Writing Toward Change

When I spoke with Dr. Atul Gawande, I expected to ask about writing.
I wanted to know how someone becomes a physician-writer. How a medical story becomes an essay. How a clinical uncertainty becomes a book. How a surgeon, researcher, public health leader, and author learns to move between the operating room, the page, and the systems that shape care.
But the conversation quickly became about something larger than writing itself.

It became about attention.

Dr. Gawande described writing not as a performance of knowledge, but as a way of thinking through what he did not yet understand. Early on, he said, he did not feel he had much to say. He did not yet have many experiences to draw from or enough perspective to bring to the page. That changed during residency, when a friend started an internet magazine in 1996. At the time, many established writers did not believe people would read seriously on the internet. That hesitation created an opening.

He began writing short pieces, around 700 or 800 words. What mattered was not only that he wrote, but that he had an editor. Someone gave him feedback. Someone helped him see what was working and what was not. Over time, those short pieces became a practice. After dozens of them, he developed a following. Then came longer pieces, New Yorker essays, books, and eventually a career in which writing became inseparable from how he understood medicine.
For me, that progression was reassuring because it was not mystical. It was not that a physician-writer simply emerges fully formed. It was repetition, feedback, audience, curiosity, and time.
There was also no single correct path.
Dr. Gawande told me that when Siddhartha Mukherjee was a fellow and interested in writing a history of cancer, he had advised him to build gradually: smaller pieces first, then larger work. Dr. Mukherjee did something entirely different. He spent years writing what became The Emperor of All Maladies. The lesson was not that one route was better than the other. The lesson was that writers have to discover the method that works for them.

That was one of the clearest pieces of advice I heard: find who you are writing for, why you are writing, and what kind of process keeps you moving.
Dr. Gawande said he never wrote primarily to explain things to people. He wrote from his own interest in questions he could not yet answer. Why are healthcare costs so high? What is an itch? How should we care for people nearing the end of life? These were not topics he approached from certainty. They were problems he wrestled with on the page.

That idea felt deeply important for Prose for Patients.
I often think of writing as a way to preserve someone’s voice or give shape to an experience. But Dr. Gawande reminded me that writing can also be a form of disciplined uncertainty. It can begin not with the sentence “Here is what I know,” but with the question, “What am I supposed to think about this?”

That distinction changes everything.
For young writers in medicine, there can be pressure to sound wise too early. We want the reflective essay to arrive at a clean insight. We want suffering to teach something. We want the story to resolve. But medicine rarely works that neatly. Patients do not exist to provide lessons. Illness does not always become meaning. Sometimes the honest task is not to explain, but to stay with the question long enough that it becomes clearer.
That is the kind of writing I hope Prose for Patients can make room for: writing that listens before concluding.

During our conversation, I shared that I had already self-published two small books: one shaped by my reflections as an EMT, and another emerging from my early work with Prose for Patients. I admitted that they were passion projects, written mostly on my own, without a formal editor or publisher. I told him that part of my hope was to be able to look back over time and see improvement — not only in my writing, but in how I understand medicine, patients, and myself.
His advice was direct.
Writing alone can build motivation, but feedback accelerates growth. He encouraged me to find an editor, a writing group, a workshop, or some structure that would force the work into conversation with other readers. A writing degree, he said, can be an accelerant, but it is not necessary. What matters is finding ways to keep writing, receive feedback, and learn faster than one can alone.

That advice landed because it named a gap I already felt.
Prose for Patients has grown through conversation. I love sitting with people, hearing their stories, and turning those stories into narratives or poems that they can review, revise, keep private, or share. I love the human immediacy of the work. That is part of why I decided not to pursue a formal narrative medicine master’s program right now. I wanted more direct medical and patient-facing experience, not only more time in books.

Dr. Gawande understood that instinct. He said that at my stage, he had not been ready to process medicine through writing in the way he later would. He did not yet have enough experience. There is a time for study, and there is a time to gather the experiences that will later need to be studied, written, and understood.
That, too, became a lesson: not all preparation looks like another degree.
Sometimes preparation looks like paying attention to what energizes you.
When I asked how writing changed his relationship with medicine and patients, Dr. Gawande described three parts of his life that began separately: clinical practice, research and public health systems work, and writing. Over time, they joined together. The real world exposed him to problems. Writing helped him explore those problems, return to first principles, and ask what he actually thought. Then, in some cases, the ideas that emerged from writing could become interventions in the world.

That cycle was one of the most powerful parts of our conversation. Reality gives a dilemma. Writing helps clarify it. Research tests a response. Implementation tries to change the system.
He described Being Mortal as an example. It grew from a patient encounter involving a woman in her second trimester of pregnancy who was diagnosed with end-stage lung cancer and also came to him with a second cancer. He struggled to know how to have a conversation that would truly help her, her husband, and her parents. That discomfort became a New Yorker piece, then a book, and then a protocol for clinicians. Eventually, the approach was studied in a randomized trial at Dana-Farber, training some clinicians in these conversations and comparing outcomes.
A story became a question. A question became an intervention. An intervention became research. That is the kind of path I have been trying to imagine for Prose for Patients.

Right now, the project begins with listening. I interview patients, caregivers, clinicians, artists, and others across healthcare. I write their narratives or poems, return the work to them, and make sure the story remains theirs. But I have started to wonder whether this process could also be studied responsibly. Could receiving a written narrative help patients feel seen beyond diagnosis? Could it support meaning-making after illness? Could it help clinicians understand values, identity, and care preferences more deeply? Could it serve medical education by making students more attentive to the person behind the chart?
Dr. Gawande’s answer was not to jump immediately to a grand intervention. It was to define the change I wanted to make.
That is the first step.

Before research design, before outcomes, before collaborators, before implementation, there must be clarity: what change are you trying to produce? More dignity? Better communication? Greater reflection? Improved clinician understanding? Reduced isolation? A stronger sense of identity beyond illness?
Only after defining the change can you find a partner willing to test it: a clinic, hospital, health system, public health institution, or educational setting. Even then, implementation takes time. He described the safe surgery checklist, the need to find people willing to test it, the difficulty of persuading colleagues, the years required to raise money and design trials, and the persistence required to move from idea to system-level change.

The lesson was both sobering and energizing.
Good ideas do not become change simply because they are good. They have to be tested. They have to find partners. They have to survive resistance. They have to produce results.

And the person leading them has to care enough to keep poking at the problem.
That phrase — to keep poking at it — felt like a realistic description of how change happens. Not through one dramatic leap, but through repeated attempts. A piece of writing about a retained surgical sponge can become a study. A study can reveal a need for a technological solution. A solution can become barcoded or RFID-tagged sponges. A question can become a system.

For me, this reframed narrative medicine. It does not have to remain only reflective. It can be reflective and rigorous. It can honor individual stories while also asking what those stories reveal about care.
But Dr. Gawande also pushed me toward humility.

Medical schools, he said, often focus on discovery. Schools of public health often think more about scaling from one to many. Even there, the pathway is not always clearly spelled out. Implementation in a resistant world is difficult. Changing minds, changing systems, and turning insight into action require skills that are often learned by doing.
That matters for Prose for Patients because patient stories are powerful, but power alone is not enough. If the project is going to become research, education, or clinical practice, it needs more than beautiful writing. It needs a clear purpose, an ethical framework, measurable goals, careful consent, and collaborators who understand the setting.

It also needs patience.
Near the end of our conversation, I asked for advice for someone interested in narrative medicine, writing, medical school, and the uncertain future of the field. Dr. Gawande did not pretend to predict the future. Instead, he pointed to his own experience. When he graduated from college, there was no internet. Many of his classmates built their lives in a world that did not yet exist.

So his advice was to try things.
Pay attention to what energizes you. Do more of what gives you energy and less of what depletes you.
That may be the most useful advice I could have received at this stage. It is easy, especially before medical school, to become obsessed with pathways: which degree, which title, which mentor, which publication, which formal credential. But Dr. Gawande suggested a different measure. Are you doing work that draws you in? Are you learning from it? Are you producing something that exists in the world? Are you paying attention to what you are good at and what keeps you alive intellectually?

That feels like a philosophy of both writing and medicine.
I left the conversation with a clearer understanding of the kind of physician-writer I hope to become. Not someone who writes because he already understands, but someone who writes in order to understand. Not someone who treats stories as decoration, but someone who asks what they reveal. Not someone who stops at reflection, but someone who wonders whether reflection can become better care.

For Prose for Patients, the next step is not to make the project larger for the sake of being larger. It is to define the change it hopes to make.
If the goal is dignity, how do we recognize it?
If the goal is feeling seen, how do we ask whether that happened?
If the goal is better listening, how do we teach and measure it?
If the goal is to preserve voice, how do we make sure the participant still hears themselves in the final piece?
These are not just research questions. They are ethical questions.

And maybe that is where writing and medicine meet most honestly: in the space between what happened and what we still do not know how to answer.
Dr. Gawande’s career shows that writing can begin with uncertainty and still lead to change. It can start as a short piece written with an editor’s feedback. It can grow into essays, books, protocols, trials, and systems interventions. But at its heart, it remains a practice of attention: noticing what bothers you, what confuses you, what feels unresolved, and what refuses to leave your mind.

That is the work I want to keep doing. To listen. To write. To ask better questions. To return the story to the person it belongs to.
And then, when the story reveals a larger gap in care, to ask what might be changed.

Not every narrative becomes an intervention.
Not every reflection becomes research.
But every honest story can teach us where to look next.