In an era of increasing medical costs, heated political debates over the nature of healthcare, and financial instability, reading about all things medical can be as unsettling as the most unpredictable of horror stories. There have been a host of acclaimed works of nonfiction dealing with their authors’ experiences with illnesses and the medical system in recent years, including Paul Kalanithi’s When Breath Becomes Air, Joshua Mohr’s Sirens, and Porochista Khakpour’s forthcoming Sick. But numerous recent works of fiction have also grappled with how people deal with the sudden onset of sickness, the calamitous effects of a sudden illness or injury, and the precipitousness of life with a chronic medical condition. These works can shine a light into imagined lives — and help us extrapolate how we might fare under similar conditions.
At the center of Don Lee’s novel Lonesome Lies Before Us is a musician named Yadin Park–a man in his forties with his roots in the alt-country scene and a penchant for offbeat side projects and forays into an array of genres. Being a cult musician hasn’t exactly brought him a life of financial stability, and as the novel opens, he’s been working for a carpeting company in an economically devastated California town. Early on, he has a moment where he savors the auditory landscape in a decidedly bittersweet way.
He listened to the crinkling of tinfoil, the rustling of plastic wrap. Wind waffled through the trees. Bird chirred. He relished the sounds. He knew that someday soon, their clarity would be denied to him forever.
Yadin’s condition is Ménière’s disease, which affects the inner ear and can cause permanent hearing loss. To an extent, his job is there to provide economic grounding–but it also allows him to maintain a kind of self-discipline, which in turn keeps his symptoms at bay. As with many aspects of this novel, Lee creates a decidedly lived-in world for Yadin, whether it’s the strict diet he maintains or the ersatz recording studio he’s assembled in the wake of personal bankruptcy in the hopes of recording one final album. All credit to Lee: this is a novel about a cult musician that renders the circa-2010s music industry in entirely plausible terms–meaning that, among other things, characters talk about the relative wisdom of crowdfunding.
The tenuousness of health is a recurring theme in the novel. Yadin’s brother died when they were both children, and his girlfriend Jeanette–the other major character in the novel–has lived a somewhat stagnant life, in part due to her mother’s death from cancer. For all that Yadin’s health troubles are at the center of the book, Lee doesn’t treat it as the only way in which these characters must grapple with illness. Yadin and Jeanette are as affected by the conditions that killed their loved ones as they are by any adversity that they themselves must deal with.
Lee likewise roots this novel in a particular moment in American history, where questions of what the government is responsible for is hotly discussed. Yadin’s struggles with debt, and his attempts to maintain the mortgage on the house he inherited, is one aspect of this. Another is the California town in the which the book is set, where voters have avoided raising taxes and are outsourcing an increasing amount of their local government. Which, Lee points out, ends up further disrupting the lives of residents whose livelihood depends on doing business with the fraying municipal government. In this novel, nothing happens in a vacuum; one’s own health and the health of one’s loved ones are interconnected, much as the economic fortunes of a place can heighten or decimate the lives of those who live there.
A Unitarian Universalist church is one of the central locations of Lee’s novel, and Yadin returns to the poetry of Gerard Manley Hopkins, attempting to parse out whether or not he’s in the midst of a proper religious conversion. Questions of faith and the body manifest themselves in Lee’s novel, and even more so in Jessie Chaffee’s Florence in Ecstasy, about a young American woman named Hannah who moves to the title city after complications from an eating disorder unravel her life in the United States.
As Hannah ponders the lives of the saints in whose paths she treads, the novel establishes parallels in the way that extreme reactions to the world–starvation, wounds, literal mortification–can be evidence of the divine for one person and a harrowing path to avoid for another. And, late in the novel, Hannah makes an explicit comparison between her disorder and the way that deities and demons possessed people centuries earlier.
Chaffee manages the difficult task of creating a narrator who’s up-front about certain aspects of her life but keeps others at a distance. Hannah isn’t unreliable per se–but, like all of us, she has memories that she savors and others she’d just as soon not revisit. At one point, Hannah describes the condition of being so immersed in one’s own difficulties that it’s difficult to have any perspective.
…when a person has slipped so far down that she can’t see anything beyond her own hands clawing to make it past the next immediate hurdle–getting up in the morning, having a conversation, breathing–each exhaustive victory too minute to be called progress.
The novel’s descriptions of life in Florence–touring historical sites, travel down the river, taking in an ACF Fiorentina game–are vividly rendered, and they make a sharp contrast with the visceral, sometimes literally nauseating passages dealing with Hannah’s eating disorder. It’s of a piece with the novel’s physicality: a subplot concerns Hannah joining a rowing club, and the physical exertion described in these sections serves an interesting contrast to Hannah’s more torturous relationship with her body described in flashbacks.
In the case of Gabe Habash’s Stephen Florida, the physical is almost all that the title character has. He’s an orphan, heading into his final year at college, where he wrestles competitively. By and large, that seems to be the main purpose of his life; when told that he “only care[s] about one thing,” his response is succinct: “That’s right. Caring about the one thing makes it what it is.”
In the novel’s first third, Stephen injures himself during a match, tearing his medial meniscus. “A time begins I’d rather skip over,” he says, by way of introducing this part of his life–which speaks volumes about Stephen’s state of mind. Introducing a character by way of their physicality, and then depriving them of that, is a revealing way to establish a character: Tracy O’Neill’s The Hopeful, John Lancaster’s Capital, and Chad Harbach’s The Art of Fielding both demonstrated how a sense of self rooted in athletics can be put into jeopardy when the threat of injury looms.
At one point, Stephen muses on a former teacher of his who “had part of her jaw removed for her mouth cancer and kept telling us she was cancer free, cancer free!” (She isn’t the only character dealing with cancer who’s alluded to in the novel; it’s a gut-wrenching recurring motif, of Stephen’s perceived immortality and the reminders of mortality all around him.) His reaction to his teacher’s surgery is especially telling, both about his approach to health and illness and regarding his worldview. “It must feel so good to get the bad part of your body cut out,” he muses. That that’s how he understands cancer surgery—or, really, any major surgery—is indicative of his approach to life, and the rude awakening that may well await him.
It isn’t just novels about the illnesses and health concerns of Americans that can be instructive for our current debate. Masande Ntshanga’s The Reactive, for instance, is set in South Africa around the rise of retroviral medication used to treat those infected with HIV. It’s a harrowing case study in what life with a chronic condition can do, and the psychological toll that it exacts on the novel’s narrator. Given that chronic illnesses can lead to depression, Ntshanga’s novel serves as a stark reminder of the psychological effects of physical afflictions–or, to be more accurate, the ways in which the two are intertwined.
There’s also the question of how one person’s illness can impact a larger community. A 2017 article on Business Insider opens with a sobering statistic: “Almost half of the money raised on crowdfunding sites like GoFundMe and YouCaring is going toward medical expenses.” Sometimes this can be due to gaps in insurance or high deductibles; at others, it can be to cover treatment or make up for lost income. A widely-circulated article by Anne Helen Petersen from last year explored this phenomenon–and noted that a compelling need for treatment didn’t always bring in a sufficient amount of money. “There’s a politics to who gets funded and who gets left behind, who collapses under the weight of the broken health care system and who’s temporarily buoyed,” Petersen wrote–and the article as a whole neatly summarizes how crowdfunding can and can’t fill the gaps in our medical system.
Still, the question of communities chipping in to help their members afford medical care is frequently cited by conservative opponents of the Affordable Care Act (and most left-of-center healthcare policy ideas). The beleaguered characters of Marie NDiaye’s 2007 novel My Heart Hemmed In (recently translated into English by Jordan Stump) face a variation of this: what happens if you’re feeling ill and the community around you utterly despises you?
NDiaye quickly establishes a surreal mood, plunging the reader into the lives of her central characters, a pair of middle-aged teachers named Nadia and Ange, with little explanation as to why they’re being shunned by their friends and neighbors. Soon, this shunning takes a horrific turn, as Ange is stricken by a wound on his stomach, which leads to a number of grisly, visceral descriptions.
A thick, dull-yellow liquid is oozing from the tattered tissue deep inside the wound. I think I smell a foul odor coming from the discharge, but surely the wound isn’t rotting already.
It’s never specifically said whether this is the result of an anonymous attack or if Ange’s body has simply turned on itself from the stress. Bodies do that frequently in My Heart Hemmed In: notably, Nadia is repeatedly asked by characters she encounters if she’s pregnant. While Nadia denies this, NDiaye has established enough of a sense of alienation in the novel that Nadia no longer seems entirely reliable, even regarding questions such as that.
To the extent that the stricken couple at the center of this novel is helped, it’s via their neighbor Noget, who frequently comes off as boorish, and seems to harbor his own agenda. Or perhaps that’s simply via Nadia’s perception of him, which is of a piece with the novel’s overall sense of alienation.
Then again, illness itself alienates ourselves from our bodies: it changes the way we interact with the world, alters how others view us, and can sometimes radically undermine our perceptions of everything around us. One could also argue that the flaws in healthcare systems add another level of alienation to the proceedings, putting us in a host of unwinnable positions. Is the most emblematic novel about the ongoing debate around American healthcare issues a French novel from 2007? It might just be—which is a chilling accomplishment in its own right. Someone in the future may well write a great novel of the early 21st century’s debates and tragedies surrounding healthcare; for those of us living through these times, that’s not much comfort.
Image source: Sobotta’s Atlas and Text-book of Human Anatomy 1909