How to Survive 20,000 Rejections
Jacob M. Appel is a bioethicist and fiction writer. He holds a B.A. and an M.A. from Brown University, an M.A. and an M.Phil. from Columbia University, an M.D. from Columbia University's College of Physicians and Surgeons, an M.F.A. in creative writing from New York University, and a J.D. from Harvard Law School. He has most recently taught at Brown University in Providence, Rhode Island, and at the Gotham Writers Workshop in New York City. He publishes in the field of bioethics and contributes to such publications as the Journal of Clinical Ethics, the Journal of Law, Medicine & Ethics, and the Bulletin of the History of Medicine. His essays have appeared in The New York Times, The New York Daily News, The Chicago Tribune, and other publications.
Appel has also published short fiction in more than one hundred literary journals. His short story, Shell Game With Organs, won the Boston Review Short Fiction Contest in 1998. His story about two census takers, "Counting," was shortlisted for the O. Henry Award in 2001. Other stories received "special mention" for the Pushcart Prize in 2006 and 2007.
He is admitted to the practice of law in New York State and Rhode Island, and is a licensed New York City sightseeing guide.
Appel contributed a Dangerous Idea to Big Think's "Month of Thinking Dangerously," advocating that we add trace amounts of lithium to our drinking water to help reduce the suicide rate.
Appel is a Big Think Delphi Fellow.
Question: How do you pursue creative writing on top of two other careers?
Jacob Appel: Well, I think part of it is the importance of viewing them as separate careers. I think there are some writers who view writing and practicing medicine are very much interrelated and they write short stories about medicine or **** by medicine, some of them are very talented. Perri Klass comes to mind, Ethan Canin comes to mind, for me they're two very separate animals. And I view my occupation as being a bioethicist. And any extra benefits or extra blessing I get from being a writer, I'm very happy to have but if it doesn't work out, I'm not devastated by it. And in some ways that makes it easy to do, I know I can step back from it and go to the hospital and do my job and I haven't abandoned something that is essential to my well being.
I don't have to earn a living as a writer, which makes being a writer both more interesting and more pleasurable. That being said, my wisdom to anybody out there who is thinking about become a writer, and I tell all my writing students, is that the vast majority of success as a writer comes just not from persistence, but relentlessness.
I have recently reached a point where I have now more than 20,000 rejection letters. I don't know if 20,000 rejection letters is a record for people submitting small journals, but it shouldn't be because anybody else out there who wants to be a successful writer should also accumulate 20,000 rejection letters. The most successful writers I know, even those who are doing well who have several good books out still submit to small journals, still submit articles and reviews, get rejected, pick themselves off of the ground and fight back again.
Question: How do you persist in spite of so much rejection?
Jacob Appel: Well it's interesting, I actually did an interview a couple of years ago where 11,000 was the number, and I have a nice little journal where I keep track of every submission I have made, and if I ever do become a more successful writer, which is not a guarantee, but if I do, some day somebody will have my journal and be able to see exactly every submission I have made. And I've gotten some horrifically discouraging rejections. I've gotten rejections that say things like, "Not only will we not accept this story, but please never submit to us again." Or, "Consider this a preemptive rejection of anything you might write in the future." And the way you deal with that, on the one hand, is to know that writing is very much a matter of taste. And once you have a certain number of acceptances, you can say to yourself, I know I've gotten 20,000 rejections, but I've gotten over 100 acceptances, so somebody must like what I'm doing. And the other half of it is to realize that the same story that may be rejected by numerous journals, or numerous periodicals can then be accepted, which shows that someone else shares your sensibility.
One example I cite frequently is, I had the honor and privilege of a story of mine called "Shell Game With Organs" receiving an award from the Boston Review about a decade ago; my first significant literary honor, actually more than a decade now. It was rejected by more than 75 journals before I finally placed it; some of them rather unceremoniously, which suggested that it wasn't the shortcoming of the story, but simply a failure of the story to match the taste of a particular writer. I also urge people submitting stories to write a cover letter that convinces whoever the intern or college student first reading your work that you are somebody important enough that they shouldn't pass up on passing this letter on to the next stage.
The story I always tell, I was once a screener, at one point, I worked for Congressman Ted Weiss down here in lower Manhattan back in 1980’s. And I screened all of his phone calls, and the poet, Allen Ginsberg called to congratulate him on a recent election and I didn't believe it was Allen Ginsberg the poet, so I told him to write a letter and hung up on him. And about 10 minutes later he called back on the Congressman's private line and I nearly lost my job. Your goal is to convince whoever has the role like mine at a literary agency that you are important enough to get through to the boss.
Question: Should writers change their work based on rejections, or have faith in it as it stands?
Jacob Appel: I think you just have to have faith. I often make changes to the work based on acceptance. The editor who will call me and say, "We loved your story, but we had trouble with the ending." We are still thinking about publishing it, will you change the ending. Now, that's someone who is invested enough in the story, but I'm willing to say, maybe this person has a point and I'll go back and take a look at it and often, I will make changes. I think one story that comes to mind was a story of mine, "Grappling," that appeared in Stories South a couple of years ago about alligator wrestling. And the editors there, Jason Stanford particularly, were excellent advisors who said, "We loved your story, but you should really change the order of the scenes. And they were dead on. The advice I give young writers is never take advice from anyone that doesn't have a vested interest in your future. Once an editor says, we might publish the story; they have a vested interest in your future. The editor that sends you a note that says, we're not publishing your story and it's no good for the following reasons, has no vested interest in you and you take their wisdom with a grain of salt.
Recorded on March 1, 2010
Interviewed by Austin Allen
Discouraged writers, take heart! Jacob Appel has been turned down by nearly every publication in existence—and has the records to prove it. So what keeps him plugging away?
A plan to forgive almost a trillion dollars in debt would solve the student loan debt crisis, but can it work?
- Sen. Elizabeth Warren has just proposed a bold education reform plan that would forgive billions in student debt.
- The plan would forgive the debt held by more than 30 million Americans.
- The debt forgiveness program is one part of a larger program to make higher education more accessible.
Researchers hope the technology will further our understanding of the brain, but lawmakers may not be ready for the ethical challenges.
- Researchers at the Yale School of Medicine successfully restored some functions to pig brains that had been dead for hours.
- They hope the technology will advance our understanding of the brain, potentially developing new treatments for debilitating diseases and disorders.
- The research raises many ethical questions and puts to the test our current understanding of death.
The image of an undead brain coming back to live again is the stuff of science fiction. Not just any science fiction, specifically B-grade sci fi. What instantly springs to mind is the black-and-white horrors of films like Fiend Without a Face. Bad acting. Plastic monstrosities. Visible strings. And a spinal cord that, for some reason, is also a tentacle?
But like any good science fiction, it's only a matter of time before some manner of it seeps into our reality. This week's Nature published the findings of researchers who managed to restore function to pigs' brains that were clinically dead. At least, what we once thought of as dead.
What's dead may never die, it seems
The researchers did not hail from House Greyjoy — "What is dead may never die" — but came largely from the Yale School of Medicine. They connected 32 pig brains to a system called BrainEx. BrainEx is an artificial perfusion system — that is, a system that takes over the functions normally regulated by the organ. The pigs had been killed four hours earlier at a U.S. Department of Agriculture slaughterhouse; their brains completely removed from the skulls.
BrainEx pumped an experiment solution into the brain that essentially mimic blood flow. It brought oxygen and nutrients to the tissues, giving brain cells the resources to begin many normal functions. The cells began consuming and metabolizing sugars. The brains' immune systems kicked in. Neuron samples could carry an electrical signal. Some brain cells even responded to drugs.
The researchers have managed to keep some brains alive for up to 36 hours, and currently do not know if BrainEx can have sustained the brains longer. "It is conceivable we are just preventing the inevitable, and the brain won't be able to recover," said Nenad Sestan, Yale neuroscientist and the lead researcher.
As a control, other brains received either a fake solution or no solution at all. None revived brain activity and deteriorated as normal.
The researchers hope the technology can enhance our ability to study the brain and its cellular functions. One of the main avenues of such studies would be brain disorders and diseases. This could point the way to developing new of treatments for the likes of brain injuries, Alzheimer's, Huntington's, and neurodegenerative conditions.
"This is an extraordinary and very promising breakthrough for neuroscience. It immediately offers a much better model for studying the human brain, which is extraordinarily important, given the vast amount of human suffering from diseases of the mind [and] brain," Nita Farahany, the bioethicists at the Duke University School of Law who wrote the study's commentary, told National Geographic.
An ethical gray matter
Before anyone gets an Island of Dr. Moreau vibe, it's worth noting that the brains did not approach neural activity anywhere near consciousness.
The BrainEx solution contained chemicals that prevented neurons from firing. To be extra cautious, the researchers also monitored the brains for any such activity and were prepared to administer an anesthetic should they have seen signs of consciousness.
Even so, the research signals a massive debate to come regarding medical ethics and our definition of death.
Most countries define death, clinically speaking, as the irreversible loss of brain or circulatory function. This definition was already at odds with some folk- and value-centric understandings, but where do we go if it becomes possible to reverse clinical death with artificial perfusion?
"This is wild," Jonathan Moreno, a bioethicist at the University of Pennsylvania, told the New York Times. "If ever there was an issue that merited big public deliberation on the ethics of science and medicine, this is one."
One possible consequence involves organ donations. Some European countries require emergency responders to use a process that preserves organs when they cannot resuscitate a person. They continue to pump blood throughout the body, but use a "thoracic aortic occlusion balloon" to prevent that blood from reaching the brain.
The system is already controversial because it raises concerns about what caused the patient's death. But what happens when brain death becomes readily reversible? Stuart Younger, a bioethicist at Case Western Reserve University, told Nature that if BrainEx were to become widely available, it could shrink the pool of eligible donors.
"There's a potential conflict here between the interests of potential donors — who might not even be donors — and people who are waiting for organs," he said.
It will be a while before such experiments go anywhere near human subjects. A more immediate ethical question relates to how such experiments harm animal subjects.
Ethical review boards evaluate research protocols and can reject any that causes undue pain, suffering, or distress. Since dead animals feel no pain, suffer no trauma, they are typically approved as subjects. But how do such boards make a judgement regarding the suffering of a "cellularly active" brain? The distress of a partially alive brain?
The dilemma is unprecedented.
Setting new boundaries
Another science fiction story that comes to mind when discussing this story is, of course, Frankenstein. As Farahany told National Geographic: "It is definitely has [sic] a good science-fiction element to it, and it is restoring cellular function where we previously thought impossible. But to have Frankenstein, you need some degree of consciousness, some 'there' there. [The researchers] did not recover any form of consciousness in this study, and it is still unclear if we ever could. But we are one step closer to that possibility."
She's right. The researchers undertook their research for the betterment of humanity, and we may one day reap some unimaginable medical benefits from it. The ethical questions, however, remain as unsettling as the stories they remind us of.
In most states, LGBTQ Americans have no legal protections against discrimination in the workplace.
- The Supreme Court will decide whether the Civil Rights Act of 1964 also applies to gay and transgender people.
- The court, which currently has a probable conservative majority, will likely decide on the cases in 2020.
- Only 21 states and the District of Columbia have passed laws effectively extending the Civil Rights of 1964 to gay and transgender people.
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