Book Review: A History of This Present Illness by Louise Aronson

 A History of This Present Illness
by Louise Aronson
Bloomsbury Press
Pub Date: January 22,  2013
272 pages
Short Stories

ARC provided  by publisher via Net Galley

Every one of the sixteen short stories in this interlocked collection is an exquisitely etched jewel.  Set in the SF Bay area in various medical care facilities they bring us characters experiencing health crisis and their families and care givers with the aggregate effect shining a spotlight on the state of the American health care industry.

Every story is unique, varying in style, tone, length, voice, tempo and form.  From the intergenerational family (made-for-TV-move?) drama in 'Heart Failure', to the list of facts in '25 Things I Know About My Mother-in-Law', to the heavily (neurotically?) footnoted memo sent by one psychiatrist to the psychiatrists chairing the panel working on the latest edition of the Diagnostic and Statistical Manual of Mental Disorders advocating for inclusion of a new subset of boundary disorders in 'Blurred Boundary Disorder' and whether attempting the objectivity of a camera in 'Snapshots from an Institution' or the intimate inner experience of an Iraq vet amputee in 'After' or the unreliable narrator in 'Lucky You' Aronson's stories open our heart and consciousness to the human condition and the modern surrealistic state of affairs in America's medical care institutions.

By drawing her characters with such observational skill and empathy she gives us back the original meaning of the word 'caring' currently so distorted by the mechanized, bureaucratized, politicized, and profitized health care industry.  This book should be required reading for every first year med student and every legislator at both state and federal level.  The stories in this book and stories like them should become the underpinning of any further national discussion about health care legislation.

My favorite story is probably the last one, 'A Medical Story', which is itself a musing on the definition of 'story' and blurs the boundaries between story narrator and author and confesses the origin of all the stories in actual events lived or learned of by the author. This also blurs the boundaries between genre making it hard to place the book solidly in either the NF or fiction categories since only names and certain details were changed to protect the privacy of families and individuals. And yet tho rooted solidly in actual events these stories are crafted like literary stories designed to elicit that inner 'ah' of awe and the collection arranged to emphasize their meaning--a meaning that cannot be stated any more succinctly.  By taking these true stories and climbing into the hearts and heads of their actors with her informed imagination and arranging the action to emphasize meaning Aronson gives us fiction that is truer than fact and stories that will live in our hearts and inform our conscience.

From the Publishers:

A History of the Present Illness takes readers into overlooked lives in the neighborhoods, hospitals, and nursing homes of San Francisco, offering a deeply humane and incisive portrait of health and illness in American today. An elderly Chinese immigrant sacrifices his demented wife's well-being to his son's authority. A busy Latina physician's eldest daughter's need for more attention has disastrous consequences. A young veteran's injuries become a metaphor for the rest of his life. A gay doctor learns very different lessons about family from his life and his work, and a psychiatrist who advocates for the underserved may herself be crazy. Together, these honest and compassionate stories introduce a striking new literary voice and provide a view of what it means to be a doctor and a patient unlike anything we've read before.
In the tradition of Oliver Sacks and Abraham Verghese, Aronson's writing is based on personal experience and addresses topics of current social relevance. Masterfully told, A History of the Present Illness explores the role of stories in medicine and creates a world pulsating with life, speaking truths about what makes us human.

What they are saying: 

“In A History of the Present Illness Louise Aronson invites us to bear witness as people--with very little fanfare, but with a profound sense of truth--to come to terms with what it really means to be a flawed, sick human being in a flawed, sick world. These stories are about medicine exactly in the way that medicine is about life: here hospitals contain whole worlds, physicians contain their patients, and the emotional and physical gestures of the urge to heal contain the whole fruitful and fruitless work of human connection.” – Chris Adrian
“A History of the Present Illness is a collection of stories about doctors and their patients, and about the chronic and presenting situations that bring them to crisis. Eudora Welty described the work of another physician/story writer by saying that 'Chekhov's candor was exploratory and painstaking -- he might have used it as the doctor in him would know how, treating the need for truth between human beings as an emergency,' words that seem to me to also apply here. Aronson's quest, too, is for that truth.” – Antonya Nelson
“Some of the most startling and memorable stories I've ever read. A History of the Present Illness is a fascinating study of our fragile human condition, both physical and emotional. Here is a writer-and a doctor-whose empathy for her people, her characters, springs forth on every page.” – Peter Orner
“In A History of the Present Illness, Louise Aronson reveals her remarkable range of voice, from bedwetting Cambodian girl to elderly Jewish man; from paralyzed Bad Boy to pampered ex-surgeon who drinks to forget her depression. If you've ever wondered what goes on behind the closed doors of the sick and the wounded--not on television or in movies but really--then this is the book for you. Compassionate and even anguished, though quietly, Dr. Aronson paints a dark, Rembrandtian portrait, where the faces are solemn, and the clothes and circumstances precisely fit to man, woman, and child. Fiction it may be, but it has the palette and the ring of truth.” – Victoria Sweet, author of God’s Hotel

Louise Aronson has an MFA from Warren Wilson College and an MD from Harvard. She has received the Sonora Review prize, the New Millennium short fiction award, and three Pushcart nominations. Her fiction has appeared in Bellevue Literary Review and the Literary Review, among other publications. She is an associate professor of medicine at UCSF, where she cares for older patients and directs the Northern California Geriatrics Education Center and UCSF Medical Humanities. She lives in San Francisco.




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