Last year, a doctor started a Web site to boost publicity
for his Louisiana practice. Over time, though, his
storytelling, thoughtful opinions, and impassioned writing
following Hurricane Katrina have made Dr. Michael Hébert's
site a beloved destination for readers all over the
country.
I've been fortunate to correspond with Dr. Hébert about his
interactions with patients, how that translates to literature,
and how the hurricane affected his life.
Dr. Genes: The first entry on your site is surprisingly
terse -- especially given the expansive posts that soon
followed. Did you know, when you started, how your writing
would develop?
Dr. Hébert: I started my blog mostly to grow my
medical practice. The site was intended as a promotional one;
I would discuss various medical topics for patients to read
and then hopefully they would come into my office. At some
point, I abandoned my plan to use the site as a practice
promotion. This was because I noticed that the people who were
reading it were almost entirely out-of-towners. So I adjusted
my posts to address the interests of a broader audience.
As I wrote, I discovered that I got no pleasure out of
writing about medicine. I have no desire to be -- and in fact
have a little disdain for -- those TV docs on the "Health
Minute" segments. I think all that facile spoon-feeding of
medical information oversimplifies medical problems, and may
even be harmful. Sometimes it scares people into seeing their
doctors, which can be good. But we live in a society of fear.
Nowadays, people are terrified of spinach and the West Nile
virus, for heaven's sake; we don't need any more of that.
About the same number of people will die from West Nile virus
this year as from lightning strikes, but the media don't care
about that. The media are only interested in making money.
Given this, I decided to refocus on what really interests
me about medicine: patient interactions. Patients are complex
and mysterious, and many doctors do not appreciate how little
they understand about their patients. I talk to patients all
the time and realize that there are thoughts and feelings
running through their brains that I will never fully
understand. Sometimes I have to guess. Why won't this patient
take his blood pressure medication? Why is this person afraid
of surgery? I knew an ER doctor once who had vaginal bleeding
for something like 10 years. She would get a CBC (complete
blood count) every once in a while, and the lab would call her
back in a panic because her count was so low. She would say,
"Oh, that's normal for me." Yet she never went to a
gynecologist to find out where the blood was coming from!
It is amazing how people think one way as a doctor and
another way as a patient. That is my primary interest when I
write about patients -- the difference between the thinking of
the doctor and the patient. The more I wrote about this, the
more it became a major theme in my site. So I guess you could
say that I grew into my blogging. I wrote about what
interested me, and ended up with what I have now.
Dr. Genes: You've done a lot of analysis since the
upheaval of Katrina, with respect to both the people it
touched and your own life and practice. Given that your blog
started shortly after the hurricane, how has Katrina affected
your writing?
Dr: Hébert: Katrina, yes. I went through it in my
fortieth year, which means, God willing I live so long, it
will have divided my life exactly in half. Everyone in New
Orleans will tell you that there is only Before and After. I
didn't intend for my blog to be about Katrina. After all, my
site was initially supposed to promote my practice, and
posting about Katrina wouldn't help that. However, as I got
hits from out of town, I began to see an opportunity to say
more to a broader audience.
I still have great difficulty getting my mind around what
happened. Everything failed with Katrina -- the levees; the
federal, state, and local governments; the police; FEMA -- you
name it, it failed. And then, the week after the storm, people
started saying, "Maybe we shouldn't rebuild New Orleans." This
really got under my skin. Perhaps if the failure had not been
so global, they would have had a point. But the truth is that
no one in authority cared enough to help in our darkest hour.
Suppose a patient came into an ER with chest pain and the
doctors there did absolutely nothing for hours and hours. Then
the man has a massive heart attack, his blood pressure drops,
and he suffers brain damage. Finally, the doctors come around
and say, "There's nothing we can do now; let's just euthanize
him." That is how I feel about the government's response to
Katrina.
Southeastern Louisiana is certainly a society on the edge,
and it was even before the storm. There were a lot of problems
before Katrina: crime, poor schools, corruption. But those are
human problems; they can be solved. The area's vulnerability
to hurricanes can be greatly reduced, too, with the proper
land management. New Orleans is and was culturally different
from any other city in the United States, even from other
cities in Louisiana. If there is one thing we lack in this
country of 170 cable channels that are all the same, it is
variety. What can help our country to survive is not that we
become all look-alike and think-alike, but that we stay
different. It is our strength, and I am really disappointed at
how often Americans are ready to throw that diversity
away.
Dr. Genes: Many of your stories begin grounded in
reality, before veering off into the satirical or absurd (like
the woman with the novel weight-loss plan or the doc who tries to dry his stethoscope). The
opinions are always well reasoned (like the effect of Wal-Mart's formulary), though
sometimes they are given the cover of a story (as when you
took the prayer studies to their logical conclusion).
How do you weigh the pleasant mix of fiction and opinion on
your site? Does the balance come naturally or do you force the
occasional creativity?
Dr: Hébert: My patient stories are usually
satirical. I like to write comedy, and I think comedy plays
better on the Internet.
I find that I am strongest as a reactionary writer. That
is, I read something, or something happens to me, and I write
in response. Writing about Katrina is easy for that reason. It
happened to me, so I can react to it. Most of my patient
vignettes are derived from something I observed in a patient
that I found odd. I often focus on the oddness of other
people. That is not intended as an insult; I like odd
people.
When I find an oddness or a contradiction in a patient, I
carry it around for a while, then devise a self-contained
story about it. I rarely, if ever, make up the main idea, but
I will flesh out my story as needed, or condense several
separate patient encounters into a single one, if
necessary.
I do try to mix opinion and fiction pieces. I don't think I
could come up with enough fiction to post regularly, so I have
to add in other topics. I like doing a little of everything,
and I hope my readers do, too. My main goal, whatever I may be
writing about, is aesthetics. I want my posts to read easily
and to be pleasing to read. This is more important than any
single point I make. Writing should always be, first of all,
compelling, and secondly, entertaining. There is plenty of
boring stuff on the Web. Plenty of strident stuff, too. So I
try to keep the ranting down and just entertain. I do say, for
example, "My last 3 posts were political. Time to write
something different." Opinion posts come easier, so I have to
concentrate on bringing out the creative side.
Dr. Genes: What have you learned from other
doctor-writers?
Dr: Hébert: Like any writer, I believe in learning
from other writers. Obviously, I do not restrict myself to
Internet writers. Since I became a blogger, I have developed a
strong interest in print writers whose style strikes me as
being "bloglike." Lately I have been reading Anton Chekov's
short stories, and have been astonished at how they resemble
blog entries. I also like Flannery O'Connor for focused,
morally powerful stories. Montaigne's Essays also have
deeply influenced my style. Montaigne in particular was a
master at writing about himself without sounding egotistical,
and I think of him often when I sit down to write a new
piece.
What I have learned from online bloggers is that a blog
doesn't have to be a personal diary; it can be a daily art
exhibition. Actually, I think of mine as more like a jazz
club. Every post is a different tune, but the overall style is
always the same.
But I have 1 major rule in my blogging: However the story
comes out, I run with it. This usually means that the posts
come out long, and frequently exhaustive. I, as some other
medical bloggers have done, opt for quality over quantity.
This reflects my personality anyway.
Dr. Genes: Readers are welcome to judge the quality of
Dr. Hébert's writing when he hosts the upcoming Halloween
edition of Grand Rounds on October 31, 2006 (the link to Grand Rounds will go "live" on
October 31). Each week, the host of Grand Rounds compiles and
edits the best of recent medical blogging. As is often the
case, the personality of the host shines through. But if new
readers need further introduction to Dr. Hébert's blog, they
can check out his collection of favorites as
well.
