Monday, July 17, 2017

Drew Knapp: On Difficult Tasks

I'm skim-fed to the city through the baleen corridor of the Lincoln tunnel. I'm aware of the oft-inhabited expectation of this place (a movie set of indeterminate expanse, where glimpsed strangers, in their thespian intersections, become saturated with the kinetic glow of promise) and find it seems to descend from paranoia and manifest as mental succor in specie. I am not searching for ambition in the gullet of this great mechanical whale, nor escape from insecurity. In truth, there is no tangible ultima Thule to discover, no other pantheonic status desired. I have come for more money, yes, and to be closer to the family of my significant other, but the defining traits of the act--position, velocity, time--don’t clarify its meaning beyond movement. That its occurrence exists outside of my general emotional ataxia makes it important, I think--archaic content given a significative insertion into the present.

My prior home is stuck in a constant state of (what to call it?) terminal prettiness. Each frontal square snapshot stretches out across that frontier town; it collects dust in blue and green (these colors used loosely to include cyan, teal, turquoise, aquamarine) so regular that the neighbors keep their clocks by it. Whirring mercy-mild we traversed that old, motley woodsmoke bridge, unpainted and unhinged, over small creeks we bottled in amethyst like reserves for rapture–goddamn we had the freedom to make fun of it. We stomped through those howls and humps like some latterday Titans letting off steam. The place disarmed me with openness and stitched up my irony, while the old blood and the gunshot cough were swabbed away. This place was peaceful before the opioid epidemic and will forever remain not yet a dreamwork, not yet Chernobyl.

Home is not the first place a man is captive (or captivated!)–but it is surely the most relatable, and so I use it to set the table: The cabin had once belonged to my grandfather–a place for last stands: haggle of brickwork, a stairway of pointed mortar jogging up the spent orchid facade, each filigree of brick entablature Earth’s rebate, a vocabulary of masonic ritual. On each revisit to the old place I find the innards of the house paused in time–MomMom’s beaded dresses lay embalmed in dime-store tissue and cedar cabinets, a number runner’s box of betting slips still wedged between the hand-sawn joists above the single room, a collection of whalebone corsets piled unceremoniously on the table among thin tubes of ether and empty glass bottles rayed in a circle. Visualizing the motions of a busy family is kind of like tracking shadows in a kaleidoscope, but I have vivid memories of the sounds of the place: my father’s shirk of duffle to the washroom, the windowsill radio humming Pacini, clack of tin and razor, screech of medicine cabinet, the whip pop of cream being frothed into a memory of meringue dabbed from cheek to chin to cheek, running water over porcelain, straight razor ringing like a tuning fork off the spicket.

Hear the loving language I tell it with. The notion of captivity should not always be reduced to the roles of prisoner and warden. Sometimes we must glance at it sideways, look down on it or up at it, move past it quickly, stop and hold it close for a while–here is the prescribed thought: I am captive to my home because the place relies on me to see it as such to be so; my home is captive to me because I rely on it to stay homelike to qualify as such–if either side waivers the whole binary notion collapses and the self-referential meaning I impart to the word disappears along with my identity in the context of this place. Preservation of the relationship requires upkeep and each moment of the present maintenance becomes a refrain for itself as it moves into the past–a structure with two shapes like Wittgenstein’s rabbit | duck–refrener from refrenare: re- (expressing intensive force) + frenum ‘bridle’; or, efraindre from refringere: ‘break’, based on the Latin refringere, ‘break up’. From the east the word lets us start over; from the west it lets us leave.

It is this express relationship with the cradle that allows the certain freedom of perspective one is gifted when assuming the identity of a pedestrian in a new city. There is nothing quite like donning the costume of an average day and witnessing it gleam in new places. Today’s life-hike begins in Astoria, named so to draw money out of the richest man in the country (an investment that never manifested in any meaningful way), at the intersection of two streets: the first is named for a piano company whose products were advertised as mania-inducing in 1867, the second after a famed curator of reptiles for the New York Zoological Society. In short, it seems I stand at the gateway to a very strange riddle.

This is perhaps why, hours later and many steps into the neon chrome and new smells of Manhattan, I am disregarding the daily spectacle of too-much-life in bloom, like I’m looking on it through the window of a backlit room, discerning mostly the reflection of myself overlaid on the hazy scenery and recalling, the way one does a mantra, a small excerpt from an old book by Siegfried J. Garethewohl on the philosophy a man must hold when he first explores new space: “[any system] of this kind must therefore be studied to define man’s objectives for the system, his functions within the system, and the information necessary to establish the requirements for an efficient use of the system.” Put another way, I am wondering what I am here to do, what I am able to do, and what I need to know to do so. All day, this curiosity is chewed up by toothy skyline and spit out as noise. If there is a simple answer, it is not easy to detect.

Foucault wrote of difficult tasks in his Madness, though he related the adjective to a scope of time, rather than hardship: “What is difficult behavior? Basically, behavior in which a vertical analysis reveals the superimposition of several simultaneous forms of behavior. Killing game is one form of behavior; recounting one’s exploits, after the event, is another. But at the very moment one is lying in wait for one’s quarry, or actually killing the animal, to tell oneself that one is killing, that one is in pursuit, that one is lying in wait, in order, later, to be able to recount one’s exploits to others; to have simultaneously the real behavior of the hunt and the potential behavior of the account is a double operation, and although apparently simpler, is in fact more complicated than either of the others: it is the behavior of the present, the germ of all temporal behavior, in which the present action and the consciousness that this action will have a future, that one will later be able to recount it as a past event, are superimposed upon one another, are meshed together.”

A short walk past the crowded National September 11 Memorial & Museum seems to prove him right, though we’ve traded the gun and buck for a phone and a monument. Somewhere in this exchange, the anticipated act of recounting has collapsed into the event itself. The snap and post has, for many, supplanted the sensory experience. In the void left behind by this compression, receiving praise--or at least, a reaction--has moved in as the expected potential.

At a macroscopic level, society produces and maintains these counter-factual expectations in spite of disappointments. In keeping experience at arm's length, one inhabits paradox: his observations are both protected from the vulnerability of true exposure and prohibited from the steady fortification of certainty. Maintaining unfulfilled expectations made in this state (to refuse to learn from facts) disables the utility of shared knowledge and of society’s role in human progress outright. More damaging still, communication of this intention uses the symbols of normativity. The cost incurred by this process is a shifted import of understanding--beliefs fall under a pathology, one does not need to have possessed a disease to know it's bad for him. In hindsight, the political turmoil present in this country was laughably foreseeable. I can look at a photo of my grandparents’ house and find a memory, but the peace formed in that transaction requires a great cache of exploits to which the signifier can call back to; it is not a commodity that can be produced solely as an object of its own recounting.

So what can be done? What is it that I am here to do? In 2016, President Barack Obama laid wreaths at the Hiroshima Peace Memorial with Prime Minister Shinzo Abe of Japan. Following the ceremony, he addressed the crowd: “The scientific revolution that led to the splitting of an atom requires a moral revolution as well.” In the context of the speech, this statement seems to imply that particularly American type of inspiration--the idea that human belief can be submitted, then worked--though I think in isolation it still holds as necessarily true. In the desire to rebel we find the morals that provide our ethics with valence. And in the way this memorial display was an act of rebellion against the very violence that necessitated it, I am pointed toward new behavior by the discovery that even in a profligate and beautiful city, stark apathy will seep into any space it’s allowed, riding the back of unattended humanity, each time gaining ground as we more regularly forget to marvel then and again at the smashing nonchalance of nature. To wander and wonder, this is what I’ve come for--through the belly and bones of this creature, each storefront inside it lit up in the last of a broad sunset strung with gems--hoping that you are as anxious as I am. I will walk like I am wary of collecting dust, forget for now my phone, my plans, my neuroses, and embrace instead a rambling devoid of adjectives, as though the very here and now were becoming a kind of paradise to sit in, listening, largely mindless of the risen, cloudy brilliances above.

What I am able to do? In the act of being consumed, food, as it turns out, is granted two specific powers--the ability to poison, and the ability to nourish. Perhaps concern is helpless here, quite extra; yet, I must believe that if we make the naive gesture, bend and hold the prone man’s head, walk the plank with strangers, we might someday ward off, at all costs, those great wounds that can be knelled dumb by each other’s presence. To patch with brand of love the rank grimace that hangs on forgotten faces. To trim back to shape the poverty that assaults the ego. To provide the mere chance of making harbor through this racketing flux. To taunt others to valor, or at least peace, in re-assuming their names.

As for what I need to know to do so? I have no idea, but I’ll figure it out. In the future everything is absurdly possible. If nothing else, I must remember to live before I speak. The story must be distilled from reality, it cannot just be poured over life like lacquer. Outside my new apartment, a fresh cigarette is lit, a fluent mayday. Through the door, Eva has fallen asleep; tonight the bed is blue and the angels of morphia will soon bear me up to walk among the sleepers. I think of lullabies: bloom about me like night flowers; moon bald and wild look down on me, eye of a little god, with your particular luster and delicate silence. I am silver and exact, he says, round and flat and full of wry advice. There is a dignity to this; there is a formality--such blue currents in the veins of my loved one, the flowers vivid as bandages now, and I am not mystical, just trespassing stupidly, casting with my snares for any intolerable vowels that might enter the woman's heart. Above the roof, clouds steer a burnished drift and the air becomes bright for looking.

*

Drew Knapp is a writer and editor based in Astoria, NY. His other work can be read at drewknapp.info. He can be reached on Twitter @ggzuzwan.

Monday, July 10, 2017

Int'l Essayists: V.V. Ganeshananthan on Sunila Galappatti



As Told To, As Heard By


Sunila Galappatti and I met back in 2009, when I was part of the Galle Literary Festival in Sri Lanka, which Sunila was then running. We had a brief but memorable conversation, and have remained correspondents and become friends. We’ve met a few times in person since, most recently in Edinburgh, where we did an event together at a conference as part of the launch of her first book. Later that year, I took the book to Sri Lanka with me, where I traveled with someone who repeatedly borrowed it. I myself devoured it in a few days, and could not help but agree with my companion, who declared it “fantastic.” (In fact, he used a more emphatic phrase than that, but this is a family-friendly column, at least today.)

Sunila’s book has a comparatively unusual form. Indeed, it is not solely Sunila’s book. It is the story of Commodore Ajith Boyagoda, an officer with the Sri Lankan Navy who spent eight years as a prisoner of the militant Liberation Tigers of Tamil Eelam, which fought Sri Lankan security forces for decades in pursuit of a separate state for Sri Lanka’s Tamil minority. The Tigers were a proscribed terrorist organization in many countries, including Sri Lanka. Sunila spent years talking to Boyagoda about those years, and then wrote a first-person account of his story based on their conversations. The result: A Long Watch: War, Captivity and Return in Sri Lanka, by Commodore Ajith Boyagoda as told to Sunila Galappatti. The book is captivating, and surprising, not least because of Boyagoda’s voice, which is measured, introspective, and clear. “I could see when I came home that people did not want to hear the story I told. I had been a prisoner of one of the most ruthless terrorist organisations in the world yet I couldn’t tell a ruthless story. People talk about the LTTE all the time; I lived with them for eight years and no one—not even my own naval command—ever wanted to hear my account of what they were like,” Boyagoda says in the book’s prologue. Here, then, the book’s dual surprise—the Tigers did not behave as one might have expected, at least with Boyagoda. And neither is he the storyteller one might anticipate under these circumstances.

After reading the book, I was interested in thinking about the liminal space and history of that ‘as told to.’ I could think of so few other books I admire that fit into that category—Malcolm X as told to Alex Haley was a prime contender. I also loved Andre Agassi’s autobiography, Open, produced in collaboration with J.R. Moehringer. Mostly, however, the American version is a form of storytelling I have associated, fairly or unfairly, primarily with celebrity and biography lite. I thought about whether I should reexamine these conceptions, and what ‘as told to’ in A Long Watch meant. Is ‘as told to’ a form of editing? Is it writing? I asked Sunila what she thought, and if in preparing to work on the book, she turned to any particular books as models.

Sunila wrote:

Believe it or not I have never myself read a book ‘as told to’. I’ll admit we chose it because it the closest convention available. I always think the more accurate description would be: ‘as heard by’.

Let me try and explain. Yes, I strove to be faithful to the way the Commodore told the story and especially to his tone in telling it. Yes, he checked that what I had written felt true to him. And yet the nuances I heard – the passages in the story that struck me - may have been different to those that caught another listener. And we know language is not incidental, not transparent – his story/my words is how I simplify it when people look for the lines of responsibility in it. 

It was writing not editing, to answer your question, but the two are close cousins – especially when it comes to the ethical responsibilities implicit in any non-fiction.

She traced her path to developing this approach: 

I could draw a line through a number of dots here – let me choose that way of telling the story. I started my career as a dramaturg in the theatre in London. In my early 20s I was fortunate to work on a production based on Shakespeare’s Pericles: a collaboration between my company, the Royal Shakespeare Company and Cardboard Citizens, that makes theatre with and for people who are or have been homeless. During one conversation, Adrian Jackson, the Artistic Director of Cardboard Citizens, showed me the transcript of an interview with a man who had been walking for, I think it was, 16 years. Reading through pages and pages of his unruly narrative you slowly realised that he had once lived in a house where the door bell had rung and someone at the door informed him his daughter had been killed in an accident. That was when he started walking. I’m not sure I’m remembering all the details of the story right but I remember the feeling of reading the transcript, the collapse of time within it and the strong sense that I could only know this man’s story by listening to him on his own terms. 

Since then, you could argue that I have been working on that principle. Soon afterwards, I worked at Live Theatre Newcastle, in the early 2000s when there was increasing interest in verbatim theatre. There I developed and directed documentary theatre pieces with individuals from the community around the theatre. I found I loved the challenge of finding form for lived experience – but form that made it clear this was a part of the story, the story still belonged to the person who lived it and they were showing you what they chose of it. Form that was ethically considered and collaboratively agreed.

I suppose the book I wrote with Commodore Boyagoda represented the first time I was working with written form in this way.

The book was published more or less a year ago, and we did an event together in Scotland at which we spoke about it. Since then, many more people have read the book and talked to you about it. Has any reaction greatly surprised you? Can you speak, broadly, about your interactions with readers of the book?

I wonder if it will surprise you to hear that although I have spoken about the book on three continents now I don’t consider that I know that much about the reactions of readers. When I do speak about the book I love being asked questions to which I don’t have ready answers; questions that make me think afresh. But what I love even more is feeling that reading is a private experience for each reader and I won’t know the conversations they have with the book as they are reading it. And the knowledge that those conversations may change over time. I felt a kind of relief when the work moved from manuscript to book form – as though it was no longer mine but anyone else’s. On my own shelves, it sits between the essays of George Orwell and a fascinating book by Bella Bathurst about the building of the Scottish lighthouses – because that’s where there was space to put it.

How did you think about Boyagoda’s emotional arc and doing justice to it as you did your research? Was straight chronology always your plan?

Funny you ask this question. I asked it of myself many times before I started writing. Should I start with the Commodore’s capture? But then I would lose the poignant story of the 19-year-old who joined a navy because he liked its uniform and never saw war coming. Should I work backwards from the Commodore’s homecoming? But did I have a good enough reason not to go chronologically. Ultimately I decided the narrative ought to seem like the man and the chronology suited the Commodore. His reaction on reading the first draft? “Do we have to start at the beginning?” In the end, I don’t think it was so much the Commodore’s emotional arc that led but the arc of change that he described in the country around him.

Can you talk, perhaps even in somewhat technical terms, about the process of going from notes and recordings to these chapters and polished narratives? 

The technical term I would use is repetition. The first time the Commodore told his story I didn’t really ask him questions. I wanted to hear the story he told. I recorded it. I listened again to it. Then I went back and asked the Commodore questions about certain passages of the story. I recorded those conversations. I listened again to them. In this way for more than three years we went over the story again and again. All the while I was trying to get to know the Commodore’s voice well enough that I could write with his tone and character even while using my own turn of phrase. The chapters and structure of the book came more naturally - I think pace and rhythm are the forms of logic I trust instinctively. I edited the book by reading it aloud over and over again.

Which section of the book was hardest to render? Why?

This is such an interesting question and one with alternative answers. Listening to the Commodore’s accounts of early captivity was hard because it was such an airless part of the story - there were no signs that things would change. Then to render that airlessness in writing was a challenge – I wanted the reader to feel the vacuum in those cells but without slowing the narrative down to a halt. 

The other challenge was the last section of the book – the Commodore’s homecoming. In many ways to me this was the most revealing part of the story – it was his return to the world that made it clear how far he had been removed from it. Yet here was a new difficulty because a more conventional privacy surrounded this homecoming – back among family and friends – and I had chosen not to intrude further into the Commodore’s life than he invited me. We were back on a conventional footing about what I would and would not ask. But I suppose this section was still easier to write than his transition into captivity. In a sense, I also knew the Commodore better later in his story.

How did you think about titling the book?

Truly? I made a long list of appalling, semi-nautical titles over several months. I wanted a novelistic title because it’s a book you read as a story. The manuscript was first named after things the Commodore had said: The Next Hour (‘if you survive this hour, the next hour is available to you’) and then The Surface of the Sea (‘on the surface of the sea you become very small’). Finally, I sat in a North London pub with my publisher and we tried again. When we came up with A Long Watch I was hopeful the Commodore would like it too, for its naval overtones. I went home and called him to ask. He did like it and that became the title.

So much of Sunila’s story of writing the book sounds appealingly collaborative. I like “as told to,” but I love “as heard by,” and the way it underlines Boyagoda’s agency and centrality as the teller of the story. Recent debates about appropriation have presented binary choices: when asking the question of who has the right to tell the story, we see only two options: the person to whom the events happened, and a writer seeking to portray those experiences. Sunila’s book presents a third path, one I hope will become more common, and which offers a method of showcasing such stories in ways that are rigorous, inventive, truthful and clear.


Further reading:

By Sunila Galappatti: Did He Go Stockholm?

&

Michael Ondaatje interviews Sunila Galappatti about her work on A Long Watch 



V.V. Ganeshananthan teaches fiction and nonfiction writing in the MFA program at the University of Minnesota. Her debut novel, Love Marriage (Random House), was longlisted for the Orange Prize and named one of Washington Post Book World's Best of 2008. The recipient of fellowships from the National Endowment for the Arts and the Radcliffe Institute of Advanced Study at Harvard, she is at work on a second novel, excerpts of which have appeared in GrantaPloughshares, and Best American Nonrequired Reading 2014.



Craig Reinbold was the managing editor of Essay Daily from 2013-2016 and co-edited How We Speak to One Another: An Essay Daily Reader. He curates this Int'l Essayists column. Send suggestions, thoughts, comments to @craigreinbold @essayingdaily








Monday, July 3, 2017

Robbie Maakestad: On Pneumothorax and Writing Medical Trauma

This past spring semester I taught an introductory literature course at George Mason University. For our final text of the semester my students read Mike Scalise’s The Brand New Catastrophe: A Memoir—a hilarious (albeit harrowing) account of dealing with the hormone-less fallout of emergency surgery to remove a ruptured tumor on the narrator’s pituitary gland. In order to undermine the medical trauma, the juggling of drugs post-surgery, and the deep level at which this event transformed his life, narrator-Scalise consistently cracks jokes.
Yet, this book is more nuanced than an entertaining take on a medical catastrophe. For instance, look how Scalise begins the prologue: “Telling a good catastrophe anecdote means becoming a maestro of sympathy.” Later, he continues, “The trick to keeping [the audience] engaged is to focus on the oddities and ironies that would seem incredible and ridiculous in any context, not just that of your disaster.” And so, throughout his memoir, Scalise takes his own advice. I found myself not so much drawn to the humor and bizarre circumstances that Scalise explores, but rather I gravitated toward his writing about the way medical stories are told, how they are crafted for an audience.
            Throughout the book Scalise tells his pocket version of his pituitary trauma to various effect and with varied purpose: via email blast to friends and family [claiming the surgery as an accomplishment], at a family get-together [complete with slideshow], at a Manhattan party [for the first time his story entertains an audience], and to his boss at his first job [empathizing with her medical condition]. He even spills his story during an interview with a publishing house [an abject failure], and follows this up by inquiring about the quality of their health insurance policy.
As the reader observes this narrator feeling his way into an understanding of how and when his story works (or does not work: see publishing house interview), the reader is able to gauge the way illness narratives function for an audience—a metacognitive analytical experience since readers are in themselves an audience. The very act of reading Brand New Catastrophe becomes a learning experience in that subconsciously Scalise’s readers consider when and how to tell tales of medical trauma while also engaging with an entertaining memoir.
As such, a recurring point of class discussion ended up being the way Scalise consistently wields humor to deflect the reader’s pity. As Scalise begins to craft the narrative of the wracking headache that first sent him to the ER, he breaks back into narratorial explication of how one best relates a story of medical trauma: “Notice how the focus here is not on the vast pain that commandeered my head that night. Pain is a socially competitive thing, and too much emphasis on it can cue people to recall their own bouts with pain, or compare theirs to yours.” And this proves true time and again in Scalise’s narrative; by attaching the reader’s focus to the humor present in his situation, Scalise causes the reader to move beyond their propensity to feel sorry for a narrator wading through difficult circumstances. Perhaps the best medical nonfiction, then, finds a way to deflect the reader’s pity, or to avoid it all together.
***
            In March of 2009, my left lung collapsed in the middle of an intramural basketball game—a spontaneous pneumothorax—which hospitalized me in middle-of-nowhere Indiana, fifteen minutes away from the college where I was studying. Though unlikely, a pneumothorax is a common-enough diagnosis for tall, thin, white dudes in their late teens. As the chest walls extend with growth, so too do the lungs, which can become unwieldy and weigh too much to be supported by lung tissue alone, causing the organ to fissure, air to escape into the chest, and the organ to shrivel like the popped balloon that it has become. Once a surgeon stabs a tube into the chest cavity, the air escapes, restoring the body’s internal pressure balance, allowing the lung to reinflate. A week or so resting in the hospital is usually standard for the body to patch scar tissue over the fissure, restoring the pneumothorax victim to health. And this is precisely what happened to me.
            Sitting in that podunk hospital, I found that when friends and family visited, they approached tentatively, as if I was fragile. After asking how I was doing, they’d inevitably express their sorrow over my defective lungs, which was the last thing I wanted. Rather, I missed the joie de vivre of college life, of living in a dorm surrounded by friends, of dinners at the dining commons, of going to class. After laying in a hospital bed for days watching America’s Funniest Home Videos marathons, the last thing I wanted was pity. I already pitied myself. When friends visited, I deflected their condolences with attempts at humor: “It’s cool cuz once the chest tube comes out the hole allows for Mr. Potato Head attachments,” etc., etc., ad nauseum. Even when my dad walked into the room immediately post-chest-tube-implant, I closed my eyes and splayed myself dramatically across the bed, playing dead—a joke to downplay our family’s first major medical drama. Without a second though, my dad, thinking I was still “out” (though I had been awake for the entire procedure), snapped a photo with his brand new smartphone so I “could see myself later”—my first attempt at pity deflection memorialized in snapshot.
***
            But this avoidance of the reader’s sympathy raises a question: if the success of medical essays hinges on the deflection of pity, what then is the purpose of writing it in the first place? For if an essayist attempts to fully encapsulate their own medical trauma on the page, is not the essay at some level a request for the reader’s pity? Likely most people have not experienced similar trauma, so exposing the reader to a nonfictive medical experience forces the reader to grapple with that account, to reckon with the experiences of another—a situation in which they cannot help but feel some semblance of pity.
            In her 2003 New Yorker essay, “A Sudden Illness,” Laura Hillenbrand writes of developing Chronic Fatigue Syndrome (CFS), a disease about which little is known, and for which she bounced from doctor to doctor in search of a diagnosis. The essay recounts years that Hillenbrand spent in bed, crippled by the disease, too dizzy to stand up, locked in a stalemate with CFS. Though Scalise argues against leveraging the reader’s capacity for pity, Hillenbrand does the opposite; of the essay’s 7525 words, 5295 (70 percent) detail her wide range of devastating symptoms and the variety of misdiagnoses that doctors ascribed. The essay reads as a veritable tsunami of pain—the chaos of symptomatic overwhelm.
Though at times the reader slogs through the narrator’s listed symptoms, the effect is that the reader begins to understand, if only fractionally, what it is that this narrator herself experienced—a shift from pity to empathy. The recounting of this disease’s resulting isolation and debilitation restricts the reader to Hillenbrand’s metaphorical bed of symptoms: “The realm of possibility began and ended in that room, on that bed. I no longer imagined anything else.” Just as Hillenbrand’s narrator is confined to a piece of furniture in her bedroom, the reader also does not move beyond the overwhelming description of the symptoms until the ending in which Hillenbrand leverages the stridency of pain in an unexpected shift outward, beyond her pain and her struggle with symptoms, to a hope for reprieve—a breath of air beyond the sick chamber—a rolling back of the reader’s pity, replaced by hope for this narrator’s future health.
***
Two months after my first hospital stay, my lung collapsed a second time, so a friend drove me to a hospital in Indianapolis—one that had actual lung specialists. When a lung deflates too significantly to permanently repair itself or when it collapses multiple times (my case), the surgeon recommends surgery to glue the lung to the ribcage in order to take the weight off of the organ: a procedure known as pleurodesis. To affix the lung, a surgeon slits open the skin to the side of the pectoral muscle, and inserts a de facto tire jack between the ribs to ratchet them apart without breaking the bones. The surgeon then sticks his hand into the orifice to manually manipulate the deflated-football lung until the ruptured tissue is located. The fissured area is sliced out, and the lung gets stapled back together, which enables breathed air to expand the organ, reestablishing the full flow of O2 to the bloodstream. The surgeon scrubs the medical equivalent of steel wool across both the lining on the organ’s exterior and the interior lining of the ribcage, and deposits acidic talc powder upon the freshly abraded surfaces. The lung is pressed against the ribs to trap the acid powder between, which reacts against the bleeding tissue and creates gobs of scar tissue, bonding the organ and bone—a procedure that sounds rather medieval in execution. But, for how inhumane it sounds, my recovery was not as bad as I had been told, and the surgery worked to lessen the self-weight of my lung.
***
            In his 2003 Georgia Review essay, “Bullet in My Neck,” Gerald Stern dramatizes the moment when two would-be thieves shot up the car he was traveling in at a stoplight in New Jersey. One bullet hit his chin and lodged in his neck, and another grazed his shoulder. Slumped over, Stern floored the gas pedal with one hand, and his driver, Rosalind—a fellow poet—took the wheel and drove them away. Though a fantastic hook to the essay, Stern’s handling of the shooting itself only spans half a paragraph.
Rather, Stern focuses on the shooting’s aftermath. He details their difficulty in finding a hospital as anyone he asked for directions shied away at the sight of all his blood. But they eventually found one; he does not remember how. Though Stern details the medical treatment he received at the hospital as well as his difficult recovery, throughout these passages, Stern continually focuses on the suffering of the other: Rosalind, who was left alone and untreated in the hospital while he was cared for; a frog that his friend abused as a child, which child-Stern put out of its misery; Bruno Schulz, the Polish-Jewish writer and painter, killed by a Nazi officer; and Stern’s own sister’s death from cerebrospinal meningitis. Stern ends his essay:
And I want to remember how small was my brief “suffering” compared to thousands of others’, what cruelty, absurdity, insanity, maliciousness they were forced to experience, how the lamb itself was twisted and pulled in a thousand ways, how it wept for itself at last, just as it wept for others—and continues to do so.
Rather than allowing his own pain and suffering to take a central role in the essay, Stern uses these as a vehicle by which he can examine suffering itself beyond his own experience, as a human experience. Rather than leveraging the reader’s pity as Hillenbrand does, Stern shows that it is also possible to redirect, affectively guiding the reader’s sympathy elsewhere.
***
Though pleurodesis solves the problem of collapsing lungs for ninety percent of people who suffer a pneumothorax and opt for surgery, I fall into the unfortunate remaining tenth percentile. Normally, if a lung collapses after pleurodesis, the scar tissue that affixes it to the chest wall holds the organ up and open, still able to breathe, which allows the lung to heal itself. Yet, in my case, two years after I’d had pleurodesis, my lung collapsed so significantly that the organ ripped away from the scar tissue and fully collapsed.
This surprised the surgeons, who relayed a more permanent option than retrying pleurodesis: a pluerectomy. The procedure would be precisely the same as pleurodesis, but this time the surgeon would rip out the pleural lining surrounding the lung so that the lung could adhere directly to the ribcage itself—an even stronger bond than previously, albeit one whose recovery would be ten times as painful given the nerve endings that would be exposed with the removal of the pleura. I opted for this procedure, rather than risking a repeat failure of pleurodesis—what I hoped would be the right decision.
That night while waiting for an operating room to open up the next morning, I had trouble sleeping, so I did some research on the procedure and found that the surgery was only about sixty-five years old—first performed in the 1950s. While that is many years during which a medical procedure can be refined, even more than that, I found comfort in thinking that I was alive within the slim fraction of human history during which this surgery has existed. Previous to 1950, a pneumothorax would have permanently invalided me if not been my death sentence.
***
            In her seminal 2014 essay in The Believer, “The Empathy Exams,” Leslie Jamison details her experiences as a medical actor, as well as her decision to get an abortion—blowing both open to explore the human capacity for empathy. Here, Jamison explores the crux of handling pity as pertains to her decision to get an abortion: “I wanted someone else to feel it with me, and I also wanted it entirely for myself.” This evidences the inherent contradiction of writing the medical trauma essay: though the writer desires to avoid overwhelming the reader with descriptions of pain and suffering (evoking pity), at some level the essayist must share their pain with the reader, in order to capture the reality of what they experienced (evoking empathy). The issue then becomes landing in the middle of the continuum of sharing too much pain and sharing too little. 
            But this leads to the question: why put the medical trauma on the page in the first place; what is gained by sharing it with the world? Again, Jamison has the answer. In her essay “Grand Unified Theory of Female Pain,” published by VQR in 2014, Jamison writes:
What’s fertile in a wound? Why dwell in one? Wounds promise authenticity and profundity; beauty and singularity, desirability. They summon sympathy. They bleed light to write by. They yield scars full of stories and slights that become rallying cries. They break open the fuming fruits of damaged engines and dust these engines with color.
Essaying medical trauma, then, presents an opportunity to mitigate the experience itself, to attach to a meaning beyond the pain and trauma, just as Gerald Stern found himself able to do. Later in the essay, Jamison returns to the explication of wounds:
Wound implies en media res: the cause of injury is past but the healing isn’t done; we are seeing this situation in the present tense of its immediate aftermath. Wounds suggest sex and aperture: a wound marks the threshold between interior and exterior; it marks where a body has been penetrated. Wounds suggest that the skin has been opened—that privacy has been violated in the making of the wound, a rift in the skin, and by the act of peering into it.
This logic holds true when broadened to the writing of medical trauma, for what is trauma but a physical or mental wound? When writers peer within the traumatic circumstances surrounding medical emergencies or treatment, they name it, giving voice to the wound. By spreading wide the skin of the medical trauma and poking around to find what’s raw, writers reveal the heart of the wound. For in the telling, some element of healing takes place.
***
Three years and a move to the east coast later, the pluerectomy still held my left lung in place, but for the first time, my right lung collapsed. I was eating a bagel sandwich when I felt the familiar gurgle of air escaping. Three days later, the hospital released me to meet with a specialist since my lung had stabilized. In an hour-long consultation, my new surgeon prodded for my complete lung history—each and every collapse or gurgle of air escaping, no matter how minor. The tally: nine lung collapses, this most recent being the tenth. Once he had established a complete timeline, he thought for a moment and said, “Well, if I didn’t know you or your past, I’d recommend waiting to see if the lung stays stable and remains inflated. But given the circumstances, I’d be willing to do surgery if that’s what you’d prefer.” When I asked what he would do in my situation, he chuckled. “If I were you, I would push straight for a pluerectomy.” As I left his office, I breathed shallowly, a pluerectomy scheduled for the next morning.
***
            Perhaps my favorite medical trauma essay is Rachel Riederer’s “Patient” from the spring 2010 issue of The Missouri Review, in which she details an accident in which a bus ran over her left leg, crushing her foot. Unlike any other trauma essay I’ve read, this one captures the raw incongruity experienced as a medical trauma unfolds: the questioning, the uncertainty. In the moment where the bus sits atop her leg, the narrator asks an onlooker, “Can you please tell him to move?” In that moment, Riederer reflects, “It is easy to be calm because I cannot really have been run over by a bus.” Though the bus sits on top of her leg, she denies the actuality of her injury—a rhetorical move that repeats itself throughout the essay.
For instance, in the hospital Riederer cannot move her toes when the doctor requests that she do so. She writes, “My toes would have bent. My feet are pretty and obedient. They are slender with high arches. Yes, they are callused on the bottom, but they are nothing like this fat red blob that has had all the foot shape squashed out of it.” By crafting the narrative to include these moments of disbelief, Riederer immerses the reader into the surrealism of the moment, allowing them to feel her shock and her inability to grasp the reality of her crushed foot.
Further, Riederer creates a deluge of drama: doctors deciding whether or not to amputate, nurses debriding her tissue, the decision not to amputate, her detached calf muscle dying a little bit every day, the first glimpse she gets of her own leg post-surgery. All these recreations of the then-narrator experiencing and feeling in the moment add texture to the essay, establishing the vividness of the “then” in order for the reader to best engage with the experience crafted on the page. By immersing the reader in breathlessly vivid scenes, no room for pity remains.
***
Before I was released from the hospital post-surgery, my surgeon stopped by my room. “Here,” he said, holding out a business card. “I wrote my personal cell number on the back. If anything happens with either lung, give me a call day or night, okay?” At first I found this reassuring—my own on-call lung specialist. But after he left I began to have my doubts; under no circumstance would a specialist hand out their personal cell number unless they thought it absolutely necessary.
Two years out, my lungs remain stationary within my torso—firmly adhered to the chest wall. Though I have been medically cleared for all activities except smoking and scuba diving, and though I have almost no residual side effects except for extreme shortness of breath if I exercise, my lungs cast a constant presence over my life. I am cognizant of every gurgle and groan within my chest, every torsional shift while sitting or laying down, of the stasis of my lungs while my other organs move freely when my body is in motion. It’s not that I am scared or afraid that they’ll collapse again; rather, it’s a finely tuned bodily awareness usually glossed over by the brain. Two years out, I have yet to call my surgeon’s cell, but it’s a number saved into my contacts just in case.
***
            In the conclusion to Brand New Catastrophe, after so many pages spent telling and retelling the story of his brain tumor in different contexts, of learning when and where and how to tell the tale, Mike Scalise writes, “And it becomes possible… to grow infatuated with something, even as it destroys you.” Here finally Scalise recognizes the way the story of his brain tumor consumed him in the years following surgery, the way that a façade of humor and an engaging retelling spackled over the hole that his medical trauma had worn throughout years spent juggling hormones levels via medication and further treatment.
And is this not precisely what the medical trauma essay must avoid? A spackling over? A façade? At heart an essay digs deep to open something up, to unearth that which is hidden within, to expose the truth tucked beneath the surface. So too must the essayist push beyond the trauma, the medical terminology, the shock, the pain, the uncertainty, and probe the wound in order to suss out greater meaning.

*
Robbie Maakestad received his MFA in Creative Nonfiction from George Mason University where he was the Editor-in-Chief of Phoebe. He currently reads and edits nonfiction for The Rumpus and has been published or has forthcoming work in The MacGuffin, Free State Review, and Bethesda Magazine, among others. In 2017, Robbie was shortlisted for the Penguin/Travelex Next Great Travel Writer Award. Follow him @RobbieMaakestad.

Source Materials:
Hillenbrand, Laura. “A Sudden Illness.” The New Yorker. 2003.
Jamison, Leslie. “Grand Unified Theory of Female Pain.” VQR. 2014.
Jamison, Leslie. “The Empathy Exams.” The Believer. 2014.
Riederer, Rachel. “Patient.” The Missouri Review. 2010.
Scalise, Mike. The Brand New Catastrophe: A Memoir. 2017.
Stern, Gerald. “Bullet in My Neck.” The Georgia Review. 2003.