Book Review: “A History of Present Illness,” by Anna DeForest

A HISTORY OF THE CURRENT DISEASE by Anna DeForest In the opening pages of “A History of Present Illness,” Anna DeForest’s novel about ...


A HISTORY OF THE CURRENT DISEASEby Anna DeForest


In the opening pages of “A History of Present Illness,” Anna DeForest’s novel about medical training, the unnamed narrator finds herself with two groups of people – her colleagues, who are future doctors, and the corpses they are responsible for dissecting.

His sympathies, it is fair to say, are with the corpses. Residents are mostly wealthy kids, brought up on ski trips and country homes, who brag about the financial sacrifice they make by going into medicine instead of finance or consulting.

Most of the residents, our narrator reports, never held real jobs, although they “sometimes had brief jobs as barbacks or clerks in a dessert shop, each role being some sort of trick or joke, the poly-blend visors and polo shirts are a kind of poor child’s disguise.

Our narrator is not one of them, having grown up in intimate conditions with drug addiction and poverty. This connects her less with the doctors than with the patients they care for, and is what allows her to describe the social structure of the hospital with unforgiving clarity, like a spy who has sneaked into the temple.

Our health care system, she reports, can look like a conspiracy of the powerful against the powerless. Surgeons, she writes, “make fun of the patients they submit (for their abdominal fat, their scars, their low-level tattoos), make fun of their students for sweating or shaking or attended public school”.

When panicked young women arrived at the emergency room with vaginal bleeding, the young doctors who gave them pelvic exams “joked that girls like these — unspecified, technically, but poor and black and brown in the context – should be sterilized before the age of 13. .”

But the worst thing doctors do isn’t even their fault: powerful machines and powerful incentives drive them to artificially prolong life, when it only serves to make suffering disappear. The young doctor from DeForest shows us these patients, tied to their beds with padded chains to prevent them from ripping out their IVs and breathing tubes.

“Kill me,” an old man scribbles to him on a piece of paper, but surgeons – who are rumored to be rated on the percentage of patients who survive 30 days after surgery – persuade his son not to listen to the hospital doctors. So they wake up the old man and he dies like that, tied up, waiting for another operation.

DeForest, a practicing neurologist and palliative care physician, sometimes seems to waver between the goals of imaginative fiction and testimony. “A History of Present Illness” offers us the point of view of a doctor who feels everything. His writing is dreamlike and fragmentary, a sequence of vivid scenes that the reader must piece together, like a puzzle, to figure out who exactly is telling us this story. The answer, hidden in the last pages of the book, is a revelation.

But what she wrote is also a pursuit, documenting life inside a system that is closed to most of us. For anyone caring for someone at the end of life, “A History of Present Illness” provides a powerful argument to push back against the hospital juggernaut, to wrest control of the process. Sometimes I wish she had written something as direct and clear as an indictment.

The problem is not so much that doctors are desensitized — the nature of their training practically guarantees that. It’s that they have so much power to decide when death is allowed to come.

The narrator admits her own mistake, with a young patient she calls Ada, who is slowly dying of encephalitis. That night, Ada is “brain dead”, beyond recovery; at the same time, his death will be etched in the life of his family. Thus, the narrator grants them time before disconnecting the tubes, keeping Ada on a ventilator for one last night. She thinks it’s a last kindness.

Then she returns home, exhausted, and Ada’s survivors turn violently, unsure whether she is alive or dead.

At the end, the husband, beaten and heartbroken, stops the future doctor in the hallway. “Keep it honest if you can,” he says goodbye to her, and his words linger in the air between them. He, too, got to know the hospital from the inside, and he doesn’t seem very optimistic.


Ellen Barry covers mental health for The Times.


A HISTORY OF CURRENT DISEASE, by Anna DeForest | 176 pages | Petit, Brown & Company | $25


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