Howard Trachtman, MD
Department of Pediatrics
NYU School of Medicine
Throughout history, reading books has often been viewed with deep suspicion by figures in authority. The Dominican priest Girolamo Savonarola collected and publically burned thousands of objects including books on February 7, 1497 in Florence, Italy, an infamous episode that has been recorded as the Bonfire of the Vanities. The books were condemned as temptations to sin. Russian dissidents put their lives on the line to gain access to books smuggled in from the West because they had been banned by the Communist politburo during the height of the Cold War. People have been imprisoned in Iran for reading Lolita. All high school students are familiar with Ray Bradbury's novel Fahrenheit 451, a science fiction novel that depicts a futuristic American society in which books are outlawed and "firemen" are authorized to seize and burn any book judged to be subversive. So even though reading books by the beach on a warm summer day is considered an innocuous activity, there is more to it than meet's the casual eye. It can be an act of great power.
One year ago, we started a reading group open to all the pediatric residents at NYU devoted to reading and discussing works of fiction. The selection process is open and consensus-driven, not particularly radical. We are receptive to non-fiction books but we have agreed to avoid literature expressly addressing medical problems or topics. The objective is to pick books that are high-quality literature. We are partial to books that are multi-dimensional and timely, expecting that they will push boundaries and stimulate thoughtful discussion. The senior member of the group prepares questions and gets the discussion started but no one has to raise their hand to speak. It quickly gets lively. We have read short stories by Edith Pearlman and novels by Jenny Offill, Kate Walbert, Kazuo Ishiguro, Edna O'Brien, and Ben Fountain.
Ms. Walbert joined the group for the discussion of her book, AA Short History of Women The books, which have been modest in length so we can finish them in time, have often been honored on lists of Best Books of the Year or Notable Books.
We meet bimonthly in the home of one of the faculty members and have a light dinner and desserts as we sit around in a tight circle to discuss the book. In part, we do this because it is worthwhile to find a friendly place outside the day-to-day hospital environment and away from the bustle of patient care for the group to get together. It is conceivable that it fosters a samizdat atmosphere among us. We can imagine that we are taking part in something that is outside the box, an underground activity that is a bit revolutionary compared to our day job as pediatricians. But apartments across the street from the Metropolitan Museum of Art are not hotbeds of revolution. If that is the case, where is the subversive element?
For starters, we read a book in hand. The Department of Pediatrics purchases the books and a hard copy is distributed to whoever wants to attend the group. No one brings a Kindle or reading device. Moreover, no one gets by reading a capsule summary or abstract of the book. We read the book from start to finish. This is a distinctly uncommon behavior in an age when most people routinely get their information online in easily accessible, abbreviated formats that can be easily read and digested. It may be considered a quiet act of rebellion when we show that an author's work deserves to be read and considered as a whole entity when we devote time and effort to understand what the author has in her or his mind.
Second, for attendings to see residents as more than a means to patient care and for residents to see attendings as more than the people who give orders and occasionally teach upsets the normal view of the residency ecosystem. The reading fosters a sense of community, a feeling that everyone in the department of pediatrics is a person with an interesting life outside the walls of the clinic or hospital. Each member of the reading group brings a unique perspective to the discussion that is worth listening to and taking into consideration. There is genuine camaraderie and free exchange of ideas between people who have usually kept apart in the hospital. We plan to open the reading group to more interested faculty because we think it promotes a type of interaction that is difficult to foster during rounds and provision of care. Instead of a hierarchical structure, the reading group promotes the revolutionary idea that residents and attendings share a common goal and can work together to achieve it.
Third, with the growing emphasis on evidence-based medicine, there is a worrisome tendency to think that everything worth knowing can be found within the pages of high-impact-factor medical journals. There is nothing to be gained or worth spending time on besides up-to-date summaries of validated clinical guidelines. Acknowledging that reading quality literature adds to one's knowledge and is time well spent goes against the grain of current residency training. There are many medical schools that have incorporated an appreciation of literature and narrative structure into patient care. These programs link medicine and the humanities and represent a welcome addition to the medical school curriculum. But they are pragmatic and primarily aim to help the residents become better doctors. Our reading group is designed to make reading good literature a worthwhile aim on its own merits, a distinctly different valuation for most residents.
Finally, it opens the possibility that reading good books can make residents better people. In a recent profile of Martha Nussbaum (New Yorker, July 25, 2016, 34-43), Rachel Aviv refers to a lecture in which Nussbaum writes that we become merciful when we behave as the "concerned reader of a novel," understanding each person's life as a "complex narrative of human effort in a world full of obstacles." The direction of Nussbaum's thought is from people to a literary mindset. The unspoken mission statement of the reading group is that Nussbaum's assertion can be made in reverse, namely, that a devoted reader of literature will become a more compassionate individual. Those who have chosen a career in the humanities have always known that the ultimate purpose of their study is to become better human beings. Physicians may have forgotten that charge in the struggle to become good doctors. Reminding them of the value of reading novels in residency may be disorienting at first. But we are optimistic. We meet and read together in the hope that introducing reading into residency will help trainees and faculty become better people. If the reading group makes us better doctors, we will take it.
If you have read this far, we want to reassure you that we do not take ourselves too seriously. We have a good sense of humor and have mostly enjoyed our careers so far in pediatrics. But we think we are on to something, a simple thing that may make any residency program a bit stronger and more meaningful for faculty and trainees. As Arlo Guthrie sang in Alice’s Restaurant if one or two residency programs start a reading group they may be considered sick or weird.
If three programs do it, the accreditation boards may think it is an organization. If fifty programs do it, it might become a movement. So go out with some resident friends, buy a book, and get together to talk about it. It is not as dangerous as it sounds.
We thank the leadership of the Department of Pediatrics for supporting the reading group.
We thank Lolly Bak for her thoughtful comments and suggestions about the essay.
Denis Chang, Deanna Chieco, Svetlana Dani, Patricia Davenport, Jasmine Gadhavi, Michael Goonan, Shelly Joseph, Sabina Khan, Marissa Lipton, Kira Mascho, Bridget Messina, Mary Jo Messito, Claire Miller, Shira Novack, Roshni Patel, Gabriel Robbins, Jessie Zhao.