Summary:

Open Wound is a novel crafted from the extensive documents of an unsettling, little-known, yet remarkable episode in the history of medicine.

In the summer of 1822, Dr. William Beaumont was practicing medicine at a rugged military outpost on Mackinac Island in Lake Huron, part of the Michigan territory.  His assignment as Assistant Surgeon, US Army represented about the best circumstances he could expect from his training as a medical apprentice without a university education.  In addition to soldiers and officers, Beaumont sometimes attended patients from the American Fur Company, whose warehouses shared the island's harbor.  On June 6, an accidentally discharged gunshot cratered the abdomen of an indentured, French-speaking Canadian trapper.  Fortunately for him, Beaumont served during the War of 1812 and knew how to care for devastating wounds.   With the surgeon's medical attention and willingness to house and feed the hapless trapper, Alexis St. Martin's body unexpectedly survived the assault.  But his wound didn't fully heal.  As a result, it left an opening in his flesh and ribs that allowed access to his damaged stomach.  Through the fistula, Beaumont dangled bits of food, collected "gastric liquor," and made unprecedented observations about the process of digestion.  

His clever and meticulously documented experiments, conducted on the captive St. Martin over several years, corrected prevailing assumptions about digestion.  Once thought to depend on grinding and putrification, normal digestion, Beaumont observed, was a healthy chemical process.  Any signs of putrification or fermentation indicated pathology.  In 1833 Beaumont published his thesis on the chemistry of digestion in Experiments and Observations of the Gastric Juice and the Physiology of Digestion.  Shortly before completing the book, he received a temporary leave from his military service to restart his research in Washington.  But to carry on his project, Beaumont had to persuade St. Martin-who entered and exited his physician-researcher's life several times before-to leave his growing family in Canada and once again become a research subject.  St. Martin does return, with pay, and briefly accepts his role.  But he also confronts Beaumont about whether the long confinement on Mackinac Island was more necessary for the patient's survival or the doctor's research agenda.  Or for the doctor's subsequently improved station in life. 

Although some of Beaumont's academically trained colleagues found fault with his methodologies, the farmer's son and frontier doctor did achieve a gratifying level of professional accomplishment and wealth.  To enjoy them, he had to set aside humiliations he experienced along the way, accept his lot after military service as an ordinary practitioner in St. Louis,  and weather an unforeseen turn near the end of life.    

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In Illness as Narrative, Ann Jurecic thoughtfully examines the unruly questions that personal accounts of illness pose to literary studies: What is the role of criticism in responding to literature about suffering?  Does the shared vulnerability of living in a body, which stories of illness intimately expose, justify empathic readings?   What is the place of skepticism in responding to stories of suffering?  Does whether or how we read illness narratives matter?  Jurecic's questions entice discussion at an interesting cultural moment.  The numbers of memoirs and essays about illness—and their inclusion in medical school and other humanities courses—multiplied from the later decades of the 20^th century to the present.   However, their increase, and their potential to encourage empathic readings, coincided with dominant literary theories that advocated vigorously skeptical, error-seeking responses to texts and their authors.  Jurecic reminds us that Paul Ricoeur called such responses "the hermeneutics of suspicion" (3). 

Jurecic's astutely researched, nuanced answers to those questions propose a corrective to the extreme skepticism of "disembodied criticism." Such criticism, she claims, dismisses testimonial writing from "a position of distance and privilege."  But her answers also affirm that intellectually "rigorous" responses to texts are central to the critical humanities (15).  To further her position, she offers attentive readings of accounts of illness by Virginia Woolf, Reynolds Price, and Jean-Dominique Bauby, as well as the theoretical writing of literary and other scholars.  For instance, Jurecic speculates that the condition of a reader's body aligns with his or her responses to texts.  In a chapter called "Theory's Aging Body," she observes that as skeptical scholarly readers age—Stephen Greenblatt, Michel Foucault, Judith Butler—they have turned their attention to "illness, vulnerability, and mortality" (93).  Jurecic also suggests that a function of criticism is to uncover the cultural conditions that memoirs and essays about illness respond to.  Living "at risk" is a recent one.  In stories of living with the risk of experiencing a particular illness in the future, potential patients create narratives of uncertainty to discover the "personal meaning of the impersonal statistics" that medical research now regularly delivers (18). 

 Jurecic also reflects on the ways theorists have understood the possibilities of representing and responding to pain in the varied approaches of philosophers Elaine Scarry, Martha Nussbaum, and Richard Rorty and of anthropologists Jean E. Jackson, Byron Good, and Veena Das.  In an exceptionally comprehensive and nuanced reading of Susan Sontag's theoretical, fictional, and journal writing about suffering, Jurecic uncovers Sontag's inconsistent, yet revelatory positions on the human capacity for responding to representations of pain.  The chapter on Sontag is enriched by Jurecic's reading of Annie Lebovitz's and David Reiff's responses to Sontag's suffering: in Lebovitz's controversial photographs of Sontag's final days (included in A Photographer's Life: 1990-2005) and Reiff's memoir about his mother's illnesses (Swimming in a Sea of Death). 

Illness as Narrative closes with examples of what Jurecic calls reparative writing and reading practices.  In the first instance, ill writers such as Jean-Dominique Bauby (The Diving Bell and the Butterfly) both recreate "a more coherent sense of themselves" and dislodge "fixed ideas and narratives" about illness (109).  In the second instance, Jurecic outlines the limits of two competing readings of Anne Fadiman's The Spirit Catches You and You Fall Down.  One assumes that readers will by nature empathically imagine those who are culturally different from themselves.  The other looks skeptically at the assumption that what medical educators call cultural competence can be acquired by reading a book.  Jurecic suggests that strategies for reading and teaching informed by Janelle S. Taylor, Eve Kosofsky Sedgwick, and Rita Felski can encourage more complex habits of response, such as Taylor's "'empathic curiosity'" (quoted 122).

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The foreground of this painting is dominated by a "pieta" type grouping. One woman hovers closely over what appears to be a dying man, while another comforts a small child. This part of the canvas is underlighted. The colors are rich earth tones. The figures are non-Caucasian.

In the background, in harsh light, is a group of identical looking starkly white men. In fact, their faces are almost skeletal. All are in suits, three are seated, with four others standing behind the seated figures. They look very much like a "tribunal."

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Large blue circular eyes stare up from this frontal self-portrait. The sclera is visible underneath the eyes, which reflect the same washed blue of the background. This blue is as startling as, and reminiscent of, the green background of a Van Gogh self-portrait. The visage is grimly determined and the mouth a thin-lipped line. Ears are large and the shoulders blend into the background. He is thin and somewhat haggard.

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A female figure stands facing us, unclothed, her left side darker than her right, occupying the middle of the frame. She is surrounded with images from the process of human reproduction. The largest of the former is the well-formed male fetus in the frame’s lower left, which is connected by a thin umbilical cord wrapped around the figure’s right leg to a fetus in an early stage of development in the figure’s abdomen, which we see as if by x-ray.

Tear-shaped droplets of blood drip down the figure’s left leg and soak into a dark mass in the earth, where they nourish the roots of several plants. A tear rolls down each of the figure’s cheeks. Just above her to her left is a weeping crescent moon. Below it is an artist’s palette that the figure holds up with a second left arm.

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Painted while Neel was enrolled in the Works Progress Administration--a New Deal program to help the unemployed-- the work depicts a scene with which the artist was probably familiar, being herself impoverished at the time. The setting is a room at The Russell Sage Foundation, established by Margaret Olivia Sage in 1907 for "'the improvement of social and living conditions in the United States.' In its early years the Foundation undertook major projects in low-income housing, urban planning, social work, and labor reform" (quote from http://www.russellsage.org/about) .

At the painting's rear center sits an elderly (gray haired) woman facing sideways, dressed all in black, head buried in her hands. From her clothing and affect, she is probably a widow. She is seated in front of a small table around which, in a semicircle, sit her interrogators - nine men and two women. They all face her. One of the women seems to be interviewing her while the other people listen with varying expressions on their faces, ranging from thoughtful to impassive. The men are all wearing suits and ties except for one (possibly two), with clerical collar. The women, including the elderly lady under investigation, all wear hats. All are white, with the possible exception of a clergyman, who may be a light skinned black. To the right foreground of the painting sit two men, facing sideways, who appear to be waiting to be questioned. The man closest to the viewer is elderly, with a white mustache, apparently Latino since his skin color is light brown; he is wearing a suit and tie and holds two bananas in his hand. The expression on his face is one of worry and fatigue. To the left foreground, with his back to the viewer, a man sits leaning forward, apparently one of the questioners.

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This documentary is a film biography of American artist, Alice Neel (1900-1984), directed by her grandson, Andrew Neel. The film utilizes interviews with art historians; comments and interviews by Alice Neel herself; comments by her two sons and other family members; interviews with some of those that the artist painted; still photographs and other archival materials; and most spectacularly, displays of many Neel paintings. There are annotations of several important Neel paintings in this database. This film or sections of it would make a good accompaniment to discussions of those works.

Neel was a complex person and the film pays attention to this complexity. She lived what was considered to be a "bohemian" life, not following social conventions of the times and determined to pursue her art. There was early tragedy: marriage to a Cuban artist eventually disintegrated but produced two girl children, one of whom died as a baby and another who was kept in Cuba by the father and his family. These events were catastrophic for Neel and resulted in psychiatric hospitalization. For many years her life was one of poverty. In the 1930s she was funded to paint by the Works Progress Administration and later survived on welfare in Spanish Harlem while raising two sons born "out of wedlock". There she painted neighbors, and others who lived in that community. During the McCarthy era in the 1950s she was under investigation by the FBI for her occasional association with the Communist Party. She struggled to have her work recognized: although her paintings date back to the 1920s, it was not until 1974 that a retrospective exhibit of her art was presented by an important museum, the Whitney Museum of American Art. By that time she was painting portraits of well known individuals like Andy Warhol.

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A few years into their marriage, while their children are still young, Sara and Phil discover that he has an aggressive form of cancer.  He undergoes grueling surgery, but the cancer returns.  For Sara the prospect of Phil's death reawakens the trauma of losing her father when she was twelve.  Phil does his best to live a normal life between chemotherapy treatments and further surgeries, and even enters an experimental treatment in hope of seeing his children grow up.  His greatest pleasure in life is sailing, and one of his deepest hopes for his remaining time with his family to enjoy sailing with them in the ocean near their New England home.  But Sara finds it scary, even though she gamely learns to crew, and the kids never take to it.  So Phil sails with friends, and sometimes alone.  After learning that the cancer has continued to spread despite every medical effort, Phil decides to take one last sailing trip, this time alone, on the ocean.  There he has to make a decision:  his intention is simply to sail until his body gives out and die on the boat he loves, sparing Sara, he thinks, having to watch him die a slow and painful death.  But he begins to realize that letting her see him through might, after all, be a better way to go.  As the novel ends, he turns the boat, now quite far from land, toward home.  

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Mary Sutter has been trained as a midwife by her widowed mother, and has demonstrated an unusual aptitude.  She is an eager learner, but her deepest desire is to be a surgeon.  No medical school will take her, however.  As reports reach her home town of Albany of the escalation toward civil war around Washington DC, and in the wake of a disappointment in love,  she decides to board a train and offer her services to Dorothea Dix as a nurse.  Though Miss Dix refuses her on the grounds of her youth, Mary finds her way into apprenticeship with a surgeon who, as the numbers of injured climb, needs all the hands he can get.  Slowly and grudgingly, he comes to accept her as a competent assistant and, eventually, to teach her as a respected apprentice, and the remarkable companion she has become to him.  She learns surgery in the most grueling circumstances possible, amputating shattered limbs of young men, many of whom die anyway of infection or water-borne diseases.  In the course of her sojourn in Washington she meets John Hay and, through him, President Lincoln, whose compassionate attention she manages to direct to the dire need for medical supplies.  Two men love her not only for her intelligence and courage, but for the passion she brings to the hard-won skill that, though it cannot save her brother from the respiratory illness that is rampant in the camps, or her sister from a disastrous childbirth, saves many lives and makes a wider way for women of her generation who find themselves called to medicine. 

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Helga Crane is a beautiful young teacher in Naxos, a southern American boarding school for black students. She is half Danish on her mother’s side, half African-American on her father’s side. Her only family is an aunt and uncle in Denmark.

Dr. Anderson, a distinguished black teacher professes love for her, but she feels stifled by him and the vision of their life ahead. She quits her job and flees to New York and the exciting cultural life of Harlem.

She thrives in that environment and men flock to her. There she meets James Vayle whom she likes and the Reverend Pleasant Green whom she does not—but once again, when Vayle proposes permanence, she flees to Copenhagen.

There, she spends an extended visit with her Aunt Katrina and Uncle Poul. At first the Danish couple are startled by her blackness, but they quickly adapt and enjoy the elevated status conveyed by having this intelligent, beautiful black woman in their world. Upon receiving another offer of marriage, Helga grows suspicious of her family’s use of her and flees once again.

She returns to America where she marries the Reverend Pleasant Green, although she doesn’t love him.  As babies come in succession, Helga develops severe post-partum depression. 

 

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