Suffering patient, suffering doctor

Seething in the Gordian knot: a view of 2015’s Man Booker-nominated novel, A Little Life, by Hanya Yanagihara.

Sue Wootton

A Little Life is a big book, a hefty tome of over 700 pages. But the length is important, because this is a story about pain, and stories about pain take time. What doctor hasn’t felt the competing pressures of already running late, an ever-filling waiting room, and the current patient just beginning to find a way to explain what hurts? Yanagihara gives Jude St Francis, her main character, plenty of time. Page by page, the reader enters an increasingly privileged relationship with this injured man. Very gradually we begin to understand that not only does Jude have wounds, he is a wound. Worse, he is a wound that cannot heal. The reader’s deepening access, over time, to Jude’s ‘little life’ (past and present) thus parallels the position of a doctor in a long-term doctor-patient relationship—except that as a reader it’s possible to put the book down for a while and take a break from the relentless suffering it describes.

Despite its unfashionably long length and often searingly uncomfortable subject matter, the book is compelling. Perhaps this is because as much as this novel is about pain, it is also about compassion. Compassion is derived from the Latin ‘com’ (with) and ‘pati’ (to bear, to suffer). It describes, therefore, the state of ‘suffering with’ another. And just as Yanagihara allows time for the true nature and extent of Jude’s suffering to be revealed, she gives space for the truly complex nature of compassion to emerge. Readers who choose to stay the length will find themselves an active partner in a dance of suffering and empathy. All readers will find this challenging to a greater or lesser extent, and many will identify with the difficulties faced by Jude’s close friends and support network. All of these characters suffer deeply because of their commitment to acting compassionately towards Jude.

Consider, for example, Andy, who is Jude’s doctor. Jude is uncommunicative, noncompliant, self-destructive—downright difficult. He will not consult any other doctor. He presents after hours at Andy’s home, even in emergencies, as when he is haemorrhaging from savage self-inflicted cuts. Andy gives and gives, and Jude takes and takes—but he never takes what Andy wants to give. Instead, he routinely sabotages all avenues to healing offered by Andy. “Thirty years of being disobeyed,” Andy reflects, late in the novel, a comment which perhaps makes him seem sanguine about this fact. Andy’s feelings are far from sanguine. From his side of the doctor-patient divide, it’s been thirty years of frustration, fear and anger, with every contact pitting Professional Andy (cool, clinical, detached) against Personal Andy (heated, subjective, involved, loving). Andy’s doctoring of Jude is always a blend of these impulses, more or less negotiated, more or less thoroughly. In his clinical interactions with Jude, Andy works hard to control his frustration, but sometimes his rage bursts through. Near the end of the book Andy suddenly realises that Jude (now a double amputee) has become anorexic. He explodes at his patient:

I think you’re lying,” Andy says. “I think you’ve lost so much weight that your prostheses are sliding off of you, am I right?” But [Jude] doesn’t answer. “How much weight have you lost, Jude?” Andy asks. “When I last saw you, you were already twelve pounds down. How much is it now? Twenty? More?” There’s another silence. “What the hell are you doing?” Andy asks, lowering his voice further. “What’re you doing to yourself, Jude?”

“You look like hell,” Andy continues. “You look terrible. You look sick.” He stops. “Say something,” he says. “Say something, goddammit, Jude.” (690-1)

In his book, The Healing Art: A Doctor’s Black Bag of Poetry, Harvard physician and poet Rafael Campo admits to feeling a similar rage in connection with a ‘difficult’ patient. “I suddenly find myself glaring at her,” he writes, “trying to contain my anger, which finally rises to the surface of my consciousness, bursting past the barriers of professionalism and emotional anesthesia that I built up during my medical training… I seethe in the Gordian knot of a cruel, irrational question: Why should I have to take care of this horrible old woman whose own family has abandoned her … whose behavior seems perennially antagonistic, and who won’t get better no matter what I prescribe….” (44-5)

From a caregiver’s perspective, the repeated failure to alleviate suffering is a powerful contribution to this Gordian knot. It might be, as in the examples above, that the sufferer rejects or sabotages care. Always entangled in the knot to some extent is the caregiver’s fear that he or she has no treatment to offer. In his classic book-length essay, A Fortunate Man: The Story of a Country Doctor, John Berger explores this vulnerability. He observes his country doctor in distress, alone and grieving. The doctor sorrows for “the suffering of his patients”, but magnifying his distress is his awareness of the “frequent inadequacy of his ability to help them.” (112)

The Gordian knot of suffering/compassion is an entanglement of many threads. What Yanagihara does so well in A Little Life is tease these out, so that we begin to understand how the knot was formed and where it is particularly stuck. Here, for example, is Jude’s reaction to Andy’s furious outburst about his anorexia: “[Jude] knows how this interaction is meant to go: Andy yells at him. He yells back at Andy. A détente, one that ultimately changes nothing, one that is a piece of pantomime, is reached: he will submit to something that isn’t a solution but that makes Andy feel better…” (691)

How to break through from pantomime, how to move beyond détente, how to ease the tensions of the Gordian knot: A Little Life takes the time to figure these things out.

Works cited:
Berger, John. A Fortunate Man: The story of a Country Doctor. 1967. New York: Vintage-Random, 1997.
Campo, Rafael. The Healing Art: A Doctor’s Black Bag of Poetry. New York: Norton, 2003.
Yanagihara, Hanya. A Little Life. London: Picador, 2015.

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Sue Wootton: Poet and novelist Sue Wootton is co-editor of Corpus.