Capturing the Anguish and Agony Which Consumes

Capturing the anguish and agony which consumes those caring for loved ones at the end of life is an exceedingly difficult task, but essayists Katy Butler and Rachel Riederer have harnessed their unique literary abilities in vastly different ways to achieve the same ambitious objective. Published within the 2011 edition of the annual anthology of American creative nonfiction The Best American Essays, Butler's haunting elegy What Broke My Mother's Heart and Riederer's visceral portrayal of her own injurious accident Patient each deploy disparate rhetorical styles to impart a shared premise. With the rancorous debate over health care and its most efficient and effective form of delivery currently embroiling the nation's political, private and public sectors, penning a polemic railing against the medical industry hardly represents an exercise in intellectual courage, which is why the contributions made by Butler and Reiderer are refreshing in their candid and emotionally honest approach to the issue. The different perspectives offered by both writers result in What Broke My Father's Heart reading as a clinical reflection on illness with an emphasis on choices and consequences, while the power of Patient is derived from its ability to describe illness in a more direct way, conveying both the physical and emotional pain with vivid descriptions. By analyzing the textual evidence provided throughout both essays, in the form of literary devices and rhetorical strategies employed by each author, it is possible to identify the common threads which link these uniquely singular works of creative nonfiction.

Butler's essay was written during a time of great personal mourning, with the author forced to watch helplessly as her beloved father succumbed to the inexorable invasion of dementia and physical deterioration, but her conscious decision to imbue the work with a tone of detachment proves to be devastatingly effective. When she opens the essay by observing that "sewn into a hump of skin and muscle below his right clavicle was the pacemaker that helped his heart outlive his brain," (12) the contrast between Butler's severe emotional upheaval and the anatomically accurate description of her father's false salvation is particularly jarring. This passage is extremely significant because it is suggestive of Butler's primary assertion, which holds that advances in modern medicine have been exploited by the pharmaceutical industry to prolong life purely in the pursuit of profit. While the focus of What Broke My Father's Heart remains the futile suffering of its eponymous patriarch, Butler flatly reminds her readers that, despite her family's apparent pragmatic preparation, "I watched them lose control of their lives to a set of perverse financial incentives -- for cardiologists, hospitals, and especially the manufacturers of advanced medical device -- skewed to promote maximum treatment" (13). When she again returns the reader's attention the plight of families held hostage by their loved one's failing health, declaring that "at a point hard to precisely define, they stopped being beneficiaries of the war on sudden death and became its victims" (Butler 13-14), the author reaffirms her original thesis that modern medicine has become irrevocably corrupted by corporatization and conglomeration.

Much of the message contained within What Broke My Father's Heart is based on the author's emotionless expression of her emotionally-motivated personal philosophy, evidenced by Butler's contention that "thanks to advanced medical technologies, elderly people now survive repeated health crises that once killed them, and so the 'oldest old' have become the nation's most rapidly growing age group" (14). While largely unfounded claims such as this can be deployed effectively by impassioned authors, any effort to persuade the average reader to shed their preconceived notions and examine the issue of irresponsibly extending life requires a certain level of empirical evidence to be truly effective. In a section of her essay in which she cites the findings of the Dartmouth Atlas public-health research group, the Journal of the American Geriatrics Society, and the Journal of the American College of Cardiology to provide statistical evidence that patients actually reject the concept of prolonged convalescence, Butler appeals directly to her reader's sense of logic and reason. By referencing the ostensibly objective conclusions put forth by respected medical organizations and scholarly journals, Butler is utilizing the expert power component of French and Raven's famed Five Bases of Power, a theory of persuasion which posits that people are far more receptive to contrary ideas when they are devised by authority figures vested with expert knowledge of a particular subject (French and Raven, 154). This is confirmed shortly after by Butler herself, who observes pointedly of the agonizing choice to install her stricken father's pacemaker: "the decision fell to my mother -- anxious to relieve my father's pain, exhausted with caregiving, deferential to doctors, and no expert on high-tech medicine. She said yes" (15). By maintaining the focus of her essay on the increasingly bureaucratized delivery of health care in America, and its endless array of time-sensitive deadline decisions, pressure intensive situations, and life-altering ramifications, Butler exposes the ultimate fallacy of our generation's stated intentions for delaying the natural occurrence of disease and death. When she provides a final, fitting eulogy to her father's proverbial purgatory, musing "and so my father's electronically managed heart -- now requiring frequent monitoring, paid by Medicare -- became part of the $24 billion worldwide cardiac device industry and indirect subsidizer of the fiscal health of America's hospitals" (17), Butler sardonically condemns a medical establishment which endeavors to extract every resource from a dying man under the guise of saving his life.

When Rachel Riederer opens her essay Patient by calmly alerting readers that "the bus will have to move," before explaining "I'm under its rear tires on the passenger side" (165), the startling juxtaposition between her unconcerned tone and the extraordinarily traumatic story being told immediately becomes a centerpiece of the narrative. By depicting the hideous details of her battering by a city bus, including her torturous time spent as an invalid recuperating at a local hospital, through a subtly satirical lens, Riederer positions Patient within the genre of the grotesque. This authorial decision to ground the recounting of real events in a slightly bemused point-of-view is especially effective because true tragedy is often an extension of life's intrinsic absurdity. The contrast between the human body's capacity to endure terrible damage, and the mind's wonderful way of processing such trauma, is highlighted time and again by Riederer, and when she describes herself "unstrapping the cute, salvageable, only slight torn shoe from the ruined foot" (167)," the incongruity of the image has a curiously disquieting effect on the reader.