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Monday, December 31, 2018

Writing a Book

by Robert Macauley

I could write a book about that…

But do I really want to? That’s the question I asked myself a few years ago, when I was invited by Oxford University Press to submit a formal proposal for a comprehensive book on the ethics of palliative care. So I reached out to mentors for advice, and they all said the same thing: Enlist twenty of your friends to each write a chapter, and you can be the editor.

Sage advice, which I didn’t take. Partly because I like challenges. Partly because I don’t really like the unevenness of multi-author texts. And partly because I drastically underestimated how much time and energy it would take to write such a book single-handedly.

Rita Mae Brown once said that “good judgment comes from experience, and experience comes from bad judgment.” I’m not sure if my decision constitutes bad judgment, but it gave me a lot of experience that might be helpful to others who are thinking about writing a book.

Can you really write a book about that?

In formulating my outline, I divided the content into thirds:
   - One-third I could write without much preparation (for the pediatrics section, it helped to be a pediatrician)
   - One-third I knew a bit about and needed to deepen my knowledge (like palliative sedation)
   - One-third I needed to start from the ground up (for the dementia section, it didn’t help to be a pediatrician)

In the process of writing, I realized that I had a long way to go in areas where I’d thought I was savvy, while knowing more about other stuff than I’d given myself credit for. So it’s important to determine where you’re starting from and how far away is the finish line.

Also figure out how much “credit” you’ll get for writing a book, such as by inquiring of your dean/chair/promotion and tenure committee. Each chapter was expected to be the quality of a publishable journal article, but most institutions give you more credit for twenty peer-reviewed publications than one book.

Even if you can write a book, do you want to?

The British comedian Peter Cook once said:
I met a man at a party and he said, “I’m writing a novel.”
I said, “Really? Neither am I.”
The idea of writing a book is romantic, but actually writing one is a slog. It involves setting (and missing) lots of deadlines, declining cool opportunities that could distract from the “big project,” and encountering annoying headlines about how textbooks are dead.

Does the world need the book you want to write?

There are a lot of books out there. Some address really narrow topics that appeal to only a few people, while others try to take a unique spin on a topic that others have already covered. In rare cases, there may be a need for something that hasn’t been written.

In researching my book proposal, I was ready to find a comprehensive book on palliative care ethics that was clinically relevant, historically informed, and philosophically rigorous. If someone else had already written it, I was ready to walk away. But no one had, so I gave it a shot.

Be strategic

   - Before starting, read the contract carefully. My attorney (a.k.a. my sister) reviewed mine, and this time I (thankfully) took the advice. Evidently, even boilerplate language can be changed if you stand your ground.
   - Block time on your calendar, rather than relying on the crumbs left over from a busy clinical day. (A sabbatical is a great idea if you can pull it off.)
   - Be willing to cut into personal time (like evenings and weekends) to find bigger chunks.
   - Be strategic with teaching topics: when I was asked to give a talk, I would choose a subject covered in the book so all that lecture prep fit seamlessly into the manuscript.
   - Dare to satisfice, which is a combination of “satisfy” and “sacrifice.” In other words, if you demand that every word be perfect, every reference be the most relevant and up-to-date, etc., you’ll never make it to page 200 (let alone, in my case, to page 570).

Gather a team of rivals

I did call those twenty knowledgeable people but instead of asking each of them to write a chapter (as my mentors had suggested), I asked them to offer feedback on one. Taking a lesson from Abraham Lincoln, who famously compiled his executive cabinet from old rivals, I made a point of not choosing “yes-people.” No former students or colleagues who seem really smart because they tend to agree with me.

If I asked friends to review a chapter, they had to be good enough friends that they felt comfortable using strong words, like weak and sucks. If I asked for help from folks I didn’t know as well, they had to be an expert in that field, ideally, someone whose viewpoint differed from my own. If there were holes in my arguments, I wanted reviewers to find them. And I was struck, time and again, by the generosity of people who made time to review a chapter and the candor of those who couldn’t.

There’s a thin line between love and hate

I loved the idea of writing a book. I was thrilled when the proposal was accepted. I felt fortunate to have a reason to dive deeper into the field I love.

Over time those emotions shifted. I resented lost opportunities. I became demoralized when the finish line stayed perpetually out of sight. I hated—there, I said it—reading a section over for what I thought was the final time, only to discover weak arguments and outdated citations.

What kept me going? The point of no return. By the time I fell out of love with the idea of writing a book, I’d invested too much time and heart to turn back. So I named the emotions I was feeling–I am a palliative care doc, after all—and kept on writing, being strategic, satisficing, etc.

The end

I never really believed it would get done. When my editor called to say that the books had been printed and were being shipped to by sea, I thought for sure the freighter would sink, the Russians would hack my computer and erase all the electronic copies, and I would be left with piles of highlighted articles that I barely remember reading.

But a week later a box of books arrived at my door, complete with heart-warming “blurbs” from some of my palliative care heroes. My kids saw Dad’s name on the cover, and the dedication to them on the first page. The omnipresent guilt of the last five years—when no matter what I was doing, I was perpetually aware that I could have been working on the book instead—dissolved into thin air.
And in that moment, it was all worth it.

Robert Macauley, MD, FAAHPM, is Cambia Health Foundation Endowed Chair in Pediatric Palliative Care at Oregon Health and Science University. His textbook Ethics in Palliative Care: A Complete Guide—which Ira Byock has called “a new classic” and Diane Meier describes as “a brilliant distillation of history, culture, and clinical practice”—was published by Oxford University Press.

Monday, December 31, 2018 by Pallimed Editor ·

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