Take two novels and call me in the morning: A discussion with doctor and novelist Richard Barager, MD

Background
Richard Barager, MD, is a nephrologist by day and a novelist by night. “He believes the two finest callings in life are doctor and writer, the one ministering to the human condition, the other illuminating it, both capable of transforming it,” according to his biography on Goodreads.com.

Dr. Barager is such an advocate of the healing power of the written word that he often prescribes books and short stories to his patients as a complement to their medical treatment.

Richard Barager, MD, is a nephrologist and novelist in Orange County, CA.

The Atheist and The Parrotfish is his second novel.

In this interview, Dr. Barager explains how "prescribing" literary fiction can help patients make sense of their illness, and how books can sometimes help when medicine cannot. He also offers physicians inspiration on both writing fiction and practicing medicine.

MDLinx: How does reading books help sick patients?

Dr. Barager: Researchers have demonstrated that reading literary fiction increases the human capacity for empathy, whereas reading genre fiction, non-fiction, or not reading at all failed to increase measures of empathy. The unique nature of literary fiction enables people to reflect upon and change themselves, as they must do in order to cope with and recover from serious illness. And the central question of all illness is this: What is it's meaning? What does my illness mean for me?

I use literary fiction in my medical practice to help patients more fully comprehend the meaning of their illness by "prescribing"? certain novels. Sometimes, only great fiction can tell the truth in a way that is transformative; we humble doctors lack the words.

MDLinx: How do patients react to your book "prescriptions"??

Dr. Barager: It all depends on the patient, so targeted selection is everything. I try to identify patients who like reading literary fiction to begin with before I suggest something, and I explain to them why I think a particular book might help them cope with their illness. They don't all act on my suggestions, but they do all seem to appreciate the effort. It shows that their doctor cares about them as a human being, not just as a patient. And many studies have shown that patients who believe their doctor personally cares about them achieve superior clinical outcomes.

MDLinx: Can you name a few books or short stories that you prescribe for certain conditions or for certain patients?

Dr. Barager: There are many such books, but two of my favorites are a short story by TC Boyle called "Sin Dolor"? about the nature of pain, and the novel Everyman by Philip Roth, which explores aging and the meaning of death.

Here is a short list of a few others:

• The Echo Maker by Richard Powers (rare neurological illnesses; family loyalty in combating illness)
• Journal of the Plague Year by Daniel Defoe (epidemics; a foreshadowing of AIDS)
• The Death of Ivan Ilyich by Leo Tolstoy (premature death; death with regret; cancer; origins of hospice)
• Middlesex by Jeffrey Eugenides (sexual identity and gender dysfunction)
• One Flew Over the Cuckoo's Nest by Ken Kesey (mental illness; nurses and compassion)
• I Know This Much Is True by Wally Lamb (schizophrenia; sibling relations; family caregivers)

MDLinx: Can you recall a particularly memorable patient case in which a book made a meaningful difference?

Dr. Barager: Most definitely. I once recommended Philip Roth's Everyman, a mordant, yet immensely moving novel intended to remind us that aging and death await us all, every man and every woman. Roth sets the tone for his 192-page novella with an epigraph quoting Keats:

Here, where men sit and hear each other groan;
Where palsy shakes a few, sad, last gray hairs,
Where youth grows pale, and spectre-thin, and dies;
Where but to think is to be full of sorrow.

The patient for whom I prescribed this story had, in addition to kidney failure requiring dialysis, such severe heart disease that it was clear to all, my patient included, that he would not survive another year. He was a fiercely intelligent man who understood his predicament intellectually, but refused to accept it emotionally. When he grew angry and then despondent, I suggested Everyman, which he agreed to read. He found the protagonist's cynicism, bitterness, and lack of grace so contemptible that he vowed to die a better way. For the remainder of his life, a few months only, he was notably happier and at peace with himself and his family.

MDLinx: How do you manage being a nephrologist by day and novelist by night? What do you get out of it?

Dr. Barager: My dual callings of doctor and writer are born of the same need: to touch the lives of others in an intimate and meaningful way, whether through patient care or by storytelling. I manage the novelist-by-night gig by writing from 8 to 10 pm during the week, and in binges on the weekend.

MDLinx: What advice do you have for other doctors who would like to write a book "someday"??

Dr. Barager: For fellow physicians with an interest in writing a novel, I would tell them that it will be easier than they think. The art of medicine and the art of fiction have much in common. Writers need to create complex characters that are three dimensional, so they seem like real people. Patients are real people who need to be related to in those same three dimensions: physical, emotional, and spiritual. It is not possible to provide effective care to a patient without knowing their story, and it is not possible to create believable characters without a story for them to act upon. In this way, the roles of doctor and writer are the same: each must understand the central character and the meaning of that character's story.

MDLinx: Your latest book is titled The Atheist and The Parrotfish. What's it about?

Dr. Barager: Cullen Brodie is a California nephrologist with a most unusual patient: Ennis Willoughby, a troubled cross-dresser whose life is saved by a rare heart-and-kidney transplant. Cullen's bitter disbelief in the afterlife is tested when Ennis begins to exhibit tastes and characteristics uncannily similar to those of his female organ donor–whose first name Ennis inexplicably knows. When Ennis becomes convinced that his donor's soul has inhabited him, Cullen sides with Ennis's psychiatrist, who tells Ennis he has confused his emerging transgender personality with the imagined characteristics of his female donor. But Ennis's eerie knowledge of his donor's greatest secret forces Cullen to consider the unimaginable: transmigration of a human soul.

About Dr. Barager:Richard Barager, MD, is a nephrologist and novelist in Orange County, CA. The Atheist and The Parrotfish is his second novel.