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Terribly and Punishingly Great
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America as a whole and American medicine in particular seem sold on narrative medicine—the idea that since stories are the backbone of how patients and doctors relate, learning how to create and listen to them assists healing. Doctors who write creatively have become big business, and many medical schools publish their own literary journals, which increasingly attract writers of the same caliber as some of the most venerable literary journals published by creative writing programs.

By concentrating the reader's eye on details and emotions whose meaning can be lost in the moment, these journals claim to move beyond art—that the work in them enables better functioning of the processes of medicine. They benefit doctors by providing a space in which to experience the sometimes overwhelming emotions their work stirs in them, and they benefit patients by allowing them to examine and share the terror and anger that accompany illness. As Sherwin Nuland writes, "attempts to heal are so much more complex than can be appreciated except by those immersed in them. . . . This is not for want of wanting—we certainly all endeavor to find empathy—but for want of being able to see inside minds not our own."

This passage comes from his introduction to The Best of the Bellevue Literary Review. The Web site of the BLR, which is published by New York University's School of Medicine, calls it "a journal of humanity and human experience." The lack of any form of the words "medicine" or "healing" in that description took me by surprise, but it shouldn't have. Human experience is shaped by the limitations of the human body. The one thing we know we share with Australians or Laplanders or Bangladeshis is probable illness and certain death.

This is not a cheery thought, and it goes a long way toward explaining why this book was so hard to read. In it, you can find just about every variation on any moment in the long, ghastly process of failure of body or brain. Many—like "Fissure," by Debra Anne Davis, in which a woman struggles through a visit to a proctologist to treat an anal fissure, the result of being sodomized by a rapist the week before; or my personal favorite, "So Much in the World Is Waiting To Be Found Out," by Sariah Dorbin, in which an advertising executive stumbles through day-to-day life after her mother is hit by a truck—are so terrible that even the bare facts leave you marveling at cruelty's inventiveness; to enter the moment in all its detail is almost more than can be borne.

Which is not to say that this is not a fine collection. The difficulty of plowing through it is directly due to the high quality of the stories and poems in it, and how evocative they are of what they try to represent. Most of the book is patient narratives, and they fall into two camps: those that remind you of some experience with illness you've had yourself, and those that you pray neither you nor anyone you know will ever experience. One of the latter, appropriately titled "The Absolute Worst Thing," sums up beautifully our options to deal with disease. Its author, Seth Carey, who had amyotrophic lateral sclerosis (Lou Gehrig disease) writes, "When you find yourself in a traffic jam, you are faced with a choice. You can get all mad, flipping the finger to everyone, banging on the dashboard. Or you put on your favorite CD, rummage around for a roach, and sing along with the guitar solo. Either way you're going to end up at the same place." (I read in his bio that Mr. Carey died in 2005. I'd been trying to believe this piece might be fiction.)

The BLR offers a free study guide to this volume on its Web site, and I believe the book's true potential is for use in teaching. After reading it cover to cover, I came away walloped by the breadth and depth of pain it highlights, but I can imagine a medical or nursing or ethics or social work student, concentrating on one story...



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