I have been wrong about a lot of things. Soon after Kathryn Harrison's memoir The Kiss came out in 1997, about her four-year sexual liaison with her father, I predicted that the most recent memoir craze, begun two years before, with Mary Karr's The Liar's Club, would begin to fade: what story of a dysfunctional family could top this one? Anyone who contemplated entering the ring would have Harrison's extreme example to contend with.
I hadn't yet read The Kiss, and couldn't have told you then that I'd come to see it as an essential text on what searing deprivation does to the body and the soul. Far from bringing the craze to a close, The Kiss moved the memoir bar quite a few rungs higher. More than a decade later, we can safely say that memoirs are the new novel: a constantly evolving form of storytelling.
In these fertile years, memoirs have taken ambitious, new shapes, from Dave Eggers post-modern Heartbreaking Work of Staggering Genius to Alison Bechdel's comic strip, Dykes to Watch Out For. A somewhat more staid form is a hybrid formerly frowned on in journalism, in which the writer is part of the story: the journalistic memoir, or the memoir with a larger story (ie: a lot of facts) to tell.
I say all this by way of introducing Michael Downing's Life with Sudden Death: A Tale of Moral Hazard and Medical Malpractice, a remarkable memoir by a writer known for his novels (Breakfast with Scot, Perfect Agreement) and his nonfiction (Spring Forward, Shoes Outside the Door, about the San Francisco Zen Center), but whose cross-generational story of family tragedy and medical mayhem is perfectly suited to this hybrid.
Told as a novel, elements of the story would strain credulity. The symmetries and parallels would seem artificial. The critique of the Catholic Church, in which Downing and his eight siblings were raised, might seem unnecessary, even de trop. Downing's mother's hell fire and brimstone reaction to him, because he is gay, might seem extreme for a Western Massachusetts Democrat. Her wanting him to go to the local Catholic college - after he's gotten into Harvard - might come off as far-fetched.
The story's leap from a childhood in rural Massachusetts, haunted by a barely remembered father who died suddenly when Downing was three, to the innards of a Harvard Medical School hospital forty-some years later - the author in danger of dying an identical death - could well work in a novel, but it has a different weight and texture with the word "true" engraved on it.
Even in this summary, it's a compelling story, but it's Downing's intelligence, his bone-dry wit, his carefully measured sorrow, carefully controlled rage, and beautifully wrought prose that make this memoir such a standout. His writing has the cerebral precision and focus of Joan Didion's, but it's got other kinds of fullness and heart too. He's not quite the "tough customer" the doctor called Didion at the hospital where her husband was pronounced dead, recounted in The Year of Magical Thinking.
But like Didion confronting her husband's death and her daughter's illness in her memoir, Downing too becomes a medical specialist in the service of the rare heart condition that killed his father and, forty years later, his brother. Yet when his father died, there was no autopsy; his death was "God's will." When his brother died, with a wife and two young children, science prevailed - and led another sibling to see her doctor, which led to a genetics laboratory affiliated with Harvard.
The lab director believes that the entire Downing family might be vulnerable to this condition - whose first symptom is sudden death. "It was the first time it occurred to me," Downing writes, "that the deaths of my father and my brother might not be eerily corresponding or suggestively parallel tragedies but two events in an unfolding sequence."
So begins the medical misadventure of the title. Whatever simmering anger Downing feels for his mother, or for the central, sudden loss of his father, is nothing compared to what he feels once he's in the hands of doctors determined to prevent another Downing sudden death. A defibrillator is hard-wired to his heart, to keep it going should it give out. The operation is a success, but the patient nearly dies some weeks later from a full-body infection brought on by the surgery. A new defibrillator is implanted - only to be taken out when the manufacturer announces a recall.
Downing describes a series of harrowing journeys through a pre-eminent Boston hospital, in which a less vigilant patient than himself would surely have fared less well - never mind what would have become of someone uninsured or completely uninformed.
Yet it isn't social commentary or critique that makes Life with Sudden Death so memorable. It's the unsentimental way Downing writes about wonder, gratitude, love, art, and even religion. It's passages like this: "My mother and I both lived long enough to understand that we had loved other people better and had been better loved by others, too. What we had was the singular authority to say, I know you."
And lines like this: "If you are about to die, I have a hotel to recommend with wrought-iron balconies hanging above the Arno and coffee service from friendly guys in tuxedos. Compared with the hospital, they're giving the rooms away."
Elizabeth Benedict is the editor of Mentors, Muses & Monsters: 30 Writers on the People Who Changed Their Lives, and author of many novels and The Joy of Writing Sex: A Guide for Fiction Writers.