Rainbow-Jan 5, x2[Rainbow off Melbourne Beach, Florida, January 5, 2014.]

Q&A: Thomas Larson on his new memoir, heart disease & diet.

The Sanctuary of Illness: A Memoir of Heart Disease by Thomas Larson. Hudson Whitman, 128 pp.

Thomas Larson Sanctuary of Illness Cover

My father’s first heart attack when he was 49, on Thanksgiving Day 1968, marked one of those before and after divisions in a family’s life.

The orange-and-white ambulance in our driveway heralded Dad’s long hospitalization and Mom’s palpable fear—her lecture about having to prepare him a special diet was itself a scary rift to me at age 12—and then his Schwinn for exercise that replaced our family boat. A new nomenclature, too: angina, myocardial infarction, dietary cholesterol, building collateral blood vessels, congestive heart disease. Dad suffered another heart attack in 1979, as a hurricane hit our county in Florida. In 1984, up in Illinois, my half-brother, age 44, sustained his own infarction. In 1989, Dad, his scarred heart barely beating, succumbed at age 71.

No help from Mom’s genetics. She got bypass surgery for four blocked arteries in 1993. “The Rounsaville blood,” she told me, “is like sludge.”

With my family’s doom-laden cardiovascular history, reading The Sanctuary of Illness: A Memoir of Heart Disease was a visceral experience. As a good memoir will,  it makes real one person’s inner and outer experience—gives you that experience. It both inspired me as a writer and animated my natural desire to escape, for as long as possible, the saving but cold ministry of the medical establishment.

Author, journalist, and critic, Thomas Larson has been a staff writer for the San Diego Reader  for 14 years. My full review of his The Sanctuary of Illness appears on the Brevity Nonfiction Blog. Larson answered some questions for Draft No. 4 about writing and the heart:

Q. You’re an expert on the memoir genre, having published The Memoir and The Memoirist: Reading and Writing Personal Narrative (reviewed). It seems you set a high bar there, declaring that self-disclosure rather than dramatic event sequence is memoir’s reason for being. How did your knowledge of the field help or complicate the writing of your first book-length memoir?

Thomas Larson1x[Thomas Larson.]

I’d phrase my book’s summation, which may have been more implicit than explicit in M&M, as such: self-disclosure is the outcome of dramatic events, which also may result from the drama of intellection, breaking through to insight as event. Put as a question, what has our writing style or choice of form led us to discover about ourselves that we didn’t know until we wrote a memoir?

This idea is core to my books whenever they use memoir elements or are memoir. The dramatic revelation about the self is key. The dramatic revelation in Sanctuary is the realization that Suzanna and I dwell in this protected space where we are aware and unaware, simultaneously, of the disease’s hold upon us—its acute attacks and its chronic dread. This is what the writing pushed me toward and thus it appears toward the end of the book as destination (true to how I experienced it), an emotional destiny if you will.

If I accomplish this in the book, it’s because I read as a writer/critic and reviewed many memoirs. Eventually, I came to see how primary such dramatic insight into the self in the books I valued was. That’s why I valued them. Once I saw this feature of contemporary memoir, I said to myself, I’m going to try and do that, too.

Q. The Sanctuary of Illness is rich in metaphors. Did they arise “naturally,” so to speak—provoked and partly furnished by the nature and inherent drama of your experience, such as your son “too shocked to deal with his old man’s sail, blown and tattered by the death gale”—or were they something you created more consciously? Of possibly the latter, I’m thinking of your describing your jotted questions for a doctor that lie on the page “like tree-dropped apples on verdant ground.” And however you created them, how can writers increase the use of metaphors in their own work?

Either you have a metaphoric spark or you don’t—Raymond Chandler was one of the best (“I belonged in Idle Valley like a pearl onion on a banana split”) while Hemingway was the worst. And yet Ernest made up for it in other ways: that chilly Anglo-Saxon declamation of his in which most things are glass-cased in their pure nominatives: rock, wind, road, pine tree, river, woods, and snow.

I’ve tried to analyze my penchant for metaphor and I can’t find the underground lake on which the sprites of my ingenuity launch their little boats. There. Came to me on the first try, though I smoothed out the phrase. They do just appear, as sadness’s visage is my mother’s face.

My sense, also, is that my music background (musician/composer until 33) did much to move my comparative imagination from a musical to a lexical fount; actually, they still go back and forth, like dogs and cats that grow up together.

Music itself is a metaphor for writing/speaking; so I’ve had much practice, more than most, in swirling and catching my thought-sound shapes. To me, words are like sounding objects and musical phrases are like characters speaking lines in a play or authors crafting bon mots.

Q. You allude to your ongoing journaling during your long health crisis and also to being able to draw on past journals to remember your history. Could you discuss your journaling practice and explain its role in your memoir-writing? Was it useful for The Memoir and the Memoirist or for your second book, The Saddest Music Ever Written The Story of Samuel Barber’s “Adagio for Strings” (reviewed), which has memoiristic aspects?

Thomas Larson2[Thomas Larson.]

I have 33 years’ worth of journals, and, prior to 1980, many music composition notebooks as well.

My logs tend to be about the many tornadic dramas in my life, rendered in and of and for the moment—which, as we know, often never ends.

I made a discovery when I worked on Saddest Music, a hybrid work that contains actual and imagined memoir scenes, that is, the experiences of my parents and my grandparents before I was born. I learned to journal (free write/recreate) such scenes or intensities with writing prompts (these can be found on my website), emphasizing the dissembled stained-glass approach to CNF.

I take a scene (I may or may not have written it down the day after it occurred: let’s say the night I spent in a ward, post-op heart attack #1) and I catalog all its sense elements (what do I see, hear, touch, etc.). Then I dwell, feel/re-feel the hottest, the most intense sensory parts (the scraping sound of the curtain on the steel rods around my bed as they are opened by doctors, nurses, visitors). Then I exaggerate, but not a lot, these details via metaphor or musical phrases (“the ticking of the hooks, scraping along the runnel”) and I think I’ve got something: felt language, felt in the sounds they occupy together.

The idea is to get the words of a sentence to listen to each other as musical notes in a fine melody might listen to one another, that is, where they’ve been and where they’re going. “Somewhere over the rainbow, way up high.” That last phrase made melodic: way leaps to up and falls to high. Can you hear the play and counter-play? Such sounding relationships are always available to writers to uncover. Certainly, reading aloud helps.

This is the sort of thing I improvise on in my journal, especially in the throes of crafting a book. Writing generates writing, yes?

Q. Okay, a dumb question. With all our medical technology, why is it still apparently so hard (or cost-prohibitive?) to determine if someone’s arteries are getting clogged, putting him or her at risk for a heart attack? It seems by now there would be a fast, easy way for doctors to see the percentage of restriction in each cardiac artery.

They’re working on it. Sending catheters up the pencil-thin arteries with scopes and measuring devices is possible to make plaque readings, but we still need to refine those tools down to nanotechnology so we aren’t disrupting the integrity of the arteries themselves. You are right: an angiogram can show, via the fluoroscope, the degree to which the arteries are occluded. Problem is we would have to spend billions doing this on everyone, say at 50, and it may or may not be preventive. My blockages could have been seen and treated prior. But they still would have grown back. Also, remember that the majority of heart attacks are sudden occlusions, not slow-building occlusions over time.

Q. After three heart attacks, you’re now on the proverbial nuts and berries regimen—except no nuts. And no animal protein; no fats of any kind. You eat mostly raw, plant-based food except for sourdough bread, Ezekial cereal, coffee, Chai, strawberry preserves, and vanilla soy milk. Many people probably doubt they could sustain such a rigorous and abstemious diet. And even with a strong desire, America’s food chain is awash in animal fats, sweeteners, and oils—which are added even to “organic,” “health food,” and “vegetarian” products. Do you have any tips for those who are trying to take baby steps toward reducing their total dietary load of bad stuff?

Thomas Larson3x
[Thomas Larson.]

A longtime veggie, I decided many years ago that food is not a source of pleasure. I don’t have a Saks Fifth Avenue palette. I’m plebian, proletarian in this regard. My tastes lie in memoir, music, and the ebb and flow (mostly ebb) of the literary author in mass, mediated society. Plain food tastes fine to me, the plainer the better. Actually, if you commit to a no-oil Vegan diet, the only thing that is, for me, preventing another heart attack and maybe reversing the disease, then it’s easy. You can’t eat anything but raw or near raw and so dinner’s a done deal.

OK, say you can’t go whole hog—be Vegan one, then two, then three days a week. Incremental. Eat out less and get rid of all crap food in the house. As a kid I ate milk, sugar, Frosted Flakes and got fat. So did my brothers and Dad. Now I eat fruit, whole grain cereal, and soy milk. And I lose weight, cut down on inflammation from animal protein. Put this sign on your fridge: Dairy Is the Anti-Christ. Or: Dairy is the Dick Cheney of health.

Q. Though you sustained some impairment to your heart muscle from three infarctions—you estimate you’ve lost 10 to 15 percent—one gets the impression that you’re in better shape now than when you first collapsed almost eight years ago: 40 pounds lighter, more active, less stressed, consuming a far healthier diet. Could you discuss this irony and perhaps the very inspiring “it’s-never- too-late” implicit message of your story? 

These infarcts were non-religious near-death experiences. Luck/fate let me live. I was changed but another I in me didn’t change or limped behind the new stented self I’d become. It was as if I’d been revised—my body, ever a draft, becoming that which it wasn’t, me, an exploded, re-blooded TL whom I wanted to be: the man who survived his disease (so far) and long enough to write its tale and, thus, morph via memoir into (almost) a new character, or new actor playing the role in the last act of his evanescent and curtain-ready five-act play. I’m still trying to catch up to the person medical intervention and veganism has allowed me to become. I’m gaining on me.

Q. What’s your favorite meal for breakfast, lunch, dinner?

I mentioned breakfast. Lunch/dinner are interchangeable; greens cooked or raw, rice, veggie burger, whole wheat pita, salad, vegetables (for example, small potatoes in the crock pot with blackberry vinegar), a frozen fruit bar for dessert. Day-in, day-out. Simple, mostly raw foods. As Michael Pollan writes: “eat food, mostly plants, not too much.” I’m lucky; no food-smothering relatives and even if I did, I just say no thanks. Plus a near-vegan partner.

Eat this way and tell me, post-meal, if you ever feel bloated, sluggish, sleepy, gaseous, lethargic—all states I once knew and now have felicitously fled.

In the Acknowledgments of Sanctuary of Illness, Larson praises the books and outreach efforts by two advocates for plant-based diets, cardiologist Dr. Caldwell Esselstyn and biochemist T. Colin Campbell, authors respectively of the bestsellers Prevent and Reverse Heart Disease and The China Study. Both are featured in a recent documentary Larson also mentions, Forks Over Knives, which cites strong correlations between dietary cholesterol (from meat, eggs, dairy products, and oils) and heart disease and cancer.

Larson has an essay up at Everyday Health about his journey toward a plant-based diet.


  • shirleyhs says:

    I first “met” Thomas Larson here, Richard, and now I find this interview fascinating. I tried to apply the idea of discovery in my own memoir. And I am impressed by the discipline both of you have in your diet. I’ll be looking more carefully at what I eat. Those two eggs at breakfast are now staring back at me.

    Loved the conversation about metaphor and the idea that you either have the gift or you don’t. The example of Hemingway’s gift for the language of concrete things was not new, but placing it in the context of metaphor brought different kinds of beautiful language into full vision simultaneously, like goggles with different colored lenses. :-) I’ll let you and Thomas Larson smooth that one. Take your time. :-)

    • Richard says:

      I think those eggs have given you good fuel, Shirley. For most of us, the lesson is be moderate. I’ve been no model. But I have actually had somewhat of a conversion experience since reading the book, finishing my first reading of it on December 18, the 24th anniversary of my father’s death. Other than fish a couple times I’ve been vegan! I have learned I love soy milk, so that was an easy one. A friend sorely tempted me with fried chicken, I admit.

      Incidentally, Larson’s memoir would be excellent for teaching in a class or workshop for adult students of memoir, both as a writing model and as a cautionary health tale anyone middle-aged can relate to. I think anyone by 50 has or has had some health issue.

  • Kim A. says:

    Thomas Larson is pretty much a hero of mine. His Memoir & the Memoirist has been a huge help to me as I’ve struggled with my own memoir efforts. It’s helped me to feel less isolated and confused during the very hairy process that is writing memoir. So it’s great to read this interview—thanks for posting it. I love especially the idea about how you have to get the words of a sentence to “listen to each other,” and also what he says about how the writing of Sanctuary helped him kind of mint a new self, a process I’m starting to sense with more clarity as I get closer to finishing my memoir. I look forward to reading his new book (and am also going to try that recipe he tossed off toward the end— little potatoes in blackberry vinegar…sounds weird but good…).

    • Richard says:

      Thank you for reading and commenting, Kim. I agree his book on memoir is great, so illuminating; I have read it a couple times and am due for a third. And now The Sanctuary of Illness is one of my all-time favorite memoirs.

  • Hi, Richard. I enjoyed your article here, but want to drag you off-topic for a moment, or at least go at things tangentially. You mention in one phrase above “contemporary memoir.” Though you may have said it before, I don’t recall reading it, and I was wondering if you would mind giving brief (or lengthy!) discussion to what you see as the main or specific differences between contemporary memoir and traditional memoir. I’ll wait until another post, if that’s more convenient, but I just wanted to ask the question. Yours sincerely, Fly-in-the-Ointment

    • Hello, Victoria. I don’t recall using the phrase, for the very question you pose, but I guess I did. I’ll have to find where I used that phrase (I am on the road with a poor connection), and context may provide a clue but I doubt it.

      I actually do think there’s a difference in the contemporary memoirs I’ve read and many but not all of the old classics. (Maybe Tom Larson will weigh in.) Contemporary memoirs seem more dramatized to me, basically.

      • Dear Richard, It may be my memory which was at fault. I could swear I’d seen the phrase “contemporary memoir” above, but I was behind in my blogging and reading of others’ posts, so I did read more than one of yours at a time. Please forgive me if I’ve made you hunt for it. I think it’s an intriguing discussion in the making, nevertheless.

      • I’ll weigh in. I think we can count on both hands (and toes) the number of “traditional memoirs,” which, prior to 1980 or so, if you want an example, I’d say Frank Conroy’s “Stop-Time.” For some reason what we know and practice as today’s memoir form, beginning in the late 1980s, grew out of writers’ and their dissatisfaction with the confession and the autobiography. (I know I never saw myself in the memoirs of ex-presidents.)

        A memoir now means a book with a single theme or subject, which intensifies and amplifies carefully chosen relational elements of the theme or subject. People write a memoir about an illness, a lost love, an idea, a practice, a spiritual calling. They keep their focus tightly wound on the subject and expand it from within, often with drama, but also with style, experiment, hybridizing, surprise. It’s a book not “the life.”

        If the autobiography or the traditional memoir is a fly-over of the life, its roles and rites taking prominence, the contemporary memoir lands the twin-prop plane on an airstrip in the jungle and explores the immediate surroundings, always within shouting distance of the runway.


  • Beth says:

    Tom Larson is one of those guys I would love to have around the table for a long conversation. Mostly I would just like to listen to the music of his phrases.

    I didn’t know about your own ambulance-in-the driveway experience, Richard. My family’s was in 1964. I was 13. My dad didn’t come back. Lots of sibling cardiac events. I’m not vegan, but have been eating a whole grain, high fruit and veg, mostly fish diet for a long time, plus lots of walking, running up and down stairs, etc. My Agatston score (coronary calcium) measured by Mayo a few years ago was zero, which is astonishing given my family history. They want to check it again this year, since I’ll be turning 63, just to be sure. You and Tom Larson have me thinking Buck and I can up our game a little more, though. I’m adding Prevent and Reverse Heart Disease, The China Study, Forks Over Knives, and of course The Sanctuary of Illness to my reading queue. Thanks for a fascinating interview.

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