A History of Present Illness by Anna DeForest

Published by Little, Brown and Company on August 16, 2022

A History of Present Illness is sort of an Inside Baseball of medicine as practiced in hospitals. The narrator is a medical student. Much of the novel is bleak, from references to unfortunate moments in medical science (the Tuskegee experiment; inducing terror in children to study its effects) to descriptions of patients who suffer from physical and mental illnesses doctors can’t cure and who, perhaps for that reason, the doctors don’t care about.

Each chapter heading — “Modified Drama,” “Withdrawal of Care” — suggests a short story, but the chapters are linked by a patient named Ada. The novel has no clearly identifiable plot unless the random thoughts and anxieties of a medical student as she learns about anatomy and patient care in a hospital constitute a plot.

Toward the story’s end, the narrator shares her biographical details. Her life has been messy, complete with victimization by at least one of her stepfathers, self-mutilation, and a 72-hour mental health hold. At least the narrator managed to avoid the fate of a sister who was shipped to an evangelical camp in the South to have the devil beaten out of her.

In the present, the narrator has no time for romance or sex, although it seems unlikely that she would have success in those endeavors even if she were not busy with medical school. She appears to be learning about love voyeuristically, soaking up the experiences of others as she wonders whether they would be a good fit if she tried them on. She wonders about doctors who are emotionally detached from their patients (as doctors must be to make sound professional judgments). Perhaps her own empathy renders her unfit for the profession. Perhaps it is her questionable mental health that renders her unfit. Or maybe she’ll be a good doctor one day. Who knows?

Putting aside biographical detail, all that remains is a series of observations about what the narrator has learned or seen or done as a medical student. She wants to die screaming rather than being the silent victim of a heart attack, a preference that seems a bit dramatic. She wonders about students who view medicine as a vehicle to a large income rather than a calling. She tells the reader that she wants to understand suffering, although her personal experience should give her a bank of relevant experience to draw upon. She feels jealous of students and patients who can take comfort from religion, although she appreciates the solitude of the hospital chapel. She ends the novel with advice she was given: “Don’t worry about your weaknesses. Just take your strengths and play them to death.” Seems like good advice for poker. I'm not sure how well it translates to living.

The narrator keeps the reader apprised of Ada’s condition (a disease causes dementia before it renders her comatose). The most powerful scenes follow the narrator’s interaction with Ada’s husband when Ada (after a gruesome procedure from which her husband is spared) is finally declared dead and removed from her ventilator. The bureaucratic, mistake-ridden process of making Ada officially dead confirms the narrator’s observation that nobody in the hospital dies until a doctor allows it. Ada wrestles with the degree to which she should be honest with Ada's husband. That struggle creates more sympathy for Ada than her vague and detached description of her childhood.

Apart from the scenes surrounding Ada's death, Anna DeForest gives us a volume of smooth prose and some interesting medical trivial but never captures the reader's imagination. The autobiographical details seem self-indulgent. Some of book is a bit dull. But other parts of the book have merit, earning a very guarded recommendation.

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