Author Anna DeForest is both a writer and a physician, having received a master's degree in fiction writing, as well as a medical degree. These ventures are in such sharp contrast, but come together nicely in her debut novel, A History of Present Illness, which follows the, frankly, random musings and observations of a resident as she learns the world of medicine. In a NPR interview, DeForest stated that she wanted to focus her novel on what it means to suffer and attend to suffering. We definitely get a lot of that in this tale told through the eyes of a young medical student who is suffering from her own unsettling past.

A History of Present Illness will not be for everyone, but it will resound with some. Just as DeForest has shared that before going into medicine, she had a preoccupation with the frailty of the human body, and that she overcame her fear of death by confronting it head on by studying medicine, I too find myself often thinking about what it means to live and die. This book served as a catharsis of sorts, allowing me to experience life and death through the eyes of those who face it every day through their occupation. This novel was very uncomfortable for me at times, but also awoke my mind to the realities of what it means to be alive and dead.

This book is a disjointed read, jumping from here to there without any real plot or purpose, aside from sharing the experiences of a young doctor in training. We follow our unnamed narrator along as she dissects cadavers, assists on C-sections, and provides end-of-life care. A History of Present Illness isn't pleasant, but it is raw, honest, and unflinching ... and very much real.

"To get over what you’ve come from but to stay who you are – what would that even look like?"
I would not recommend this to everyone. It was bleak and intense and shockingly graphic at parts, but it felt human in the ways the other books about sad people going about their daily lives don't ever seem to reach.
I don't have any medical training but I still enjoyed it.
Dark and existential, like life. Concise and complex. Worth the investment of those who are curious.

Thanks #netgalley for this book in exchange for an honest review. I tried this but it was really boring to me. Don't recommend.

I have to say, I did not know what to expect with this book. I was really interested in it because I have a degree in a healthcare related field, love medical drama books, love medical non-fiction books, shows, etc. So, I thought this would be right up my alley.

However, it was just so.. empty. I understand the detached, namelessness was intentional but it was so cold and distant that it felt unpleasant to read. Not in a "wow this is opening my eyes and I'm sitting with my discomfort" way, but in a "why am I reading this still when there are so many other medical based books I could be diving into?".

The title drew me in because of the tie to H&P's that are the base of every procedure, appointment, and interaction with a physician care team. What was inside the cover, was closer resembling pure icy dread. Each page felt more like a bitter papercut than the 'biting prose' that was dangled in front of us. There are some stories that work with anonymous(ish) narrators, but they are not common and this was certainly not one of them (to me). I felt that even just slightly more depth to the narrator could've added a pathway to connection to the traumas and experiences.

It pains me to leave such a low rating for story I thought would be a homerun for me, and I do not think this is so much a reflection of the author's ability to write as the marketing prepping us for a different experience than is within the pages of the book.

I would read more by the author in the future, despite this particular book being a miss for me. It is clear Anna DeForest has talent and an intricate mind, I hope that she continues to write, and I will continue to give it a try.

Published by Little, Brown and Company on August 16, 2022

A History of Present Illness is sort of an Inside Baseball of medicine as practiced in hospitals. The narrator is a medical student. Much of the novel is bleak, from references to unfortunate moments in medical science (the Tuskegee experiment; inducing terror in children to study its effects) to descriptions of patients who suffer from physical and mental illnesses doctors can’t cure and who, perhaps for that reason, the doctors don’t care about.

Each chapter heading — “Modified Drama,” “Withdrawal of Care” — suggests a short story, but the chapters are linked by a patient named Ada. The novel has no clearly identifiable plot unless the random thoughts and anxieties of a medical student as she learns about anatomy and patient care in a hospital constitute a plot.

Toward the story’s end, the narrator shares her biographical details. Her life has been messy, complete with victimization by at least one of her stepfathers, self-mutilation, and a 72-hour mental health hold. At least the narrator managed to avoid the fate of a sister who was shipped to an evangelical camp in the South to have the devil beaten out of her.

In the present, the narrator has no time for romance or sex, although it seems unlikely that she would have success in those endeavors even if she were not busy with medical school. She appears to be learning about love voyeuristically, soaking up the experiences of others as she wonders whether they would be a good fit if she tried them on. She wonders about doctors who are emotionally detached from their patients (as doctors must be to make sound professional judgments). Perhaps her own empathy renders her unfit for the profession. Perhaps it is her questionable mental health that renders her unfit. Or maybe she’ll be a good doctor one day. Who knows?

Putting aside biographical detail, all that remains is a series of observations about what the narrator has learned or seen or done as a medical student. She wants to die screaming rather than being the silent victim of a heart attack, a preference that seems a bit dramatic. She wonders about students who view medicine as a vehicle to a large income rather than a calling. She tells the reader that she wants to understand suffering, although her personal experience should give her a bank of relevant experience to draw upon. She feels jealous of students and patients who can take comfort from religion, although she appreciates the solitude of the hospital chapel. She ends the novel with advice she was given: “Don’t worry about your weaknesses. Just take your strengths and play them to death.” Seems like good advice for poker. I'm not sure how well it translates to living.

The narrator keeps the reader apprised of Ada’s condition (a disease causes dementia before it renders her comatose). The most powerful scenes follow the narrator’s interaction with Ada’s husband when Ada (after a gruesome procedure from which her husband is spared) is finally declared dead and removed from her ventilator. The bureaucratic, mistake-ridden process of making Ada officially dead confirms the narrator’s observation that nobody in the hospital dies until a doctor allows it. Ada wrestles with the degree to which she should be honest with Ada's husband. That struggle creates more sympathy for Ada than her vague and detached description of her childhood.

Apart from the scenes surrounding Ada's death, Anna DeForest gives us a volume of smooth prose and some interesting medical trivial but never captures the reader's imagination. The autobiographical details seem self-indulgent. Some of book is a bit dull. But other parts of the book have merit, earning a very guarded recommendation.

RECOMMENDED WITH RESERVATIONS

Reading this book felt like it was being written by an unfeeling alien robot observing what it is like in med school and this person has absolutely NO business whatsoever being a doctor. The structure of the book makes little sense and feels like it was cobbled together from different bits of paper, like "oh by the way I should add this part here" even if it disrupts the flow of the book. Plus this is classified as a "novel" in the back but it doesn't read like that.

You know those jokey memes where they have a robot write a movie? This feels like that. The book actually gave me a headache. Don't waste your time or money

FIRST SENTENCE: "All this happened, more or less."

Intending to read the first sentence or two, instead I continued on to the end. I'm still not sure what to make of Anna DeForest's first novel "A History of Present Illness". Who is the audience for this literate book composed of short, well-crafted sentences that reads like a memoir?

Someone suggested that only those involved in medicine would appreciate such a book, but my fascination was with how my life has changed since I was swept up in that world as a patient. Now I have the other side of the story. Now I have some insight.

Following an unnamed narrator through her first year as a medical student, her random thoughts are like listening to a friend tell you what defines life. The humor is macabre and subtle. I'm thinking I will need to read this again if only to revisit the many sections I highlighted. There is so much to think about, so much to absorb.

DISCLAIMER: I received a free e-copy of "A History of Present Illness" by Anna DeForest from NetGalley/Little, Brown & Company for my honest review.

This book is fiction but reads like a memoir by a doctor. I found it very interesting, even if it did jump around a bit.

𝙄 𝙬𝙖𝙨 𝙧𝙖𝙞𝙨𝙚𝙙 𝙬𝙞𝙩𝙝 𝙖 𝙧𝙚𝙫𝙚𝙧𝙚𝙣𝙘𝙚 𝙛𝙤𝙧 𝙘𝙖𝙩𝙖𝙨𝙩𝙧𝙤𝙥𝙝𝙚.

Doctors are people too, even if many patients are intimidated by the white coat, and the fact they often hold our lives in their hands; a gift and heavy burden, I imagine. The story begins with a student doctor telling the reader she has ‘seen a beating heart in a wide-open chest‘, she has studied a cadaver, exposed the spine and cracked the vertebrae, and of course she has feelings for the body, and thinks about where they come from, these donations for science that weren’t all happy stories. This isn’t the most depressing part of the journey; a hospital is full of sad stories. It is a world of catastrophes, illness, disease, violence, aging, mental decline, holding therapies gone wrong and aren’t doctors the pillars, meant to lift us out of our suffering, keep our minds and bodies well? They aren’t supposed to be emotional, and yet, not all can hack it. Interesting word, hack. Death is always lurking; it is relief and horror both.

Sometimes, they laugh at patients behind their backs, it it cruelty or simply one way to react in the face of hopeless cases, those who will never change to save themselves? How, she wonders, are the doctors meant to manage their terror, facing death day in and day out caring for the ill and infirm? Harder to confront, the poverty, the lack of means and proper care for those who are poor, disabled or people of color, the injustice of how much value is placed on certain lives. Then, the ugly truth of how often the mentally ill are easily manipulated into volunteering to be tested on. Our young student doctor is stunned to learn about how to take a history of psych patients and what to ignore, history that seems vital to helping them. This is not a happy book, it is raw honesty, and it can be disheartening considering these characters and their suffering, characters that resemble us, our family and friends. Language barriers, there is a point in the book where the narrator informs us that it can cost a patient their life or lead to a debilitating outcome. With a grandmother whose English wasn’t very strong, I witnessed how much the medical community missed, specifically what were evident to us, her mental health struggles. Remember, communication isn’t only about language, there are many disabilities that hinder health care, worse when time is of the essence. Doctors are not gods, they too are flawed humans and, often, are only as good as the science they’ve been taught. The narrator of this story has a broken heart, one that she assures us she ‘can pull out over work’, but she has her own family origins to deal with, old wounds and grievances, a deep loss, just like patients she will tend to. She wants to heal too. Her humanity makes her the doctor you just might want at your bedside.

A fictionalized peek at the people behind the stethoscope. An intelligent read, especially for me as I have had my share of hospital stays.

Publication Date: August 16, 2022

Little, Brown and Company

Though it is fiction, this feels like a medical memoir. Follows an unnamed narrator through medical school & clinical work. It is heavily graphic, so trigger warnings may be important. Though I found the information interesting, organization was a problem. The narrative is jerky & lacks effective transitions. The writing has good qualities & an excellent ability to describe the medical context, but the lack of organization detracts heavily.

I was so excited for this book as I am always looking for more stories based in the medical field. Unfortunately, this book completely missed the mark.

At a bit more than 100 pages in length, you would think this would be a quick read but it was SO CONFUSING you could barely follow and it slowed reading down a lot.
Each paragraph will jump from present to past with no warning and absolutely no explanation. I learned nothing from this book, I didn’t care about anything being said, there was absolutely no plot.
There was also completely random mentions of child abuse and religion which didn’t add to the story in any way and as a reader, I did not appreciate that.

2 stars because I give the author props for trying

I wasn't enjoying this book and it was a little on the depressing side, which was not great for my mental state at the time. I may give it another shot at some point, but I am not finishing it now and will not rate it outside of NetGalley.

I love this book so much. The language! The voice! Each sentence is as precise and balanced as a feather. I can't articulate what this type of writing would be called but Jenny Offill (who also writes like this) in her blurb describes the book as "wholly original and shockingly brilliant" and it is definitely both of these things. Anna DeForest is a writer's writer and she makes me want to write better, which is about the highest praise I can bestow. Gorgeous prose. I hope this book is heaped with attention and that more books like this are published.

My thanks to both NetGalley and the publisher Little Brown & Company for an advanced copy of this novel about a young woman training to be a doctor, and what it gives and takes from her.

Truth is stranger than fiction, but fiction can sometimes be alot easier to swallow. People tend not to want to know what goes on behind the scenes, or to quote a popular statement how the sausage is made. Reading a book about a young woman and her daily life being educated in the field of medicine as a memoir might not appeal to others much, but as a possible work of autofiction the story is enthralling. The author is a doctor, Dr. Anna DeForest, and the book, A History of the Present Illness, features the education of a young woman, but where the truth ends and novel starts well that might be left to the reader.

On a hot day a group of students are presented with white lab coats, given speeches that go on and with that a new class of student doctors is inaugurated. We follow this class to an autopsy where the class is broken into groups of four with the lesson being how to determine the reason for the person's passing. Our narrator describes the group as a microcosm of society, those who have always had, and those who have to struggle. From there we follow our narrator, back and forth on her journey to becoming a doctor, flashing ahead into procedures, and back in dealing with her fellow students and a system that doesn't seem to know what it is anymore. Along the way we begin to notice that the young woman might be keeping some of the story to herself, making a diagnosis of who she is faulty, and easy to get wrong.

A book that seems very distant in the beginning, as if the character had never had anything go wrong, or even right, but as the book unfolds, becomes clearer and clearer. This is not just a persona for dealing with patients, this is a persona to deal with life. There is a lot of jumping in time, but everything holds together well, and again as the story goes on becomes clearer. Class and the discrepancy between rich and poor and the health care they receive is touched on, and I don't remember when this subject seemed so overwhelming. As someone who has dealt with health insurance woes these snippets of stories made me more uncomfortable than the medical problems that the author was relaying. I enjoyed the writing and the style, readers expect the narrator is going to snap and loose it, either from the misogyny, class discrimination, white privilege, and yet the narrator goes on. A small book, but one with a lot of impact and a lot to discuss.

I assume that a lot of the stories are from the author's medical training. There is a certain to quote Gandalf 'ring of truth' that one does not get from just research. A story that raises a lot of questions and concerns about what this society asks of its healers, what can and should be changed, and how to make medical care not a privilege but a right, all wrapped in a very well- written novel. I look forward to more books from the author.

It is a rare novel that makes me double check that the book is indeed fiction. In her debut novel, Anna DeForest invites the reader into the mind of a medical student’s stream of consciousness account of her experiences during her med school training.

We follow the narrator’s mind as she navigates the ethics in medicine, her understanding of her relationships, spirituality, while getting glimpses of her past. There isn’t really a plot in this novel, it reads more like a section of a memoir written by an unreliable narrator. From the first page it feels like non-fiction as our narrator describes having a class with real cadavers and hits the reader with nonchalant details about her thoughts regarding the complicated morals involved.

It’s a short book but you must pay attention. The book’s back and for storytelling and quick prose give the reader the bleary-eyed feeling that they’ve spent time in the hospital right along-side our protagonist. The reader is often given a short aside in one chapter, then is given the full story later on in the book. The novel also grapples with serious themes throughout from medical trauma to abuse and self-harm.

Dr. DeForest has written a book that will not leave my mind soon. Pick it up if you want a short book that takes a long time to read because you have to stop and take something in on each page.

It will be released August 16, 2022. Thank you to Netgalley and Little, Brown, and Company for the ARC.

"A History of Present Illness" by Anna DeForest
Little, Brown and Company
August 16, 2022
10-0316381063


This novel is an insightful tale of an unnamed young woman venturing into the field of medicine. As she commences her training as a student doctor, she finds herself with her colleagues as they receive their lab coats from the already practicing doctors dressed in their doctoral robes. The day is oppressively hot as she and others sit through a ceremony with speeches explaining what it takes to be a top-notch physician.

Following this, the group spends the rest of the day in the cadaver laboratory with four students assigned to each corpse. Our protagonist is in a group consisting of two women and two men. One of the men they label "country boy" for he states he owns a country home nearby. The other male is from Texas, and that is the moniker they give him. The other female remains silent and reticent while she holds her textbook. Their "patient" is a Black woman on whom they will perform their first autopsy. As they begin the dissection, they wonder where these deceased have come from? Have they donated their bodies for science? Are they homeless? It appears some may be indigent, isolated with no family, or nursing home residents who lost all their funds and are unable to afford a burial.

The procedure offers details of the process as they then learn the techniques used. Those remains are either cremated or buried in mass graves not far from the school, where convicts stack pine boxes in rows and then place them in trenches.

Many students, as well as doctors, for that matter, are overworked and unprepared for this intense vocation, so many give up, and even some may turn to suicide as an escape—the stress of it all being too much to bear.

Our student believes in caring for her patients, getting to know them, and working to alleviate their fears. She has a young female in a coma who suffering from encephalitis, which is inflammation spreading to her brain. Not knowing her identity, she calls her Ada and spends time with her husband learning more about her. Knowing her case is terminal, she soon gets attached to her, spending time at her bedside.

She states: "We are schooled in taking, not giving, a history. We are taught to reach first for open-ended questions. How you ask can earn an answer closer to the truth. For example, you don't ask someone if she drinks; you say, 'How much do you drink on an average day.' You don't ask if someone is compliant with his medication; you ask, 'How often do you miss a dose.' We are told to normalize our queries about drugs, sex, and death by asking them to everyone."

As they progress through training, they spend time in operating rooms. One of the surgeries she assists in consists of replacing heart valves, another is repairing gunshot wounds or less serious operations such as removing an inflamed appendix.

A rotation in the emergency ward for psych patients is somewhat frightening. There are wards full of those who have gone mad, gone off their meds, cry through the night, etc. And these folks who are suffering intensely have our student questioning if this is the specialty she wants to set her sights on.

There is a great division when it comes to treatment in hospitals as our protagonist states:

"The sick poor, you could probably guess, are treated poorly in the hospital. They are more likely to be obese, to be smokers, to suffer a slew of other ills along a social gradient that we attribute, casually, to a failure of will. These health disparities are especially bad for Black people, though in the cohort, outcomes don't improve much with higher incomes or more education. Our older lecturers attribute the difference to genetics perhaps because they have been forbidden from promoting frank eugenics or phrenology. New data suggests that the stress of daily indignity may cause plaque to build up in the arteries and lower the birth weight of babies. These, they say, are the social determinants of health."

As training continues, the students learn the nature of the profession is to constantly approach the patient to attempt to connect with them and impress upon them some lesson that the way they are living or the things they are doing is detrimental to their health. Not only is a lot of their training repetitive and often boring, but the hours are long and the need for studying and being tested seems constant—a great cause of burnout.

This novel depicts many aspects of the medical field but also consists of in-depth book learning as well as the student acquires the skills on how to placate difficult patients or how to deal with scurrilous physicians, as well as how to stay cool in extreme situations and adjust to long hours and ever-changing schedules.

"A History of Present Illness" is a debut for Anna DeForest, a neurologist, and palliative care physician. It is a powerful and somewhat complicated read of a story about a young woman dealing with the intensity of becoming a doctor while she also faces the ramifications of her past and current personal life. Though this is written as fiction it reads more like a memoir.

A History of Present Illness by Dr. Deforest follows a young medical student from the initial white coat ceremony. While the book was interesting, it read like a memoir, but it is actually a work of fiction. It was a confusing read and difficult to follow. I am extremely interested in the information presented and was intrigued by the presentation of her patient with encephalitis as I thoroughly enjoy reading medical novels (fiction and non-fiction). This book may be overwhelming and distressing to some as it does touch on abortion and rape. Thank you to the publisher and Netgalley for the advance review copy in exchange for my honest review.

An unusual, slow burn of a medical novel, not so much a plot, more a collection of thoughts and vignettes to do with health service and response. The narrator has a flawed background and brings her odd perspective to the expectations of the industry. The result is unsettling, but not especially memorable.

"In a special section on brain pathology, I watched a fetus have an autopsy. The limp little body was draped over a chunk of two-by-four."

There are a lot of sentences like this one in this novel. It reads like a story told by a young person who has just discovered that people suffer needlessly, and who doesn't know yet what to do with that information.

"…A teacher I once had was not fond of similes. She said nothing really is like anything else, described a church as being quiet as a church…"

Thank goodness DeForest proves true her teacher’s statement and delivers a novel only she could have written. And absent are the cute little deformations of words she had previously tried out in some earlier work, linguistic deviances famously made copious by the gifted writer Gary Lutz who created in his mischievousness his own personal act of genius. Problem for me is that too many other so-called writers followed suit and it became annoying as hell. So fucking obvious, these writers trying to be something only Lutz could pull off successfully. Not sure if pretentious is the right word here but it did feel fake when others employ the same sort of cleverness. Yes, ostentatious is the better word. For example, in one of her previously published short stories titled "Family Meeting" DeForest followed what I am going to imagine as Lutz’s lead in using her own made-up words like "unboundaried" and "spittiness", which both made me cringe. But it pleased me to no end to find not even one aberrant word sprinkled throughout the text of this, her very first novel, a book I chose to read based simply on the lofty praise offered by my fellow Lish-Fiction classmate Gary Lutz who, lest you get discombobulated by it all, has recently changed that first name to Garielle.

"…Remember looking in the mirror as a child, saying your name? This face, you’d think, these hands. This house and yard and mother, going to bed without dinner on cabbage night, jumping from the roof of the shed. The bravery of it all, the obvious import. But this is how it ends: Surrounded by strangers, your clothes cut off with shears, cold blue hands, and gone then, with your body humiliated and left alone to stiffen……Humiliation—is human hidden in the root of that word? It comes up so much in humanity…"

DeForest continually wins me over and over again with her savagely dark but warm personality coming through the page. And as much hurt and injustice that keeps emerging from these pages she manages to retain a sense of humor all the while embarking on her sacred mission toward honesty and truth. And there is a difference. For example, a criminal defense lawyer does not have an obligation to present the truth. The lawyer certainly must be honest, but in his zealousness to make a good defense, he does not have to be actively truthful. Though remaining pleasant, as well as horrid, DeForest accomplishes both.

"…There is one prayer I know will be answered: Lord, let me suffer a lot and then let me die…being dead is the only thing any of us will ever permanently do…By the end, her eyes were splitting open at the corners, and serious fluids ran down the sides of her face like tears. What does it mean? The husband would ask. Sad as it was, it didn’t mean anything…"

My old friend Jesus (and I am not referring to the Jesus you just might be thinking of) believes we are put on this earth to be punished. And my youngest son connects the dots of this claim by Jesus to Buddhism, though my Jesus was raised Catholic. But I am not that privy to the Buddhist religion, nor its teachings, enough to pass judgment or concur. My problem rests in my not believing at all in God, so it pretty much lands on my own doorstep in regards to past addictions and their damages to my brain, as well as my original upbringing, the family I was born into, my Midwest cultural environment or lack thereof, certainly a brainwashing or two, and of course those genomes that by luck, or not, I was born with which in total certainly have determined every segment of my past life and will continue to map what’s in store for me going forward.

"…Another skill is this: I am brave enough to ask people anything I want to know… something turns rotten when we stop having any answers. We forget to wonder when we forget to ask…"

Years ago, after spending thousands of dollars in recovery therapy from the disease of alcoholism, I realized the most important lesson I learned was to ask for 100% of what I wanted. But that didn’t mean prying into someone else’s privacy and it also didn’t mean I would get what I wanted. And fact is, you don’t generally get it if you don’t ask. And I do like to ask, but I have learned to show some restraint when it comes to invading another person’s space. But it’s possible DeForest didn’t literally mean that choice of the word anything. Perhaps she simply meant there are no dumb questions you can ask in class, and I may have taken this thread far past her line of demarcation.

"…Esteban said we don’t do things because of what we believe in, but we come to believe in what we are doing…Esteban asked if I would come see him preach. I told him I liked churches only when they are empty…"

As do I. Admittedly I am not sure what to make of this first novel by Anna DeForest. I certainly liked it. And I like her and want to read more of what she writes. Her words feel relaxed and are comfortable to read, even if her content isn’t. And I relate to much of what she has written. I know that life is eventually gonna get ugly for most of us, if it hasn’t already. But for now I am enjoying the beauty and sensuality this world has to offer, at least while I still have my faculties and a modicum of good health. But the truth is, a long life isn’t necessarily a good one. And thanks to the songwriter Neil Young all of us should already know, or at least be aware, that rust never sleeps.