A History of Present Illness

by Anna DeForest

Genres: Family Life; Literary Fiction

Synopsis

A novel of meticulous brevity and a tone and vision all its own, transmuting the practice of medicine into a larger exploration of humanity, the meaning of care, and the nature of annihilation—physical, spiritual, or both.

A young woman puts on a white coat for her first day as a student doctor. So begins this powerful debut, which follows our unnamed narrator through cadaver dissection, surgical rotation, difficult births, sudden deaths, and a budding relationship with a seminarian.
 
In the troubled world of the hospital, where the language of blood tests and organ systems so often hides the heart of the matter, she works her way from one bed to another, from a man dying of substance use and tuberculosis, to a child in pain crisis, to a young woman, fading from confusion to aphasia to death. The long hours and heartrending work begin to blur the lines between her new life as a physician and the lifelong traumas she has fled.   

In brilliant, wry, and biting prose, A History of Present Illness is a boldly honest meditation on the body, the hope of healing in the face of total loss, and what it means to be alive.

Publisher: Little, Brown and Company

Print pages: 140

Sample

All this happened, more or less. I have seen a beating heart in a wide-open chest. This place has been a miracle land. No one even dies until we let them.

I have a picture from the first day, the white-coat day. We all lined up and had little lab coats placed on our shoulders, our arms, by practicing physicians in doctoral robes. I struggled, I remember, to bend my arms back right, though there must be loads of people who know how to get a coat put on them. This was a sweltering day in the far part of summer when the rich leave the city and the poor flee into the margins, line the city’s beaches in search of open air. At the service, the ceremony, faculty gave speeches, made cursory nods to the deeds we future doctors would perform for the good of society. But they were most clear and constant and explicit about our suddenly obvious worth. Over and over, each of them said: You must be smart, so smart, or else you wouldn’t be here. All of the other students had somehow known in advance to wear the school colors as a tie or a dress. So my clothes were all wrong, I can see looking back, as were my teeth, as was my hair. I look displaced and I am soaked in sweat. There is a sense, though, of light or life around the eyes—hope, almost? Now that I’m done, or close enough, I still have saved no lives myself, though I did check the pulse once of a woman who fainted on the subway. Let go of me is what she said.

We ended that first day by starting straight in with anatomy. They had us change into scrubs in a large conference room next to the cadaver lab divided by a rolling wall between the women and the men. I tried to keep my eyes on the floor. Four students were assigned to each table, each with a body facedown and draped in terry cloth soaked in phenol and glycerin. Ours was an elderly Black woman, almost gray, in size and shape so much like a West Indian neighbor I’d had before I came here who kept a barrel in the hall for all the goods she collected to send home monthly on a freighter. She lived with her brother, a gangly man who collected bottles and cans, who smoked in the stairwell and drummed on the walls to music playing only in his head.

The anatomy group was two women and two men. If you looked around the room you could see the groups were for the most part arranged this way, with some rare imbalance—the gender skew in medical school had recently turned slightly toward women. My group was an even split. One of the men was tall, white, with a tan, built but not quite well enough to counter his childlike face. For some reason he mentioned right away that he had a country house nearby to stay in on the weekends. The other man was from Texas. He said that whenever he said that, on interviews or wherever, they would next ask him where his parents were from, because of his name, apparently, or the color of his skin. He certainly did not have an accent. We all wore masks, which made faces hard to read, but made it, I found, easier to sustain eye contact. The other woman stood near the textbook, which was under a sheet of plastic to protect it from the fluids that quickly came to coat our gloved hands, and read out instructions to the rest of us.

Where did the bodies come from? I assumed they volunteered, though of course it would be difficult to recruit for such demand, to find enough people perimortem so committed to medical education. A fourth-year who used to write death notices for a national newspaper rounded up a group of us to write obituaries for some of the cadavers. After learning the basic technique, we would meet with the families or speak to them on the phone. I wanted to be assigned my own body’s family, but this was ruled out by the study’s design. Everything we did was studied, written up, and published in peer-reviewed journals. The whole school was rich with projects to prove that doctors could be made humane. So I was assigned some other group’s cadaver. His wife told me that she planned to become one too. For science, she said, and the savings they gave you on burial.

The country-house man took the first turn with the scalpel and drew a long line down our body’s back, and then we took turns pulling the skin away from the fat and fascia with knives and little scissors. She had wide shoulders and thin arms and was unnaturally flat from settling in the fixative. Her face and hands were wrapped in black plastic to keep them from drying out. It is normal from what I have read to have some feeling for your cadaver, though only the students who are women ever seemed to admit this. But the body was a problem right away for the country-house man. Once the spine was exposed, we had to crack each vertebra with a chisel and a hammer, slowly revealing the spinal cord. Fuck, this man said. Goddamn it, as the chisel slipped again. I had to imagine he was disappointed to be making such a bad job of her. Don’t swear, I said, and he did stop, though it was his high-stakes disposition that later passed us through every test. I was the weak link from the beginning. I have never had much skill at or interest in learning just the names for things. Once I came to the lab alone to attempt remediation, trying to learn the nerves of her neck. I even cut her ear off to clear the field, but it was useless. I was distracted, alone in the lab. Of thirty-one bodies, the only one who wasn’t dead.

But I was right about the volume. The lack of donor bodies was made up in unclaimed remains. The indigent or chronically isolated, so common in the city, even nursing-home residents, done now languishing in dementia, who had saved for a nice single grave in a field somewhere, but the money got lost or diverted somehow, so they ended up here on these tables with their pieces thrown out bit by bit along the way, whatever was left in the end burned and put unclaimed in a closet.

I never learned where our body came from or if we had her consent. After our first year, a state law was passed, placing stricter restriction on the bodies’ provenance and final place of rest. Some high-profile donor had, after dissection, been buried by accident in a potter’s field. He had signed up for a tidy cremation. There were, still are, mass graves on an island in the Sound, ten miles from the school, the largest mass graveyard in the country. Convicts in white jumpsuits bury bodies there for fifty cents an hour, stack pine boxes in neat rows three deep and five wide. The trenches for babies hold up to a thousand. After a century of epidemics and mundane city deaths, there are a million people buried there. You can’t visit without an escort from the Department of Corrections. A carved stone by the ferry launch reads BLESSED ARE THE POOR IN SPIRIT, FOR THEIRS IS THE KINGDOM OF HEAVEN.

We would go out sometimes, the group from anatomy, though the country-house man rarely made it. He didn’t drink. He may have been underage, in fact—of note, we never asked. So the Texan, and the other woman, whose name was June, and me. We were in one of those bars full of television screens, tuned to sports and nightly news broadcasts with subtitles—crowds cheering, scattered applause—unrelated background music loud and exhausting, when we heard on the news that a man with Ebola virus rode the subway from the hospital all the way out to an outer borough. He had done this to go to a bowling alley. The man from Texas had never heard anything so funny.

I was raised with a reverence for catastrophe. The thought of mass casualties—in the hospital, they call this Code D—has haunted me since I was a child. Back then I had a recurring dream that a trap I had crafted on the bottom bunk of my bed had filled up with the dead and dying bodies of my family, neighbors, and friends. Despite this, or perhaps because of it, I’ve always been a little nuts for plague literature and films, the desiccated bodies, heads hung back, mouths agape, leaning on each other in church pews, THE END IS NEAR graffitied on the walls, that sort of thing. The Texan, as much as I could hear, was describing the chaos that Ebola would bring to the city—people bleeding out on the subway, in the streets—with a speculative masculine glee.

I learned about Ebola in middle school from a video played on a rolled-in TV. Afterward I couldn’t close my eyes for weeks without seeing piles of bloody bodies with flies in their eyes, Croix-Rouge in white aprons over yellow Tyvek suits, graves marked with crossed plywood, the names written in marker. I had nightmares of pine coffins the size of children, wrapped in floral paper. The outbreaks in West Africa, the video said, were made worse by the local funeral customs: washing the bodies by hand, crying over them, cooking and sleeping beside them. The remedy arranged by well-meaning foreigners was mandatory cremation, so families kept bodies hidden in their homes, and whole households were lost this way, bleeding out from everywhere.

The city emergency departments stocked up . . .