On Thursday, March 17, apenndx had the wonderful privilege to interview Dr. Jonathan Reisman – author of The Unseen Body: A Doctor’s Journey Through the Hidden Wonders of Human Anatomy.
Jonathan Reisman M.D. is a doctor of internal medicine and pediatrics (having trained in med-peds), as well as an author, naturalist, traveler, and teacher of wilderness survival and prehistoric crafts. He has practiced medicine in some of the world’s most remote places, including the Russian and Alaskan Arctic, Antarctica, at high-altitude in Nepal, rural Appalachia, the urban slums of Mumbai and Kolkata, India and on Pine Ridge Reservation in South Dakota. His writing has appeared in The New York Times, The Washington Post, Slate and Discover Magazine. He runs a non-profit to improve healthcare and education in India, and he lives in Philadelphia with his wife and children.
Below is an edited transcript of the conversation. Dr. Jonathan Reisman along with Dr. Sara Manning Peskin will lead a panel about writing in medicine on 3/31 from 12-1pm. Register here
Heta
It seems like anatomy has very much resonated with you, especially with your book being divided into different body parts and bodily fluids. Was that something you’ve thought about doing for a long time or did something inspire it?
Dr. Reisman
It was something I always thought about doing. I think part of the inspiration for that came from a lot of the non-medical books that I read, especially nature writing. Two of the books that I most loved were called Arctic Dreams by Barry Lopez and Refuge by Terry Tempest Williams. Both of those books were broken down by species and wove together stories and scientific information, reflecting on interspecies relations and the unexpected connections between the lives of animals and our lives. And, so I took that same approach just instead of species in the world, it’s body parts and bodily fluids. One other book that was inspiring was Michael Pollan’s The Botany of Desire where each chapter is a plant species that humans grow for either food, beauty, intoxication, or sweetness. So, I figured I’d never seen that approach done with the human body and that someone had to do it, so I did.
Heta
I thought it was so creative and insightful how you drew from different cultural experiences and your love for the wilderness and ecology. What particularly stood out to me is how you erase this distinction that we’ve made as humans between us and other animals in nature. And, I know your dinner series Anatomy Eats and your “Lung” chapter dove into that as well. What do you hope to impart to your readers and viewers through this writing style?
Dr. Reisman
In some ways it’s similar to what I got from the books I mentioned – learning about something you might not know much about before. Most people who haven’t gone to medical school have no idea what most of these body parts do. So, I wanted to convey a basic learning about something many people don’t know much about. And, then beyond that, there’s an emphasis on connection – how our body parts are connected to each other and how the natural world is also connected. In nature writing, there’s this kind of ecological perspective on how species and nature are related to each other and how humans are related to nature which is not so obvious in modern life with technology. In the same way, with Anatomy Eats, it’s about teaching people how the same thing they’re eating (whether internal organs or muscles) functions inside of them and how life becomes food after death. I am always interested in pulling back the curtain on that connection as well. It’s also about directing people’s attention to things that they might have overlooked or never thought about. In medical school, I started looking more deeply at things and connecting unexpected ideas or weird seemingly disparate concepts that I never knew anything about. So, I try to do the same for my reader.
Heta
I loved how you’ve breathed a sense of beauty into topics such as bodily fluids like urine and feces, things that we’ve conventionally considered to be repulsive and gross. You’ve really made me see them in a new light. Throughout your journey as a physician and in your career, what have you found to be the most surprising? Is there anything that you’ve encountered that you didn’t get to convey in your book that still resonates with you today?
Dr. Reisman
There are certainly other body parts that I didn’t cover and there are other aspects of daily life that could be written about. In terms of what was so surprising for me, medical school has so much to offer in this regard. You go from knowing nothing about the liver to being forced to memorize an ungodly amount of detail from the gross, to the microscopic to the biochemical level. And knowledge is always growing, an inexhaustible supply – that was surprising about the body for me. The other thing that surprised me about medical school is how much of being a doctor is not scientific at all. Much of being a doctor is relating to another human, and I really try to be a human in the room with my patients and hear their whole story. People are sometimes on these diagnostic odysseys and it’s so frustrating to deal with doctors and the healthcare system that such a huge part of being a doctor is just empathy. It’s a lifelong learning journey, and you’re hopefully becoming a better doctor as time goes on. It’s just one of the realities of being a doctor but that’s fun. I never want to stop learning. I feel like if we weren’t lifelong learners, I wouldn’t enjoy being a doctor and would do something else. I’ve really liked that about our profession.
Heta
What you’ve mentioned brings to mind Atul Gawande’s article “Curiosity and what equality really means.” There’s been a lot of conversation about curiosity and its role in empathy. Our medical education with its rigid curriculums doesn’t necessarily incentivize exploring things beyond what we have to study but it sounds like you’ve really created a life for yourself where you’ve been able to cultivate your curiosity and pursue your passions. Do you have any advice for medical students on how to cultivate that spirit of curiosity?
Dr. Reisman
I would encourage medical students to follow their passions and take the road less traveled if that’s what they want. In medical school, I always bristled when I heard other students say, “Why do we need to know that?” I understand that the truth is we probably don’t need to know 90% of what we’ve learned in medical school but I came at it very interested in everything. It’s a very good approach to be interested in material because it’s fascinating and not only from an utilitarian perspective of “what will I need to know.” Also, I took some time off between college and med school, and it gave me perspective. I did a lot of traveling and those diverse interests have helped me in being a doctor and keeping me curious and interested in all aspects of medicine. I also took a year off between my third and fourth year and spent time working in a public hospital in Mumbai where I saw every disease that I ever learned about, and working for a medical charity in Kolkata. Working with people in Kolkata and Mumbai who lived in slums and on the streets was eye-opening in a million different ways. I think that perspective helps me in my daily life even though I’m not always practicing in that setting. I also got the opportunity to do some global health electives such as public health research in Alaska. Some of those stories appeared in the “Fat” chapter in my book. After residency, my love of travel and seeing the ends of the earth and practicing medicine in the middle of nowhere led me to doing locum tenens jobs in areas like Arctic Alaska, an Indian reservation in South Dakota, and now in rural Pennsylvania. Other opportunities include doing cruise ship medicine in Antarctica and the Arctic and volunteering in Nepal. I was both fortunate to have all those opportunities but I was also aggressive in taking those opportunities. I’ve been pretty fearless but maybe also a bit foolhardy to go off to the middle of nowhere and practice medicine. I might also have something of a cowboy doctor mindset. But, I would just push students to aggressively pursue their different interests and not worry about some cookie cutter medical career that you see others doing. I didn’t want to follow a straight and boring path and work myself to death, as doctors often do, and I think others shouldn’t either.
Heta
For sure. I was also curious because you’ve talked a lot about the different experiences you’ve had in other countries in your book. How have these experiences abroad really shaped you as a physician, writer, and global citizen, and how do you anticipate it continuing to impact your work?
Dr. Reisman
I think going abroad as a doctor helps in a variety of ways. When you work in a developing country or resource poor setting, you get a different perspective on the cost of things and what people have access to. I did a Med-Peds residency, and for pediatric patients with gastroenteritis, patients would get IV fluids for a few days and then they would go home. It was a very ho-hum diagnosis. But, when I went to India, I realized that it’s impossible for many people who have to pay upfront for fluids that are financially prohibitive. And, then kids just die of gastroenteritis in huge numbers. It brings perspective on how fortunate we are even with our very broken healthcare system. Also, you get to see a lot of diseases that you might not get to see in the US right now. However, with immigration, refugees, and populations moving due to war and climate change, I think we’ll start to see more of these diseases in the US. So, just being able to get some experience with them is useful from a strictly clinical perspective. I think you also gain greater cultural sensitivity and competency and understand different perspectives on health and taking medicine or even how to break bad news to people. One more thing, just working in the middle of nowhere such as Nepal or on a cruise ship and being on your own with limited resources forces you to depend on your physical exam. I remember in Antarctica treating a guy in rapid A-fib. There was no help anywhere, no cardiac monitors. So, I just felt his pulse, and I realized that it had been a really long time since I had done that, especially with monitors nowadays. I realized, “Wow, I’m actually using my hand for something other than typing a note or orders into a computer – how nice.” It makes you depend on your physical exam skills and weigh risks and benefits differently. It gives you a good perspective that you can then bring back to the high-tech setting of a modern hospital, and it sharpens your clinical acumen in ways that nothing else can.
Heta
Sounds like everyone should practice in a wilderness setting. With the advent of technology, we’re not practicing those clinical hands-on skills as much, and if you don’t practice them, you lose them. What are some other interesting things that you feel like you’re much better at because of these experiences practicing in the middle of nowhere?
Dr. Reisman
One thing is you really gain more confidence and competence in your ability to do procedures. I finished my residency in internal medicine and pediatrics, and you don’t learn much about trauma. After residency, I went to work in the Alaskan Arctic where I did many procedures for the first time. Maybe the cowboy mindset helped there. When you’re in that setting, if you’re not going to do it, nobody’s going to do it. When I’ve talked to other doctors about working in remote places, some told me they’d be afraid to work in such a setting: “What do you do if someone has a brain bleed?” My response is, “Sadly, people die of things in the middle of nowhere that they wouldn’t die of if they were in the ER of an urban hospital.” That perspective is important. Another thing is working with limited resources and getting creative with them. I worked in the ER in Pine Ridge Reservation in South Dakota where the equipment was always broken. Knowing how to temporize things and being able work with what you have is a crucial skill for doctors.
Heta
Creativity is definitely a skill of yours. Have you always been a writer? When did writing and medicine intersect for you or have you always viewed them in synergy with each other?
Dr. Reisman
I’ve always been a reader, and I always wanted to be a nature writer or travel writer. I did some writing while traveling and then once I started medical school, I continued writing. You see so many interesting things in medical training, whether it’s dissecting a cadaver, or in clinical medicine being present for the lowest moments in people’s lives, or in the delivery room their most amazing bodily events. I couldn’t help but write about all the things I was seeing. My bizarre, curious interests helped in anatomy lab. In the “Lung” chapter of my book, I visit a slaughterhouse, and I actually did that two months into medical school. So, combining those unique interests with the already amazing experiences you have while training to be a doctor helped create this overlap. I was just jotting down stuff throughout medical school – a million little jottings. When I was a resident, I got my first piece published in the New York Times and the first article was about that slaughterhouse and it ended up getting incorporated into the book. My wife also helped me tremendously with this first essay and all subsequent ones – she was a travel writer and an editor in the past, and she helped me turn a million little jottings into an essay that can actually be published. One of the most important skills she gave me was how to pitch. So, one article turned into another and it snowballed. My first article was in 2014 and then around 2018, I thought, “Maybe, I have enough material for a book now. And, then millions of hours later it was finished.
Heta
I did take a look at some of your writing from when you were a med student, and I could see the origins of the stories you’ve put into this book. Can you tell us a little more about your writing process?
Dr. Reisman
I was always jotting down ideas or pretty turns of phrase. As a resident I always carried a little notebook to write these in. In terms of actual writing, I am best in the morning time with a big mug of coffee before breakfast – that is my golden hour for writing. I sometimes listen to music without words (ambient or classical). I also like writing with a little bit of noise in the background, such as at an airport waiting for a flight or at a park where children are playing and geese are honking. My writing process basically consists of taking a million little jottings and putting them together into a single linear essay or book.
Heta Patel is an MS1 at the Perelman School of Medicine.
