Goodbye, Nanoism

When I started the current iteration of this site in January 2009, I was also writing short fiction. In fact, one of my self-imposed creative writing projects was an exercise in the form of a daily tweet-sized story. Very strange, it’s true, but 2009 was a long time ago in internet years, and it seemed like a good idea at the time. Perhaps even odder, but I found this experiment so creatively fulfilling that I decided to do something that remains unique: a paying venue for literary Twitter fiction, self-contained stories in 140 characters or fewer. (For reference, this is so long ago that it predates the official retweet function, and to this day, most literary magazines do not pay writers for their stories.)

After 14 years of continuous publication, Nanoism remains by far the longest-running venue of its kind. This has been on the About page since day one:

We’re not just catering to the 21st-century attention span, we’re publishing flexible fiction: stories that you can read on your computer or cellphone, stories that fit in the cracks of your day.

Over the past fourteen years, we published 1000 standalone tweet-sized stories from 660 writers, multiple longer serials, ran contests to raise money for charity (judged by amazing writers like Ethan Canin and Robert Swartwood), been on NPR, and had stories featured in best short fiction anthologies and books on craft. Not a bad run.

It was a fun hobby and relatively well-suited to the preclinical/basic science years of medical school. But in the years since, through residency and fatherhood and the many wrinkles that make up a life, it was harder and harder to find the bandwidth to promote this art form, this venue, and the hundreds of writers I’ve published.

This is a small project (forgive the pun), but it took what I had just to keep it running week after week. I was remiss in rarely taking the time to submit stories for the many possible awards and anthologies that work like this can appear in (especially since they often did well!). But the fact is that even if the recognition were to start and stop with just my nomination, every writer who sits down to do the work, puts themselves out there, and hopes for the best deserves as much recognition as they can receive. And for that lack, I truly apologize.

I know that it seems silly to publish things so small and call them stories, but, sincerely, it was an honor and pleasure to read and share your work.

Writing “Content”

I’ve been writing online (“blogging”, cringe) for over 14 years now, and there can be a sometimes strange (and strained) relationship between writing-as-service and writing-as-expression. I’ve mostly written whatever I want, or at least whatever I thought had two or three of this magic combination:

  • interesting to me
  • would be helpful to other people
  • either no one else was doing it or I had an individual (ideally unique) perspective

And yes, sometimes I just wrote whatever.

Over the years, this site has focused on a variety of topics until they’ve covered the ground I wanted to cover or exhausted my interest. I wrote a lot about studying in medical school (choosing books, approaching questions, etc) until I wasn’t interested anymore (not a great financial decision, but hey). I wrote a lot about approaching the residency selection process.

I wrote the book for the Texas JP exam because that test was a stupid hassle and no one had made what I thought should exist. So I did.

I wrote a lot about personal finance specifically for medical students and trainees and especially about student loans, mostly because content on student loans just did not exist at the time (I know, hard to believe). Now it does, and I felt I covered that sufficiently in the book, so I mostly moved on (also not a great financial decision, but hey). I’ll probably return to personal finance again in the future. I still have more to say, but I’d be kidding myself if I pretended even for a second that my opinions are particularly unique or interesting or that this space isn’t being adequately covered (frankly, it’s saturated; there’s plenty of content and almost infinite noise to wade through already).

I’ve written a lot about medical training, radiology, and various topical issues related to organized medicine like board certification (ABR I’m looking at you) or healthcare trends like private equity takeovers. People like these posts. I (still) like writing them. I genuinely think these issues aren’t talked about enough, even though my fly buzzing on the internet probably isn’t going to move the needle much.

I was going through my archives at the end of the year, and I noticed just how much of the writing that I thought was evergreen is slowly aging out. Posts that used to be perennial traffic drivers have eventually lost their mojo. A lot of that may be because “the blog is dead,” and some of it just that Google overall favors fresh content all things being equal, even if the classics are still fire. But some of it is because even things that don’t change quickly sometimes still change slowly. 14 years is a long time on the internet. I guess that’s both a testament to how long I’ve been doing this and also a little sad.

There has never been a shortage of things I’d like to write about. I could easily fill up my days writing full-time, and my collection of potential post ideas and article fragments is comically long. It only gets longer. I get a lot of topic requests, and they’re almost always things I’d be happy to write about given time. But there’s also that unavoidable truth that every yes to one thing is a no to another.

I’d like to have more of my writing be timeless. (Maybe it’s time to go back to fiction too?) We’ll see. I also want to keep being a resource for radiologists and other physician readers, but I also wouldn’t mind writing things that might be interesting to someone who doesn’t work in a hospital. Morgan Housel, who wrote the excellent Psychology of Money, tweeted:

I think “know your audience” can be dangerous advice for writers.

Write stuff you yourself find interesting and entertaining.

Writing for yourself is fun, and it shows. Writing for others is work, and it shows.

One perk of jumping around over time is that I haven’t had to worry too much about audience capture.

As for me, I want you to know this has been fun, and I hope that shows. Thanks for reading.

The Reward of Writing

Anne Lamott from her lovely book on writing, Bird by Bird:

Writing has so much to give, so much to teach, so many surprises. That thing you had to force yourself to do—the actual act of writing—turns out to be the best part. It’s like discovering that while you thought you needed the tea ceremony for the caffeine, what you really needed was the tea ceremony. The act of writing turns out to be its own reward.”

I gave a talk about the benefits of writing last year at WCICON21. I didn’t know about this passage back then, but if I had, I would have included it at the beginning.

As the absurdly prolific Brandon Sanderson repeats in The Way of Kings as one of the ideals of the Knights Radiant: “Journey Before Destination.”

Process > outcome.

A reader asked me recently about starting a website, something that happens every so often and a topic I’ve written about before. And my answer in that post, which Lamott so beautifully captures, is that the writing has to be worth it in and of itself.

You think you want to teach others, get a following, sell something, or influence (as a verb). And of course you do! You’re human. I do too. But most people can’t just write for that and keep it going very long. Because while the output can be awesome, the outcome is unknowable. The process is the only guarantee.

A slow end to a long hobby

The more intrepid readers of this site may know that one of my more unusual hobbies for the past 13 years has been running an indie lit mag called Nanoism. Back when it launched in March 2009, you see, I was doing more short fiction writing than blogging or other writing (oh how times change). Some of you even submit stories from time to time, which I always enjoy.

Nanoism was and remains relatively unique because it is a venture dedicated to the admittedly absurd artform of tweet-sized fiction (I promise I don’t take it too seriously). There are many independent literary journals, and they rise and fall with the seasons. This has been a pretty long run compared to average, but it’s near time for this chapter to end.

Here is part of today’s announcement post:

Nanoism wasn’t the first “twitterzine” in the world (that would be the long-defunct speculative fiction account @thaumatrope), but it was one of the first, by far the longest continuously running, and remains the only paying venue for literary/nongenre stories of this extremely tiny size.

Over the past thirteen years, we’ve published 948 standalone tweet-sized stories, multiple longer serials, ran contests to raise money for charity, been on NPR, and had stories featured in best short fiction anthologies and books on craft. On a personal note, I got married, finished medical school, finished residency and fellowship, and had two kids. I did a lot of blogging and less and less fiction. Such is life. I’ve been an overscheduled and generally poor steward for the form and this venture, but it’s been a lovely little journey.

Now, I believe we’re reaching the end. I think that our 999th (or maybe our 1000th?) story would be a nice number to complete the collection. With our current weekly schedule, that means Nanoism will cease publishing new stories around April 2023 after 14 years of continuous operation.

So this will be my final year of reading thousands of submissions and publishing new weekly stories. If you’re a closet writer or are even just curious to try, check out the announcement post, read a few of the collection, and then try your hand.


Carving out a Creative Routine

From Keep Going: 10 Ways to Stay Creative in Good Times and Bad by Austin Kleon:

In his book Daily Rituals, Mason Currey catalogs the daily routines of 161 creative individuals: when they woke up, when they worked, what they ate, what they drank, how they procrastinated, and more. It’s a wild collage of human behavior. Reading about the habits of writers alone is like visiting a human zoo. Kafka scribbled into the night while his family slept. Plath wrote in the morning before her children woke up. Balzac slugged fifty cups of coffee a day. Goethe sniffed rotten apples. Steinbeck had to sharpen twelve pencils before starting his work.

It’s undeniably fun to read about the routines and rituals of creative people, but what becomes clear after a while is that there is no perfect, universal routine for creative work. “One’s daily routine is a highly idiosyncratic collection of compromises, neuroses, and superstitions,” Currey writes, “built up through trial and error and subject to a variety of external conditions.” You can’t just borrow your favorite artist’s daily routine and expect it to work for you. Everyone’s day is full of different obligations—jobs, families, social lives—and every creative person has a different temperament.

I’m not always sure that what I do here qualifies as creative work, but it’s so easy to fall into the jealousy trap looking at the routine of a full-time professional creative. It’s not hard to read a book like Cal Newport’s excellent Deep Work and think, yeah, that’s how you do it–if you’re an academic or knowledge worker.

I’m an academic physician working in a private practice. When you break it down transactionally, I trade time for money and then do a whole bunch of unpaid work on top that helps give my job extra meaning.

I’m a dad and a husband.

And that’s why it’s so much easier to have an amateur’s mindset instead of a professional’s: to do something because you like it or when the stars align.

But I’ve also found that I do better work and find more satisfaction in the work when it’s part of a routine (i.e. a modified professional mindset). My routine just isn’t one that involves long uninterrupted periods of deep work or a cabin in the woods.

I think the key is carving out a habit–or maybe a better word is a pattern–that allows you to fold in your avocations in a way that allows for regularity despite dominant competing obligations, recharges your battery, and still results in enough forward progress on your larger projects (if you have them) as to not be demoralizing (and it’s actually that last part that’s the hardest).

RBG on Writing

Former two-time law clerk for Ruth Bader Ginsburg, David Post:

Most of what I know about writing I learned from her. The rules are actually pretty simple: Every word matters. Don’t make the simple complicated, make the complicated as simple as it can be (but not simpler!). You’re not finished when you can’t think of anything more to add to your document; you’re finished when you can’t think of anything more that you can remove from it. She enforced these principles with a combination of a ferocious—almost a terrifying—editorial pen, and enough judicious praise sprinkled about to let you know that she was appreciating your efforts, if not always your end-product. And one more rule: While you’re at it, make it sing. At least a little; legal prose is not epic poetry or the stuff of operatic librettos, but a well-crafted paragraph can help carry the reader along, and is always a thing of real beauty.

Even paraphrased, that’s a satisfying approach.

When Ginsburg was in law school, she was passed over for clerkships literally just because she was a woman. Later she became one of the most influential justices on the supreme court while consistently applying the principles of equality and fairness to her jurisprudence.

American law didn’t just change during her lifetime, she helped make those changes.

What a legacy.

Student Loans: In Print and Online

I published the first edition of Medical Student Loans: A Comprehensive Guide in 2017. Waiting almost three years to put out a print version is what happens in the perfect storm of total DIY, extreme retentiveness, and being a generally lazy procrastinator. Oops!

But I’m happy to say I finally put the finishing touches on the print editions for both of my loan books this month, so those of you hankering for the perfect beach read need wait no further:


Even better?

But in what is surely a terrible business move, I’ve also put the entire text up online at

So yes, you too can join the ranks of folks still exchanging money for that hard-fought knowledge (thanks!).

And yes, you definitely still download a nice ebook file in the format of your choice in temporary exchange for your email address so I’ll have a nice big audience for that infrequent newsletter I’ll probably never actually start. (PS I even put the unsubscribe link in the first sentence of the download email; did you know it actually costs a bunch of money to have an email list? Crazy.)

But if you just want to scroll through 45k words in a web browser, now you can do that too.

Student loans are crippling a generation of Americans and have a chilling effect on personal+financial wellbeing. I’m just trying to do whatever I can to help you get the information you need to make thoughtful decisions about managing your debt.

Updated Student Loan books

Nice, productive holiday weekend. I also got around to making some minor revisions and 2019 updates to Medical Student Loans and Dealing with Student Loans, both of which you can always download for free right here. Yes, these beloved best-in-class books are completely free, because student loan debt is crippling generations of Americans, and that outweighs every other consideration.

If you already have a copy, you can still drop your email on the download page and get this most recent edition in your inbox. (And of course you’re always welcome unsubscribe immediately.)

While I would recommend reading one of the two books to literally anybody with a student loan from current college students to seasoned physicians, I strongly recommend any graduating students to take a few hours this month and get your financial house in order.

This is literally the perfect time.

Updated Guide to Fourth Year

I’ve just updated my guide to being a senior medical student, Fourth Year & The Match. It remains awesome and free as well as being up-to-date for 2019-2020.

Even if you’ve downloaded the old version, you can still receive the new one by dropping your email address here.


Get your free book download (ebook and PDF) of Fourth Year & The Match.


I have yet to actually start that planned infrequent/sporadic newsletter, and even if I had, I have no interest in cluttering your inbox. But if you just want the freebie, no sweat: just click the friendly unsubscribe link in the download email.

Student Loans Books: Free Forever

When I began the project that eventually resulted in my two books on student loans, my long-term plan was to sell them temporarily, recoup some of the incredible time (and opportunity cost) burden of putting them together, and then eventually release them for free.

I’m happy to say that day is finally here.

From now on, you can always download the Kindle, epub, and pdf versions of Medical Student Loans and Dealing with Student Loans for free right here.

To receive your copy, you’ll need to sign up for my email list, and if you’re not interested in actually hearing from me again (which is totally fine), then just hit the unsubscribe link in the very first line of the email. (Okay, I admit I still haven’t actually started my newsletter yet, so I don’t have any gauge of how good it will be; the plan is quarterly [maybe?] starting 2019, 2020? Who knows?).

In order to subsidize the cost of giving these downloads away, I may occasionally bring on a sponsor. I want you to know that there could even be a single ad on a single page of this site (up from the current number of zero), but there will be absolutely no tracking or cookies or anything of any kind. Ever. Because that makes the internet worse.

But most importantly, I’m happy these books are free for the long term. I wrote them first and foremost to help as many people as possible, and making them free forever is the biggest part of that. While they say “student loans” in the title, these are also a good introduction to personal finance for young doctors and other professionals.

So, learning about student loans and basic personal finance will cost you a few hours and not a dime. And, if you’re on the fence about the time, let me leave you with a quote from a recent review by Dr. James Dahle, author of The White Coat Investor:

[Dr. White] does a fantastic job though; I wish I had written the book. But more than that, I wish every medical school required it to be read before you could receive your first student loan.

Download your copy today.