Parenthesis

Book Title: Parenthesis

Author: Élodie Durand

Publication Information: San Diego, CA, Top Shelf Productions, 2021, 224 pp., $19.99, paperback

Patient memoirs of their experiences with illness are powerful teaching tools. Through them, physicians gain new insight into what their patients endure. Psychiatry curricula have included works from the patient’s point of view such as William Styron’s harrowing description of his depression, Darkness Visible,1 and Elyn Saks’ The Center Cannot Hold,2 a brilliant lawyer’s tale of her life with schizophrenia. By understanding the patient’s perspective, physicians learn about diseases in ways impossible to learn by reading textbooks.

Author Élodie Durand makes a memorable addition to this genre with Parenthesis, a graphic novel that recounts the author’s life with epilepsy; eventual diagnosis of the cause, astrocytoma; and treatment by the gamma knife when this treatment was still experimental. The “parenthesis” of the title represents the 3 years during which the illness disrupts her life. The disruption is depicted in part by the contrast between the detailed images drawn before and after her treatment and the crude, disturbing sketches drawn during the displacement.

Written in French,Parenthesis was originally published in 2010, 10 years after the events described. It was recently translated by Edward Gauvin. The book begins when Durand is 22 and newly independent from her parents. Her disease manifests as black outs, periods of which she has no memory, which eventually force her to relinquish her freedom and move back into the house where she grew up.

The core of the memoir is her memory of the series of hypotheses and procedures, culminating in a biopsy, which yield her diagnosis and are followed by treatment and the treatment’s aftermath. Durand describes, and shows us in her drawings, the agony she experiences when doctors disagree over the correct diagnosis and its treatment. One image has several doctors in white coats arguing as they climb over the surface of her brain. When the biopsy result comes in, the doctor does not want to go into detail so tells Durand the Latin name for her illness, unaware that Durand, given her extensive research, is still able to understand that it is a cancer.

Her physicians seem oblivious to the brain fog—illustrated in the graphic novel through distorted views of her head—caused by anticonvulsants. Because of both the disease and the treatment, Durand’s memory deteriorates to the point that her parents have to review with her the basic elements of her life; at her worst, she forgets her name and her way home through streets she has known most of her life. Her physicians fail to recognize both the symptoms and the distress that they cause. Listening to the patient is a key skill in family medicine, and Durand’s examples remind the reader of the nuances of what the patient says and the ways, good and bad, that physicians react to it.

Another cause of Durand’s distress is the ambiguity of radiology images. As a lay person, she is confused by false positives and false negatives. She struggles to decide whether to undergo gamma knife therapy, in part because it is a new treatment. Her doctors have no direct experience with it and so can only explain it in generalities. Once she proceeds, there is significant pain during a part of the procedure she was assured would be painless. She develops side effects of the radiation unusually early, and her doctors initially dismiss the symptoms, further undermining her relationship with them.

Despite all of this, as she moves from denial that she has a problem through recognition to eventual acceptance, her attitude toward her doctors and other medical professionals changes from anger to appreciation.

In summary,Parenthesis provides a striking description of a patient’s experiences with both illness and the medical profession. The images enhance her words in a visceral way, deepening the reader’s understanding of her ordeal. For physicians, seeing how a patient negotiates medical uncertainty, physician language, and the social stress of a serious illness can inform our dealings with our own patients.