The Vitruvian Woman
By Jumaana Abdu
In most cases, patients already know what’s wrong with them when they come to be diagnosed. It’s an aphorism of medical education that eighty per cent of diagnoses can be made from history alone. A doctor may need only listen until they have been handed all the information required to synthesise incongruent and anomalous signs and symptoms into a logical narrative. Their craft is to illuminate this narrative for patients in an effectual way. Sometimes, it is a maddeningly slow-going art if the mind’s eye is blind-folded or one lacks supplies. Other times, ideas must be conceived in an instant or a person will die. To be a good doctor, therefore, is to know the most important question to ask—and just how to ask it.
A good writer is a practitioner of a kind. Doctors and writers both are remembered, if at all, for how well or how poorly they can bring one to understand their life’s condition. What one learns from a diagnosis or a good book can reframe decades of experience. To author a diagnosis is an intimate authority that risks causing intimate harm. To ‘doctor’ means to deceptively alter an image and, thereby, create a fiction.
Neither writing nor medicine is worth it for the money or the prestige. In the case of medicine, ‘quality’ of life rots the carrot on the end of a long, long stick. In the case of writing, it pays no prestige in this country and a very red cent. Without purpose, without clarity, without urgency, all the study in the world cannot take you the distance in either of these fields and it certainly cannot make you good. If, by foolishness or iron will, a person finds themselves in possession of a medical licence or a pen and a blank piece of paper, they must ask: What vital thing can I do with my position as minister to the lives of strangers? What is already known? What is left to know? How do I go about knowing it in a way that will have a wide and lasting impact?
This is what it is to have a calling. I flit between a few—a call to medicine, writing, nature, family, and, encompassing all that, God—and a calling is like a question in that to reciprocate is to answer. How does one begin? In an author’s note to Wise Blood, Flannery O’Connor wrote on the question of God and free will, ‘it is a mystery and one which a novel […] can only be asked to deepen.’ Here, at last, fiction and medicine diverge, for where the deepening of a mystery would be the doctor’s failure, the writer’s failure would be aiming to solve it.
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So now we understand the part-time-creative-cum-doctor. Let us then imagine a doctor who is first and foremost a novelist. We shall set a difficult stimulus: say, The Muslim Woman. For the sake of intrigue, say this is the first Muslim woman we have ever seen. She enters the clinic and sits across from us that we might form a first impression.
Naturally, The Muslim Woman is of average height, average build, average colour, and probably average intelligence. Her eyes are mostly brown. Her hair is covered; we can guess she is brunette. If we were to proffer a hand, she would not shake it. Ah, well.
Doctor, she asks, what is happening to me?
Serendipity has delivered a research project certain to attract funding. The subject of The Muslim Woman is one of those rare cases yet un-overturned by the literature and, as doctor-writers, we must ready our plough. The vital thing is to develop an angle of inquiry. When deciding to seek and share knowledge, one must ask: who will know the answer to this already? So, for this scenario, let us set a research rule: Will The Muslim Woman know the answer to this question? If no, we will find it interesting. If yes, we won’t.
It is custom to begin by asking: What has brought you here?
The Muslim Woman says, I have been to every doctor’s office I could find. I have spent years in waiting rooms. You’re the first to call my name.
We dig further: Are you in pain?
She scoffs, Is there a person who reaches adulthood and they are not in pain? My pain is not why I’ve come.
Patients often misinterpret the clinical significance and origin of their pain, which can be referred to parts far from its anatomical cause. The Muslim Woman must rely on her doctor to understand this better than she does. When prompted to expand, she gives a vague and migratory reply. We might ask where the pain started. Impatience infiltrates her tone. She says, It didn’t start in me, I inherited it with a love for all my kin in this world. Then she quotes the Prophet, peace be upon him: The parable of the believers in their mercy, mutual love and compassion is that of a body. When any limb aches, the whole body reacts with sleeplessness and fever.
A doctor-writer would latch onto these symptoms as clues. Perhaps they would ask, So, you don’t sleep? Because you can’t drift off? Or you wake in the night? Do you have bad dreams? Virginia Woolf has investigated this already. Spent is the funding for research into whether sleeps are ‘trances in which the most galling memories […] are brushed with a dark wing which rubs their harshness off […]. Has the finger of death to be laid on the tumult of life from time to time lest it rend us asunder?’ That The Muslim Woman sleeps, dreams, that she, through dreaming, processes life within the balm of minor death, can be assumed and should come as no surprise, though it does – the thought of her privately experiencing something unrelated to the logic of the world. In the public mind, she is always soberly experiencing reality.
If we ask instead, Do you believe in dreams? she will say, Some. For a doctor-writer, there are fractals off this question: What does it mean to her life that she believes in dreams, or how can she tell a true dream from a false one, or what is the difference, for her, between dreaming and experiencing? We should jot this down.
Ostensibly, we could turn our minds then to her fever, but in her face is the echo of Cathy Earnshaw crying, ‘Oh, I'm burning! […] Why am I so changed? why does my blood rush into a hell of tumult at a few words?’ By logic, The Muslim Woman originated from a Muslim Girl. We can deduce that she has responded to a warping, aching body and that, surely, this body continues to respond to ‘a few words’.
But what words? Can we ask? The whole world has seen the news, social media, phrases like ‘stripping’ and ‘torn off’ and ‘forced’ and ‘hidden’ and ‘only their eyes’. There is an obscenity in looking at The Muslim Woman while thinking about these things, one that feels tantamount to doing them. When you are told someone has used an unspecified slur, ‘you must immediately become offended,’ says Chimimanda Ngozi Adichie in Americanah. ‘Even though you are thinking ‘But why won’t they tell me exactly what was said?’ Even though you would like to be able to decide for yourself how offended to be, or whether to be offended at all.’ Does our sleepless, febrile, aching woman who loves all her kin in the world have energy left for undifferentiated offence? ① This is a boring question, by the way.
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Okay, enough. Medically speaking, our approach to the hypothetical patient thus far has been scattered. History-taking has failed. The next step is a physical exam. There are ways to regain control of the narrative. For example, we can make The Muslim Woman stand up and hold her arms out by her side like a robed Vitruvian Man. She pins our face under a humid gaze. What initially seemed a bleary and placid look now becomes the glassy eye of fever and the salt-sheen skin of insomnia and the blood-rush of hell to a cheek. She is exhausted by dreams. She is burning. You want to touch her forehead with the back of your hand to see if the fever is real or a figment of a true feeling. Does The Muslim Woman want to be touched? Her look betrays nothing; her thoughts are not ones you have been taught to read.
We instruct The Muslim Woman to lie down on the patient bed. Ordinarily, exams begin with general inspection, which involves looking for scars, deformities, swelling. The predecessors of The Muslim Woman exist in books on male figures as footnotes indicating the dates these women married, gave birth, or died. Our own patient might be swollen from bruises or pregnancy; she might have recovered from collateral deformities leaving tell-tale scars. But we can’t see much of her skin.
On or off? one might ask, out of courtesy.
This confuses her. What, the office lamp?
Your headscarf.
A dark irony flickers across her face. We can perform the examinations over her clothes, starting with her nails, pulse, blood pressure, conjunctiva, mucous membranes.
And the eyes: her pupils are equal and reactive. Her visual field is intact. It is difficult to examine her gaze. While the doctor-writer studies and interprets how her eyes track their finger, she does not just follow instructions but studies and interprets back. And to be this close to her eyes, which are so absorptive, close enough to see one’s own reflection, inflicts a bout of disquiet. Has it always been so? But this was asked by the oldest written tale in history, when Enkidu, dying, was met with the close image of Gilgamesh’s face: ‘Your eyes have changed./ You are crying. You never cried before./ It’s not like you./ Why am I to die,/ You to Wander on alone?/ Is that the way it is with friends?’ The Muslim Woman may have friends, and there may be questioning, ambiguity, and even grief in how she loves them, but it is unclear how one might explore this possibility. Medical schools condition doctors to ask a woman of her demographic, Are you married? Is there conflict at home? Do you feel unsafe? Is your marriage consanguineous?
Cardiology may offer interesting metaphors. Under a stethoscope we might auscultate dual heart sounds with a murmur over the apex of The Muslim Woman’s heart. A heart murmur is not a figure of speech: it refers to the sound of blood rushing through faulty heart valves. But as an expression, it stimulates the imagination nicely. One might call the language spoken secretly by women in Cristina Rivera Garza’s The Iliac Crest, with syllables like questions or raindrops, a murmur of the heart. The narrator of The Iliac Crest is also a doctor. After a kiss, the doctor walks away ‘like someone wearing shackles around their ankles, this sensation of the body against air in an age-old battle, this weariness, this desolation. What do I know about the great wings of love?’
What does The Muslim Woman know about the great wings of love? Most religions are driven by love’s directive—and Islam? In the little literature written on The Muslim Woman’s predecessors, how and why she loves is eclipsed by what love causes her to suffer. And it is always the suffering that must be diagnosed. Can The Muslim Woman seek love without having to prove or re-examine her suffering? ‘Oh, what does my grief, what does my sorrow matter,’ Dostoyevky’s ‘idiot’ has wept, ‘if I can be happy?’ The Muslim Woman is beholden to expectations of sorrow. It may be that she wants other than sorrow, and yet to want is to be dissatisfied, and in literary history, dissatisfied women are punished by the world for being unable to aspire to the hard, mono-climactic, impregnable state of men. Is it possible to write a disconnected, discontented woman who is lured back into life by a bombardment of love on all sides?
A gynaecological history and exam may offer clues, but this would present the obstacle of The Muslim Woman’s hijab, which, up close, appears inviolable even if her clothes and headscarf were to be removed. Can a writer investigate her intimacies even while insisting upon the dignity of her privacy? This world is not in the business of privacy. To insist on privacy is to forfeit the investment of the world.
Charlotte Brontë’s Villette is helmed by one of the most private protagonists in literature. Lucy Snowe—friendless, ascetic—self-isolates until her position rises upon her ‘like a ghost. Anomalous, desolate, almost blank of hope…What was I doing here alone in great London? What should I do on the morrow? What prospects had I in life? What friends had I on earth? Whence did I come? Whither should I go? What should I do?’ And yet when someone attempts to reach her by asking, ‘Who are you, Miss Snowe?’ she offers only another question: ‘Who am I indeed? Perhaps a personage in disguise.’ Resolution and familiarity she dismisses as signifying nothing. The frozen doors of her ‘personage’ open inwards to a secret knowing. As Brontë felt deeply, for all those dealt the lesser hand of power, only one’s internal realm is without bounds. In that place of flux and fruition, Brontë sought, if not answers, ongoing revelation.
This search, as opposed to indicating refusal to consummate, demonstrates a remarkable appetite of the mind. For example, were our fictional patient, The Muslim Woman, to say she often goes without food, either because she is observing religious fasts or because there is nothing good to eat, I would not mind so long as she is hungry. One sign that a terminally ill person is nearing death is the end of their appetite. When I say that literature doesn’t owe The Muslim Woman, that’s because to owe implies a debt capable of being repaid. It suggests the possibility of satisfaction and the end of hunger, at which point the questions asked about The Muslim Woman will become dead questions and the literature written about her will become dead literature. Emily Dickinson, in the first line of her first letter to her future publisher, announced the aspiration that drove her genius: ‘Are you too deeply occupied to say if my Verse is alive?’
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But we have lost track. We are running out of questions and still have not struck inspiration for a novel about The Muslim Woman. Perhaps we should rehash the basics. Is The Muslim Woman born overseas? Is she homesick? The Prophet said, Be in this world as though you were a stranger or a wayfarer, she will say. Why should I be homesick except for the life that comes after death?
True enough, but she may love one country above others. At this suggestion, she will supply another quote, this time from The Left Hand of Darkness: How does one hate a country, or love one? I know people, I know towns, farms, hills and rivers and rocks…
It is said that people should write from their ‘own voice’. What of The Muslim Woman who comes from many places? Or who will say she ‘came from’ an international tradition of poets and polymaths across the once-preeminent culture of the world and, before that, from heaven? What if she is cut off from her ‘own voice’, or if belonging is irrelevant or undesired, or if her historical inheritance is lost to amnesia? On what basis does she build community? Can labels be useful? If they are meaningless, does that give her a kinship with everybody or nobody?
Perhaps she is just in search of her own image. But when directed to a mirror, she will say, I’ve seen all that already. Tell me something I don’t know.
In Proust and Signs, philosopher Gilles Deleuze wrote, ‘To love is to try to explicate, to develop […] unknown worlds that remain enveloped within the beloved.’ So, I, as doctor-writer must love The Muslim Woman though I have done poorly to explicate. What else? Is there anything left that has not been researched or headlined or protested or explored in debate?
Our hypothetical is running its course and the character of The Muslim Woman begins to exit scene just as I say, Wait, I forgot something.
I know. She stops and faces me with a lifetime of inquiry: You missed my soul. She keeps her hand on the door. It’s not your fault, she says. Debates, headlines, protests draw a crowd. But while you debate…how much of me should remain seen or unseen, or how difficult it should be for me to enter the world, or how easy it should be for the world to enter me, or how much of myself I should or shouldn’t liberate by allowing my tastes, my spending to be commodified by the multibillion dollar industry of surveilling women’s bodies—questions as uninteresting as ‘on or off?’ and other instructions that could apply to an office lamp—what of my soul? And my sisters? Who amongst you thinks once of our souls? Oh, never mind. We are considering our own souls – and how deeply. Who amongst you thinks once of our relationships outside oppression and men? We are considering our own love for other women, for the children who will become us, be assured. We are considering our direct line of communication with God.
The Muslim Woman exits the essay, and she leaves the door ajar. Now, the author is alone. I put down my pen, then I pick it up, then put it down again. Is it impossible to write what she has said?
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NOTES
① Regarding this question, the author feels compelled to interject with a case study, but given the subject (myself), a footnote seems more appropriate. My first publication was a short story around this question of ‘whether to be offended’; now I find its aims regrettably boring and self-defeating. A better writer would have said, Who cares, I don’t want to explain, use your imagination. I try not to be harsh because people tell me they enjoyed that story. I was younger, I hadn’t read the books that I would go on to read, so I didn’t know what questions had already been asked. This must be why Virginia Woolf advised writers not to publish before thirty. To remember how ignorant I was of my own ignorance brings to mind the joke about the old fish asking the young fish, ‘How’s the water?’ to which the young fish responds, ‘What’s ‘water’?’
This chronic affliction of idiocy-in-hindsight has been studied with much heart and humour in The Idiot, by Elif Batuman. Her auto-fictional protagonist finds everything, even basic information, utterly bewildering. She searches constantly for cues on how to act, what to say, how to think. Scarcely can you turn to a page but it is spattered with question marks. The cumulative effect is disorienting and unwittingly wise. More pervasive yet is the silent, compassionate anguish of present-day Batuman who knows how severely the Batuman of thirty years ago lacks the vocabulary to even imagine the questions that could break open her life. Even the freshman narrator laments of her teenage self, ‘It can be really exasperating to look back at your past. What’s the matter with you? I want to ask her, my younger self, shaking her shoulder.’ I am about the age of The Idiot’s titular idiot, an apparently irremediable condition. Perhaps a disclaimer to this study would be wise. Shall I request a grace period of twenty years, at the closure of which I will realise how much this essay has failed to conceive?
Jumaana Abdu is currently working on her debut novel. In 2023, she won the Dal Stivens Award and placed as runner-up for the Peter Carey Short Story Award. She was a Wheeler Centre Next Chapter fellow in 2022. Her work has been published in Kill Your Darlings, Westerly, The Griffith Review, Overland, and Debris. During the day, she is a junior medical doctor.