I first met Bud at a gathering of writers, where he was introduced to me as the “boyfriend” of my novelist friend, Becca. Imagine my surprise to later learn that he’s an internationally renowned transplant surgeon. Dr. Shaw founded the program at the University of Nebraska Medical Center that quickly became one of the most respected transplant centers in the world. An author of 300 journal articles, 50 book chapters, and a founding editor of the prestigious journal, Liver Transplantation, he retired from active practice and the department chairmanship in 2009, and now focuses on writing, teaching, and the value of narrative studies in medical education and clinical practice.
I meet with Bud at a Midtown coffee shop. He’s very tall and looks more like a retired athlete than a retired doctor or a writer. Over coffee, Bud speaks candidly about the difficulties and rewards of writing a memoir—both personally and in the medical world—and about the healing power of narrative.
Eve: First of all, thank you for meeting with me and sharing your thoughts for Along the Way. Before we talk about your book, let me get a little background. How old were you when you first started writing? What kinds of writing did you do?
Bud: My mother helped me write stories in the summer after second grade. They involved an 8 year-old boy and a pony who solved mysteries or rescued puppies. I wrote on Goldenrod tablet paper and published books with hardboard covers and used a soldering iron to burn in the title and my author name. While cleaning out my dad’s house after his death several years ago, I found one of these masterpieces in the attic. All four pages had several corrections in my mother’s handwriting.
Eve: You have won too many awards to mention for your “skill and vision” in the field of transplantation. Most people would be satisfied with that, so what drives you to do the many other things you do?
Bud: I’m easily distracted.
Eve: (laughs) Do you like to read?
Bud: I’ve been a voracious reader since childhood, and I think that’s one key element to learning to write. At least I know that reading good writing has always made me want to write.
Eve: I agree. Who are some of your favorite writers?
Bud: The ones I liked enough to read nearly everything they wrote, include Hemingway, Faulkner, Steinbeck, Vonnegut, Grass, Kesey, Thomas Wolf and Tom Wolf, John Barth, Richard Brautigan, Tom Robbins, John Irving, Thomas Mann, Thomas Pynchon, EL Doctorow, and Cormac McCarthy.
Eve: Very eclectic! Who was or is your biggest influence as a writer?
Bud: I think McCarthy’s The Road may have had inspired me most toward stripping my sentences leaner.
Eve: The journal intima said about you that “medical humanities has found its Raymond Carver.” What made you decide to write a book?
Bud: I never had any interest in writing nonfiction until several years after I stopped doing surgery. I couldn’t imagine any of my experiences being interesting to anyone who wasn’t there. But once I wrote a few short essays and got encouragement to continue from local writers, I soon had a collection of essays involving a wide range of experiences.
Eve: I understand one of those essays, “Last Night With Ellen Hutchinson,” won a national contest?
Bud: Yes, it was sponsored by Creative Nonfiction and The Salt Institute for Documentary Studies. After that I was contacted by Amy Grace Loyd about writing a book for Byliner.
Eve: And the rest is history?
Bud: (laughs): I worked with them for nearly two years before they finally turned me down (something about changing their direction, again). Fortunately, I met a newly minted literary agent about six months later, he read a bunch of my essays, thought he could sell a book-length assembly of them if I could create a narrative arch, and two years later, the book came out.
Eve: In Last Night in the OR you are amazingly open about things that a lot of people wouldn’t want to face, let alone put out there for the world to see, like anxiety and panic attacks. And about the need to control.
Bud: I think my anxiety disorder is congenital, and that like my father, I subdued it for many years with the unshakable belief that I could control everything around me that was important.
Eve: So how does one go from that place of needing to control everything to writing a memoir about being in “remission” from that need as the arc of your memoir suggests?
Bud: My growth, from writing these essays and, more so, from struggling to put them into a perspective that would form a long narrative, was mostly about learning to live with the understanding that I control a lot less than I imagined.
(Laughs ruefully) But then there is also the reality that every time I have tried to NOT control difficult situations in which my expertise was useful, I inevitably stepped in and saved the day. That I should need to do that is incredibly baffling, and frustrating. It feels contradictory to the lesson I thought I had learned.
Eve: So have you been able to let go of some of that need to control?
Bud: Yes, but it’s a work in progress. One example, in working with medical students, I am finding that they actually learn more and better when I let go of trying to expound on every one of the thousand things I could explain about a given situation.
Eve: As a writer, you’re developing themes that are universal, so that readers can relate in a broader sense. But are you saying that, personally, there is healing in writing?
Bud: Absolutely there is personal therapeutic value in writing. It can be an outlet. I found that writing helped me understand my behavior and responses in the past, to understand anxiety not as a defeat, but as a medical condition.
But beyond personal growth, research in a number of fields suggests the value of narrative. For instance, in the corporate world, writing helps people set goals when they imagine the future as a storyline. Patient outcomes can be improved. It’s of value for health care professionals, as well.
Eve: I know you’re a proponent of the humanities in the medical education. Do you encourage students to write?
Bud: Medical curriculum is very traditional and slow to change. But yes. For instance, for years I’ve met with a writers’ group of medical students on Friday evenings. We call it The Burn Out Club.
Eve: (laughs) That seems appropriate, considering the days and hours without sleep that you detail in your book! That brings me to my next question about the medical world.
One review of Last Night in the OR said it was “enlightening, educational and raw,” and that they respected you “for opening [your]self up to show [your] human side and not just the role of esteemed clinician,” including “physicians’ ego, power trip, need for adrenaline, and of course God complex.” Did you get any pushback from medical colleagues who didn’t appreciate some of your candid observations?
Bud: Yes, and lots of silence, which I tend to imagine is a form of pushback. Some people did not want to see it published. They cited privacy laws and HIPPA, which didn’t apply, as I was very careful to change names, places, and identifying details as a precaution. Actually, some former patients would have been happy to be named if they had been asked.
I had a conversation with one lady at UNMC who said I was wrong to show what went on behind the scenes, so to speak. She said something to the effect that patients need and want to think of their doctors as invincible.
Eve: What about reactions from physicians?
I’ve actually had very few direct comments from physicians. One surgeon I worked with years ago told me he liked what I had written about him, he thought I had made him look better than he actually was. But he was offended that I hadn’t okayed it with him first.
After the book came out, I sent a copy to Dr. Starzl, the pioneer of liver transplant surgery and my former mentor. He reacted very generously and graciously with a lot of praise about my literary endeavor. (Laughs) I was waiting for the other shoe to drop. A couple weeks later he sent me a thirty pound box of notes about supposed factual errors and inaccuracies.
Eve: (laughs) Okay, that doesn’t at all suggest ego or power trip. Because how could that be relevant when all the names and locations had been changed?
Bud: (laughs) In general, though, the positive [comments] greatly outnumber the negative.
Eve: What’s your advice to someone who wants to do what you do (either medicine or writing or both)?
Bud: Becoming successful at these two vocations is strikingly different. Becoming a doctor is pretty straight forward. The entire process is already sorted out, all you have to do is follow the rules and put in the necessary work, and you’ll end up becoming a doctor, and you will almost certainly get a decent job.
When I was twenty-three years old and hating every day of my first year in medical school, I really wanted to quit and become a writer. I was writing all the time, submitting stuff to magazines (Reader’s Digest, Redbook, Playboy) and was certain that with luck, I could drop out of school and write one great novel after another.
I was too much of a coward, though. I couldn’t see any clear pathway and the risk seemed too much, especially compared to the well-paved highway, with proper signage and painted lines, that I was already traveling.
Eve: So what is your typical day like? Do you have a writing routine that you follow?
In 1997 when I took a sabbatical to write, I found myself with all this free time after many years of having none at all unless I left town on a trip. I soon discovered that to keep from frittering my new free time away, I had to create some very strict rules: stop all Internet activity at 0800 and start writing, take an hour for lunch at 1200, stop at 5 p.m. no matter how well or bad things were going.
I added to that a bike ride after lunch if I found myself getting sleepy, and the rule that no matter how certain it felt that I was not going to be able to write a word, I had to sit there until I did. The latter was surprisingly effective and resulted in some of the most productive days.
Eve: From your book it seems that you had to make a lot of sacrifices in both relationships and peace of mind to become successful in the field of transplant surgery. Have there been setbacks or sacrifices you’ve had to make to become a writer? Have you ever considered giving up writing?
Bud: I can’t think of any sacrifices I’ve made either way. Inevitably, I just did what I chose to do without any sense of sacrificing anything. I can understand the external perspective that interprets some of what I did as sacrifice, but never once did I imagine that I was sacrificing anything, even when I set my personal record of sixty hours without sleep.
Eve: What is your current project?
I just finished a short essay for Popular Mechanics. A junior editor read my book and wanted my voice in the magazine. Their circulation is 1.2 million and in March, they had 5.7 million visitors to their online magazine, so of course, I said yes. I’m also working on several essays and a novel that I started in 2009.
Eve: What are you happiest about as a writer?
I strive most to write a compelling story that’s clear and free of my tendency to explain things, or my bad habits of skirting truth, or hiding it with subtlety, obtuse language, or attempts to be clever. I don’t want to be clever. But then, I also don’t want to be obvious. Somewhere in there I think balance is obtainable.
Now that writing is one of two jobs I do, I find myself putting it off too much with the belief that all the other stuff in my day is more important. I need to get going again!