places also feel like starting places, the story’s momentum not fully spent. Those two final chapters were necessary, but they left the whole book feeling bloated. In the end, I ripped out 18,000 words from the original manuscript, anything that didn’t serve the story. The result, I hope, is a better, leaner book where what words remain don’t take up space, that they truly count.
AM: Which writer most influenced your style? Or even broader since you work within a multitude of disciplines, who has most influenced your writing style?
BV: The list is long, but the most important influence on my writing as a whole is Wendell Berry, though that may be visible to no one but me. I desire his clarity. I covet his mastery of the natural cadence. I want to stand by my words as resolutely as he stands by his. I envy those clean sentences that prove amiable and challenging at the same time. He’s just like that in real life. There are no visible seams between the way he lives and the way he writes. Other prose influences include Tobias Wolff and Ernest Hemmingway, who showed me the power of short, declarative sentences, and Annie Dillard, who renders complexities in accessible language and reveals the mystery hidden in the mundane.
Poetic influences include Wendell Berry again, and Scott Cairns, who writes in a rather different style, though both render the body in ways I find instructive. B H Fairchild showed me how to tell stories in contemporary poetic form. Howard Nemerov and Emily Dickinson are my exemplars for knotty, gnomic lines engaging immensities. Then there’s Mary Oliver, whom I can’t read often enough. I also draw inspiration from the lyrics of poetic singer-songwriters such as Joni Mitchell, John Gorka, Karin Bergquist and Linford Detweiler of Over the Rhine, and Joe Henry.
AM: What’s one thing you wished you’d known when you first began writing?
BV: That writing is learned by writing, period. The learning is in the doing. Mentors and books on writing provide some helpful tips, but books don’t set deadlines. Mentors do. I’m indebted to my mentors for the nuts and bolts critiques they provided, but their greatest gift lay in their expectations. They wanted the best I could do and they wanted it on time.
The poem, essay, or story in my head is always better than what ends up on the page, where I can see all the joints and seams, the flaws and holes I never fixed to my satisfaction. Yet what’s on the page, unlike the story in my head, exists. It can be read by another person. However perfect the imagined work seems, it doesn’t exist until it’s at least spoken (if it’s short) or written. Waiting for my writing ability to catch up with the story I want to tell is like waiting for a rowboat to grow an outboard motor. Use what you have. Read a lot. If you’re fortunate, someone will show you how to row more efficiently, but you’ll still have to row if you want to get anywhere.
AM: What’s next for you?
BV: With Attending Others published, I’m out of excuses not to write the book I’ve been researching for the past seven years. I hint at it in the last chapter of the memoir. Some of the Navajo children I was privileged to care for had conditions unusually common or unique to the western half of the Navajo Nation. The reasons for this geographical concentration include historical events 150 years ago: the Navajo Long Walk, which has similarities to the better-known Cherokee Trail of Tears. I’m trying to tell the story of the families I know, the doctors, nurses, and researchers who cared for them, and the culture and history behind the Long Walk and events since. I’ve written some of that story, but there’s much to do before the book exists. So you needn’t worry about me. There’s enough to keep me busy and out of trouble for a long time.
Brian Volck is a pediatrician who received his undergraduate degree in English Literature and his MD from Washington University in St. Louis and his MFA in creative writing from Seattle Pacific University. He is the author of a poetry collection, Flesh Becomes Word, and a memoir, Attending Others: A Doctor’s Education in Bodies and Words. His essays, poetry, and reviews have appeared in The Christian Century, DoubleTake, Health Affairs, and IMAGE.