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All the King’s Editors–Sarah Callender

This post is the next in the ‘All the King’s Editors’ series, the brainchild of WU contributor Dave King. In this series, WU contributors edit manuscript pages submitted by members of the larger WU community, and discuss the proposed changes.

This is intended to be an educational format, and we hope this exercise will generate useful comments about the proposed changes–why the editorial suggestions do or don’t work. 

Interested in submitting a sample for consideration? Click HERE  [1]for instructions.

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Hi friends. I am happy to share this submission today as it gives us the opportunity to examine memoir, an oft-misunderstood genre. I oft-misunderstood it myself until I began working with two critique partners, both of them memoirists. As it turns out, memoir and fiction are as similar as (fraternal) twins!

First let’s look at the submission from chapter nine of OUTLASTING ANGIE, the moment during which the narrator receives a terrifying diagnosis.

Notes of clarification from the writer:

1. Sean is my brother.

2. There are three surgeons (introduced earlier in the MS) mentioned in this excerpt: Dr. G, a brain surgeon; Dr. L, another brain surgeon I saw 11 years earlier; and Dr. T, my primary care physician.

The Submission from Chapter Nine:

“You have a cavernous angioma. It’s on your brain stem.”

Dr. G rolled his chair back and angled his computer monitor toward me and Sean. He pointed to a series of images—my skull, in two-dimensional slices. The local hospital had emailed my latest MRI scans several days prior. I looked at my left and right brain lobes. Saw my eye sockets. Nasal cavity. He held a pen to the screen, hovering over layers of gray, and traced the single black mass in each, just right of center. The part that shouldn’t be there. The part they said had grown by nearly two centimeters.

“You have a cavernous angioma,” he said. “It’s on your brain stem.”

A … what? I thought. What’s he talking about? I have a calcification. A calcium deposit.

Dr. G rolled his chair back and angled his computer monitor toward me and Sean. He pointed to a series of images—my skull, in two-dimensional slices. The local hospital had emailed my latest MRI scans several days prior. I looked at my left and right brain lobes. Saw my eye sockets. Nasal cavity. He held a pen to the screen, hovering over layers of gray, and traced the single black mass in each, just right of center. The part that shouldn’t be there. The part they said had grown by nearly two centimeters.

He spoke to me and Sean in a windowless exam room, telling us what I had and what it could, and already was, doing to me. Yet, he called it something else. Not a calcification. A neurovascular disease. A cavernous angioma. 

“Pathological yawning,” the doctor continued, “can be a clinical sign of a disorder affecting the brain stem,” Dr. G explained. You’re also presenting with persistent hiccups—chronic for days, you said, yes?”

“Yes,” I confirmed.

“Persistent hiccups, those lasting at least forty-eight hours without stopping, can lead to what is called intractable hiccups, those. Much more serious. Intractable hiccups are those that last a month or more without stopping. Clearly, we don’t want to wait for it to get to that point.”

“How do we know it will? Maybe it won’t?”

“No,” Dr. G interjected. “It will.”

In the windowless exam room, he explained that my symptoms pointed to pressure on the brain stem, the small but mighty region roughly three inches long and about an inch-and-a-half wide that connects our spinal cords to our brains and controls functions essential to life. Breathing. Heartbeat. Consciousness.. We learned what the brain stem lacks in size it makes up for in rank, controlling the central nervous system and functions essential to life.

I looked at Sean. How I wished we were back in the air-conditioned car, drinking coffee and just … driving. Tina’s garage story popped into my mind. I needed Tina here to bang her fist on Dr. G’s desk like she had on the pub table. Tell him to stop this. Now.

“I don’t understand,” I said. “I met with Dr. L right here eleven years ago and he called it a calcification.”

Dr. G cut in again. I was finding him to be a man of little patience and scant manners, bedside or otherwise. “Had you presented with similar symptoms then?” he asked.

“No … well, some. But not all of them. I’ve had headaches my whole life and limped since childhood. but t The constant yawning, the dry-heaving, these hiccups that won’t stop, that’s all new.”

“New, yes, but also and chronic,” Dr. G. said clarified. “These symptoms have sharpened the focus, and along with your recent scans that show the angioma’s growth and a pattern of previous bleeds, we have information today that the previous surgeon you saw here eleven years ago did not have.”

Bleeds …? I wasn’t following any of this. How does a calcified deposit—something that’s hard—bleed?Wait, So … it’s not a calcification?” I asked.

 “It’s not a calcification.” Dr. G studied my face from across his desk. “It’s a cavernous angioma.”

I wasn’t ready to let The calcification diagnosis, if I could call it that, had been imprecise, , go. It was imprecise, yes, and ever since hearing it, I’d often wanted a diagnosis that sounded more definitive. Yet, I was ready to trade back for it. I didn’t want this cavernous sounding thing pinned on me. It reminded me of a lecture from a college sociology class years earlier: If people were invited to sit in a circle and throw their problems into a big pile in the center, nine times out of ten they’d want to retrieve their own hang-ups and baggage, take them back over anything another person had cast into the pile—once they saw what everyone else was dragging.

Better the devil you know than the one you don’t.

“And that’s what, exactly?” Sean asked.

A cavernous angioma is It’s …” Dr. G paused to select an appropriate word. “It’s a lesion. An organ or tissue that has been damaged through injury or disease. They can be ulcers, abscesses, tumors.”

He told us a lesion is an area in 

“This isn’t a tumor, is it?” I grasped the chrome arms of the chair, grateful for the metal coolness as another flash of heat rocketed from my chest to the top of my scalp. 

“Technically? Yes.” 

Oh my God, this sucks. He sucks! At delivery, at tact, at walking a mile in another’s shoes. Does he hear himself?

I turned to look at Sean, giving me time to see his face drain. The news seemed to hit him with the same air-sucking force that had gutted me moments earlier. We had expected—we and hoped for—a follow-up that would reconfirm it was still simply a calcification; that it had not grown. as Dr. T intimated it had. That it shouldn’t be touched. 

We heard nothing of the sort. 

Dr. G explained that our bodies’ healthy vascular walls run smooth, but an angioma is a neurovascular disease characterized by a malformation of dilated blood vessels [angi] that result in a tumor [oma]. 

“Picture a raspberry,” he Dr. G suggested. “A cavernous angioma causes berry-like chambers—caverns—to form in clusters and fill with blood to the point of rupture.”

He told us small, infrequent bleeds can be reabsorbed into brain tissue, often with few effects. A history of larger bleeds, however—like those my MRI showed—introduce a range of motor and neurological deficits. 

Essentially,” he explained, as my your hemorrhages grew increase in size and frequency, so too my your symptoms.

We discovered why these symptoms, many of which I found inexplicable like my hiccuping, were textbook examples of a tumor-like mass pressing where it shouldn’t be, in my case against the respiratory center the brain stem regulates. Vision, hearing, eye and facial movements; involuntary functions such as yawning, swallowing, and coughing; body coordination; all take their cues from the brain stem. It controls pain sensitivity, alertness, and awareness. 

It was a part of my anatomy I never considered, and one I would never again take for granted.

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My thoughts:

I’d like to thank you, dear writer, for sharing this personal, scary moment. Your writing is powerful in its sparseness; it has a cold, metallic feel that establishes a sense of place (a sterile, windowless office), the doctor’s frosty, abrupt bedside manner, and the narrator’s shock and confusion.

Essayist Vivian Gornick says memoir is less a confession or a retelling of events. Rather, it’s a self-investigation that provides “motion, purpose and dramatic tension.”

With Gornick’s words in mind, I cut medical details that I felt detracted from the motion (and therefore emotion) of the scene.

I also wanted the final sentence of the submission to really punch us in the gut.

It was a part of my anatomy I never considered, and one I would never again take for granted.

Can you alter that final sentence to increase that “motion, purpose and dramatic tension”? The narrator says she will never take her brain stem for granted. That’s what she will (or won’t) do, but what does she want? The narrator is in a state of shock in that moment, but the writer now has the luxury of hindsight. She now has a better understanding of what that moment meant. She now understands why she remembers that scene in a particular way. Can writer-you increase the emotional punch by going beyond a statement of how she will never take this organ for granted?

I assume this submission is only a portion of the scene so here are a few reminders and thoughts (ones I too often forget as I am writing):

The delivery of this terrible news is not, on its own, a complete scene. A complete scene will allow the reader to see how these raised stakes either strengthen or alter the narrator’s drive to get what she most wants in the world. Will the narrator fight or surrender? Does this diagnosis change what she wants most in the world? What does this news and her reaction to the news say about universal truths? I often forget that in memoir, there are two narrators: the one in the middle of the action, and the one reflecting on this action. Readers want to see not only what happened but what happened to the narrator as a result of what happened.

My critique partners are often discussing a memoir’s “through line” or “desire line,” i.e. the thread present throughout the entire story. That thread can simply be the desire that drives the narrator in spite of hurdles, obstacles, monsters and personal shortcomings.

The thread can also be more tangible. In Cheryl Strayed’s Wild, for example, the narrator hikes the Pacific Coast Trail because she’s desperate to survive her personal grief. In Claire Dederer’s Poser, the narrator pursues a yoga practice because she’s desperate to make sense of her roles of mother and wife. The PCT and yoga poses are overt through lines, the threads onto which we readers can hold through the narrator’s emotional journey.

Finally, a few questions for any memoirist: Why are you compelled to tell this story? What do you want to say in and through this memoir? And ultimately, how does the narrator change and evolve through this story?

People write stories not only to tell what happened but to understand and show how what happened reveals something important about being human.

And you’re off to do just that, brave writer! Keep going, keep going, keep going.

WU Community, have you read any memoirs with particularly powerful and appealing desire lines/through lines? Please share some titles with us. Why do you read memoir? Why don’t you read memoir? What other tips or clarifications can you add to this discussion? 

About Sarah Callender [2]

Sarah Callender lives in Seattle with her husband, son and daughter. A crummy house-cleaner and terrible at responding to emails in a timely fashion, Sarah chooses instead to focus on her fondness for chocolate and Abe Lincoln. She is working on her third novel while her fab agent pitches the first two to publishers.