Dark, Disturbing, but Deeply Insightful

By Leela Rottman

I came across Silverstein's book unexpectedly, while browsing in a second-hand bookshop. Not a frequent reader of health memoirs, I flicked through a few pages and was about to put it back on the shelf. But something about this book tugged at me: maybe it was the title, Sick Girl, carrying an unusually pessimistic tone for a memoir of a heart transplant recipient. Or perhaps it was the cover's confronting close-up of a post heart-surgery scar; identical to my own. Whatever the reason, before I had finished the first chapter I knew that Sick Girl would be profoundly relevant for anyone facing transplant surgery, and in fact, for anyone living with a chronic illness. Sick Girl's unflinching honesty enters territory unexplored in many sickness memoirs; the emotional and psychological impacts of illness. Although at times tending towards a bleak, and self-pitying tone, Sick Girl is also sharply observant, and tinged with a wholesome dash of realism. The keenly questioning nature of Silverstein's book, responsible for no little amount of controversy on its 2007 release, makes for confronting and ultimately inspiring reading.

At twenty-four years of age, Silverstein is a Law Student, who, after a sudden decline in health learns that receiving a heart transplant is the only option for survival. Given ten years to live post-transplant, Silverstein attempts as normal a life as possible. She nurtures strong relationships with friends and family and becomes an adoptive mother. But as the ten years trickle by into an astonishing seventeen, Silverstein becomes deeply weary of many drawbacks to living with a transplanted organ: invasive check-ups, emergency dashes to hospital, life-threatening infections, crippling nausea, and the alarmingly unpredictable palpitations of a heart that never quite feels like her own.

There is much to be gained from reading Sick Girl, but first a word of warning. This book will take you to dark places: undergoing cardiac catheterisation with a doctor tugging uncomfortably, over and over again, at the muscle of your heart. Realising that your supposedly 'expert' specialist has mistakenly sent you for a painful and invasive procedure for no reason. Feeling dehumanised by a medical establishment that sees you as nothing more than a diseased organ. Most challenging of all, is Silverstein's resolution towards the end of the book to reject the label of 'miracle patient' and realistically assess life with a transplanted heart. She writes, "... I would do the unthinkable and the uncharacteristic: lie down on the couch, close my eyes, and allow myself to feel my transplant body in all its insidiousness (259)." Silverstein bravely resolves to experience the reality of her condition, a decision mirrored in the memoir's candid honesty. Her refusal to gloss over the darker side of transplant makes for scary, but worthwhile reading.

Surely, one of the reasons Silverstein wrote this book, was to bring these hidden aspects of illness out into the open. Perhaps she feels sickness should not always be concealed behind a brave smile and a resolution to keep positive. This is cleverly illustrated in Silverstein's account of a holiday with nine energetic friends. Silverstein writes, "Nine gleaming pictures of health and one heart transplant patient... She was the one wiping tears aside on the back of her hand, super-quick, before they'd fall and be seen... She was the one in the group photos whose smile had a hint of grinding molars behind it.(232)" Her exhausting experience, where she is literally propelled through a teeming Spanish city in a human chain with her group of oblivious friends, becomes a metaphor for the often nightmarish self-denial and pretence at health practised by sick people in a society in which illness is often unaccounted. This part of the memoir puts the costs of 'keeping positive' into sharp relief. 'Soldiering on' may keep sick people going day-to-day, but comes with long-term drawbacks. Silverstein's portrayal of this issue is yet another confronting but valuable aspect of Sick Girl.

Also compelling, is how Sick Girl demonstrates the inherently solitary journey of illness. Silverstein writes, "Even the greatest love is powerless to overcome the connection between serious illness and loneliness. Built into the doctor's visits, hospital stays, and diagnostic tests are pockets of isolation (265)." These moments are illustrated in vivid detail throughout Sick Girl, shedding light on how the often de-humanising hospital system produces complex and undefinable emotions, leaving the patient feeling alone and misunderstood. The ill person may not know why they leave a simple and relatively painless diagnostic procedure feeling emotionally drained. Or why they feel frustrated, as Silverstein did, when a well-intentioned family member describes their cold, clinical, specialist as 'that nice man'. The blind optimism of family members is another frustration for the sick person, and compounds loneliness. Silverstein writes, "I'd wasted my breath too many times trying to relay my impressions of illness and death to people who, ultimately, would disappoint me by proving they'd been hard-wired only for processing information that supported their ignorance and showcased the brighter side of modern medicine... Optimistic nonsense about my health made everyone feel so much better. Except for me" (268/269). Society's belief in the ability of science to cure all ills, as well as a general tendency for people to hope for happy endings, hinders loved ones' capacity for empathy. Sick Girl shows how different attitudes and understandings of illness can make the experience uniquely painful.

In one of the darkest parts of the memoir Silverstein perhaps pushes this theme too far. She evokes a sense that sick people are forever isolated from healthy people, due to an immovable wall of different experiences and expectations. Silverstein writes, "This was how I saw it... the big ugly secret for those who have no idea what it is like to be young and permanently sick. Everyone else's life goes on... There are [fun parties and great trips] you are able to attend, but you're so sick when you do its almost as if you weren't there at all... But no-one knew because you wore your mask..."(262) Reading these parts of Sick Girl gave me the terrible sensation of being cut-off and alone, a sense of physical and psychological separation from the 'healthy world'. This may be Silverstein's experience of illness, but it doesn't have to be everyone's. As a young person suffering an often debilitating cardio-pulmonary disease, watching my healthier peers pursue careers, travel, and have children, I can easily relate to Silverstein's feelings of being left out and alone. I also know, however, that many avenues of empathy flow between people, that there are many ways of experiencing the world that go beyond the usual, middle-class, aspirations. Additionally, Silverstein's idea of 'healthy' and 'sick' is too fixed, ignoring the fact that people often move in and out of health and illness, with varying abilities for empathy. And most people, healthy or ill, at some stage in their lives, feel isolated and alone. Loneliness is, after all, a part of the human condition and is not the sole property of sick people. Sick Girl is valuable for its deeply probing nature, for its refreshing cynicism, for its insight into so many aspects of illness, but I would caution against getting too caught up in Silverstein's bleak outlook on this point.

Silverstein does not only chronicle the darker aspects of illness. Throughout the memoir she insists on her gratitude for the extra time her transplant has given her. She has good friends, an adoring husband, and a much loved adopted son. And she even illustrates some benefits of illness. On her wedding day, confronted in a mirror with her 'bride-perfect' image, her transplant body hidden in swathes of white, Silverstein feels a building euphoria and a sense of being in touch with her inner strength. She writes, "Life had pushed me all the way to the edge- maybe even beyond- but I had pushed back hard enough to stay alive. And now, here I was, a woman in my mid-twenties, and I had discovered something few people glimpse in a whole lifetime: I had learned what I was made of (170)." This aspect of Sick Girl and other positive moments show the empowerment gained from being a survivor. They demonstrate how understanding the fragile nature of good health brings a valuable wisdom and appreciation of life on a moment-to-moment level. Silverstein's memoir is, in many ways, charged with optimism and love for life.

Through most of this review I have sung the praises of Sick Girl, and for good reason. Silverstein's brave refusal to conform to the traditional rose-tinted sickness memoir would alone, make this book worth reading. Unfortunately, a google search of 'Sick Girl' brings up a slough of hate-mail contending this view. Silverstein is accused of excessive cynicism and labelled an ungrateful organ recipient. She is basically told to shut up and be glad for what she has. While Silverstein's book does question the long-term viability of transplant, I don't feel that it is excessively self-pitying or that it paints an exaggeratedly awful picture of chronic illness. Nor is she ungrateful for her transplant, stridently insisting the opposite throughout the memoir, and in post-publication interviews. Silverstein is essentially a realist. In a society that demands sick people live in almost continual denial of reality, Sick Girl is guaranteed to provoke animosity. And at the heart of public ambivalence about Sick Girl is fear of the challenge it raises. Silverstein courageously enters the ongoing debate over the sanctity of human life; the mandate to draw that next breath, however painful; for the heart to keep thudding along, however erratically, is pitted against a more holistic engagement with illness; a recognition that all aspects of a person's life are important, not just the collection of cells under the specialist's microscope. A brave acknowledgement, that in some unique circumstances, letting go is preferable to struggle. This issue is left, as much else is in Sick Girl, with a big question mark. And this is what I admire most about this memoir: the questions Silverstein so daringly raises are deeply examined, but ultimately unresolved. Silverstein is not dictating how to feel about illness, she is showing us a range of possible feelings. Sick Girl is brave, sharply cynical, and focuses on so many important, but little-discussed aspects of sickness. I would recommend this book for anyone learning to cope with chronic illness.

Sick Girl, by Amy Silverstein, was published by Hatchette Australia, Sydney, Australia, 2007, and Grove Press, Grove/Atlantic, New York, 2007, and is copyright of Amy Silverstein, 2007.

Contributor: Leela Rottman
Leela Rottman is a writer and student attending university. She has ten years experience living with pulmonary hypertension which developed due to a congenital heart defect. Ms. Rottman loves books, music, hanging out with friends and exploring the nooks and crannies of her adopted city, Hobart, located in Southern Tasmania off the coast of Australia. Ms. Rottman has one other published work on PHCentral. We hope she becomes a regular owner to the site. You can read "Navigating The Health Care Super-Highway" HERE.

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