Prescription for award winning fiction


An oncologist has just won the Francis Mac Manus competition with a story which was inspired by his work in a Cork hospital, writes FIONOLA MEREDITH

WHILE THERE is plenty of fiction about doctors, there is very little actually written by doctors themselves.

That’s why a new prize-winning short story by Co Louth-born oncologist Austin Duffy is so unusual.

Duffy has just won RTÉ Radio One’s long-running Francis Mac Manus short story competition with his story, Orca, which was inspired by Duffy’s own medical experience working the lonely night shift as a young doctor in a Cork hospital.

RTÉ producer and competition organiser, Séamus Hosey, says the story casts new light on “the relationship between medicine and literature, and how a medical practitioner depicts from the inside the harrowing and stark world of a cancer ward”.

Duffy, aged 36, now works as a staff clinician at the National Cancer Unit in Bethesda, Washington DC, where he specialises in the treatment of gastrointestinal cancers.

But unbeknown to his work colleagues, Duffy has been quietly working away at his own writing, getting up early to get a session in before his shift at the hospital. And now he has won a €3,000 prize for his efforts.

“Up until now, it’s been my dark little secret,” he laughs. “But writing has become an important part of my life, part of my daily routine. I like the craft of writing. The act of putting the words in order is satisfying, no matter what the subject matter is.”

It’s clear from reading Orca – which explores an encounter between the doctor narrator and Ruairi, a young man dying of cancer – that Duffy’s medical knowledge enlivens his writing, making it stark, vivid, almost uncomfortable at times.

He describes Ruairi’s cancer as “lit from the inside by immuno-histochemistry like a stained glass window”; he speaks of a needle feeling “soggy in the bone”.

A scan of Ruairi’s lungs shows tumours “hanging from his bronchial tree like ripe fruit”. There are references to vitamin K, clotting factors, trocar needles.

So how big a part does Duffy’s identity as a doctor play in his writing? “Because of my job, I do have access to terms and terminology, a store of words. It’s like a second language, and I suppose this can only be useful. But I’m not sure that my medical training has influenced me as a writer.

“My career does influence the way I look at life, but it is difficult to separate this out from what would have been my outlook regardless.”

Evidently, Duffy does not want to be typecast as an exclusively medical writer. In fact, he’s cautious about focusing too much on ill health.

“Writing about illness can be tough. It can be like using too much black paint – you end up killing the story.”

Duffy says he has been writing on and off since his schooldays in Dundalk.

Apparently his father encouraged him to read widely by Sellotaping money inside the backs of books to ensure he had an incentive for getting to the end – a strategy which may have eventually paid off.

In 1998, Duffy graduated in medicine from Trinity College Dublin and spent a year in Cork as a registrar, which provided the background and setting for his winning short story.

But it wasn’t until 2006, when he moved to New York and joined the well-known Writers’ Studio in Greenwich Village, that his own fiction writing really took off.

Attending the school, founded by Pulitzer prizewinner Philip Schultz, gave Duffy a structured approach to his work, as well as an incentive to persevere in a world very far removed from his day job in the world of cancer research and treatment.

“I really took to it,” says Duffy. “The external stimulus of the workshops got me into the discipline of writing every day.”

He first started Orcaa couple of years ago, and reworked it “umpteen” times before submitting it for the Mac Manus prize.

As he admits modestly, “these things don’t come easily to me”. Duffy says he is influenced by short story writers such as Javier Marias, Denis Johnson, Roberto Bolano and Colm Tóibín, as well as Joyce and John McGahern.

“I’m not sure what the common thread is except that there’s a truthfulness in them. I tried to write like Marias once and it wasn’t pretty.”

Writing that engages with medicine can be very powerful. Recognising this, the British-based Wellcome Trust Book Prize offers a £25,000 award each year for the finest fiction or non-fiction book on the theme of health, illness or medicine.

The 2010 prize was won by Rebecca Skloot for The Immortal Life of Henrietta Lacks, a harrowing work of non-fiction which tells the story of a poor Southern tobacco farmer whose cancer cells, taken without her knowledge, became one of the most important tools in medicine.

Of course, you don’t have to be a doctor to write fiction in the guise of one. As research for his novel Saturday, which describes a day in the life of neurosurgeon Henry Perowne, Ian McEwan famously spent two years work-shadowing Neil Kitchen, a neurosurgeon at the National Hospital for Neurology and Neurosurgery in London.

It’s true that writers who are medics themselves are not unheard of either – William Carlos Williams, Rabelais, Chekhov, Somerset Maugham and the late Michael Crichton were all doctors. Yet few practising doctors today turn their hands to writing fiction.

Despite the ready source of inspiration that his job offers him, Duffy is wary of mixing the worlds of medicine and literature.

His “dark little secret” may be out of the bag now, but he doesn’t want to become known as a doctor-writer. “I’d like to keep my two lives as separate as possible,” he says.

Orca, read by actor Hugh O’Conor, will be broacast in the first of the Mac Manus Season on Monday, June 6th in The Book On One slot at 11.10pm on RTÉ Radio 1

Extract from Orcaby Austin Duffy

Winner of the Francis Mac Manus short story competition 2011

‘You can’t beat the feeling of coming to the end of a night on-call. When you’ve got to the morning without anyone dying on account of some vacancy in your medical knowledge. It was close though. All evening there’d been calls about Ruairi. His dressing was seeping with blood at the spot on his hip I’d drilled into earlier that day with a large trocar needle, hand-held like a power drill and bevelled, for bone marrow biopsies. My advice over the phone had been simple. Keep with the pressure dressings and watch the blood pressure. Then around eight, Debra called. She’d just started her night shift. You can see it pumping, she said, you’d be as well to come in. I didn’t argue. Sometimes doing marrows you can be unlucky, hit a small artery. Potentially cause a bleed out. Sort of the opposite to an oil-strike, luckwise. Sure enough, when we peeled back the dressings there was a good trickle coming from the spike hole. Took hours to quell it. His blood pressure started to hover low. Vitamin K and clotting factors did the trick eventually. His mother came up to me afterwards and asked, is this normal with cancer? I told her no, it wasn’t.

I turned the corner by the brewery then crossed the footbridge to the North Mall. At that point you can see the river for some length before it bends into grey walls. A complete moon was over where the open sea would be. Most of the light was coming from streetlamps, hunched over the footpath like lanky tulips. They threw my shadow on the water as I walked under them.

I’d only met Ruairi and his mother a few days previous in outpatients. He came referred after noticing a lump on the side of his nose. Looked like a horse kick. He was into horses. When we did a scan of his lungs there were tumours hanging from his bronchial tree like ripe fruit. Tests showed small round blue cell tumour, which, believe it or not, was the technical term. When the pathologist announced it at the multi-disciplinary conference it was the first time I’d ever heard of it.

A very primitive . . . aggressive tumour, the pathologist said, poorly differentiated . . . hasn’t evolved much . . .

Like a great white shark, someone said.

I suppose so, said the pathologist.

Small round blue cells, Like tiny irises. There was a picture shown, projected from the microscope onto the back wall. It certainly didn’t look like a vicious cancer, lit from the inside by immuno-histochemistry like a stained glass window. The pathologist pointed out the characteristic features with a bright red dot, showing clumps of cells, a bit bloated, suspended in serum, not very blue actually. They looked like the frogspawn I’d dip jamjars into as a child, then place on a windowsill and watch day by day as the tadpoles evolved. Sprouting mini-hindlegs, then weeks later released into the grass at the back of our house.

He kept texting on his mobile phone throughout that first outpatient visit. I kept waiting for his mother to tell him to stop. Will it take long? was the only thing he said. As if cancer was school work. I looked at him severely, thought to myself, one of those immortal teenagers, did he not listen to a word I was saying? Had he never heard of cancer? What he really means doctor, his mother said smiling, is will he be long away from the horses? Hopefully not too long, I said. Forget about the fucken horses was what I was thinking. He wanted to be a jockey but had grown too tall. Hoped now to be a trainer. He prefers horses to people you see, said his mother ruffling his hair.

He looked down and away, red-faced, embarrassed, his thumbs still working away on the phone. Mam!! Ah he’s still my wee pet, she said, my wee fella. Mam will you shut up will ya!