Q and A with Louise Aronson, A HISTORY OF THE PRESENT ILLNESS
1. Tell us a little about your book.
With A History of the Present Illness I wanted to take readers into the real lives of real and often overlooked people - all of whom might be described as either patients as doctors, among many other mostly more important characteristics - in the hugely varied neighborhoods, hospitals, and nursing homes of San Francisco. Among the stories are: the elderly Chinese immigrant who must sacrifice his demented wife's well–being to his Americanized son's authority, the busy Latina physician whose eldest daughter's need for more attention has disastrous consequences, the psychiatrist who advocates for the underserved but may herself be crazy, the gay doctor who learns very different lessons about family from his life and his work, and the young veteran whose injuries become a metaphor for the rest of his life. I wanted to show the humanity of many different sorts of people, to be honest about life and medicine, to make people laugh and cry. I also wanted to explore the role of stories in medicine and offer a portrait of health and illness in American today that was different from what was already out there, and completely honest.
2. You write with extraordinary sympathy about so many different people - the elderly and the very young, immigrant families from all over the world, young medical students, experienced physicians. I'm guessing that as a practicing MD, you have treated people who might or might not resemble your characters. How do you immerse yourself in these different perspectives and voices?
I write about all the different sorts of people I have met as a medical student, resident and practicing doctor, though my characters are never representations of those people. The characters often start because of a real person or event but then they take on a life of their own informed by all the other people I’ve met and by what’s going on in the story. It is a total privilege to have had such intimate access to so many different people’s lives; it’s one of the most incredible and wonderful things about being a doctor, at least for me. I wanted to capture that and use it to tell true stories through fiction.
3. I love the postmodern elements in some of our stories, e.g. "Blurred Boundary Disorder," which is structured as a letter written to the doctors charged with updating The Diagnostic and Statistical Manual of Mental Disorders, and includes lengthy footnotes. I suspect others have asked you this - were you inspired by David Foster Wallace's frequent use of footnotes? Or maybe by medical texts you've encountered?
I love postmodern writing and metafiction. David Foster Wallace definitely was one indirect inspiration for this, as were early footnoted stories by Rick Moody and Aleksandar Hemon. In Blurred Boundary Disorder, the story really exists in the footnotes. Since everything else is flipped on its head in this story, that structure made sense to me too. Usually footnotes are secondary and what’s above them is primary. Here the letter and the invented diagnostic criteria in the letter describe the condition the narrator of the footnote story clearly has. It’s also a play on how people with mental illness and other marginalizing conditions are so often treated like footnotes in society, even as they tell us so much about ourselves and our values.
4. What books did you find yourself thinking about most often as you wrote A History of the Present Illness?
The most influential book for me was Tim O’Brien’s The Things They Carried. If I were sufficiently talented, I would have liked my book to be for medicine what his is for war. I love the way he plays, overtly and covertly, with truth and fiction. I also appreciate how he contrasts the ugliness of war and the beauty and fragility of human resilience and does so showing but not judging multiple perspectives even as he strongly advocates for his own.
Of course, many other books influenced me too, each in different ways: Amy Hemple’s spare, smart prose; Alice Munro’s revelation of entire lives in 30 pages; Hemingway’s recurrent themes in In Our Time, the way stories and place were linked in Winesburg, Ohio and Dubliners; Michael Ondaatje’s gorgeous sentences. I could go on and on!
5. In addition to being a writer, you see patients, teach medical students, and oversee various health-related organizations; when and where do you find time to write?
I do juggle a lot of things but so does almost everyone I know. So how did I manage? I wrote a lot in the very early morning, and on weekends, and I used vacation time to go on writers residencies. When I started taking writing classes at the University of California extension school, a lot of my classmates would say they were in the class because they wanted to write but never did. I wondered how badly they really wanted to write and whether maybe they wanted to have written something instead. There have been times when I could relate to that, when writing has been agony, but it’s also one of the activities in life that I find most interesting and fulfilling. I can’t not do it and I’m willing to make sacrifices of sleep and time with friends and family to get it done. Oh, and I should probably admit that this isn’t a perfect system. It took me a decade to write the book. Part of that was because I was learning how to write (some stories had over 20 drafts over 8 or more years….) but part was because I do have a busy career and a person life and I can’t always get up at 4:30 AM.
6. If you don't mind telling us, what are you working on now?
I was lucky enough to get a two book deal and my publisher wanted creative non-fiction for the second book. I very much want to write a novel but having watched many friends write first novels, I’m not sure I can do it while doing my current job, and although I’d like to spend more time writing, I have a terrific job. My second book is about aging and the challenge is to come at the topic in a new way. This won’t be a textbook or how-to manual or a memoir/lament or some utopian treatise on how eating enough blueberries and kale can spare you from old age. I’m hoping it will be fun to read, full of characters people enjoy spending time with and good sentences and interesting takes on topics that matter but haven’t always been much fun to think about. I don’t know if I can manage all that but I figure it’s more likely to happen if I try!