Something Constructive Out of Chaos: Talking with Suzanne Koven


I first met Dr. Suzanne Koven when I was a medical student with aspirations of becoming a writer. Our first meeting was in the sun-soaked atrium of the medical school, flanked by marble busts and imposing columns. With her floppy curls and chunky jewelry, Dr. Koven immediately cut through the pomp I had grown accustomed to in medical school.

In that first meeting, I rambled about all kinds of things I wanted to write about—organ transplantation, psychiatry, sexism in medicine. She listened patiently, then immediately probed deeper. “Why is writing so important to you? Why not just focus on becoming a doctor now, and write later?”

I’d soon come to learn that this was her characteristic style, to pause and ask, What is this really about? It’s an approach that serves her well as a primary care physician at Massachusetts General Hospital (a teaching hospital of Harvard Medical School) and in the many workshops she leads as the hospital’s Writer in Residence. Throughout my remaining years in medical school, Dr. Koven mentored me closely in writing, and by extension, life. She showed me that both medicine and writing are more about the questions we ask than the answers we think we know.

In May 2017, the year I graduated from medical school, Dr. Koven published an essay in the New England Journal of Medicine entitled “Letter to a Young Female Physician.” The letter was inspired by an exercise at her hospital in which the interns—newly minted doctors just beginning their residencies—write letters to themselves to open six months later. In her own letter, Koven identifies an insidious form of self-doubt has permeated her career. In addition to the overt sexism she sometimes experienced, she learned to denigrate her own strengths, especially those traits deemed “soft” like empathy and attentive listening. For years, she didn’t feel good enough, because being good enough meant always knowing, doing, fixing, and curing. But these things are often out of a doctor’s control, and they aren’t necessarily what patients value most.

Koven received an outpouring of responses from people around the world, especially women physicians, who saw themselves in her letter. Now, it’s the title essay of her new memoir, Letter to a Young Female Physician: Notes from a Medical Life, published last month by W. W. Norton. Koven’s book is deeply personal, often self-deprecating, and not meant to be any sort of self-help guide or doctor’s dictum. Perhaps precisely because she doesn’t try to be prescriptive, her wisdom as a doctor, a mother, a writer, and a woman finding her way in the world shines through. [Read an exclusive excerpt from the book here. – Ed.]

This spring, we turned the tables on our first meeting. This time I got to ask the questions, and we spoke about the truth about feeling like a fraud, the differences between medicine and writing, and what mentorship really means.


The Rumpus: In your 2017 essay that inspired your book you wrote, “I’ve been haunted at every step of my career by the fear that I am a fraud.” What does the word “fraud’’ mean to you?

Suzanne Koven: Through the course of writing the book I forced myself to really examine that. It’s kind of nonsensical. Like what would the opposite of it be? Would it be for me to be perfect? That’s not attainable; that’s not realistic. I think to say that “I feel like a fraud” is a shorthand for a lot of different kinds of thoughts and emotions. But none of them really is fraud. Fraud doesn’t really quite get it, nor does impostor. We’re not really saying when we say we feel like an impostor that we’re masquerading. I think what we’re really saying is, what I was saying is, I actually am who I am. And I’m not that great. For me a very key feature of this is the belief that other people simply do not feel this way in the same way. They can’t.

And so for me, talking about it, interviewing people about it, writing about it, and particularly, writing that original essay and having people from all over the world say they felt the same way—made me think gee, we can’t all be impostors. We can’t all be frauds. It just statistically doesn’t work.

Rumpus: Do you ever feel like a fraud as a writer, or has it just been in relation to medicine?

Koven: No, I don’t. I never really even thought about that before. The only time I’ve ever felt like a fraud when I’m writing is when I started to write professionally and I was writing the way I thought a doctor ought to write, being authoritative and informative or journalistic. I was doing a little bit of an Atul Gawande imitation. And that just wasn’t my voice and I knew it. As time went on though, I felt more and more emboldened to write exactly what I wanted to write.

Rumpus: That’s so interesting to me. You went to this prestigious medical school and felt like a fraud, but then in your forties you’re sneaking off to take writing classes and you didn’t feel like a fraud?

Koven: Here’s the other saying about this impostor syndrome stuff: the more you achieve, the more brass rings you accumulate, the more you feel like an impostor. You think, Okay, I’m a fraud as a premed because I’m really just an English major and I’m hanging on to organic chemistry by my fingernails. However, if I get into one of these really fancy medical schools I applied to then this slate will be wiped clean and I will not feel this way anymore.

But the opposite happens. Every rung you climb, you feel more unworthy. There are a lot of famous, accomplished people who have said publicly that they have impostor syndrome. So you know, being a Wimbledon champion, or a Supreme Court Justice, or a Hollywood star doesn’t fix your impostor syndrome—in fact, it makes it worse.

When I was sneaking off from the hospital to take writing courses the stakes were really low. Nobody knew, nobody cared. Nobody had any expectations. It was entirely my own little thing. It was entirely internal. It was not external. And so it didn’t fan the flames of my impostor syndrome in the way going to Johns Hopkins Medical School, becoming the Chief Resident, or getting my first job at Mass General did. Those were like impostor syndrome superfood.

Rumpus: Often in conversations about writing and medicine, we talk about the ways they overlap and what they have in common, which I want to hear your take on. But I’m perhaps even more interested to hear from you how they’re different.

Koven: This is a wonderful question. The ways in which they’re similar we will dispense with, because it’s very easy. I think the practice of medicine and writing are both deeply rooted in story and curiosity about the human condition and empathy for other people. And it doesn’t hurt to have had a little bit of training in persevering when you’re tired and uncomfortable, because writing is very uncomfortable.

But they’re really different. Medicine is pretty linear. Once you get into medical school, you don’t get rejected too much after that. You may not get your first-choice residency. Maybe you don’t match that first year. But essentially you’re following on a path that is pretty well defined.

In writing there is no path. There are no rules. You can get an amazing publication and then you get a stream of rejections. Also, in medicine there’s no encouragement to be messy, to make mistakes, to try something, throw it out, start it again, to dabble around, you know?

The idea in medicine is to be efficient and accurate and to get it right the first time. And in writing, you don’t want to get it right the first time. You want to make a mess, you want to be expansive. Though I think there’s a little more of that in medicine than perhaps we sometimes realize.

Rumpus: You write in the book, “I’ve read somewhere that it’s a woman’s job to make life less awful for everyone else.” You explore that in relation to doctoring and motherhood. But as you developed as a writer, or in writing this book, did you feel that?

Koven: People who have read galleys of the book have said that this really isn’t just for doctors, this isn’t just a medical school graduation present. It’s really about growing into yourself. Which hopefully is universal, and certainly applies to one’s evolution as a writer.

Look, the repertoire of human psychology is fairly narrow, ultimately. Coming-of-age stories have a lot of the same features. Self-doubt, obstacles, reckoning with where one comes from. This is what the ancient Greeks wrote about. It is sort of fundamental to the human experience.

As far as making things less awful for other people, I tried in this book to write very honestly and to not sugarcoat myself or certain things that were painful. There’s a particular kind of self congratulatory doctor writing that I did not want to emulate. And there’s a kind of older doctor affect, that’s about “you kids don’t know how easy you have it.” I really didn’t want to fall into that tone. I feel like what I’m presenting is pretty unvarnished, both in terms of certain realities of medicine, sexism, racism, and of my own frailty and fallibility.

On the other hand, I didn’t want to be disingenuous. I have a pretty good life and I’ve had a pretty good career and I’m not a fraud and I’m not a failure. I hoped that by shaping a story out of all of this that I would make something positive both for myself and for the reader.

You could call that making things less awful, in the same way that my mother used to take the greasy bags from the deli and put them on a china plate. In a certain sense, isn’t that what all writers do? We have this sort of greasy bag of reality and we find our own platter and then we lay it out.

In fact, that’s what doctors do, too. We take the chaos of illness and the patient’s story and life, and we try in our own very imperfect way to organize it and make a diagnosis and a plan. I guess you could say that’s another way in which medicine and writing are similar. We try to make something constructive out of the chaos of a particular reality.

Rumpus: I felt, reading your book, that you wrote it for yourself, and that helped me. It’s an example I needed to see. Because as women in medicine, so much of what we do is take care of everyone around us and put ourselves second.

Koven: I did not set out to write a how-to book or an inspirational book. If it’s either, that’s great, but I wrote it to make sense of my own life. If that provides some sort of template or mirror for someone else, then that’s deeply gratifying for me.

Rumpus: You and I have trained in medicine several decades apart, yet a lot of what you write about I really relate to.

Koven: Which upsets me, that so little has changed.

Rumpus: You write about realizing in hindsight the sexism built in but that you didn’t quite see it in real time. Part of me envied that. I came to medical school with a background in feminist theory and gender studies. I almost knew too much and was very critical of the system, which made it hard to get through.

Koven: In medical training, for better and worse—and there was a lot of worse—there was this feeling, at Hopkins especially, of really being in the trenches together. We wore uniforms. We called ourselves Osler Marines. And as I say in the book, I think the reason I didn’t hate it was because I loved it. I was in a club. And I belonged in that club.

Now, all right, there were little details, like the fact that I got preeclampsia because, you know, pregnant women were not supposed to be doing this. But I felt I was part of the club. I was completely blind to the sexism. Which is kind of remarkable. We’re not talking about 1952. We’re talking about 1986 to 1990.

If I’m really going to be honest, I would say my insecurity is what saved me. Because I was so determined to succeed and, at some level, so sure that I wouldn’t, that I didn’t have the psychological real estate to be thinking about sexism and racism and all of the many things that were wrong with the system. I just wanted to succeed in the system.

In the book, I describe talking to my Black co-resident, who I call Edward. I had that conversation with him just a few months ago. I’m still, thirty-five years later, gaining new insight into this. I said to Edward, “How could I have bought in so thoroughly to a system that had so little regard for me?”

He said, “You got it all wrong. They loved us.”

But Edward and I knew that it wouldn’t take much for them to stop loving us.

Rumpus: You mentor a lot of medical students and younger doctors, including me. Your experience and expectations of medical training were in many ways so different than what they are today. How do you relate to the younger generation?

Koven: In some ways, heartbreakingly, the concerns that younger physicians come to me with are very familiar to me. I feel that there is this part of me that is your contemporary. Maybe that’s what people mean when they say, as my mother did with her book club, that as you get older, you want to make younger friends. They draw out that part of you that is vigorous and forward thinking. To me, talking with younger people and younger doctors is just pure joy. The biggest challenge, of course, is to let people walk their own paths even though you want to guide them.

Rumpus: When you mentor younger people, do you ever feel like you’re providing something to them that you wish you had had at their stage?

Koven: Oh God, yes. Hearing you say that almost brings me to tears. I have had many dear mentors. In retrospect, the best mentors I had weren’t forcing someone into their mold, but just helping someone form a vision for themselves that’s broader than what they themselves imagine. I’ve given a lot of thought to what mentorship means and the best definition I can come up with is that it’s somebody who has a broader vision of you than you do at any given moment. Or as a friend of mine said, “If you leave a meeting with a mentor feeling that your possibilities are smaller, not greater, then that’s the wrong mentor.” I think the mentors I had, even back then, did that. But my own focus was so narrow that I don’t think I fully appreciated that.

When I talk to young doctors and medical students, particularly women, it always stuns me that people start out with the idea that they can’t do what they want to do. And these are people of great privilege and advanced education. People who have options. To this day, undergraduates ask me, “Can English majors really go to medical school?” I mean, my father did it in 1939! I did it in 1982. I still have people asking me “Is it really okay if I don’t like research?” Or if it’s really possible to be a doctor and a writer. I didn’t invent this! Somehow, for all the progress that’s been made, women are still acculturated to not take too many candies, not take up too much space, not be too big, not to want what we want.

Rumpus: I’m only thirty-two but lately I’ve been feeling old. I have this feeling that I should have things figured out by this point. And so I love this idea of a coming-of-age story that’s continuous, without an arrival point. You offer this path of being a woman living a full life, and how much that evolves over time.

Koven: This feeling of “I need to figure it out, I need to tie it up in a bow,” that’s very familiar to me. For a long time the locus of that idea was my weight. When I’m thin, I will have figured it all out. Which is a lot of—pardon the expression—weight to put on weight. Then it kind of drifted to, I’ll have figured it out when my identity is readily recognized and summarized by other people.

But somewhere along the line, particularly in the last ten years, that feeling went away entirely. I think there are a number of reasons for that. But chief among them was writing. I simply don’t feel that way anymore. I’m not jealous of people who are younger than I am. I’m not jealous of people who are thinner. I’m not jealous of people who are richer or more famous.

I guess I’ve arrived at that comfortable-in-my-skin stage. It took me a long time to get here. I really think it was the writing. If you write as authentically as you can, over and over and over, it’s hard not to experience yourself as authentic. You develop that elusive voice, for better or worse, and it is you. When you’re tempted to think, It’s not really me, well, it is you.


Photograph of Suzanne Koven by Patrick B. Duffy.

Colleen M. Farrell MD is a fellow in pulmonary and critical care medicine at Weill Cornell Medicine in New York City. Her candid writings about her experiences in medical training and on the frontlines of the COVID-19 pandemic have appeared in the New York Times, the Washington Post, and The Nation, among other publications. Find her on Twitter at @colleenmfarrell or visit her website: More from this author →