Novelist, Doctor Chris Adrian On 'The Great Night'

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The worlds of the magical and the medical collide in Chris Adrian's fiction. Often set in dreary hospitals, fumbling doctors are sometimes accompanied by angels or fairies with magical powers. Adrian, a pediatric oncologist, talks about his new novel, The Great Night, a retelling of A Midsummer Night's Dream.

IRA FLATOW, host:

This is SCIENCE FRIDAY. I'm Ira Flatow.

After a long day at the hospital, most doctors probably want to relax. But when pediatric oncologist Chris Adrian gets home, he takes off his stethoscope and picks up a pen. What happens when a physician becomes a novelist and uses his medical and personal experiences to create a new work of fiction? Flora Lichtman is here to tell us more about it. Flora?

FLORA LICHTMAN: Chris Adrian is hard to peg. He has a degree in divinity, he has an M.D., he's a fellow in pediatric hematology/oncology at the University of California, San Francisco and he also writes fiction, in which these worlds collide: Angels and demons find themselves in hospitals dealing with bumbling residents and incurable diseases.

Adrian's new novel, "The Great Night," is a retelling of Shakespeare's "A Midsummer Night's Dream, but the catch is, this time the fairy king and queen steal a mortal child who develops an ailment their magic can't fix: Leukemia. So they pass many hours in a dismal hospital ward.

(Soundbite of archived interview)

Dr. CHRIS ADRIAN (Hematologist/Oncologist, University of California, San Francisco; Author, "The Great Night"): (Reading) The ward was almost the ugliest place she had ever seen and certainly the ugliest place she had ever lived. In other places on the wall, someone had thought to put up bas-relief cartoon faces, about the size of a child's face, but the faces looked deformed to her eye - goblin faces - and they seemed uniformly to be in pain.

LICHTMAN: Chris Adrian joined us in our studio in New York a few weeks ago. Welcome to SCIENCE FRIDAY,

Dr. ADRIAN: Thank you. The way that you portray doctors and hospitals is pretty different from what we see on "ER," or...

(Soundbite of laughter)

LICHTMAN: ..."House." Do you think about that all?

Dr. ADRIAN: Uh-huh. "ER," I think, was in its heyday when I was a med student and everybody - and it was something of a student ritual to gather at somebody's house and watch it and (unintelligible)...

LICHTMAN: Is that right, really?

Dr. ADRIAN: Mm-hmm.

LICHTMAN: Doctors watch "ER"? Wow.

Dr. ADRIAN: And we learned - and we - and oddly enough, it could be helpful for the boards or for tests because they generally got their medicine right. But certainly, there was something that we recognized of our own experience in representations like that.

But as I grew up as a physician, there started to be a lot that I didn't necessarily see in popular representations. And in a book like "The Children's Hospital," I think I may have perhaps gone a little overboard in other direction.

LICHTMAN: Actually, I'd love for you to read a little passage from "The Children's Hospital."

Dr. ADRIAN: Sure.

LICHTMAN: This is one of my favorite places. Maybe you can tell us just a little bit more, set the scene a little bit.

Dr. ADRIAN: OK. So the novel is about a hospital that's flowing around in the ocean after the end of the world again. So there's a second flood. Despite the fact that God promised not to flood the world again, it happens anyway. And the only folks who survive are the people who happen to be in the hospital, either as patients or employees.

So Jemma Claflin is the, essentially, the main character. And Jemma very - is sort of a not very well put-together or with it medical student. She may -medicine may not really have been her true calling. But she finds, as the weeks go by, that people there getting - she's doing - not necessarily doing things right, but kids are getting better around her, and eventually she figures out the she actually is able to heal people just by the power of her will alone or by one (unintelligible) enough.

And she wants very badly to be able to help these children. And, I think, in this passage, she's with a young lady with sickle cell disease name - whose name is Magnolia.

(Reading) Jemma conceived the fix as an argument. For a period of time that could be measured only by the languid ticking of Magnolia's hair, Jemma instructed a stubborn stem cell in the marrow of Magnolia's hip on the proper synthesis of hemoglobin. Like this, she told it, holding up in her mind the lovely molecule, pointers of green fire indicating the place where the cell was doing wrong and how to do it right. It wanted to know why like that and not like it had always been done. It wanted to know who Jemma thought she was, barging into the marrow in the middle of the night to demand that the sun rise in the west instead of the east.

As if in defiance, it squeezed out some faulty molecule. You're killing her, Jemma said furiously. Her who, the cell said. Who is she, and who are you? I am, Jemma said, I am. Who was she? Who was she to do these things to declare a new order to the sick body? It was not a question profitably to be pursued here in the middle of things. She crushed its stubborn will, the smallest violence she would do that evening coming, commandeering the machines of it's molecular industry and churning out perfect hemoglobin in a swelling tide. See, she asked it. Now do you see?

She crushed its stubborn will, the smallest violence she would do that evening, commandeering the machines of its molecular industry and churning out perfect hemoglobin in a swelling tide. See? she asked it. Now, do you see? Yes, it said, and it proclaimed the secret to its neighbor. But with that information, it passed along also a hint of feeling, the sullen residue of wounded pride. Jemma tried to burn it out, afraid it would turn sweet Magnolia into a sulker who'd eschew the taste of delight to feed on habitual resentment.

LICHTMAN: So much to talk about there.

(Soundbite of laugher)

LICHTMAN: You have a degree in Divinity, and at least your characters in your book, many of them seem to believe in the power of things beyond the documented scientific world. And I wondered if you - having training - having been trained as a doctor and in theology, if you feel - those two things are at odds or do they work together?

Dr. ADRIAN: They haven't been particularity at odds for me, I guess, or at least I have - I find that I don't have trouble operating in the evidence-based world of pediatric oncology, but then also operating in the not so evidence-based sort of anecdotal experience, individual experience-based world of, I guess I can call it pastoral care or ministry, even though I'm not a minister and probably won't ever get ordained.

But I certainly think that what I've learned in divinity school - and I went, in part, aside from wanting to know more about theology because of what I was working on as a writer. I went because I knew I wanted to be a pediatric oncologist and I thought I would learn things there about how to take care of patients that I wouldn't necessarily learn in the hospital, people who are going through what is very likely to be the worst time of their lives.

So I think that what I've learned as a divinity student or as a ministry student is not incompatible at all with what I learned in the hospital. I guess the closest that the ministerial side and of evidence-based side come to being in conflict is just in having, I guess, a healthy respect for the possibilities of mystery or even miracle is probably not too strong a word.

And for me, that doesn't necessarily mean, you know, the knitting circle of church prayed for so and so, and they got better. It just means that there is a lot that we don't know, even though there's a lot that we do know in medicine.

LICHTMAN: Do you have parents who you've worked with for children that you've treated? Have they read your stuff? Have you heard any reaction?

Dr. ADRIAN: A little bit. You know, it's - up until the past couple of years, I guess, that tended to be less of a problem, if problem is the right word for it. And so, sometimes, especially if - you know, there was one occasion where a mom had just read a story that was about a ne'er-do-well pediatrician who's a drug addict. And she realized I was the person that wrote that story just as I was to do a relatively - not very complicated but kind of a dramatic procedure on her child. So that made for a mildly awkward conversation about the differences between real life and fiction.

But with this story, the idea of Titania and Oberon being the parents of a critically ill child came from an interaction with a particular child and a particular set of parents. And before it was published, I approached them and said I need to have a really funny conversation with you.

I basically told them that the story that had been accepted for publication had a lot to do with their child. They probably would recognize their child, because the, sort of, line that was at the center of the story and the title of the story was something charming and brilliant that their child had said that I had borrowed or...

LICHTMAN: Is that the tiny feast story from "The Great Night," your new book?

Dr. ADRIAN: Uh-huh. So the situation was that there was this, you know, enormously charming and lovely little girl who we had, as part of her treatment, stopped letting eat. She couldn't take anything by mouth, which upset her understandably.

And we were - and the physicians and the med students and the social workers and the rest of the ginormous team that goes around in the morning was in her room, talking to her parents and sort of typically ignoring her or waiting for, like, the last few minutes of the visit when we turn to the child and say, is there anything you'd like to add?

And she interrupted us halfway through and said, essentially, something to the effect of what's wrong with you people? Why can't I have just one tiny little feast, which everybody, you know, got repeated around the ward as something enormously charming but also kind of heartbreaking and certainly something that gave us a pretty dramatic window onto what the world was like for her in that moment what we were making it like for her.

LICHTMAN: Dead brothers appear a lot in your fiction. I know this is personal for you. But something that struck me as I was reading it, I was reminded of the story of Cain and Abel and how the surviving brother with - marked. And with your training in Divinity, I wondered if this story in particular had crossed your mind when you were writing that or if I'm just totally reaching?

Dr. ADRIAN: No, not totally. Certainly, all those, you know, I grew up Catholic and pretty - even though I wasn't in a very religious family, I was a somewhat serious child and took the - and took my Catholicism pretty seriously.

The frequency of dead brother appearances in my fiction has, I think, probably has less to do with echoes of those sort of primal stories I was exposed to as a kid than with the fact that my own brother's death when I was 22 and he was 25. And fiction became a way to sort of explore being obsessed by the fact of his death and the injustice of his death.

But I think as I turned his death over again and again in my mind and in my writing, that I drew in on my previous experience of old stories. And I think one thing I discovered in a - in a late reading of the Cain and Abel story that I had completely missed as a child was that Cain is marked for Abel's death but as a protection, not as - not really in a way that's necessarily punitive.

God sets him aside as somebody who has killed his brother. And that, you know, that idea of being permanently marked and marked as culpable, and the way it was sort of a - sort of invitation to rhapsodize on the varieties of guilt, that surviving any kind of death, regardless of whether or not you can convince yourself you're remotely culpable or guilty even though - even in just the sense of the guilt of survivorship, I think that old story entered into my new stories.

LICHTMAN: You're listening to SCIENCE FRIDAY on NPR.

Yeah. I mean, it seems like that is the power of story for author than for readers, to be able to sort of make sense of something that seems just incomprehensible.

Dr. ADRIAN: Mm-hmm. Yet - and certainly with my own stuff, with my writing, I think that every - at least every long project has started with being deeply troubled about something. And then, with this book, you know, the - with the new novel, the experience in the - as learning to be a - in the first year that I was learning to be a pediatric oncologist and also the experience of having a relationship fall apart in just the right way that made it suddenly very necessary and urgent to write a story about love.

And I think that, you know, I think for me, I feel like I ultimately always miss the mark. But that's OK in a way. You know, it seems pathetically naive to think telling a story could really make everything all better because that seems almost as pathetic as thinking telling a story could make an actual sick child better. It really, you know, it doesn't.

The worst outcome that I deal with professionally when a child dies, there's nothing that's ever gonna make that better. And so it's naive to think that something as simple as telling an emotionally resonant story would help.

And yet, there is, for me as a physician, you know, the reason I think I can -at least now, the reason I can get up and go back to work every morning despite those outcomes is because those parents get up and go back to work. They go back to their regular lives. They love their remaining children, and they get it together and get on with it. And they don't just live or they don't just survive, they live and they thrive in a way that is wonderful and mysterious to me.

And just the simple fact or the privilege of getting to witness not just their trauma and their tragedy, but how much they love their children and how extraordinarily powerful, even though it can ultimately be helpless and powerless, that love is - it turns out to look a lot like what that target is that I'm always just missing in the fiction. So in that sense, it's not useless at all. It's fundamentally important.

LICHTMAN: Well, if missing the mark means you'll keep writing, I hope you continue to miss.

(Soundbite of laughter)

Dr. ADRIAN: I can guarantee I'll keep missing for a while yet.

(Soundbite of laughter)

LICHTMAN: Thank you, Chris Adrian, for joining us today.

Dr. ADRIAN: Thank you. This is really neat.

LICHTMAN: Chris Adrian is a fellow in pediatric hematology/oncology at the University of California, San Francisco. He's also a fiction writer. His new book is called "The Great Night."

FLATOW: Thank you, Flora. Flora Lichtman also has her Video Pick of the Week up there this Friday, "Sun Spots." Go to our website at sciencefriday.com. And it's a really cool video of - she put together by looking at sunspots.

As I say, if you missed any part of our program, or you want to subscribe on iTunes or a podcast, we have audio and video ones up there for you to take along with you. You can also take us along on your iPhone and Android app on sciencefriday.com. And we're tweeting all week @scifri, @-S-C-I-F-R-I. And you can also go to our Facebook page, facebook.com/scifri, and our website at sciencefriday.com. Have a great weekend. We'll see you next week.

I'm Ira Flatow in New York.

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