Tag Archives: research and writers

Research Blues…

Here we are, on the way to writing the Boob Book, swimming through dense swamps of academic research by way of compiling something to say and maybe even getting it right. Each new research report and serious news report points me in the direction of some other paper I really ought to read. The pile of print-outs now numbers about 800 pages…and counting.

Plowing through all this material, reading it carefully, and annotating it, I’ve reached page 701 and probably will get through another 50 pages today. But of course…this morning I stumbled across this little gem:

Rastelli, Antonella L., Marie E. Taylor, Feng Gao, Reina Armamento-Villareal, Shohreh Jamalabadi-Majidi, Nicola Napoli, and Matthew J. Ellis. “Vitamin D and Aromatase Inhibitor-Induced Musculoskeletal Symptoms (AIMSS): A Phase II, Double-Blind, Placebo-Controlled, Randomized Trial.” Breast Cancer Research and Treatment 129, no. 1 (August 2011): 107-116. doi 10.1007/s10549-011-1644-6.

Damn! A randomized study on a BIG topic and the thing is dated 2011! How the hell could I have missed this?

WhatEVER. I’ve got my sticky little hands on it now and will be reading it within the next day or two.

As dry as it sounds, I’m finding this stuff extremely interesting. It’s so fascinating, as a matter of fact, that once I’m launched on a study session, it can be difficult to tear myself away from it.

And it makes me regret that I was born 40 years too soon. I always loved the sciences and, as a little girl, craved to grow up to become an astrophysicist. Over time I came to find the life sciences more interesting. But come the 1960s, when I entered college, neither field was, shall we say, welcoming to female students. Oh well.

In any event, the project feels a lot like writing the dissertation, only considerably more engaging.

Reading the research on breast cancer, DCIS, breast cancer treatments, and the breast cancer industry can be surprisingly disturbing, too. I’ve found it’s wise to limit the number of hours spent working on this stuff to about four a day — otherwise, it can really ramp up the stress level.

As an example… One of the most startling revelations this little project has uncovered has been the very negative effects radiation therapy has when applied after the “immediate reconstruction” procedure that is widely hawked to women who have mastectomies. “Immediate reconstruction” entails inserting a saline or silicone implant under the chest muscles during the same surgery that removes the diseased breast.

If the woman has an invasive cancer, then even after a mastectomy she will be subjected to radiation treatment. (Many women who do not have invasive cancer end up with mastectomies: a large enough DCIS will do the trick, as well the presence of a mutated gene that hikes up your chance of developing breast cancer as high as 70%). But radiotherapy hugely increases complication rates when it’s done after cosmetic surgery (which is what “reconstruction” is, boys and girls). The unsightly and often painful results can lead to repeated new surgeries and extended misery.

Overall, if you think you’ll need radiation therapy — or if there’s even a chance that you will — you’re better off to wait on the reconstruction until after the radiotherapy is done.

I came across images illustrating said stark fact in a review of recent research, what we humanities PhD’s would call a “survey of the literature”:

Rozen, Warren M. and Mark W. Ashton. “Radiotherapy and Breast Reconstruction: Oncology, Cosmesis and Complications.” Gland Surgery 1, no. 2 (August 2013): n.p. http://www.glandsurgery.org/article/view/662/712.

Doctors don’t tell you this when they propose that you should undergo a mastectomy. When mine first suggested that she felt getting rid of the boob was the best course of action, in the same breath she said “but we can do an immediate reconstruction while you’re on the table.” As though everything would then be said and done.

Well. Not quite.

Nor was I told, during the eight months or so that we attempted to excise the criminal DCIS from my dainty little boob, that the radiotherapy they intended to subject me to after the lumpectomy could cause the scar to contract and hideously deform the breast they were trying so valiantly to save.

Actually, I was given a choice between going with lumpectomy, radiation, and aromatase inhibitors or having a mastectomy and being done with the whole effing ordeal. WonderSurgeon indeed had managed to excise the entity to fit the 2014 ASTRO/SSO guidelines. These say that “no ink on tumor” suffices and that wider margins of tumor-free tissue make no difference in survival rates. But she wasn’t buying the new guidelines and felt strongly that the better part of valor resides in wider margins.

Being the incurable skeptic that I am, every time the woman opened her mouth I resorted to my research tools. And yea verily: I easily found research studies that were just freaking NOT THAT OLD suggesting — convincingly! — that wider margins = better results.

After learning what radiotherapy can do to a gifted surgeon’s work of art, I am so glad we elected to go ahead with mastectomy. And…after learning how much can go awry with “reconstruction” — and how often — I’m also mighty glad I elected to go flat.

Even though I was assured that a mastectomy would mean no radiotherapy and no hormone therapy, something else was left unsaid: Naturally, the excised boob would be carefully studied by a pathologist, and if any invasive cancer showed up after all, none of the above would apply.

Obviously, it would be good if the Writer never had a dog in this particular fight. When you’re this close to it, reading the research surely can raise your blood pressure.

But…having lived the application of all that research, I’ll have plenty to say about it and what I have to say should be pretty lively. This is going to be a great book. Good reporters by their nature have high blood pressure. 😉

Just the Facts, Ma’am. Lots of them…

Writing tips - facts and details spice things up and make the world real to your readers.I’ve been revisiting one of my very favorite writers, John McPhee. How can I count the ways I love McPhee? His astonishing style, his engaging voice, his eclectic subject matter, his amazing story structure, his mind-boggling erudition, his sense of humor…it goes on and on.

One of the things I especially love about John McPhee is the hefty, dense factual content of his prose. To say you can’t read a McPhee piece without learning something is to understate grossly. Truth to tell, you can’t read a McPhee piece without learning something in almost every sentence.

Some of it is observed fact:

Carol [dissecting a snapping turtle killed by a car]…talked to the dead turtle, soothingly, reassuringly, nurse to patient, doctor to child, and when she reached in under the plastron and found an ovary, she shifted genders with a grunt of surprise. She pulled out some globate yellow fat and tossed it into the pond. Hundreds of mosquito fish came darting through the water, sank their teeth, shook their heads, worried the fat. Carol began to move fat from the turtle’s body. The eggs were like ping-balls in size, shape, and color, and how they all fitted into the turtle was more than I could comprehend, for there were fifty-six of them in there, fully finished, and a number that had not quite taken their ultimate form. (John McPhee, Travels in Georgia, in The John McPhee Reader)

In four sentences we learn snapping turtles contain ball-shaped chunks of yellow fat, that mosquitofish will eat flesh (or at least free handouts of turtle fat), that snapping turtle eggs are as big as ping-pong balls, that a mature female can lay upwards of 56 of them, and that this Carol knows how to dissect a large, hard-shelled reptile.

His prose is informed as much by research as by observation, though:

The purpose of such projects [we’re viewing a type of reclamation project called stream channelization] was to anticipate and eliminate floods, to drain swamps, to increase cropland, to channel water toward freshly created reservoirs serving and attracting new industries and new housing developments. Water sports would flourish on the new reservoirs, hatchery fish would proliferate below the surface: new pulastions in the life of the rural South. The Soil Conservation Service was annually spending about fifteen million dollars on stream-channelization projects, providing among other things, newly arable land to farmers who already had land in the Soil Bank. The Department of Agriculture could not do enough for the Southern farmer, whose only problem was bookkeeping. He got money for keeping his front forty idle. His bottomland went up in value when the swamps were drained, and then more money came for not farming the drained land. Years earlier, when a conservationist had been someone who plowed land along natural contours, the Soil Conservation Service had been the epicenter of the conservation movement, decorated for its victories over erosion of the land. Now, to a new generation that had discovered ecology, the SCS was the enemy. Its drainage programs tampered with river mechanics, upsetting the relationships between bass and otter, frog and owl. The Soil Conservation Service had grown over the years into a bureau of fifteen thousand people, and all the way down at the working point, the cutting edge of things, was Chap Causey, in the cab of his American dragline, hearing nohting but the pounding of his big Jimmy diesel while he eliminated a river, eradicated a swamp. (John McPhee, “Travels in Georgia”)

In ten sentences, we learn the following:

  1. Stream channelization is a flood control technique.
  2. It’s used to drain swamps.
  3. It’s used to increase cropland
  4. It’s used to channel water into reservoirs.
  5. It benefits sporting, and real estate development industries.
  6. By 1975 (when “Travels in Georgia” was published), the Soil Conservation Service was spending $15 million a year on stream channelization.
  7. The supposed benefits of the projects were often redundant and served to profit those who were already plenty affluent and who had already acquired sufficient wealth through government programs.
  8. Southern farmers benefited from government support projects by collecting money to leave land idle.
  9. Southern farmers benefited from soil channelization when swamp draining enhanced the value of their bottomland.
  10. Southern farmers further benefited by collecting federal dollars to leave this newly valuable bottomland fallow.
  11. The SCS used to be one of the nation’s premier conservation agencies, thanks to programs to prevent soil erosion.
  12. By 1975, the SCS had built a reputation for harming the environment, largely because of its drainage programs.
  13. Drainage projects harm ecological balances such as those involving bass and otters and frogs and owls.
  14. By 1975, the SCS employed 15,000 people.
  15. The operator of the American (brand name) dragline crane engaged in the project at hand was named Chap Causey.
  16. The engine of an American dragline crane runs on diesel.
  17. The crane’s engine was made by GMC.

Think of that: 17 hard facts in 10 sentences. That’s almost 2 facts per sentence, and it’s not even one of McPhee’s true tours de force.

Being a writer of what today we call creative nonfiction, McPhee uses observed fact (and sometimes researched fact) for literary as well as journalistic purposes. To paint a setting, for example:

A stop for a D.O.R. [“dead on road”] always brought the landscape into detailed focus. Pitch coming out of a pine. Clustered sows behind a fence. An automobile wrapped in vines. A mailbox. “Donald Foskey.” His home. Beyond the mailbox, a set of cinder blocks and on the cinder blocks a mobile home. (“Travels in Georgia”)

Or to perform a deft, swift characterization:

…Carol turned on the radio and moved the dial. If she could find some Johnny Cash, it would elevate her day. Some Johnny Cash was not hard to find in the airwaves of Georgia. There he was now, resonantly singing about his Mississippi Delta land, where, on a sharecropping farm, he grew up. Carol smiled and closed her eyes. In her ears — pierced ears — were gold maple leaves that seemed to move under the influence of the music.

Facts — accurate facts, astutely observed details — are the heart of journalism, but they’re also the heart of any writing, fiction, essay, and even poetry included. You doubt it? Check out, for example, a random passage from Alice Munro:

That was the time of their being women together. Home permanents were tried on Juliet’s stubborn fine hair, dressmaking sessions produced the outfits like nobody else’s, suppers were peanut-butter-tomato-and-mayonnaise sandwiches on the evenings Sam stayed late for a school meeting. Stories were told and retold about Sara’s boyfriends and girlfriends, the jokes they played and the fun they had, in the days when Sara was a schoolteacher too, before her  heart got too bad. Stories from the time before that, when she lay in bed with rheumatic fever and had the imaginary friends Rollo and Maxine who solved mysteries, even murders, like the characters in certain children’s books. Glimpses of Sam’s besotted courtship, disasters with the borrowed car, the time he showed up at Sara’s door disguised as a tramp. (Alice Munro, “Soon,” in Runaway)

  1. Juliet and Sara were close friends.
  2. Juliet has fine hair.
  3. They tried to permanent it.
  4. They ate awful food when one of them didn’t have to cook for a man.
  5. They related stories from their lives.
  6. Sara was once a schoolteacher.
  7. Sara had a bad heart.
  8. Sara’s heart trouble stemmed from rheumatic fever.
  9. Sara’s rheumatic fever probably occurred when she was a child.
  10. Sam drinks, or possibly he’s just clumsy
  11. Sam got into some sort of trouble with a borrowed car.
  12. Sam has done some odd things.

Twelve facts in five sentences. Not bad!

It’s the details that allow the reader to visualize, understand, and absorb your message. So facts, whether they come from research or observation (and the imagined facts of the fiction writer or poet are based on observation and experience) are indispensable. Writing is a process of reporting research.

Every writer needs facts. Lots of facts.

Get them. Don’t neglect them!