A History of Present Illness by Anna DeForest

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

Elizabeth Finch by Julian Barnes

Published by Knopf on August 16, 2022

Elizabeth Finch could be read as a celebration of intellect. That, at least, is my less than intellectual impression of the novel. The central theme of the unconventional narrative concerns ideas — following an idea, exploring it, evaluating it, and drawing conclusions about the idea’s merit. The novel takes a close look at several ideas that relate to the meaning of life. To some extent, the novel might also be seen as the celebration of teachers, or of the rare teacher who opens the minds of students rather than stuffing minds full of facts that might or might not be accurate.

The story is told in three parts. Elizabeth Finch is the glue that binds them. When the story opens, EF is teaching a course in Culture and Civilization at the University of London. The course touches upon monoculture and foundation myths, the deception of histories that cultures embrace as “comforting bedtime stories.” EF deals in “truths not from previous generations but from previous eras, truths she kept alive but which others had abandoned.” Students like Neil and Anna find their lives transformed.

EF challenges her students, poses questions and critiques answers without moral judgment or derision. EF does not teach in the traditional way — dates, names, facts, “all leading to broader ideas.” She begins with the broad ideas, and then illustrates them with dates, names, and facts. Students who are unsettled by ideas, who are unwilling to rethink their own ideas, who just want to memorize facts and dates so they can pass exams, drop her class or become confrontational. One of the confrontational students, Geoff, provides a different perspective on EF at the novel’s end. Which view of EF is correct (or maybe both or neither) is left for the reader to decide.

In any event, we learn in part three that EF published a piece after she retired that caused the tabloids to paint her as a heretic, anti-Christian, and a disciple of Hitler. Geoff may have been the instigator of that attack. EF was reclusive before the tabloids attacked her and stopped publishing after, but she never published much anyway, apparently preferring solitude and a life of the mind to sharing with others. As with so much else in her life, it may be that she just didn’t want to be bothered.

EF is an enigma. She is sympathetic but distant. She answers questions with candor and concealment. She speaks of love as bringing clarity and delirium. She resists having labels stuck to her because she is “not a steamer trunk.” Apart from these contradictions, we learn very little about EF because the novel’s narrator, Neil, never uncovers her secrets.

If we can be sure about anything, it is that EF is is a stoic who believes that freedom lies in controlling what you can and accepting the things you cannot. We might be able to control what we think or feel but we cannot control how others will behave in a relationship. EF once cautioned her students that passion, like reason, “may mislead us furiously.” Neil once glimpsed a man who might have been important to EF, his best clue that passion might have influenced her life, but he struggles to learn more.

Neil views EF as a romantic pessimist and then as a romantic stoic. EF tells Anna that love is the only thing that matters. Yet EF believes that love, for a woman, has always meant “possession followed by sacrifice” — being possessed and then being sacrificed. She knows that people will look at her and say she never married, “a reductive way to describe and contain a life.” EF is solitary but not lonely because solitude is strength and loneliness is weakness. EF abhors weakness and will never be possessed.

After Neil is no longer EF’s student, he begins meeting her for lunch two or three times a year. They continue their meetings for twenty years, through two of Neil’s failed marriages. The lunches always begin with EF asking, “What have you got for me?” They spend the lunch discussing ideas, often ideas that EF touched upon in her class. EF never talks about herself because, to EF, ideas are the things that matter. Everything else, including the food served at lunch, is likely to be disappointing.

The novel’s second part is an essay. Neil writes it in response to an implied challenge, a way to prove something to EF despite his knowledge that EF will never read it. The essay is astonishing. It explores Julian the Apostate, “the last pagan emperor of Rome,” whose death made possible the rise of Christianity (or at least that’s how Christian history tells the story). The essay recounts the deeds and words of Julian, imagines how history might have unfolded if he had lived (perhaps the Age of Reason would not have been delayed by fourteen centuries), and examines how thinkers and poets through the ages viewed Julian, including Montaigne, Milton, Voltaire, Gibbon, Goethe, Byron, and Swinburne. This is heavy thought, but the essay is lively, never stuffy or dense. This is how history and philosophy should be written, with all the rigor but none of the drudgery of scholarship.

The third part reconnects Neil and Anna (and Geoff by email) as Neil continues his quest to understand EF. EF’s brother, who could not be less like her, contributes his limited perspective. Neil and Anna both admire (and even love) EF but in different ways, while Goeff thinks she’s a bit of a fraud. Yet as EF made clear, none of us can really understand another person. Our best hope is to understand something of ourselves, a hope that comes from taking control of those things that we can control about our lives and stoically accepting the things we cannot. That’s probably the novel’s great lesson (giving intellectual force to the AA serenity prayer), although the book overflows with lessons.

I have never read a novel like Elizabeth Finch, a novel that is largely devoted to an essay about history, religion, and philosophy, a novel in which thought supplants action or characterization. We learn only superficial details about Neil and his failed marriages because Neil isn’t important. We learn almost nothing about Anna. None of the characters, not even EF, are as important as ideas. Yet the essay is so brilliant and the unknowable character of EF so fascinating that the novel’s unconventional nature, its refusal to give the reader a plot or detailed characterizations, becomes a virtue. This isn’t a novel for every reader, but it may be a novel that would reward every reader who gives it a fair chance.

RECOMMENDED

Bark to the Future by Spencer Quinn

Published by Forge Books on August 9, 2022

I knocked Spencer Quinn a bit for his last Chet and Bernie novel because I thought he was recycling thoughts that, while amusing, Chet had shared in other novels. For those who aren’t familiar with the series, Chet is a dog. Chet narrates his adventures with his owner/partner, Bernie Little. The thoughts Quinn attributes to Chet are spot on, at least from the standpoint of humans who try to imagine what dogs think. I am happy to report that Quinn did not fish in the same pond of jokes when he wrote Bark to the Future — or if he did, he caught some new ones and threw most of the old ones back.

Bernie Little was a star pitcher in high school. Now he’s a private detective. He’s driving with Chet in his latest Porsche when he spots Rocket Saluka at a freeway exit. Rocket is a former teammate, now homeless and mentally unsound. Bernie’s attempt to help Rocket leads to a mystery that has its roots in high school. The mystery involves a switchblade that, for a time, was in Rocket’s possession. Before that, it was kept locked up by a chemistry teacher, only to be stolen.

When Rocket goes missing, Bernie follows a trail that takes him to a divorced woman he took the prom when they were in high school, the ex-husband of the woman’s deceased sister, a pastor, the chemistry teacher, the teacher’s advanced chem students, the school janitor, a prisoner, and a diving instructor. The investigation eventually gives birth to a murder mystery.

Chet keeps the action moving by chasing suspects, swimming to recover evidence, and sniffing under the table for any crumbs that might have been dropped. The plot is light-hearted and entertaining. Bernie has his moments but Chet is always the star in these novels. Apart from thinking dog thoughts and making fleeting efforts to understand the strange behavior of humans when they aren’t petting him, Chet contributes to the story by noticing things (typically scents or glimpses of people) that the reader will recognize as clues even if Chet does not. Bernie is typically clueless until he finally pieces things together. Chet doesn’t always understand the details of the plot he narrates, but he is confident that all will be well because Bernie is the smartest, strongest, kindest, and all-around best human on the planet, an opinion that is reinforced by treats and cheeseburgers.

Bernie’s rocky love life has evolved over the series, although he seems settled in with Weatherly. Chet’s love life may have produced a dog that Weatherly adopted, a dog that looks suspiciously like Chet, a dog Chet considers the most annoying dog on the planet because how could there possibly be another Chet? Spencer Quinn is back in form with Bark to the Future, making this an easy novel to recommend to dog lovers. This would be a good starting point for fans who are new to the series.

RECOMMENDED

Mercury Pictures Presents by Anthony Marra

Published by Hogarth on August 2, 2022

Mercury Pictures Presents is a sprawling but tightly controlled novel. Set before and during the Second World War, most key characters are Italian immigrants, although one is an American-born citizen of Chinese ancestry. While the novel is centered around a minor movie studio owned by two estranged brothers, its grand theme is America’s dependence upon and distrust of immigrants. That theme is captured in this description of an immigrant character: “There was nothing he wasn’t willing to fail at. Besides denying his racism, it was his most American quality.”

The brothers who co-founded Mercury Pictures are Artie and Ned Feldman. They had success making silent movies, but larger studios surpassed them with talkies. Ned works in New York handling the financial side of the business. Artie is in Los Angeles, overseeing the operation of the studio. Maria Lagana is Artie’s head of production, having worked her way up from typist.

Maria’s mother fled Italy with Maria when Mussolini exiled Maria's father, a prominent lawyer, to an internment colony in the Italian hinterlands. While in exile, Maria’s father saved young Nino Picone from drowning. He arranges for Nino’s informal adoption by the Cortese family. Nino works as a photographer, often taking passport photos that will be used in forged passports. He plans to travel to America with Maria’s father, who has acquired a forged passport of his own. That plan falls apart but, thanks to an act of sacrifice, Nino comes to America using the passport of Vincent Cortese.

The novel opens with Maria trying to get a proposed Mercury Pictures film approved by the Production Code Administration, a censor that, like the Senate, regards Hollywood as anti-American. Maria is the brains behind some of Mercury’s best films but she can’t get a producer credit, much less an executive position and decent salary, because of her gender. Maria lives with Eddie Lu, an American actor of Chinese ancestry who can’t get a decent role until after Pearl Harbor, when he becomes typecast playing Japanese villains.

Nino has been in the US for three years before he finds the courage to track down Maria in California. Maria blames Nino for abandoning her father but, for reasons she doesn’t quite understand, gives him a job as a photographer at Mercury. Nino works under his assumed identity but is always at risk of being exposed and perhaps branded as an Italian spy.

Foreign spies are on everyone’s mind. One of Mercury’s propaganda films claims that 25,000 Japanese residents of Los Angeles were sabotaging America, justifying the nation’s horrific internment of Japanese Americans because of their ancestry. The hatred that fuels wars causes Mercury to lose German and Italian employees because wartime laws prevent them from working with cameras or chemicals. Maria must carry an enemy alien registration card and will be arrested if she travels outside a small zone in LA.

The plot is a collection of memorable scenes and vignettes. Eddie Lu is a friend of Bela Lugosi, who resents being typecast after Dracula but regrets turning down Frankenstein after Boris Karloff became Hollywood’s go-to monster. Eddie understands what it means to be typecast. He cherishes Ibsen and Shakespeare but will never perform in film as anything other than a Japanese villain. “Studios strove to make ethnic characters more relatable to white America by casting them with actors who supposedly brought them one step closer to Anglo-Saxon: Chinese actors played Japanese characters, Jewish actors played Chinese characters, Catholic actors played Jewish characters, and Protestant actors played Catholic characters.”

In another scene that emphasizes America’s history of racism, the Army recruits a failed architect who works on set design for Mercury to build replicas of Berlin in Utah that can be destroyed in propaganda films. She supervises prison laborers who construct the buildings, including a young black man who insisted on being served at a lunch counter, setting events in motion that ended with the death of a German POW. The innocent teen is serving a life sentence despite playing no part in the German’s death. The architect was born in Germany and, while she is worried that the Army might hold her ancestry against her, she does not face the same kind of bigotry as the black teen.

While the novel tracks the lives of many characters, the story is primarily Maria’s, including the extended family she makes for herself. She is a victim of fascism in Italy and of nationalism in America, losing a father in Italy and a lover in the US while enduring a loss of liberty simply because she fled a country that went to war with America. Her moving story hits home when, in an epilogue, she returns to Italy to learn what she can about her father’s fate.

Mercury Pictures Presents offers a perfect blend of humor and drama. People are awful until a good one comes alone, making simple decency seem remarkable. Social commentary is poignant without becoming overbearing. The story evokes emotion without becoming saccharine. The plot takes the reader on entertaining detours without becoming lost. Dialog is intelligent and surprising. Historical research (cited in the acknowledgements) contributes to a detailed atmosphere, both in Hollywood and Italy. This is an award-worthy novel. I admired everything about it.

HIGHLY RECOMMENDED

40 by Alan Heathcock

Published by Farar, Straus and Giroux/MCD on August 2, 2022

A beginning and ending of moderate interest sandwich a dull middle that offers almost nothing of interest. But for the protagonist’s wings, 40 begins like a standard dystopian tale. Mazzy Goodwin views her job as protecting her little sister, but she’s awful at that job. In her regular Army gig, Mazzy is also protecting West Texas from the Novae Terra, a religious cult that became a movement that birthed an insurrection. The cult’s leader is Jo Sam, who might or might not be a space alien. The Novae Terra gives a boatload of cash and a lifetime income to its initiates, provided they wear a white-sleeved uniform and carry an assault rifle. The Novae Terra have created an elite military force known as the Pearl.

A shockingly incompetent government can’t seem to identify the source of Novae Terra’s wealth, but it sees the results. Novae Terra has acquired much of the country’s farmland and has poisoned the rest of it, giving itself control over the nation’s food supply. Novae Terra has promised to create a world that is free of suffering, but only initiates benefit from that pledge. Jo Sam knows that most people will sell their soul to avoid even a day of hunger. Novae Terra distributes food from rural churches while its drones bomb cities. The government seems powerless to do anything about it.

Jo Sam trades on the reality that weak-minded people will believe any stupid conspiracy theory if it appears on multiple websites and feeds into their underlying anger. Claims that the government is trying to starve American citizens to enslave and control them and that the president eats babies (sound familiar?) have contributed to anti-government sentiment.

Jo Sam appears to be a drunk who likes to sing American Pie, making him an unlikely leader, but perhaps he attracts a following by being an ordinary guy. Or perhaps his followers are love with their conspiracy theories and don’t care who leads them. Or perhaps the drunk is a front for the true Jo Sam.

Against this background, Mazzy’s home has been attacked. Her sister Ava Lynn has been taken by Nova Terra. An actor named Raja Garbos has defected from Novae Terra. Garbos offers to use his Nova Terra contacts to help Mazzy recover Ava Lynn. The story trudges on from there.

Most of the middle involves Mazzy’s attempt to recover Ava Lynn, which may or may not be part of a larger plan that Mazzy may or may not understand. Nova Terra promises to return Ava Lynn if she plays the role of Seraphine, the Angel of 40. The “40” refers to the Nation of 40, formerly New Los Angeles, a nation controlled by Jo Sam and Novae Terra.

Mazzy’s role in the novel is to fret about all the awful things she’s seen until she flies to a different location so she can fret some more. She is “haunted by what might have been.” What if she had studied harder or if her mother had money or if she’d watched out for her sister? All prompting me to ask, What if you stopped fretting and did something useful, or at least interesting? Most of the time, Mazzy is either showing off or hiding her wings.

Oh right, the wings. A half-baked explanation for the wings that tries to sound sciencey appears near the novel’s end, but it’s a crock. It’s better to view this as a fantasy with a winged protagonist whose magic wings represent angelic purity of heart. Or something.

Alan Heathcock’s prose strives to be poetic and while it often achieves that goal, the style is too often a distracting substitute for actual storytelling. It’s fine to aim for literary prose, but Heathcock tries too hard, sometimes delivering pretension rather than beauty. “The silo’s amoebic light ever shifting, the tree’s golden leaves winking, and the odd birds ceaselessly singing, I became disoriented, not just feeling that the place was manufactured, but that the same could be said of my childhood home and maybe even for me.” This sounds like a description of someone tripping on acid, but it’s just Mazzy laying on her couch doing nothing.

Mazzy spends a lot of time doing nothing, other than feeling sorry for herself or pontificating about grief or her crisis of faith or the unfairness of human existence. Heathcock balances Mazzy’s dystopian angst with Mazzy’s little sister’s uncanny wisdom and strength because stories like this always have a little kid who sounds like an Ivy League divinity professor. I didn’t believe a moment of this story (at least after the wings appear), nor  was I drawn sufficiently into the story to generate a willing suspension of disbelief.

NOT RECOMMENDED