The Little Burst

Today's lengthy selections are devoted to a scene taken from the short story, "A Little Burst," included in Elizabeth Strout's Pulitzer Prize winning collection of stories, Olive Kitteridge.   The stories focus on the life of a retired schoolteacher in coastal Maine.  A 21st century counterpart  to Sarah Orne Jewett's late nineteenth century stories about the changes of the once familiar coastal communities of Maine in the aftermath of the Civil War, Strout's collection documents change, loss,  and disappointment as well as life's unexpected tendernesses.  Much like Jewett's unconventional heroine from The Country of the Pointed Firs, Mrs. Todd, Strout's own heroine looms large, literally and physically.  She is a formidable and yet comforting presence in the collection, which is told not only from her perspective, but from those whose lives are entwined with hers.   In the best of the regionalist tradition, we grasp the importance of perspective from the collection's own shifting viewpoints, which position Olive at center-stage as well as on the periphery.  (This aspect of the collection reminds me a bit of Jewett's Strangers and Wayfarers).  In this story, Olive introduces a theory about life that she describes as  "big bursts" and "little bursts":

 Big bursts are things like marriage or children, intimacies that keep you afloat, but these big bursts hold dangerous, unseen currents.   Which is why you need the little bursts as well: a friendly clerk at Bradlee's, let's say, or the waitress at Dunkin' Donuts who knows how you like your coffee. Tricky business, really.

Yet this wholesome definition of the "little burst" is soon revised when Olive is at her son's wedding and she overhears her new daughter-in-law (the perfectionist therapist, "Dr. Suzanne Bernstein, MD PhD")  making fun of her flowered dress and critiquing her parenting of Christopher.   Crushed, she retreats to the couple's bedroom. Snooping in the closet and drawers, she is further humiliated by Sue's petite clothing, which only reminds her of her own large physique. Soon, however, she discovers a way of diminishing Dr. Sue: 

Olive slides open the top drawer of the bureau.  Once a place for a boy's sock and T-shirts, the drawer is now filled with her daughter-in-law's underwear---tumbled together, slippery, lacy, colorful things.  Olive tugs on a strap and out comes a shiny pale blue bra, small-cupped and delicate.  She turns it slowly in her thick hand, then balls it up and pokes it down into her roomy handbag. 

Then, she marks a sweater: 

The beige sweater is thick, and this is good, because it means the girl won't wear it until fall.  Olive unfolds it quickly and smears a black line of Magic Marker down one arm.  Then she holds the marker in her mouth and refolds the sweater hurriedly, folding it again, and even again, to get it as neat as it was at first.

And finally she steals just one shoe, satisfied that in introducing chaos into her daughter-in-law's life, that she will subject her to the common denominator of self-doubt:   

It does not help much, but it does help some, to know that at least there will be moments now when Suzanne will doubt herself.  Calling out, "Christopher, are you sure you haven't seen my shoe?  Looking through the laundry, her underwear drawer, some anxiety will flutter through her.  "I must be losing my mind, I can't keep track of anything....And my God, what happened to my sweater?"   And she would never know, would she?  Because who would mark a sweater, steal a bra, take one shoe?

The story ends with a sharp revision of the earlier notion of a "little burst." As it turns out, life's little lifts are not simply a matter of human kindness, but are equally produced by our  less magnaminous acts--our attempts to correct and compensate, even devilishly, for life's injustices:

 As a matter of fact, there is no reason, if Dr. Sue is going to live near Olive, that Olive can't occasionally take a little of this, a little of that---just to keep the self-doubt alive.  Give herself a little burst.  Because Christopher doesn't need to be living with a woman who thinks she knows everything.  Nobody knows everything--they shouldn't think they do."

---Elizabeth Strout, Olive Kitteridge (2008)

Damn straight.

Hands and Feet

   "Mentally, it is tough cutting into the foot because I know how sensitive my own feet are.  Cutting into any part of my body could hurt, but there is something about the feet (as there was about the hands) that makes me squirm at every poke." 


---Marcus 


   "Today we did the hand.  Now I am on the crosstown bus back to the West Side, and I can't stop looking at people's hands.  I feel like tapping someone on the shoulder and saying, 'I know what it looks like inside there---it's beautiful!'
     What incredible organization:  it's simple and complex at the same time.   I strum the back of my seat with my fingers and try to visualize all that is going on inside, like which muscle groups are involved, which nerves, and the order of their electrical commands. I think of my son and how small his hands are and how everything is there functioning, but in miniature.  It's miraculous.  And then I remember backing into our cadaver's rigid left hand, splayed open, palm-side up at the end of his outstretched yellow arm."


---Michael

Journal entries from first year medical students in Gross Anatomy class.  Excerpted from
Anatomy of Anatomy: in images and words (2000)  by Meryl Levin

Wine of Christ

"We'll see how the surgery and histology go.  Then we'll start with chemo the week following.  A little light chemo:  vincristine and----"

"Vincristine?" interrupts the Mother.  "Wine of Christ?"

"The names are strange, I know.  The other one we use is actinomycin-D. Sometimes called 'dactinomycin.'  People move the D around to the front."

"They move the D around to the front," repeats the Mother.

"Yup!" the Oncologist says.  "I don't know why--they just do!"

"Christ didn't survive his wine," says the Husband. 

"But of course he did," says the Oncologist, and nods toward the Baby, who has now found a cupboard full of hospital linens and bandages and is yanking them all out onto the floor.  "I'll see you guys tomorrow, after the surgery."  And with that, the Oncologist leaves.

"Or rather, Christ was his wine," mumbles the Husband.  Everything he knows about the New Testament, he has gleaned from the sound track of Godspell.  "His blood was the wine. What a great beverage idea."

"A little light chemo.  Don't you like that one?"  says the Mother.  "Eine kleine dactinomycin.  I'd like to see Mozart write that one up for a big wad o'cash."

---Lorrie Moore, "People Like That Are the Only People Here: Canonical Babbling in Peed Onk" in Birds of America (1998)

Moore's story originally ran in The New Yorker; while there are many passages that more adequately capture the subject matter, tone, and unique style of this piece, oddly enough, this is one that I recall from my initial reading of the piece in the magazine over a decade ago.  Moore's depiction of the typical Oncologist as part mathematician, part "mad, overcaffienated scientist" is exemplified through this dialogue in which the doctor's superficial and somewhat lighthearted description ("Yup!") of the chemotherapeutic agents stands in stark contrast to the desperation, confusion, and enervation of parents in the pediatric oncology ward.

The story is told through the perspective of "The Mother," a writer whose point of view shifts precariously between the darkly comedic and the abject.  Her eighteen month old son has been diagnosed with Wilms' tumor, a kidney cancer, and the reader follows her on her dizzying journey into the pediatric oncology ward and the experiences of parents who endure the ineffable.  The narrator's stream of consciousness disorients and then reorients the reader, revealing that what seems as surreal as a nightmare is actually a reality.

The next entry will also come from this piece. 

A Worn-Out Baseball

"When my father's father died in the French Quarter of New Orleans sixty years ago, the popularly accepted story was that on a humid night in mid-August, he had eaten a dozen bananas and then taken a cold bath.  He was a man of eighty-seven whose life had been a strenuous assertion of his appetites, and this explanation suited him, just as it suited his friends in the French Quarter.  It would be more satisfying to me, it would allow me to feel that I owned my illness, if my urologist were to say: 'You know, you've beat the hell out of this prostate of yours.  It looks like a worn-out baseball.'  Nobody wants an anonymous illness.  I'd much rather think that I brought it on myself than that it was a mere accident of nature." 

---Anatole Broyard, "Doctor, Talk to Me"

Today's selection is taken from On Doctoring: Stories, Poems, Essays edited by Richard Reynolds, MD and John Stone, MD (with Lois LaCivita Nixon PhD, M.P.H. and Delese Wear, PhD). This book is given to all first year medical students in the United States and includes literary works (plays, poems, short stories, excerpts) by dozens of well-known authors on the subject of doctoring and what it entails.  Some of these authors, such as the American modernist poet, William Carlos Williams, were doctors themselves and share their unique insights into the doctor-patient relationship.

Broyard is both wise and humorous in acknowledging the importance of fitting the diagnosis to the patient's needs and personality.  This does not entail misconstruing the illness, but rather shaping the narrative of that illness so that it is consistent with the life of the suffering subject. This is not a small distinction.  In the case of Broyard's grandfather who over-indulged, the tale of  the bananas and cold baths that brought him to his death is wildly improbable, yet nonetheless "fits" the character of the man.  His death, far from happening to him,  is cast simply as the natural culmination of a life lived at a high pitch.   

In the similar case of Broyard himself, it is clear that he desires agency.  He does not want the doctor's reassurance that his prostate cancer is not his fault, a mere chance or accidental happening. Rather, he wants to know that his prostate was expended--hilariously "beat" (got to love that verb choice) through over-use. As Broyard concludes, "If only the patient could be allowed to see his illness as not so much a failure of his body as a natural consumption of it."  

Facing It Part II: Putting on a New Face

Today's quote comes from a New York Times article on the first U.S. face transplant that took place in December 2008 at the Cleveland Clinic. The exact date of the 23 hour surgery, the identity of the recipient and the donor, and the cause of the woman's facial injuries are not identified in this article.  However, it does offer surgeon Maria Sieminonow's matter-of-fact insight on the value of a face,  generally speaking:

"'You need a face to face the world.'"

Sieminonow's commentary seems almost too direct and too reductive when compared to the nuanced and elegant treatment of facial trauma as expressed in Lucy Grealy's account, which I wrote about in my last entry.  Nevertheless, her commentary proves interesting in that it suggests a gap between the identity of an individual and his/her face. So significant are the injuries of face transplant patients that a passable face--even one that bears little resemblance to the original face of the patient--is a prerequisite for "facing" others.    You need a face. The cadaveric face--a permanent mask of sorts-- is a prop for negotiating the world.

--Lawrence K. Altman, "First U.S. Face Transplant Described," New York Times, December 17, 2008