Interpreting My Malady


On May 4, 2012 at 7:05 a.m., while rushing to work, I slip on my rain-slick front porch and land on my outstretched right palm. What happens next, according to CAT scans and the notes of the orthopedic surgeon who repairs the damage, is that the impact of my palm against the porch sends my humerus, the long bone in my upper arm, crashing into my glenoid bone, the roof of my shoulder socket, like a battering ram. The humerus cracks, the glenoid shatters, the surrounding muscles and ligaments tear, the shoulder pops out of its socket and my right arm drops to my lap and will not rise again for many painful weeks.

These are the facts, the only things we can agree on.

And by “we,” I mean “I.”


Virginia Woolf once commented on how curious it is that more fiction hasn’t been written about illness. In 1930, she wrote:

Considering how common illness is, how tremendous the spiritual change that it brings, how astonishing, when the lights of health go down, the undiscovered countries that are then disclosed, what wastes and deserts of the soul a slight attack of influenza brings to view, what precipices and lawns sprinkled with bright flowers a little rise of temperature reveals, what ancient and obdurate oaks are uprooted in us by the act of sickness, how we go down in the pit of death and feel the waters of annihilation close above our heads and wake thinking to find ourselves in the presence of the angels and the harpers when we have a tooth out and come to the surface in the dentist’s arm-chair and confuse his “Rinse the mouth-rinse the mouth” with the greeting of the Deity stooping from the floor of Heaven to welcome us – when we think of this, as we are so frequently forced to think of it, it becomes strange indeed that illness has not taken its place with love and battle and jealousy among the prime themes of literature.

Woolf was half right. It’s true that there are surprisingly few published works of fiction about the nearly universal experience of being sick. The long list of memoirs and other nonfictional accounts of illness grows every year, and includes modern classics such as Anatole Broyard’s Intoxicated By My Illness (prostate cancer), Nancy Mairs’s Plain Text (multiple sclerosis), Kay Redfield Jamison’s An Unquiet Mind (bipolar disorder), Audre Lorde’s The Cancer Journals (breast cancer), and Lucy Grealy’s Autobiography of a Face (Ewing’s sarcoma). But fiction about illness? Well, let’s see, there’s The Death Of Ivan Ilyich, of course, and The Magic Mountain…and Philip Roth wrote that short novel about polio a couple of years ago…but, really, how many others can you name?

And yet, the unpublished catalogue of fiction inspired by illness is limitless, composed every day, at every hour, in every hospital, clinic, hospice, and bedroom where the ill and injured and even the mildly indisposed attempt to make sense of our altered conditions.

In the first two weeks after my shoulder surgery, fueled by pain and pain medication, sleeplessness, and immobility, claustrophobia, and the inability to write so much as my own name, I have a burst of creativity. I invent several versions of what is happening to me, through which I flip day and night as if they’re TV channels, but different from TV channels in that I amplify and embellish each with every round.

My stories aren’t comforting. They are, mostly, self-pitying and self-blaming–though blame, at least, implies control. And, though I work on them day and night, as doggedly as any first drafts I’ve ever written, they don’t distract me from my pain. If anything, they intensify it, drawing an ever tighter circle around me until I begin to lose the distinction between my throbbing limb and my synchronously throbbing mind.

Herewith, a sampling from my little collection, arranged in alphabetical order by the titles I assign them.



A helpless weight dangles from my chest, requires dainty bathing. Bouquets of well-wishing flowers line the kitchen counter. Husband home from work in broad daylight. I am barely out of my nightgown when I put it back on again for bed. Time becomes viscous. I move slowly, by inches, careful not to disturb the swaddled bundle.


“Beginning Of The End”

Beneath the colored hair and the porcelain crowns, the stethoscope and the publications, the younger friends with their edgy humor, the bones have turned soft and weak.


“Failing The Test”

How I would act if…? Now I know: badly. I am not dignified. I do not suffer in silence. I wince, moan, and whimper. I cry. One day, I cry all day. I cry when an old friend phones out of the blue, when the rabbi’s wife checks to see how I am coming along, when the orthopedist’s secretary calls with my follow up appointment. Faced with severe pain, I fold like a cheap suit, a cheap camera, a cheap tent.

Now I know.



The nurse practitioner hands me the glossy pictures nonchalantly: “For your records.” I see the tidy system of metal hooks and synthetic rope–royal blue woven with white–that holds me together. I will never be fully human again.  One handed, my fingernails and hair go untended, my hygiene declines. The physical therapist pries up my wing and says, “Oh! What’s going on here?” She holds a mirror to my armpit. I don’t want to look. I expect adders.


“Pride Goeth Before A Fall”

The morning it happens I am wearing a new blouse of especially fine cotton knit, in a becoming dark mustard, in a long, flattering cut. How well I look, rushing to work: doctor, writer, wife and mother! The dahlias I’ve wintered so skillfully are coming up in the ceramic pots on the porch. A new car is in the driveway. Once down, I reach up to investigate my lifeless arm. For a moment I conclude that it feels misshapen simply because the fabric of my new blouse is unfamiliar, and so especially fine.


“Taste of My Own Medicine”

I will never again keep a patient waiting. I will never again raise an eyebrow to a request for a narcotic refill. I will never again doubt someone who says he or she isn’t ready to go back to work. I will never again interrupt a detailed description of three simultaneous but subtly different kinds of pain. I will never again be lying when I tell a patient that something will be done about that rude person on the phone–immediately.

I will never again utter the word “psychosomatic.”


“Wounded Deer”

My husband comes home from work, loosens his tie, and gets dinner on. The kids start doing their own laundry. There are no urgent calls from the office. “Don’t worry about a thing. Just rest up and get well.”

No one likes the smell of death.


On the fourteenth day after surgery, my stories loosen their grip. A psychiatric colleague once told me that psychotics, as they return to reality, don’t so much stop believing their delusions as much as they become less interested in them. This is how I now feel about my own Shoulder Anthology. I wake clear-headed and limp with relief, as if a fever has broken. In her essay, “In Bed,” Joan Didion describes the blissful denouement that follows her bouts of migraine:

I open the windows and feel the air, eat gratefully, sleep well. I notice the particular nature of a flower in the glass on the stair landing. I count my blessings.

Because I am still in pain and partially immobilized, my own moment of thanksgiving is less expansive: I crave lemonade. Not the fresh squeezed kind, flecked with pulp and served in an icy crystal pitcher garnished with fresh mint, but Snapple in a bottle, from the convenience store at the gas station. I’ve never even liked the stuff before, and now I can’t get enough.

Maybe it’s the miniature cacophony of sensation the drink offers: the acid pink or yellow, the cold, metal-topped glass, the harsh sourness and the cloying sweetness. A tiny, manageable way for my taped up, drugged up, splinted body to re-enter the world.

Or maybe it’s simply the pleasure of wanting something — anything — however humble, other than wanting not to be in pain, not to have fallen.

But no — here’s the truth:

A couple of days after my surgery, when I can’t turn the pages of a book or magazine, a friend suggests that I buy an e-reader, something I’ve avoided smugly. It is a godsend. My first download is Cheryl Strayed’s wonderfully absorbing memoir, Wild, in which — as everyone who has not been on a months long silent retreat knows by now — she recounts her 1100 mile hike along the Pacific Crest Trail. For minutes at a time, flicking through screens with my left thumb, I am transported from my chair and my ice pack and the clock (with its teasing promise of the next Dilaudid dose) to Cheryl’s journey. At several points along the trail she craves lemonade: Snapple.

Now I do, too.

My circle of stories enlarges, if only by a few cool sips.

And I begin to heal.

Suzanne Koven MD, MFA is a primary care physician and writer-in-residence at Massachusetts General Hospital in Boston. Her writing has appeared in the New England Journal of Medicine, the Boston Globe, VQR, and elsewhere. Her interview column “The Big Idea” appeared at The Rumpus. Her memoir-in-essays, Letter to a Young Female Physician, will be published by W. W. Norton & Co. on May 4, 2021. More from this author →