Today, Hartford Books Examiner welcomes J.D. Kleinke.
Kleinke is a medical economist, author, health industry leader, and patient advocate who has been instrumental in the creation of four health care information organizations. A regular contributor to the policy journal Healthy Affairs, Kleinke has also contributed to numerous other publications. He is the author of two non-fiction titles—Bleeding Edge: The Business of Health Care in the New Century (1998) and Oxymorons: The Myth of a U.S. Healthcare System (2001).
Kleinke will be in Connecticut on Wednesday evening to discuss his debut novel, Catching Babies (Fourth Chapter Books, $15.95), which he began researching and writing in 2003. (See event details below.) George P. Pillari, healthcare entrepreneur and co-founder of Solucient, noted, “This may be the great American medical novel,” while Peter Frishauf, founder of Medscape, said that Catching Babies “defines what it means to live the life of a young urban doctor.”
From the publisher:
Birth, and death. Two ends of the same spectrum. And sometimes the only person standing between is a tired, overworked resident with personal problems of her own.
Welcome to the world of Catching Babies. In the halls of a busy metropolitan teaching hospital, a group of OB/GYN doctors complete their residencies and embark on ambitious careers, all while trying to hold their lives together at the seams. Jay is running from a life he’s tried to leave behind, while Katie sacrifices everything she has to serve an endless parade of needy patients. Anna is out trying to save the world, while Tracy is trying to save twins dying in utero. Based on true stories from delivery rooms and labor decks, Catching Babies spins the doctors’ stories into a gripping mosaic of the obsessions, the anxieties, and the heroism of doctors who have chosen to preside over life’s greatest medical drama—high-risk childbirth.
Now, J.D. Kleinke gives us an inside look at the conception of Catching Babies…
1) CATCHING BABIES was originally conceived as a work of non-fiction. What inspired you to switch genres? How did you find the process of writing a novel in comparison to your other books and writings?
With Catching Babies, I actually switched back to fiction. In my early 20s, I wrote several dozen short stories and one-act plays, some of which were published in obscure literary journals, and one very dark, very young, brooding literary novel that was, despite my lack of efforts, nearly published. Luckily, I ran out of patience for starvation and struggle before I ran out of ideas or ambition, so I was saved from permanent professional obscurity by a massive derailment into the health care system. A few years into what would become an intense and captivating health care career, my writing re-emerged in radically different form: strictly non-fiction, highly technical, engaged in the practicalities of health policy and medical research. Catching Babies began in earnest as the next installment in my ongoing analysis of what’s best and worst about the American health care system, this one focused on women’s health and childbirth. But not that far into the process, there was an almost explosive re-emergence of my long dormant literary impulse; the stories I was gathering were screaming out at me for a deeper, literary expression. At the risk of sounding precious about it, I have to say that in all honesty, I had very little to do with the decision, actually. As a vehicle for expressing the incredible hope and anguish involved in obstetric medicine, Catching Babies really did want to be written as fiction, with all the drama, irony, suspense, and literary devices you now see in its pages.
2) The book is equal parts medical and human drama. How do you see the personal lives of caregivers as impacting their professional identities (and vice versa)?
They are hopelessly intertwined, and that’s one of the points of the book. These are people who have made extreme personal sacrifices – not just relative to most people, but relative even to most other physicians. The four-year OB/GYN residency is especially grueling on all levels; these mostly gifted and headstrong young people are forced to subvert their own needs, and press on through unspeakably horrible hours, days, weeks, months; and they confront, while still young, some of life’s greatest cruelties, some of the highest highs and lowest lows in any medical setting. By the time these folks are fully acculturated, their personal lives and identities have been deeply fused, for better or worse, and they inhabit what appears to the rest of us as a very odd, alien, occasionally frightening culture. This was another source of fascination for me with the subject, not unlike the fascination of a cultural anthropologist, a lot of it driven by, frankly, a kind of morbid curiosity. Where did these people come from, how did they all get so tough, and how do so many – though God knows not all – maintain their compassion through it all?
3) You cover both medical procedures and conditions in depth. Is it difficult to balance technical accuracy with reader-friendliness? Also, can you tell us about the pre-publication vetting process that a book such as yours is subjected to?
There are actually scant few good literary models out there for striking that balance between medical detail and artistic flourish. That was actually a problem for me at first, because I have learned to write by example, through a lifetime love affair with great books. So if I had to point to where I found examples and inspiration for my own approach to Catching Babies, you might be surprised to hear that it was two somewhat odd sources: from the better medical memoirs, and from the best of the medical dramas on TV. There are some wonderful physician memoirs out there: Pauline Chen’s Final Exam, Marc Flitter’s Judith’s Pavilion, Atul Gawande’s Complications, the personal passages in Sherwin Neuland’s and Oliver Sacks’ great medical non-fiction works. And while there have been dozens of medical dramas on TV over the ages, some of them garbage, and some glorified soap operas, many have actually been brilliantly done, thoughtfully written, carefully produced, shows that have managed to fold a great deal of highly technical medical and ethical content into great dramatic scripts. The absolute best examples of course would be the early years on ER and the later years onM*A*S*H. But so too the old Chicago Hope, China Beach, and St. Elsewhere. And episodes of House. These all may have been television, but in an earlier era, the same exact stories would have had the mass appeal in the form of novels – back when novels had mass appeal anyway!
4) You confront numerous issues that plague high-risk childbirth, both inside and outside of the delivery room. What do you see as being the most prevalent issues currently? Did you find that there were issues that you simply ran out of space to address?
I hope you can see, in the book or percolating just below its surface, the biggest legal, ethical, cultural, economic and political issues among the dozens I could have included. The ones I tried to focus on confront not only reproductive medicine and obstetrics, but all of the health care. Unfortunately, in obstetrics they are all turned up to “10.” I certainly don’t get to all of them in the book, but I believe I deal with the most important: the pervasive and perverse practice of defensive medicine, all driven by constant fear of medical malpractice lawsuits; the wounded healer problem, reinforced by the mindless non-system on bad auto-pilot; lack of access to primary care and prenatal by women outside the system; the absence of good data on what works and doesn’t work; the turf wars between types of providers, ultimately over money, that takes almost no account of what individual patients really want; the guinea pigging of the poorest women as subjects for residency training; the brutality and ugliness surrounding the imposition of one group’s moral beliefs on all women; and on; and on; and on! These are the big issues in all of health care, and they bear down especially hard on the most vulnerable women in our communities.
5) Caregivers often face a division between moral beliefs and ethical responsibilities. Are there any specific messages that you intended to convey in regards to this with your book? What has the response been like from readers?
This is a central theme of the book, and its message is or should be absolute tolerance and mutual respect for our diversity of views. When equally valid medical choices are available, no physician should impose his or her own personal values on a patient’s decision-making. That of course cuts both ways, especially when you toss in the abortion issue and the mostly unchecked problem of physician-patient transference or projection. When equally valid medical choices are available, no system should impose its values on any physician. Reproductive freedom and birth choices are sacrosanct; we are a society defined and driven by a rich diversity of great cultures, all with their own birth practices and beliefs; and beyond the issue of medical safety, all of these practices and beliefs deserve the full protection of the first Amendment’s separation of church and state. Period. This goes for doctors as well, who should never be harassed for their own beliefs. Needless to say, my sticking to such a strict constructionist view of these issues has angered many readers, on both sides of several issues. I specifically chose an abortion story that would ride right down the middle of the fence of medical necessity and morally-charged choice – if only to show the politicians and pundits that this issue is far more complex in the real world than any of them seem to understand. And yes, I have gotten some interesting hate mail for that story in particular.
6) What can you tell us about your upcoming projects? Would you consider writing a sequel to CATCHING BABIES?
Already writing it. I was deeply relieved to see what happened on page 330 – but given how well I know at least one of the characters involved, I’m a little worried about what happens on about page 331!
With thanks to J.D. Kleinke for generously sharing time and thought.
Thanks also to Lila Eidi for providing a review copy of Catching Babies and for facilitating this interview with the author.
J.D. Kleinke will be appearing in New Haven on Wednesday, May 25, at 7 PM to read from Catching Babies. Immediately following will be a discussion with the author and several Connecticut maternity care providers and health care reform advocates about how new systems of health care delivery can improve health and rein in costs. This event will take place at the Carriage House at The Grove, located at 71 Orange St. Parking is available on the street or in several public lots located downtown. For more information, you can call The Grove at 203-654-WORK or visit their web site.