A HISTORY OF PRESENT ILLNESS

A trainee doctor offers her perspective on her work and its environment, exposing a less-than-sunny view of institutional medical practice.

In an unusual, quiet, but dark debut, DeForest plunges the reader into an unspecified hospital environment, guided by a nameless narrator who is training to be a “future doctor.” This woman introduces a chilling world of dutiful care threaded with incidental horror, inadvertent cruelty, and occasional macabre humor, glimpsed in a variety of contexts: the emergency psych ward; the abortion clinic; the quiet room “where we held the difficult conversations”; neurology; end of life care; and more. The tone can be abstract, musing on poetry or anatomy, at other times, revelatory of medical norms and modes of expression: “Empty speech, the neurologists call it”; “Failing the medication is what we call this.” Slowly the narrator’s personal history emerges: an impoverished childhood, “never seeing doctors”; a religious school with no science or world history; separated parents; visits to her father “in dirty clothing, with head lice, with no clear habits of dental hygiene”; and a string of fearsome stepfathers. Now, in adulthood, she is in a celibate relationship with a seminarian “from a bad-hearted family.” This strange and oppressive context explains some of the oddity of her commentary on her medical training and experience, as does her “fascination with disaster.” Her more political observations on the increased suffering of the poor, the disabled, and people of color are shocking but less unfamiliar. Snapshots of bad behavior by medical personnel—racist comments or derogatory asides about overweight or tattooed patients—seem persuasive. The case of Ada, a patient with slow encephalitis, intersperses the short text and showcases the gamut of process, endurance, loss, and, above all, care and its complex shortcomings.

An original, disturbing new version of hospital fiction.