Issue #56, Summer 2015
The Lengthening of Time
A conversation with Joe Fassler
The Lengthening of Time
Joe Fassler is the winner of Creative Nonfiction's $1,000 prize for best essay in the Waiting issue. His essay, "Wait Times," chosen by the magazine's editors from more than 650 submissions, describes a harrowing trip to the emergency room with his wife, Rachel. Suffering from ovarian torsion, an incredibly painful condition that can lead to the loss of an ovary if untreated, Rachel waits for hours, writhing but unexamined, in the ER. In this experience, Fassler sees not only the failures of an overburdened healthcare system, but also a system that especially fails women. "I feel certain of this," he writes: "Rachel was easier to ignore because she is a woman. The diagnosis of kidney stones—repeated by the nurses and confirmed by the attending physician’s prescribed course of treatment—was a denial of the specifically female nature of her pain."
Fassler's work appears in the Boston Review and Electric Literature's "Recommended Reading." He also interviews authors for TheAtlantic.com's "By Heart" series. A graduate of the Iowa Writers' Workshop, he currently lives in Brooklyn.
CNF: In “Wait Times,” you weave the narrative of your wife’s near-disastrous medical ordeal with an important conversation about the failings of women’s medical care. What made you want to sit down and write your wife’s story?
FASSLER: Writing autobiographically isn’t my first impulse. I tend to use fiction, or outward-looking nonfiction, to work through my ideas and experiences. But Rachel made it clear she wanted me to write about what happened. Her direct urging gave me the courage and license to write this piece.
Inside the hospital, Rachel’s pain was minimized, downplayed, ignored altogether. I think that’s part of why she wanted this essay to exist: to acknowledge a cry for help that previously went unheard. Recognizing what happened, and trying to account for it, has been important to both of us.
CNF: To what extent was Rachel involved in the writing process? Did you ask for her input? Was she happy with the final result?
FASSLER: Rachel was involved throughout the process. Due to the pain, and then the drugs, her memory wasn’t always as clear as mine, but on some things it was clearer. She helped with dialogue and the timeline of the piece. I showed her every draft and she gave feedback at every stage of the process. I wrote the essay for her, and it was crucial that my telling of the experience rang true to her. The essay wouldn’t exist, on several levels, without her—but it’s a better piece of writing than it would have been without her help.
I asked Rachel for her thoughts:
Someone with the power to tell a story—both to attract and captivate an audience—has a responsibility to represent those of us without that power. After the hospital, I actually tried to sit down and write my story many times to no avail. And yet, I felt very strongly that more than my immediate friends and family needed to know. People needed to know what we are all up against. I’ve spent the past year asking everyone if they have a hospital plan, if they know where they’d go in an emergency and what to expect when they get there. I’ve reiterated to friends “never go to the ER alone” so many times I sound neurotic, traumatized, ridiculous. But I mean it every time I say it. The takeaway for me that day was: we’re not living in the world we thought we lived in. The rules to this game are different than the rules you’ve been taught. When we got to the hospital that day, I realized how unprepared we were. We had no idea that we were supposed to fight. We didn’t know how to even throw the first punch.
CNF: How do you think the essay would have turned out if you had written it from Rachel’s point of view or in the third person?
FASSLER: I couldn’t have written this piece in any voice except my own.
Part of this essay was acknowledging that empathy has limits—I’ll never really know what Rachel went through, even though I was a witness. Writing this story honestly required acknowledging the limits of my own perspective.
CNF: In general, do you gravitate toward the first person point of view as a writer? As a reader?
FASSLER: I’ve noticed that my favorite novels and stories and essays tend to be in the first person. I don’t fully understand why—it’s more of an emotional, gut-level preference. Something about a confessional tone just works for me. I also like writing that acknowledges that a person is writing it—even if most of the story is in the third person. The omniscient or disembodied third person can feel artificial or overly literary to me.
CNF: In what ways do you think using creative nonfiction as a vehicle was beneficial for this piece?
FASSLER: I didn’t want to fictionalize this experience. And a straightforward, journalistic take on emergency room wait times would have left out the crucial personal part of this story. Sometimes, there is an instinct to tell the reader: This really happened. What you’re about to read about really happened to a person. I think, more than anything, I just wanted to tell the story.
There is an instinct to tell the reader: This really happened. What you’re about to read about really happened to a person.
I’m drawn to essays that contain the personal and the journalistic, that have the capacity to look inward and outward at the same time. I tried to do that here—though it was a challenge to balance Rachel’s experience with a broader critique, without downplaying our narrative or sidelining the larger systemic problem.
In the end, I love the way the essay form allows the writer to tell a deeply personal story, then seek to understand it in a broader context. That was the impulse for this piece.
CNF: What was your overall purpose in writing the essay? What do you hope will come from it?
FASSLER: The primary impulse is to say: Here. This happened to us. Listen.
The secondary impulse is to say: there’s a problem. As I researched and wrote this piece, I found too many stories just like Rachel’s. Hospital patients are at the mercy of their caretakers, and the medical community must do all it can to take symptoms seriously, treat pain with urgency, give the sick dignity. Why isn’t that happening to the degree it should? We should pay attention, start a conversation, and do better.
More broadly, I think part of the point of literature is to engage with underserved viewpoints and acknowledge overlooked forms of suffering. At the hospital, Rachel experienced callous treatment I don’t often hear talked about—and yet her experience is altogether common. You can always hope what you write will, in some way, encourage people to take better care of one another.
CNF: Why was addressing Yentl Syndrome important, both to you and to the community of readers who will read this essay?
FASSLER: Dr. Bernadine Healy coined the term “Yentl Syndrome” to describe a pervasive medical phenomenon: when a condition manifests differently in men and women, women who express more stereotypically “male” symptoms tend to get better treatment. (She took the name from Isaac Bashevis Singer’s story “Yentl the Yeshiva Boy,” in which a 19th-century Polish woman impersonates a man in order to enjoy male social privileges.) More broadly, the term describes the way systemic gender biases affect the care women receive—the way women often find themselves in the unfortunate position of having to prove they’re just as sick as men.
Of course, male-dominated institutions have a long, inglorious history of minimizing female suffering. We shouldn’t settle for a culture that gives male pain preferential treatment. But equitable care requires us, paradoxically, to recognize the meaningful differences that exist between genders.
Women’s health issues can’t be treated on a male paradigm—and if women are going to be fairly treated, we’ll need to think more carefully and critically about the way gendered constructions affect medical practice. As Dr. Healy put it in her essay “The Yentl Syndrome”: we must “address the diseases of women as different from the diseases of men but of equal importance, even when [those diseases] also affect men.”
CNF: Did this experience change your view of healthcare, particularly women’s healthcare, in this country?
FASSLER: Rachel’s ER, like many others, had no attending gynecologist. We confronted an unfortunate reality: most emergency rooms aren’t well-equipped to handle specifically female ailments. This deficiency was evident in the inadequate care Rachel received.
As soon as the OB-GYN team got involved, the quality of Rachel’s care increased dramatically. She was treated with much more sympathy, too: we both saw genuine care and concern in the surgeon’s eyes. He was the first person we encountered with the experience and expertise to understand the heights of Rachel’s agony, and take her suffering seriously.
Emergency rooms should be prepared to serve the needs of women. Unfortunately, many of them aren’t. I hope that starts to change.
Beyond that, I have to say—I didn’t anticipate the callous, hardened indifference we experienced that day. I didn’t expect it, and I don’t understand it. If what we experienced is common—well, something is really wrong.
CNF: The essay features one-line informational bits about the various wait times you and your wife, Rachel, endured. Why did you decide to build the narrative around those lines rather than weave them into the narrative itself?
FASSLER: The day entailed so many forms of waiting. Waiting to arrive at the hospital. Waiting for pain medication. For scan results. For a diagnosis. For the surgery to be finished. For the aftershocks to fade. The italicized lines were a way of breaking out those many distances and looking at them.
Of course, units of time are subjective and imprecise. A minute can feel like an hour—and did, many times, that day. Those “objective” measurements don’t capture what the intervals actually felt like. Pain and anguish lengthen time. And if time’s flying by, you’re not really waiting. I wanted to pit those standard units against the more uncertain measures of our own lived experience.
CNF: How extensive was your research for the piece, and what kinds of research did you use?
FASSLER: It took a lot of research to track down all the time-related statistics I included in the piece.
I also read a lot about ovarian torsion—how common it is, how easily it’s diagnosed. I read, too, about triage as I tried to piece together my sense of what should have happened that day. How badly underserved was Rachel, in those hours? How angry should we be? And to what degree was our experience symptomatic of a larger problem? Going beyond my own firsthand experience meant orienting myself towards these questions, and that meant reading a lot of medical literature.
Unfortunately, most of the work encountered suggested that emergency medical wait times are unacceptably long. And that women tend to wait even longer than men.
Part of the point of literature is to engage with underserved viewpoints and acknowledge overlooked forms of suffering. … You can always hope what you write will, in some way, encourage people to take better care of one another.
CNF: The physical consequences of the medical situation described in the essay most directly affect your wife—but the emotional and psychological effects clearly took a toll on both of you. How did you balance the inclusion of your own emotions and experiences with those of Rachel?
FASSLER: This essay is about trying to comfort a person in the throes of excruciating pain. It’s an intimate experience, but also alienating—Rachel’s physical suffering could only manifest in me emotionally, no matter how much I wanted to take part. I think that’s why my own feelings are less present in the first part of the essay: Rachel’s feelings overwhelmed my own. I was a bystander, looking out at something I couldn’t fully comprehend, no matter how much I wanted to.
Later, when it was over, we were able to share this experience in a more mutual way. Rachel became more distant from the fact of the pain itself—she could only remember it, like me, through memory and imagination. It was a bonding experience to process the whole saga together, and I felt more room for my own thoughts and feelings during that time. Maybe that’s why there’s more room, at the end of the piece, for my own perspective to come out.
CNF: That day moved so agonizingly slowly, and yet it also seemed to be a blur of pain and worry. From where did you draw your memories of that day in order to write about it?
FASSLER: Just a day or two after this happened, I tried to write things down as specifically as I could. I’m glad I did. You think you’ll never forget something like this, but it’s amazing how quickly the details start to fade, or morph, or blend with myth. Luckily, I had a fairly objective draft to work off of.
Still, it wasn’t easy, and I’m glad I had Rachel to help me establish the timeline and remember just how things were said. In the end, I think the two of us did a pretty good job—though there are surely pieces we’ve forgotten forever.
CNF: In the middle of the essay, you begin referring to Rachel as Patient X. Why did you do this?
FASSLER: I saw this as a story written in two voices. The first is my own. The second, italicized voice interjects with numbers and statistics. I wanted to contrast my human thoughts and feelings with a pseudo-objective voice that tells the same story through factual information. Though this was something of an intuitive choice, I think wanted to dramatize the way that living, breathing, suffering humans are distilled into specific-but-heartless medical data. It’s one thing to read a sentence like “Most women who experience ovarian torsion receive treatment within twelve hours.” It’s another thing to watch your wife writhe on a shitty hospital cot while no one seems to want to help.
It didn’t seem right for the second voice to call Rachel “Rachel”—it’s not me speaking. “Patient X” seemed truer. It anonymized Rachel, made her one of the faceless many whose lives and anguish contribute to the data, but whose stories remain untold.
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