Book Review 2016-006
Hesitation Wounds by Amy Koppelman
2015 by The Overlook Press, 187 pages

(I purchased a copy of this hardcover when it came out late in the fall)

(There are a plot spoiler or two in this review--couldn't really figure out how to keep them out)

Amy Koppelman might be the bravest writer I know. She writes of difficult subjects--specifically various forms of depression--and does not shy away from any aspects of the disease. Her debut, A Mouthful of Air (MacAdam/Cage, 2003) told the story of a new mother suffering from postpartum depression. Her follow-up, I Smile Back (Two Dollar Radio, 2008), followed a married mother as she tried to work through her bi-polar depression through searching for wider ranges of high excitement. In each of these cases, Koppelman chose to allow the reader to feel as close to what it feels like to have either of these forms of depression by digging deeply into their minds. Not simply implying or stating that they were feeling dark, but expressing exactly what they were feeling and how their actions might help or hinder any development toward their improvement.

In Hesitation Wounds, while still dealing with the subject of depression, Koppelman has switched points of view and has as her main character Susanna Seliger, a renowned psychiatrist working with patients suffering from treatment-resistant depression. Koppelman gives us the thoughts from one who helps battle depression for others, and not one battling herself. And while depression, specifically of two individuals, plays a prominent role in this novel, Koppelman has really tackled grief and memory in Hesitation Wounds.

The novel begins with Dr. Seliger in an airport--she's recently received a phone call from an adoption agency suggesting they believe they've found her a daughter. Without much warning the narrative goes into her remembering a patient, Jim, telling her a story. It's something Koppelman does very well in this novel--she changes time frames and what one might refer to as scenes freely and while the time span covers some nearly 30 years, the novel is mainly written in the present tense. However, Koppelman's writing is so crystal clear, it never takes more than a sentence or so for the reader to realize that a switch has been made.

The patient, Jim, is undergoing ETC (electroconvulsive therapy) as what one would have to consider a last ditch effort to battle the voices that have been in and out of his head for years. At this time he's in for his last treatment. He's middle-aged, married, has a couple of dogs, and is a freelance writer. As this afternoon comes to an end, Jim is headed off with his wife and Dr. Seliger runs slightly late to meet Evan for dinner at an Italian restaurant. I don't remember it being clear at the moment of this meal, but it comes out later that the two are in a long-standing relationship but not married. During the meal, right after Susa (her childhood nickname) tells Evan that she loves him, he lets her know that he impregnated a waitress on his last trip out of town. Which leads to their relationship ending and throughout the rest of the novel has Dr. Seliger remembering incidents from this and other relationships.

Getting back to grief and memory--Jim ends up succumbing to the voices and hangs himself. Something about his death really brings to the forefront Susa's memories of her brother Dan, dead now some 28 years. While Dan didn't necessarily commit suicide, Susa's memories have her convinced that he was suffering from depression, was offering her clues, and that her hesitation to act upon them allowed him to not prevent himself from dying in a fire. While he may not have planned out a suicide, from his best friend's (Ray) description of the event, Dan didn't do very much to stop it from happening once he realized what was going on--in fact a little grin crossed his face upon that realization. And Susa has been suffering from his loss ever since.

The novel spends time in the 80's, back before Dan died, times when he and Susa and Ray (and at times 2 or 3 others were mentioned but not strongly) spent time getting high, talking about the two boys going out tagging--this in NYC when it wasn't shiny like it is now. It spends more closer to current time with Evan and Dr. Seliger. There's time not so long after Dan dies that Susa and Ray have a long relationship, moving in together. It also leaps to what would seemingly be the future considering the starting point of the novel, a time where Dr. Seliger has adopted a nearly five year old Cambodian named Mai. Much of it is in the form of Susa talking to her deceased brother, and, in this way, it feels as if she's speaking directly to the reader.

Throughout each different time period (beyond that when Dan is still alive), Susa constantly grieves for Dan. The levels vary, and the things that trigger her grief aren't consistent. What also varies, albeit slightly, is how Susa remembers things. She seems to be letting her memories convince herself that Dan was trying to signal to her that he was suffering, that he was going to do something about it, and that she could have done something to stop from happening what eventually did. Especially after her patient Jim's final actions.

If instead of calling you crazy I said I was willing to go with you, would you have waited for me? Could I have saved you? Could I have?

At one point she even wonders if she continues to think about the past will she be able to keep track of what is memory and what is real.

Koppelman's writing also needs mentioning here. To call it spare is not an overstatement. In the sections that are not dialogue, one imagines that Koppelman must have done a lot of deleting during revisions until she found just the right words, just the right number of syllables, just the right structure:

I can feel the pages of the book against my thumb. A paperback. The edges worn. Dog-eared.

The above is a typical paragraph. No lengthy, descriptive, sentences. Information chopped up and offered piecemeal. Between that and the time jumps but keeping everything in the present tense, the book really flies by. I read it in two sittings and if I didn't have to stop in between I wouldn't have. People frequently tell each other to work through their grief--it will get better. What Koppelman shows through Dr. Seliger is that it might not necessarily really get better, but when you can find other things to keep your thoughts busy, that grief isn't the main focus of your attention. While the topic isn't the brightest, the writing and structure are so fantastic that it's truly a great read.

5 stars