Interview with Paul Austin

Photo by Sally Somers Austin

I met Paul Austin in 2005 at the Bread Loaf Writers’ Conference. Paul was what’s known as a “contributor” that year – in other words, a paying student – and a more gentle, thoughtful, hardworking and dedicated classmate I can’t imagine.  At that time, he had written and published a few essays about his experience as an emergency room physician, and he was thinking about weaving them together in a book. It’s a dream that many Bread Loaf alumni share, but in Paul’s case, the dream came true. He went back to Bread Loaf several times, as a work-study student and a scholar; this year, he holds a coveted fellowship to the conference. And his memoir, Something for the Pain, appeared in the fall of 2008 to deserved acclaim. In prose as clean as a scalpel’s shave, and as fast-moving as the pace of the emergency ward itself, Paul re-creates the atmosphere of blood and guts and heart-stopping pain, of wry humour and supercharged adrenaline that fuels a busy hospital. At the same time, he describes the ripple effects that emergency work can have on a family, and his own efforts to achieve balance in the midst of so much death and suffering – not to mention, sleep-depriving shift work.  Honest, gripping, fiercely compassionate, and unafraid to pose big questions, Something for the Pain should interest anyone who likes good memoir and anyone who cares about the caring professions.

Photo by Paul Austin

Photo by Paul Austin

Q: When did you start writing? Tell us a bit about your writing history.

A: My first go-round with college, I was an English major. I dropped out during my sophomore year, to build a cabin on five acres of land in rural North Carolina. I was an English major at the time, and planned to use my experiences in the woods, to write an updated Walden Pond. The book would be a literary success due to the singularly clear-eyed prose I would bring back from the woods. It would also be a block-busting commercial success, because it would include sex – lots of sex.

I worked construction for a year, saving money to move out to the land. During that period, I filled beer-soaked napkins with morose and heart-felt poetry, but surprisingly, the poems did not result in literary fame. Equally surprising, the young women in my hometown did not swarm to my table, to see what I was writing. I was baffled – isn’t beery poetry a sure-fire turn-on?

Eventually I had enough money to quit my construction job, live in a tent, and build the cabin. But I did not write a book – having enjoyed insufficient sex to ensure the huge commercial success the project deserved. (This was before James Frey established that fiction sells very well as non-fiction.) But it was just as well: the sex scenes I would’ve made up – the kerosene lantern flickering a smoky yellow light, embers from the campfire pulsing red, blouses unbuttoned with trembling fingers, jeans unzipped and shimmied out of – would have been as implausible as any Penthouse letter ever written.

After a long series of jobs, I eventually became a fire fighter – yellow hat and red truck, canvas hoses and aluminium ladders. I did not write much then, but I read more than in any other time of my life. I eventually went back to college, and from there, to medical school. During residency training, I wrote a detective novel. The hero was an emergency medicine intern. Smart. Brave. Intrepid. I’ve not shown the manuscript to anyone.

Q: What inspired you to write this book?

A: I have always loved to read, and about ten years ago I took a Saturday morning class on creative writing. I wrote several stories about different jobs I’ve had: trash truck labourer, carpenter, pizza cook, and firefighter. They were okay. Then through the North Carolina Writers’ Network, I had some of the stories critiqued. I got the hang of “show, don’t tell,” pretty quickly, and began to get encouraging feedback from teachers. Then I wrote a story about working as a doc in the emergency room. I read an excerpt of that story a local writer’s weekend retreat. Everyone loved it. So I stuck with ER stories.

Q: What kind of work routine did you use?

A: My writing schedule is just like my ER schedule: totally random. I get some day shifts, some night shifts, some afternoons. The bad news is that I work half of the weekends, and that there is no pattern to my schedule. The good news is, I get days off during the week (when the kids are in school) and I get used to being interrupted. ER docs and nurses get interrupted constantly, so we have to be able to re-focus on a problem quickly. When I sit down to write, I write.

Q: What was the biggest challenge you encountered completing this book?

A: Knowing when it was good enough. Early on, my teachers thought that agents would snap it up. It took me four or five years to get an agent. I am so grateful for each and every agent who rejected my manuscript. The book is much, much, much, stronger than it was when I first started sending it out. If I’ had been “luckier,” I could’ve published a book that was half-assed, at best.

Q: What was the greatest reward?

A: I think that the process of writing – the hours at the keyboard, trying to get the words on the page to do what I want them to – has been the biggest reward. And those hours continue to sustain me. It’s like spending a morning in a tree stand, bow hunting for deer, or canoeing on a lake or river. Those are hours are in “the sanity bank,” and those hours help bring a different focus to my life. At one level, it doesn’t matter if I don’t even see a deer, or don’t get a nibble on the hook. What matters is losing myself in that focused moment, suspended in the moment of waiting for what might come, and hoping that I’m ready for it when it does.

Q: What do you like most about writing non-fiction?

A: With non-fiction, I don’t have to generate a good story – all I have to do is recognize one. The creativity revolves around choosing the best words to tell the story. With non-fiction, the life experience provides a big chunk of marble. The creative decisions involve what to chip away, what to leave in.

Q: Why did you choose this particular title?

A: Titles are hard. I wanted one that would be all evocative and everything. Poetic. At first I pitched it as The Topography of Night, because a poet at Bread Loaf loved the line – I was trying to explain what the book was about. But that title was too static. I then scanned the book, looking for phrases that sounded cool, and came across “something for the pain.” I was hoping that my agent, or editor, would come up with something better, but they didn’t. I read a lot of poems about insomnia, hoping to come across something. I suggested, “Day Destroys the Night,” from the Doors’ song “Break on Through,” but they didn’t like it. Ultimately, the editor decides what the title will be, and what the cover looks like. So all the writer has to do, is to come up with something that doesn’t suck so bad that no-one will look at it.

Q: What advice would you give to writers trying to get published?

A: Focus on the writing. The redemption occurs in the struggle to get the words to be as honest and true and clear as possible. Each “success” along the way – placing a story in a literary magazine, finding an agent, publishing your book, are undoubtedly great milestones, and should be celebrated. But the real successes are the moments in which we find the right words and put them in the right order. The second piece of advice is one I was given by a writing teacher: “It’s a war of attrition. Don’t attrish.”

Q: What book would you tell them is a must to read and why?

A: Something For the Pain: One Doctor’s Account of Life and Death in the ER, because the more books I sell, the sooner I can cut back on my shifts in the ER. But seriously, I think it is always a good idea to go back to your favourite book, and read it again. Another book that is worth reading is the one that your favourite teacher loved, but you didn’t. I’ve read The Great Gatsby four times. I like it okay, but I’m embarrassed that I don’t “get it,” as deeply as other writers. So I keep reading it, hoping that I’ll understand it better, and that my writing will improve.

Q: Who is your favourite author and why?

A: Gosh. Can I answer with my favourite books? I’ve read The Angle of Repose, several times because the writing is so good, and it’s a guy’s take on a marriage. Stegner gets so much done, in so many layers, in that book. I also love Nobody’s Fool, and Empire Falls, by Richard Russo. He does such a good job writing about men who are struggling to remain true to themselves and maintain relationships with the people around them.

Q: What are you reading now?

A: A Tale of Two Cities. It’s the second time I’ve read it, and I’d forgotten what a fun read it is. I love reading a classic that is also such a good story.

Photo by Mark Austin

Photo by Mark Austin

Paul Austin has worked in emergencies for twenty years: first as a firefighter, and now as an emergency room physician. His essays have been published in The Gettysburg Review, Creative Nonfiction, Ascent Magazine, The Southeast Review, and turnrow. His essay, “Tucker Put His Gun to His Head,” was listed as a notable essay in Best American Essays 2005. His memoir Something For the Pain: One Doctor’s Account of Life and Death in the ER was published by W.W. Norton September 8, 2008. Contact Paul at

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