A doctor’s fiction examines the profession itself—and beyond.
A History of the Present Illness: Stories by Louise Aronson
Bloomsbury USA, 272 pp., $24.00 hardback, $16.00 paperback. Also available in ebook versions.
Guest Review by Lanie Tankard
Everyone who is born holds dual citizenship,
in the kingdom of the well and in the kingdom of the sick.
Louise Aronson’s book of short stories, A History of the Present Illness, was published in 2013, and just came out in paperback a few weeks ago.
Each protagonist in the sixteen tales, all set in the San Francisco area, is a different doctor treating a new patient, but Aronson varies the voice, the gender, the age, the venue, the disease or circumstance, and the background of both. As we turn the pages, either physically or electronically, we view assorted scenarios through the eyes of a changing cast of physicians as the dramatis personae move from one theater to another. Aronson examines the traditions of their globe-spanning histories as if she were watching culture grow in a Bay Area petri dish, so much do these immigrants vary.
The author, a doctor herself, describes these fictional cases in a dispassionate, clinical manner while at the same time imbuing them with an underlying humanity that explores the ethos of the events. Not all the characters are likable. Aronson details the course of an illness alongside the complexities of assimilation in a different nation with a minimalist touch. The characters inhabit a shared community within a medical setting—which represents yet another new nation in which they must adjust to an unfamiliar culture.
Aronson maintains a running commentary on the surrounding society all the while. She notes in passing, for example, the architecture of prisons as she gradually peels back the layers of a psychiatrist designated to determine for the court how a prisoner (who is a doctor) came to be where he is. One encounters moments of brilliance here, such as when the physician under examination realizes for the first time what “doctor mode” actually looks like—a demeanor that a medical person “could apparently turn on or off at will.” He mulls over the ensuing “silence standoff” between himself and the psychiatrist, allowing the reader in on his musing.
Despite a dry wit at times, such as the description of a medical student’s first patient—the med school cadaver, Aronson requires the reader to ponder tough questions by having the characters pose them to one another: “’What makes a life worth living?’ she asked. ‘And who has the right to make that decision?’” A few sentences here and there are weak while others are pure poetry, as when the author employs the phrase “a once-blind man” as a metaphor.
This collection of fables is meaningful not only for its allegorical and literary worth, but also for the uncluttered techniques it utilizes to posit the dilemmas of our collective impermanence. Merriam–Webster defines diagnosis as “the act of identifying a disease, illness, or problem by examining someone or something, or a statement or conclusion that describes the reason for the disease, illness, or problem.” It is the job of those in the medical profession to produce diagnoses. What Aronson has attempted in her book is a metadiagnosis, a valiant search for meaning underlying her work. That theme is a running thread throughout the course of these unrelated stories.
How does a doctor accomplish a diagnosis? Past medical history (PMH) can give an overview, but then determination of the chief complaint (CC) is needed. The next step in a medical examination entails taking down a history of the present illness (HPI), which includes aspects such as location, severity, onset, duration, and aggravating factors. It is the last facet, the provoking influences of these fictional maladies, with which Aronson seems most concerned. And it all feels so true that one senses the author has lived every one of these narratives herself. The book is suggestive of an Appendix to the Merck Manual addressing overlooked aspects in medical training from a humanistic angle.
The entire Merck, by the way, is available free online in its most recent edition for anyone to peruse. I found it fascinating reading. Under “The Dying Patient” is the subsection “Care After Death,” which counsels a doctor to use clear language when communicating with the family, avoiding euphemisms such as “passed on” in favor of “died.” The stories in Aronson’s book deal mostly (but not always) with end-of-life issues—yet of course, the author (a doctor) specializes in geriatrics. A broader spectrum of cases would have brought in variety, but what is present draws strength from being what it is.
We who are patients gain much from learning to see ourselves as doctors see us, perhaps becoming better partners in the management of our own health after we comprehend how physicians are created and how they make decisions. Yet A History of the Present Illness offers far more to consider. It’s a valuable addition to the ever-growing collection of works in the medical humanities, called “medhum.”
Susan Sontag once wrote: “literature remains one of our principal modes of understanding.” Aronson exemplifies Sontag’s idea by opening wide the windows of her hospital for us. We sense her presence on every page, in each story, her stethoscope wrapped around her neck observing the total picture. Her memories guide her writing as she bears witness through fiction to what she has seen.
Here is a video of Louise Aronson discussing her book.
Lanie Tankard is a freelance writer and editor in Austin, Texas. A member of the National Book Critics Circle and former production editor of Contemporary Psychology: A Journal of Reviews, she has also been an editorial writer for the Florida Times-Union in Jacksonville.