Skip to main content

“A History of the Present Illness”, a New Book by Dr. Louise Aronson

It’s here, it’s here!

Dr. Louise Aronson, a geriatrician here in our division at UCSF, just released her book A History of thePresent Illness last week. It is a series of short stories, many connected by characters like a small gleaming thread through the text. They feature all manner of people—patients, physicians, mothers, children, writers, dog walkers—living their lives in the pocketed landscape of San Francisco. As the title might suggest, illness touches everyone, but the stories are far from uniform or predictable. And lucky us, we could absorb some of the behind the scenes magic when Dr. Aronson read this week from her work at a small event we held in her honor.

Now that it’s in our hands, the pre-release buzz in the air has turned into effusiveness about the communal verdict: it’s stunning. It’s what you hope a book will be: engaging in a can’t-put-it-down way, an effortless read with natural breaks (hey, we’re busy doctors), deeply affecting, and thought-provoking with no easy answers. It draws you in at the first line, which was much commented on at the reading : “She lies in bed the way a letter lies in an envelope”, depicting an older woman in the end stages of dementia.

For me, there were some joys which may not be universal-- the small thrill of recognizing hospitals, clinics, and parks as these characters lives their lives in my current city; the over-identification with a woman going through medical school training, another through residency (I’m only 2 years into fellowship).

But as specific as some of these scenes—to doctors or doctors-in-training, to San Franciscans—I can’t overstate that A History of the Present Illness is also remarkably universal. These stories, all fiction, go deep into the most personal experiences and stories of these lives, and doctors are not the majority. By doing so, they become the most universal of tales about how illness can be complex for everyone involved. Many people asked Dr. Aronson about how she was able to write such raw and intricate characters, often in dark circumstances: a doctor in jail accused of killing a patient, a young girl from an immigrant family navigating a bed-wetting problem on her own, a woman who left medicine years before having to respond to a fatally injured boy in the street. These stories become general because the depiction is honest and the emotions and reactions believable. After reading them you understand what she means when she describes her stories as “fiction, but true”.

She also has a way with uncertainty (go geriatrics!). She assured us that she always focuses on writing a good story, but providing tidy answers is not her style. Life is messy and ambiguity the norm, so her stories reflect this. She said life is not about knowing the answers; “it’s about asking the right questions.”

A History of the Present Illness is a wonderful collection of stories that makes the medical world accessible and its heartbreaks deeply felt. It rewards you now with the joy of reading good stories and for the longer term with vivid images and vexing questions that will stay with you.

by: Anna Chodos


Helen Chen,MD said…
To steal from Aristotle: if poetry is the skillful telling of lies, then fiction is the telling of truth framed as lies and this book has much truth in it. While not an easy read, Louise's voice evokes a depth and complex authenticity that reaches all of us whether clinicians, patients, or both. And for those of us who trained in San Francisco, we will find much that resonates, is heartbreaking, and ultimately TRUE.

Popular posts from this blog

Dying without Dialysis

There is a terrific article in this weeks Journal of Pain and Symptom Management by Fliss Murtagh of King's College in London about the epidemiology of symptoms for patients with advanced renal failure who die without dialysis.  This study is important because while we know that patients with advanced renal failure have a limited life expectancy and the average age of initiation of hemodialysis is increasing, we know little about the alternatives to hemodialysis.  Specifically, we know nothing about symptoms affecting quality of life among patients who elect not to start dialysis (so called "conservative management" - is this the best label?).  This article provides a terrific counterpoint to the article in last years NEJM showing that nursing home residents who initiated hemodialysis tended to die and decline in function (see GeriPal write up here). 

The study authors followed patients with the most advanced form of chronic kidney disease (the new name for renal failu…

Language Matters: Podcast with Brian Block and Anna DeForest

One of our first GeriPal posts was titled "Rant on Terminology," by Patrice Villars, NP.  In the spirit of looking back over our first 10 years, here is the opening paragraph to that post:

News Headlines read: Sen. Edward Kennedy loses battle with cancer. Really, he lost? I thought he died from a malignant brain tumor, an “aggressive” brain tumor. The median survival is less than a year for people for his particular tumor. Kennedy was diagnosed in May of 2008. He lived over 15 months after diagnosis. What a loser. He must not have fought hard enough. Huh? I thought he spent most of his life battling for social and health care reform in America. In this week's GeriPal podcast we take a deeper dive into this issue of language and medicine.  We are joined by guests Anna DeForest, MD, MFA, a resident in Neurology at Yale, and Brian Block, MD, a pulmonary critical care fellow at UCSF.  

Anna recently published a paper in the NEJM describing her reaction to hearing terms like, &…

The Dangers of Fleet Enemas

The dangers of oral sodium phosphate preparations are fairly well known in the medical community. In 2006 the FDA issued it’s first warning that patients taking oral sodium phosphate preparations are at risk for potential for acute kidney injury. Two years later, over-the-counter preparations of these drugs were voluntarily withdrawn by the manufacturers.  Those agents still available by prescription were given black box warnings mainly due to acute phosphate nephropathy that can result in renal failure, especially in older adults. Despite all this talk of oral preparations, little was mentioned about a sodium phosphate preparation that is still available over-the-counter – the Fleet enema.

Why Oral Sodium Phosphate Preparations Are Dangerous 

Before we go into the risks of Fleet enemas, lets spend just a couple sentences on why oral sodium phosphate preparations carry significant risks. First, oral sodium phosphate preparations can cause significant fluid shifts within the colon …