Review: Adrian Nicole LeBlanc on Anna DeForest
I began Anna DeForest’s A History of Present Illness just after my brother died at a major American medical center, hoping for a lung transplant, which, like the odds of recovery for the poor and helpless patients the narrator of DeForest’s exacting novel intimately describes, is akin to banking on the lottery. DeForest’s narrator is a first-year medical student beginning rotations. Unnamed yet always naming, she moves, honest and hungry for honesty, through the rooms and corridors of her own major medical center, willing to connect to people whose suffering she finds everywhere, and the physical space soon disappears. She yearns to put language to the anguish—theirs? hers?—and, in the inventory of its other concerns, this is a book about the denial and eventual cynicism of the unsaid, a book about need. It is also a book that feels very much like hospital time—to the family of the patient. I devoured it, then had to keep it down. So much of the fear I had for so long about my brother’s life up until he entered the ICU that final time had remained unspoken. To him, anyway.
Unlike most of her medical school classmates, who are buffered by wealth and the illusions of independence granted by privilege, DeForest’s narrator is unprotected. Her trauma meets the trauma forming in her midst, and her personal history begins to emerge in a dreamlike way. Associations are the sutures. After an uncomfortable evening hosted by the white dean of medicine at a private gentleman’s club (“I had a drunk, underwater feeling by the time it was time to leave. I managed, I think, not to say much of anything”), she applies to join a clinic that treats the homeless, where she continues to need to learn that the real questions must go unasked:
The clinic was in a church basement in a Blacker part of town. It, too, was a club for members only. In our year, it was run by the Texan and a woman on a military scholarship—one way to afford the six-figure tuition. She did not have the teeth of a person raised poor, but why else would you join the military? I had applied for a spot at the clinic too. You had to write an essay. I did not know yet that you aren’t allowed to talk about poverty from the inside. You could only look back on it. I wrote about never having health insurance, knowing how it feels to be sick and afraid. But the clinic decided, the Texan said, to go in a different direction.
She becomes the confessed-to, noting how the powerful treat powerlessness as a kind of repository. (The Texan confides that he can “stand the shelter men in the clinic, but on the street they made him sick. Is that wrong, he wanted to know, but why would I be the one to tell him?”). As our awareness of the operating environment of the hospital builds, patient by patient, the narrator’s clinical descriptions spill over, to the only audience that might hear their moral surfeit, incriminating questions that can increasingly only be uttered to the reader:
Holes and metal rods and wires everywhere. They called this apparatus the bundle, cute as it was not. They, the doctors, took to scrawling meticulous notes by hand on a grid of squares with a space for every hour—what were the salts, the chemicals, the pressures. Am I allowed to say this was an experiment? And around her, a whole family hoping for the best.
DeForest is a neurologist and palliative care physician at Sloane Kettering, and an exceedingly fine writer. She takes great care with language as much as with knowledge, and these skills, in her hands, are matters of trust. They made even the fictional honesty of her fictional hospital more truth than I could immediately bear; for the better part of a year, I looked at the book, which I kept out, and I avoided it.
Books are conversations, and, like some conversations I have avoided at my peril, there are books I have resisted re-reading: John Edgar Wideman’s Brothers and Keepers, for example, in which Wideman, sitting at his desk in a warm home, imaginatively occupies the divergent—and proximate—paths that led him to such evenings, while leading his brother, Robby, to a life term in a prison cell. Jamaica Kincaid’s My Brother, which rails against the losses and costs incurred triangulating her, her mother, and the beloved son, Kincaid’s brother, Devon, who dies an early—and terribly predictable—death. Another is Lillian Rubin’s Worlds of Pain: Life in the Working Class Family, a sociological book that broadened the perspective opened for me by my union-organizing father. I came across Rubin’s work in college, and it accounted for some of the less calculable causes of the community strife I grew up in. The conversations Rubin documented—voices I recognized from my experience—were conversations stunted by the systemic poisons feeding my split roots.
Now, approaching the first anniversary of my brother’s death, I re-read A History of Present Illness, and I remain haunted by its descriptions of the brutality implicit in the routines of power. Sometimes, I want to believe as much as my brother did in his doctors, and those staffing hospitals, whose combined skills held some promise for a future that was fast slipping through his hands. There are always books you find when you need them, but sometimes need requires courage that takes a second—or third—time around. I had a comparative literature professor who fled Czechoslovakia during the German invasion, when she was a young girl. I knew little of what these facts meant when she was my teacher, but their importance revealed itself over the decades during which we became adult friends. Each year, she read each book she taught—Crime and Punishment, The Idiot, War and Peace. She re-read these texts for fifty-three years, in some ways a portal to her own experience. I once asked her if she could be anything in another life, what would she be? A hermit, she said.
Of the tiered themes DeForest quietly erects—the dehumanizing assumptions in our kind of medical training; the ugly bigotries of selective professionalized attention; the compounding of environmental trauma in unaddressed grief; language, and its suppressions, or disclosures—her fierce commitment to honesty is what spoke to me most directly, and the answers are devastating. “How do you recover from anything?” the narrator asks her professors.
The cure, of course, is charitable works, said a teacher who spent her off-hours writing personal ads for dogs at the kill shelter. She would take them out on the designated day, show them the green grass along the river, touch her head to their heads, tell them they were good—then return them to the place where they would be euthanized. Everyone else was telling me to protect myself. And what would happen if I did not?
The narrator tends to Ada, her first patient, who has encephalitis: “The way she disappeared was subtle at first … Empty speech, the neurologists call it. She can speak, but she can’t say anything.”
She tends as much to Ada’s husband, once Ada vanishes into a coma. “I wish I could remember every word of what he told me. He had a white-hot purity of heart you never see in real life, like something from a work of art.”
Do writers turn to conversations with readers because the people they need to talk to aren’t willing to listen, or because they are too afraid to tell the people they love what they fear most? Which is another way of asking, with whom can we share all that we see?
All around DeForest’s narrator are people whose lives are suddenly, permanently changed, or uprooted—like her own life, not quite so suddenly, by her mother’s series of husbands and relocations. Words are more important than most of the tasks she performs in the hospital, yet so much of the suffering she understands and longs to find better ways to relieve remains untouchable, until the silence afflicts her understanding, too.
My brother was already struggling when I left for college. His struggles continued as I graduated, and went on to graduate school. I moved to the city. He married and moved and divorced, and also went to graduate school. He held different jobs, lost loves, found others, and eventually came back home. He had good stretches, and then the hard times lengthened. When he died, the good stretches were difficult for me to remember, and he could barely breathe. Our young doctor writes:
How did that first life, that childhood, end? Hard to say how, and hard to say when. But I can tell you how I got out of town. Every book I read said you had to go to the city to see what the world really was. I applied to one college and I got in. In that interstitium, when I knew I was leaving but hadn’t yet gone, I felt for sure that I would die, because getting out was harder to imagine than being dead.
Adrian Nicole LeBlanc is a journalist who lives in New York.
Read Anna DeForest’s extraordinary essay of July 2020 about being a physician caring for hospitalized Covid patients.
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