A History of Present Illness: A Novel
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.