Kelly Fig Smith is the winner of Creative Nonfiction’s $1,000 prize for best essay in The Memoir Issue. Her essay, “Do No Harm,” was chosen by the magazine’s editors from more than 1,700 submissions. In it, she meditates on the experience of loss and the fragile nature of memory, writing: “In the aftermath of a traumatic event, some details recede to the blurry gray edges of the frame while others stand up, stiff like colorful pop-up book cutouts, their bright reds and greens imprinted upon the forefront of memory.”
Smith writes from her home in Mount Vernon, Ohio. Her essays have been published online at Literary Mama, the Christian Science Monitor, and The Huffington Post, and in the book Three Minus One: Stories of Parents’ Love and Loss. “Do No Harm” is an excerpt from her memoir.
CNF: “Do No Harm” is a piece from the memoir you are currently writing. How were you able to rework this excerpt into an essay that could stand on its own?
SMITH: I think it was actually the reverse for me in that the memoir itself sort of sprung up as a result of this essay. This particular piece of my story was important for me to tell, primarily for my own healing. But the further I got into it, the more apparent it became that there was more to the story and certainly more I had to say about both the experience itself and the lasting effect it’s had on me.
CNF: Where does the essay fit into your memoir? Is it the starting point or its own chapter?
SMITH: This essay obviously reflects on what was, for me, a very formative event. So it’s a key part of my larger narrative. There are elements of the essay that are foreshadowed at the beginning of the book, but the essay in its entirety lands more towards the middle. From there, the memoir follows the subtle ripple effects that loss has had on me, both personally and on my most significant relationships.
CNF: Deciding when to tell one’s story can be more difficult than the writing itself. How and when did you decide it was time?
SMITH: As we were going through the experience, I kept a journal which for me was absolutely vital in helping me process everything that was going on at the time. There was so much going on in my head, so much emotional brain clutter that I needed a place to dump it all- and my journal served that purpose. I tucked it away and thought maybe someday I’d turn those journal entries into something larger or, at the very least, try to put them out as a collection.
Ten years later, when I attended a nonfiction writers workshop at Kenyon College, the instructor gave a writing prompt in which we were to try and write an essay that made some very intentional moves. As I flipped back through my journal from all those years ago, I thought the assignment might be a good opportunity to try my hand at telling the story I’d been wanting to tell, but in a different way. I hoped that in coming at it from several different angles the result would be a much more deeply layered story than had I attacked it head on, as in a journal format for instance.
CNF: What caused you to focus on writing about your medical experience? From where did you draw the details and emotions surrounding that day?
SMITH: When we were going through this experience, I looked at everything I could find that was written by mothers or fathers who had experienced a stillbirth. I scanned forums, blogs and books looking for people like me. I spent hours reading research and scientific articles. It helped me to know I wasn’t entirely alone. So partly this essay is an attempt to give back to the pregnancy loss community and to assure other parents that they are not alone in their grief journey. Also, I wanted to help break the silence that has seemed to surround the tragedy of stillbirth. Knowledge is power, and it is my deepest hope that shedding light on this issue will not only bring about additional training for healthcare professionals, but help to make others feel more prepared and equipped to be a support network for friends or family who may be experiencing a similar loss.
As for the details, some of them were noted in my journal, but most of them are just memories that stuck around. The brain is such a strange thing. So much of my life is a blur of memories I can’t grab on to anymore- things, people, and places that I’d love for just one moment to remember with absolute clarity. Then, other images which I have no desire to keep—a silver stemmed spoon, a rosebud gown, a knit cap—seem happy to stay, year after year, as vivid as when they first occurred.
CNF: Did the process of writing your medical narrative change your view of the healthcare system? If so, how?
SMITH: I don’t know that it necessarily changed my views regarding the healthcare system, but I do think I’ve been left with a very intimate knowledge of just exactly how much power our words can hold. Everyone has the ability to hurt someone else—sometimes it’s calculated, sometimes we’re just careless. Unfortunately, none of us are exempt from that.
Healthcare professionals have a difficult job. The emotions they have to manage on a daily basis—their own and those of the patients and families they come into contact with—must be absolutely overwhelming. As a writer, I’ve never had to bear the weight of delivering life-changing news to a complete stranger, so I can appreciate why it’s necessary for physicians to take a step back, emotionally, from their patients. Otherwise, I’m not sure how they’d get up and go to work every day. But certainly there is a line that must not be crossed and an appreciation for the gravity of carelessly chosen words, particularly when those words are spoken at someone’s most vulnerable moment.
I’d also like to say that I’ve had the privilege of being cared for by some very empathetic and kind physicians over the years. In fact, six years after we lost our first child, we experienced another late-term loss. The second time, my physician not only delivered me the news as gently as she could manage, but she slept in the hospital room right next to mine to ensure she wouldn’t miss the delivery. So, was the essay a blanket indictment against all healthcare professionals? No. Rather, it was more a plea for further exposure and education on stillbirth. Even more than that, it was a place for me to say the terrible thing: that it might have been all my fault. Then, having done that, having said it out loud, I was able to stand back and look at it more objectively.
CNF: In your essay, you reflect on what “do no harm” means; did you expect the story of your personal experience to turn into a bigger exploration of the condition of healthcare?
SMITH: I didn’t, and I think that is very often the case for writers. You start off writing about one thing, and somewhere along the way you discover something else. The essay began, very simply, as a way for me to try and explain what the experience of stillbirth looked and felt like from my perspective. And in the telling of it, particularly in my attempt to try and reach beyond myself to access a larger truth, I found that I had some real feelings about how we were given the news we’d lost our son, and that it seemed to me there was, and is, a real need for more education for caregivers on how to approach these delicate situations.
But, and it’s my hope this carries through in the essay, the imperative to do no harm wasn’t directed at medical personnel alone. For instance, I’m certain I did great harm when I delivered the news to my mother in the same cold fashion it was delivered to me. Granted, I was in shock, but the harm was done nonetheless. Then, as the essay ends, it’s clear I still struggle to forgive myself for not taking action sooner. I spent a number of years doing a great deal of emotional harm by relentlessly pointing the finger at myself. I think we all have things we’re trying to let go of as we sludge through our baggage and crawl towards a deeper love for both each other and ourselves. So, I’m learning to be kinder to myself, and that’s part of the message too.
CNF: Before writing this essay, or in the course of writing your memoir, did you read any other medical narratives? If so, which ones?
SMITH: I guess more than medical narratives specifically, I’ve just tried to read widely, both fiction and non-fiction. When something resonates with me—when it’s so depressingly good that I want to lay my head on the table and quit writing—I read it again and try to figure out why it worked. Then I attempt to translate that form into my own voice so I can better communicate whatever it is I’m trying to say. In the end, I think everything we read informs our own writing in some way, but writers such as Annie Dillard, Lorrie Moore, Vanessa Veselka, Jo Ann Beard, Charles Baxter, J.D. Salinger and Tobias Wolf have all played a part in shaping my own work and voice.
CNF: Usually, we see healthcare stories written by doctors or nurses; what challenges did you face in writing from a patient’s perspective? Were there any elements of the story that you struggled with most?
SMITH: I have enough distance from the story now that, for the most part, it doesn’t get terribly emotional for me. However, writing (and reading) the small section when the nurse tries to find the baby’s heartbeat with a Doppler is still difficult. I think it’s because there was a moment when we had hope, and when it was pulled out from under us it became clear, very quickly, that our lives were about to change. Even as a mother of four healthy children now, I have an intense hatred for Doppler machines. I break out in a cold sweat when I see them. So it was difficult for me to put myself back on that table.
CNF: A story tends to change over time even after being written down, and this essay is being published ten years after the events it concerns. How do you think your experiences would have appeared on paper had you written this earlier—say, five years ago?
SMITH: I did write it five years ago, multiple times. I took my journal entries and moved the order of events around, added some description here and there and told myself it was good enough. The main problem was, I wasn’t ready to relive it all. So I skirted around the edges and tried to give the basic details. After the workshop, once the narrative had been expanded and was starting to take much of the shape it has today, a friend of mine graciously offered to read and edit it for me. He noted some spots where it seemed like I needed to zoom in and expand even further. He was right, and much of this essay is due to his willingness to nudge me a little further into the dark corners I was trying to avoid.
CNF: You mention a “revelation of meaning in a seemingly idle moment.” Appropriately, there is a sequence of foreshadowed events throughout your essay. Did it take all of these years for you to see these events in this way? And how did the process of writing the story change how you saw it, if at all?
SMITH: It did take me a long time to connect the dots. At some point, I made a decision, subconsciously, to not allow myself to remember the phone call or the kicking. Initially I dealt with a tremendous amount of guilt and self-blame (a very natural response), even though at the time, no one could tell me what caused our loss. Recapturing that painful memory in the early stages of the grief process would have been too hard.
I still dealt with the additional guilt and grief later, but I was removed enough from the incident that I could face it. Through the writing of the essay, and through years of playing it out in my mind, I’ve worked towards accepting there was most likely nothing I could have done to save him, even had I realized he was in distress. That’s what writing, in general, helps me to do. It brings a lot of clarity to what, in my brain at least, seems a little murky.
CNF: What advice would you give a writer who is turning their own personal experience into a literary project?
SMITH: As writers, I think we often know what it is we’re supposed to write—the thing that’s setting our brain on fire. Unfortunately, it’s also usually the hard thing—particularly when it involves our own lives. Writing the hard thing will require a great deal more of you than had you taken a safer route, but once you’ve committed to it and bled all over the page, I think you’ll find it was worth the effort.