Author Talk: January 2004
Q: Numerous themes recur throughout the stories: the difficulties facing immigrants and the children of immigrants, the ways children are affected by their parents' relationships, individuals who travel to remote corners of the world in order to do good, or to do scientific research, and issues faced by those in the medical profession. What significance do these and other recurring themes have for you?
JM: I am interested in how people cope with change. People who are displaced have to make a new reality for themselves and have this conform somehow with their past experience. There is an emotional cost. All immigrants struggle with this, I think, in one way or another. Children from broken families experience something like it, too. It is hard to separate yourself from your family and friends and the places where you grow up, and make a new life. You always have another life buried in you. Going back--returning home if you are an immigrant--is not easy either. Memories of the past do not always reflect what the past was really like. I'm interested in how people dealing with change balance the past and the present, and how they learn to think about things. Many of the characters in these stories - doctors or scientists - have very sophisticated ways of rationalizing what they see - in medical or scientific terms - but are unable to deal emotionally with the situations they face. Because they do not know how to express emotions directly, they do it in other ways - by thinking technically, or in intellectual terms, or by not thinking about it at all. I think this is true of all of us to varying degrees - we all learn ways, good and bad, to deal with our emotions.
Q: You spent some time working in Africa. Can you tell us something about your experiences there?
JM: I have worked on child health programs in Africa since 1992, first with the Centers for Disease Control and Prevention and then with Johns Hopkins University. This work has involved research, policy and program development - all in the area of child health. I have worked most in Burundi, Central African Republic, Eritrea, Ethiopia, Ghana and Uganda. During this time I have become friends with many wonderful Africans who are very inspiring to me - people who are committed to improving their own countries under the most difficult conditions. I have learned a great deal from the people I have met and worked with, and have spent a lot of time out in rural communities - where people have very little, but where there are diverse cultures and a great sense of human spirit - and often a generosity that you do not find in more developed places. At the same time the years I have spent in Africa have seen a dramatic worsening in some health problems - HIV/AIDS and multi-drug resistant malaria, in particular - and widespread civil war. War and political unrest make changing anything difficult. I have also been sometimes frustrated by the process of international assistance which is often very bureaucratic and does not direct enough resources down to the communities where most people live. Often international aid is not given for long enough to make any real changes in health - it is given for a short time and then withdrawn. I did refugee work when I was with the CDC and was in Burundi for the civil war there. Many people were killed in the most terrible ways, because of their ethnicity, and this was very difficult to deal with. We had been working for some time to improve local health systems and in a few days all of this work was completely destroyed. Several colleagues disappeared, and we were threatened often by people with knives and guns. This really made me question what I was doing there and whether it was possible to change anything in the face of deep-seated ethnic and tribal conflicts. More than that, I felt as if all of my training and technical knowledge was really quite useless. But many of the Africans I know working in health have an amazing capacity to bounce back, and take a pragmatic view, and keep going. This is inspirational. The temptation is to switch off and walk away because the problems seem so difficult. But to do this is to deny the human spirit that is alive and well in Africa.
Q: In general, how have your experiences as a doctor informed your fiction?
JM: Medical training puts you in the unique position of talking to people about things that they do not usually talk about. Taking a medical history is often a process of learning in some detail about a person's daily life, and their family, and about tiny details of their physical condition and what they feel and see. It is a privilege. Sometimes I found myself more interested in a person's story than in their illness. And I realized, too, that people are infinitely complex and unique - there are more ways of seeing the world than we will ever be able to write down. So I think being exposed to this put me in touch with the power of stories - and the incredible range and depth of how people perceive things. Also, doing medical training, you see a lot of death, and this really affected me. When I was an intern, I was seeing an elderly man one afternoon in the hospital, when he had a cardiac arrest. I started CPR straight away, and a nurse ran in and began ventilating him with a bag. He was a man of about eighty. Just before he lost consciousness he had been telling me about how he used to be a farmer, and it turned out that he knew my grandfather, who was also a farmer. I stood there for five minutes pushing up and down on his chest, and then the cardiac team arrived, but they could not bring him back. And I remember standing over this man, now dead, who had been talking to me a few moments before, and feeling as if a part of my own history had been lost. It was quite bewildering - life itself seemed like a mystery - and this feeling has stayed with me. On one level, I think fiction is way of trying to make sense of people, and to understand what it means to be alive, and what death means. Later, when I started working in developing countries, I began to realize that the medical professionals working in these places were a strange group. I was sitting in a meeting in Ethiopia one day with several colleagues and realized that everyone in the room was divorced. Many of them were risk takers to large and small degrees - refusing to take antimalarials when the risk of malaria was high, for example, and spending months away from home under very difficult and sometimes dangerous conditions. I started wondering why they were really there. A lot of doctors do not have happy personal lives, and do not deal well with emotions, and devote themselves to their work to an almost pathological degree. This was the germ for the stories in this book, because I wanted to imagine how people with very technical training saw the world - and what was really motivating them. I do not think of myself as a "medical" writer, but in these stories I wanted to write about characters with a medical or scientific background.
Q: The rigors of practicing medicine and the kinds of discipline such a profession requires seem contradictory to the kinds of conditions that would nurture a career in fiction writing. How do you manage to do both? What made you decide to focus on a writing career, and do you intend to return to medicine?
JM: I realized that I would never write unless I took time off. I was trying to write at night and at odd times, but I found this increasingly difficult, especially when I was traveling to other countries. I managed to keep a journal, but that was all. In the end the drive to write was stronger than the drive not to write - I am not exactly sure why. I think I had reached a point where I had accumulated so much uncertainty about the purpose of what I was doing, that I had to write fiction to work it out. It was very hard for me to stop working full time. I applied to the Iowa Writers Workshop, not imagining that I would be accepted, and then when I was accepted, it made the decision easy. This book was written during my two years at the workshop. During this time I have continued to work on projects in Uganda and Ghana - and to make trips to these countries. So far, this has worked out quite well. I would like to keep doing some international health work because I enjoy it and believe in it. For now I am mainly writing.
Q: Which writers have inspired you?
JM: There are many of them. Gustav Flaubert - for rigor and attention to detail; Antoine Chekhov - for character and clarity; Joseph Conrad - for setting and place and plot; James Joyce and Sherwood Anderson for the truths contained in Dubliners and Winesburg, Ohio; Vladimir Nabokov - for the possibilities of language; Graham Greene - for explorations of inner life and morality; Alice Munro - for range and scope, and for opening up the possibilities of the short story.