Volume 16 Number 4, SUMMER 1999

writing fiction, exploring reality

Students' stories prompt discussions of real-life experiences in the worlds of medicine and biomedical research.

BY CONSTANCE CHEN

Related stories:
Instinct

When Stanford chemistry professor Carl Djerassi, PhD, decided to create a new class on ethics at Stanford University School of Medicine, he wanted students to come up with their own topics.

"I didn't want to say, 'Today will be a talk on plagiarism, and tomorrow on sexual discrimination.' " So, in his course Ethical Discourse Through Science-in-Fiction he has participants pen fictional stories about the lives of clinicians and scientists, and then uses the tales to launch discussion of the embedded ethical dilemmas. As far as he knows, his class -- offered the past two Winter quarters -- is one of a kind.

Harriet Washington, a medical journalist at Stanford as a 1997/98 Knight Fellow, admits she was impressed. She took the course the first time Djerassi offered it. "I was bowled over when I read the stories." Jonathan Eisen, PhD, a basic scientist now at the Institute for Genomic Research in Rockville, Md., agrees that most of the stories were spectacular. "It left me thinking since then about a lot of these things," says Eisen. "You have to give credit to the writers."

Many of the students saw the course as a way to fulfill the National Institutes of Health requirement that those receiving NIH support take an ethics course -- an alternative to the weekly lecture series organized by the School of Medicine to satisfy the NIH mandate. The students were pleased with their choice, reporting that the level of discussion went far beyond what they would expect in any lecture series, no matter how good. As Eisen puts it, "None of the stories were 'Oh, I wouldn't do that' type of stories. Instead, they focused on very complicated, nebulous hard-to-think-about issues. You knew that something was wrong, but it was hard to put your finger on exactly what was wrong." According to Washington, Djerassi was brilliant at finding the subtle issues and moral dilemmas hidden within the worlds of medicine and science.

When it came to "Instinct," published in this issue of Stanford Medicine, the class discussion fell into two camps. While one group found the story offensive and unfair to physicians, the second group felt it was troubling but realistic. Touching upon whether or not a doctor should recommend abortion for a patient, the story raises issues about doctor-patient communication, informed consent and the lack of compassion that could display itself in the medical profession. Indeed, it was the latter issue that raised the most controversy. Protesters insisted that the story was "disturbing, unrealistic, couldn't have happened ... no doctor could be that cold, no mother could be that unfeeling." Yet the author, an MD herself, says patients have told her that doctors need "personality transplants." Says the author: "People in medical professions can be very judgmental, and patients can feel it."

The debate itself had practical benefits. Melissa Minor, a second-year medical student at Stanford, emphasizes that the class allowed her to develop verbal reasoning skills -- "Something that is not really stressed during the pre-clinical years at Stanford and is vital in communicating with patients and colleagues," she says. Djerassi, who is known as the inventor of the Pill and teaches in the feminist studies department, says he was particularly interested in issues facing women in science. Discussion often centered around subjects like the struggle to balance a career with relationships and childbearing, striving for tenure, collegiality and competition, the glass ceiling for female scientists.

Not everyone thinks a writing course for scientists is a great idea -- Djerassi says he has heard that some faculty feel their students should be in the lab instead of taking a writing course. But if success in academic medicine is measured by publications, participants may have had the last laugh. The first-year class produced a renga, a Japanese literary form in which successive stanzas are produced by alternating writers, and Djerassi arranged for the result to be published in Nature. A literary experiment in the spirit of scientific collaboration, the process itself engendered debate about authorship, priorities, journal choice and competition. In the end, as Washington put it: "Who can gripe with being published in Nature?" SM