Picture of Ronald LeungRonald Leung is a medical student in the Class of 2018 at McMaster University


“I think I’m dying,” one of my patients says to me one day. We stop, halting in the middle of the hallway of the inpatient acute psychiatry unit that leads toward the interview rooms in the back. She takes in my expression of concern and waves it away. “Not like that,” she laughs, launching into a monologue on the philosophical fragility of human existence. She is articulate beyond her years, just entering the second decade of her life.

She also reminds me of Jude. Despite the disparities in their age and appearance—she is a petite millennial with a distinct sense of style in contrast to middle-aged Jude with his crisp oxford shirts—the same strings seem to reverberate when they speak.

Jude carries his preternaturally lean frame with perfect composure and speaks in measured tones. I know he also wields this voice with incisive efficiency in courtrooms as a decorated litigator. And beyond his wildly successful professional life, beyond his rich social life of dinner parties spent discussing artwork and law with a side of Chardonnay, I also know he cuts himself.

I’ve never spoken to Jude. Ink, rather than blood, runs through his veins; he is the central character in Hanya Yanagihara’s 2015 novel A Little Life. It begins like a classic bildungsroman—a story about four young adults fresh from college who are trying to jumpstart their careers in New York City: Willem, an aspiring actor grinding his hours away as a waiter; JB, an exuberant and passionate artist; Malcolm, a fledging architect working at a cookie-cutter corporation; and Jude, a mysterious and brilliant lawyer in an underpaid government position. As the novel continues to describe the blooming of this core friendship in loving detail, so too do their careers flourish to exceptional heights. But unbeknownst to the reader for the majority of this coming-of-age tale, Jude’s own fractured past slowly returns.

Yanagihara adroitly reveals the depths of Jude’s trauma, uncovering each layer meticulously. Interspersed between truly wonderful descriptions of Jude’s triumphs are descriptions of his past, plumbing the depths of human depravity in a shocking, yet realistic, manner:

He had looked at Jude, then, and had felt that same sensation he sometimes did when he thought, really thought of Jude and what his life had been: a sadness, he might have called it, but it wasn’t a pitying sadness; it was a larger sadness, one that seemed to encompass all the poor striving people, the billions he didn’t know, all living their lives, a sadness that mingled with a wonder and awe at how hard humans everywhere tried to live, even when their days were so difficult, even when their circumstances were so wretched. Life is so sad, he would think in those moments. It’s so sad, and yet we all do it. We all cling to it; we all search for something to give us solace.”

Unlike any encounter in medicine, I hold the advantage of having direct access to Jude’s thoughts; an omnipresent observer, I fondly watched as he rose to a forte in both his professional and personal relationships, his immense achievements underscored by his irresistible humility. As invested as I was, I felt the same weariness that threatened to overwhelm him as the past continued lapping at his shores. Jude’s scars did not exist solely in his memories; he suffered from irreversible difficulties in gait, chronic lower-limb neuropathy, and pain crises thanks to one of his past abusers. Jude’s struggles to resist being defined by his trauma illustrated to me his continued motivation for self-harm: he had so little control over his body in the face of his medical issues that cutting was a way of regaining that control, however temporary.

The justification for self-harming behaviour is intensely personal, and A Little Life admirably does not attempt to provide a sweeping explanation for such actions. There is an unstated expectation that the narrative is Jude’s, and that these are not necessarily the truths of others’ lived experiences. How can I ever reach this level of understanding with my patients? Our daily hour-long conversations feel transient in the face of the literal years that fly by on the page. Fiction holds up a mirror that shows reflections beyond what superficially exists; clinical snapshots are no match for a lifetime of experience. We distill our patients into soundbites, while their greater narratives may never be explored.

The trauma inflicted upon Jude demands justice, and he does not go gentle into that good night. But in reading the raw conclusion, the words of A Little Life probe me to consider society’s expectations of redemption narratives. An arc of suffering surely must offer a reward; but as Jude’s life comes to a premature end, my sorrow is balanced by the beauty of his relationships with all the other rich characters that populated his world. He is not defined by his tribulations, his scars, or his death: 

“….and whenever he looked at Jude, scraps of his narrative would return to him, and he would study him covertly, wondering how he had gotten from where he had been to where he was, wondering how he had become the person he had when everything in his life had argued that he shouldn’t be. The awe he had felt for him, then, the despair and horror, was something one felt for idols, not for other humans, at least no other humans he knew. “I know how you feel, Willem,” Andy had said in one of their secret conversations, “but he doesn’t want you to admire him; he wants you to see him as he is. He wants you to tell him that his life, as inconceivable as it is, is still a life.”

And so I turn to my patient and listen, hearing the notes that are the score of her existence with all its highs and lows, all its flats and sharps: the crescendos and decrescendos that form all of our lives.


Note: All characters in this work are fictitious. Any resemblance to real persons, living or dead, is purely coincidental.