Anatole Broyard died before I had a chance to meet him, and that gives my reading a particular regret. I’m not sure why I would have liked to have met him, whether that involves resolving some question or gaining some approval. I think part of his success as a critic was his ability to make authors want, even need him to approve. The first chapter in his book, “Toward a Literature of Illness,” appeared in the New York Times just before my book At the Will of the Body was available in bound galleys for prepublication review. Broyard died much sooner than he hoped or anticipated.
I was sent the bound galleys of Broyard’s Intoxicated by My Illness for review about a year after my book was published. I was obsessed with illness narratives; they were all I could read, beside the social theory I was teaching in my day job. Many of Broyard’s aphoristic lines have been my constant companions for three decades: the idea of illness as “a great permission” (23), the recognition that “It may not be dying we fear so much, but the diminished self” (25), and “I want to be a good story for him” (45). These lines helped me to understand how to turn the memoir I had written into an expanded project. Broyard articulated an agenda for me: how to offer ill people a permission that could stave off the diminishment of self; how to help people to become good stories both to others and to themselves, because as Broyard realizes, we can embrace our story only if others give it their recognition.
Years later I read with curiosity but surprisingly little surprise Henry Louis Gates’s chapter on how Broyard spent his life passing as white. Later I read reviews of the book by Bliss Broyard, Anatole’s daughter, in which she traces her family’s tangled history and deals with her own racial identity, as that had been obscured in deceptions. I realized how deeply Broyard had hurt people by how he had lived. Knowing all that changes how I read lines like: “I’m making my own narrative here and now … my performance” (42). When Broyard writes that what he likes about emergency departments is how they are “a continual improvisation” (57), we can now hear him projecting a quality of his own life.
Knowing what Gates discovered affects how we read the first line of the essay: “I want to begin by confessing that I’m an impostor” (33). We read differently Broyard’s desire expressed throughout the essay to be known. I appreciate how, for Gates and many others, Broyard’s life exemplifies a lie, and his book is tainted by that. My own relationship with Broyard is closer to narratives in which a lost child is treated kindly by a stranger who, the child discovers later, is a criminal. But what continues to count most for that child, now an adult, is the memory of the kindness that made such a consequential difference. Broyard helped me; he still does.
What remains for me—others may feel differently—is the agenda set by Broyard’s text. How is narrative medicine the work of forestalling the danger of illness that Broyard articulates: “When your soul leaves, the illness rushes in” (40). Although, what I would inscribe over hospital doors to remind everyone what is truly at stake is the converse: When illness rushes in, your soul leaves, unless someone helps you hold onto it. Broyard writes that once upon a time, priests “perhaps understood the scope of what you were saying” (42)—scope is the key word for me—and on his account, physicians inherit the possibility of filling that need. He speaks to their reluctance to do so. Narrative medicine, on the physician side, seems to be about learning how to encounter and to work with the scope of what ill people are often not yet able to say—the scope of the unsaid. What Broyard wants in a doctor is what I wanted during my illnesses: one who could “imagine the aloneness of the critically ill” (42). How could I repudiate an author who knows, and expresses, the aloneness I still felt so keenly in 1992, when I was I struggling to live with endless false positives in my follow-up examinations that perpetuated having cancer.
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Broyard’s wife Alexandra, in her Prologue, describes him as a “superb storyteller”. Actually, Broyard doesn’t tell many stories in these writings. Arguably the only stories in “The Patient Examines the Doctor” involve Broyard’s confusion over which doctor’s office he’s in, and later, the physician disrupting the wedding that Broyard had arranged for a dying friend (51). This latter narration is properly a story, in the sense of beginning with a trouble—the need for the marriage under unusual circumstances—and then proceeding through escalating “complicating actions” (William Labov’s term): first the rabbi’s reluctance and then the physician’s unwarranted intrusion. Finally there is an evaluation, which makes the story into a fable of medical shortcoming: the physician first not knowing enough about the patient, and then acting disruptively, as actions based on too little knowledge inevitably end up being.
Such stories are exceptions to Broyard’s usual style which is to create settings that are complicated by imminent troubles—medical settings. What carries his narration are not subsequent events, but rather aphorisms, often expressing a desire for a relationship in which the doctor as other allows him to be … what illness compels him to seek to discover. Or, Broyard seeks a relationship that at least enables him to sustain his performance, because his self and what we can call his dignity depend on that performance being sustained. Broyard’s complaint, in one of the rare moments when he directly criticizes medicine, is that doctors “discourage our stories” (52). For me, now as much as in 1992, that message: Don’t let them discourage your story is crucial. Find your own way to “turn our lives into good or bad stories” (53), because although we have always needed to do that, throughout our lives, illness makes the need immediate, compelling, or in the word Susan Sontag preferred, necessary. If you’re lucky, someone trained in narrative medicine might be able to help, or at least not discourage you.
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Broyard gives us a beautifully simple description of narrative medicine in his metaphor of the physician as landlord who takes seriously “how he could make the premises more livable” (43). Such a good doctor never forgets that the clinician’s routine is their patient’s crisis of a lifetime (43). I didn’t need Broyard to point out that disjunction to me, but he confirmed my sense that it’s a central barrier to the provision of what deserves to be called care.
More demanding is Broyard’s call for clinicians, especially but not exclusively physicians, to be comfortable with the ever-present reversal of perspectives: “he is my patient also and I have my diagnosis of him” (45; cf. 53). Doctors and nurses, in my experience, are seriously disturbed by the idea that their patients are watching them, noting, discussing. Even though the internet has facilitated people making public their appraisals of clinicians, I don’t see clinicians having gotten used to that. The clinical gaze still imagines itself as one-way. Broyard’s reversal—the patient is also examining the doctor—aspires to a mutuality I’d call dialogue: “There should be a place where our respective superiorities could meet and frolic together” (45). Is narrative medicine the creation of such spaces, striving to understanding what it is to meet and why Broyard chooses the verb frolic? What counter-narrative does that word express?
Broyard does not put all the weight on physicians; responsibility is always mutual. The patient’s responsibility is expressed in that great line, “I want to be a good story for him” (45). But then, clinicians must be ready to hear that story. More than ready: the clinician must know their life depends on hearing patients’ stories, because in that openness, “the doctor may talk himself back into loving his work” (57). Broyard’s recognition of necessary reciprocity remains vital thirty years later, because it remains unachieved. How can two people, clinician and patient (the ill person who is now in the clinic) help each other to talk themselves back into loving themselves, as their respective conditions have diminished them?
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Reading Broyard today reminds me of what I have tried to do for half my life. His phrases became my constant sources of reorientation, whenever I lost the plot of the narrative I was making. He reminds me of what within myself I need to retain contact with, and who I write for: “I was not so much a patient,” Broyard says of his experience in an emergency department, “as a needy person coming in from the street” (57). That’s fundamental medicine: a person in need, coming in, finding not only treatment but hospitality. How can we hold onto the simplicity of that ideal?
Arthur W. Frank 