Most of the time I juggle my roles as a writer and a doctor without thinking about it. But once a year, I try to attend a writing conference where I can feel like a writer among my peers. This year I chose the Santa Barbara Writers Conference, in its 43rd year. It was a heady experience, with a myriad of workshops, speeches and panels, almost around the clock, with "pirate" workshops starting at 9 pm. It is always fun to talk to other people who are passionate about prose, especially since the Electronic Health Record has reduced day-to -day medical writing to stilted computer-speak stitched together from templates. It was striking, when I returned to my doctor work, reviewing disability applications, how difficult it was to extract the story from the claimant's frequently confusing allegations and the medical jargon of the health care team. The clarity we writers strive for in fiction is elusive in medical files. I thought about the importance of establishing an authoritative voice in a file, just as in fiction. There can be a thousand pages of evidence, but if there is no note that tells the story in a logical, coherent manner, from the beginning, supplies a careful, comprehensive exam and bases the diagnosis on a synthesis of all the pertinent testing, I must stitch the narrative together from patches of isolated facts. I face backwards, trying to figure out what happened, rather than writing a story forward. Most of the time the claimant is stuck in the middle of the catastrophe, with no resolution in sight. I can only offer my best guess as to an ending, disabled or not disabled.

Toni Martin Writes