The medical world is both fascinating and high-stakes, which is probably why so many novelists are inspired by in. For Ismée Williams, who has worked as a pediatric cardiologist, writing about the medical world was only natural. In her new novel, Water in May, Williams tells the tale of a teenage girl who learns that her unborn child has a serious heart problem. Here, Williams writes about the challenges of balancing her novelist-self and her physician-self in the writing process.
Years ago, before I became a writer, I explained to a non-medical friend what I did at the hospital. My friend’s eyes grew round and her mouth dropped open as I told her I scanned pregnant bellies to check the fetus’s heart. “That must be so emotional!” she said when she recovered her voice, realizing that sometimes the tiny hearts aren’t normal. “It is,” I responded. Telling a young family that their unborn baby’s heart is sick is a great responsibility. My words change people’s lives. The guidance and hope I offer rarely outweigh the dread that accompanies the information I deliver. It is humbling to witness the grief of a parent for a child. The experience is raw and human. As a writer, I wanted to transfer these emotions to the page so the reader might know what it would be like to be told such devastating news. It is my hope that empathy among my readers will raise awareness and support for the more than two and a half million families in the United States affected by congenital heart disease.
Crafting a novel about a Dominican-American teen pregnant with a much-wanted baby who has only half a heart should have been straightforward given my background as a pediatric cardiologist. The medical knowledge I amassed from over fifteen years of practice informed the technical details of my novel. The seemingly endless days and nights spent in emergency rooms, exam rooms, and long, antiseptic-smelling corridors ingrained in me a deep understanding of what occurs between medical staff, non-medical staff, and patients. The hospital scenes in my book, while fiction, are so steeped in reality, I can close my eyes and see myself in that room watching as my main character is told her baby might die. But being a pediatric cardiologist also affected my writing in ways one might not expect.
Balancing the physician and the writer in me brought challenges. I had to view the experience from the eyes of someone who did not know anything about medicine. I tried to have fun with this one, recalling counseling sessions I had witnessed over the years when the message was lost in translation, when physicians unconsciously slipped into ‘medicalese’, using terms the patient did not understand. A common point of confusion was the hierarchy of medical staff in the hospital. The distinction of intern, resident, fellow, and attending is often missed, unless the patient has a close friend in the medical field. In my writing, I emphasized some of the misunderstandings that occur between physician and patient, trying for humor and hoping not to alienate any of my physician readers.
I also had to translate what I had lived countless times from the viewpoint of the doctor to that of the mother. Having gone through three pregnancies that ended with bed rest helped me recall the deep anxiety of clutching my swollen belly while being told something is not right. Another challenge I faced was having a protagonist who is a difficult patient. I am a scientific researcher. I have run clinical trials funded by the National Institutes of Health that seek to identify early predictors of outcome in children born with heart defects. I want to be able to tell my families something more useful than, “We will have to wait and see how the baby develops before we will know if she/he have significant special needs.” As a physician researcher, I want women who are in my protagonist’s position to participate in research studies. I want them to contribute to the greater good, to advance scientific knowledge. Especially when doing so brings no harm to them or the baby. (My studies were observational meaning we took measurements and recorded information and did not administer any procedure or pill.) But my protagonist, Mari Pujols, is feisty and suspicious and stubborn. She would never consent to participate in research of any kind. So I had to write it that way. I had to stay true to my character, even though it may anger my fellow physician researchers. So while being a pediatric cardiologist informed my writing, I had to remember when to pull away from my physician-self and allow the writer to take charge.
Ismée Williams is the author of the contemporary YA novel, Water in May (September 12, 2017; Abrams/Amulet Books). She is a pediatric cardiologist who trained and practiced for 15 years at Columbia University Medical Center in New York City, the daughter of a Cuban immigrant partially raised by her abuelos, and the mother of three daughters, all of which have helped her to understand the many Maris she has met along the way.