Mini ARC

1. A SELECTION OF EXCERPTS FROM
A History of the Present Illness
by Louise Aronson
Winner of Sonora “Some of the most startling and memorable stories I’ve ever read.”
Review prize, the New
— Peter Orner
Millennium short
fiction award and three
Pushcart nominations
EXCERPT FROM
SOUP OR SEX
Once Maurice caught his
breath and settled in, I
Maurice Kasmarek was my second admission on the first day of my went into his room to do
first real job as a doctor. I’d been hired as a hospitalist by the same the history and physical.
large San Francisco health maintenance organization where I’d fin-
ished my training just two weeks earlier, and I marveled that the “Mr. Kasmarek—” I began.
world suddenly and somewhat arbitrarily considered me fit for un-
supervised practice. My inaugural patient that day, a twenty-two- “Oh, hell,” he interrupted.
year-old with cystic fibrosis, came in every three months carrying “The name’s Maurice.
preprinted orders from her pulmonologist detailing every aspect We’re both grown-ups.
of her care. I was fairly sure I’d admitted her at least once before Why don’t you call me
during residency, but though she knew all the nurses by their names that?”
and significant others and children and even pets, she didn’t remem-
ber me at all. When I walked into her room, she said, “Do you really “Okay,” I said, though
even need to examine me?” I said I really did, and she said, “All right usually I’m a bit of a tradi-
then, let’s get this over with. But you’re gonna have to read my chart tionalist when it comes to patient-doctor etiquette.
to get the history.”
He raised the part of his forehead that should have had eyebrows.
Maurice showed up an hour later and, after being wheeled across “So what’s your name?”
the street from oncology, refused to let the transport guys push him “Chitra,” I replied. “But you can call me Dr. Agarwal.”
down the hallway to his room. “If I’ve got to go into this place,” he I waited a split second, and then I smiled.
argued, “at least let me get there under my own steam.” It took him “Ha!” he said. “You had me going. Yes you did. Bravo, Dr. Chitra,
twenty minutes to cover twenty yards. bravo!”
I tracked his progress from the nursing station. “Look out, honey,” And so, in the first two minutes of our acquaintance, we became
said the nurse beside me, who, despite his omnipresent five o’clock Maurice and Dr. Chitra, a compromise arrived at without any nego-
shadow, was rumored to be one of the locally famous transvestites, tiation and a solution that pleased us both...
the Sisters of Perpetual Indulgence. “This one’s a heartbreaker.”
1 A History of the Present Illness by Louise Aronson

2. EXCERPT FROM
LUCKY YOU
instead of opening the tailgate, whistled that unique series of notes
all her dogs knew. Standing alone on that flat stretch of rocky rubble
Wednesday, the day the boy fell, Perla Weldon walked her after- a week later, I could almost hear the sound — the pitch rising, then
noon dogs out over the saddle of Bernal Hill. Because it was early retreating, then rising some more, like a complicated question.
December, after the first of the El Niño rains, the mud was orange
brown, slippery in some places and as thick as peanut butter in oth- Perla pointed past the gate at the pavement curving north down
ers. It clung to her boots and splashed on her jeans as she threw the hill. The chocolate labs, Silo and Seamus, barked, and a black-
sticks and rocks for her charges. Perla and her dogs covered most of and-white collie named Bailey turned circles. The others sprinted
the hill’s twenty-four leash-free acres that day, from the Monterey forward with raised tails and lowered shoulders, and Perla ran
pines in a lonely cluster on the highest peak to the grassy eastern with them, enjoying the stretch of her legs and the catch of cold
slopes and short red rock bluff s to the west. She praised the dogs air in her chest. She ducked under the gate. Beside her, Taco’s nails
in her usual voice — which was childishly high — and reprimanded clicked on the blacktop. They passed the patch of giant cacti and the
them in deep tones that required her to lower her chin to her chest. graffiti-tagged view bench that looked west toward Twin Peaks. At
Heading back to the K9 Safari truck, they walked along the cliff path the curve, Perla heard her own panting, the swish and rustle of the
that would be closed off three hours later and planted with indig- wind in the eucalyptus, and just beyond the Esmeralda Street steps,
enous grasses the following week. an abrupt, high wail that stopped her mid-stride.
I watched as a group of neighborhood volunteers planted the grass- She registered only color and motion at first, something bright red
es. Perla had told me her version of the story by then, and my wife tumbling past the yellow grass and orange rock. Then, twenty yards
had read the brief account in the Chronicle aloud one breakfast as down the road, the figure rolled off the cliff, and a second after it
a warning to our boys, but I wanted to get a sense of the place for landed, she heard the thud of skull on asphalt.
myself. Leaving work early, I drove to the gate at the top of Bernal
Heights Boulevard and retraced Perla’s route. I wondered how Some people would have run to the boy right then. …
many afternoons she had passed the boy, walking home from school
with his friends. The paper said the friends always walked together,
Maya Cohen and Jessica Fernandez, both age ten, and Dylan Hunter,
“If you’ve ever wondered what goes
age eleven, who had been admitted to San Francisco General Hospi-
on behind the closed doors of the sick
tal in critical condition. Perla had said she couldn’t remember seeing
them, but she didn’t pay much attention to kids unless they were
and the wounded – not on television
harassing her dogs. Children, she believed, were cute one minute, or in movies but really – then this is
unspeakably cruel the next, the demands of their bodies and imagi- the book for you.”
nations endless and unpredictable. She much preferred animals.
In the parking area, I imagined Perla’s K9 Safari camper truck with
its trademark paint job: frolicking canines and squat, flat-topped —Victoria Sweet
trees on a background that was savanna tan on the bottom and the
brilliant blue of African skies on top. Then I pictured Perla coming
down off the hill toward the truck. She glanced at her watch and,
2 A History of the Present Illness by Louise Aronson

3. EXCERPT FROM
A MEDICAL STORY
I’d been before my medical training — a happy, caring person I liked
and hoped to become again — but the time I devoted to writing
So much of medicine is stories. Or potential stories. For example: was time not spent reading medicine or making money. I began to
the year before I began doing palliative care, I visited an elderly wonder what counted as meaningful work and, by extension, as a
couple in an apartment complex named for Martin Luther King. Ro- meaningful life. I didn’t see that those questions linked my writing to
gelio said that was the only good thing about the place. Beer bottles medicine as surely as did my subject, each story the tale of a patient
and cigarette butts ornamented the sidewalk; urine and streaks of or doctor I knew or had heard about.
barely clotted blood garnished the walls. A woman reeking of dust
and sweat reached for my jacket and stumbled, smearing saliva on
my sleeve. The guard checked me over, then buzzed me in, showed
“She combines a doctor’s eye with
me where to sign, told me to take the elevator, not the stairs. The
elevator wobbled and creaked. On its walls were faded admoni-
a writer’s heart.”
tions about garbage disposal and the use of fire escapes printed in
English, Spanish, Chinese, Russian, and Tagalog. Rogelio and Carina
lived on the fifth floor, in the last apartment along a narrow, win-
dowless corridor. Someone had obliterated the hallway lights. I
turned on my otoscope and held it in front of me to light my way. It —Elizabeth Day
helped just enough.
By the time I finished my eight years of medical training — the year I So many medical stories are about death, or potential death. From
met Rogelio and Carina — I had abandoned the Midwestern friends the fifth floor of the Martin Luther King apartments, where I occa-
of my childhood, the mountain biking I’d taken up with such enthusi- sionally visited them as part of an outreach team for an understaffed
asm upon moving to San Francisco, the ability to sustain a romantic neighborhood health center, Rogelio watched helplessly as his wife
relationship, and any reading that artfully conjured the pain of oth- disappeared. He was a tiny man, so frail that once, when I passed
ers or took longer than half an hour to complete. By way of trade, I him with only a foot of space between us, he wobbled, clutching his
had acquired expertise in internal medicine, a twenty-pound diabet- walker as if it were the safety bar on a roller coaster. His wife, Ca-
ic cat with a fondness for sushi, and a spacious apartment on Rus- rina, sat smiling and mute in a wheelchair, fat and healthy except for
sian Hill from which I could walk to Chinatown, North Beach, and her brain, a not so vital organ if you have the right husband.
Fort Mason. Still unsure of what I wanted from my career, I signed
up for a year of locum tenens, filling in for doctors on vacation or Each visit was the same. Rogelio wouldn’t discuss any of his many
family leave, moving from one clinic or hospital to another every few worrisome diagnoses, just his guess about how much longer their
weeks or months, and sometimes juggling more than one job at a luck would last. And he wouldn’t consider a nursing home. With a
time in hopes of paying off my student loans before I turned forty. nod at the caregiver, he’d say, “I must watch them with her.” And, “I
am so lonely.”
Very quickly, stories of lives damaged, unnoticed, and discounted
accumulated in my imagination. I could neither forget nor make The aide sat beside her charge, engrossed in a soap opera. Carina
sense of them, so I began taking notes and then signed up for a writ- smiled. When I left, Rogelio squeezed my arm and whispered, “She
ing class online in hopes of capturing and better understanding my must die first. Promise me...”
work and my patients’ lives. The class reminded me of the person
3 A History of the Present Illness by Louise Aronson

4. Buy the Book
The book is forthcoming from Bloomsbury in January 2013
and is available for pre-order at Amazon, IndieBound,
Barnes & Noble and Powell’s Books.
About the Book About Louise Aronson
A History of the Present Illness takes Louise Aronson is a graduate of Harvard Medical School and an
readers into the lives of doctors, pa- Associate Professor of Medicine at the University of California
tients and families in the neighbor- San Francisco (UCSF). A geriatrician and medical educator, Louise
hoods, hospitals and nursing homes of cares for frail older adults, directs the Northern California Geriat-
San Francisco. It introduces a striking rics Education Center, the UCSF reflective learning curriculum, and
new literary voice and offers a deeply the Pathways to Discovery Program, and serves as associate editor
humane and incisive portrait of health for the JAMA Care of the Aging Patient series and director of Pub-
and illness in America today. lic Medical Communication for the Program for the Aging Century.
She is the recipient of the California Homecare Physician of the
An elderly Chinese immigrant sacrifices his demented wife’s well- Year award, a Geriatric Academic Career Award, the Cooke Award
being to his son’s authority. A young veteran’s injuries become a for the Scholarship of Teaching and Learning, the Lieberman Schol-
metaphor for the rest of his life. A gay doctor learns very different ar Award, and the AOA Edward D. Harris Professionalism Award.
lessons about family from his life and his work. A psychiatrist who
advocates for the underserved may herself be crazy. A busy doctor Dr. Aronson also holds an M.F.A. from the Warren Wilson Program
juggles an errant teenage daughter and a seriously ill father. for Writers, and her fiction has appeared in both literary and medi-
cal journals including Bellevue Literary Review, Northwest Review,
Together, these honest and compassionate stories provide a view of Fourteen Hills, The Literary Review, Annals of Internal Medicine, and the
what it means to be a doctor and a patient—unlike anything we’ve Journal of General Internal Medicine. She has won the Sonora Review
read before. Readers are taken “behind the curtain” into the anxiet- Prize, the New Millennium Short Fiction Award, multiple writer’s
ies, elation and exhaustion of the physician experience. At the same residency fellowships, and three Pushcart nominations. A History of
time, the book illustrates the challenges faced by patients from the Present Illness is her first book.
varying socioeconomic backgrounds battling sudden and chronic
diseases and compassionately illustrates the psychological toll ill-
ness and caregiving take on patients and the people, family and pro- CONTACT AUTHOR
fessionals who care for them. Louise Aronson
louise@louisearonson.com
www.louisearonson.com
Twitter: @LouiseAronson
4 A History of the Present Illness by Louise Aronson