The Care of Strangers

Book Title: The Care of Strangers

Author: Ellen Michaelson

Publication Information: Brooklyn, NY, Melville House Publishing, 2020, 209 pp., paperback $16.99

Think back to your days as an intern (or perhaps you are imagining what internship will be like); long, hard days caring for many complicated patients. What happens in those moments where exhaustion meets frustration meets isolation? Where does one turn for support? Dr Ellen Michaelson captures the highs and lows of internship in her novella, The Care of Strangers. However, she does this through a unique lens: through the eyes of a Polish immigrant orderly named Sima in a public hospital in Brooklyn in the 1980s.

The title of the book reflects the layers within the story. Our care as clinicians often starts with caring for strangers; so too do our relationships with fellow caregivers. The book sheds light on the evolution of strangers becoming more familiar and the pros and cons of such intimacy. The cleverness of the author is using the orderly to tell the story of patients, residents, and others. It gives the medical reader a different perspective of the medical field and the work we do. The story is timely and timeless. The perspectives of immigrant medical personnel, the underserved, African American patients, and women in medicine are all highlighted. Isak Dinesen, author of Out of Africa, once wrote: to be human is to have a story. Dr Michaelson has captured these human stories, stories that so often go overlooked.

We learn about Mars Peabody, the prisoner from Rikers Island looking for some respect. Other patients include Skinny coping with HIV in the early 80s; Brandy who is transgender; and Mrs Sampson dealing with cancer and family dysfunction. The list goes on: Alma Mae, Miss Osborn, and others, all characters for sure, but with personal stories that draw the reader in. Through Sima, we learn about the hardships of anti-Semitism and navigating passage to America. Soon these strangers are strangers no more.

While the attention to patient stories is important, the book primarily focuses on the unique relationship and lives of Sima and the intern, Dr Mindy Kahn. So often house staff and support staff work together but do not really connect; in this book these two groups endure some serious patient issues together. Dr Michaelson leans on their common bond of being Jewish and having Polish origins. Sima aspires to attend medical school while Dr Kahn is trying to survive internship. Each has dealt with loss in their lives; they come together through these commonalities and a hospital mishap. The author clearly has experience with many aspects of the subject matter, and yet it is also clear that poetic license is invoked. Like Abraham Verghese in Cutting for Stone, she balances the medical detail with the craft of storytelling.¹

Dr Michaelson has a knack for developing her characters and adding a level of detail to the background that allows the reader to be present in the story. While this is her first book, she has published many stories, has an MFA, and is a former National Endowment for the Humanities Fellow. She is also a veteran internist who did her residency in Brooklyn. She credits many in her acknowledgements with editing and advice. This level of experience shows. Without giving anything away, there is a moment in the climax of the story that reminds me of the feeling one gets when reading Raymond Carver’s “A Small, Good Thing.”² Mindy, Sima, and the daughter of a Ukrainian patient who died recently are talking about the loss. Each woman has suffered her own personal tragedies, as daughters, and as immigrants. She writes, “Something in Sima let the Old Country fall away. She looked up at Mindy, then back to the daughter. They were three. Not Ukrainian, not Polish, not American” (p. 113).

This book grows on the reader; it has something for everyone. For medical students, there is enough medicine that they will appreciate recognizing the symptoms and treatments while enjoying a good story. For residents, there are lessons about empathetic care and straddling the ethics of doing one’s job well while being overwhelmed. And for practicing clinicians, the book offers some nostalgia to the days of training (I found my own heart beating rapidly during the busier moments!). For any reader, there are important lessons on nontraditional paths to medicine and what those different than us endure in life. Ultimately, this is a book that reminds us why we do this work, why we care for strangers, and how we help one another along, both professionally and personally. It is a quick read, and well worth it.