Making a Case

Making a Case" Kathryn Montgomery Hunter The controversy provoked by David Barnard's "A Case of Amyotrophic Lateral Sclerosis" and Eric Rabkin's attack upon it is something of a milestone in the development of literature and medicine. 1 It is not just that (as a colleague of mine once taunted me) the criteria of an independent discipline include, along with an annual meeting and a journal, a measurable level of internecine strife; the topic of the BarnardRabkin controversy itself marks an era in literature and medicine. For ten years or more we have talked and written about physician-writers, the images of illness and the doctor in literature, pathographies, bibliotherapy, and the maladies of authors—all of the valuable and interesting ways that medicine enlightens literature and its creation. 2 With this controversy, however, we at last have begun to talk about what literature brings to the understanding of medicine, that is, about the inescapably narrative quality of knowledge in medicine and the shape that narrative should take. 3 David Barnard's case study, related by an almost effaced first-person narrator, is the account of the terminal illness of Maurice Baker and the care given him by his wife Paula Baker and his physician Valerie Walsh. Barnard accompanied Dr. Walsh on three-quarters of her house calls to Mr. Baker during a ten-month period near the end of his life. The physician talked freely to Barnard about her concerns, and he seems to have enjoyed the confidence of the Bakers, whom he interviewed separately. Barnard is minimally present as a narrator, preferring to focus on the events and interactions he witnessed, interspersing summary narration with exchanges from transcripts of his interviews. He is a good observer, reporting to us glances and gestures, and his affection for his characters is expressed in the care with which he describes them and their various viewpoints. Far from passing judgment on his characters, he leaves us to infer (and, if we are so inclined, to label) Mr. Baker's early denial of his illness, Mrs. * This paper was written with the support of a fellowship from the American Council of Learned Societies. I am indebted to Anne Hudson Jones for our tablethumping discussion of this matter over breakfast at the Camellia Grill during the 1986 meeting of the Association for Faculty in the Medical Humanities. Literature and Medicine 7 (1988) 66-79 © 1988 by The Johns Hopkins University Press Kathryn Montgomery Hunter 67 Baker's desperate need to control what is happening to her and her husband, and Dr. Walsh's more than ordinary involvement in the case. Although the narrator's reticence is not entailed by Barnard's intention "to depict illness as a shared experience in the lives of sufferer and healer" (p. 27, note), it is consistent with his subsequently stated aim of writing a case study that could be read and discussed by medical students soon to begin their engagement with patients. Despite the use of suspense and dramatic irony and the narrator's easy movement between summary narration and reported dialogue, for the most part the account is straightforwardly chronological. It begins with a brief biography, a description of amyotrophic lateral sclerosis (ALS), and a report of Mr. Baker's first visit to a physician in April of 1978. Like Boswell's Life of Johnson, the fully detailed and engaged story does not begin until the narrator meets his subjects—and Dr. Walsh her patient. Joanne Trautmann Banks, editor of the volume of Literature and Medicine in which Barnard's work appears, describes it as "informative, intelligent, moving—and unusual, as far as she knew, in the tradition of case histories. " Believing that these "qualities seemed to stem partly from its power as a narrative, " she intended to ask several literary critics to address questions, first, about the relation of the case study to fiction and, then, about the consequences of this relationship for medicine and the education of physicians. 4 As it turned out, however, the questions went unanswered, and there was room for only Eric Rabkin's "A Case of Self Defense. " A professor of English literature who has written extensively on science fiction. . .