In her memoir
Your Heart Is the Size of Your Fist (Brindle & Glass Publishing) Dr. Martina Scholtens shares her experience as a doctor specializing in refugee medicine and stories of refugees navigating new lives in North America. Today we chat with Martina about the differences and similarities between doctoring and writing, influential writers, and writing rituals.
All Lit Up: What’s the toughest part about being a writer?
Martina Scholtens: The self-doubt. I had worked as a physician for twelve years when I took time off to write this book. In medicine, you train for years, write the licensing exams, and get a diploma proving your legitimacy. But who’s a writer? How do you know you’re any good? Even when I wasn’t seeing patients, was writing virtually full-time, and had a book deal, I couldn’t bring myself to call myself a writer. I’m hung up on credentials.
I attended a narrative medicine conference in Iowa City in 2012, where half the attendees identified as clinicians and half as writers. Every physician introduced him/herself to me with the specifics: “I’m an interventional cardiologist” or “I’m a pediatric oncologist.” I was immediately oriented. Every writer said simply, “I’m a writer,” and I felt lost.
Clinic days are social, fast-paced, and full of distractions. I drive home certain of the value of my work. Writing days are quiet, deeply focused, and isolating. I go to bed wondering if I’ve been self-indulgent. Writing lets me create something, though. I never get to make things at the clinic.
There’s constant feedback as a doctor, most of it affirmative: from patients, colleagues, the regular paycheques. I wrote for months at my kitchen table with no feedback at all. And then the book comes out, and there’s some fanfare and applause—some of it literal. It feels like overcompensation for the months of lonely work. We don’t applaud the steady work, like seeing patients for years on end, or being a mother. We celebrate productions with a release date. It’s fun. It’s confusing and exhausting.
ALU: Which writers have influenced you or had the most impact on your own writing?
MS: In 1980 my older sister received Laura Ingalls Wilder’s Little House in the Big Woods for her seventh birthday. It was the first children’s chapter book in our home, and I remember the intoxication of reading it. The possibilities of my world expanded exponentially. The physical, financial, and cultural limits of my childhood dissolved.
I’ve always enjoyed writing that looks closely at the everyday. I love Emily Carr’s writing for that reason. She describes the different kinds of raindrop patterns on the roof of her trailer on Vancouver Island; it’s familiar and beautiful. In her childhood memoir The Book of Small, rather than going through her childhood chronologically, she writes a chapter on what she did on Sunday afternoons, one about her family’s Chinese servant, one about the local cemetery. As I read it I thought, if I ever write about the refugee clinic that’s how I’ll do it—a chapter on what they named their kids, one on gifts they brought me, one on the interpreters. I did initially organize the book this way, with about forty topics. I ended up reworking the material to provide a narrative arc, but it was Emily Carr’s book that gave me the idea for the initial framework.
I also admire Canadian novelist Miriam Toews. She takes a character in particular circumstances and pays such close attention to the details of their conversations and their everyday choices. I find her writing funny and moving. I particularly enjoy her observations on religion. I always read with a pen and make a mark next to lines or paragraphs that I think are extraordinary, and her books end up more marked than most.
Other favourite books include Annie Dillard’s An American Childhood, Bernard Malamud’s The Assistant, and Henry Roth’s Call it Sleep. Physician writers that I admire include
Shane Neilson and Daniel Becker (both poets).
Advice Martina favours.
ALU: Do you have a book that you’ve gone back and read several times?
MS: When I was a kid, an older lady from church named Mrs. Stadt gave our family several boxes of used books, including a worn paperback copy of John Steinbeck’s The Red Pony. I read it at age eight or nine. I reread it ten years later, and was shocked that it was about more than a boy and his pony. I’ve reread it in every decade of my life. It’s a different book every time I read it.
ALU: Do you have any rituals that you abide by when you’re writing?
MS: The house must be completely silent. Since I have four kids, this means I can only write in the early morning when they’re asleep, during school hours, or—once—holed up for a few days in the Empress Hotel in Victoria, BC. Paradoxically, I also write well when out to eat, alone, with a buzz of conversation around me.
I do three kinds of writing. One is journaling—what was memorable today? It might be a conversation, an idea, a gesture, something overheard, something that irritated me, something funny. I write just enough to jog my memory when I come back for it later. It is quick writing, meant just for me, and completely honest, and because of that it’s probably my best.
Another kind of writing is around themes that currently have my attention. For example, I recently came across the statement, “You can’t hate what you see up close.” I think there’s some truth there—as a physician, seeing patients at their most vulnerable, it is virtually impossible to dislike them. But then I thought, wait—I preferred the North Shore mountains when they were the blue background to life in Vancouver, over living right on their dripping green flanks in Deep Cove. I like them at a distance. And sometimes I like the idea of things—a job, or a course—more than the actual experience of my sleeves rolled up, doing the work. So I started a document to note which things I prefer up close and which from a distance, as I think of them. I’ll turn it into something, eventually. I have three or four of these theme documents going at a time.
And the third is purposeful writing, a book chapter or an essay. This writing always draws on the first two.
If I’m journaling, I need twenty minutes. If I’m adding to a theme document, five or ten. If I’m working on something specific, I work in two-hour blocks, with thirty- to ninety-minute breaks in between.
My writing life changed completely when I rejected the many insistent recommendations I’ve received over the years to write by hand. I use my laptop, where I can type rapidly, edit with ease, and use the search function. I will break things up by printing out a chapter or essay, editing by hand (usually while out to eat), and then typing the edits back into the document. And repeat.
My creative energy peaks in the morning and is depleted by mid-afternoon, and I try to use it judiciously. I make myself start every writing day by producing new material—at least two hour’s worth. Once that’s done, I let myself move on to editing previous material. Any leftover energy goes to research. I end each segment of writing time with something “good” to pick up next time.
Martina's workspace: "I’m not attached to a workspace. I write outside, at my desk, at the kitchen table, on the couch and on the bed. I need (a) silence, (b) pen or keyboard and (c) ideally, a cat."
ALU: Have you ever experienced writer’s block? What did you do about it?
MS: I no longer have the time for the luxury of writer’s block. I’m back to working full-time as a physician and I have kids. If I have a slot of time to write, I make every minute count. It’s the sitting down and starting that’s the hardest. Once that’s done I’m in flow within minutes. I always have multiple writing projects on the go, so if I feel stalled or bored with one I will work on another.
ALU: What question do you wish someone would ask you about your book?
MS: I’ve been waiting for someone to ask how being a physician and being a writer are similar. They both involve paying close attention, being endlessly curious, bearing witness, and reflection.
I also want someone to ask about my favourite part of writing the book. It was the organization. Taking hundreds of ideas and anecdotes, and grouping them by theme, linking them to each other, and forming some kind of narrative arc. Drawing connections—especially between things that appear disparate—is immensely satisfying to me. Come to think of it, that’s what I do as a doctor, too.
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Martina Scholtens autobiography:
I’m a family doctor who has practiced refugee medicine in Vancouver for the past dozen years. I’m currently doing further residency training, this time in Public Health, at UBC.
I live just outside of Vancouver in the seaside village of Deep Cove, with my husband and four kids (six to sixteen). We live in a weathered 1970s home on stilts, on a cliffside overlooking Indian Arm. The setting is serene, even if my home isn’t. Deep Cove is an outdoor lover’s paradise, with ocean in front of us and mountain behind. I’m partial to the indoors, personally. Culture over nature.
I love to impose order in my free time. I’m a ruthless editor—of words, possessions, my garden.
Things about me that surprise people: I’m an introvert. I’m highly irritable. I’m more conservative than you think.
My alter ego is a psychiatrist who lives on ten acres on Vancouver Island and drives a red Jeep with a border collie riding in the passenger seat.
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