The Writer's Learning Curve

Before plunging into a sunny Sunday comprised mainly of trying to catch up on Writing Salon tax bookkeeping/itemized deduction duties (given that I'm three months behind) I decided to preface this daunting task (daunting for ME, the poet/photographer type, not the accountant/math type) by taking 30 minutes to read an essay by a surgeon named Atul Gawande, which was published in the New Yorker a few years ago.

At the top of the essay is this editor's intro:

"Practice, practice, practice" . . . is as true for surgeons as it is for musicians. Atul Gawande, who has chronicled his own surgical training with honesty and humor, shares his experience—and anxieties—about the way doctors learn their skills: performing supposedly routine procedures on unsuspecting patients.

Gawande describes in harrowing detail how these procedures are not necessarily "routine" at all—not when the person performing them is an intern or a resident. You see, the thing is, surgeons have to begin at the beginning, just like anyone else learning a new skill. There has to be a first time, and a second and a third...before the student surgeon gets to the hundredth or thousandth time. There has to be PRACTICE, and the practice has to be done on real live humans. Not animals. Not cadavers. Real live people.

Anyway, Gawande talks about the training that surgeons go through, and I found this paragraph to be a good validation of what I already know to be true (not because of studies but from years of experience):

"There have now been many studies of elite performers—concert violinists, chess grand masters, professional ice-skaters, mathematicians, and so forth (ME: you can add "famous writers" to this list)—and the biggest difference researchers find between them and lesser performers is the amount of deliberate practice they've accummulated. Indeed, the most important talent may be the talent for practice itself. K. Anders Ericsson, a cognitive psychologist and an expert on performance, notes that the most important role that innate factors play may be in a person's  willingness to engage in sustained training. He has found, for example, that top performers dislike practicing just as much as others do. (That's why, for example, athletes and musicians usually quit practicing when they retire.) But, more than others, they have the will to keep at it anyway.

Gawande devotes a large part of his essay to describing what his learning curve was like for the difficult and scary procedure of inserting a "central line" into a patient's chest. Oh my god. What an eye-opener this was for me. Learning this procedure did not come easy for Gawande; time and time again he made all KINDS of mistakes with this procedure, ranging from minor to major. No, he didn't kill anyone, but he came darn close, and he knew of other interns/residents who HAD killed patients simply because they hadn't had enough practice and basically just blew it!

Toward the end of the essay he describes the day when he finally, finally GOT it:

"S., the chief resident, was watching me this time, and when everything was ready I had her tip him back, an oxygen mask on his face. His flesh rolled up his chest like a wave. I couldn't feel his clavicle with my fingertips to line up the right point of entry. And already he was looking short of breath, his face red. I gave S. a "Do you want to take over?" look. Keep going, she signaled. I made a rough guess about where the right spot was, thought it wouldn't be long enough to reach through, but then I felt the tip slip underneath his clavicle. I pushed a little deeper and drew back on the syringe. Unbelievably, it filled with blood. I was in. I concentrated on anchoring the needle firmly in place, not moving it a millimeter as I pulled the syringe off and threaded the guide wire in. The wire fed smoothly. The patient struggling hard for air now. We sat him up and let him catch his breath. And then, laying him down one more time, I got the entry dilated and slid the central line in. "Nice job" was all S. said, and then she left.

"I still have no idea what I did differently that day. But from then on my lines went in. That's the funny thing about practice. For days and days, you make out only the fragments of what to do. And then one day you've got the thing whole. Conscious learning becomes unconscious knowledge, and you cannot say precisely how."

This is something I try to get across to students in my classes, especially those who take the Daily Write Round Robin class. There are impatient students who want you tell them the shortcuts to success. Isn't that your job as a teacher? To deconstruct the process of writing? To spell out the elements of craft? Well, my answer is: yes and no.

We can show you examples. We can give you models to emulate. We can break it (the craft) down into many manageable fragments (plot, character, description, setting, point of view, concrete versus abstract, dialogue, etc.) that can be discussed one by one.

But that alone is not enough. Like it or not, you still have to practice. Over and over and over and over. . . until conscious learning becomes unconscious knowledge.

Comments

[linda]

This is a great post. Thanks.

[mary ann stein]

Great post. I love this doctor and we know he is fighting for socialized (tee hee) health care. OK,
now I'll do my daily writes.