How is a writer like a surgeon?

Note: I’m taking a short break this week, so I’ll be republishing a few posts from earlier in this blog’s run. This post originally appeared, in a slightly different form, on July 22, 2015. 

The late E.L. Doctorow belonged to a select group of writers, including Toni Morrison, who were editors before they were novelists. When asked how his former vocation had influenced his work, he said:

Editing taught me how to break books down and put them back together. You learn values—the value of tension, of keeping tension on the page and how that’s done, and you learn how to spot self-indulgence, how you don’t need it. You learn how to become very free and easy about moving things around, which a reader would never do. A reader sees a printed book and that’s it. But when you see a manuscript as an editor, you say, Well this is chapter twenty, but it should be chapter three. You’re at ease in the book the way a surgeon is at ease in a human chest, with all the blood and guts and everything. You’re familiar with the material and you can toss it around and say dirty things to the nurse.

Doctorow—who had the word “doctor” right there in his name—wasn’t the first author to draw a comparison between writing and medicine, and in particular to surgery, which has a lot of metaphorical affinities with the art of fiction. It’s half trade school and half priesthood, with a vast body of written and unwritten knowledge, and as Atul Gawande has pointed out, even the most experienced practitioners can benefit from the use of checklists. What draws most artists to the analogy, though, is the surgeon’s perceived detachment and lack of sentimentality, and the idea that it’s a quality that can be acquired with sufficient training and experience. The director Peter Greenaway put it well:

I always think that if you deal with extremely emotional, even melodramatic, subject matter, as I constantly do, the best way to handle those situations is at a sufficient remove. It’s like a doctor and a nurse and a casualty situation. You can’t help the patient and you can’t help yourself by emoting.

And the primary difference, aside from the stakes involved, is that the novelist is constantly asked, like the surgeon in the famous brainteaser, to operate on his or her own child.

Closely allied to the concept of surgical detachment is that of a particular intuition, the kind that comes after craft has been internalized to the point where it no longer needs to be consciously remembered. As Wilfred Trotter wrote: “The second thing to be striven for [by a doctor] is intuition. This sounds an impossibility, for who can control that small quiet monitor? But intuition is only inference from experience stored and not actively recalled.” Intuition is really a way of reaching a conclusion after skipping over the intermediate steps that rational thought requires—or what Robert Graves calls proleptic thinking—and it evolved as a survival response to situations where time is at a premium. Both surgeons and artists are called upon to exercise uncanny precision at moments of the highest tension, and the greater the stress, the greater the exactitude required. As John Ruskin puts it:

There is but one question ultimately to be asked respecting every line you draw: Is it right or wrong? If right, it most assuredly is not a “free” line, but an intensely continent, restrained and considered line; and the action of the hand in laying it is just as decisive, and just as “free” as the hand of a first-rate surgeon in a critical incision.

Surgeons, of course, are as human as anybody else. In an opinion piece published last year in the New York Times, the writer and cardiologist Sandeep Jauhar argued that the widespread use of surgical report cards has had a negative impact on patient care: skilled surgeons who are aggressive about treating risky cases are penalized, or even stripped of their operating privileges, while surgeons who play it safe by avoiding very sick patients maintain high ratings. It isn’t hard to draw a comparison to fiction, where a writer who consistently takes big risks can end up with less of a career than one who sticks to proven material. (As an unnamed surgeon quoted by Jahuar says: “The so-called best surgeons are only doing the most straightforward cases.”) And while it may seem like a stretch to compare a patient of flesh and blood to the fictional men and women on which a writer operates, the stakes are at least analogous. Every project represents a life, or a substantial part of one: it’s an investment of effort drawn from the finite, and nonrenewable, pool of time that we’ve all been granted. When a novelist is faced with saving a manuscript, it’s not just a stack of pages, but a year of one’s existence that might feel like a loss if the operation isn’t successful. Any story is a slice of mortality, distilled to a physical form that runs the risk of disappearing without a trace if we can’t preserve it. And our detachment here is precious, even essential, because the life we’ve been asked to save is our own.

The poet’s paperwork

There’s a famous quotation, attributed to the humorist Peter De Vries, that sums up how a lot of aspiring writers feel about their chosen craft: “I love being a writer. What I can’t stand is the paperwork.” In fact, it’s really a line from one of De Vries’s many novels, and the punchline is that it’s credited to a character making a list of clever observations in preparation for the interviews he’ll give after he writes a bestseller:

Standing at the window with his hands in his pockets, Mopworth had a vision of the day when he would be interviewed by the press on the publication of his book. He had some mots all ready. “What I hate about writing is the paperwork.” And: “A writer is like the pencil he uses. He must be worn down to be kept sharp.”

It’s a little amusing to see how the line mutated and detached itself from the underlying story to become exactly the kind of pithy remark that it was intended to satirize. De Vries was a shrewd writer in his own right, and he captures the feel of a writing aphorism so well that it transformed itself into the real thing. And most of those who quote it probably don’t realize that it’s poking gentle fun at the whole notion of canned writing wisdom.

Still, if the line remains so popular, it’s in part because it’s the kind of quote that comes dangerously close to vindicating those who love the idea of being a writer, but don’t much care for the actual writing. (As Martin Sheen says to DiCaprio in The Departed: “Do you want to be a cop, or do you want to appear to be a cop? It’s an honest question. A lot of guys just want to appear to be cops.”) But there’s a grain of truth to it. Anyone who sits down to write a story of any length soon realizes that he’s spending most of his time on work that he doesn’t particularly feel like doing for its own sake. Research can be fun at the beginning, but it quickly turns into a laborious hunt for useful material, or into a futile search for the one scrap of information you need. Outlining is a pain, especially if you’re doing it right: you find yourself asking boring questions like “What does the protagonist want?” and “What is this scene about?” when you’d rather just jump into the story. Even after you start writing the first draft, you find that it’s frequently hellish, too—or, at best, a daily uphill climb in the face of the morning’s crippling doubt. Revision, which writers like Toni Morrison have called the best part of the process, all too often turns into a scramble to put out countless fires, with each problem opening up into a dozen more. And then, if you’re lucky, you get notes.

In fact, after years of writing, I’d say that there are only three parts of the process that give me undiluted pleasure: 1) The moments of inspiration when I come up with an idea better than anything I could have consciously invented. 2) The early stages of research, when I’m learning about a new subject or exploring a location without any thought to the story itself. 3) The very last stages of revision, when the story is already more or less finished, I like what I’ve got, and I’m just looking for ways to make it better. The first category accounts for maybe one percent of my total writing time; the second, about ten percent; and the third, something like five percent. Add them all together and round up the total, and I find that I’m happy while writing about a fifth of the time. The rest ranges from long stretches when I’m not actively unhappy, but grinding out material in a mechanical way, to moments when I’m ready to pack it in with frustration. And if there’s a pattern here, it’s that I’m happiest as a writer when I’m most outside myself. A flash of intuition, absorption in research, or the detached revision of a story that might have been written by someone else: these are all times when I’ve escaped my personality. Otherwise, I’m stuck in my own head, and when you’re just trying to fill a blank page, that isn’t a fun place to be.

Yet I keep at it, primarily because the eighty percent of the time I spend in a state of tedium or existential despair enables the twenty percent that I love. And I wouldn’t be doing this at all if that didn’t strike me, in the end, as a fair trade. Over the last ten years of my writing life, the moments of inspiration, set end to end, could fit into the space of an hour, but they made the rest of it worthwhile. I never tire of quoting the poet Vladimir Mayakovsky, who compared the act of writing poetry to mining for radium: “The output an ounce, the labor a year.” And it’s the paperwork that makes the poetry. Those who can’t endure it will never know how it feels when months of preparation crystalize into a few seconds of insight. And although such ideas feel as if they’ve come from the outside, they’re really the result of all the labor that came before, just as the eureka moments in science only come to those who have spent years thinking about specific problems. A writer is a little like a novice who comes to a monastery seeking enlightenment, only to find that most of his time there is spent sweeping the floor and cleaning out the toilets. The one can’t exist without the other, and trying to live in a way that is nothing but the former is bound to end in failure. Nobody, not even the most productive or successful among us, can really stand the paperwork. But it’s the work that makes the paper possible.

How is a writer like a surgeon?

The late E.L. Doctorow belonged to a select group of writers, including Toni Morrison, who were editors before they were novelists. When asked how his former vocation had influenced his work, he said:

Editing taught me how to break books down and put them back together. You learn values—the value of tension, of keeping tension on the page and how that’s done, and you learn how to spot self-indulgence, how you don’t need it. You learn how to become very free and easy about moving things around, which a reader would never do. A reader sees a printed book and that’s it. But when you see a manuscript as an editor, you say, Well this is chapter twenty, but it should be chapter three. You’re at ease in the book the way a surgeon is at ease in a human chest, with all the blood and guts and everything. You’re familiar with the material and you can toss it around and say dirty things to the nurse.

Doctorow—who had the word “doctor” right there in his name—wasn’t the first author to draw a comparison between writing and medicine, and in particular to surgery, which has a lot of metaphorical affinities with the art of fiction. It’s half trade school and half priesthood, with a vast body of written and unwritten knowledge, and as Atul Gawande has pointed out, even the most experienced practitioners can benefit from the use of checklists. What draws most artists to the analogy, though, is the surgeon’s perceived detachment and lack of sentimentality, and the idea that it’s a quality that can be acquired with sufficient training and experience. The director Peter Greenaway put it well:

I always think that if you deal with extremely emotional, even melodramatic, subject matter, as I constantly do, the best way to handle those situations is at a sufficient remove. It’s like a doctor and a nurse and a casualty situation. You can’t help the patient and you can’t help yourself by emoting.

And the primary difference, aside from the stakes involved, is that the novelist is constantly asked, like the surgeon in the famous brainteaser, to operate on his or her own child.

Closely allied to the concept of surgical detachment is that of a particular intuition, the kind that comes after craft has been internalized to the point where it no longer needs to be consciously remembered. As Wilfred Trotter wrote: “The second thing to be striven for [by a doctor] is intuition. This sounds an impossibility, for who can control that small quiet monitor? But intuition is only inference from experience stored and not actively recalled.” Intuition is really a way of reaching a conclusion after skipping over the intermediate steps that rational thought requires—or what Robert Graves calls proleptic thinking—and it evolved as a survival response to situations where time is at a premium. Both surgeons and artists are called upon to exercise uncanny precision at moments of the highest tension, and the greater the stress, the greater the exactitude required. As John Ruskin puts it:

There is but one question ultimately to be asked respecting every line you draw: Is it right or wrong? If right, it most assuredly is not a “free” line, but an intensely continent, restrained and considered line; and the action of the hand in laying it is just as decisive, and just as “free” as the hand of a first-rate surgeon in a critical incision.

Surgeons, of course, are as human as anybody else. In an opinion piece in today’s New York Times, the writer and cardiologist Sandeep Jauhar argues that the widespread use of surgical report cards has had a negative impact on patient care: skilled surgeons who are aggressive about treating risky cases are penalized, or even stripped of their operating privileges, while surgeons who play it safe by avoiding very sick patients maintain high ratings. It isn’t hard to draw a comparison to fiction, where a writer who consistently takes big risks can end up with less of a career than one who sticks to proven material. (As an unnamed surgeon quoted by Jahuar says: “The so-called best surgeons are only doing the most straightforward cases.”) And while it may seem like a stretch to compare a patient of flesh and blood to the fictional men and women on which a writer operates, the stakes are at least analogous. Every project represents a life, or a substantial part of one: it’s an investment of effort drawn from the finite, and nonrenewable, pool of time that we’ve all been granted. When a novelist is faced with saving a manuscript, it’s not just a stack of pages, but a year of one’s existence that might feel like a loss if the operation isn’t successful. A story is a slice of mortality, distilled to a physical form that runs the risk of disappearing without a trace if we can’t preserve it. And our detachment here is precious, even essential, because the life we’ve been asked to save is our own.

Googling the rise and fall of literary reputations: the sequel

Note: To celebrate the third anniversary of this blog, I’ll be spending the week reposting some of my favorite pieces from early in its run. This post originally appeared, in a somewhat different form, on December 20, 2010.

After playing over the weekend with the new word frequency tool in Google Books, I quickly came to realize that my recent post on the subject barely scratched the surface. It’s fun to compare novelists against other writers in the same category, for example, but what happens when we look at authors in different categories altogether? The graph above, for instance, shows us what we get when we chart two of the most famous literary authors of the latter half of the century against their counterparts on the bestseller list. And while the results may seem surprising at first, they aren’t hard to understand.

Looking at the chart, it’s clear that books by Philip Roth and John Updike might be outsold by Harold Robbins and Jacqueline Susann in their initial run (the occasional freak like Couples or Portnoy’s Complaint aside), but as they enter the canon, they’re simply talked about more often, especially by other writers, than their bestselling contemporaries. (Robbins and Susann, by contrast, probably aren’t cited very often outside their own books.) Compared to the trajectory of a canonical author, the graph of a bestseller begins to look less like a mountain and more like a molehill—or a speed bump. But now look here:

Something else altogether seems to be at work in this chart, and it’s only a reminder of the singularity of Stephen King’s career. Soon after his debut—Carrie, ‘Salem’s Lot, The Shining, and The Stand were all published within the same five years—King had overtaken the likes of Robbins and Susann both on the bestseller lists and in terms of cultural impact. Then something even stranger happened: he became canonical. He was prolific, popular, and wrote books that were endlessly referenced within the culture. As a result, his graph looks like no other—an appropriately monstrous hybrid of the bestselling author and serious novelist. So what happens when we extend the graph beyond the year 2000, which is where the original numbers end? Here’s what we see:

A number of interesting things begin to happen in the last decade. Robbins and Susann look more like speed bumps than ever before. King’s popularity begins to taper off just as he becomes officially canonical—right when he receives lifetime achievement honors from the National Book Awards. And just as Updike himself once predicted, he and Roth seem to have switched places in 2004, or just after the appearance of The Plot Against America, which marks the peak, so far, of Roth’s late resurgence.

Of course, the conclusions I’ve drawn here are almost certainly flawed. There’s no way of knowing, at least not without looking more closely at the underlying data, whether the number of citations of a given author reflects true cultural prominence or something else. And it’s even harder to correlate any apparent patterns—if they’re actually there at all—with particular works or historical events, especially given the lag time of the publishing process. But there’s one chart, which I’ve been saving for last, which is so striking that I can’t help but believe that it represents something real:

This is a chart of the novelists who, according to a recent New York Times poll, wrote the five best American novels of the past twenty-five years: Toni Morrison (Beloved), Don DeLillo (Underworld), John Updike (Rabbit Angstrom), Cormac McCarthy (Blood Meridian), and Philip Roth (American Pastoral). The big news here, obviously, is Morrison’s amazing ascent around 1987, when Beloved was published. It isn’t hard to see why: Beloved was the perfect storm of literary fiction, a bestselling, critically acclaimed novel that also fit beautifully into the college curriculum. Morrison’s decline in recent years has less to do, I expect, with any real fall in her reputation than with a natural settling to more typical levels. (Although it’s interesting to note that the drop occurs shortly after Morrison received the Nobel Prize, thus locking her into the canon.)

It might be argued, and rightly so, that it’s unfair to turn literary reputation into such a horse race. But such numbers are going to be an inevitable part of the conversation from now on, and not just in terms of citations. It’s appropriate that Google unveiled this new search tool just as Amazon announced that it was making BookScan sales numbers available to its authors, allowing individual writers to do what I’m doing here, on a smaller and more personal scale. And if there’s any silver lining, it’s this: as the cases of Robbins and Susann remind us, in the end, sales don’t matter. After all, looking at the examples given above, which of these graphs would you want?

When not to revise

As Toni Morrison reminded us yesterday, the act of revision can be a lot of fun. For me, it’s invariably the most satisfying part of the writing process. Instead of facing a blank page, you’ve written something that exists, for better or worse, and now your only obligation is to improve it. Revision is when all the old metaphors about writing as a manual craft, like carpentry, seem the most convincing: rather than willing something into existence, with its attendant emotional strain, you’re planing, sanding, and polishing a block of responsive raw material. It’s subtractive rather than additive. You feel less like a poet and more like a diligent hobbyist. In general, instead of the neurotic fever of the first draft, revision feels rational, calm, considered. As a result, it casts its own kind of narcotic spell, a sort of hypnosis, until you feel that you could happily go on revising the same few pages forever.

Which is why revision can be so dangerous. As important as it is—and in many ways, it’s the heart of what a real writer does—it’s less important than the primary act of creating a complete story for the first time. For some authors, it only generates the illusion of progress. I’ve known too many writers, including myself, who wrote one chapter of a novel, then kept polishing it to make it “perfect.” But there’s no such thing as a perfect chapter, at least not in isolation: a chapter succeeds or fails based on its place in the overall pattern. Without context, any standard of perfection is a mirage, and it retreats farther into the distance the more you revise. In the end, that one chapter is all you’ll ever have. Of all the rules for writing I once posted here, then, I’ve come to believe that #4 is the most pragmatically important: Write an entire first draft before going back to revise, and never edit an unfinished manuscript.

I’m going to put this as bluntly as possible: if you start revising a novel before you’ve completed a first draft, your chances of finishing it at all are essentially zero. This isn’t a value judgment, but an empirical observation, and it’s especially true if you haven’t been published. Right out of the gate, no writer is all that good, so the best thing to focus on is cultivating good habits—and the most important habit of all, the one on which all others depend, is finishing what you start. Revision is about coaxing a story into its strongest possible form, but it can too easily degenerate into its opposite, which prevents the story from existing at all. Compulsive revisers of unfinished work are only postponing the hard choices that come with pushing a project to its conclusion. And the worst part is that they don’t even grow as writers: technical proficiency doesn’t come from constantly revising the same handful of pages, but by applying your tools to as great a variety of scenes and circumstances as possible.

There’s only one solution: even if the first draft of a chapter seems terrible, and it probably is, write it, finish it, and move on.  When you finally do get the chance to go back and revise the finished manuscript, you’ll find that much of your work has already been done for you. As I’ve said before, a problem that seems intractable in Chapter 1 is often solved by an unexpected inspiration while writing Chapter 20—but only after you’ve written nineteen other chapters first. There’s a world of difference between revising a paragraph with a hazy sense of the surrounding story and approaching it with the full weight of a finished novel pressing comfortably around you. You’ll understand the story more deeply than before, and you’ll have learned a few tricks along the way: no matter how experienced the author, there’s no project that leaves the writer’s craft entirely untouched. In the end, then, you must revise. But probably not yet.

Toni Morrison on the pleasures of revision

I love that part; that’s the best part, revision. I do it even after the books are bound! Thinking about it before you write it is delicious. Writing it all out for the first time is painful because so much of the writing isn’t very good. I didn’t know in the beginning that I could go back and make it better; so I minded very much writing badly. But now I don’t mind at all because there’s that wonderful time in the future when I will make it better, when I can see better what I should have said and how to change it. I love that part!

—Toni Morrison, in Conversations with Toni Morrison

Googling the rise and fall of literary reputations: the sequel

After playing over the weekend with the new word frequency tool in Google Books, I quickly came to realize that last week’s post barely scratched the surface. It’s fun to compare novelists against other writers in the same category, for example, but what happens when we look at authors in different categories altogether? Here’s what we get, for instance, when we chart two of the most famous literary authors of the latter half of the century against their counterparts on the bestseller list:

The results may seem surprising at first, but they aren’t hard to understand. Books by Philip Roth and John Updike might be outsold by Harold Robbins and Jacqueline Susann in their initial run (the occasional freak like Couples or Portnoy’s Complaint aside), but as they enter the canon, they’re simply talked about more often, by other writers, than their bestselling contemporaries. (Robbins and Susann, by contrast, probably aren’t cited very often outside their own books.) Compared to the trajectory of a canonical author, the graph of a bestseller begins to look less like a mountain and more like a molehill—or a speed bump. But now look here:

Something else altogether seems to be at work in this chart, and it’s only a reminder of the singularity of Stephen King’s career. Soon after his debut—Carrie, ‘Salem’s Lot, The Shining, and The Stand were all published within the same five years—King had overtaken the likes of Robbins and Susann both on the bestseller lists and in terms of cultural impact. Then something even stranger happened: he became canonical. He was prolific, popular, and wrote books that were endlessly referenced within the culture. As a result, his graph looks like no other—an appropriately monstrous hybrid of the bestselling author and serious novelist.

So what happens when we extend the graph beyond the year 2000, which is where the original numbers end? Here’s what we see:

A number of interesting things begin to happen in the last decade. Robbins and Susann look more like speed bumps than ever before. King’s popularity begins to taper off just as he becomes officially canonical—right when he receives lifetime achievement honors from the National Book Awards. And Roth and Updike seem to have switched places in 2004, or just after the appearance of The Plot Against America, which marks the peak, so far, of Roth’s late resurgence.

Of course, the conclusions I’ve drawn here are almost certainly flawed. There’s no way of knowing, at least not without looking more closely at the underlying data, whether the number of citations of a given author reflects true cultural prominence or something else. And it’s even harder to correlate any apparent patterns—if they’re actually there at all—with particular works or historical events, especially given the lag time of the publishing process. But there’s one chart, which I’ve been saving for last, which is so striking that I can’t help but believe that it represents something real:

This is a chart of the novelists who, according to a recent New York Times poll, wrote the five best American novels of the past twenty-five years: Toni Morrison (Beloved), Don DeLillo (Underworld), John Updike (Rabbit Angstrom), Cormac McCarthy (Blood Meridian), and Philip Roth (American Pastoral). The big news here, obviously, is Morrison’s amazing ascent around 1987, when Beloved was published. It isn’t hard to see why: Beloved was the perfect storm of literary fiction, a bestselling, critically acclaimed novel that also fit beautifully into the college curriculum. Morrison’s decline in recent years has less to do, I expect, with any real fall in her reputation than with a natural settling to more typical levels. (Although it’s interesting to note that the drop occurs shortly after Morrison received the Nobel Prize, thus locking her into the canon. Whether or not this drop is typical of officially canonized authors is something I hope to explore in a later post.)

It might be argued, and rightly so, that it’s unfair to turn literary reputation into such a horse race. But such numbers are going to be an inevitable part of the conversation from now on, and not just in terms of citations. It’s appropriate that Google unveiled this new search tool just as Amazon announced that it was making BookScan sales numbers available to its authors, allowing individual writers to do what I’m doing here, on a smaller and more personal scale. And if there’s any silver lining, it’s this: as the cases of Robbins and Susann remind us, in the end, sales don’t matter. After all, looking at the examples given above, which of these graphs would you want?