The Page 69 Test: "Trouble"

Tuesday, February 20, 2007

"Trouble"

Jesse Kellerman's first novel, Sunstroke, earned praise from the likes of Harlan Coben ("a thriller that delivers") and Sue Grafton ("a masterly debut!").

Now he's out with a new book, Trouble.

Jesse applied the "page 69 test" to his novel and reported the following, starting with the text from page 69:

…and the state of the patient’s rectal vault, which he imagined as bolted down with a mammoth brown padlock. The documents are in the rectal vault, 007, set to self-destruct. Guaiac before it’s too late.

The medical student’s real job during rounds, however, was to carry the Bucket, a turquoise emesis basin filled with gauze, dressing, scissors, syringes, gloves. Tegaderm patches in three sizes; if the resident called for a medium, and all you had was small and large, the world screeched to a halt as you sprinted to the supply closet. Lots and lots of Surgilube. Especially on colorectal. Yokogawa would stick out his glove. Lube me, Superman. Jonah felt like a hot dog salesman.

He felt lucky if he had time to wolf down a granola bar while jogging to the OR. Often not, which left him standing, unfed, through eight or ten hours’ worth of colecystectomies, rectal polyp removals, appendectomies. He snipped and sutured and suctioned and retracted. Up to his elbows in ligature, he learned, first, the two-handed knot; then the one-handed knot; and then spent a whole surgery woozily considering the philosophical implications of a no-handed knot.

On colon resections he wielded the staple gun, a device that looked like an early-80s rendition of “futuristic weapon.” Preparing to fire it would say in its creepy electronic voice. The attending would nod, and Jonah would pull the trigger.

Firing!

And lo, the Bowel was One.

He met a lot of surgeons. There was Kurt Bourbon, who came in twice a week to work in eighteen-hour blocks, a schedule that freed up Tuesday, Thursday, Friday, Saturday and Sunday for the pursuit of extramarital affairs. There was “Phat” Albert Zakarias, the Hip Hop Doctor, who liked to operate while hollering along to “Real Niggaz Don’t Die.” There was Elliot Steinberger, who — though lanky, balding, and potbellied — had clearly once strutted Lothario, his yearning for the bygone manifest in long rants about how unbearably hot he found his daughter’s friends. They were thirteen. Was that wrong?

Although page 69 of my novel, Trouble, doesn’t directly bear on the plot, in a way it’s far more revealing, as it touches upon one of the book’s central themes: the gruesome process of American medical education. The book was in large part inspired by watching my wife endure the first two years of medical school. I found it peculiar that a system purporting to train in the art of compassionate healing is itself rigid, impersonal, cruel, and stressful.

At no point is that truer than during the medical student’s third year, when she begins to work on the wards, and rapidly finds herself the lowest person on the totem pole. I’d go so far as to say that she’s not really even on the totem pole: she’s the part of the totem pole stuck in the ground, invisible and suffocated, under the thumb of everyone from megalomaniacal surgeons to bitter, dumped-on nurses who are glad to have someone less important around.

Most books, movies, and TV shows about medicine focus on the experience of doctors or residents: ER, for example, or Samuel Shem’s classic memoir The House of God. Almost nothing has been written from the perspective of a third-year. To me, though, that’s the story most worth telling, because it’s the experience that non-doctors can most easily relate to. The third-year is thrown into a blurry, disgusting, hectic, and terrifying world, with only the barest minimum of knowledge or preparation. In chapter seven of the book — which includes page 69 — I tried to give a sense of how disorienting that can be, and how it might render a person vulnerable to making extremely, extremely bad decisions….

[insert ominous noise of your choice]