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A History of Present Illness
A novel of meticulous brevity and a tone and vision all its own, transmuting the practice of medicine into a larger exploration of humanity, the meaning of care, and the nature of annihilation—physical, spiritual, or both.
A young woman puts on a white coat for her first day as a student doctor. So begins this powerful debut, which follows our unnamed narrator through cadaver dissection, surgical rotation, difficult births, sudden deaths, and a budding relationship with a seminarian.
In the troubled world of the hospital, where the language of blood tests and organ systems so often hides the heart of the matter, she works her way from one bed to another, from a man dying of substance use and tuberculosis, to a child in pain crisis, to a young woman, fading from confusion to aphasia to death. The long hours and heartrending work begin to blur the lines between her new life as a physician and the lifelong traumas she has fled.
In brilliant, wry, and biting prose, A History of Present Illness is a boldly honest meditation on the body, the hope of healing in the face of total loss, and what it means to be alive.
A young woman puts on a white coat for her first day as a student doctor. So begins this powerful debut, which follows our unnamed narrator through cadaver dissection, surgical rotation, difficult births, sudden deaths, and a budding relationship with a seminarian.
In the troubled world of the hospital, where the language of blood tests and organ systems so often hides the heart of the matter, she works her way from one bed to another, from a man dying of substance use and tuberculosis, to a child in pain crisis, to a young woman, fading from confusion to aphasia to death. The long hours and heartrending work begin to blur the lines between her new life as a physician and the lifelong traumas she has fled.
In brilliant, wry, and biting prose, A History of Present Illness is a boldly honest meditation on the body, the hope of healing in the face of total loss, and what it means to be alive.
176 pages, Hardcover
First published August 16, 2022
152 people are currently reading
3875 people want to read
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Displaying 1 - 30 of 219 reviews
August 21, 2022
Rating: 2.5
This unconventional novel initially read like an autobiographical record of a young woman's medical training. However, for this reader at least, as the pages turned, the book became increasingly frustrating--nihilistic, fragmented, and difficult to follow. It was only minimally less exasperating and slightly more comprehensible than A K Benjamin's recent The Case for Love: Reflections on a Medical Career. That isn't saying much, however. De Forest's book has a twist that is very similar to the one in Benjamin's first book, a memoir, Let Me Not Be Mad: A Story of Unravelling Minds. The twist worked in his book, but it just irritated me here.
A History of Present Illness is an intense, demanding book. Barely over a hundred pages, it feels a great deal longer. While sharply observed and thought-provoking at times, for the life of me, I cannot say what the author was ultimately attempting to achieve. Less distracting MFA affectation would have served the author well.
This unconventional novel initially read like an autobiographical record of a young woman's medical training. However, for this reader at least, as the pages turned, the book became increasingly frustrating--nihilistic, fragmented, and difficult to follow. It was only minimally less exasperating and slightly more comprehensible than A K Benjamin's recent The Case for Love: Reflections on a Medical Career. That isn't saying much, however. De Forest's book has a twist that is very similar to the one in Benjamin's first book, a memoir, Let Me Not Be Mad: A Story of Unravelling Minds. The twist worked in his book, but it just irritated me here.
A History of Present Illness is an intense, demanding book. Barely over a hundred pages, it feels a great deal longer. While sharply observed and thought-provoking at times, for the life of me, I cannot say what the author was ultimately attempting to achieve. Less distracting MFA affectation would have served the author well.
May 31, 2022
"In a special section on brain pathology, I watched a fetus have an autopsy. The limp little body was draped over a chunk of two-by-four."
There are a lot of sentences like this one in this novel. It reads like a story told by a young person who has just discovered that people suffer needlessly, and who doesn't know yet what to do with that information.
There are a lot of sentences like this one in this novel. It reads like a story told by a young person who has just discovered that people suffer needlessly, and who doesn't know yet what to do with that information.
March 17, 2022
The author is a neurologist and palliative care physician in New York City and so this book reads almost like a memoir. The novel begins abruptly but it is the unnamed narrator's first day as a student doctor. It's white coat day and so all the student doctors line up with their little lab coats and take a picture. But she immediately goes into all the things she has seen, where they get the bodies from for her anatomy group, and then we meet her last patient, whom she names Ada. Ada has encephalitis, inflammation of the active tissues of the brain, who is fighting fevers after her seizures get under control. Throughout the short novel, we go in and out learning about Ada's hospitalization along with all the other things the narrator has experienced as a student doctor; her growing friendship with a seminarian, who eventually becomes the hospital chaplain; and her childhood, specifically her relationship with her negligent mother. It's a bit clumsy and confusing and it's hard to see the change of topic until a few sentences in. Are we still talking about Ada or someone else? DeForest's writing has appeared in the Paris Review, the Journal of the American Medical Association, the New England Journal of Medicine, among other places and I feel like all of her writings were just thrown together to form a book. The topic is interesting if you enjoy reading morbid stories (I do!) and learning odd little medical facts including what happens to the aborted fetal tissue after an abortion. This is when it reads less like a work of fiction and more like a memoir or nonfiction piece. The story isn't for the faint of heart and could trigger lots of readers as it touches on abortion, rape, child abuse, alcoholism, religion (sorry, but I find religion triggering), and of course, death.
August 16, 2022
DNFed. Cannot stand the judgemental narration and a very negative perspective of everyone else in the writing. Yes, reasons may be there. It's fiction, it's realistic, it's the complicated bad world out there, it's a book that's a genre of its own and so many things BUT to sum it all up: NOT THE BOOK FOR ME.
August 27, 2022
هرقدر از فیلم بیپلات خوشم میآید، از رمان بیپلات دل خوشی ندارم. چون معمولا نویسنده نمیتواند خط فارقی بکشد میان صدای خودش و صدای راوی. تازه اگر مثل این یکی لحنش هم قرقرو باشد که دیگر گلیست به سبزه آراسته
September 18, 2022
This was without a doubt the most beautiful book I have read in a while. I am surprised to see the low ratings because it’s such a concise and extremely complex view into the medical system and personal trauma. Anna DeForest writes with raw honesty and the glimpse into the mind of a young, unnamed medical student that she gives us opens up so much to think about. I did not find that it read like a memoir — it felt like a journal that were allowed to peek into. Highly recommend!!!
August 1, 2023
a beautifully written novel (that almost reads like a memoir) about working, living, and surviving in the medical field. love, grief, loss, death, rebirth, mental illness — all these topics are covered. this is a love letter to those who take care of us, our friends, and family when we are at our lowest points. a love letter to those who are ill and the preserverance of human compassion.
May 25, 2022
I am completely obsessed with this book. Yes, I do work at Little, Brown, and Company so some might consider me biased but, in my defense, I am not the publicist, and this is a work of art. Anna DeForest’s debut novel is a gut punch to the soul that I want to experience over and over again. The question "To get over what you’ve come from but to stay who you are – what would that even look like?" left me in shambles. Also, the quote below is quite possibly my favorite from the whole book:
“I don’t suspect I will ever love anyone enough to feel that way when I have lost them. Or perhaps I mean that none of us will ever feel enough for anything. But it kills me, it breaks me down entirely, to see the world as full of backdated regrets when in real life we can seldom stand the sight of each other and work so hard to keep anyone from guessing what we need or feel. No one, for example, calls me. So when my phone rings, and it is family, I lose a breath and fear the worst – a fall, a death – fear it so badly that I almost believe that I want it by now: a death, a fall, something to freeze them all in time so I can come to terms with them. And then some days I wonder, how could it matter? It is all just a thing that has happened.”
“I don’t suspect I will ever love anyone enough to feel that way when I have lost them. Or perhaps I mean that none of us will ever feel enough for anything. But it kills me, it breaks me down entirely, to see the world as full of backdated regrets when in real life we can seldom stand the sight of each other and work so hard to keep anyone from guessing what we need or feel. No one, for example, calls me. So when my phone rings, and it is family, I lose a breath and fear the worst – a fall, a death – fear it so badly that I almost believe that I want it by now: a death, a fall, something to freeze them all in time so I can come to terms with them. And then some days I wonder, how could it matter? It is all just a thing that has happened.”
August 13, 2022
Written in a novel style, this work feels a lot like a medical memoir. The story follows an unnamed narrator from her white coat ceremony through medical school and some clinical work. There are a lot of graphic events in the book, so trigger warnings may be important for some sensitive readers. Though I found some of the information interesting, the organization of the novel was a problem. The narrative is very jerky and jumps around without meaningful transitions. There isn't a cohesive flow and I was frequently confused by what turned out to be a transition to a new topic or pulled out the book by incoherency. Overall, the writing does have good qualities with an excellent ability to describe the medical context, but the organization of the information requires a heavy edit.
August 27, 2022
Dark. Existential. Will read again.
Read
January 21, 2023I’m going to have to come back to the rating for this one because I can’t decide. There were parts that I found really poignant and beautiful, but I also grew increasingly annoyed with the author and her writing style. The writing is very fragmented, which some authors can make work, but I’m not sure that she pulled it off. Also, the ending was very abrupt. I could have done with another chapter or so. I did find some really lovely quotes, though, and I really enjoyed some of the chapters. Rating will be forthcoming once I have some more time to think about it.
October 4, 2022
While there is no real plot to speak of and seemingly endless conflicts coming from all directions, I found the author’s prose and powers of observation absolutely riveting. All topics are covered - death, hope, history, privilege, regret, shame, and youth - and no storylines are tied up. You are left with more questions than when you began.
This is not a happy novel but one I would recommend to anyone who wants a glimpse into the dark side of medical training.
Furthermore, having recently started my residency at the hospital where the character trains makes the novel all the more relatable. Will read again.
This is not a happy novel but one I would recommend to anyone who wants a glimpse into the dark side of medical training.
Furthermore, having recently started my residency at the hospital where the character trains makes the novel all the more relatable. Will read again.
September 15, 2024
welp this book does not help my fear that becoming a physician will make me severely depressed and mentally ill
reading this book I not only admire DeForest deeply as a writer but also a physician. she has an acute sense of care embedded in her observation of her patients. this book is a series of short stories told from the pov of an unnamed medical student. it is a cold sad account of medical education and personal family/generation trauma. it contains subtle and overt critiques of the lack of humanism and empathy in medical school education and hospitals, class, language and translation (in the context of medical translation + interpreters), race and gender. i am surprised at the unpopularity of the book within the reviews. i think to only view this book and main character as cold and pessimistic is to misunderstand this book. within all of her negativity and dispirit in medicine, there is a subtle hope and faith that she has. hidden within all the death and suffering and gross shit, there is also hope, joy, care, and community.
reading this book not only emphasized the importance but also inspired me to try to implement a writing practice/reflection as a medical scribe and hopefully future med student and practicing physician.
thank you to dr sasannejad who recommended me this book and who encourages me to write about medicine
reading this book I not only admire DeForest deeply as a writer but also a physician. she has an acute sense of care embedded in her observation of her patients. this book is a series of short stories told from the pov of an unnamed medical student. it is a cold sad account of medical education and personal family/generation trauma. it contains subtle and overt critiques of the lack of humanism and empathy in medical school education and hospitals, class, language and translation (in the context of medical translation + interpreters), race and gender. i am surprised at the unpopularity of the book within the reviews. i think to only view this book and main character as cold and pessimistic is to misunderstand this book. within all of her negativity and dispirit in medicine, there is a subtle hope and faith that she has. hidden within all the death and suffering and gross shit, there is also hope, joy, care, and community.
reading this book not only emphasized the importance but also inspired me to try to implement a writing practice/reflection as a medical scribe and hopefully future med student and practicing physician.
thank you to dr sasannejad who recommended me this book and who encourages me to write about medicine
April 3, 2023
This is a very short book without any real plot or connected narrative giving an account of a young woman medical student's four years at a teaching hospital, apparently in New York City. She comes from a totally dysfunctional family with an alcoholic mother and multiple stepfathers and half-siblings. The author is a palliative care physician. Judging from this book, that seems a very good choice. In my own work as a hospital chaplain, I've been appalled by the needless suffering, as well as expense, caused by families' refusal to allow patients to be taken off life support, even though it is clearly doing more harm than good. Too often they have neither the medical knowledge nor the training in moral and ethical reasoning to make the correct choice.
September 4, 2022
This is a gorgeous novel, stunning in its depth of perception and the beauty of its prose. Few books are this powerful and beautifully written and so wholly original. Few books make you cry and laugh and think and feel deeply. Few books illuminate the frailty of our bodies and minds and the strength and sickness so inherent to our medical system.
A History of Present Illness is by no means an easy read.
- The novel focuses on mortality, pain, and illness, largely in the context of medical training, as well as a childhood and adolescence laced with trauma. Illness and pain, and death most of all, are topics most of us work hard to avoid (whether consciously or unconsciously). But in turning us toward these topics, this novel illuminates our human frailty and suffering and underlines our need for humanity.
- The narrator is unreliable, the plot structure is loose, and the style is brilliant and unpredictable, almost stream of consciousness, as the narrator glides from one scene to another. It is not always easy to follow, and sometimes we have to work a bit to reach understanding. But I think it is is worth it.
This is a tremendous first novel-- I can't wait to read more from this unimaginably talented author.
A History of Present Illness is by no means an easy read.
- The novel focuses on mortality, pain, and illness, largely in the context of medical training, as well as a childhood and adolescence laced with trauma. Illness and pain, and death most of all, are topics most of us work hard to avoid (whether consciously or unconsciously). But in turning us toward these topics, this novel illuminates our human frailty and suffering and underlines our need for humanity.
- The narrator is unreliable, the plot structure is loose, and the style is brilliant and unpredictable, almost stream of consciousness, as the narrator glides from one scene to another. It is not always easy to follow, and sometimes we have to work a bit to reach understanding. But I think it is is worth it.
This is a tremendous first novel-- I can't wait to read more from this unimaginably talented author.
January 7, 2023
I get it, being a neurologist and palliative care physician (author) is draining and quickly trims away the fat in life but this book (fiction) is incredibly depressing and very cynical. I’ll just watch the nightly news if I’m looking for that
May 6, 2023
full of wise punches to the GUT
it took me forever to read this book and it was hard to motivate to pick it back up each time — it is def more notes than narrative. but now that i finished it i’m really glad i did!
it took me forever to read this book and it was hard to motivate to pick it back up each time — it is def more notes than narrative. but now that i finished it i’m really glad i did!
January 12, 2024
Really a novella. Listened. Recommended by my sister since I have a daughter in law about to start her residency. Narrative all comes from one
Young female med student ( we never learn her name ) likely not top of her class and her journey.
Full of lots of harsh medical scenes rape abortion psych. Pulling plug. Graphic but done in so few words. Amazing so few words. Talented writer. Would this offend a practicing doctor ? Or is this total truth ? I have no idea. Had to go look up author. Was convinced she was no longer a doctor after reading - not the case. Need to discuss Margaret. Lots to think about.
Young female med student ( we never learn her name ) likely not top of her class and her journey.
Full of lots of harsh medical scenes rape abortion psych. Pulling plug. Graphic but done in so few words. Amazing so few words. Talented writer. Would this offend a practicing doctor ? Or is this total truth ? I have no idea. Had to go look up author. Was convinced she was no longer a doctor after reading - not the case. Need to discuss Margaret. Lots to think about.
April 12, 2022
By crafting A History of Present Illness as a novel rather than a memoir, Anna Deforest provides a creative and compelling departure from the popular model of introspective medical memoir meets social commentary.
We initially join our narrator reflecting on her white coat ceremony and, as such, her introduction to life as a medical student. From this point onward the novel winds and jumps somewhat unpredictably through her youth, her later medical training, and her present reflective moment. The common threads of topical reflection and her experience with one neurologically declining patient, Ada, represent a faint narrative path as she explores her past and inner life against the context of the biased, demanding, and often heartless experience of medicine.
The prose alternates between beautiful and overly affected. It seems crafted to set a tone of ambivalence and passivity for the narrator, an approach that later serves to emphasize the stronger, starker reflections subtly presented at surprising moments. The writing style becomes more refined in the latter half of the novel but feels poorly conceived and even confusing in the first chapters. The overall narrative style is interesting; however, the delivery could use some refinement to avoid nonsensical and wandering moments that could turn off unforgiving readers.
Pick up this novel if you enjoyed When Breath Becomes Air or Educated: A Memoir and the idea of these topics dropped into a creative narrative arc appeals to you. I look forward to what comes next from this author.
My gratitude goes out to NetGalley and Little, Brown and Company for access to this advance review copy in exchange for an unbiased review.
We initially join our narrator reflecting on her white coat ceremony and, as such, her introduction to life as a medical student. From this point onward the novel winds and jumps somewhat unpredictably through her youth, her later medical training, and her present reflective moment. The common threads of topical reflection and her experience with one neurologically declining patient, Ada, represent a faint narrative path as she explores her past and inner life against the context of the biased, demanding, and often heartless experience of medicine.
The prose alternates between beautiful and overly affected. It seems crafted to set a tone of ambivalence and passivity for the narrator, an approach that later serves to emphasize the stronger, starker reflections subtly presented at surprising moments. The writing style becomes more refined in the latter half of the novel but feels poorly conceived and even confusing in the first chapters. The overall narrative style is interesting; however, the delivery could use some refinement to avoid nonsensical and wandering moments that could turn off unforgiving readers.
Pick up this novel if you enjoyed When Breath Becomes Air or Educated: A Memoir and the idea of these topics dropped into a creative narrative arc appeals to you. I look forward to what comes next from this author.
My gratitude goes out to NetGalley and Little, Brown and Company for access to this advance review copy in exchange for an unbiased review.
February 25, 2023
Reading this book felt like it was being written by an unfeeling alien robot observing what it is like in med school and this person has absolutely NO business whatsoever being a doctor. The structure of the book makes little sense and feels like it was cobbled together from different bits of paper, like "oh by the way I should add this part here" even if it disrupts the flow of the book. Plus this is classified as a "novel" in the back but it doesn't read like that.
You know those jokey memes where they have a robot write a movie? This feels like that. The book actually gave me a headache. Don't waste your time or money
My thanks to Netgalley and the publisher for this ARC. Opinions in this review are my own.
You know those jokey memes where they have a robot write a movie? This feels like that. The book actually gave me a headache. Don't waste your time or money
My thanks to Netgalley and the publisher for this ARC. Opinions in this review are my own.
July 21, 2023
This is definitely not the book for me. It was dull and I was confused regarding what this author was trying to say or convey to the reader. I made it halfway through and had to "throw in the towel". I am surprised I didn't like it since I find books/stories about the medical field interesting.
This story just seemed like a med student wanted to be interesting and tried to pick a story here and there that would capture each phase of their training, but the stories were nothing interesting, nothing that would make you sit back and feel awed, nor impressed. The writing actually made me feel that the protagonist was speaking in a monotone type of voice, and we all know how exciting it is to listen to someone like that! (Yup, sarcasm)
This story just seemed like a med student wanted to be interesting and tried to pick a story here and there that would capture each phase of their training, but the stories were nothing interesting, nothing that would make you sit back and feel awed, nor impressed. The writing actually made me feel that the protagonist was speaking in a monotone type of voice, and we all know how exciting it is to listen to someone like that! (Yup, sarcasm)
April 8, 2023
Written from the perspective of a medical student with chapter titles like “Anatomy” and “No Apparent Distress,” this book reads like mini essays but then acts like a novel as characters appear and reappear in a kind of weave. Woven throughout are the narrator’s reflections on race and especially social class as it relates to her experience of medical school. Underneath all of this are stories of a traumatic childhood. It’s short and I would benefit from rereading it, but there’s a distance in the narrator’s voice that didn’t pull me in. I admire the book, but did not feel drawn to it.
April 3, 2023
1.5 stars*
i’m not sure how to put into words exactly what bothered me about the writing but i guess, for the most part, it just felt very disjointed. some parts of it were definitely interesting, but i found it difficult to stay connected to the story when there was barely any cohesion from one paragraph to the next. not to mention the amount of times that the narrator randomly went off-topic and just never got back to the point..
i’m not sure how to put into words exactly what bothered me about the writing but i guess, for the most part, it just felt very disjointed. some parts of it were definitely interesting, but i found it difficult to stay connected to the story when there was barely any cohesion from one paragraph to the next. not to mention the amount of times that the narrator randomly went off-topic and just never got back to the point..
September 1, 2025
"Pity poor meat!"--Deleuze (epigraph to Laurie Weeks's story "Debbie's Barium Swallow")
Just a placeholder for a review. I loved this book.
Just a placeholder for a review. I loved this book.
July 5, 2022
"A History of Present Illness" by Anna DeForest
Little, Brown and Company
August 16, 2022
10-0316381063
This novel is an insightful tale of an unnamed young woman venturing into the field of medicine. As she commences her training as a student doctor, she finds herself with her colleagues as they receive their lab coats from the already practicing doctors dressed in their doctoral robes. The day is oppressively hot as she and others sit through a ceremony with speeches explaining what it takes to be a top-notch physician.
Following this, the group spends the rest of the day in the cadaver laboratory with four students assigned to each corpse. Our protagonist is in a group consisting of two women and two men. One of the men they label "country boy" for he states he owns a country home nearby. The other male is from Texas, and that is the moniker they give him. The other female remains silent and reticent while she holds her textbook. Their "patient" is a Black woman on whom they will perform their first autopsy. As they begin the dissection, they wonder where these deceased have come from? Have they donated their bodies for science? Are they homeless? It appears some may be indigent, isolated with no family, or nursing home residents who lost all their funds and are unable to afford a burial.
The procedure offers details of the process as they then learn the techniques used. Those remains are either cremated or buried in mass graves not far from the school, where convicts stack pine boxes in rows and then place them in trenches.
Many students, as well as doctors, for that matter, are overworked and unprepared for this intense vocation, so many give up, and even some may turn to suicide as an escape—the stress of it all being too much to bear.
Our student believes in caring for her patients, getting to know them, and working to alleviate their fears. She has a young female in a coma who suffering from encephalitis, which is inflammation spreading to her brain. Not knowing her identity, she calls her Ada and spends time with her husband learning more about her. Knowing her case is terminal, she soon gets attached to her, spending time at her bedside.
She states: "We are schooled in taking, not giving, a history. We are taught to reach first for open-ended questions. How you ask can earn an answer closer to the truth. For example, you don't ask someone if she drinks; you say, 'How much do you drink on an average day.' You don't ask if someone is compliant with his medication; you ask, 'How often do you miss a dose.' We are told to normalize our queries about drugs, sex, and death by asking them to everyone."
As they progress through training, they spend time in operating rooms. One of the surgeries she assists in consists of replacing heart valves, another is repairing gunshot wounds or less serious operations such as removing an inflamed appendix.
A rotation in the emergency ward for psych patients is somewhat frightening. There are wards full of those who have gone mad, gone off their meds, cry through the night, etc. And these folks who are suffering intensely have our student questioning if this is the specialty she wants to set her sights on.
There is a great division when it comes to treatment in hospitals as our protagonist states:
"The sick poor, you could probably guess, are treated poorly in the hospital. They are more likely to be obese, to be smokers, to suffer a slew of other ills along a social gradient that we attribute, casually, to a failure of will. These health disparities are especially bad for Black people, though in the cohort, outcomes don't improve much with higher incomes or more education. Our older lecturers attribute the difference to genetics perhaps because they have been forbidden from promoting frank eugenics or phrenology. New data suggests that the stress of daily indignity may cause plaque to build up in the arteries and lower the birth weight of babies. These, they say, are the social determinants of health."
As training continues, the students learn the nature of the profession is to constantly approach the patient to attempt to connect with them and impress upon them some lesson that the way they are living or the things they are doing is detrimental to their health. Not only is a lot of their training repetitive and often boring, but the hours are long and the need for studying and being tested seems constant—a great cause of burnout.
This novel depicts many aspects of the medical field but also consists of in-depth book learning as well as the student acquires the skills on how to placate difficult patients or how to deal with scurrilous physicians, as well as how to stay cool in extreme situations and adjust to long hours and ever-changing schedules.
"A History of Present Illness" is a debut for Anna DeForest, a neurologist, and palliative care physician. It is a powerful and somewhat complicated read of a story about a young woman dealing with the intensity of becoming a doctor while she also faces the ramifications of her past and current personal life. Though this is written as fiction it reads more like a memoir.
Little, Brown and Company
August 16, 2022
10-0316381063
This novel is an insightful tale of an unnamed young woman venturing into the field of medicine. As she commences her training as a student doctor, she finds herself with her colleagues as they receive their lab coats from the already practicing doctors dressed in their doctoral robes. The day is oppressively hot as she and others sit through a ceremony with speeches explaining what it takes to be a top-notch physician.
Following this, the group spends the rest of the day in the cadaver laboratory with four students assigned to each corpse. Our protagonist is in a group consisting of two women and two men. One of the men they label "country boy" for he states he owns a country home nearby. The other male is from Texas, and that is the moniker they give him. The other female remains silent and reticent while she holds her textbook. Their "patient" is a Black woman on whom they will perform their first autopsy. As they begin the dissection, they wonder where these deceased have come from? Have they donated their bodies for science? Are they homeless? It appears some may be indigent, isolated with no family, or nursing home residents who lost all their funds and are unable to afford a burial.
The procedure offers details of the process as they then learn the techniques used. Those remains are either cremated or buried in mass graves not far from the school, where convicts stack pine boxes in rows and then place them in trenches.
Many students, as well as doctors, for that matter, are overworked and unprepared for this intense vocation, so many give up, and even some may turn to suicide as an escape—the stress of it all being too much to bear.
Our student believes in caring for her patients, getting to know them, and working to alleviate their fears. She has a young female in a coma who suffering from encephalitis, which is inflammation spreading to her brain. Not knowing her identity, she calls her Ada and spends time with her husband learning more about her. Knowing her case is terminal, she soon gets attached to her, spending time at her bedside.
She states: "We are schooled in taking, not giving, a history. We are taught to reach first for open-ended questions. How you ask can earn an answer closer to the truth. For example, you don't ask someone if she drinks; you say, 'How much do you drink on an average day.' You don't ask if someone is compliant with his medication; you ask, 'How often do you miss a dose.' We are told to normalize our queries about drugs, sex, and death by asking them to everyone."
As they progress through training, they spend time in operating rooms. One of the surgeries she assists in consists of replacing heart valves, another is repairing gunshot wounds or less serious operations such as removing an inflamed appendix.
A rotation in the emergency ward for psych patients is somewhat frightening. There are wards full of those who have gone mad, gone off their meds, cry through the night, etc. And these folks who are suffering intensely have our student questioning if this is the specialty she wants to set her sights on.
There is a great division when it comes to treatment in hospitals as our protagonist states:
"The sick poor, you could probably guess, are treated poorly in the hospital. They are more likely to be obese, to be smokers, to suffer a slew of other ills along a social gradient that we attribute, casually, to a failure of will. These health disparities are especially bad for Black people, though in the cohort, outcomes don't improve much with higher incomes or more education. Our older lecturers attribute the difference to genetics perhaps because they have been forbidden from promoting frank eugenics or phrenology. New data suggests that the stress of daily indignity may cause plaque to build up in the arteries and lower the birth weight of babies. These, they say, are the social determinants of health."
As training continues, the students learn the nature of the profession is to constantly approach the patient to attempt to connect with them and impress upon them some lesson that the way they are living or the things they are doing is detrimental to their health. Not only is a lot of their training repetitive and often boring, but the hours are long and the need for studying and being tested seems constant—a great cause of burnout.
This novel depicts many aspects of the medical field but also consists of in-depth book learning as well as the student acquires the skills on how to placate difficult patients or how to deal with scurrilous physicians, as well as how to stay cool in extreme situations and adjust to long hours and ever-changing schedules.
"A History of Present Illness" is a debut for Anna DeForest, a neurologist, and palliative care physician. It is a powerful and somewhat complicated read of a story about a young woman dealing with the intensity of becoming a doctor while she also faces the ramifications of her past and current personal life. Though this is written as fiction it reads more like a memoir.
August 15, 2022
via my blog: https://bookstalkerblog.wordpress.com/
𝙄 𝙬𝙖𝙨 𝙧𝙖𝙞𝙨𝙚𝙙 𝙬𝙞𝙩𝙝 𝙖 𝙧𝙚𝙫𝙚𝙧𝙚𝙣𝙘𝙚 𝙛𝙤𝙧 𝙘𝙖𝙩𝙖𝙨𝙩𝙧𝙤𝙥𝙝𝙚.
Doctors are people too, even if many patients are intimidated by the white coat, and the fact they often hold our lives in their hands; a gift and heavy burden, I imagine. The story begins with a student doctor telling the reader she has ‘seen a beating heart in a wide-open chest‘, she has studied a cadaver, exposed the spine and cracked the vertebrae, and of course she has feelings for the body, and thinks about where they come from, these donations for science that weren’t all happy stories. This isn’t the most depressing part of the journey; a hospital is full of sad stories. It is a world of catastrophes, illness, disease, violence, aging, mental decline, holding therapies gone wrong and aren’t doctors the pillars, meant to lift us out of our suffering, keep our minds and bodies well? They aren’t supposed to be emotional, and yet, not all can hack it. Interesting word, hack. Death is always lurking; it is relief and horror both.
Sometimes, they laugh at patients behind their backs, it it cruelty or simply one way to react in the face of hopeless cases, those who will never change to save themselves? How, she wonders, are the doctors meant to manage their terror, facing death day in and day out caring for the ill and infirm? Harder to confront, the poverty, the lack of means and proper care for those who are poor, disabled or people of color, the injustice of how much value is placed on certain lives. Then, the ugly truth of how often the mentally ill are easily manipulated into volunteering to be tested on. Our young student doctor is stunned to learn about how to take a history of psych patients and what to ignore, history that seems vital to helping them. This is not a happy book, it is raw honesty, and it can be disheartening considering these characters and their suffering, characters that resemble us, our family and friends. Language barriers, there is a point in the book where the narrator informs us that it can cost a patient their life or lead to a debilitating outcome. With a grandmother whose English wasn’t very strong, I witnessed how much the medical community missed, specifically what were evident to us, her mental health struggles. Remember, communication isn’t only about language, there are many disabilities that hinder health care, worse when time is of the essence. Doctors are not gods, they too are flawed humans and, often, are only as good as the science they’ve been taught. The narrator of this story has a broken heart, one that she assures us she ‘can pull out over work’, but she has her own family origins to deal with, old wounds and grievances, a deep loss, just like patients she will tend to. She wants to heal too. Her humanity makes her the doctor you just might want at your bedside.
A fictionalized peek at the people behind the stethoscope. An intelligent read, especially for me as I have had my share of hospital stays.
Publication Date: August 16, 2022
Little, Brown and Company
𝙄 𝙬𝙖𝙨 𝙧𝙖𝙞𝙨𝙚𝙙 𝙬𝙞𝙩𝙝 𝙖 𝙧𝙚𝙫𝙚𝙧𝙚𝙣𝙘𝙚 𝙛𝙤𝙧 𝙘𝙖𝙩𝙖𝙨𝙩𝙧𝙤𝙥𝙝𝙚.
Doctors are people too, even if many patients are intimidated by the white coat, and the fact they often hold our lives in their hands; a gift and heavy burden, I imagine. The story begins with a student doctor telling the reader she has ‘seen a beating heart in a wide-open chest‘, she has studied a cadaver, exposed the spine and cracked the vertebrae, and of course she has feelings for the body, and thinks about where they come from, these donations for science that weren’t all happy stories. This isn’t the most depressing part of the journey; a hospital is full of sad stories. It is a world of catastrophes, illness, disease, violence, aging, mental decline, holding therapies gone wrong and aren’t doctors the pillars, meant to lift us out of our suffering, keep our minds and bodies well? They aren’t supposed to be emotional, and yet, not all can hack it. Interesting word, hack. Death is always lurking; it is relief and horror both.
Sometimes, they laugh at patients behind their backs, it it cruelty or simply one way to react in the face of hopeless cases, those who will never change to save themselves? How, she wonders, are the doctors meant to manage their terror, facing death day in and day out caring for the ill and infirm? Harder to confront, the poverty, the lack of means and proper care for those who are poor, disabled or people of color, the injustice of how much value is placed on certain lives. Then, the ugly truth of how often the mentally ill are easily manipulated into volunteering to be tested on. Our young student doctor is stunned to learn about how to take a history of psych patients and what to ignore, history that seems vital to helping them. This is not a happy book, it is raw honesty, and it can be disheartening considering these characters and their suffering, characters that resemble us, our family and friends. Language barriers, there is a point in the book where the narrator informs us that it can cost a patient their life or lead to a debilitating outcome. With a grandmother whose English wasn’t very strong, I witnessed how much the medical community missed, specifically what were evident to us, her mental health struggles. Remember, communication isn’t only about language, there are many disabilities that hinder health care, worse when time is of the essence. Doctors are not gods, they too are flawed humans and, often, are only as good as the science they’ve been taught. The narrator of this story has a broken heart, one that she assures us she ‘can pull out over work’, but she has her own family origins to deal with, old wounds and grievances, a deep loss, just like patients she will tend to. She wants to heal too. Her humanity makes her the doctor you just might want at your bedside.
A fictionalized peek at the people behind the stethoscope. An intelligent read, especially for me as I have had my share of hospital stays.
Publication Date: August 16, 2022
Little, Brown and Company
September 15, 2024
I had seen a review of this book, & was fascinated by the premise -- a novel written by a physician written about the experiences of a medical student...but it is so.much more than that. This brutal and brave novel transmuted the practice of medicine into a larger exploration of humanity, the meaning of care, and the nature of annihilation--physical, spiritual, or both. As a retired Nurse Practitioner I have seen and experienced many of the same scenarios she writes about in this short but powerful little book. She essentially is saying of modern healthcare...we need to be better and do better. This I know to be true...just because we can do something ( a treatment, a medicine, a procedure) ... doesn't mean we should. Death is a part of life...its terminus, yet still a part. Highly recommend this book.
November 6, 2024
I really love when a non-fic author isn’t trying to entertain you. They aren’t trying to cater to you, or soften the blow, or make it all seem more palatable. They aren’t telling you what you want to hear; they are just trying to articulate something true. It feels authentic and raw and fundamentally worthwhile.
Reviews seem to be either 2 stars or 5…..For me it’s a 5. It’s dark but it’s ultimately refreshing to just be spoken to plainly about all these facts of life we spend so much time refusing to acknowledge.
Medical work IS bizarre. The human work and the dehumanizing needed to do it. Our universal experience of living and dying and being afraid, of having our bodies betray us. I work in locked care facilities for patients with advanced dementia and I think constantly about the existential reality of it, of the body and the mind and what makes a person alive. Everyone will tell you not to “take work home” with you but…. is this not something worth examining? The ending of things? We are supposed to present this narrow, specific version of ourselves at work but do we not continue to be who we are everywhere we go?
I already know I’ll be rifling through this again, looking to revisit particular quotes.
Reviews seem to be either 2 stars or 5…..For me it’s a 5. It’s dark but it’s ultimately refreshing to just be spoken to plainly about all these facts of life we spend so much time refusing to acknowledge.
Medical work IS bizarre. The human work and the dehumanizing needed to do it. Our universal experience of living and dying and being afraid, of having our bodies betray us. I work in locked care facilities for patients with advanced dementia and I think constantly about the existential reality of it, of the body and the mind and what makes a person alive. Everyone will tell you not to “take work home” with you but…. is this not something worth examining? The ending of things? We are supposed to present this narrow, specific version of ourselves at work but do we not continue to be who we are everywhere we go?
I already know I’ll be rifling through this again, looking to revisit particular quotes.
February 7, 2023
Not everyone's cup of tea, like House of God but not funny, this book mentions many of the things you've heard about medical training and wondered if they were true. I'm afraid to say a lot of it rang bells from my own training, such as the discussion with a family about a brain-dead patient! I could feel myself back in that room, the medical student, and the one speaking plain English. I wish I had thought to say "she died without pain"!
April 19, 2023
I want to reread this in a year. Its written in a kind of stream-of-consciousness style and follows an unnamed narrator throughout medical school. It is abstract and jumps from one story to a thought to a jarring scene in a hospital to the narrators own childhood memories. It reminds me of working in an emergency room and how patient stories interact with your own thoughts. I think if you work in healthcare, it’s an interesting read, if not, it might just read as confused and kinda sad.
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