Shattered, a memoir by novelist, screenwriter and playwright Hanif Kureishi

Hanif Kureishi is a novelist, screenwriter, and playwright. He is the author of nine novels, including The Buddha of Suburbia (winner of the Whitbread Award for Best First Novel), The Black Album, Intimacy, and The Nothing. His screenplay of My Beautiful Laundrette was nominated for an Oscar, and he is the recipient of the PEN Pinter Prize and the Chevalier de l’Ordre des Arts et des Lettres. He was made a Commander of the Order of the British Empire. He lives in London.
Author hoto by Kier Kureishi

In December 2022, novelist, screenwriter (My Beautiful Launderette) and playwright Hanif Kureishi was at his girlfriend Isabella’s apartment in Rome when he had a fall after fainting due to a change in blood pressure. Because of how he landed, he ended up hyperextending his neck resulting in immediate tetraplegia. His memoir Shattered (Ecco, 2025) is his account of the following year he spent in various hospitals and rehabilitation centers as he tried to understand how he would live moving forward, as the accident reshaped his view of himself and his body, especially what that means for him as a writer.

 Throughout the book, Kureishi has the reactions one would expect from a life-changing event such as his. He cycles through Kübler-Ross’s stages of grief, though he never reaches acceptance (he has moments of hope, though), and he spends most of his time in anger and depression. Kureishi shares moments of disbelief—how waking up (when he’s able to get a few hours of sleep) can be the worst moment of the day, when he realizes all over again what has happened to him. It’s like “re-entering a horror movie that I had thought, for a moment, I could turn off.” He sometimes suffers from envy, especially when friends who visit him talk about going on vacation and he recalls what it’s like to travel with such ease.

He doesn’t say much about the care he receives, but that’s mainly because of the boring routines of a long hospital stay. Early in the book, he does provide details, even interjecting humor to his description of receiving an enema, but once he’s established that routine, he shifts his focus away from the medical descriptions. Similarly, given that he moves through five different hospitals/rehabilitation centers, he doesn’t truly get to know the people who care for him. Not only that, he notices the turnover in the staff, which prevents him from knowing them more fully. That’s a frustration for him, as he seeks to build relationships in a place where he’s spending several months of his life.

Empathy plays a part in how he sees his caregivers, as he reflects on all they do for him and how they see their job as a calling, despite the long hours and low pay. The experience is as humbling as it is existentially exasperating: He learns how to ask for help, as he has lost the ability to do anything for himself. Kureishi makes a clear contrast between the hospital in Italy, where he spends the first five months, and the various locations in England, which range from grim to adequate. There’s an implied criticism of the British National Health Service, but he never comes out and skewers it directly. As an American reader, I couldn’t help but wonder how much all of his care would have cost in the U.S. system and how somebody who makes their living as a writer would be able to afford it, even with insurance.

The main strength of Shattered consists of reflections on his identity after the accident. Early on, he writes: “I am a stranger to myself. I don’t know who I am any more. Someone new is emerging.” After ten months, he reflects, “I can feel my identity slipping, as if I am forgetting who I am and becoming someone else, or almost nothing. I never thought my identity would be scrubbed out or superseded by something else.”

Part of that change revolves around the idea of disability. He has gone from being a person who could function in a society built for those who are physically able to move around without assistance to somebody who requires help for every action they want to do. Daily activity becomes heightened for him: For example, Kureishi describes how those helping him eat either give him food too quickly or not quickly enough, a distinction most readers wouldn’t have thought about but one that makes perfect sense once one stops to consider it. For his return home to his house in London, a number of accommodations are needed, including adding a bathroom and bed to the main floor. The most mundane activities must be navigated with care. Kureishi chronicles, for example, the amount of attention he has to pay to the uneven quality of the sidewalks when he and one of his sons go to a pub.

He devotes a small amount of time to thinking about sex, as well as a discussion of psychoanalysis (which he has been in for decades), but not how he and Isabella will continue to have any type of intimacy. Instead, he talks about the sex he had in the past and his lack of interest in it now. He’s frank about it, even making Isabella uncomfortable in relating a story about a supposed orgy he was a part of (the story does not live up to that description), but he doesn’t seem concerned with it moving forward.

A Writer’s Life, Interrupted
Given how much of Kureishi’s life consists of writing, that part of his identity comes in for the most scrutiny. He wonders what life is like as a writer who is unable to pick up a pen and physically write. The only way he was able to compose Shattered, for example, was through dictation and the help of his family. It is telling that Kureishi begins writing this book within a couple of weeks after his accident, as his way of processing the world. In his first entry, dated 6 January 2023, he ends by saying, “I am speaking these words through Isabella, who is slowly typing them into her iPad. I am determined to keep writing, it has never mattered to me more.” One of the reasons his identity as a writer is so important is because it has provided him with an identity of his choosing, unlike the racial identity British society, especially his peers, put upon him when he was younger. After providing a list of words other people called him, he “found [his] own word, [he] stuck to it, and never let it go. It is still [his] word.” Some of the strongest sections of the book, certainly some of the best quotes, come from his thoughts about writing and being a writer.

Occasionally, he forgets the privilege he does still have as a male writer. He tells the story of one of his students who is working on a novel. Before giving a draft to an editor or agent, she asks a sensitivity reader to evaluate it to see if it contains anything that is offensive. Kureishi is appalled by such an idea and spends several pages talking about how writers of the 20th century would not have taken such an approach, that the point of literature is to transgress, especially writers such as Dostoevsky, Sylvia Plath, Jean Rhys, Céline, William Burroughs, Henry Miller, James Baldwin, Franz Kafka, and D.H. Lawrence, all of whom pushed boundaries and forced readers to see a wider world. He fails to notice that most of them are male—Rhys and Plath are the exceptions— and while there have been female writers who were literary disrupters, it has been (and continues to be) much more difficult for them to do so.

 One other aspect of his identity that he explores is the nature of his body. He admits he hasn’t thought about his body much during his life, as he’s not an athlete and hasn’t suffered from any other significant ailments or injuries, but this accident has brought him more in touch with that body, even as it has become more of an object. At times, he talks about parts of his body as if they don’t belong to him, given his lack of control over them, but he’s also fascinated with what his body can and can’t do. His hands are of particular interest, given they are the conduit for his writing. He regularly mentions how he has given up any kind of embarrassment about his body, given how often people undress and wash and handle him, which causes him to see his body as more of an object, but also to appreciate the lack of judgment from those who do such work.

 His list of acknowledgements is longer than for most books, given how many people have taken care of him. He spends some of the time in the book talking about the effects such care has taken on his family. His now-fiancée Isabella (they get engaged during the course of the book) has effectively given up her work as a PR agent for writers and festivals to be there for him, and his three sons work out a rotation of visits to help her. He describes the change that happened:

“Two weeks ago a bomb went off in my life which has also shattered the lives of those around me. My partner, my children, my friends. All my relationships are being renegotiated. It makes everybody a little crazy, it changes everything. There is guilt and rage, and people resent their dependence on one another and the fact they can’t do everything for themselves. My accident was a physical tragedy, but the emotional outcomes for all of us are going to be significant.”

He also talks about the wide variety of friends and even acquaintances who come to see him, with Isabella even joking about how busy his room often is. There are days where several people end up there at the same time, having lengthy intellectual conversations, much like they would have had in the past. On most of those days, he’s suffering too much to truly enjoy them, but it’s clear he noticed them, given that they show up in his account. He realizes that such an accident has taught him who his true friends are, and he reflects on when he might not have been as good of a friend as he should have. Like most of us, he resolves to be different moving forward.

I would be remiss if I neglected to mention the humor he works throughout the book, given the lack of jollity in his situation. He tells the story of a time before his accident when a nurse mistook him for Salman Rushdie—the author of Midnight’s Children and one of Kureishi’s friends—while a nurse was flipping him over, preparing to put a finger in his “backside.” Kureishi jokes that if he had written Midnight’s Children, he would have “gone private,” implying that he would be able to afford private care and wouldn’t be in such a public setting, given the threat on Rushdie’s life. When he relates a story about having a long conversation with a doctor in Italy about raising children, translations of Russian novels, the doctor’s performing surgery on a Mafia don, among other subjects, Kureishi ends by saying, “I have to say that becoming paralyzed is a great way to meet new people.”

The book ends with his going home to a different life, but one where he can still find some joy in the world. His book is not treacly or saccharine, as he doesn’t try to deliver any life lessons he’s learned along the way, nor does he end with any implication that moving forward will be easy. However, he has begun to try to see the small parts of life that will continue to provide happiness. In fact, he reflects on the collaboration of editing this book with his son Carlo and how much he has enjoyed that. Even if he doesn’t pick up a pen again, it’s clear Kureishi will find a way to communicate with the world around him.—Kevin Brown

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Kevin Brown (he/him) teaches high school English in Nashville. He has published three books of poetry: Liturgical Calendar: Poems (Wipf and Stock); A Lexicon of Lost Words (winner of the Violet Reed Haas Prize for Poetry, Snake Nation Press); and Exit Lines (Plain View Press). He also has a memoir, Another Way: Finding Faith, Then Finding It Again, and a book of scholarship, They Love to Tell the Stories: Five Contemporary Novelists Take on the Gospels. Find out more about him and his work on social media sites at @kevinbrownwrites or at http://kevinbrownwrites.weebly.com/.

Our Long Marvelous Dying by Anna DeForest

One moment of Anna DeForest’s Our Long Marvelous Dying, just published by Little, Brown and Company, captures the immense grief at the root of their new novel:

 In the interval between giving a dose of intravenous opioids and seeing the peak effect, I will sometimes pass the time by catching up on the news. There is almost always a disaster imminent…You get used to it…

A sense of resignation and detachment pervades the story told by an unnamed narrator, who works as a palliative-care fellow in New York City after the peak of the early COVID-19 pandemic.  In the first chapters, she recounts aspects of her training as a specialist, who “serves as a sort of illness interpreter, bringing the jargon of clinical medicine into the life and language of the patient who is living the experience.” It’s a specialty also “trained to be comfortable with [prescribing] the stronger stuff: morphine, hydromorphone, fentanyl.” As the fellow learns these skills, an assessment of how her specialty serves the dying patient and her colleagues becomes clear:

The trouble that the other doctors have is not a lack of gentleness. Well, not only that. More often what they cannot do is tell the truth. They pack death up in so much misdirection, talk about the success or failure rate of this or that procedure or treatment, when the truth is the patient will be dead soon no matter what we come up with to do in the interim. That’s the part they need a specialist to say.

 We also get glimpses of the narrator’s personal life: her relationship with her husband Eli, the dark ground-floor apartment they rent, the chess games she plays with her young niece Sarah, who her brother has left with them. We learn about the death of her father. Throughout the novel, the narrator seeks ways to withstand suffering—the global and local, present and past—in her daily existence.

Anna DeForest (they/their) is the author of the novels A History of Present Illness and Our Long Marvelous Dying, and a palliative care physician in New York City.

Photo by Stephen Douglas

Our Long Marvelous Dying is DeForest’s second novel and in some ways narratively follows A History of Present Illness, published in 2022, which challenged the lore of medical education through the story of a student managing her own personal trauma and the wider trauma of American healthcare. Reviews of DeForest’s first novel linked the writer, who works as a palliative care physician at Memorial Sloan Kettering Cancer Center in New York City, to the narrator—and the same might apply to Our Long Marvelous Dying, as many moments seem pulled from the firsthand experience of a physician versed in hospice and palliative care.

In many of the novel’s settings, bereavement surrounds the narrator and often consumes her. But the grief that grounds the story and proves most unsettling for the narrator stems from the death of her absent and unkind father. DeForest structures the story to reflect the narrator’s apprehension towards him. We see him in pieces between scenes in the hospital, and can’t put him together as a whole until the very end. In managing the arrangements for his death, the narrator takes us through their fraught relationship. His favorite story to tell her romantic partners when meeting them for the first time is how whenever she cried as an infant, he said “I never liked you from the beginning.” But the cruelty of his abandonment is in its persistence—he is a “latent monster,” a “ghost” from whom she never stops craving acknowledgement.

Beyond her family, the narrator guides us through additional layers of grief in a way that we never stay long enough in one place to take up the devastation. The world offers constant tragedy—floods, destruction of coral reefs, extinction of thousands of species. And every day the COVID-19 pandemic rages. The reader hears about the refrigerated trucks lining New York City blocks, but what the reader sees in specific detail are the causalities for healthcare workers: their loneliness and coping mechanisms of alcohol use, disordered eating and SSRIs for suicidal ideation. During rounds, for example, an attending physician recounts the peak of the pandemic and says absently, “I am on an SSRI.” Meanwhile, the narrator notices the spring air coming through the window in his office that has “no bars, no screen. Fourteen floors up, with a view of the Empire State Building.” There is an omnipresent threat of self-harm, if not from one tragedy, then from the weight of so many others. 

But Our Long Marvelous Dying is not a trauma dump. It confronts the obvious truths we train ourselves to overlook: the truth of death in a hospital, the truth of our own progression to death. It forces the question of “what is the purpose of living?” and does not give a satisfying answer. In this way, the novel’s title does not allude to the hidden deaths in the hospice wings, it alludes to us. Without despair, the narrator states “that all of us will die…that all of us are dead already.” The narrator acts as a palliative-care physician for us all, interpreting the jargon and euphemisms that drown the simple truth of daily tragedy.  The sugar coating has dissolved, and she wants to communicate that “no one is coming to comfort you” and “nothing will help.”

 One of the most provocative aspects of DeForest’s work is their ability to situate the reader in the day-to-day clinical world. The narrator normalizes death, dying and the grim collapse of human bodies that happens, not because of dispassion, but because of routine. While contributing to the book’s undercurrent of grief, the hospice unit provides meaning on a quotidian basis. On a phone call, in response to a mother’s dismay that her daughter may die before they arrive, the narrator reflects: “of course she can and does die alone.” In another situation, she reflects that an aging actress “dies the same as anyone.” These are tragedies that are contained, expected and managed. 

Despite submission to muted sorrow, the narrator still attempts to manage her trauma. The palliative-care fellowship itself, in the view of its program director, draws those with personal layers of grief in addition to their professional interest. For the narrator, her work keeps the despair at bay and allows her to reflect on the minutiae of existence—for example, describing her underground commute as “the long stretch of track between where I live and everything that matters.” In revolving her life around the care of others, she does not have to generate her own will to continue living.

She also tries to endure by tempering her connections, especially to her husband Eli, a “well-adjusted” and handsome chaplain with a network of friends who adore him. The constant in their marriage is the restrained threat of its end, from “red flags” or laments that “it isn’t working.” This sense of detachment also manifests with her niece Sarah, who she describes as her “temporary daughter” while Sarah’s father is unable to care for her due to his substance use. We learn that an intergenerational dearth of attention and love has conditioned the narrator to the security of pain rather than love; the cycle of abuse contributes to her decision not to have children. The place where she seeks connection is a monastery out of the city, where she arrives and departs anonymous to her peers.  

While there is no neat resolution, the protagonist steadily approaches the grief that eludes her—the death of her father. We see this through the lengthening of the scenes themselves. Initially, we learn about her father in brief moments between scenes of her palliative-care fellowship; by the end, we are allowed to linger as she sorts through his belongings. For a person who asks uncomfortable questions (Are you happy?) and speaks revolutionary words in a hospital (death and dying), the narrator takes her time to confront his death. She asks a rabbi at the hospital what to do after death about the bad acts her father committed in his life. Just as she can cut through medical euphemisms and jargon, he cuts through her question: “The weight you feel, he says, is not a need to forgive anyone. Just call it grief. Call it trauma.”

In Our Long Marvelous Dying, DeForest challenges our discomfort with death and instead leads with loss and our search for meaning within it.—Margo Peyton

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Margo A. Peyton is a resident physician in neurology at Massachusetts General Hospital and Brigham and Women's Hospital. Prior to medical school at Johns Hopkins, she worked in film and television story development for DreamWorks Animation. Her essays and book reviews have appeared in The New England Journal of Medicine, JAMA and the Boston Society of Neurology, Neurosurgery, and Psychiatry.

Some Kind of Happiness by Claire Legrand

In her 2017 YA novel Some Kind of Happiness, Claire Legrand paints a poignant picture of mental illness and the difficulties of navigating family relationships. It is a fictional account of teenager Finley Hart as she spends a summer with grandparents and cousins she has never met while her parents resolve their relationship issues. Interspersed in the chapters is a magical story of a place called “Everwood,” a fantasy realm that serves as a coping mechanism for the young girl, who uses it to journey through dangers, meeting friends and foes both without and within. Fantasy and reality bleed into each other as Finley struggles with what she sees as “a darkness” within her, a darkness that threatens to destroy the Everwood.

Claire Legrand used to be a musician until she realized she couldn’t stop thinking about the stories in her head. Now Ms. Legrand is a full-time writer living in New Jersey. She has written two middle grade novels—The Cavendish Home for Boys and Girls, one of the New York Public Library’s 100 Titles for Reading and Sharing in 2012, and The Year of Shadows—as well as the young adult novel Winterspell. Her newest book A Crown of Ivy and Glass Book One of the Middlemist Trilogy will be published by Sourcebooks Casablanca in May 2023. Visit her at Claire-Legrand.com and on Twitter @ClaireLegrand.

Some Kind of Happiness is an insightful tool that can be used to teach teenage and adult audiences the difficulty in confronting and naming mental illness in one's life. The book starts off with Finley being dropped off for the summer at her grandparents' house. For reasons not yet known Finley’s father is estranged from his parents, so until this point Finley has never met them or her aunts and uncles. Her parents need the summer alone to “work on things” and it is implied they are approaching divorce but not explicitly stated.

This refusal to give a name to problems is a recurring theme that’s true of the teenagers and adults alike in this insightful narrative. Like Finley many teenagers may be unable or unwilling to articulate what they are feeling. They are suddenly dealing with complex emotions and adult situations they’ve never encountered before. Finley’s journey through this symbolic forest of emotional struggles—and how much her viewpoint as a teenager differs from the adults around her—is a reminder of the confusion adolescents experience and the real benefits that come from confronting and giving voice to their struggles.

While the story is geared towards a Young Adult audience, Legrand’s skillful and engaging prose creates a useful depiction of working through these emotions and figuring out what they mean. It also helps to combat the stigma of mental illness, normalizing it as a part of life. Adult readers can glean a lot of insights as well. I found myself reflecting on how I try to recognize struggles in children and youth around in my life, and how I approach difficult and sensitive topics with them.

As the story progresses Finley tells her cousins about the Everwood and the children play fantasy games in the nearby forest together. Her cousins are knights, squires and princesses, and Finley plays the orphan turned queen. Against the warnings of their grandparents, they make friends with the neighbor boys and create a world full of lore and magic. The tone and story of the book made me think of Bridge to Terabithia by Katherine Peterson.

Though she plays with her cousins the Everwood isn’t a game to Finley; it is something more, a place where she escapes from her problems. One day the young girl realizes the Everwood is changing and decaying and as she investigates, she meets a snake. The snake warns that something within her is destroying the Everwood and helps extract a portion of oily darkness from her. Unfortunately, the snake isn't powerful enough to remove all of the darkness, but warns that it must be removed to save the Everwood, as seen in this passage:

“Whatever we carry within our hearts, the Everwood’s power makes it real. And soon what you carry will destroy not only you but everything you touch. The Everwood is not as strong as it once was; your darkness will bring out its own. To save the forest you must face this thing inside you.”

The orphan girl held back tears of shame. Her great secret, the one she had worked so hard to conceal, lodged in her heart, “But how?”

“First you must give it a name,” said the snake. “Naming a thing takes away some of its power and gives it to you instead.”

But Finley refuses, finding it too hard. This reminded me a lot of when a patient I worked with told me that being diagnosed with depression was almost as hard as suffering from it. To have their sadness given a name made it real and was painful, in part, because they couldn’t hide from it anymore. This is what Finley feels, and later, when she is confronted with a fox, she still refuses to name the darkness. It is unclear whether Finley is just afraid to name her condition and admit what is going on, or if she truly doesn’t understand what is happening and is unable to name it.

Legrand uses Finley’s internal dialog to adeptly describe the struggles of mental illness. Her young protagonist often has “blue days” and “episodes” that seem to be panic attacks. Finley, who feels incredible guilt about these attacks, recognizes her life is better than others and feels she has no reason to feel the way she does. When her cousins and friends discover a burned-down house with three graves in the front, they name it “Bone House” and learn about a young family that died in a fire. As the revelation comes to light, Finley begins to have a panic attack:

“...not even fresh air can get rid of this fear living like bugs underneath my skin.
This fear that I have no reason to feel.
There is no reason for the heaviness I can feel pressing down on me. Like when you step outside before a storm and the air feels heavy and damp, like you’re drinking it instead of breathing.
Like that, but worse.
It seems wrong to feel these things while standing in front of this poor, broken Bone House.
I ought to be able to get rid of these feelings—right?
Shouldn’t I be able to live in my beautiful, clean house (which is not burned) with my family (who are still alive) and be happy about it?
I ought to be able to get rid of these feelings.”

Eventually, as she explores the Everwood and receives help from her parents and family, Finley is able to name her darkness when she goes to see a therapist:

“I breathe in. I breath out.
(Its ok, Finley.)
(Let her see.)
Dad squeezes my hand.
“I think I have depression.” I hesitate, “And anxiety, too.”
When I say it, the words float away from me and leave nothing behind.
They are only words. They are only part of me, and I am still here.
I do not need to be afraid of them.”

With an understanding of what is going on within herself and a realization that things aren’t as perfect as they appear on the outside, Finley is able to accept who she is, and as she does the darkness of the Everwood recedes. Things are right again and she becomes more than “the orphan,” she becomes Queen of the Everwood.

I was impressed with the honest way mental illness was portrayed. I’ve read many clinical books that describe mental illness, but Claire Legrand was able to portray it in an emotional way that strikes one's heart. Some Kind of Happiness does what Finley struggles to do: It adeptly names and beautifully describes the struggles of depression and anxiety in a way that connects with readers. While Legrand doesn’t have an academic background in mental health, she has spoken on the struggles of living with mental illness. Her personal experiences shine through in the way she describes these struggles, making it an insightful one for those who are confronting their own difficult emotional landscape. Using both real world examples and allegory Some Kind of Happiness is a useful story for younger readers as well as clinicians in understanding mental illness. It gives voice to those who feel like outsiders in their own families or feel inadequate compared to everyone around them. It teaches us we don’t have to be afraid of what's inside us. We can face it, and when we do, we don’t need to face it alone. —M.T. Bennett

M.T. Bennett is a student at Trinity School of Medicine. He enjoys writing and spending time with his wife and two sons. Bennett is the author of “Dark and Bright: Poetry and Prose.” His writing has appeared in various publications from the Harvard Medical Student Review, to the Journal of Supernatural Studies, World Medical & Health Policy, Graphic Medicine, HEAL, America Media and MedPage Today.

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The Song of Our Scars: The Untold Story of Pain by Haider Warraich

Almost everything we know about pain and how to treat it is wrong, Haider Warraich says in his insightful book The Song of Our Scars: The Untold Story of Pain, published earlier this year by Basic Books. The physician and assistant professor at Harvard Medical School claims that there are dire misunderstandings between patients who feel pain, the clinicians who address it, and the researchers who study it. Worst of all, he says, pain has transformed from a symptom into a disease.

Haider Warraich is a physician, author and researcher at the VA Boston Healthcare System, Brigham and Women’s Hospital and Harvard Medical School. He has published more than 140 research papers including in the NEJM, JAMA and BMJ. He frequently writes for the New York Times and Washington Post, and is the author of the books Modern Death, State of the Heart and the just published The Song of Our Scars – The Untold Story of Pain (Basic Books).@haiderwarraich

One in five American adults—an estimated sixty-six million in total—experience chronic pain, resulting in billions of dollars in direct medical costs and lost productivity. Lower back pain is the leading cause of disability in the United States, followed by migraine headaches, neck pain and conditions like osteo and rheumatoid arthritis. And Americans are most likely to use opioids to help alleviate their pain. Yet, as Warraich points out, opioids provide little to no benefit for chronic non-cancer pain, and can even make it worse.

Pain’s storied complexity is multifaceted and multilayered. Its treatment, in Warraich’s view, requires empathic holistic care that considers how pain is racialized, gendered and personal. Pain is subjective. You can have pain without suffering. There is no single dedicated pain center in the brain. The pain of Black people remains both under-recognized and under-treated. Women are more likely to feel pain, but their pain is also more likely to be dismissed. Simply assessing pain on a numeric scale doubles the risk of opioid overdoses in hospital. And exercise is a vital part of any multidisciplinary approach to managing chronic pain.

Warraich himself has chronic back pain due to a sports injury that happened many years ago when he was a medical student in Pakistan—around the time when he felt confirmed in his vocation to be a doctor. Just when he felt like he had fallen in love with medicine, he broke his back.

Now an insightful, wounded healer, Warraich draws from his own experience of how disruptive chronic pain can be—how it “disrupts the way a person moves through their life, the narrative they define themselves by, the arc of their stories.”

The Song of Our Scars is filled with research findings, clinical vignettes, historical details and sociopolitical commentary. Yet the story Warraich tells is so broad and at times surprisingly sequenced—jumping from the mythological Greek world, to the history of opium, to the American Civil War—that it can sound like listening to the radio while scanning the channels, catching snippets of newscasts in search of a good song. We as readers want to hear more of Warraich’s own personal self-reflections, which would help focus his narrative by giving voice to his song, and deepen its impact on readers, his listeners.

Perhaps most helpful is Warraich’s concern for the origins of the opioid addiction crisis in America. The story of the opioid crisis continues to unfold in the United States, and recently came into the headlines in the documentary “All the Beauty and the Bloodshed,”directed by award-winning director Laura Poitras about artist Nan Goldin’s life and chronicles her addiction and activism that led to major museums such as the National Portrait Gallery in Washington, DC, the Guggenheim, the Tate and others to stop taking donations from the Sackler family and removing the Sackler name from the walls of their institutions. The documentary won the prestigious Golden Lion at the Venice Film Festival in September.

In The Song of Our Scars, Warraich highlights how Cicely Saunders’s revolutionary approach to pain management in hospice care was “hijacked” into a business strategy by the pharmaceutical industry, whose goal, he says, “was to take Saunders’s approach toward total pain experienced by people at the end of life and apply it to people in every phase of life, treating routine medical conditions as if they were terminal illnesses.” Saunders, who started her clinical practice as a nurse and became a doctor, is credited with founding the first modern hospice and establishing the discipline and the culture of palliative care in the late 1950s.

In terms of narrative care, Warraich brings to mind, but does not reference, other prominent physicians and scholars who describe and advocate also for such empathic patient-centered care, including Rita Charon, Victoria Sweet, Arthur Frank and William Randall.

What are the songs of our scars? What type, form and shape do they take? There are love songs, ballads, laments and anthems, to name an obvious few. How do they help us? Do they capture our hearts and move our spirits? Warraich hopes so. As patients tell us their tales of pain, he knows how important it is to listen to them. And he wants healthcare providers to learn how to listen more fully, deeply and more compassionately in clinical practice. Empathy is what makes a good doctor, he says—empathy and kindness.

“As we look to the future and take stock of all that we know about chronic pain,” he says, “we find that the most promising treatment approaches don’t involve any chemical inebriation or procedural manipulation. They involve one human being talking to another, helping them realize that the path to relief was within them all along.”—Robert Mundle

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Robert Mundle is a graduate of Yale Divinity School and a palliative care chaplain in Kingston, Ontario. He is the author of How to Be an Even Better Listener: A Practical Guide for Hospice and Palliative Care Volunteers (JKP 2018).