by Monique Williams, former Assistant Fiction Editor
Fourteen Hills catches up with physician and writer, Louise Aronson, whose short story, “(F is for) Fragments, Fires and Flat Lines” was published in Fourteen Hills 19.1.
Fourteen Hills: Congratulations! You have a book coming out January 2013, A History of the Present Illness. How long have you been working on this book and how was the process of creating a book different for you?
Louise Aronson: I partly live in fear of that question! The book took a long time – a decade, more or less. Of course, I didn’t know I was writing the book for several years. I started writing in the very late 1990s and thought I might write a mystery series that included some geriatrics. As I took courses (at UC Extension and with Tom Jenks and
Carol Edgarian who later founded Narrative Magazine) I realized I wanted to be able to write well and maybe wanted to write something more literary.
In 2001 I started the Warren Wilson Program for Writers and five years later, I had an MFA. I had to do the work intermittently since an MFA requires lots of reading and writing and so does medicine. Basically, I alternated focus so I could keep up to date as a doctor. When I started the MFA, I thought I would write a multigenerational novel about a Cambodian-American refugee family. As it turned out, I was one of the weakest of the fiction students at Warren Wilson, and it made more sense to write short stories since they allowed me to develop different sorts of skills as a writer. Because I spend so much time as a doctor, that material inevitably crept in. And people really liked it. So eventually I came to be writing stories about doctors or patients or both.
In late 2006, when I thought I was almost done, I took a job as an academic physician at UCSF – the exclusively health sciences campus of the University of California. That turned out to be a great job but very time consuming. Ironically, the less time I had to write, the better the stories became. It was almost as if, since I often hadn’t looked at them for months and months, I could edit my own stories in that ruthless way one can edit others, and that made them so much better. Suddenly, I could see where they needed to go more easily than I could recall whatever my initial motivation had been. So to my surprise – over nearly 5 more years! – the stories got much better until one day, in my fantastic cabin during a writer’s residency at Hedgebrook, I realized I had a book.
FH: You obtained a medical degree from Harvard University and later decided to earn an MFA in fiction writing. What drove you towards each of these professions? Are they very different worlds to you that meet when you create a story or are they similar in ways that most people don’t recognize?
Aronson: When my high school college counselor gave me a list of colleges, I crossed off all the schools that had math or science requirements. I had no intention of becoming a doctor! If anything, I wanted to become a writer, though I didn’t have much confidence and had already moved from creative writing more toward the social sciences in high school.
When I got to Brown, there were very confident students from New York prep schools who dressed all in black, smoked cigarettes, and were sure that Brown’s best known writers at the time, Angela Carter and John Hawkes, were just dying to read their work. So I focused on history and anthropology, two fields that are also about stories and people and culture, the things that interest me most, although they take different approaches to those topics than most writers do. As part of my anthropology studies, I began working with Southeast Asian refugees, first in Providence, then after graduation in a refugee camp on the Thai-Cambodian border. Those experiences were what made me a doctor. Anthropology seemed too theoretical and not helpful enough. People had been through unbelievable traumas and they felt comfortable seeing a doctor but not a psychologist, and I watched lots of very smart and capable women, all social workers or nurses, have to take orders from doctors who knew far less.
So I went to medical school because I wanted skills that would help people, and also enough power that I didn’t have to be subservient to someone just because of our genders or roles in the health system. And once I finished my medical, I came back to writing because I wanted to find the “me” that had been squelched by the [. . .] cult-induction-like process that is medical training, and because every day I heard and witnessed the most incredible stories. The last story in the collection addresses this fairly directly; it’s fiction again, but of all the stories, it most closely speaks to some of my thoughts and experiences as a doctor who became a writer as well.
FH: I imagine that caring for the ill is stressful and sometimes emotionally draining. How does writing about illness help you process your emotional experiences? Or is it also draining?
Aronson: Caring for the ill is stressful and this is a topic I cover in many ways in the book since I think how doctors and other health care providers do or don’t deal with that stress is key to the care their patients receive, their relationship with those patients, and their own health. The stress isn’t singular – for me, it has three key parts, though there are many other contributors: wanting very badly to provide the best care possible in situations most of which don’t have one or even several obvious right approaches or answers; juggling all the responsibilities and competing tasks of medical practice (and life); and coping with the sadness of watching someone I care about struggle, suffer, and sometimes die.
I’m not sure writing helps with any of these in the moment or “acutely,” as we say in medicine. But over the long haul – chronically – it definitely helps me a lot to process my feelings and to pay tribute to the incredible people I’ve been fortunate enough to care for and work with. That sounds sort of sappy but it’s true. I look at certain stories or anecdotes within stories and I think of various people, and it means something to me at least that they aren’t forgotten and that others will have a chance to see and hopefully learn from all they went through.
FH: Are there contemporary issues that your book is commenting on about illness and if so what are they?
Aronson: I hope the book comments on many contemporary issues, in society and in medicine, directly and indirectly. It’s fiction and should transport readers the way fiction does but it is very much based in the world and so – I hope – offers perspective and commentaries on life, being a patient, being a doctor, and health care in America today. Some of the key issues are the ways in which we meld and don’t as a multicultural society; the ways people cope or don’t cope with illness; how we age and die and do or don’t help people to age and die [well];, the experience of caregiving either professionally or personally; how class still very much impacts where people live and what their options are or are not; and the remarkable courage and fortitude of people in the face of all kinds of challenges.
FH: The piece Fourteen Hills published, “(F is for) Fragments, Fires and Flat Lines,” used an experimental form. The piece “After,” which received the New Millenium Writings award, was written in the traditional narrative form. How do you choose your form?
Aronson: I think the form has to serve the story. It should reflect the character’s state of mind or someone’s experience of the main issue in the story – the character’s, the reader’s, the average person’s.
In “After” the character is stuck, so a traditional narrative made sense; he is there and we are too, with him. In “(F is for) Fragments, Fires and Flat Lines,” all the characters are having a traumatic experience, each in a different way, and what tends to happen with trauma is that some things stand out vividly and indelibly and others are lost. Life takes on a staccato character, and I wanted the experience of reading the story to mimic that and also for the reader to be able to see all the different perspectives, the narrator-doctor’s, the boy’s, his father’s, his aunt’s, the narrator’s wife’s, even the critically ill Vivian’s.
Though most of the stories in [my] book [A History of the Present Illness] are traditional narratives, there are a handful that use different borrowed forms – a numbered list, a diagnostic manual entry, a series of photographs – and each one does so for a particular reason related to that story and the particular form. We make lists so we don’t forget things and so we get them right. We create diagnoses to recognize that a certain set of symptoms or signs is clustering in people who otherwise have nothing in common, and that those signs and symptoms matter. We see only snapshots of certain sort of people, even when the reality of their lives, like the reality of ours, is in fact a film, not a series of still shots.
FH: What do you hope people walk away with when they read your writing?
Aronson: I hope they feel that the work took them places they hadn’t been before. I hope it gives them greater empathy for others. I hope it gives them new insights into the health care system and the struggles of patients, caregivers, and doctors. I hope they think some of the sentences are beautiful or powerful or original, or all three. I hope they remember the characters while they are jogging or on the bus or walking their dogs. I hope they are upset in a way that motivates them to think about what matters to them and those they love in life and in death. I hope they think they read some good stories and a good book.
FH: Do you stray from writing about illness, and if so what are your other interests?
Aronson: That is the question of the moment! I have lots of ideas and lots of beginnings and pieces of other works. I still want to write my multi-generational Cambodian-American refugee novel. I also want to write something more specifically related to geriatrics, though I’m not entirely sure whether that will be creative non-fiction or more fiction. I have some wild ideas for novels, only one of which is medical in focus in a bizarre, reality-TV sort of way. I’m honestly a bit nervous to tackle a novel given the constraints of my day job. Several of my closest writing friends have worked for a decade or longer on their first novels. I don’t want my second book to take a decade. I want to write several more books. I also realize I’m being vague, and I apologize. I think it’s in part because the ideas are early and I don’t want to put them out into the world yet and in part because I feel superstitious about committing so soon, as if telling you will curse the idea, which is absurd, though – and this may surprise you – very doctorly: we have lots of rituals and superstitions in medicine, even as we pretend to be entirely rational and evidence-based.
So, yes, I have many interests, and I have a two-book deal with my fantastic publisher, Bloomsbury. So soon, I hope, I’ll have a far better answer to this very reasonable question!