There’s a truism in medicine that’s not entirely true, but it’s important for doctors to think it’s true. This truism goes something like: “90 percent of all diagnoses can be made based only on what a patient tells you.” I’ve heard some minor variations of this truism in my 16 years as a medical student, resident, fellow, and attending physician — sometimes the percentage dips to 80 percent; sometimes the 90 percent diagnostic rate requires both the patient’s history and physical exam — but the underlying message remains consistent and unwavering. The patients will tell you what’s wrong with them if you just pay attention to the stories they are telling. In academic hospitals, teaching physicians (like me) throw around this 90 percent statistic to encourage old-fashioned doctoring skills and make students less reliant on the relatively modern luxuries of lab tests and imaging studies that can be ordered with a click of a mouse.
Reading Wendy Walters’s first book of prose, Multiply/Divide, made me think of this truism. Walters’s three previous books were collections of poetry, and, perhaps not surprisingly, her first formal venture into prose obsesses over how we construct stories. I still believe that most patients can self-diagnose their illnesses (or lack thereof), which is why I always end my patient interviews with the question “So, what do you think is going on?” if the patient hasn’t already volunteered his or her own theories. I believe less and less, however, that the stories patients tell their doctors are accurate reconstructions. The patients, in recounting what doctor notes call “the history of present illness,” are picking and choosing the salient elements of their story: the plot points, the clues, the signs and symptoms that would be derided in a fiction workshop as too obvious examples of foreshadowing. The patients are telling a story that ends in the diagnosis they’ve made on their own. In other words, the patient sitting across the desk from me, answering the question “What brings you to the office today?”, is real-time drafting a personal essay, and almost certainly doing so without a clear distinction of what’s exactly fact and what’s a little bit fiction.
I spent way too much time reading and rereading the three-page introductory notes that Walters provides for Multiply/Divide. In this preamble, she labels the 13 pieces that compose the book as fiction, non-fiction, and lyric essay, even though she acknowledges that “the border between nonfiction and fiction — while seemingly clear as black and white — is often porous enough to render the distinction irrelevant.” Before, or more often, in the midst of reading an essay (for convenience, I will label all the works in this book as essays, partly because I wish they were all labeled as such), I’d flip back to that introduction and peak at what classification Walters gave it. And just as often I became disappointed — disappointed in myself for feeling the need to seek out a category, and disappointed in the essay that I was reading for being so apparently easy to classify.
I’m not entirely sure what distinguishes an essay from a story. If pressed, I’d crib from the Supreme Court’s line about pornography — “I know it when I see it” — and, if pressed further, I’d say that essays, like all of the pieces in Multiply/Divide, are about ideas whereas stories are about, well, stories. In “Cleveland,” which Walters labels as fiction, the narrator invents a documentary project for the chance to interview the experimental playwright Adrienne Kennedy. Who knows if Walters ever did such a thing (she thanks Kennedy “for serving as instigator and metaphor” in her acknowledgements), and who really cares? “Cleveland” is an essay about “a fundamental insecurity I couldn’t overcome,” Walter’s explanation for stalking Kennedy, and delves into the insecurities she’s experienced as an artist, lover, and parent.
The way stories are told and retold, deconstructed and reconstructed, is the major theme of Multiply/Divide. Walters is essaying the story (here I’m using the verb form of essay, “to put to a test,” partly to be clever, partly because it’s the most appropriate word choice, and partly because this word choice confirms my theory that every piece in Multiply/Divide is an essay) as she explores how people, like my patients, fit their narratives into their current frame of mind. The book’s first essay, “Lonely in America,” begins, “I have never been particularly interested in slavery,” and goes on to recount the author’s experience researching a gravesite for slaves recently discovered in Portsmouth, N.H. Her investigation into this gravesite follows, and by implication was inspired by, a trip to New Orleans to view the wreckage of her Aunt Lou’s home in the wake of Hurricane Katrina. The account of how her New Orleans relatives have been abandoned by the government juxtaposed with her own frustrated attempts to explore the gravesite in a fairly tony (and oblivious) section of New Hampshire depicts an author who is interested in all forms of slavery, past and present.
It’s not just people who are reshaping their narratives in Multiply/Divide. Cities, towns, and neighborhoods also recount their histories and often do so with a similar blurring of fact and fiction. Walters dissects people by focusing her gaze on their places as much as their personas, and her various approaches to these dissections reflect ambivalent feelings about such places. In “Manhattanville, Part One,” she uses an intimate tone in describing the subtle and sometimes not-so-subtle racism she encounters raising a mixed-race child in a section of New York City that sits between the affluent Morningside Heights to the south and poorer Harlem neighborhoods to the north and east. When an older white man approaches her outside a hardware store with the warning that her son will “sell you off in an instant,” the scene and its dialogue (written in italics, not quotes) strike a deliberately hazy quality: Is the old man, a representative of Manhattanville, supposed to be a prophet, a relic, or just a lunatic?
A later essay about this same neighborhood, “Manhattanville, Part Two,” takes a journalistic approach recounting the murder of a promising high school basketball player in a local housing project side-by-side with tales of the ongoing construction in and impending takeover of Manhattanville by Columbia University. Walters, an academic who teaches at another Manhattan-based university, has infiltrated this neighborhood, too; her struggle to align with the aggressed, rather than the aggressor, in her home surfaces in an anecdote, slipped into this reportage, of walking her child home from daycare past a murder scene. “Once you know a place well, it is impossible not to feel impacted by the history that shaped it,” Walters writes. “And though I know these stories and have, at times, lived in the midst of them, they are both mine and not mine, though facts can sound like my truth in the moment I speak them.” We are the cities we live in, and the cities we live in are us. People are places, places are people, facts are fictions, fictions are facts, and all of these players serve us in the stories we tell.
“What do you think is going on?” I asked the patient’s wife. The patient’s kidney disease was in complete remission by his labs, and he said he felt fine, but his wife insisted that he still wasn’t back to his usual self. In her opinion, he was too weak. “To me, it seems very different from when…” his wife said. “It’s the same weakness I’ve had for years,” the patient interrupted, “and it’s not as big a deal as you’re making it out to be.” He glared at his wife. I tried to defuse the situation. “One of my professors in medical school used to have a saying,” I said, “that if you’re at the track and the jockey wants to give you a tip, you take it.” I smiled. The patient relented and let his wife explain why she was worried that a stroke had been missed at some point. “Okay,” the patient said when she finished, “now can the horse speak for itself?”
I listened to the jockey, not the horse, and sent him to a neurologist. “There’s no stroke,” the neurologist told me over the phone, “but there’s certainly weakness. I think he may have myasthenia.” By which he meant myasthenia gravis, an autoimmune neuromuscular disorder that, if untreated, can be fatal. Within a week, blood tests confirmed the neurologist’s hunch. Later, I reflected on the patient’s luck that his wife spoke up about her concerns, and my luck as his doctor that I believed her more than him. I wondered why he downplayed his weakness to me, and why I trusted his wife’s story more than his. Walters might argue that the setting of our conversation, a doctor’s office, held the answer. In that office, all three of us had a story we wanted to tell. The patient, whose kidney disease was in remission, wanted to think of himself as healthy, regardless of whether he was truly at full strength. His wife wanted help, and she felt safe to ask for it in an over air-conditioned exam room. And me, who knows what I would have said or done if I’d heard this story in another arena, if, for example, an aunt pulled me aside at a family gathering to express concern about an uncle’s strength? All I can say is that I sensed a lack of closure in my office. The patient was ready to end his story, even if it relied to some extent on the fiction that he was well, but his wife felt that her version was still evolving. She didn’t know what was going on. She couldn’t give me an answer to my question. She needed more — more places, more people, more facts, more fictions — and, at that moment, so did I.