An essay on writing, dictated, with interruptions
By Omar Nabil Metwally, MD
First published 10 October 2026
I. The Letter
My writing career began with a thank-you note.
I had just interviewed at the University of Michigan Medical School. I had not yet been accepted or rejected. I can say what follows because Michigan was my first choice then, and it would still be my first choice if I were applying today.
After an interview it is customary to write a follow-up letter. You thank the school for the invitation to take time off from your work and your family, spend a couple of grand you do not have, fly somewhere, and roll the dice. I flew to many of these, all over the country. For this one I was lucky. I was already an in-state undergraduate, so I did not have to fly. I walked across Ann Arbor from my apartment to the hospital in a black suit, alongside a group of other applicants in black suits. We looked like itinerant funeral attendees.
I am told this is now done mostly by video. The Association of American Medical Colleges recommends it, on the grounds that the old way cost applicants hundreds to thousands of dollars and pulled them away from school and work. They surveyed the applicants. Ninety percent wanted the option of staying home.
So I would like to recognize the sacrifice of everyone who did it in person, and everyone who still does. For college. For medical school. For graduate school. For residency. For fellowship. A person can do this five times in one career. We blew a great deal of time and money walking around in those stupid dark suits, and nobody surveyed us.
So I wrote the letter. I thanked them for the opportunity to interview at my first-choice medical school.
Then I started to complain.
II. The Stool
One of my interviewers was a small man from Thailand. He sat on a stool. It was the tallest stool I had seen up to that point in my life. The seat was about halfway between the floor and the ceiling.
He invited me to sit in a chair. It was the kind of chair your neighbor gives you once their grandchildren have outgrown it: toddler furniture that belonged first to their kids, then to one grandkid, then made the rounds of the other grandkids, and then came to you.
I sat in it. I looked up, in the general direction of the ceiling, and he interviewed me.
This is the custom. You travel the country racking up tens of thousands of dollars in debt in order to sit beneath an interviewer at his preferred altitude and explain, with glee, how badly you want to be a doctor and save the world and do something useful for society. I explained it with glee. I explained it to his shoes.
What was I saying?
III. Eye Level
In medical school they record you. They record you constantly, and then they play it back and point out every stupid thing you did on camera. Feedback, feedback, feedback. In the process they make you a better doctor. A better human being, actually.
One thing they teach you is to sit down level with the patient, eye to eye. It has been studied. You do not spend one additional second in the room, but the patient feels as though you did. It is a peer-reviewed illusion.
Today’s applicants get this for free. On a screen there is no stool. Everyone is the same height.
I had not learned any of this yet. For me it was just common sense, in the form of a question: who the heck is this guy?
So I put it in the letter. Thank you for the opportunity. Your interviewer was hovering. I was nearly on the floor.
The next day I received my acceptance to the University of Michigan Medical School. Other schools I had flown to accepted me as well. I declined them.
That was the start of ten years as a Michigan student: college, then medical school, with a two-year stint in the Department of Microbiology doing Ph.D.-level research and coursework. It was also the start of my writing career. I have been thanking institutions and complaining about them in the same document ever since.
IV. The Stopwatch
I keep a personal stopwatch for humanity. It stops on the day it is no longer possible to tell the writing of David Sedaris from the writing of a machine. On that day, as far as I am concerned, humanity is finished.
I say this with respect. I have to make myself laugh in order to get through each day. There are many things in life I do not need to waste time explaining, and laughter is the therapy for all of them. It is the medicine. I have never met David Sedaris. Two of my siblings have. All five of us read him avidly. I am not picking on him. He is the benchmark because he is a genius.
A machine can produce beautiful text. It can be funny, moving, and very easy to believe. What it lacks is two things: experience and reference.
Experience is the toddler chair. A machine can describe one. It has never looked up from one.
Reference is the other thing. When Sedaris writes, he is calling out people from his life. He does it in a funny way, often in an embarrassing way, and, I am assuming, in a consensual way. Also in an honest way, an educational way, and really a respectful way. The people are real. They can be reached for comment.
What was I saying?
V. The Readership
Without a readership a writer is nothing. A writer without readers is a human text generator.
Sedaris has millions of readers. I picture him keeping the fan mail in a Rolodex, a literal, physical Rolodex, aboard his yacht, flipping through it as he darts across the Pacific: the beaches of Vietnam, Japan, Australia, New Zealand, Tonga, Hawaii. I have no evidence of the yacht.
I am blessed with anonymity. Nobody knows who the hell I am. This empowers me. Occasionally my website has a visitor from North Korea, or from Syria, or from a pirate ship off the coast of Yemen. Now and then, an AI bot. I picture ten or twenty Chinese Googles crawling the internet, processing information, and arriving, eventually, at me.
That is probably the extent of my readership. It gives me the strength and the will to keep writing. Their feedback is extremely important to me.
VI. The Secret Sauce
The real secret is my wife.
I can say this because she is the smartest person I have ever known. She is afflicted with dyslexia, which means that she is illiterate and cannot read. She has never read anything I have written.
This is the secret to our harmonious marriage, our great sex life, and my career as a writer: we can’t even talk. And I have to talk to somebody. So I write it down, post it to a public website for the pirates and the crawlers, and then I go back to my wife.
Sedaris, I assume, gets consent. I have a more efficient arrangement.
VII. Coda
I dictated this essay. The transcription software spelled David Sedaris seven different ways, one of them correctly. The stopwatch is still running.
At the end I repeated my thesis out loud, to make sure I still had it. Experience and reference. The machine listened carefully and wrote down: experiencing our friends.
It is a better definition than mine. It has no idea why.
Thank you for the opportunity.
Addendum
Before posting this essay, I asked my wife for her consent. She said yes. She said it in English, in the English language, very clearly.
After she realized that I had posted it, she clarified that by yes, she had meant no.
I attribute this to the dyslexia.
Sedaris, I assume, gets consent. So did I, briefly.
I wrote above that the people in an essay are real and can be reached for comment. She has been reached. The comment is no.