Ten years ago, Irv Yalom and I—along with Audrey Shafer and Larry Zaroff—met at my house to form what would then become the first Pegasus Physician Authors group.  Our goal: to preserve the art of medical storytelling that has been part of medicine since its inception. Science had changed medicine dramatically during our careers, mostly for the better.  But all of us—Irv and I as psychiatrists, and Audrey and Larry as an anesthesiologist and surgeon—had perceived the way that data and instruments could crowd the person out of the exam room, sometimes obscuring the patient altogether.

I met with Irv on the eve of publication of the inaugural Pegasus Review—a journal that I hoped would carry our vision into the future.  Irv was an early and avid proponent of using literature to deepen the clinical encounter, and vice versa. Just as Irv pioneered a novel style of psychotherapy (the existential approach), his writing–“Love’s Executioner,” “The Schopenhauer Cure”—has been credited as founding a new literary genre: the psychiatric case tale.  Along the way, Irv has become first bestselling author at Stanford medical center—a tradition that now includes Abraham Verghese and Paul Kalanithi, among others—and an inspiration for the rest of the now 100-plus Pegasus Physician Authors.

Irv’s home is in Palo Alto, on a slight slope towards the coastal range.  It is on a small road, protected on both sides by high walls of green, easy to miss if you blink while driving up the hill.  But as you approach the house, the road opens up invitingly. The house to the right, the garden to the left, and at the bottom of the slope, a separate small building: the inner sanctum. It is here that the stories Irv writes about unfold. Its entryway is loaded with Irv’s beloved bonsai trees, whose twisted stems always remind me of the inner conflicts that are being brought to the doctor for restoration, growth, and healing. Inside are bookshelves and a big writing desk.  In the room’s center, there are several inviting looking chairs. “Come, have a seat,” they seem to say. “Tell me all about it. Let’s figure this out together.”

     Irv sat opposite me, wearing one of his elegant hats. As the dialogue unfolded, he stayed there, speaking in short and even terse language. I was used to that; Irv is not only one of the most famous and productive physician writers at Stanford.  He is also my friend and confidant. I was excited to hear what he had to say.

Hans: Good to see you, Irv.  As we publish our first edition of THE PEGASUS REVIEW, I want you to help people understand why it is so important that doctors should write.

Irvin: One of the great teaching tools of medicine is the case report, the story about how a patient got to where they are and how they can get better. Every time a patient walks into my office, I am curious about what I am going to hear. What will this story be? And then you can use the tools of creative writing to make this case come to life. It is a teaching tool.

Hans: So doctors should write to educate. The young among us, the patient, and the public in general. Does the writing also help us, the doctors?

Irvin: Yes, naturally. Putting something in writing helps us putting something behind us, transforms the quotidian suffering and disability into something higher and deeper.

Hans: What do you say to people that think doctors writing creatively is a waste of time –[that] they should be current in their respective specialties [and] that’s enough. That they should keep up with the incredible pace of research, which helps us saving so many lives.

Irvin: Well, then you have a risk of doctors descending into hell.

Hans: You mean, become depressed, worn out, demotivated, or even abusive and addicted to drugs and alcohol?

Irvin: Yes. We need to be able to put misery behind us and re-charge.

Hans: Do you think such readings are a reason why creative non-fiction is the most popular literary product right now? The public gets to know us better? You certainly never have been secretive about this aspect of our work.

Irvin: Well, that might be one reason. The other ones probably have to do with curiosity and reaching for something higher.

Hans: So –  no Wizards of Oz, sons and daughters of Apollo, just people with a lot of knowledge and skill, who also have their limits.

Irvin: Exactly.

Hans: So we also write to give words to the wise. Which brings up the young ones…medical students, medical trainees, doctors in their first years of practice. Our group has now well over a third such wonderful people in our midst. All of them are asking the question, in one form or another, how can I pursue this dual interest in the humanities and medicine? Can I make a career of this? What should we tell them?

Irvin: Running on these two tracks will make you the best doctor and writer you can be. Doctor, because you will be able to see the world with the patient’s eyes. Writer, because you will have real stories, deeper stories, told from a very privileged point of view.

Hans : I still remember the first books by you I read: Ginny – A Twice Told Therapy and your group psychotherapy textbook. I used the textbook in the 70’s all the time. But I loved Ginny, this view of the private worlds of a patient and even yourself, showing the process of healing in psychiatry. I always thought this was a very courageous book to write.

Irvin: Yes, both these books are still alive within me. A good start. The case stories and vignettes from the textbook caught many people’s attention. They also showed me I could really be a writer.

Hans: As your writing unfolded, do you think something grew that was always present, or did you learn along the way?

Irvin: I always was a voracious reader, enjoyed stories and tried my hand at poetry from my teen years forward. It was something in me, but it took a great deal of refinement and work to turn it into good writing. Being at Stanford in the medical and humanistic community, I got lots of help and input. Toby Wolff, who is on our advisory board now, was one of those people. But help also came from my agent of many years, my editors and publishers, and then of course also the readers. And in the last 10 years, the people in our workshopping group have contributed as well.

Hans : I was so happy in 2008, when you and others agreed to form a group of physician writers. Its been very educational for me, and probably all the others in the group, to see your latest stories, books and your memoir in statu nascendi. I have always admired your ability to bare your soul – in your books and in group. A real privilege to see this happen. Why and when did you decide to shift from science to creative writing?

Irvin: Well I started in earnest with David Hamburg’s help. He was a very good chair of our department. He gave me tenure early and strongly encouraged me to write. I felt liberated: I had always considered the greatest achievement for me would be to write a creative nonfiction or fiction book. And now I was free to do this…And of course it has been my privilege to be a member of my Pegasus group.                           

Hans: Thanks, Irv. This is a good place to stop. A clarion call to future generations I completely agree with. THE PEGASUS REVIEW will be a medical literary journal which will carry this message on for many years to come.