Nursing Book Club

Sick: A Memoir by Porochista Khakpour

Portrait of a difficult patient

There is an entire genre of literature about the experience of illness in which the author seeks to understand and explain the disease to themselves and to others. As a nurse who has a belief in holistic medicine, I’m always fascinated by what these writers have to say to us.

It was to that end that I read Sick: A Memoir by Porochista Khakpour. The author is critically acclaimed for her novels, short stories and essays and has been published in Elle, The New Yorker, the New York Times and the Los Angeles Times. She’s had a National Endowment for the Arts fellowship and taught at Ivy League schools.

All this is to say that her writing has been well-received by other writers. Personally, however, I don’t know what to make of her latest book.

Khakpour’s disease, which is detailed in the book’s last chapters, is chronic, late-stage Lyme disease, which she assures the reader is a CDC-diagnosed case. If you aren’t familiar with Lyme disease, this last point is important because the clinical criteria for diagnosis are very specific. The number of people who think they have late-stage Lyme disease is considerably greater than the ones who have been formally diagnosed with it.

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I live in an area where Lyme is endemic, so my daily responsibilities as a public health nurse include extensively examining symptoms and lab work and contacting patients and physicians to see whether a case meets the diagnostic criteria. Patients often self-diagnose and then use fringe physicians and outside mail-order labs to seek treatment. (A Google search will show you the kinds of “experts” I deal with!)

Biting the Hand That Feeds

In her search for the cause of her chronic pain, Khakpour laments that she has never been taken seriously by the medical profession. She cites a variety of reasons: Her family immigrated from Iran, she’s a woman of color and she has often suffered a lack of funds.

However, reading this book, I was left with the suspicion that her biggest problem is her own outrageous behavior. Khakpour seems to be a terrible patient, caught in a loop of visiting provider after provider and then ignoring their advice. She has also encountered quite a few quacks along the way.

My own experience may have made me jaded, but the way Khakpour describes her treatment of those around her does not help her case. It’s difficult, as with many patients, to decide whether the behavior is cause or effect, but by her own account, she has treated her family and friends horribly and her employers shabbily.

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It isn’t a flattering picture. Khakpour describes a litany of mental illness, drug abuse and failed relationships. She finds men that are as needy as she, but walks away when they have breakdowns. She begs people to check in on her — as well as sending blast emails to her friends asking for help with drugs, money, rides to appointments and places to sleep — even as she tells them she probably won’t answer. She hires people to help with her work who are poorly suited to the task. She is contemptuous of her parents even as they continuously rescue her, resenting their small house and their inability to communicate with her.

If anything, Sick: A Memoir left me with greater sympathy for providers who deal with patients like this: Your hands are tied as they fail to follow your advice, refuse the medications you prescribe (or take them either too often or too infrequently) and bounce from doctor to doctor and specialist to specialist.

In her epilogue, Khakpour acknowledges that this isn’t a neat or tidy story. It might make for a good book club discussion, but I found it chaotic and poorly told. I doubt you could learn much about Lyme disease from it, but with each new chapter, you certainly do reflect on how you might handle such a difficult patient. I know that’s what I was doing.


Christine Contillo, RN, BSN, PHN, is a public health nurse with more than 40 years of experience, ranging from infants to geriatrics. She enjoys volunteering for medical missions.

 


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