Darin Strauss – More Than It Hurts You

The Brooklyn based author Darin Strauss was hailed by critics in the New York Times, The Wall Street Journal and The (London) Times among others for his first two novels Chang and Eng (2000) and The Real McCoy (2002). Chang and Eng was based on the real-life conjoined twins and is in the process of being made into a film, while The Real McCoy related the trials of a boxer. For his third novel, More Than It Hurts You, which is published in paperback on Feb 9th 2010 by Atlantic books, Strauss turns his attention to an ostensibly perfect young Long Island couple in present times and the shattering of their perfect world by the inexplicable episodic  illness of their only child.

Josh Goldin is one of those handsome young men who sails effortlessly through life. Social chit-chat comes easily to him; with a few well chosen words he can charm anyone. This is a great advantage in his career – he works in Sales at Sparkplug TV, selling airtime to wealthy companies. He has a beautiful wife, Dori, and a gorgeous kid, eight month-old Zack. But Josh’s idyll erupts one day when he receives a message that his son has been taken to hospital.

The situation when he arrives is fraught and confusing. Dori took Zack in and was reassured and sent away, only for Zack to suffer a cardiorespiratory arrest in the car park and be rushed back in. Dori accuses the junior doctor who first saw her, Dr Weiss, of ignoring key information she gave him about Zack having blood in his vomit and thus neglecting to carry out vital tests, but Dr Weiss insists he was never given this information.  Zack is now being subjected to a battery of tests. The sight of her baby having an endoscope – a camera on a tube – pushed down his throat and into his stomach is too much for Dori to bear, and she seizes her baby and takes him home. The paediatric consultant in charge of the case, Darlene Stokes, is perturbed and uneasy. In all her years she has never seen a mother who has refused to complete necessary tests to ascertain the cause of a child’s illness. The police are called to force the Goldins to return Zack for completion of his tests. But other than an inexplicable anaemia – shortage of red blood cells – the tests shed no light on the situation. Dr Stokes is a thorough, sharp-eyed diagnostician. Where other less dedicated doctors might shrug and move on to the next case, she is compelled to investigate all options, including the ugly possibility that Dori, a trained phlebotomist (blood taker), has inflicted Zack’s illness on him by taking blood from him. But why would any mother harm her own child?

The reader is thus plunged into the dark world of Munchausens Syndrome By Proxy (MSBP). Munchausen’s Syndrome is a  phenomenon where healthy people simulate illness by presenting with made-up symptoms, often skewing their own medical tests by contaminating and otherwise interfering with them. MSBP is the even more horrifying condition whereby a parent harms their own child in order to receive this attention.

But MSBP is exceedingly rare, and cases are steeped in controversy. Many authorities on the condition have subsequently been shown to have been over-zealous in their diagnoses, subjecting innocent parents to unfounded suspicions and, worse, to the pain of being incarcerated or having their children taken into custody. 

More Than It Hurts You hurtles into this nightmare world. Dr Stokes is only being a  stringently conscientious, caring doctor, trying to protect her helpless child patient. She may be more dogged than many of her contemporaries but the reason for this is because she has had to work many times harder than them, having been brought up by a single mother in a working-class neighbourhood and been imbued with the knowledge that diligent - no, fevered - studying is the only way out.  Stokes has, like many women in traditionally male positions of power, sacrificed so much for her career – private life, leisure time, personal happiness. She spends far less time than she would like to with her beloved son James, for example, and her last relationship with a man was with her (white, Jewish) late husband, who she divorced years earlier.

   But the media seizes hold of the story and manipulates it to render it expedient and thrilling to their readers. Darlene Stokes’s private life is plundered, her past contorted and twisted. She is portrayed as a black activist with sinister motives and with a personal grudge against Jews, none of which is true. And so the themes of race and religion enter the fray, turning already muddy waters more opaque still.

Strauss writes with a smart, confident ease and employs a devastatingly sharp, scathing eye to his subjects, a  trait he shares with Jonathan Franzen with whom he has been compared.  His scavenging wit swoops down on tiny inconsequential details and savages them to comic effect:

 ’Her heavy mascara threw him too; her eyelashes were clotted black like the tines of a muddy rake.’

 ’Dr Stokes tried a smile at Josh,  tried to avoid the condescension that passes between doctors and those who need them.  The professional face of physicians and prostitutes: the mouth getting the job done, the eyes belonging to someone else.’ 

‘His son was bouncing in Dori’s arms now, still smiling one of those tongue-out smiles – a tiny heavy metal aficionado enjoying a guitar solo.’

‘He had all the elan of a substitute teacher  wearing a taped ‘Kick Me’ sign and wondering why the class won’t listen to his calls for quiet.’

‘…flexing his brow the way people do when they want a repeated observation to seem an original thought.’

The narrator is omniscient so that humourous reflections are sometimes made by characters one wouldn’t expect. A Methodist  do-gooder, for example, casts her eye over the ex convicts being dropped off the prison bus after completion of their sentences and muses  ’He’d  be called The Lamb because His beard was soft and curly but not the gross crinkled way that real lambs sometimes looked, almost like they were made of gray old men’s pubic hair’. 

 For the most part this works fine because even the most unexpected people have flashes of irreverent thoughts.

Strauss is not all wise-guy humour and sardonic acerbity, though. He conveys the raw, overpowering emotions of fear, grief and anger with authentic insight. When Josh receives the message that his son is in hospital, Strauss captures brilliantly the aftermath of shocking news and the feeling of unreality, with Josh feeling as though he’s in a movie watching someone else’s trauma unfold on screen. Similarly, the mixed thoughts that flood Josh’s brain later in the novel are portrayed vividly, the forbidden questions jostling with his love for and unconditional trust of his wife. And, most wrenchingly of all, Strauss transports the reader into the world of a doctor with uncompromisingly high standards whose actions may save a life, but, because they threaten the status quo of the ideal American family and the stability of big business, are met with anger and disapproval. 

Strauss’s characterisation is excellent. Josh starts off as the golden man who has it all and who, the reader senses, Strauss despises. Misfortune and trauma render him a more human, likeable person as he loses his patina of smug charm. Darlene Stokes is a complex figure and Strauss makes her come truly alive, her decades of studying and passion for her work transfering into other areas of her life as an inability to make small talk or compromise her ideals. The downfall of someone with such high standards and altruism is almost Shakespearean in its tragedy.  Darlene’s estranged father, Charles Stokes, is also plausible for all his contradictions – an ex drug dealer who inexplicably risks his life for a near stranger and seeks out his long-lost daughter. Strauss is adept at articulating the emotional intelligence of this uneducated man.

Dori is perhaps the character who is least explored but she is still convincing, a woman who has always craved drama and attention, someone who can endlessly justify her own actions. Some reviewers of the hardback edition of this novel in 2009 raised the spectre of misogyny in Strauss’s paradoxical portrayal of a mother who loves her baby yet whose rare but devastating actions contradict this devotion, but humans are complex and occasionally simultaneously capable of acts of love and astonishing cruelty. Strauss’s feat in capturing this contradiction and avoiding the simplistic evil/good dichotomy is masterful. There is a harrowing section where the action flits sequentially from an innocuous work scene back to Dori at home with the baby. The sense of suspense invoked as well as the structure are both reminiscent of the dreadful scene in Updike’s Rabbit Run where the baby dies.

 More Than It Hurts You is a complicated novel that touches on a large number of complex themes - media manipulation, the power of the press, prejudice, race, inconvenient truths which may hinder business, family and trust.  It is often uncomfortable and disturbing, dealing as it does with a highly emotive minefield. The real life British paediatrician Ray Meadows, who undoubtedly diagnosed several real cases of MSBP, fell spectacularly from grace when his over-zealous eagerness to diagnose led to innocent parents being imprisoned or losing their children. The result of that, however, is that paediatricians are now very reluctant to appear as expert witnesses in suspected cases of child abuse by parents  in case they are publically castigated for even well-founded suspicions. 

 One reviewer declared that More Than It Hurts You is needlessly cynical. Another suggested that the very real and ugly anti-black prejudice in the novel is matched by the character of Dr Stokes being, as the fictional press in the novel suggests,  motivated by anti-Jewish/anti-white prejudice, since she is aware of  the Goldins being Jewish have-it-alls. I don’t concur with this interpretation -  the tragedy is that Stokes is acting purely professionally, and Strauss is just highlighting an uncomfortable truth by  pointing out her rapidly suppressed flash of personal feeling.   More Than It Hurts You is a strikingly powerful book about a difficult subject, carried off with verve and aplomb.