February 11th, 2024
THANK GOODNESS, JOAN IS OKAY AFTER ALL, a book review by Jim W. Vogele
JOAN IS OKAY by Weike Wang, (Publisher: Random House) 2022, ISBN 9780525654834 [Hardback]
Weike Wang’s 2022 novel, JOAN IS OKAY, came to my attention over the past year and I thought it might be of interest given that the narrator is an ICU attending physician in a New York City hospital. With its publication date of January 2022 and its NYC setting, I wondered if this would be a ‘Covid novel?’ While this would not have been a deal breaker for this reader, my enthusiasm is not yet stoked to read anything in which Covid is pivotal. For reasons touched upon below, I’m still at the stage of yearning to forget about Covid (which I admit isn’t a very realistic mindset . . . ).
While JOAN IS OKAY is not a ‘Covid novel,’ Covid does make its unwelcome appearance in Joan’s life in NYC, just as it did in our lives. Joan lives in a “classic prewar ten-story, thirty-six unit [ ] built the same year the Titanic sank [1912].” Joan prefers seclusion when she is not working, yet her classic pre-war abode employs an aggressively-attentive doorman and is occupied by neighbors who would like to engage, to be neighborly, in particular one neighbor down the hall who seems to struggle with the concepts of desirable solitude and quiet.
Does Joan love her job as a healthcare provider? Yes, although she would likely find that question to be misplaced or even irrelevant, because Joan fully appreciates being a ‘cog in a wheel.’ As she says:
“[W]hereas . . . each of my residents . . . felt the training had stifled their personhoods, I relished that feeling of anonymity and of being a cog in the whole.”
And, indeed, Joan provides a reasonably compelling explanation of her affinity for the medical profession as practiced in a large hospital system: “The medical system wasn’t perfect because no system is perfect, but I still admired it for being a hierarchical masterpiece of specialized skill. Moreover, how could a system be that flawed if it had allowed someone like me in?”
Being a cog in the wheel is arguably not the first thing that comes to most of our minds when we think of job satisfaction. I can’t say that I’ve ever heard an Oregon, Washington, or California physician contract review client mention looking forward to being a cog in the wheel. On the other hand, being part of a team is something that many of us do enjoy. So perhaps Joan’s affinity for cog-in-a-wheel status is not so unusual. She is a cog in a highly-functioning hospital environment and that suits her. Her Medical Director finds that Joan’s devotion makes her an ideal employee and exemplar physician. Suffice to say that Joan’s Medical Director would, if he could, sign her to a physician employment of infinite duration – none this ’90-day notice of without cause termination’ business that we see in most physician employment contracts.
Given that I spend much of my working day wading through physician employment contract legalese, it is a welcome respite to read prose that is free to meander. And JOAN IS OKAY readily passes the first test in my book when it comes to reading, which is that Weike Wang writes lovely prose, clean and wry. Not to mention, why would anyone aspire to be a cog in a wheel? While this question might not be a catchy hook for a mystery novel, it piqued my interest and is an apt hook for an existential novel set in the pinballing universe of employment at a busy hospital.
THE BOOK
Wang’s protagonist drew me in with her voice from the first paragraph, including her first-page disclosure of her own height and weight, a habit of description she displays throughout the book when she meets someone new. Doctor Joan tells us that her colleagues include, “Reese [ ] a six-two, 190 pound all-American guy . . . [and] Madeline [ ] a five-seven, 139-pound robust German woman with a slight accent.” This may sound annoying, but it’s something that I can certainly relate to — as an avid sports fan, I’m used to checking the height and weight of various athletes (along with 40 yard dash time and vertical jump). In JOAN IS OKAY, height and weight numbers serve the dual purposes of sketching character and affirming that we are seeing the world through the eyes of a medically-trained narrator.
Yet another trait that reveals Joan’s mind at work is her fondness for the medical machines she uses in the ICU:
“In any specialty, an attending is expected to lead and guide her interns and residents along in their careers. To become an attending, I had trained for twelve years. The job was to teach machine readings, and a question I liked to ask was how is this patient interacting with her machine, what’s the dance there like? If a patient fought, machine and patient became dyssynchronous. If they danced, the two were synchronous. Usually, the patient fought. Our innate desires to breathe and to dance alone are strong.”
That’s an interesting observation from Joan, who we do not see dancing much in this story; and yet this also makes perfect sense once you get to know Joan, who sees the dance of life through a lens all her own. The lens is that of a first-generation American, born in China, with parents who immigrated to America for a decade before returning home themselves. Joan’s family, particularly her wealthy finance-bro brother and his wife, cannot understand Joan’s satisfaction as a single woman, no kids, grinding in a big city hospital. Move to their wealthy Connecticut community, they tell Joan, where you’ll find riches, happiness, and fulfillment. But . . . you guessed it, Joan is okay right where she is.
Apropos of Joan’s family, I enjoyed the brief explanations, interspersed throughout, of Chinese words and representations. This reminds me in a fashion of Malcolm Gladwell’s explanation of how math can be more efficient in other systems where numerical terminology is more efficient and/or logical. Which in turn reminds me of the recent Nate Bargatze skit, “Washington’s Dream,” on Saturday Night Live which centered upon America’s shunning of the metric system and other oddities of American number-crunching and measurement systems; or, put more affirmatively, America’s battle to adopt its own “system of weights and measures,” standing apart from the rest of the world. I recommend checking out Bargatze’s skit if you haven’t seen it. It is very funny.
My, how I digress. Since I established this website for my practice as a physician contract review attorney, I have previously posted eight book reviews with a healthcare setting. This is the first work of medical fiction I’ve reviewed, and, fortunately, I can highly recommend Weike Wang’s work. I would note that in the Acknowledgments of JOAN IS OKAY, Wang thanks several friends and colleagues “for patiently answering my many, many questions about medicine, hospitals, and doctors and for their one question back, that this story wasn’t going to be about them, was it?” Ms. Wang did her research and it shows in the final product, which is right in the sweet spot for both a general reader and a physician contract review attorney.
I always learn about the medical profession when I read and review books with a healthcare setting. While I won’t say that JOAN IS OK speaks directly to Washington physician contracts, Oregon physician contracts, or California physician contracts, the books I read always provide useful context for my work in reviewing physician contracts. For example, I know the difference between the ICU and ED (Joan doesn’t get into the shift in terminology from ER to ED, about which there are various theories, including references to the hit t.v. show “ER” as well as alternative applications for the term ED which do not refer to the “Emergency Department”). But Joan’s description of the distinction is still educational:
“A common confusion is between intensive and emergency care. The latter is chaotic, usually on the first floor near the ambulance drop-off, in a room without dividers or enough beds. Someone might scream, Doctor! And because no one answers, that person screams on. Intensive care is just the opposite. It’s the best care that a hospital can give, and the room is quiet except for machine sounds, alarms that go on and off.”
Also relevant to reviewing California physician contracts and Montana physician contracts is Joan’s insight about work and home and the possible confusion of same:
“Director, the first time I put on my white coat, it felt like home. From having moved around so much and with no childhood or ancestral home to return to, I didn’t think myself capable. I didn’t prioritize home or comfort, because if everyone did, then immigrants like m parents, brother, and sister-in-law couldn’t exist. Home was not a viable concept for them until later, and it wasn’t a concept for me until the day I put on that coat, this coat. I pulled at my white lapel to show him. From then on, I knew that my occupation would become my home. To have a home is a luxury, but I now understand why people attach great value to it and are loyal to defend it. Home is where you fit in and take up space.”
Well said, Joan. The unique phrasing and metaphors are among the most enjoyable aspects of Weike Wang’s writing, e.g. that Joan’s white coat would become her home. Of course, there is much debate these days over what is and is not healthy interplay between work and home; endless articles have been published about “work-from-home” in these post-pandemic years; nonetheless, why would anyone want to deprive anyone of their personal sense of home? At a time when many physicians are leaving private practice for employment with health systems, the sense of relationship one has with one’s workplace setting will continue to be of interest to physicians and to those of us who work with physician employment contracts and other healthcare provider employment contracts.
I took special interest in Joan’s identification with the “gunner” label:
“As the director had put it when he hired me, I was a gunner and a new breed of doctor, brilliant and potent, but with no interests outside work and sleep. I’d asked if he was trying to compliment me or insult. Compliment, he’d said. Because being a gunner was good. Disease is war, and in war, gunners operate the military.”
As I’ve never been to medical school, I’m not intimately familiar with a med school gunner; but I did go to a competitive law school, and I know that we had colleagues at law school who were legal “gunners.” So I get the drift. I personally didn’t mind the gunners, but I often wondered whether they might be losing the forest for the trees. In short, I felt some empathy and/or sympathy for the gunners, because I feared, frankly, that they may turn out to be less happy than they could be in life. On the other hand, as a hard worker myself, ambitious and competitive, I felt some comradery with the gunners. To be honest. I didn’t want to be them, but I understood their mindset and motivations. Perhaps this is why I could so easily relate to Joan. While her experience as the daughter of first-generation immigrant parents was certainly different than mine as a kid from rural eastern Montana (who found himself in an Ivy League law school full of gunners), I know what it’s like to be outside the mainstream in an educational setting or profession. Without getting too far off topic, after many years of law practice and life, I will note that you can flourish with an outside-the-box mindset in spirit and practice, while working squarely within the mainstream. Someone could write a book about this – and Weike Wang has done just that.
CONCLUSION
As mentioned, JOAN IS OKAY is not a Covid novel, but Covid appears in the second half of the book. Joan recounts the unfortunate casting of the virus in racial or nationalistic terms; and her description of the symptoms certainly rang true for this reader: “Felt like a hot anvil had been placed on my chest . . . [and then the] fever dreams . . . .” I was there last fall. Did not enjoy being there. Did not enjoy the hot anvil and the fever dreams. On the bright side, once Joan emerges from her bout with Covid, she finds a pleasant surprise springing from her role as a valuable cog in her workplace, a little development which I won’t spoil by revealing here.
Unlike my time under the Covid anvil, I thoroughly enjoyed my time in Joan’s fictional world. It’s a world amusing and quirky, intelligent and hard-working, and ultimately empathetic and tolerant. That’s Joan’s world and this reader likes that sort of world, painful as it can sometimes be.
