Literature and Medicine II

16 Voices: Five Doctors Speak, which was made into an edition of twelve, emphasises the interpersonal dimension of medicine in an intriguing way. The book reads like a theatrical play or script—if one is accessing this book through the exhibition catalogue Holding In, Holding On, there is a section at the end which provides information on the “cast” by giving the full names corresponding to the five voices, distinguished in the text through the use of their surname initials. However, this is not how the original book sorts out the various voices. There, a different font and paper are used by Hall to differentiate each doctor. Voices also consists of skull, eye, and skeleton stamped images and of a miniature book entitled Legacy attached to one page inside an envelope. This idiosyncratic script can be better described as a series of monologues since the voice of the patient is not audible. The choice not to turn the sections of which this “performance” consists into dialogues is perhaps a statement in itself: Medicine takes away the voice of the patient, which returns us to Frank’s idea of the doctor’s “monological authority.”

17 Voices documents what five doctors each said to Hall when telling her about her second recurrence of breast cancer over a six-day period (July 7-16, 1998), and they can be read comparatively to emphasise different approaches and patterns of interaction between doctors and patients. Some of the voices are more generous, and though they communicate the same bad news, do so with more empathy and caring, while others consist of thoughtless comments (“Four and a half-years is not bad”; “We are buying time”) or superficial interactions and uncaring comments (“Do you want to speak to me on the phone or in person?”). A few of the voices contain condescending or patronising comments (“You are my poster child. You’ve done so well”) or, on the contrary, blame the patient for failing to do well (“You’ve failed”), sustaining the ideals of female infantilisation and dutiful compliance already mentioned. In I Make Books, a documentary created by the University of New England Media Services Department in 2003, Hall explains that the doctor who said that she had “failed” used the term merely “in a medical-terminology sense,” but it was only after she confronted that doctor that the burden she had to carry for a long time softened. In the same film, Hall explains how she uses the books to communicate with her physicians, doctors, and the medical community in general. She did show Voices to all of her physicians, including the one she was most angry at, who delayed seeing it providing various excuses. As she writes in her artist’s statement, the book “elicited various responses including denial, disbelief, and discomfort, but overall using the book to communicate with physicians and nurses has a positive impact on her interactions with the medical community” (13).

18 In his chapter “Physicians’ Generosity,” which draws on Bakhtin’s work, Frank argues that identification with others requires giving up the monologue; dialogue is achieved when a “physician reconstitutes him- or herself in the voices of his or her patients” (101, emphasis in the original). In Hall’s case, we also notice a reverse process taking place, which confirms the mutual positive impact meaningful communication between doctors and patients can have. One of the voices, belonging to her female doctor Mills, already mentioned, tells Hall the following: “In order to live you must live with the fear of dying. Your books will be your legacy, for family and for friends. And if you live to be an old lady you’ll reminisce” (26). As Broyard writes, “Whether he wants to be or not, the doctor is a storyteller, and he can turn our lives into good or bad stories, regardless of the diagnosis” (53). Mills’ statement encouraged Hall to continue to make books, and inspired the miniature book Legacy, made in March 2001, which she decided to include in Voices as a separate book, using the image of a dancing skeleton to dramatise her doctor’s story. It serves as an example of the patient, this time, reconstituting herself in the voice of her practitioner. Hall of course shows the finished book to all her physicians, which means that now that Mills’ words have been transmuted into her patient’s book, the doctor can also reconstitute herself in the voice of her patient in future—the circle is complete but can open again. In her foreword to the catalogue, this becomes evident as Mills constantly returns to Hall’s work, speaking in her voice, in order to show the impact Hall’s art has had on her own practice and life: “Martha’s stories will speak to each of us differently and their meaning will change as we change and grow” (7).

19 The last page of Voices is a haunting page which is filled with a single phrase repeated on every line in all the different fonts of the doctors: “I am sorry.” The use of different fonts suggests that all of the five doctors have said that to Hall at some point. The litany of “I’m sorry” leaves barely any white space on the page creating the effect of concrete poetry or of a painting made of words rather than images. Besides causing a visceral response, it raises questions concerning the frequency with which “I’m sorry” is being uttered by physicians and its implications: Is “I’m sorry” meaningful in any way or simply a distancing technique from an emotionally difficult situation as in the example of the voice by a doctor already discussed—“Let’s take this one step at a time. I am sorry. Do you want to speak to me on the phone or in person?” (25, emphasis added)? Does it evoke, instead, the difficult issue of failure (for either the patient or the doctor) to which I have already alluded? Medicine and science are resistant to the idea of failure: The modern medical narrative can only be sustained if progress and efficacy are confirmed through good survival rates for patients and expensive treatments that work rather than through the acknowledgement of victims, which belie the triumphant discourse of science. If through “I am sorry” a doctor relinquishes his or her authority, does this signal a shift from an emphasis on cure to care, which has been foregrounded in recent memoirs by doctors? Lisa Diedrich concludes her study Treatments with a chapter entitled “Towards an Ethics of Failure.” In it, drawing on Lyotard’s idea of the “différend,” which he defines as “an unstable state and instant of language wherein something which must be able to be put into phrases cannot yet be” (qtd. in Diedrich 149), Diedrich asks whether the process of truly addressing uncertainty, errors, failure, and suffering by the medical community, might be the beginning for a search to find “new rules for forming and linking phrases” between the subject positions of doctor and patient (150). For Diedrich, an ethics of failure “takes failure not as an ending” (as, for instance, in Hall’s doctor’s statement “We failed. You failed” in Voices) but “as a beginning” (166), and I suggest that illness narratives, like Hall’s books, which explore despair, frustration, and pain, can help the medical community take the risk of opening up to failure.

20 This possibility is not explored in the book It’s Nothing, an ironic title for a story of misdiagnosis. Hall insists that she is in pain, but since the tests do not show anything her judgement is disregarded. The new tests, however, reveal multiple lesions “there where I had shown you [to the doctor] I had pain. There where I had told you” (45). The medical notes mute this incident and present “aches which [the patient] has minimized and really brought out fully today” while they describe Hall as “slightly more depressed than she has been in the past” (45). Hall’s determination to “keep listening—to hear what her bones are saying” (45), at the end of the book, challenges the knowledge monopoly of doctors as well as the patients’ supposed ignorance. This book is interesting, in that like others in which Hall shifts between the positions of breast cancer patient and artist, it compares and contrasts the consulting room and the art classroom as spaces of body examination. The suggestion is that the latter can become a model for a more holistic approach to health and healing. The book starts with Hall drawing the skull in art class while holding it cupped in her hands and proceeds to trace the rest of the body: “We gently moved our fingers down our vertebrae, felt for our first rib. […] The next week we traced our sternum, pushed on our ribs” (44). While this exercise is painful (Hall hates “knowing where the jabs of pain would be—long ago memorized”), it is also a healing experience. The book concludes with Hall asserting the need to draw her body and pain: “So in art class I draw my ribs, my vertebrae, my skull. I draw my pain. I draw delicacy that hides anger, fragility that holds strength. These are my bones. I need to draw them to heal” (45). The lines she draws are not the same as the lines revealed by the bone scan. The emphasis on touching the body (feeling the different parts), which takes place in art class, complements the medical gaze, or “the machine vision” of “the watchers,” as Hall calls it, in Test Day. In turn, listening to hear what the bones are saying is a corrective to the doctors’ only and distant words: “‘Take a deep breath.’ ‘Hold it.’ ‘You can breathe’” (38).