December 3, 2012 1 Comment

A History of the Present Illness

The world is full of books – over 129 million at last count. And parts of the world – Boston, Atlanta, Nashville, Denver, London – are full of doctors. What’s more, the ranks of doctor-writers keep growing. So why, a very reasonable person might ask, do we need another book by another doctor?

One answer might be that we don’t. But if we don’t need another book about health and illness, courage and compassion, doctors and patients, then I would argue that we also don’t need another book about love or loss, war or sacrifice, heroism or injustice.

Medicine matters in no small part because it is the arena in which many of literature’s greatest themes play out in real life:

  • The great journey
  • The loss of innocence
  • The great battle
    - Man v. nature
    - Man v. self
    - Man v. technology
    - Man v. society
    - Man v. man
    - Man v. God
  • The inevitability of death
  • The noble sacrifice
  • The fall from grace
  • The importance of love and friendship

Here’s one way of thinking about how this works for patients, for doctors, and in A History of the Present Illness:

Literary Theme Patient experience Doctor experience Illustrative stories in A History of the Present Illness
The great journey Illness, from first symptom to resolution or a changed life Medical training
Medical research
  • Twenty-five Things I Know
  • Vital Signs Stable
  • A Medical Story
The loss of innocence Healthy → sick Student → doctor
  • An American Problem
  • Becoming a Doctor
The great battle Against a disease
Against the health care system
Against a disease
Against the health care system
  • Fires and Flat Lines
  • Lucky You
The inevitability of death Resistance: hope against the odds; trying experimental treatments
Acceptance: hospice; preparing with family/friends
Resistance: death as professional failure
Acceptance: having the skills and expertise to help provide a ‘good death’
  • Soup or Sex
  • Days of Awe
The noble sacrifice Donating an organ to a loved one or stranger
Giving up sleep and youth, time with family to train and practice medicine
  • Snapshots from an Institution
  • After


The fall from grace Losses and disabilities can feel like a fall from the grace of good health Malpractice
Substance abuse
Unprofessional behavior
  • Giving Good Death
  • The Psychiatrist’s Wife
  • Blurred Boundary Disorder
The importance of love and friendship Support of family and friends
Feeling that the ‘care’ in patient care is present
Compassion and empathy for patients
Supportive family
  • Heart Failure
  • The Promise
  • Acknowledgements


Quote of the week:

I am not ashamed to admit that I belong to those who fantasize that literature is capable of bringing new horizons and new perspectives–philosophical, religious, aesthetical and even social.

– Isaac Bashevis Singer Nobel Lecture (8 December 1978)

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