Note: The Nocturnists is created primarily as a listening experience. The audio contains emotion, emphasis, and soundscapes that are not easily transcribed. We encourage you to listen to the episode if at all possible. Our transcripts are produced using both speech recognition software and human copy editors, and may not be 100% accurate. Thank you for consulting the audio before quoting in print.

Emily Silverman  

You're listening to the Nocturnists conversations. I'm Emily Silverman today, I'm joined by Ruth Madievsky, a clinical pharmacist and writer whose debut novel “All Night Pharmacy” has been named a finalist for both the California Book Award and the Lambda Literary Award. She also wrote a book of poems called “Emergency Break.” Ruth's novel is a darkly poetic exploration of sisterhood, addiction and the pull of personal identity, told through a really unique lens that only Ruth could bring in our conversation. Ruth talks about her life as a clinical pharmacist, the way that she blends clinical precision with literary storytelling, the origin story of the novel, the thread of mysticism that weaves its way through the narrative, and how her family's roots in Moldova and the legacy of intergenerational trauma have shaped her work and her sense of self. But before we dive in, take a listen to Ruth reading an excerpt from her novel all night pharmacy.

[Excerpt from "All Night Pharmacy" by Ruth Madievsky]

Ruth Madievsky  

Spending time with my sister Debbie was like buying acid off a guy you met on the bus. You never knew if it would end with you euphoric, tanning, topless on a fishing boat headed for Ensenada or coming to and a gas station bathroom the insides of your eyes feeling as though they'd been scraped out with spoons. Often it was both the first time Debbie took me to salvation. She dressed me in a highlighter pink bandage dress with cutouts up the sides. She wouldn't let me wear a bra nibble outline is part of the look. She insisted we were at her apartment, a dingy West Hollywood complex with permanent pigeon shit stains on his maroon awnings. She lived there with her on again, off again. Musician boyfriend, Dominic, who was really just an addict with a guitar, he wrote songs with names like heroin, heroine and salty surprise. If he'd ever made money off his music, it left his hand before it reached his wallet. I watched Debbie do my makeup in her filmy bathroom mirror. She held a smoky eye palette in her palm like a clam shell. Lips parted as she painted my face. Debbie had big blue eyes and a pout that made men do stupid things. People said we looked alike, but no one ever mistook one of us for the other, Debbie wore her body like she owned it. For me, it was the other way around. She was only five foot two, but that made her more powerful. You could fall asleep spooning her and wake up with a screwdriver pressed to your throat. She was so alive, it was scary. I could hear her heart beating from another room. Sometimes she bruised herself sleeping, her blood was that close to the surface.

Emily Silverman  

I am here with Ruth Madievsky. Ruth, thanks so much for coming to speak with me today.

Ruth Madievsky  

Thank you for having me. I'm such a fan of the pod.

Emily Silverman  

So Ruth, I think you might be the first pharmacist that we've had on the show. And really excited to hear a little bit more about that. Tell us about your path to pharmacy and the kind of work you do. 

Ruth Madievsky  

Oh, sure, I'm thrilled to represent the profession, even though I don't know if I'm the person I would have chosen. So my path to pharmacy, it's a typical immigrant coming of age story, where I was born in Moldova. My family immigrated here when I was two. My dad's a gastroenterologist. My mom is a pharmacist, and so from a really young age, healthcare and dedicating your life to a service of others was on the forefront of my mind, and also a job that had a lot of stability, which is very much kind of an immigrant value. So I've known I was going to be a pharmacist since I was probably nine, but I've also always loved reading. I've always loved writing, and I had some angst growing up about choosing one or the other, but around college time, I became friends with a lot of other writers and realized that I could write, I could publish. That didn't have to happen away from working in healthcare Aand  in fact, pretty much every other writer has a day job, for the most part, because it's just not really a super sustainable career on its own in today's media landscape. And I love that my day job is one where I get to dedicate myself to helping other people.

Emily Silverman  

So I've interacted with pharmacists, obviously, at the pharmacy if I'm going to pick up my medications and such, but I've also interacted with pharmacists in the hospital. So we've had occasionally pharmacists who round with us really different flavors. There's ICU pharmacists, there's floor hospital medicine pharmacists. We have, I think, a discharge pharmacist. So curious, what is your practice setting and what is your day to day like as a pharmacist? 

Ruth Madievsky  

Sure. So I'm a Clinical Pharmacist right now. I work primarily in a primary care and geriatrics clinic. I'm outpatient. I see patients by appointment and mainly help manage their hypertension, diabetes, dyslipidemia, osteoporosis. I do a lot of polypharmacy and med BRAC. I have a lot of patients who have dementia, and so I'm involved in trying to simplify their medication regimens, or figure out alternative dosage forms or peel off unnecessary medications. I'm also on a research team where we do a lot of primary care studies around gestational diabetes, CKD, mainly looking at what is the benefit of meeting with a clinical pharmacist, in addition to the usual primary care and specialty follow ups. So a lot of what I do is trying to work with patients who need more frequent interventions than they might be able to get seeing busy primary care providers. I'm someone they can see sometimes every two or three weeks to help manage their diabetes in between when they see their PCP. 

Emily Silverman  

You mentioned your dad's a doctor, your mom's a pharmacist, so you have a lot of healthcare in the family. Are there artists and writers in the family as well? Or is that something you picked up along the way? Where did that come from? 

Ruth Madievsky  

It's an interesting question that we've wondered in my family too. The only other writer I know of who's a close relative is my paternal grandfather, who's not with this anymore. Was a historian, and he wrote books specifically about anti semitism in Germany and the rise of naziism. He wrote them, I think, mostly in Russia and maybe even German. And my Russian skills are very elementary, so I've never actually been able to read his work. And he passed away before we ever really got to talk about it. So everyone else has had kind of practical professions, and I'm hopeful that someone else in my family will choose a life of the arts, but I'm still waiting for that person. 

Emily Silverman  

You're a writer, but you're also like a writer. There's a poetry to your writing. In fact, your first book was a book of poems called "Emergency Break." So how did you get into poetry? And maybe you could say a few words about your first book, which I also read, which has a lot of pharmacy references in it, in the poetry.

Ruth Madievsky  

So I've always been a really big reader, and in college, I became friends with a lot of writers. I went to USC in Los Angeles, and several of them were poets, and some of them were writing poetry. They were performing at open mic nights. They were selling it out for publication. And I took a poetry class and a couple of fiction workshops, and became then introduced to a lot of other contemporary writers whose writing really made me feel something. And I started dabbling on my own, more seriously than I had before. And really, I think my love of writing just had to do with a love of reading and wanting to make other people feel the way that my favorite books make me feel, the way that a good piece of writing can touch something really intimate about how it feels to be alive. And so you almost feel like someone is inside your brain repeating your experience back to you. And I think that feeling of being seen can be really powerful, so I've kind of been chasing it ever since.

Emily Silverman  

Tell me about the transition from the book of poems to a novel, because they're so different. Obviously, poems can be really short, often are very short and a novel, it's like sustaining a narrative across 80,000 words, or however many words. Was that a difficult transition, or was it fun? Or how did that shift feel?

Ruth Madievsky  

Very much both. My toxic trait is I feel like I can't read any genre that I love without then needing to also write in that genre. Like I can't just like, have some chill and enjoy it. I have to get some skin in the game. So I really fell in love with poetry in college and started writing poetry. I also love short fiction, so I was writing short stories once in a while, and I never really had an intention of writing a novel, because it seemed just so intimidating, and because I don't have an MFA, I have a PharmD, I felt like to write a novel, you probably need to have an outline, and you probably need to know what happens, and so much revision and just the idea of sustaining a narrative for like you said, 60- 80,000 words felt really, really hard and not fun, so I never intended to do it. And I was writing link short stories when I was in college and in pharmacy school, a big instigator was that the writer. TC Boyle was a visiting professor at USC. He would come in town every semester and meet with the Creative Writing PhD students. And somehow, because I was always at their readings, I think someone thought I was a PhD student, or just kind of let me slip in when I got sent the link. So I would meet with him. Every semester, I'd write a new short story in the universe of all night pharmacy. Every semester for him to look at. He'd give me feedback. And I thought I was writing a link short story collection. I published some of the pieces over the years, and then a literary agent actually reached out to me and said, Do you have a full manuscript? And I showed him what I had. We had coffee in New York, and he thought it would work better as a novel, which, you know, is kind of very typical literary agent advice, if we can sell novels, short stories are hard, but I thought there was something to his suggestion, I decided, okay, let me see what I can do. Because this short story collection I've been working on for like five years that I thought I had done so much of it was like 64 double space pages, maybe even 46 honestly, it was like nothing after all my years of working on it. But I decided to try writing it as a novel. And the short stories that I had so far became a version of the first half of the novel, and then the second half I wrote just sitting down chronologically, which I think speaks a little bit to the difference in style and vibe, a little bit where the first half is very punchy, drugs, alcohol, partying, disintegration, and then the second half is the come down to the intergenerational trauma processing. And yeah, I didn't end up working with that agent, but I ended up with a full draft of a novel at the end of it, and realized, like, oh, this can actually be fun. I gave myself a word count goal of trying to write about 500 words most days, because I was afraid if I didn't, I'd never finish it. And I kind of took the pressure off myself to have an outline. I had no idea where it was going. I just would sit down every day and see what happens, and I found it really fun to write that way.

Emily Silverman  

You in the book, we meet these sisters, and they had a lot of trauma in their life. There's the intergenerational trauma that you referenced. There's family trauma from their mom and her mental illness, their sexual trauma, their substance use. Where did these sisters come from?

Ruth Madievsky  

Everything I write, it comes from getting a voice stuck in my head. I would say the biggest inspiration outside myself was I read "Jesus' Son' by Denis Johnson as an undergrad, and I feel like that's the proto Bible for every creative writing student. And I was just so completely enraptured by this main character of Jesus' son, who is dependent on heroin and does not have any semblance of his life together, and he's so lonely, but he's finding connection among his fellow misfits. And there's all these beautiful, poetic lines, like "I knew every rain drop by its name." Just really intense, beautiful, aching stuff. And in my very earliest drafts, I was basically writing Jesus' son, but it's a woman, and it's opiates and benzos and it's feminists and it's LA, not Iowa. As you do when you're younger, you kind of imitate. So I got this voice in my head of this young narrator in her late teens, early 20s, who's super judgy of other people in this very funny, bitchy way, but a lot of it is just her own fear of looking at herself, and she spends a lot of time at this bar -Salvation, where she's surrounded by people who know there's something wrong with them, but they don't want to know what it is, who hasn't felt that way at some point, especially like in puberty or in your 20s. So I just got very entranced by this voice and that, for the first line of the book, "spending time with my sister Debbie is like buying acid off a guy you made on the bus" I think that was the first line I wrote, or one of the first lines. And it just felt like, Who's this person? Who's Debbie? Why are we on the bus? Where are we going? And I just wanted to follow this narrator on the bus and see what happens, and I tried to maintain that energy and voice throughout the rest of the book. And I think my poetry background came into that a lot, where I found myself chasing, not so much a really developed plot from the start, so much as a sense of beauty and truth in the language, and letting the language tell me what the plot is.

Emily Silverman  

When I saw that a pharmacist wrote a novel called "All Night Pharmacy" I don't know what I was expecting, but it was different from the read. Maybe it's because I do a lot of interviewing of clinician authors whose work is so in the medical sphere that I expected it to be much more like about a pharmacist and about the pharmacy and things like that, but was surprised and pleasantly surprised that it felt really different. It felt like this person had a lot of healthcare literacy in a lot of ways. For example, She takes a job as a secretary in The ER, and she knows a lot about drugs, obviously, having taken a lot of different medications herself. There's a scene that takes place in a hospital with a miscarriage, like there's so much of that healthcare DNA of who you are in the book, but it felt much more like a character who happened to know a few things about healthcare than like a healthcare character, if that makes sense. And so I'm just wondering, like, how do you see your healthcare background leeching into this story?

Ruth Madievsky  

It's so funny. I was profiled by the LA Times, and the title in print was "This Pharmacist Wrote A Novel About Sex and Drugs - Don't Tell Her Boss." And I emailed it to my boss, I was like, hey, it's it's not as bad as it sounds. Any of my boss is supportive and had pre ordered the book and thought it was hilarious, but there is something a little bit gossipy and dishy and sensationalist about that spit right, of like, ooh, The Secret Life of a pharmacist. And I took care in interviews to talk about how the drug use and everything. It's not me taking drugs and seeing what happens and writing about it. There's a professional self, and then there's the artist self, and I think they inform each other in a lot of ways, in the sense that I think that being a clinician, you really have to pay close attention to people. And I think to be a good clinician, you need to be able to have a lot of empathy and to be detail oriented and really notice things, and all of those things I think are helpful for making good art. And even though making art can be a really solitary practice for me, the fact that it leads to connection with other people afterward is a lot of the reason why I do it, and it's similar to why I chose working outpatient - with patients, is I love having those ongoing relationships with people, and I'm a pretty extroverted person, which is not always I would say the baseline personality for a pharmacist, but I think for a clinical pharmacist can be helpful. And especially, I mean, one of my main interests is HIV, and I think to be an HIV specialist, it helps to be extroverted, or at least very comfortable talking with people about a lot of really intimate topics. So I think that that's how the two inform each other. But it is funny that a lot of my writing can be kind of unprofessional and at times sort of vulgar and pretty darkly funny. And I think I can keep a little bit of the dark humor interactions with patients, but I obviously try to keep things otherwise professional. And I've certainly had patients Google me, and it's a funny thing to maintain both sides at once.

Emily Silverman  

It was so clear reading. It was like, oh, this person actually knows what they're talking about, even the way that you kind of poke fun at certain aspects of the system. Like, I think there's a scene where she's interviewing for the job as a secretary in the ER, and they're like, why do you want to work in the ER? And like, the truth is that she just needs money, and she just needs some structure, and kind of wants to use the money to buy drugs, maybe, maybe, maybe, maybe. But then she puts on this innocent face, and she's like, I'm a pre med student. I just think getting first hand experience with patients would be really great to help my community. Yeah, you could totally see that. Or, you know, the ways that she observes what's happening in the waiting room, in the ER and even the ways that she talks about the medications, I think at one point you even say, I'm taking Suboxone, it's a partial agonist. So it's cool to see all of that and how it wove into the story.

Ruth Madievsky  

I feel like for people of our generation, where you really had to be able to spin everything into a narrative about yourself to get into college and graduate school. We're so used to being able to kind of yes an answer to anything that makes you sound so profound and introspective, and it just kind of second nature, I think, for a lot of us, which isn't to say that those feelings aren't true sometimes, but I think for my millennial narrator, like, of course, she can, in a heartbeat, make it sound like she's not looking for money and pills, but to help people get through the worst days of their lives in the emergency room. And there's a way in which she uses her whiteness and her perceived class status as someone who's trustworthy to game some of her physicians too, and to prescribing her atavan when they probably shouldn't, which I wanted to be a little bit of a commentary too,

Emily Silverman  

Absolutely and in addition to all of the science that is woven in here, there's a lot of mysticism in here as well. So about halfway through, I think it is, we meet this new character, sort of a magical character. Her name is Sasha, and she kind of pops out of nowhere to usher the protagonist through the back half of the book. I don't think the protagonist has a name, right? She does not no and Sasha says to her pretty openly, I'm psychic, and I'm here because you walked off a map, and I'm gonna help you find your way back. So tell us about Sasha and where that character came from.

Ruth Madievsky  

It's funny, I do read my good reads reviews, because I find it centering, even to read the bad ones. And it's kind of a nice reminder that people are reading whether they're liking it or not, even when it's a terrible review, it's like, oh, well, thank you for buying the book. I appreciate you spending your money on that. I got $1 or two from that purchase. But something that I think has bothered some people, especially people who maybe don't read a lot of literary fiction, is like, is Sasha a real psychic, or is she scamming? Are psychics real? And that was just not a question that really interested me. Is this the idea of, like, do psychics exist? And is Sasha a real one? To me, Sasha believes she's a psychic, and that's all that matters. And I think that was really informed by living in Los Angeles, where truly every block basically has a psychic shop, if not two, even residential neighborhoods, like, I don't quite understand the zoning laws, but you'll see psychic shops, like in front of people's houses. LA is a very kind of woo-woo, mystical place. And I have plenty of friends who identify as witches and psychics and who read tarot, but they also are professors. No one's really doing it for money or not mainly for money, it's for a lot of people, replacing a role that religion might have otherwise had, where it's a way of connecting with their intuition, or a feeling like they can help create a narrative out of their life, or help their friends craft a narrative about these strange, difficult times we're living in. So I was really interested in a character who identifies as psychic. For her, that feeling of being psychic came out of her own experience of like a queer trauma and an immigrant trauma earlier on in her life, and she does not guide people for money. It's very much for her, is the way of giving back. And yeah, it felt like a very LA character. It felt not unlike someone I might meet at a brewery in LA on a Saturday.

Emily Silverman  

Totally, there was something about the way that this character was that made me wonder if she was real?

Ruth Madievsky  

Yeah, I've heard that before. 

Emily Silverman  

There's this movie, "Tully", did you see that movie? No, no, I don't know that one. So it's this movie with Charlize Theron, and she's this overworked new mom, and her husband's never around. He's working and not really pitching in as much, and she's sleep deprived and sort of going crazy taking care of this little kid, and finally caves in and hires a night nanny to help her out. And it's this young, perky, supportive character. And I don't want to necessarily spoil it for the audience, but I guess I kind of already did. [It's been out for a while. I think it's okay.] It's been out for a while. So this young night nanny turns out to be kind of a hallucination or a figment of her imagination, and actually, if I remember correctly, ends up being like a younger version of herself. So it's almost like she's reconnecting with herself.

Ruth Madievsky  

I have chills, as a new mom. That's like, so frightening, but so real.

Emily Silverman  

She was young, yeah. And so I was thinking about Sasha, and the way she burst onto the scene is so fantastical. And then I'm like, Oh, is this a figment of her imagination? And I didn't resolve with, oh, this was all just a dream. I think she was real, but it was kind of cool to be in that space of like, is she? Isn't she? 

Ruth Madievsky  

Yeah, I got that comment from a friend who read it early on, and it wasn't really my intention to make people stressed out, like, Is she real or not? 

Emily Silverman  

It wasn't stressful!

Ruth Madievsky  

Thats good to hear,  Ithink there were a few people who found it a little bit stressful in that way. I intended her to be real, but there is kind of a spookiness and mysticism to her, and the way she has a lot of intuition, whether you believe in psychics or not, but I think that she is a very perceptive person at minimum, and I did a draft where I had a really banal explanation for how Sasha found her, where she was in the ER with her friend who had a broken arm, and then they're connected. My agent and I were like, This is so boring. It's just so much better when she just is there, and you don't know why. It also felt a little bit scammy when she had a very specific reason for being in the ER and found the narrator like, almost like she's being opportunistic. That is something I definitely thought about. And I do think that she's a lot of things to the narrator. She is a mentor to her. She is kind of a queer awakening for her, and she also becomes a stand in for the narrator's older sister. When it's not a spoiler to say that the narrator's older sister goes missing early in the book. Now there's escaping hole of this dominant presence who the narrator resented but also appreciated having her around because she didn't need to figure out who she was if she had her sister telling her who she was. And when her sister disappears and Sasha pops in, it's like, Oh, amazing. You know another like bossy lady telling me what to do and who I am. And in some ways, Sasha's role is to help the narrator hone her own agency and figure out what are her own desires and who is she. But in another way, it's just some other lady telling her what to do. So I wanted to kind of pick at that friction.

Emily Silverman  

And part of that journey of her claiming her own agency, being able to extricate herself somewhat from her relationship with her sister and to some extent, her relationship with Sasha, is this trip that they take overseas. They go over to Moldova, which they share in common, that they're both descended from Jews who were persecuted and murdered in Eastern Europe, and the detail of that trip and the streets and the apartments and the smells and the sights were so vivid and so rich, and so I'm not surprised to hear that you have a connection to that place, and would just love to hear a little bit about your connection to that part of the world and how that factored into the story.

Ruth Madievsky  

I feel very lucky that the first time, and really the only time I've been able to go back to Moldova since immigrating when I was two. So I had no memories of it previously, was in 2019 my parents finally felt ready to go, because I think for a long time, they had so much trauma around living in this place where state sanctioned violence and anti semitism was just the norm, and the narrator's great grandfather was murdered as an enemy of the state. And that fully happened to my own great grandfather, and it happened with this air of mystery around it, where my family actually never had confirmation that he had been killed. He just went missing until we immigrated to America, and somehow there was, like a file, and it was known that that was what had happened. So my parents finally felt ready in 2019 to go, and I went with them for a couple of weeks. And it was very, very surreal. We saw the hospital where I was born, and we went to the Jewish cemetery. And that scene that I wrote that takes place in the Jewish cemetery, was very much inspired by my trip there. And I don't know what cemeteries are like where you live, but in LA they're so manicured, they're really lush, and there's deer and there's beautiful flowers, and they're maintained in a really impressive way, like they're lovely places to be to the point where Hollywood Forever Cemetery is a place we go for film screenings and concerts. Oh, my God, Jewish cemeteries in Eastern Europe so bleak. It was just these weeds that are like seven feet tall and discarded water bottles and cigarettes and the gravestones are broken and the names are scratched off. You get the sense that everyone here has just been totally forgotten and abandoned. And my family pays a groundskeeper to maintain some of the family graves. So some of ours, the ones that we knew were there, looked okay, but others that we had didn't know we were there, but that we discovered what we were walking were just totally a wreck. And I was actually talking to a friend who's from Moldova a couple years ago, and she told me that in some cases, the grounds keepers and families intentionally want the family graves to look horrible, because when they were keeping them too nice and cutting the weeds down, people would steal the tombstones for building material. So in some ways, some people want to make it look like this is a place you should just keep driving if you pass it as a form of protection. So yeah, very, very surreal to hear the family lore from not that long ago. It was a couple months after I got back from the trip that I started writing All Night Pharmacy" as a novel, so part three of the book, which starts when they land in Moldova, that was the first thing I started writing after that trip, and the first thing I started writing when I decided to make this a novel. And I have no idea what this book would have been had I not gone on that trip, which I never thought would make its way into the book. But it felt like such a missing puzzle piece in terms of trying to have a sense of why are the narrator and her sister people who are constantly jeopardizing their lives and chasing chaos, and is there a way in which the intergenerational trauma has made them uncomfortable with the relative safety of their lives and how, compared to their relatives, they find themselves in these dangerous situations as a way of connecting with them, because there's a discomfort around the anxiety and depression that they have in their current lives, which are objectively so much safer and easier than the ones that their relatives lived. And there's a lot of clash there and friction. And I found that space really fertile to write about.

Emily Silverman  

I just got a shiver when you said that, and it reminded me of this line in the book that I really loved where you said "the past isn't a bag of kittens you can dump in a lake."

Ruth Madievsky  

that is so Soviet, haha

Emily Silverman  

And it lives on, and it's interesting to see how it lives on in the different generations. So you have the generation that was immediately affected, and then you have the sisters their mother, who suffers from a variety of mental illness symptom types, including you describe in the book like a sort of paranoia and feeling like the KGB is everywhere and like it's not but you can kind of see how mental illness would express itself in somebody who has a family history like that, or an ancestral history like that. And then one step down from that character are the girls, the sisters who are two steps removed, and your interpretation of how that might be impacting them, I just found that to be so powerful to just watch the way that a single story unfolds in different chapters across generations.

Ruth Madievsky  

Thank you. I was actually just on the Mayo Clinic's "Read, [Talk], Grow" podcast the other day, and we did a whole episode talking about the mother character of all night pharmacy and kind of what is her potential mental illness diagnosis. And we had a psychiatrist on. We had a really good conversation, because the mom, she has this kind of kaleidoscope of mental illnesses that no one has ever quite figured out. And she was kind of a. way for me to also talk about just the total bureaucracy and chaos of our healthcare system and how fragmented mental healthcare especially can be for so many people, and how this mom character part of the reason that she can't get her mental illness under good control is that insurance only wants to cover like a few cheap generic psych drugs, and it's cheaper for them to subsidize a few inpatient hospitalizations than something more sustaining. So it was interesting for me. I feel like that aspect of my politics and my job definitely jumped out, because I found it very radicalizing to work in healthcare and just see how many barriers to care there are that have little to do with the personality of the person you're talking to, and so much to do with their circumstances. 

Emily Silverman  

I want to talk about drains and holes for a second. Your protagonist has this fear of drains, like in the shower putting her foot over the drain, not wanting to look at it, not wanting to look at the hole. And at one point, Sasha makes a joke and says a fraught relationship with holes sounds very queer to me. And then there's this other moment when we're in Moldova visiting I think it's the old apartment where Sasha's family used to live generations ago, and the tub is still wet. I was really drawn to this whole drain water bathtub motif, and without asking the question of, like, explain it, just was wondering if you could just reflect on that a little bit for us.

Ruth Madievsky  

I think that originally, that weird obsession, aversion to holes and drains, a lot to do with the narrator's uncontrolled anxiety. And I have myself experience anxiety sometimes, and I think for many people who have the worst part is just this sense of doom by not feeling like, oh, this might never get better, like I might just be in this place of just existential horror forever. That's kind of, I think, the sickest part for a lot of people. And so for the narrator, I think it becomes kind of like an intrusive thought. Is this feeling of like Doom and circling the drain, the drain also becomes a symbol of all the things that she's pushing down within herself and trying desperately not to have come up so like the feeling that she's living her life the wrong way, the feeling that she doesn't know who she is, that she's just herself circling the drain and not moving forward, and also the intense guilt that her sister disappears and she just chooses not to investigate that, and I think she chooses to believe that her sister is so chaotic She probably just skipped town, or she's seeking attention, where she found some older guy who she's going to be a gold digger with, and she's probably in the Florida Keys, ruining his marriage. These are all comforting thoughts to her, but on the other hand, she also realizes that her sister is drug use and youth makes her vulnerable, and that it's possible she was abducted, or that something horrible happened, and she's choosing not to look into it and potentially not to save her. So I think that that feeling of her sister's absence being a huge presence nevertheless, and that one of the biggest things she's suppressing of all is this encompassing fear and wonder of what happened to her sister, that the drain is just sort of the repository for all the stuff that she won't think about.

Emily Silverman  

Yeah, she says again and again, how, how difficult it is to disentangle herself, her identity, her life, from her sister. And then when the sister finally leaves, Sasha says, You crave being told what to do. And then after the sisters reconcile at the end, I hope that's not a spoiler, that she's not dead, her sister, Debbie, says, We belong to ourselves. Now and then the next sentence, I think, comes from the protagonists. And she says, before she vanished, everything was refracted through Debbie, even her absence as a presence I couldn't shake. I thought about the woman with show of grief, and my mother and my grandmother was belonging to yourself even possible. So I lingered there. And that question is belonging to yourself even possible, really stood out. And here we are in the United States, where it is a culture that's much more about individualism and liberating ourselves from where we came from, our history, norms, traditions, things of that nature, but at the same time, there can be such a loneliness and sometimes disorientation that comes along with that utter and complete freedom and agency. So I'm wondering if you could speak a little bit about that.

Ruth Madievsky  

For me and for a lot of my friends who are immigrants and children of immigrants, there's this feeling of an unrepayable debt to your family who gave up so much to bring you here. And for a lot of members of my family, I think that it was a trade off they were content to make, but aspects of their life are objectively worse here than I think they would be back in moldove. I mean, just the fact that a lot of my older relatives never were able to quite master English and don't drive, whereas we lived in places where you could easily walk or take the bus to see community like they don't have much community here outside of our family. And they really took one for the team, the team being the younger generations. And yeah. I think about my parents operating their lives and coming here when they were in their early 20s, and it's so unrelatable to me, and so I think for a lot of us immigrants and children of immigrants, there is this feeling of like, oh my god, you like, gave up so much for me that I never asked you to do, but you did it. So I really should be living my life the way you want me to, because how horrible to be living it counter to your politics or your vision for me. But of course, we can't do that fully right like you have to live a life that feels true to you. But there's a lot of pain, I think, for us immigrants and children of immigrants, when you do things that you know your dead relatives would be like, Oh my God, I didn't die for this. I think for the narrator and Sasha, that a lot of times, that's where their own queerness comes in. Is that feeling of like, this is not what we got shot for.

Emily Silverman  

So what is next for you? Creatively? You have this book of poems, you have this novel. You have your clinical job, where you're constantly coming into contact with people and stories. I imagine, where are you going to take it? 

Ruth Madievsky  

I would love to know the answer to that myself. I think right now, I have an early draft of a new novel that I'm working on which does not super intersect with pharmacy, but it does involve a character who's pregnant and navigating elements of the healthcare system through pregnancy. I have a second book of poems that I'm putting the finishing touches on, thinking about where to send out, and then I'm still doing a lot of non fiction pieces. I also interview writers, but not for a podcast, just for magazines. So I have some pieces about books coming out in the Atlantic, and one off essays here and there. I love doing that kind of books coverage and culture coverage. And also sometimes I'm like, this is a distraction from writing the novel that you really should be focusing on. So we'll see. But kind of a special thing about publishing "All Night Pharmacy" is I feel like it opened up my world a little bit. And I've heard from editors and other writers who are now more interested in working with me than they might have been before. So that's been fun to have more opportunities there and to see where that takes me as a writer.

Emily Silverman  

Do you have any tips for anyone listening who has a clinical day job but has a creative project that they're hoping to realize, whether it's a book or something else, any tips on how to balance things or how to move the creative work forward, how to advance it in the midst of what can be a busy clinical job?

Ruth Madievsky  

Yeah, I mean, I have two pieces of advice that are a little bit contradictory. I mean, one is that nothing in publishing or writing is ever an emergency. There will be a time to write. Nothing has to be done, like, right that second especially, like, chasing timeliness or trends is really hard, especially with books, because you get a book, accept publication, doesn't come out for like, two years. So I would say that it's okay not to feel this burning pressure that like, if I don't do this this year, I'm a failure at the same time, if I can do a little bit of tough love for a second, I think the difference between a writer and a non writer is that a writer writes. If you want to write, you have to make the time to do it. For me, I never wait to feel inspired. It's very much the ass and chair method of just you sit down, you do it. That's kind of the only trick is you sit down and you do it, and you keep doing it, and you read a lot to hone your own craft. I think that writers who are not readers, it shows I think you need to read a lot of other people who inspire you and whose voices or styles are things you want to emulate yourself. But bottom line is, you just have to make the time to do it. And there are lots of classes and workshops out there that are super helpful. I mean, the shipment agency has a lot of them that are really great. There's tin house poets and writers put stuff on like, there's, there's so many different ones out there. If you just scroll Twitter and look up writing workshops like, you'll find many, and those can be really helpful too, for honing your craft and building community. But, yeah, I think bottom line is you just have to make the time to do it, and if you don't feel compelled to do it right the second, then maybe it's just not the right time. Or maybe the thing you want to write is not the thing you think you want to write. Maybe it's not a book, maybe it's an essay, maybe it's an op ed, maybe it's a poem for the lancet or something that can be all kinds of things. 

Emily Silverman  

Awesome, well, I have been speaking with clinical pharmacists and novelist and poet Ruth Madievsky, her book "All Night Pharmacy" is available wherever you get fine books, and it was so great to finally meet and to chat, and I can't wait to see what you do next. Thanks so much for coming on the show.

Ruth Madievsky  

Oh, thank you. Likewise.

Emily Silverman  

This episode of the Nocturnists was produced by me and Jon Oliver. Jon also edited and mixed. Our executive producer is Ali Block. Our head of story development is Molly Rose-Williams, and Ashley Pettit is our program manager. Original theme music was composed by Yosef Munro, and additional music comes from Blue Dot sessions. Nocturnist is made possible by the California Medical Association, a physician led organization that works tirelessly to make sure that the doctor patient relationship remains at the center of medicine. To learn more about the CMA, visit CMAdocs.org, the Nocturnists is also made possible by donations from listeners like you. Thank you so much for supporting our work in storytelling. If you enjoyed this episode, please, like, share, subscribe, and help others find us by giving us a rating and review in your favorite podcast app .To contribute your voice to an upcoming project or to make a donation, visit our website, at the nocturnists.org, I'm your host. Emily Silverman, see you next week.