In conversation: Dr. Sanjay Gupta

On writing medical fiction, cutting out meat, and why doctors need to own their mistakes

AP Photo/Mark Lennihan

Dr. Sanjay Gupta is best known as the chief medical correspondent for CNN and as a special correspondent for CBS. He’s also a practising neurosurgeon, on the faculty at the Emory University School of Medicine in Atlanta, and the author of two bestselling books of health advice, Chasing Life and Cheating Death. Gupta has now written a novel, Monday Mornings,published last month. Its title refers to the weekly morbidity and mortality (M&M) meetings where doctors at the novel’s fictional hospital, Chelsea General, discuss recent surgeries, including instances of medical error.

Q: What inspired you to move to writing fiction?

A: It was driven by the content. I kept a lot of notes when attending M&M meetings for 20 years. As I looked over them, I realized they contained a lot of amazing stories. Originally, I thought I’d write a book about medical mistakes, which wouldn’t be the first. What I found, when I started to write, is that in order to be as candid as I wanted to be and tell the stories that I could tell, it needed to be fiction, because it wasn’t about implicating particular doctors or particular institutions. It was about giving people a real look at what happens inside a hospital after a mistake occurs: what happens to the doctors, and what happens to the hospital.

Q: Two of your characters, Dr. Park and Dr. Ridgeway, learn there is more to life than chasing a career; that life is about caring for your family and your community of patients. Which of your characters do you relate to most, and why?

A: The characters were all composites of people that I’ve met in my life. Dr. Villanueva was the purest of the characters. You knew how he was going to behave in almost every situation. There were no soft edges to him, certainly, and he was insatiable. Dr. Ridgeway represents what we fear about organized medicine—working at this fancy hospital with all the bells and whistles, but there’s a free clinic just down the road and those people could really use my help.

Q: What are the three lessons you’d like us to learn from your novel?

A: First, most people who don’t work in hospitals or in the medical profession are unaware that a morbidity and mortality meeting even exists. Two is to recognize—as unsettling as it is to think about—that, ultimately, medicine moves forward because people learn from their mistakes, and that means that mistakes happen. But the worst crime of all would be that it continues to happen because no one learned from it. What I’m always struck by is when something has gone wrong and when everyone sort of knows that a mistake has happened, but hardly ever does anyone really have a completely candid meeting, not to be punitive, but to hold each other accountable and to say, “Look, can we all agree that this was a mistake? And can we all figure out a way not to let that happen again?” I think if we did that, if we applied what we know as surgeons and from M&Ms, to all sorts of different facets of our society, I just think things would run so much better, and there wouldn’t be so much dabbling around the edges with regard to these issues.

Q: How did you get your start in the media world?

A: I was a writer; I used to do a lot of writing for various magazines and then I worked at the White House as a fellow, where I primarily wrote speeches—mostly health care-related things in the early ’90s. Around that time there was an increasing demand for health care reporting in broadcast. I had been approached in 1997 and I didn’t really fully know how that would work. Then in 2001, I was coming to Emory University looking at a job and Atlanta happened to be CNN’s world headquarters. In the airport, I ran into the CEO, who had approached me originally. It was one of those serendipitous things. There wasn’t much of a plan when I agreed to do some television. It just sort of evolved, and in many ways I just sort of designed it as I was going along.

Q: You’ve got a venture under way now to bring Monday Mornings to television, as Chelsea General. Had you planned for your book to be developed into something for television?

A: That was not at all the intent. In fact, it’s tough sometimes to convert books to television shows. David E. Kelley, who is a terrific television writer and someone I’ve admired for some time, got a hold of the book early on and called me. He’s done a lot of legal shows, and he’s done other medical shows, including Chicago Hope and others, and he very much wanted to turn this into a TV show. So we had a lot of conversations, and eventually a pilot and it’s been accepted. We have to finish editing the pilot and then go back to the studios and figure out if there are changes to be made and all that. So it can be a long process.

Q: You’ve got at least three careers going simultaneously—neurosurgeon, TV correspondent for two networks, and you’re a bestselling author. How do you do it all? When do you sleep?

A: Some days if I’m really being very productive, I’ll be working late into the night, and other days, not as much. It varies, but [I usually get] about six hours sleep. I compartmentalize pretty well. So, I will operate every Monday and every other Friday, and see patients in the office on Thursdays. So, that’s 2½ to three days a week as a neurosurgeon, depending on the week. With the media stuff, I have some time Tuesdays and Wednesdays for my TV and magazine writing, and when I travel, the schedule varies.

Q: You’ve said that much of what you’ve learned about preventative measures was learned outside of medical school. If you became dean of your medical school at Emory, what would you change in the curriculum?

A: Well, keeping in mind it’s very hard to make broad sweeping changes, one thing I would focus on is nutrition, early on. I’d love to have a lot more focus on prevention. Some of the medical schools, certainly, over the last 20 years since I graduated, have gotten better about that, but not all. I’m always amazed at how poorly nutrition is either understood or taught and it’s sort of reflected in the practices of physicians today. I would rather see our patients never get sick in the first place; I think one place that begins is through smart nutrition, and doctors should be smart on this. They should be able to educate their patients. We shouldn’t be going to pills and procedures and diagnostic tests full of radiation so quickly.

Q: I know that you’ve worked hard to spread the message about prevention. What do you advise in the way of nutrition?

A: Very pragmatic sorts of things. One thing I try to do is to eat seven different coloured foods every single day. Two, is I would try to eliminate or greatly reduce meat intake. We’ve eaten meat, as a species, since the beginning of our existence, but we also combine that with lots of other things. We don’t exactly chase woolly mammoths through the forest anymore to get our meat. We sit down and eat meat all the time, and I think it’s probably one of the more significant risk factors for cardiovascular disease, along with sugar intake, which is something I would also greatly reduce. I think sugar is a calorie like no other. I think of the way it’s metabolized in the body, the way the liver becomes fatty as a result, and the way that your lipid levels can respond to sugar. Leaving aside diet for a second, I’m not a big person on gyms. I think that gyms can be a great idea, but I think the point is this: I don’t think the human body was designed to either sit or lie for 23 hours and then go to the gym for an hour a day. I think the more natural movements you can have in your daily life, the better.

Q: We’ve heard rumours you were considered for the surgeon general role by President Barack Obama. Had you accepted, what would have been your first act as surgeon general?

A: I would try to make us a healthier country and make sure that more people had access to health care. With regard to prevention, we have some incredible health tools and innovations nowadays that we didn’t have even a decade or two decades ago, but they’re not available to everybody. I think we’ll look back on this chapter of our collective history and say, “Well, that was pretty embarrassing that we did all these wonderful things and we made so many things possible in our lifetimes and yet people still died of preventable diseases.” I don’t think anyone finds that acceptable.

Dr. Elaine Chin is a regular contributor to Maclean’s, Canadian Business, Chatelaine and CityNews.