carte blanche‘s Maria Schamis Turner spoke with Durcan about the relationship between narrative and neurology for her project The Brain Detectives. Here is part of the wide-ranging conversation that followed.

As a neurologist and a novelist, how do you see the relationship between narrative and neurology?

Liam Durcan: I guess I approach it in a few different ways. As a neurologist I am interested in the generation of narrative, that is, in the neurobiological mechanisms—the language areas plus the emotional part of the brain plus the frontal lobes—that together generate some sort of sequential order out of things. I find that just fascinating in terms of narratives and disordered narratives that we see in neurology. For example, you can have perfect language function and good recall but if your frontal lobes aren’t working, it is sometimes quite difficult to be able to relay history in an organized way. You see that in some patients with frontal temporal lobe dementia.

Also, as a physician the way into any problem is through narrative. You realize fairly early on that you are in the process of translation: translation of the patient’s experience into their history. There can be multiple parallel histories and then you translate that into the history for the medical record, history that you will base investigations, diagnosis, and prognosis on. I think you gain either an explicit or implicit reverence for narrative. Some people have said that it’s on the wane, that we are relying more on technology. There’s a joke that the only question you really have to ask people now is “Do you have any metal in your body?” because you need to ask that before you get into an MR. I can understand that but it’s not just about having the tools but appropriately using them. Not only is narrative important to become an effective clinician in terms of getting the right diagnosis and applying medical technology properly, but I also think it’s probably a key step in the development of empathy.

It strikes me that narrative is probably still more important in neurology than it is perhaps in other medical fields.

Yes, simply because the complaints can be so complicated or protean or vague. Psychiatry relies on narrative even more but we rely on it a great deal. That being said, it’s always interesting, especially in a hospital, to understand how the narrative can be split. One of the things you’ll notice if you see a patient waiting for a test and they’re away from their ward, is that they cannot help but look in their chart. And that’s because they understand that their narrative and the narrative about them are not necessarily the same. And they want to know all the discrepancies. And they have the right to know. I always feel like asking, “Were you surprised? Shocked? Disappointed?”

Rita Charon at Columbia has done pilot projects where she’s had patients keep their own chart, a parallel chart, to see what the major differences were. Sometimes I’ll come out of a patient’s room with the team, and I’ll think, “that went well,” and then I realize through conversations with the nurses, or with the family, that the patient understood nothing. Or misinterpreted or felt that the explanations were brief, or too complicated, or lacked any sort of emotional content. You see all these discrepancies. I think that’s true of any form of communication but when health issues are involved it’s heightened. Especially when there are neurological issues and the ability to understand what’s going on might be impaired somewhat.

When did you start writing?

I’ve written since my teenage years and then I put it away for medical school. I finished my residency when I was 28 years old. I was a qualified neurologist but I felt grossly unprepared in some larger sense to look after people. I felt like I needed more of a liberal arts education at that point in my life. And I think that I probably began writing for that reason, to try and address some of that. I think part of it was also emulation—I love reading and I love well-written prose, it gives me a tremendous amount of pleasure.

How do you find the time to write?

It was easier before. I would get up at four in the morning and write for an hour and a half. After the second child, it was a bit more difficult. Thomas, our youngest, was born in 2008, and there was just less and less time. Also, I have just taken on a few more administrative duties in the last couple of months that have made any sort of pretence at writing more difficult. I used to think that having a limited amount of time to write was conducive to writing and I still do. I deal better when I have constraints than when I have absolute freedom. If I had a week off, I don’t think I would write, but if I had 30 minutes a day, then I would. I remember commuting and writing on the suburban commuter trains. I found that really concentrated my writing. And I found that the individual plot issues or story issues that I was concerned about would seem to have been addressed in the time when I wasn’t thinking about it and I was interested in that. It seemed to work for me. I published a fair bit in a few years. When I wrote a book, I think I had been thinking about it for a long time, because it didn’t take that long to work the book into shape. It was almost a bit embarrassing—it just seemed to happen fairly naturally.

Why did you choose to make the main character of Garcia’s Heart a neuroscientist?

When I started writing, I thought there is no way I want to write medical narratives. I thought if I write, I just want to be a writer, I don’t want to be labeled as the doctor/writer. I wanted people to read the book and be refreshed that it wasn’t a narrative in a hospital. The one lament I had about the book is that I couldn’t make it work any other way. I really hesitated at every step. The story didn’t start with a person interested in neuroscience, it started out as a short story about a person who works in a Dépanneur, for someone who used to be a doctor. (It was originally set in the 1980’s, with a Vietnamese doctor.) As it got bigger and bigger, I realized that he would have to identify with him in a professional way, so he had to be a doctor too. Then as I was writing, I was thinking about theories of moral responsibility and who can best understand these ideas on an intellectual level and yet be baffled on an emotional level, and I ended making the character essentially a neuroscientist. I didn’t want to write it that way, but I couldn’t see any way out of it. So I ended up writing a narrative about a disaffected doctor who wasn’t practicing medicine. That was the saving grace.

But it’s interesting, especially for those of us who aren’t neuroscientists. One of the things that struck me was the way Patrick sees things, how he sees the world through the lens of neuroscience. Is that partly how you see things?

Well, no. I think that’s the bias that we have in medicine and in neurology. We’re necessarily materialistic and reductionist. We deal with understanding function through dysfunction, which pushes us in that direction. That being said, I wanted the character to have very sophisticated technical and material understanding and yet be completely baffled emotionally. I mean he was not only baffled, he was miserable at his inability to figure things out. I wanted to make that point, that things have to be understood not just at an intellectual level but also at an intuitive level.

He comes across as a stereotypical scientist – he knows a lot about the world but doesn’t know why his relationships failed.

Or how to think about this person. I think that’s perhaps that’s how I felt when I finished my training, and I was trained by very humane people and in a curriculum that I don’t think meant to produce a person who felt the way I did. But I just felt that I was missing something. By the end Patrick comes towards that understanding, and I think he’s more satisfied in certain ways. Not to say that I think I have achieved that—I think it’s always a process, a continuing process.

You can see more of this conversation at braindetectives.blogspot.com.