Not long ago I received a letter from one of my nieces, who is in college and was taking a course entitled “Literature and Medicine.” She wondered if I had any thoughts on the subject. As a doctor for 40 years and an unrepentant English major for longer than that, it turns out I did.

What follows is a short version of my reply.

Dear Grace,

What does literature have to do with medicine?

Let’s start with the question of what the purpose of literature is. For most human activities this is obvious; for the builder, it is to build things we need, for the farmer, to grow our food, for the parent, to love, protect, and nurture our children, for health practitioners it is to comfort and, when possible, to heal.

The purpose of literature on the other hand—or any other art form for that matter—is not so clear. It may, or may not, educate, instruct, or entertain us; it may, or may not, explain certain things; it may be lyrical or harsh; it may be crystal clear or densely obscure; it may try to tell the truth or spin the wildest fantasy; it may be a pleasure to read or deeply painful. What is purpose of such a thing? Couldn’t we get by without it?

Well, apparently not. One certainty is that literature must be pretty important, since throughout history people have been willing to risk, and sometimes lose, their livelihoods and occasionally their lives in order to write it or to read it. Books get banned because they are so powerful that they make the powerful afraid.

Here is why I think this is so: the purpose of literature is to keep us alive. What I mean by that is that although each of us exists in a specific body and circumstances, where we really live is in our imaginations. I am defining imagination here not as the ability to conjure up fantastical things that do not exist, but as the ability to perceive the world as it might be. Without imagination, we are imprisoned in the limitations, the loneliness really, of our selves and our circumstances, and it is both horrific and well known that solitary confinement drives men mad. I believe every individual has an irrepressible need for context, connection, and meaning, a need as strong and ineradicable as hunger, and this need cannot be satisfied inside the prison of the self. It is the same need that gives birth to religion, to community, to friendship, to love. Literature is where the world grows, where the hidden becomes visible, where meaning is revealed, where the inexpressible can be expressed. In literature you do not merely read about the world as it might be, you live it. Hamlet, Oliver Twist, Dorothea Brooks, Laine and Leah—these are not just characters you read about, these are people whose lives you live—these people are you.

So to the question of literature and medicine, I think the answer is this: for the physician, as for anyone else, literature nurtures the moral imagination of both reader and writer because it must be created from the raw material of the moral imagination. It allows us to break out of the prison of the self, to experience the lives of others, to understand who we really are and what we are really doing in this world, and from this flows, one hopes, compassion, a greater empathy, and a knowledge of our shared humanity that is both comforting and challenging.

On occasionally revealing my educational history and literary proclivities over the years, I have sometimes been asked: what does Shakespeare have to do with medicine? I think the best answer is: everything.

I would like to close with another poem from Wislawa Szymborska, which I think illustrates some of the things I have been trying to say.

The Joy of Writing

Why does this written doe bound through these written woods?
For a drink of written water from a spring
whose surface will xerox her soft muzzle?
Why does she lift her head; does she hear something?
Perched on four slim legs borrowed from the truth,
she pricks up her ears beneath my fingertips.
Silence – this word also rustles across the page
and parts the boughs
that have sprouted from the word “woods.”

Lying in wait, set to pounce on the blank page,
are letters up to no good,
clutches of clauses so subordinate
they’ll never let her get away.

Each drop of ink contains a fair supply
of hunters, equipped with squinting eyes behind their sights,
prepared to swarm the sloping pen at any moment,
surround the doe, and slowly aim their guns.

They forget that what’s here isn’t life.
Other laws, black on white, obtain.
The twinkling of an eye will take as long as I say,
and will, if I wish, divide into tiny eternities,
full of bullets stopped in mid-flight.
Not a thing will ever happen unless I say so.
Without my blessing, not a leaf will fall,
not a blade of grass will bend beneath that little hoof’s full stop.

Is there then a world
where I rule absolutely on fate?
A time I bind with chains of signs?
An existence become endless at my bidding?

The joy of writing.
The power of preserving.
Revenge of a mortal hand.

—Robert Foote