One big man and the power of story

Since this conference began on Thursday (an eon ago), we health writers have been confronted with a series of fascinating if not always easily grasped topics in public health. Elicitation strategies in social epidemiology. The use of P-values to analyze medical findings. Grandfathered insurance plans. The biochemistry of the hippocampus.

It's a deluge that can send you scurrying for cover. In my case, it's made me do some thinking about the power of story.

Health journalism, by definition, is the story that no one wants to read - the one that tells you you're sick, or you're at risk for getting sick, or you are going to get sick and the healthcare system we have is just not going to be there for you. Simply getting audiences to read what we write, and to know what we think they ought to know, is a daunting task.

During a presentation yesterday, Mary Agnes Carey (Kaiser Health News), Victoria Colliver (San Francisco Chronicle) and Peter Harbage (president, Harbage & Associates), gave a masterful, detailed explanation of the new health care reform law. But after it was over, they asked us: "So, how would you turn this into a story?" And despite their knowledge, or maybe because of it, all three acknowledged that even they struggle with this.

I thought about a couple of things. One was T.S. Eliot's theory of the objective correlative - a person, place or object that symbolizes a problem, an idea or a situation, and exerts a strong emotional pull on the reader.

So, for example, I might write a story about a storm in your city yesterday that dumped an inch of rain in an hour. You, dear reader, will yawn.

However, if I tell you that a little girl named Sarah was walking her new puppy, Starlight, down the streets of your city when they were caught in the downpour, you might stir.

If I elaborate a bit further, telling you that in the chaos and commotion of that sudden downpour, Starlight slipped through his collar, ran into the street and was killed by an investment banker in a cherry-red Porsche, rushing to collect his annual bonus, I can practically hear you yelling, "but what happened to Sarah?" This imaginative extension is something every writer knows is important; as health writers, it's absolutely critical to the work we do. For their own sakes, our readers shouldn't put our stories down.

The second thing I thought about came to me as I was reading Stephen Koch's excellent book on craft, "The Writer's Workshop." Koch, who taught creative writing at Columbia and Princeton universities, aims his book at the fiction writer, but the daunting task we face as health journalists makes it good reading for us as well.

Koch quotes Chekhov, who was a physician as well as a writer of short stories: "I feel more confident and more satisfied when I reflect that I have two professions, and not one," Chekhov said.

"Medicine is my wife, and literature is my mistress. When I get tired of one, I spend the night with the other. Though it's disorderly, it's not so dull, and besides, neither really loses anything through my infidelity."

To put it much less eloquently, the task of a health writer is to toggle back and forth  between the science of a story and its humanity, to move constantly between the facts, data and statistics that give a story heft, and the irritating voice that asks, "but why the heck should I care?"

If you need an example of a writer who does this, look no further than Colliver herself. Her latest project for the Endowment, an Oct. 21 article in the San Francisco Chronicle entitled "Severe mental illness robs years from the lives of victims," tells the story of Barbara Redfield, who watched her brother die on the streets of San Francisco. 

Homeless and mentally ill, Sherwood Roberts, Jr., was a big man fighting big demons. Like many in his situation, Roberts resisted care and needed it badly. Colliver deftly weaves into her story sidebars that show that those with severe mental illness are more likely to be obese (in part due to the medications they take for their illness), more likely to smoke, and are 2.7 times more likely to die from diabetes. 

Among the many shocking statistics in her story is that the percentage of chronically homeless people with serious mental illnesses now living in San Francisco "is estimated at 50 percent to 80 percent."

I did the math: That's as many as 5,211 people.

Colliver's story is part medicine, but also part literature. And after reading it, I felt two things: I knew much more about the science linking mental illness and life expectancy, and I cared much more about the kind of person I see every day on my way to work, one of maybe 5,000 souls caught in the downpour of mental illness, an illness that we absolutely know how to treat, and yet they slip through and die.

Thanks, Victoria.