When Pamela Mulloy invited me to contribute to the Day Jobs column, I felt honored to be asked, rapidly followed by totally panicked. How to describe coherently and literarily what I have been doing for quarter of a century?
Then I remembered an essay that I had been writing for almost five years.
Its first iteration was written in 2016, for a CNF course in my MFA program, but the seed for this story lay in my mind for few years before that. The realization that geneticists go through stages of professional life dawned on me when I was seeing the patient described as Justin in the essay — that watershed moment in my examining room when I realized that diagnosing patients was not the only thing that I was providing to my patients.
That idea got further traction when I mentioned it to the then editor of the American Journal of Medical Genetics, Dr. John Carey, over a plate of nachos and guacamole in a dive-ish Tex-Mex restaurant in Salt Lake City in 2011. He readily agreed that the concept of a natural history of disease would be an apt analogy for a physician’s professional trajectory, especially since the conceit of natural history of disease came from those written for pathology textbooks and was also used in genetics to describe the progression of genetic syndromes. He asked me to write it for his journal and published it. That article was the great-grandmother of the essay published in The New Quarterly this winter.
But in 2016, my MFA classmates told me that there were too many “things pushed into the story” but that it would make a great start for a memoir that they would all love to read (!). I kept rewriting it, always maintaining the conceit of the natural history. For a long time, I didn’t realize that half of that essay dealt with my mental health issues which were not part of the natural history of a clinical geneticist but of this particular clinical geneticist. Two years ago, I wanted to submit the essay to a memoir contest with a 4000-word limit and my essay was three thousand words too long. I edited out all of the mental health references et voilà! — I had what I had always wanted: a clinical — meaning “detached and dispassionate, like a medical report” — description of the stages of my professional life. That was the conceit, except, of course, it wasn’t cold and dispassionate, I couldn’t be that when writing about my life.
That is the beauty of and irony inherent in the hermit crab essay: an essay that takes the form of something un-essay-like and subverts it into a personal account. “This kind of essay appropriates other forms as outer covering to protect its soft, vulnerable underbelly, it deals with material that is exposed and tender and must look elsewhere to find the form that will best contain it.” Using the form of a pathology textbook entry on the natural history of disease converted my fraught, fragmented story into eloquence and a coherent — I hope — narrative.
American Journal of Medical Genetics, 2012, Part A 170A:2591–2593
Forthcoming from Wolsak & Wynn, fall 2021
Oxford Dictionary of English, online
“Tell it Slant” by Barbara Miller and Susanne Paola, McGraw-Hill, 2012
Margaret Nowaczyk is a pediatrician-geneticist and an award-winning short form writer living in Hamilton, Ontario. Her memoir about life in the medical profession will be published by Wolsak & Wynn in 2021.