A History of the Present Illness

  • Louise Aronson
  • Bloomsbury USA
  • 272 pp.
  • February 6, 2013

Set in San Francisco, this debut collection explores the lives of physicians, patients and their families.

Reviewed by Craigan Usher

In his satire of medical training, House of God (1978), Samuel Shem introduced a non-medical audience to a host of pejoratives: “gomers” were patients, usually the elderly, who needed to “get out of my ER.” “Turfing” a patient meant sending the person away to the “geri,” “ortho” or “psych” service.

If these terms and House of God provide the literary gold standard for medical misanthropy, consider Louise Aronson’s collection of 16 medical stories, A History of the Present Illness, the humanistic antidote. The only problem with “turfing” here will be for booksellers: should they shelve it in fiction or non-fiction, with first-person medical narratives or novels? This is because, though the author assures us she has adequately masked the stories, these tales feels real.

Aronson, an academic geriatrician and writer, borrows her book title from medical nomenclature. The history of the present illness (or HPI) is the part of a consultation note that details what a patient says about his or her problem, wherein the physician outlines what triggers a patient’s pains, how frequent, intense and severe his or her suffering is, and what exacerbates or alleviates the symptoms. HPIs are a delicate art — packaged too neatly, they may lead readers to draw only one, possibly erroneous, diagnostic conclusion. Insufficiently coherent and too data-inclusive, an HPI may lead to a differential diagnosis list far too lengthy. As one who undoubtedly has written and read thousands of HPIs, Aronson knows this and teases and tests readers.

With the details she includes, the UCSF School of Medicine professor invites us to empathize with those who suffer. Among the suffering is the man who returns every day to sing to his wife despite her dementia; the traumatized Cambodian child who wets the bed; the physician whose teenage son screams at her; the med student, who might just be the author, lulled into an unsatisfying relationship with anatomy jokes as foreplay. In the end Aronson’s fragments leave readers frustrated. Like a patient who eventually gets discharged or “lost to follow-up” (medicalese for “never comes back”), A History of the Present Illness hurts. Aronson makes us care, then leaves us wondering about these characters’ fates and the impact of their behavior — or misbehavior.

Aronson’s work prominently features intergenerational distance as an illness. Here the children, adolescent and adult alike are often torturers — abandoning elderly parents to the doctor’s care without providing advanced directives, misconstruing information offered by well-meaning medical staff to insist that demented mothers be kept alive at all costs. Aronson also presents teens repeatedly telling their parents to “fuck off” (12 times) and running away.

The author moves from perspective to perspective, sometimes narrating as a character very much like her, at other times adopting a patient’s voice, occasionally as an omniscient fly on the ward wall. My single criticism is that she doesn’t give much of a voice to these kids. Other characters give us a sense of kindness, purpose. Not so for many of the children of History. I wonder then, as Aronson no doubt has during difficult family meetings, why are these sons and daughters acting this way? Can we turn our psychological inquiry to them? Perhaps, as a physician for the young, I am being unfair to the author. It does seem, though, that geriatricians and their patients get to be the stars of this show.

Despite this, Aronson’s examination of medical culture in stories, of the brutality and tenderness at home and hospital, is a gem. Aronson’s voice is tender and one from which I hope we’ll hear more histories in the future.

Craigan Usher is a graduate of Georgetown University School of Medicine and Director of Child and Adolescent Psychiatry Education at Oregon Health and Science University.

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