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

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

HT: This story is part of your novel Alice & Oliver, which will be published in April by Random House. How does “Case Studies” fit in the larger narrative of the book?
CB: The case studies are breaks, believe it or not. There are six of them, littered through the first two hundred and fifty pages. On one practical level, they give the reader a space to breathe and take a break from Alice and Oliver’s drama, which can get intense. Like a little commercial where the reader regathers with what seems like a random medical tale. They have their own pace and energy and voice. It’s not necessarily a relief for the reader, but something else to look forward to. Meanwhile, at some point in the book, each case study subject also reappears, just for a scene or a few moments, in a way that should allow the reader to recognize him or her. The grandmother at the end of her life who gets put on a feeding tube shares a hospital room with Alice, for example. Not huge or hitting the reader over the head but she’s there. I was trying to widen the scope of the novel, a bit. To show that there is something universal about what was happening in the hospital, through a panoply of characters and backgrounds and stories. With any luck, this all comes together: there’s a later point when Alice talks about all the people you see in the hospital, for just one or two seconds and then you move on. She has some thoughts about what this means. So really, on the macro scale, I wanted to use the construct and the eventual payoff as a gateway to some ideas in there about how we are all related or connected. 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.
HT: While the stories in “Case Studies” are completely fictional, they are based on your own personal experience. Can you tell our readers a bit about what inspired you to write about the medical system in the United States?
CB: In the summer of 2009, my late wife, Diana Joy Colbert, was diagnosed with leukemia; our daughter was six months old. We were in New Hampshire for the summer, and Diana spent the first month getting induction at a hospital there. My priority was to try and make sure Diana would be okay and our baby was taken care of. The notes I took at the time were for the purpose of being able to understand what was happening: names of drugs, what to do that might keep the swelling in her throat—one of the chemo side effects—under control. But somewhere in the back of my mind, I’m sure that Lorrie Moore’s short story “People Like That Are the Only People Here” was also rattling around (a key part of that story involves a husband telling his wife, who is a writer, to take notes while their child is undergoing treatment for cancer). So along with lists of things I had to get at a pharmacy, I jotted down details. To some degree, that’s part of the gig. Writers process the world like this, sifting through details, phrases, moments. 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.
HT: What made you choose to explore this subject matter via fiction, instead of memoir? And do you consider this story (and this book) a call to arms, of sorts, for change?
CB: I very much believe in fiction and its capabilities, and I’ve basically devoted huge amounts of my adult life to these things. I also have religious amounts of faith in the writing process itself. If done correctly, the process makes time work for you. Even when I was deep in mourning, and trying to figure out how I was possibly going to start to write again, the veil of fiction gave me some room. This helped, I think: having more artistic and psychological freedom than if I were trying to match event for event, without any escape, any fun. 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.
HT: These Case Studies start off looking like medical histories, factual data, and then they begin to shift. Why did you choose this format? (including the address, room #, etc.)
CB: Honestly, it seemed cool and interesting — a way to break things up and then get new stories in there. I experimented with a lot of different forms for the case studies, and wrote a few of them to include more surreal and experimental writing, with wild leaps of logic and humor. One thing I discovered was that too absurd or experimental would get in the way of the larger project of the book. I kept trying, writing different types. Eventually I settled on the idea of starting out straight, and then shifting that much more. So I found a spot that felt right and explored. But it really was a learning process with them.
HT: Case Study #121 and Case Study #368 really brings home the predicament of caretakers, struggling to advocate for their loved ones. Can you talk a bit about why you wanted to include the stories of these mothers/granddaughters/fathers/sisters?
CB: Sometimes, I’d hear that what the spouse goes through during an illness is just as intense as what the patient experiences. I don’t believe that, and the reasons for this are obvious. But my experience as a loved one and caretaker was certainly intense. It’s different, but also hard beyond words, having a person you care about be gravely ill—that is a deep emotional pain and a panic that won’t subside. Meanwhile, being a caretaker is obviously, a full, immersive ordeal. Handling the insurance and financial ends: sucks rocks. I am close to some health care professionals as well, and sometimes I’d listen to them talk about their jobs, what it was like working at a hospital, anecdotes, etc. The case studies gave me a way to cast that wide net, to flesh out the entire experience, capturing more points of view, without necessarily turning the novel into a sprawling, uncontrollable beast.
HT: Why did you decide to end Case Study #33 on Dwight Gooden?
CB: Ha! Nothing gets by the intrepid people at One Story! Here’s why: for the few literary and writer types and readers who actually follow sports, Gooden is an epic figure. He’s a particularly special figure in New York sports history, specifically the mid to late eighties. His name carries weight, and his story has levels to it. Nicknamed, Dr. K, Gooden was a true phenom, the best pitcher in baseball, at twenty years old, then he led the Mets to their last championship, that fabled 1986 World Series team. For something like ten years, Nike had a huge billboard of him in Times Square. But Doc also fell from grace, had a long slide due to cocaine, and eventually was suspended from the league. A great thing that happened to him, at the end of his career, he got a chance at rehabilitation. I am not a Yankees fan, but in 1996, when his suspension was over, Gooden, now sober, signed and played for the Yankees. He actually pitched a perfect game for them and was on a team that won the Series. So in a way he’s a comeback story. Someone who had carried so much on his shoulders and fell, but who also got back up. The timelines matched up with the book, and the themes seemed right, and this way if someone knows his story, they will get excited. I have a lot of references and stories like that buried in the subtext of Alice & Oliver. You don’t need to know them to enjoy the tale, but if you do, it is a special treat.
HT: How long did it take you to write Alice & Oliver?
CB: I’m not sure how you’d total it. I took notes while Diana was ill, and during her two remission periods actually tried to do some writing on what would end up being this book. But I don’t know how much of that work is in the present version of the novel. After Diana passed, I had to reorganize things and pretty much started over. Four years after she passed. And whatever while she was sick as well.
HT: What are you working on now?
CB: Hmm. Good question. I wish I knew. I have some essay ideas I’m piddling around with, as well as a larger project that may or may not be going somewhere. I’m sort of searching for something to really land on and commit myself to, to be honest.
HT: What is the best bit of advice about writing you have ever received?
CB: You will fail. You will fail. When you think you cannot fail any further, you will fail again. You will be humiliated and then when you think that can’t get worse, they will come up with new and creative and exciting ways to humiliate you. But if you pay attention to your work, and stay at it, you will write something good. And then people will respond. Because people need good stories. Good stories will find a place in the world.