Pass the scalpel and a pencil

November 3, 2000

What does a writer-in-residence do at a medical school? Carol Clewlow, who will do the job at Newcastle, reflects on what she can offer and what she can gain.

One of the surprises in the recent Channel 4 documentary series Why Doctors Make Mistakes was the appearance of Sir Lancelot Spratt. More than half a century has passed since Richard Gordon wrote the "Doctor" books that became the films and the actor James Robertson Justice went on to embody the image of the God-like consultant forever in the public imagination.

And, while entire working landscapes may have altered beyond recognition - some, like shipbuilding and mining, almost disappearing altogether - the message from the documentary was that, in one working environment, some things have not changed.

Autocratic consultants, it comes as no surprise to learn, still rank high on the list of grumbles of medical students. "I hate the way they treat you with such contempt, refusing to address you by name," one said. And there are other associated grievances: "I hate the thought that to get on I still have to play the game," as another put it.

I have spent a lot of time talking to medical students lately. This is because I have just become a writer-in-residence in a UK medical school, possibly the first.

A word is needed here about the background to what is, at the very least, a ground-breaking appointment at Newcastle University Medical School. The 18-month residency is the work of the Policy, Ethics and Life Sciences Research Institute at Newcastle's new International Centre for Life, itself a collaboration between the universities of Newcastle and Durham and the centre which, among other things, houses Newcastle medical school's genetics department.

The medical school appointment follows a concerted effort in this country, begun in the 1980s, to inject what were perceived as much-needed humanities into the inevitably science-dominated medical degree.

The result was the General Medical Council's seminal 1993 report Tomorrow's Doctors , which recommended a radical revision of undergraduate medical education - in particular the introduction of extra study modules in the humanities to improve communication skills and to engender "an approach to medicine that is constantly questioning and self-critical".

Five years later, the first Windsor conference - "Humanities in Medicine, Beyond the Millennium" - eloquently endorsed the introduction of an element of literature into the medical degree: "Literature and the theatre also provide us with a window on personal suffering. Talk of empathising with patients is meaningless without a genuine understanding of their fears and sufferings."

In simple terms, literature, in particular fiction, can be a fast track to a knowledge of humanity, an invaluable source of research for the medical student who has to bid farewell to the security of the lab and the lecture theatre in his or her early 20s and confront human beings, and sick ones at that.

This is reflected in the novels, poetry and medicine course at Newcastle's medical school. The course originated in the department of epidemiology and public health and is now in its third year.

The concentrated seven-week course provides students with an introduction to literature and goes on to study doctors in literature, death and dying as portrayed in fiction, mental illness, genetics and, perhaps most important of all, the tricky business of narrative, something that confronts doctors every time they see a patient. Works studied include One Flew over the Cuckoo's Nest , Heart of Darkness , The Catcher in the Rye , The God of Small Things , The Citadel , war poets and war reportage.

My appointment builds on this effort. In the forthcoming academic year, fourth-year students searching for a humanities option will, for the first time, have not only the novels, poetry and medicine course on offer but one on imaginative writing, too.

My qualifications for the job may seem sparse at first sight. Asked recently to find doctors in any of my four published novels, I drew an embarrassing blank. Whenever I am asked what sort of books I write, I never know what to answer. In the end, I am thrown back on the simplest explanation - which is that I write about people and relationships, the answer that almost every author would give.

What I think I might bring to the job is a more important question. Incidentally, the word "think" is important here. I am only a couple of months into the 18-month appointment.

Although I will contribute to the excellent novels, poetry and medicine module, my main concern is the imaginative writing course. As an author dealing with medical students, what can I bring to that?

The first point to make is that I am not just a novelist. For the past decade, I have been encouraging people, often at community level, to write and get their thoughts down on paper. Many of them are not interested in producing a work for other people's eyes, only for their own. They merely want to organise, consider and review their own thoughts and feelings.

This should, at the very least, be a useful resource for those for whom life and death is a part of the working day at what the rest of us might feel to be an absurdly young age. Consider this from one final-year medical student: "I had to certify someone as dead. It was remarkably grim. It was the first time I had to do it. You always introduce yourself to a patient, and I found myself almost doing it even though it was just me and this dead body in the room. It seemed such a remarkably intimate thing to do. To examine someone to see if they were dead. It struck me then that I was 23 and experiencing everything... life... babies being born... and death..."

Then there is the business of writing, which I can also offer. My whole life is taken up with narrative. How would the narrator tell that story? What would he or she tell, what would he or she hide? And then there is dialogue, how people tell the truth, how they lie, how they talk with their bodies as well as their voices. What happens in moments of grief when language, that most precious of things, simply breaks down?

On top of that, there is that business of people, of relationships. Like Trigorin in The Seagull by Chekhov (a hero of mine and perhaps the archetypal great doctor), my life is spent metaphorically walking around with a notebook in my hand, observing human life. I may not get it right on the page when I attempt to copy faithfully, but I do my damnedest. It is this sort of experience that I hope to bring.

Finally, perhaps, being in fiction myself, I am aware that medical students belong to a highly fictionalised profession. What are the growth areas in television but medical and police dramas? And since the police officer has been heavily demoted from the position of hero, what is left for the public - even in these days when the medical profession has taken such a battering - but the doctor?

Add to this that battering itself, the increased public knowledge of disease encouraged by such things as the internet, the desire for certainty on the part of the public in the face of illness, the sheer technical nature of modern medicine, and it can be seen that it is not the easiest of times to sign up for a career in the medical profession.

What will I get out of all this? Well, I cannot imagine a more extraordinary opportunity that could be offered to a novelist than the one that has been presented to me.

Will I end up with a novel about the medical profession? Maybe, maybe not. "Write in yesterday's blood," Bernice Rubens once said - one of the best pieces of advice I have ever heard and a good one for a writer-in-residence at a medical school. Translated, it means that experiences should, and often do, take time to work through.

More important is what the medical students themselves will produce, because - who knows - maybe even now there is someone signing up for the imaginative writing course who will go on to produce a novel, a television series or a film script set in the medical profession.

And thanks, in part at least, to the introduction of that thing called humanities into their course, if not now then at some time in the not too distant future, Sir Lancelot will no longer be alive and well in these students' chosen profession.

Carol Clewlow's novel A Woman's Guide to Adultery , first published ten years ago, was reissued as a Virago Modern Classic on November 2.

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