A History of Present Illness

June 6, 2022
Palliative care physician DeForest delivers a reflective debut about cadavers, family trauma, and perplexing ailments. During the unnamed narrator’s term as a medical student, she tries to process her experiences as well as her history of abuse and neglect. She spends a lot of time by the bed of Ada, a younger woman with a slow encephalitis. Throughout, the narrator offers arresting reflections on the godlike powers doctors hold over their patients (“No one even dies until we let them”), on the desensitization that comes with seeing so much pain and death, and the pressure and competitiveness that often pushes residents to self-harming behaviors. Fascinating medical facts abound (for example: during an autopsy, fixative is used on the brain to preserve it), along with disturbing passages about the narrator’s stepfather, who would lock her and her siblings in the basement. The tone remains detached, creating an atmosphere that echoes the narrator’s “mechanical existence.” There’s not much of a story, but DeForest does a great job conveying the impact of the surroundings on her narrator, as well as how she learns the value of honesty with patients’ families, after giving Ada’s husband the unvarnished truth about her fate. This slim volume gives readers much to contemplate. Agent: Sarah Burnes, Gernert Company. (Aug.)Correction: An earlier version of this review mistakenly referred to the book's narrator as a medical resident.

June 15, 2022
A trainee doctor offers her perspective on her work and its environment, exposing a less-than-sunny view of institutional medical practice. In an unusual, quiet, but dark debut, DeForest plunges the reader into an unspecified hospital environment, guided by a nameless narrator who is training to be a "future doctor." This woman introduces a chilling world of dutiful care threaded with incidental horror, inadvertent cruelty, and occasional macabre humor, glimpsed in a variety of contexts: the emergency psych ward; the abortion clinic; the quiet room "where we held the difficult conversations"; neurology; end of life care; and more. The tone can be abstract, musing on poetry or anatomy, at other times, revelatory of medical norms and modes of expression: "Empty speech, the neurologists call it"; "Failing the medication is what we call this." Slowly the narrator's personal history emerges: an impoverished childhood, "never seeing doctors"; a religious school with no science or world history; separated parents; visits to her father "in dirty clothing, with head lice, with no clear habits of dental hygiene"; and a string of fearsome stepfathers. Now, in adulthood, she is in a celibate relationship with a seminarian "from a bad-hearted family." This strange and oppressive context explains some of the oddity of her commentary on her medical training and experience, as does her "fascination with disaster." Her more political observations on the increased suffering of the poor, the disabled, and people of color are shocking but less unfamiliar. Snapshots of bad behavior by medical personnel--racist comments or derogatory asides about overweight or tattooed patients--seem persuasive. The case of Ada, a patient with slow encephalitis, intersperses the short text and showcases the gamut of process, endurance, loss, and, above all, care and its complex shortcomings. An original, disturbing new version of hospital fiction.

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Starred review from July 22, 2022

DEBUT Neurologist and New York City physician DeForest has written a distinctive debut novel, a first-person narrative of a woman serving her medical residency in New York City. She describes learning anatomy in the cadaver lab with her residency team and doesn't flinch when she discovers where the medical school bodies come from--unclaimed remains, the indigent, and the chronically isolated. On the emergency ward for psychiatric patients, the doors stay locked, the guards are armed, and the narrator notes how the drugs administered to these patients disrupt their metabolisms and cause their hands to shake and their identities to disintegrate. She confronts the moral dilemma of employing machines to keep a life going with no hope of recovery, studies apocalyptic diseases resistant to all medications, and learns that what people of color face in everyday life is worse in a hospital. It is a journey fraught with instant, life-changing decision every hour of the day until the residents all make it to graduation--and beyond to their careers. VERDICT DeForest's fast-paced, tell-it-like-it-is story describes medical school in harrowing detail, with all the niceties stripped away. Essential insights for lay readers.--Donna Bettencourt

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Starred review from August 1, 2022
Fluctuating between frightened and fearless, an unnamed medical student shares her thoughts and experiences in a candid but anguished narrative as she navigates the challenges of medical school and her personal life. Already enduring family calamity, this compelling doctor-to-be is searching for human connection and admits to a ""fascination with disaster"" and being ""raised with a reverence for catastrophe."" Physician and first-time novelist DeForest goes all in on effect and energy here, less so on plot and denouement. Descriptions of a cadaver lab, encounters with patients in the ICU, psychiatric ward, and ER, and attending the autopsy of a fetus whose mother was infected with the Zika virus are featured. Terror and suffering lurk everywhere in the hospital. An elderly man, delirious and restrained, scribbles a note, ""Kill me."" Another patient's ""skin was coming off in sheets."" A young woman with encephalitis (inflammation of the brain) is slowly dying. Underscoring the toll of medical training, the narrator comes clean on exhaustion, insecurity, futility, and the inescapability of death. Still she clutches empathy, truth, and hope. Brutal and brave, DeForest's novel is one of the best in the ""making of a doctor"" genre. And its plucky protagonist, casualty and hero, roars a universal truth, ""We all hurt.

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