The narrator has enjoyed a mostly healthy life. He has traveled to Europe and once was treated for syphilis while there. He has been together with L for seven years. Both men are writers who teach at the university. Now, the pain that grips him defies exact description (even for a professional writer). The closest comparison that he can conjure is having someone’s hand plunge into his body and twist his guts along with the sensation of being kneed in the groin. He’s reluctant to seek medical attention since medical facilities are especially risky during the pandemic. So he waits and hurts. The pain is soon accompanied by fever, chills, and aching of the limbs. 

He decides to go to urgent care. After a brief evaluation, he’s referred to the university medical center ER. Covid testing is negative. A CT scan reveals an aortic dissection (tear in the aorta) associated with aortitis (an inflammation of this large blood vessel). He is told that such a tear is frequently fatal. He’s lucky to be alive. The narrator is placed in the ICU and treated with IV antibiotics, fluids, and antihypertensive medications. The vascular surgeon recommends holding off on any operation (either a stent or a graft), hoping the tear and inflammation will stabilize and heal. 

Hospitalized for a week and a half, the narrator confesses his feelings of helplessness, shame, bewilderment, and fear. He is intrigued by the bustle of the hospital – almost electric with human energy – but despondent over the seemingly omnipresent suffering there – his own, that of fellow patients, and even the distress of healthcare workers. He is most impressed by and appreciative of his ICU nurse, Alivia. As for the physicians involved in his care, the narrator notes the stark clinical detachment of many doctors. Reflecting on a visit from a rheumatologist, he concludes, “I was nothing to her, really, I was her job, she would clock out and enter her real life” (p124). He craves to sense some vulnerability and genuine concern emanating from his physicians. As for empathy, the narrator reveals some of his own when he decides, “it must be hell to be a resident” (p129) in training. 

The search for possible rare etiologies of his condition comes up empty. As his condition slowly improves, the narrator still worries about his current predicament and the future: “I was an enigma, they said, a conundrum, they were running out of ideas” (p121). The waiting for and indecision about any kind of surgical intervention wears on him. He wonders if it might be best to have an operation. 

But the narrator never has surgery. A repeat CT scan confirms stability of the aorta and resolution of all inflammation. He is discharged home on oral medicines and continued IV antibiotics. Frequent follow-up appointments with his doctors and imaging studies of his aorta are scheduled. His partner L lovingly tends to his needs. His sister G arrives to help too. The narrator’s prognosis is murky. Did he dodge a bullet? Or are further problems with his aorta inevitable? How does a person cope with such chronic uncertainty. Although the narrator is weak and emotionally rattled, he is happy to be alive, pain-free, ambulatory, and home with his lover. Shouldn’t that be enough? 

The novel reads more like a memoir than a work of fiction. It is impressively authentic and accurate about medical matters – the lingo and professional behavior of physicians, nursing care, clinical procedures, what it feels like to be a patient. Readers will rightfully consider whether the book’s author is perhaps recounting his own experience with a serious health problem.  

In this novel, the human body is depicted in many ways: sensuous, serviceable, surrendered to others, surreal when sick. The narrator’s experience of illness includes a warping of time, the pull of memory, the weight of regret, the need for truth, and the magic of love.  

The poet-protagonist is occasionally irritated by the language and metaphors spewed by doctors and nurses. The use of broad-spectrum antibiotics is explained to him as a “carpet bomb approach.” He is warned about the caustic effect of IV drugs and that his veins might “burn out.” This medical lexicon prompts the narrator to ponder “who taught these people, who gave them their vocabulary, their stock of images” (p86).  

We don’t need a novel (even an exceptional one like Small Rain) to remind us about the randomness and chaos of ordinary life, the uncertainty of health in the future. But we can look to great literature for inspiration, to help us understand and cope with those looming, difficult experiences. The word rain is both a noun (drops of moisture or a spiritual blessing) and a verb (something sent down in abundance). Whether it is tears (of pain and emotion), love, or gratitude, the rain in this story is hardly small.  

Small Rain: A Novel 
by Garth Greenwell 
New York: Farrar, Straus and Giroux, 2024, 320 pages 
ISBN 9780374279547 
Web photo by Pawel Nolbert 

We examine excerpts from Siri Hustvedt’s novel, The Blindfold, and from Joan Didion’s essay, In Bed, for the perspectives they offer on what people experience when migraines strike them. We discuss how Hustvedt’s and Didion’s renderings of migraines add to classic biomedical descriptions, and consider the implications of migraine prevalence on the degree of suffering, functioning, and health care consumption. We muse about how these literary texts and others like them can be applied in helping people who suffer migraines and in helping people who care for them.

Bibliographic information:
The Blindfold, Siri Hustvedt, Picador, New York, 1992
In Bed: In The White Album, Joan Didion, Farrar, Straus and Giroux, New York, 1979

Additional background on the excerpts we cover, and excerpts from other books describing the effects of migraine are in Russell Teagarden’s blog, According to the Arts. An expanded analysis of the physical effects of migraine as depicted in The Blindfold can also be found on the blog here.

Some migraine prevalence data available from open-source publications are here and here.

The Clinic & The Person is a podcast developed by our editor Russell Teagarden to summon or quicken the attention of health care professionals, their educators, researchers and others to the interests and plights of people with specific health problems aided through knowledge and perspectives the humanities provide.

Feature image by Adrian Swancar