JUNE 28, 2014
A FIST-SIZED HEART, beating in a stranger’s chest. A headless torso, stashed in a walk-in closet. A flap of loose flesh, drooping over a man’s eye. A lone big toe, hacked from a foot, the toenail painted blood red.
These are just a few of the body parts memorably examined by Kodi Scheer in her debut story collection, Incendiary Girls. The book takes its title from its final story, which follows the path of Vartouhi, a refugee from an unnamed atrocity (her story comes from a tale out of the Armenian Genocide) who loses her family and is sold as a slave. She eventually makes her way across a vast desert to travel to America, where she raises a family of her own. Narrated by an observing angel, the story is interested in how, specifically, the mind and body operate in order to survive something as horrific as a “systematic massacre.” In other stories, survival takes place on a smaller — but no less significant — scale. One woman survives a heart transplant and, for the first time, feels close to God. Another prepares to conduct her own cancer surgery, willing herself to beat the disease for her daughter’s sake. Women survive breakups, bad drug trips, and betrayal by their own genes. Not every character is so lucky — a burn victim succumbs to a “superbug,” a beauty queen is dismembered by her competitors — but taken together, these 11 stories encourage you to marvel at human resilience in both its physical and spiritual forms. You’ll likely marvel at Scheer’s imagination as well. In direct and unadorned prose, she reveals the strong emotions and the strange selves that are unearthed by medical procedures, by doctors’ hands.
Scheer, a premed undergrad, understands well the relationship between illness and identity. While pursuing her MFA, she helped develop a writing workshop for cancer patients. She later won a grant to fund a similar program for patients and caregivers at a Michigan hospital. These projects allowed her to merge her youthful fascination with the body’s internal workings with her more mature interest in narrative. Explaining her choice to abandon medical training, she told the LA Times book blog, “I worked for several years in a neurology lab, but found myself much more interested in people’s stories than their pathologies.” As a teacher and a writer both, she shapes these painful narratives into compelling art.
Of course, Scheer is far from alone in making the connection between medicine and storytelling. Narrative medicine has emerged as a robust field, one that influences periodical contributor lists, academic scholarship, and medical school curricula. The New Yorker and The New York Review of Books regularly feature the writing of doctor-writers Atul Gawande, Oliver Sacks, and Jerome Groopman, among others. Conferences join scholars in the humanities and social sciences with clinicians. At one such conference, “A Narrative Future for Healthcare,” held at King’s College London in 2013, participants discussed “narratological thinking in literature, philosophy, and ethics.” Columbia University offers a terminal masters degree in Narrative Medicine and requires its doctors-in-training to do a fair bit of writing when they’re not in anatomy lab. In their Foundations of Clinical Medicine course, students respond to prompts based on poems, fiction, and essays. As a friend of mine who had recently finished the Foundations course put it, “I think the point is to get medical students — stereotypically robotic type A people — to learn how to feel through literature and writing.”
Learning how to feel. How strange to think of cultivating emotional capacity in a classroom, as part of one’s professional skill set. But learning to feel — or learning to give the impression of feeling — is now a central part of medical training. This is an education that Leslie Jamison describes beautifully in the title essay of The Empathy Exams, her essay collection published earlier this year. Working as a medical actor, Jamison displayed a set of symptoms and received a diagnosis, and a med student’s staged sympathy, in return. Afterward, she evaluated each student’s performance according to a checklist. “Voiced empathy for my situation/problem” reads one item. “It’s not enough for someone to have a sympathetic manner or use a caring tone,” Jamison explains. “The students have to say the right words to get credit for compassion.” This, perhaps, is what Columbia’s medical students hope to acquire when they read fiction or respond to a poem: not just feelings, but the language in which to voice them.
A code-switcher, Scheer writes in two voices that are often in counterpoint. Like a doctor with a good bedside manner, she is clear and measured without being brisk or cold. Her language is precise, even technical at times; she uses words like “systole” and “pericardium” when talking about the feelings stored in the heart. These words surprise. She also, though, allows herself some descriptive moments that are less original:
Elliot rolls up the hospital Johnny and lifts the gauze from her chest. It sticks to her skin, the goo resembling strawberry jelly. Dark stitches zigzag like railroad tracks, not quite straight down her torso. Her olive skin is swollen and puffy.
But her most powerful writing comes from less expressive prose; she is wisely economical when presenting the most bizarre events. “Hannah found his left ear in the laundry hamper,” begins one story. “It was unmistakably her husband’s — small with a leaf-shaped brown mole on the lobe.” The combination of fine detail and authorial understatement draws us into the story and forces us to suspend our beliefs about how bodies work.
In some ways, the stories in this collection conform to our expectations about medical fiction. They are short, often little snapshots of crisis as seen through one woman’s eyes, but they showcase Scheer’s knowledge of medicine. They contain their fair share of tumors and lacerations, surgeries and scars. “Ex-Utero,” a story partly about a medical anomaly, involves episodes we might not be surprised to see on Grey’s Anatomy or House. But in other, significant ways, Scheer breaks with the genre’s conventions. In her medical dramas, ghosts walk, people give birth to hairy primates, and human souls descend into animal bodies. These are not metaphors but events. We could consider these stories examples of magical realism, but that label doesn’t do justice to Scheer’s powerful combination of science and spirituality, nor does it explain how her straightforward prose emphasizes the weirdness of her images. Instead of searching for the right generic category, I think it’s more pressing to examine how and why she brings a set of concerns — medical practice, spiritual belief, and, crucially, female experience — into direct relation.
The “girls” of the title story are two young women, one burned to death and one who witnesses the burning. They are not, however, the only girls who suffer. All of the stories center on women, frequently caretakers of some kind: mothers, doctors, elder sisters, or nurses. (“Salt of the Earth,” a parable about a rapidly spreading lovesickness, is the one exception.) These women get sick or get pregnant; they lose patients, boyfriends, and their grip on reality. But sometimes, in each other’s company, they find solace.
The opening story, “Fundamental Laws of Nature,” explores the consolatory function of maternal attachment. “Ellen is convinced her daughter’s lesson horse is the reincarnation of her mother,” the story begins. Ellen bases this conclusion on the horse’s eyes and her mother’s love of “anything equine.” Three generations of women share this love of horses. They also share a genetic predisposition to cancer. An oncologist, Ellen is only too aware of how genes determine disease, including the disease that gave rise to her own malignant tumor. As she contemplates her treatment options, she performs a routine pelvic exam on a young woman, a carrier of the BRCA gene, who had elected to have a preventive mastectomy. “That must’ve been a difficult decision for you,” Ellen suggests. “Not really,” the patient replies. “Watch your mom and two aunts die of cancer. I couldn’t schedule the surgery fast enough.” Ellen, who had watched her own mother die, didn’t make the same choice, but she now plans to “take matters into her own hands” and cut out the tumor. “She will take control of her own destiny.”
Destiny, like an unruly mare, proves difficult to tame. Ellen’s patient is diagnosed with cervical cancer, a disease notoriously hard to cure. “Welcome to the sisterhood,” Ellen says, pointing at her own breast; the patient sobs uncontrollably. “Fundamental Laws of Nature” ends before we learn Ellen’s fate, not to mention those of her patient or her daughter, but it ends on an ebullient note, with a nighttime ride on the lesson horse:
Now the absurdity of the situation hits her: she’s riding her mother. The laughter rises from her belly into her throat and the sound of her joy echoes in the night.
In this story, the magic of reincarnation (or at least the suspicion that such magic exists) is more curative than any medical treatment.
A mother-daughter relationship is also at the center of “Gross Anatomy,” a story titled after the class that acquaints medical students with their first dead body. This body is grosser than most, and for a different reason than we might expect. It’s not anything about the man’s corpse, which is surprisingly beautiful when described by our narrator, Kate, a first-year med student: his “subcutaneous fat was bright yellow, a vivid contrast to the gray skin,” and his “breastbone and ribs” are “hard and curved like a tortoiseshell.” It’s not his body that’s off-putting but his spirit, which haunts Kate’s home, wisecracking and interrupting her caretaking duties. Her mother is dying, her father has left, and the home nurses have been fired, one after the other. The mother, once a doctor herself, has replaced her scalpel with a gold cross, worn around her neck. “No ventilator,” she insists, “and no feeding tube.” She’s placed her remaining faith in something other than medicine.
The mother’s seemingly misplaced faith produces one of the book’s most striking images. Kate returns home one evening to find her mother “on a chair in the middle of the living room, her face partially obscured by wet strips of plaster. It looks like a death mask but Maureen’s left holes for her mouth and eyes.” Asked what she’s doing, the mother explains, “‘For a shrine in Brazil. People leave replicas of the diseased body part’ — she pauses — ‘pray to the Virgin and wait for a miracle.’ She speaks without moving her jaw or the drying plaster.” Rather than relying on doctors, this character first prays to a mother, then begins to make art. The scene helps us understand the plaster casts, maternal-eyed horses, and replicas of body parts that are scattered throughout Incendiary Girls: these are the things that might offer salvation. Kate listens to her mother and adds more plaster to the white mask.
Kate’s mother, like many other characters, is waiting for divine force to intervene in her life. The only interventions we witness, however, are medical ones. Consider the surgery in “Ex-Utero,” a story that takes place between the ER and the OR (with a couple of detours into the locker room for illicit activity). The story describes several different trauma cases, but the most puzzling case is that of a young musician who presents as a man but who possesses a uterus, one that now carries a fetus. The musician elects to have surgery and terminate the pregnancy; our narrator — who also terminated a pregnancy, but for very different reasons — describes the scene:
Nate swirls the blood around in the dish, and there it is, a translucent little humanoid that could fit in the palm of my hand. It’s hideous. Somehow, I expect it to move. It’s mostly head, an encephalus developing under the clear membranes, but there are distinct riblets and a curved spine. Tiny feet and a webbed alien hand. The other miniature arm floats nearby, an accidental amputation from the surgery. It’s both wondrous and repulsive.
The last sentence doubles as a fitting description of the newborn in “Primal Son,” the story that immediately precedes “Ex-Utero.” In this story, a couple of human parents give birth to an adorable little animal, one covered in fur. These repeated motifs — malformed babies, life-saving surgeries, the sewing together of clothing and flesh — give the collection its shape. The result of reading Scheer’s stories in one fell swoop, one after the other, is that one becomes more credulous, a true believer in the most mysterious things. She normalizes the seemingly aberrant, reminding us of how much of our world is by turns hideous, by turns wondrous. To a reader of Incendiary Girls, a spirit animal, or a resurrected cadaver, seems no more alien than a 13-week-old fetus.
After all, what could be more hideous than loss? Or more wondrous than a life saved?
For a collection that derives much of its power from painstaking accounts of medical treatments and the feelings that accompany them, it’s surprising that one of the most moving stories has very little to do with medicine. “When a Camel Breaks Your Heart” is about art, not science. Like “Fundamental Laws of Nature,” the story asks you to imagine that your loved one has assumed animal form, and it does so quite directly: told in the second person, the story achieves the kind of conversational intimacy that’s more often reserved for communication between lovers. “When a Camel Breaks Your Heart” takes place in the aftermath of a breakup. Mahir, a medical student, has left his girlfriend, or he’s turned into the camel that’s now sitting on the living room futon; it’s hard to say which is true. “Mahir’s human form just disappears,” reports the narrator. “Neat and tidy. If it were a bone breaking instead of a relationship, he’d call it a simple displaced fracture, in his medical parlance. Feel your insides twist and ache from the emptiness.” The abandoned girlfriend is as fluent in medical parlance as her former lover. Years ago, she took an anatomy class in order to better render the human form, and now, as “an accomplished figure artist,” she encourages her students to do the same. “How could they draw the human body,” she asks, “without knowing what was inside?”
Scheer is an anatomy artist of the same sort. She knows the body inside and out, can name tendons, bones, organs — all the stuff bound by skin. In drawing the body with such precision, she cuts to the heart of the feelings we have about our bodies, so vulnerable and so temporary.
The bodies drawn here are human bodies, and they are almost always women’s bodies, sometimes obviously so. A nurse performs a striptease for a dying patient in “Modern Medicine.” The beauty pageant contestants in “Miss Universe” describe, in gruesome detail, the body of Miss Afghanistan, waxed, plucked, then brutally skinned. It’s harder to say what makes the bodies in other stories necessarily feminine, or how these stories would be different if events were filtered through men’s eyes. Would they be colder, more rational, more about science and less about feeling?
I’m tempted to say, as Jamison does in her essays, that there’s something unique about female pain, its expression and its historic pathologization. For centuries, women have been seen as frail, vulnerable, histrionic, hysterical. Even now, they are more likely to have their pain dismissed by doctors as psychosomatic, as feelings that aren’t real. Theyare supposed to be in pain but not indulging pain. (And they are certainly not supposed to indulge in self-pity.) This set of dictates presents a challenge for the writer interested in women’s wounded bodies and the feelings they have about them. “How do we talk about these wounds without glamorizing them?” Jamison asks in her book’s final essay. “The moment we start talking about wounded women, we risk transforming their suffering from an aspect of the female experience into an element of the female constitution — perhaps its finest, frailest consummation.”
Scheer talks about women’s wounds in the language of doctors, those who first diagnosed women as hysterical and those who will still, on occasion, dismiss their ailments as hallucinations, insistent ghosts. But Scheer appropriates medical discourse in order to create female characters who can name their pain and who are prepared to transcend it. They will cut out their own tumors if necessary. Medicine is what saves these stories from melodrama. Still, Scheer’s women, wielding their scalpels, can’t be called cold or “robotic” or dispassionate. They feel their losses and betrayals acutely; they burn.
Maggie Doherty teaches literature and writing at Harvard University.