by Charles Bock
Issue #215 • March 3, 2016•Buy Now!
Case Study #53
Whitman Memorial, 1220 York Ave., 4th floor, Hematology/Oncology (follow-up appointment: patient background/personal history)
He couldn’t afford one of the office supply company’s high-end jobbers, so he’d sprung for your solid, middle-of-the-road, basic ergonomic desk chair. This was what he sat in. As for his diet, he tried, he really did, loading up on greens and boiled chicken, although he still snuck in red meats and fried calamari, more than he’d care to admit. Ever since kids had come into the picture, he’d been lucky to get to the gym once a fortnight. Admittedly he could have dropped fifteen pounds. Twenty pounds. So, basically he was a middle-aged somewhat-overweight white-collar dad going through the rite of manly passage known as chronic back pain. Maybe not a human interest feature in the local paper. But his spasms sure felt newsworthy. Had to pile throw cushions on that desk chair just to sit; pop Advils like they were candies just to get through the day. And rolling around on the carpet with Timothy and Suzy Jo? Please.
Charles Bock is the author of Beautiful Children, which was a New York Times bestseller and Notable Book, and which won the Sue Kaufman Prize for First Fiction from the American Academy of Arts and Letters. “Case Studies” is an excerpt from his forthcoming novel, Alice & Oliver (Random House, April 2016). His fiction and nonfiction have appeared in Harper’s, The New York Times, the Los Angeles Times, and Slate, as well as in numerous anthologies. He has received fellowships from the Civitella Ranieri Foundation, Yaddo, UCross, and the Vermont Studio Center. Charles is a graduate of the Bennington Writing Seminars. He lives with his wife, Leslie Jamison, and his daughter in New York City.
Hannah Tinti on Case Studies
A few years ago, two close family members of mine were diagnosed with cancer. I’d lost other relatives, friends, and co-workers to the disease before, but this was the first time I was dealing with the day-to-day and sometimes hour-to-hour intricacies of care-taking, surgeries, treatment side-effects, hospital visits, and health insurance. The anxiety, strangeness, intimacy, love, helplessness, humanity, and at times, God-help me, dark humor of that experience came rushing back as I read Charles Bock’s “Case Studies.”
Set as a series of fictional medical histories, each record moves quickly from the hard facts of diagnosis to the existential questions of healing, building a mosaic of the daily, quiet heroism of patients and their caregivers, while at the same time condemning the bureaucracy of our current health care system. I encourage everyone to read Charles’s Q&A with us as a companion piece to this extraordinary story, where he talks about his own experience caring for his late wife Diana, his decision to explore this subject matter via fiction instead of memoir, and how “Case Studies” fits into the larger narrative of his highly anticipated forthcoming novel, Alice & Oliver.
To steal a phrase from Charles—dealing with cancer sucks rocks. But “Case Studies” is more than just a cancer story. It asks: How do we face our daily lives with dignity and hope when our bodies begin to fail? Every one of us will have to answer that question someday. But we don’t have to do it alone. One of the magical things about fiction is how it creates a mirror of interior worlds. Moments of recognition. When you find one of them on the page, you feel it in your bones. Yes, you think. Exactly. That is exactly how it feels. And you know that you have found a fellow traveler. In these brief medical histories, “Case Studies” introduces us to six such fellow travelers as they navigate the treacherous path of illness, exploring the failures, sorrows, hopes, and mysteries of the human experience.
Q&A by Hannah Tinti
I also think that put back to back, as in this gorgeous One Story volume, the case studies definitely gain some dramatic momentum and emotional intensity. They make for quite a reading experience. I hope that there’s some emotional momentum gained from them in the novel as well. That each time a new case study appears, the reader gains a charge, like, uh oh, or maybe, buckle up.
So, for sure, the roots of Alice & Oliver—the novel which features these case studies—are autobiographical. I wanted to write about what Diana went through. Her struggle was wrenching, dramatic, and tragic; at the same time, her conduct, day by day through two and a half years, was as heroic as any definition I could imagine. Diana passed away just before our daughter’s third birthday. The truth is, it was hugely important to me to write something my daughter could read when she’s fifteen, which would allow her to understand how much Diana wanted to be here—how much Diana loved her. How much she wanted to be her mother. Now, to a lesser extent this meant what I went through as well. So, then: a book about love, parenthood, marriage, and responsibility, all that stuff. What happens to those bonds when put under this impossible, unimaginable pressure? And yes, it also follows, a book about the medical system in the United States as well.
The fact is, it is a hugely dramatic situation, a hugely dramatic environment and the novel’s infrastructure—in terms of various procedures, reactions, and what have you—has real-life equivalents. For instance, Diana went through a three-day stretch of vision problems after a chemo treatment; Alice goes through a version of that.
Meanwhile, John Barth has this sentence: The story of us is not us, it’s our story. I thought about this a lot as I wrote. For this novel to be any good, I knew it would have to stand up as its own experience. Characters would have to stand on their own feet and have their own organic relationships with one another, form their own connections with a reader. So Alice Culvert couldn’t just be a stand-in for my late wife, who was a graduate student when she fell ill. Alice has to exist on the page as her own person—a freelance fashion designer who lives in a pre-gentrified version of the Meatpacking District, circa 1994. Similarly, Oliver can’t be me—his character emerges as a software designer trying to get a company off the ground. The love between these two has to be tangible and real on its own volition.
Throughout the writing of Alice & Oliver, whenever I was beginning a new scene, it always happened: open a file and read through notes and, oh, Jesus—the memories would fall on me like a piano. The only thing I could do was get into bed and curl up into a ball. But after hour three, shock wears off, a bit. You begin to live with those details, might even start placing them. What does this scene need to do, anyway? Yes, I want my daughter to understand how much her mother wanted to be here, but doing this correctly means capturing the psychological process for a woman facing the unthinkable, which starts to get technical. I might start altering, adjusting, projecting. It has to break down into moments, scenes. By necessity, questions of form and aesthetic issues matter. How long can we stay inside her head before something needs to, you know, happen? Can the scene be done in dialogue instead of thoughts, and if so, then who is she talking with, and toward what end? What other plot points might intersect? Is there a more structurally clean way to do this? Are the emotions earned, is this wrenching enough?
Once you start thinking about it in terms of material, things open up. Fiction is the lie that is better than the truth—that’s what all writing teachers tell their students, right? So now the idea of a truly excellent reading experience is another goal, a desire running alongside wanting my daughter to know. And this new goal has so many components. Are characters properly alive on the page? What else might this scene need to quicken the pace, even as you want to stay accurate about medical events? I have ideas about empathy and generosity I might want to write about, and how these come into conflict with personal ambition—do those ideas connect to this moment? If so, how might they aid or augment what’s going on here? How do I best serve the core emotional power and moral complexity of both the given moment and the larger dilemma?
You start to have a number of different masters, different levels of intellectual and emotional engagement. A sort of three-dimensional chess game emerges. This kind of intellectual engagement was something I had a level of comfort with. A world where I could exist. Even as the subject couldn’t have more personal importance or emotional impact.