Larry Kramer graduated from the University of Western Ontario in 1973. A rotating internship in Victoria BC and family practice anesthesia program back at Western followed. In 1975, he joined a family practice clinic in a small southwestern Ontario town near the north shore of Lake Erie. There he did general practice, anesthesia, obstetrics, ER, and in-patient care for 27 years. In 2002, Larry took a hospitalist position at a larger centre and remained there until 2011. Three years of locum then completed his medical career.

His collected experiences formed the basis of his first book, An Imperfect Healer: The Gifts of a Medical Life (Pottersfield Press, 2019). Other writing has appeared in various magazines and newspapers (CMAJ, MedicalPost, Globe and Mail, Hamilton Spectator, and others). In 2023 he published a novel, Where the Road Ends, also with Pottersfield Press. Now retired, he lives in Calgary with his partner Claire and continues to write.

Larry joined our Creative Lead, Damian Tarnopolsky, to discuss writing, medicine, and the connections between the two.

Damian: Can you tell us about your journey as both a writer and a doctor? How did you start writing, within the context of your medical career. Or, were you always trying to find ways to write even before you were a family doctor?

Larry: I heard Michael Crummey do an interview on CBC some time ago. He suggested, “There is only one reason to write and that is because you can’t not.” Best summary I ever heard.

I have been writing things down for most of my life. Putting words on paper has been of tremendous therapeutic value. I don’t think I could have managed forty years of medical practice without it.

In first year of university, I briefly contemplated quitting school, jumping on a tramp steamer, and running away, Jack Kerouac reborn in all the hopeless romanticism of a nineteen-year-old. Never mustered the courage to do that. Ended up in medical school instead. Taking the time to write or even read anything except textbooks was very guilt inducing then. Internship and residency followed. In 1975 I joined a clinic in small town southwestern Ontario. Besides the clinic patients there was anesthesia, obstetrics, ER, and in-patient care. Balancing medicine with the demands of raising a family and still finding time to write seemed impossible. A few lines written when I couldn’t sleep was the sum of my writing.

So, the dream lay dormant. Eventually the longing could not be denied. I returned to Western to complete my undergrad BA, (with an emphasis on English literature) in 1980. There followed creative writing, editing, and grammar courses. And, always reading, reading, reading.

I began to write down a few stories — usually about my experiences with patients. It helped me to cope with the stresses of practice and life in general. On a lark, I sent a piece off to The Medical Post. To my surprise, it was accepted for publication. My first taste of the opiate of writing. Thereafter I sent in a few pieces every year. Occasionally I ventured out of this framework and submitted pieces to other magazines and newspapers. Rejection was common. But when something was accepted — pure joy. Writers are needy people.

When I retired, I took a number of the pieces I had written over the years, re-wrote, edited, and collected them into a book of stories. After many submissions and rejections, a small literary press in Halifax (Pottersfield Press) accepted the manuscript. An Imperfect Healer: The Gifts of a Medical Life was published in 2019. A small advance and the hassle of marketing followed. The advance was welcomed, the marketing experience, not so much.

When medicine was no longer providing me with material. I wondered if I could write a novel. Could I create, rather than write what I knew? I began researching and jotting down ideas. About five years later, Where the Road Ends, was published (Pottersfield Press, 2023): the story of a PTSD affected trauma surgeon in the Canadian Armed Forces in Afghanistan.

That has been my writing journey. I’m now working on a collection of short stories and essays. Whether it ever sees the light of day remains to be seen. But the joy is in the journey.

Damian: Could you elaborate on how health matters influence your writing? What makes particular cases or ailments right for creative exploration? Additionally, how do you handle patient confidentiality in your work?

Larry: I have wrestled with the idea of writing stories derived from my work. Was I appropriating patients’ stories? In time I came to appreciate that their stories were also my story. My interactions with them over many years informed a large part of my life and identity. The tragedies, the victories, even the mundane parade of patients passing through my office provided welcome fodder for my words. By writing, I was more able to understand my patients and more able to cope with the feelings – good and bad — that medical practice evokes.

Consideration of patient confidentiality is always a very real concern. Early on I changed details, diagnoses, settings, dates, genders and never (obviously) used names or even initials. All the while I tried to maintain the essence of what I wrote. Before publishing An Imperfect Healer, I spoke to a lawyer. After that I followed guidelines suggested by my editor and publisher.

As to what makes particular ailments or events right for creative exploration, it was usually something that moved me, that elicited strong feelings. This proved a wide spectrum — from the obvious (mass casualty event) to the unexpected (an early morning drive to a farmhouse in the country to pronounce death). So many things can trigger the impulse to write.

Damian. You’ve written full-length works in both creative non-fiction and fiction. Do you consciously decide to switch genres (e.g., “Now I’m going to write a novel”), or does the genre come into place organically, based on the material and the writing process. Or . . .?

Larry: It was a conscious decision to change genres. Writing about “what I know” is, for me, easier than creating something original. I wanted the challenge of generating something from scratch: using my imagination and a lot of research to help create a story. Where the Road Ends does, as well, draw on experiences and knowledge from a life in medicine. I wanted to write a contemporary story that would have particular relevance for a few and broad appeal for many. The topic and the time seemed right, and I believed there was a good story. So, I started to do the research, began creating plot lines and writing text. About two years later — when Covid arrived — I began writing seriously. I got up every morning and treated it like a job: go to my writing space (den with the door closed) and try to get 500 useable words before the day ended.

Damian: Publishing in Canada today poses significant challenges. Based on your experience, what advice do you have for medico-literary people seeking to publish and advance their writing careers?

Larry: Advice to “medico-literary” people seeking to publish and advance their writing careers:

1. Read. Read some more. Read in the genre you are writing in. Read broadly, including the classics. Learn what good writing looks like. Join or create a book club and discuss what good writing looks like.
2. Study writing. It’s a craft that needs to be learned. There are no shortages of writing courses. Learn about grammar and punctuation, point of view, and voice. They will not make you a writer any more than anatomy and physiology make you a doctor, but they are so necessary. Join or start a writer’s group.
3. Develop a thick skin. Rejection is part of the writing business. Believe in your work. Be persistent. Make multiple simultaneous submissions (as a courtesy inform each publisher you are submitting to, of this). Send your work to newspapers and magazines (literary and otherwise) if it fits.
4. Research publishers before you submit. Are they taking unsolicited manuscripts? Are they publishing work in your genre?
5. Be prepared for long waits. A reply to submissions may take months and amount to little-more than, “Thanks for sending. Not interested at this time.”
6. Consider a literary agent. It will cost you money. Fifteen percent of your take is a ballpark figure. But it may open doors and get you a better deal. However, finding an agent who wants to represent an unknown author can be difficult. It is hard to to get published if you are not known and it is hard to be known if you are not published. The catch-22 of writing in Canada.
7. Realize that publishing is a difficult journey that may involve as much luck as talent. In 2018 about 42% of books published in Canada were self-published. The advantage of self-publishing is that anyone can do it, and the problem with self-publishing is that anyone can do it. There is no quality control. If you choose to go this route you can pay a lot or a little, depending on how much you are prepared to do and spend. Do you have the time and inclination to design, format, edit, and market your book? Yet some well-known (whether well-written or not is a different matter) books were self-published before they were bought up by large presses (e.g., Fifty Shades of Grey). The traditional route of trying to get a publisher interested in your manuscript is no less daunting. Big name publishers are unlikely to accept unsolicited manuscripts. Some smaller houses do accept work unprompted from unknown or new writers and, if you are lucky, you will find one that will take you seriously. The odds are, however, against you. Get used to that. It makes success sweeter.