Literature Annotations


Aronson, Louise
A History of the Present Illness


Genre Collection (Short Stories) (261 pp.)
KeywordsAbandonment, Acculturation, Adolescence, African-American Experience, African-American Experience, AIDS, Art of Medicine, Asian Experience, Cancer, Caregivers, Catastrophe, Children, Chronic Illness/Chronic Disease, Cross-Cultural Issues, Death and Dying, Dementia, Disability, Disease and Health, Doctor-Patient Relationship, Drug Addiction, Empathy, Euthanasia, Family Relationships, Father-Daughter Relationship, Father-Son Relationship, Grief, Hospitalization, Human Worth, Illness and the Family, Latina/Latino Experience, Love, Marital Discord, Medical Ethics, Medical Mistakes, Mother-Daughter Relationship, Pain, Patient Experience, Psycho-social Medicine, Public Health, Society, Suffering, Women in Medicine
Summary

This collection of 16 short stories focuses on doctors and patients in San Francisco, where a wide variety of wealth and culture impact the delivery of medical care.  Further, there are many restrictions—financial, bureaucratic, ethical, and legal —that limit what doctors can do, especially in cases of patients near death.

The author, Louise Aronson, is a geriatrician who knows this terrain very well, having trained in San Francisco and worked as a physician there. A skilled writer and close observer, she has created dramatic and often funny stories that reveal social and bioethical complexity. About half the stories describe end-of-life issues for the aged and the dilemmas for their physicians and families.

In ‘The Promise,” Dr. Westphall orders comfort care only for an elderly patient who has suffered a massive stroke, but a hospital gives full treatment because there was no advance directive and the daughter told the attending to do “what he thought best.”

When Dr. Westphall sees this barely functioning patient in a skilled nursing facility seven months later, he tenderly washes her face and hair—although the text teases us that he might have been prepared to kill her.

In “Giving Good Death,” a doctor is in jail charged with murder; he has fulfilled the request of Consuela, a Parkinson’s patient, to help her die. When it appears that she may have died for other reasons, he is released, his life “ruined.” He leaves San Francisco, and, we surmise, medicine. In three other stories, doctors also leave the profession: the cumulative stresses of work and family and/or a sense that it’s not the right path bring them to that choice.

On the other hand, one of the longer pieces “Becoming a Doctor” celebrates the profession, despite all the rigors of training including sexism against women. 

The stories bring multicultural insights; we read of people from China, Cambodia, Latin America, India, Russia, and the Philippines. Some are African-American; some Jewish, some gay. These different backgrounds color notions of health, death, and medical care. There are also pervasive issues of poverty and, at another extreme, professionalism that is hyper-rational and heartless.

Indeed, a recurring theme is care and love for people, no matter their background or current health status. A surgeon realizes (regrettably too late) that the secret of medical care is “caring for the patient—for anyone—just a little. Enough, but not too much” (p. 135). 

Commentary

This is an intelligent and pleasurable collection rich enough for re-reading, study, and discussion. Aronson effectively combines her extensive medical experience with her considerable storyteller’s gifts.

The last story of the volume, “A Medical Story” can be read as an Afterword, as essay by the author, or even a Preface that gives a statement of her poetics. The narrator (who sounds a lot like Aronson) interweaves a story of Rogelio and Carina with her own medical career in San Francisco and her growth as a writer. Anecdotes, she learns, need literary depth to become stories, given that there are backstories, social contexts, and many literary choices. Further, physicians have feelings, personal lives, and a desire to experience limits, including death itself. While William Carlos Williams wrote of poems as places where writers could hide their “punishable secrets,” Aronson shares and celebrates in prose the complexities of illness and medical treatment.

There is much humor. In the satiric “Days of Awe,” a man in his 80s wishes to be the social butterfly of the New Israel Care home, abandoning his depressed and wheelchair-bound wife of 62 years. A Filipino nurse helps the wife regain her energy and drive; together they shape a plot. The resulting scene at a synagogue service combines high comedy with poetic justice. The reader can laugh because these are characters and not actual people. Whether through comedy or stark realism, this book provides some trenchant social criticism of American medical care.

The title “A History of Present Illness” has been borrowed from the first part of a medical chart, a patient’s report as noted by a doctor. Aronson’s stories expand this concept by exploring the treating physicians’ experience of dealing with the patients, their families, hospitals, laws, and so on. Taking the book as a whole, we see that there are several illnesses present and pervasive in America: social injustice, an absurd medical “system,” neuroses about death, and a dominant, secular culture obsessed with money, status, and Darwinian competition. In general, we lack the consolations of philosophy, religion, and a shared sense of the commonweal. 

PublisherBloomsbury
Edition2013
Place PublishedNew York
Annotated by Carter, III, Albert Howard
Date of Entry 02/25/13
Last Revised 03/08/13