"The Essayist at Work" is our first special issue. The cover is different, and although it is our habit to center each issue around a general theme, the essays and profiles in "The Essayist at Work" are narrower in scope. In the future, we intend to publish special issues on a variety of topics, but this one is especially important, not only because it is our first, but also because it helps to launch the first Mid-Atlantic Creative Nonfiction Summer Writers' Conference with the Goucher College Center for Graduate and Continuing Studies in Baltimore, Md., a supportive and enthusiastic summer partner. Many writers featured in "The Essayist at Work" will also be participating at the conference - an event we hope to continue to co-sponsor with Goucher for years to come.

The writers in this issue represent the incredible range of the newly emerging genre of creative nonfiction, from the struggle and success stories of Darcy Frey ("The Last Shot") and William Least Heat-Moon ("Blue Highways") to the master of the profession, John McPhee. From the roots of traditional journalism to poetry and fiction, Pulitzer Prize-winner Alice Steinbach, poet Diane Ackerman and novelists Phillip Lopate and Paul West, have helped expand the boundaries of form and tradition. Jane Bernstein, Steven Harvey, Mary Paumier Jones, Wendy Lesser and Natalia Rachel Singer ponder the spirit of the essay (and e-mail!), while I continue to reflect on and define the creative nonfiction form.

From the beginning, it has been our mission to probe the depths and intricacies of nonfiction by publishing the best prose by new and established writers. Creative Nonfiction provides a forum for writers, editors and readers interested in pushing the envelope of creativity and discussing and defining the parameters of accuracy, validity and truth. My essay below, "The 5 Rs of Creative Nonfiction," is dedicated to that mission. It will appear in "More than the Truth: Teaching Nonfiction Writing Through Journalism," which will be published in the fall of 1996 by Heineman.

The 5 Rs of Creative Nonfiction

It is 3 a.m., and I am standing on a stool in the operating room at the University of Pittsburgh Medical Center, in scrubs, mask, cap and paper booties, peering over the hunched shoulders of four surgeons and a scrub nurse as a dying woman's heart and lungs are being removed from her chest. This is a scene I have observed frequently since starting my work on a book about the world of organ transplantation, but it never fails to amaze and startle me: to look down into a gaping hole in a human being's chest, which has been cracked open and emptied of all of its contents, watching the monitor and listening to the rhythmic sighing sounds of the ventilator, knowing that this woman is on the fragile cusp of life and death and that I am observing what might well be the final moments of her life.

Now the telephone rings; a nurse answers, listens for a moment and then hangs up. "On the roof," she announces, meaning that the helicopter has set down on the hospital helipad and that a healthy set of organs, a heart and two lungs, en bloc, will soon be available to implant into this woman, whose immediate fate will be decided within the next few hours.

With a brisk nod, the lead surgeon, Bartley Griffith, a young man who pioneered heart-lung transplantation and who at this point has lost more patients with the procedure than he had saved, looks up, glances around and finally rests his eyes on me: "Lee," he says, "would you do me a great favor?"

I was surprised. Over the past three years I had observed Bart Griffith in the operating room a number of times, and although a great deal of conversation takes place between doctors and nurses during the long and intense surgical ordeal, he had only infrequently addressed me in such a direct and spontaneous manner.

Our personal distance is a by-product of my own technique as an immersion journalist - my "fly-on-the wall" or "living room sofa" concept of "immersion": Writers should be regular and silent observers, so much so that they are virtually unnoticed. Like walking through your living room dozens of times, but only paying attention to the sofa when suddenly you realize that it is missing. Researching a book about transplantation, "Many Sleepless Nights" (W.W. Norton), I had been accorded great access to the O.R., the transplant wards, ethics debates and the most intimate conversations between patients, family members and medical staff. I had jetted through the night on organ donor runs. I had witnessed great drama - at a personal distance.

But on that important early morning, Bartley Griffith took note of my presence and requested that I perform a service for him. He explained that this was going to be a crucial time in the heart-lung procedure, which had been going on for about five hours, but that he felt obligated to make contact with this woman's husband who had traveled here from Kansas City, Mo. "I can't take the time to talk to the man myself, but I am wondering if you would brief him as to what has happened so far. Tell him that the organs have arrived, but that even if all goes well, the procedure will take at least another five hours and maybe longer." Griffith didn't need to mention that the most challenging aspect of the surgery - the implantation - was upcoming; the danger to the woman was at a heightened state.

A few minutes later, on my way to the ICU waiting area where I would find Dave Fulk, the woman's husband, I stopped in the surgeon's lounge for a quick cup of coffee and a moment to think about how I might approach this man, undoubtedly nervous - perhaps even hysterical - waiting for news of his wife. I also felt kind of relieved, truthfully, to be out of the O.R,, where the atmosphere is so intense.

Although I had been totally caught-up in the drama of organ transplantation during my research, I had recently been losing my passion and curiosity; I was slipping into a life and death overload in which all of the sad stories from people all across the world seemed to be congealing into the same muddled dream. From experience, I recognized this feeling - a clear signal that it was time to abandon the research phase of this book and sit down and start to write. Yet, as a writer, I was confronting a serious and frightening problem: Overwhelmed with facts and statistics, tragic and triumphant stories, I felt confused. I knew, basically, what I wanted to say about what I learned, but I didn't know how to structure my message or where to begin.

And so, instead of walking away from this research experience and sitting down and starting to write my book, I continued to return to the scene of my transplant adventures waiting for lightning to strike . . . inspiration for when the very special way to start my book would make itself known. In retrospect, I believe that Bart Griffith's rare request triggered that magic moment of clarity I had long been awaiting.

Defining the Discussion

Before I tell you what happened, however, let me explain what kind of work I do as an immersion journalist/creative nonfiction writer, and explain what I am doing, from a writer's point-of-view, in this essay.

But first some definitions: "Immersion journalists" immerse or involve themselves in the lives of the people about whom they are writing in ways that will provide readers with a rare and special intimacy.

The other phrase to define, a much broader term, creative nonfiction, is a concept that offers great flexibility and freedom, while adhering to the basic tenets of nonfiction writing and/or reporting. In creative nonfiction, writers can be poetic and journalistic simultaneously. Creative nonfiction writers are encouraged to utilize fictional (literary) techniques in their prose - from scene to dialogue to description to point-of-view - and be cinematic at the same time. Creative nonfiction writers write about themselves and/or capture real people and real life in ways that can and have changed the world. What is most important and enjoyable about creative nonfiction is that it not only allows, but encourages the writer to become a part of the story or essay being written. The personal involvement creates a special magic that alleviates the suffering and anxiety of the writing experience; it provides many outlets for satisfaction and self-discovery, flexibility and freedom.

When I refer to creative nonfiction, I include memoir (autobiography), and documentary drama, a term more often used in relation to film, as in "Hoop Dreams," which captures the lives of two inner-city high school basketball players over a six-year period. Much of what is generically referred to as "literary journalism" or in the past, "new journalism," can be classified as creative nonfiction. Although it is the current vogue in the world of writing today, the combination of creative nonfiction as a form of writing and immersion as a method of research has a long history. George Orwell's famous essay, "Shooting an Elephant" combines personal experience and high quality literary writing techniques. The Daniel DeFoe classic, "Robinson Crusoe," is based upon a true story of a physician who was marooned on a desert island. Ernest Hemingway's paean to bullfighting, "Death in the Afternoon," comes under the creative nonfiction umbrella, as does Tom Wolfe's, "The Right Stuff," which was made into an award-winning film. Other well-known creative nonfiction writers, who may utilize immersion techniques include John McPhee ("Coming Into the Country"), Tracy Kidder ("House"), Diane Ackerman ("A Natural History of the Senses") and Pulitzer Prize winner Annie Dillard ("Pilgrim at Tinker Creek"), to name only a few of the many authors who have contributed to this burgeoning genre.

Currently, many of our best magazines - The New Yorker, Harper's, Vanity Fair, Esquire - publish more creative nonfiction than fiction and poetry combined. Universities offer Master of Fine Arts degrees in creative nonfiction. Newspapers are publishing an increasing amount of creative nonfiction, not only as features, but in the news and op-ed pages, as well.

The 5 Rs

Reading, 'Riting, 'Rithmitic - the 3Rs - was the way in which basic public school education was once described. The "5 Rs" is an easy way to remember the basic tenets of creative nonfiction/immersion journalism.

The first "R" has already been explained and discussed: the "immersion" or "real life" aspect of the writing experience. As a writing teacher, I design assignments that have a real-life aspect: I force my students out into their communities for an hour, a day, or even a week so that they see and understand that the foundation of good writing emerges from personal experience. Some writers (and students) may utilize their own personal experience rather than immersing themselves in the experiences of others. In a recent introductory class I taught, one young man working his way through school as a sales person wrote about selling shoes, while another student, who served as a volunteer in a hospice, captured a dramatic moment of death, grief and family relief. I've sent my students to police stations, bagel shops, golf courses; together, my classes have gone on excursions and participated in public service projects - all in an attempt to experience or re-create from personal experience real life.

In contrast to the term "reportage," the word "essay" usually connotes a more personal message from writer to reader. "An essay is when I write what I think about something," students will often say to me. Which is true, to a certain extent - and also the source of the meaning of the second "R" for "reflection." A writer's feelings and responses about a subject are permitted and encouraged, as long as what they think is written to embrace the reader in a variety of ways. As editor of Creative Nonfiction, I receive approximately 150 unsolicited essays, book excerpts and profiles a month for possible publication. Of the many reasons the vast majority of these submissions are rejected, two are most prevalent, the first being an overwhelming egocentrism; in other words, writers write too much about themselves without seeking a universal focus or umbrella so that readers are properly and firmly engaged. Essays that are so personal that they omit the reader are essays that will never see the light of print. The overall objective of the personal essayist is to make the reader tune in - not out.

The second reason Creative Nonfiction and most other journals and magazines reject essays is a lack of attention to the mission of the genre, which is to gather and present information, to teach readers about a person, place, idea or situation combining the creativity of the artistic experience with the essential third "R" in the formula: "Research."

Even the most personal essay is usually full of substantive detail about a subject that affects or concerns a writer and the people about whom he or she is writing. Read the books and essays of the most renowned nonfiction writers in this century and you will read about a writer engaged in a quest for information and discovery. From George Orwell to Ernest Hemingway to John McPhee, books and essays written by these writers are invariably about a subject other than themselves, although the narrator will be intimately included in the story. Personal experience and spontaneous intellectual discourse - an airing and exploration of ideas - are equally vital. In her first book, "Pilgrim at Tinker Creek," which won the Pulitzer Prize, and in her other books and essays, Annie Dillard repeatedly overwhelms her readers with factual information, minutely detailed descriptions of insects, botany and biology, history, anthropology, blended with her own feelings about life.

One of my favorite Dillard essays, "Schedules," focuses upon the importance of writers working on a regular schedule rather than writing only intermittently. In "Schedules," she discusses, among many other subjects, Hasidism, chess, baseball, warblers, pine trees, june bugs, writers' studios and potted plants - not to mention her own schedule and writing habits and that of Wallace Stevens and Jack London.

What I am saying is that the genre of creative nonfiction, although anchored in factual information, is open to anyone with a curious mind and a sense of self. The research phase actually launches and anchors the creative effort. Whether it is a book or essay I am planning, I always begin my quest in the library - for three reasons. First, I need to familiarize myself with the subject. If it is something about which I do not know, I want to make myself knowledgeable enough to ask intelligent questions. If I can't display at least a minimal understanding of the subject about which I am writing, I will lose the confidence and the support of the people who must provide access to the experience.

Secondly, I will want to assess my competition. What other essays, books and articles have been written about this subject? Who are the experts, the pioneers, the most controversial figures? I want to find a new angle - not write a story similar to one that has already been written. And finally, how can I reflect and evaluate a person, subject or place unless I know all of the contrasting points-of-view? Reflection may permit a certain amount of speculation, but only when based upon a solid foundation of knowledge.

So far in this essay I have named a number of well-respected creative nonfiction writers and discussed their work, which means I have satisfied the fourth "R" in our "5R" formula: "Reading." Not only must writers read the research material unearthed in the library, but they also must read the work of the masters of their profession. I have heard some very fine writers claim that they don't read too much anymore - or that they don't read for long periods, especially during the time they are laboring on a lengthy writing project. But almost all writers have read the best writers in their field and are able to converse in great detail about the stylistic approach and intellectual content. An artist who has never studied Picasso, Van Gogh, Michelangelo, even Warhol, is an artist who will quite possibly never succeed.

So far we have mostly discussed the nonfiction or journalistic aspects of the immersion journalism/creative nonfiction genre. The 5th "R" the "riting" part is the most artistic and romantic aspect of the total experience. After all of the preparatory (nonfiction) work is complete, writers will often "create" in two phases. Usually, there is an inspirational explosion, a time when writers allow instinct and feeling to guide their fingers as they create paragraphs, pages, and even entire chapters of books or complete essays. This is what art of any form is all about - the passion of the moment and the magic of the muse. I am not saying that this always happens; it doesn't. Writing is a difficult labor, in which a regular schedule, a daily grind of struggle, is inevitable. But this first part of the experience for most writers is rather loose and spontaneous and therefore more "creative" and fun. The second part of the writing experience - the "craft" part, which comes into play after your basic essay is written - is equally important - and a hundred times more difficult.

Writing in Scenes

Vignettes, episodes, slices of reality are the building blocks of creative nonfiction - the primary distinguishing factor between traditional reportage/journalism and "literary" and/or creative nonfiction and between good, evocative writing and ordinary prose. The uninspired writer will tell the reader about a subject, place or personality, but the creative nonfiction writer will show that subject, place or personality in action. Before we discuss the actual content or construction of a scene, let me suggest that you perform what I like to call the "yellow test."

Take a yellow "Hi-Liter" or Magic Marker and leaf through your favorite magazines - Vanity Fair, Esquire, The New Yorker or Creative Nonfiction. Or return to favorite chapters in previously mentioned books by Dillard, Ackerman, etc. Yellow-in the scenes, just the scenes, large and small. Then return to the beginning and review your handiwork. Chances are, anywhere from 50 to 80 percent of each essay, short story, novel selected will be yellow. Plays are obviously constructed with scenes, as are films. Most poems are very scenic.

Jeanne Marie Laskas, the talented columnist for the Washington Post Magazine, once told me: "I only have one rule from start to finish. I write in scenes. It doesn't matter to me in which order the scenes are written; I write whichever scene inspires me at any given time, and I worry about the plot or frame or narrative later. The scene - a scene - any scene - is always first."

The Elements of a Scene

First and foremost, a scene contains action. Something happens. I jump on my motorcycle and go helter-skelter around the country; suddenly, in the middle of July in Yellowstone National Park I am confronted with 20 inches of snow. Action needn't be wild, sexy and death-defying, however. There's also action in the classroom. A student asks a question, which requires an answer, which necessitates a dialogue, which is a marvelously effective tool to trigger or record action. Dialogue represents people saying things to one another, expressing themselves. It is a valuable scenic building block. Discovering dialogue is one of the reasons to immerse ourselves at a police station, bagel shop or at a zoo. To discover what people have to say spontaneously - and not in response to a reporter's prepared questions.

Another vehicle or technique of the creative nonfiction experience may be described as "intimate and specific detail." Through use of intimate detail, we can hear and see how the people about whom we are writing say what is on their minds; we may note the inflections in their voices, their elaborate hand movements and any other eccentricities. "Intimate" is a key distinction in the use of detail when crafting good scenes. Intimate means recording and noting detail that the reader might not know or even imagine without your particular inside insight. Sometimes intimate detail can be so specific and special that it becomes unforgettable in the reader's mind. A very famous "intimate" detail appears in a classic creative nonfiction profile, "Frank Sinatra Has a Cold," written by Gay Talese in 1962 and published in Esquire Magazine.

In this profile, Talese leads readers on a whirlwind cross country tour, revealing Sinatra and his entourage interacting with one another and with the rest of the world and demonstrating how the Sinatra world and the world inhabited by everyone else will often collide. These scenes are action-oriented; they contain dialogue and evocative description with great specificity and intimacy such as the gray-haired lady spotted in the shadows of the Sinatra entourage - the guardian of Sinatra's collection of toupees. This tiny detail - Sinatra's wig lady - loomed so large in my mind when I first read the essay that even now, 35 years later, anytime I see Sinatra on TV or spot his photo in a magazine, I find myself unconsciously searching the background for the gray-haired lady with the hatbox.

The Narrative - or Frame

The frame represents a way of ordering or controlling a writer's narrative so that the elements of his book, article or essay are presented in an interesting and orderly fashion with an interlaced integrity from beginning to end.

Some frames are very complicated, as in the movie, "Pulp Fiction"; Quentin Tarantino skillfully tangles and manipulates time. But the most basic frame is a simple beginning-to-end chronology. "Hoop Dreams," for example, the dramatic documentary (which is also classic creative nonfiction) begins with two African-American teen-age basketball stars living in a ghetto and sharing a dream of stardom in the NBA and dramatically tracks both of their careers over the next six years.

As demonstrated in "Pulp Fiction," writers don't always frame in a strictly chronological sequence. My book, "One Children's Place," begins in the operating room at a children's hospital. It introduces a surgeon, whose name is Marc Rowe, his severely handicapped patient, Danielle, and her mother, Debbie, who has dedicated her every waking moment to Danielle. Two years of her life have been spent inside the walls of this building with parents and children from all across the world whose lives are too endangered to leave the confines of the hospital. As Danielle's surgery goes forward, the reader tours the hospital in a very intimate way, observing in the emergency room, participating in helicopter rescue missions as part of the emergency trauma team, attending ethics meetings, well-baby clinics, child abuse examinations - every conceivable activity at a typical high-acuity children's hospital so that readers will learn from the inside out how such an institution and the people it services and supports function on an hour-by-hour basis. We even learn about Marc Rowe's guilty conscience about how he has slighted his own wife and children over the years so that he can care for other families.

The book ends when Danielle is released from the hospital. It took two years to research and write this book, returning day and night to the hospital in order to understand the hospital and the people who made it special, but the story in which it is framed begins and ends in a few months.

Back to the Beginning - That Rare and Wonderful Moment of Clarity

Now let's think about this essay as a piece of creative nonfiction writing, especially in relation to the concept of framing. It begins with a scene. We are in an operating room at the University of Pittsburgh, the world's largest organ transplant center, in the middle of a rare and delicate surgery that will decide a dying woman's fate. Her heart and both lungs have been emptied out of her chest and she is maintained on a heart-bypass system. The telephone alerts the surgical team that a fresh and potentially lifesaving set of organs has arrived at the hospital via helicopter. Suddenly the lead surgeon looks up and asks an observer (me) to make contact with the woman's husband. I agree, leave the operating room and then stop for a coffee in the surgeon's lounge.

Then, instead of moving the story forward, fulfilling my promise to Dr. Griffith and resolving my own writing dilemma, I change directions, move backwards (flashback) in time and sequence and begin to discuss this genre - immersion journalism/creative nonfiction. I provide a mountain of information - definitions, descriptions, examples, explanations. Basically, I am attempting to satisfy the nonfiction part of my responsibility to my readers and my editors while hoping that the suspense created in the first few pages will provide an added inducement for readers to remain focused and interested in this Introduction from the beginning to the end where, (the reader assumes) the two stories introduced in the first few pages will be completed.

In fact, my meeting with Dave Fulk in the ICU waiting room that dark morning was exactly the experience I had been waiting for, leading to that precious and magic moment of clarity for which I was searching and hoping. When I arrived, Mr. Fulk was talking with an elderly man and woman from Sacramento, Calif., who happened to be the parents of a 21-year-old U.S. Army private named Rebecca Treat who, I soon discovered, was the recipient of the liver from the same donor who gave Dave's wife (Winkle Fulk) a heart and lungs. Rebecca Treat, "life-flighted" to Pittsburgh from California, had been in a coma for 10 days by the time she arrived in Pittsburgh; the transplanted liver was her only hope of ever emerging from that coma and seeing the light of day.

Over the next half-hour of conversation, I learned that Winkle Fulk had been slowly dying for four years, had been bedbound for three of those years, as Dave and their children watched her life dwindle away, as fluid filled her lungs and began to destroy her heart. Rebecca's fate had been much more sudden; having contracted hepatitis in the army, she crashed almost immediately. To make matters worse, Rebecca and her new husband had separated. As I sat in the darkened waiting area with Dave Fulk and Rebecca's parents, I suddenly realized what it was I was looking for, what my frame or narrative element could be. I wanted to tell about the organ transplant experience - and what organ transplantation can mean from a universal perspective - medically, scientifically, personally for patients, families and surgeons. Rebecca's parents and the Fulk family, once strangers, would now be permanently and intimately connected by still another stranger - the donor - the person whose tragic death provided hope and perhaps salvation to two dying people. In fact, my last quest in the research phase of the transplant book experience was to discover the identity of this mysterious donor and literally connect the principal characters. In so doing, the frame or narrative drive of the story emerged.

"Many Sleepless Nights" begins when 15-year-old Richie Becker, a healthy and handsome teen-ager from Charlotte, N.C., discovers that his father is going to sell the sports car that he had hoped would one day be his. In a spontaneous and thoughtless gesture of defiance, Richie, who had never been behind the wheel, secretly takes his father's sports car on a joy ride. Three blocks from his home, he wraps the car around a tree and is subsequently declared brain dead at the local hospital. Devastated by the experience, but hoping for some positive outcome to such a senseless tragedy, Richie's father, Dick, donates his son's organs for transplantation.

Then the story flashes back a half century, detailing surgeons' first attempts at transplantation and all of the experimentation and controversy leading up to the development and acceptance of transplant techniques. I introduce Winkle Fulk and Pvt. Rebecca Treat. Richie Becker's liver is transplanted into Rebecca, while his heart and lungs are sewn into Mrs. Fulk by Dr. Bartley Griffith. The last scene of the book 370 pages later is dramatic and telling and finishes the frame three years later when Winkle Fulk travels to Charlotte, N.C., a reunion I arranged to allow the folks to personally thank Richie's father for his son's gift of life.

At the end of the evening, just as we were about to say goodbye and return to the motel, Dick Becker stood up in the center of the living room of his house, paused, and then walked slowly and hesitantly over toward Winkle Fulk, who had once stood alone at the precipice of death. He eased himself down on his knees, took Winkle Fulk by the shoulder and simultaneously drew her closer, as he leaned forward and placed his ear gently but firmly between her breasts and then at her back.

Everyone in that room was suddenly and silently breathless, watching as Dick Becker listened for the last time to the absolutely astounding miracle of organ transplantation: the heart and the lungs of his dead son Richie, beating faithfully and unceasingly inside this stranger's warm and loving chest.