First of all, how old are you?
I'm 31.

When you were younger, what did you want to be first: a doctor or a writer?
A writer. But in the midst of wanting to be a writer, I felt it would be a very good thing to have a job. Because all the writers I admired had also done things in the world. I thought that was a really important thing to do. My thought process, very simplistically, went like this: "Well, I should choose a job where I can learn about people, and what would be perfect? Well, I could be a doctor."

How old were you when you thought this?
14 or 15. I had very little appreciation for how incredibly tough it would be to become a doctor.

Were you writing when you were a teenager?
"Writing." And then, after I finished my medical school residency, I carved out some time to sit back and do it again.

How could you possibly carve out that time? I assume your days are jam-packed. Do you work full time?
I do. Actually, I'm working a little less right now. Not because of writing, but because I have a son. While I was writing the book, I was working a full-time emergency medicine schedule. But, emergency medicine is very focused. The way the work is structured, you go there and you work very hard. And you're very busy. But once you're done, you leave, and your responsibility has ended. So you can customize the time a bit more. It's possible to work one day less per month or three more days this week and not work the next week. That's not really possible in most types of medicine, where there is an ongoing suite of responsibilities that you must attend to every day, regardless of whether or not you see a patient. In other medicine, the absolute maximum you can work is basically 24 hours a day, seven days a week. Certainly, as a resident, I was putting in 150-hour weeks. That was just what you did. But not every hour was intense. I would be sitting there, waiting for tests to come back, or staring at an X-ray box, under incredible stress, but ultimately not doing anything. I'd be miserable and exhausted, but I wasn't doing anything. So the limitation was just the amount of hours that exist. In emergency medicine, frankly, the limitation is your psychological exhaustion. That limit kicks in quicker.

What's the average limit?
Most of the people who have a sustained career in emergency medicine work 15 to 16 shifts a month, a shift being anywhere from six to 12 hours. Hospitals where it's very intense will have shorter shifts. Places where the pace is a bit slower can have 12 hour shifts. The hours don't tell the whole story. I've worked in places that have 12 hour shifts, and I would finish work feeling refreshed, relaxed, as though I'd had a walk in the park. At my place, Toronto East General, I finish an eight-hour shift and I'm completely exhausted. I just have to lie down.

I can't imagine you run home and crack open the laptop.
I usually write before I go to the hospital. My routine, before I had a son, was to write and then go to the hospital. Now, my routine is to stumble from one thing to the next and try to get something done.

How long did you work on Bloodletting & Miraculous Cures?
Two years.

And during that time, what was a typical day like for you?
The ideal day was to wake up around 8 a.m. and write from breakfast until two or three in the afternoon. Then, I'd either go the hospital or, if I didn't have a shift, do other things.

I imagine a lot of the book is autobiographical?
There's one story that's autobiographical, called "A Long Migration," about my grandfather. The rest, not really. I know they sound like interesting or notable events—or at least I hope they do—but actually, they're pretty common. Cardiac arrest on the floor, heart attacks...

Alcoholic doctors?
I've heard of those (laughs). It's part of the legend. I can't say I have cared for many alcoholic doctors.

When you're working at the hospital, do you ever think, "This would be a great story"—or are you so focused on what you're doing that such thoughts don't occur to you?
Usually, I feel a certain emotional tension in a particular situation, and I think, "Gee, this conflict I'm feeling would work well in a story." That's what occurs to me, rather than the actual event. There are two very important problems with writing about things that happen in the hospital. One is that a lot of the events that happen in real life are so ridiculous you couldn't write about them. People would say, don't make up stuff, that's so silly. The other issue is that the events often don't make sense the way we see them. Something we see may have psychological and emotional parameters that only make sense if you have a certain amount of technical knowledge. If you sit down to write about them, it wouldn't actually work. I'm also mindful of patient confidentiality. I try to genericize the medical events because, ultimately, they're just a stage and the drama grows out of a larger conflict.

I can think of maybe three doctor-writers in the history of literature. You'd think, given the fact that it's such a site of drama, more doctors would come out of medicine. Did you look to those doctor-writers for inspiration?
I can't say I was primarily influenced by doctor-writers when writing this. I was influenced by the writers I love—Peter Carey, Margaret Atwood, Hemingway, the list could go on and on. And there are many writers whose books I love who probably exert some subconscious influence, but who have an entirely different style than mine: José Saramago, Gabriel García Márquez. One of the reasons there are some doctor-writers out there—and I agree with you, probably not enough—is that the two things are really similar on some levels. They're both exercises in storytelling. What happens to you, as a doctor, is that someone comes to you and tells you the beginning of the story. What they're hoping you'll do is tell them the end of the story.

A happy ending?
Yes. But even if you can't make it a happy ending, I think people perceive an immense amount of value in being told what the end of the story is. Ultimately, you have to understand how the human mind navigates from fear to understanding to hope. You need to do that as a doctor. It's the same thing a writer does, but a doctor does it as a personal interaction, and a writer has to conjure it on the page.

In my limited experience, a lot of doctors aren't very great storytellers.
Well, the problem is, we've become a very technological society. Before we had that technology, doctors had to be great storytellers, because they had little else to offer people. People loved their doctors, because they could tell them what was going to happen, or they could give the impression of a human narrative. Now, we can do incredible things, things we could never have dreamed of 50 years ago. We've become so engrossed in that. And it happens on both sides. People expect the cure, the pill, the operation, the treatment. And doctors have this really rigorous process by which they're held intellectually accountable, so that they do things that are scientifically supported, that are technically right, and have demonstrated benefit. So, on both sides, we pay great attention to these technical issues. They are incredibly important; I don't mean to diminish the importance of using technology and science to our advantage. But the art is in danger of being waylaid. People may think, I don't care if my doctor tells me a story or not, I just want my doctor to do the right thing. And the doctor may think the same thing. They may think, what does this person care if I've explained this to them properly or not? Because I'm doing the absolutely right, medically-based, evidence-supported whatever. But all the science, all the technological knowledge, exists as a detached truth. It holds true in large groups in their generalized circumstances. Whether or not it's applicable to an individual person who's facing a human dilemma, well, that's tough. And that's why there are doctors. I think it would be a shame if we lose the art of it.

Did you have the linked story structure in mind from the beginning—or was it something that grew organically?
I had the arc of it in mind—in the sense that I did set out to write a book of integrated short stories. However, the specific way each story linked changed throughout the writing. I'm a child of the word-processor generation, so I would literally try different combinations. I would do a find-and-replace and change characters' names. At various points, there were more characters.

Is there one character in the book who's especially close to your heart?
They would be upset if I chose one. All of them experience things I've experienced emotionally. So I would not say, honestly, that I had a favourite character. They all can say things I have been tempted to say, but have never said. So they are all very dear to me.