The Graceview Patient and Gothic Medicine: An Interview with Caitlin Starling
Followers of mine will know I’ve just come through 3 years of eldercare emergencies, so it felt appropriate to find myself interviewing Caitlin Starling about her upcoming book, The Graceview Patient. The blurb describes it as a “claustrophobic hospital gothic” and that is about as spot-on a description as one could ask for. Anyone who has had an extended hospital stay or shepherded a loved one through such will recognize the setting instantly; anyone who has endured treatments such as chemotherapy, immunotherapy, and more will know all too well what Meg is experiencing. It was a peculiar delight to read a horror novel that hewed so closely to my lived experience, and I found myself eager to hear what Ms. Starling had to say. She did not disappoint. (Stay to the end for the Cassie Alexander shoutout!)
Caitlin Starling is the nationally bestselling author of The Death of Jane Lawrence, the Bram Stoker-nominated The Luminous Dead, and Last To Leave The Room. Her newest novels The Starving Saints and The Graceview Patient epitomize her love of genre-hopping horror; her bibliography spans besieged castles, alien caves, and haunted hospitals. Her short fiction has been published by GrimDark Magazine and Neon Hemlock, and her nonfiction has appeared in Nightmare, Uncanny, and Nightfire. Caitlin also works in narrative design, and has been paid to invent body parts. She’s always on the lookout for new ways to inflict insomnia.
LSJ: I wanted to start with a version of that age-old question, “what inspired you to write this book”? You write in the Acknowledgments of both your mother’s illness and your own hospitalization, but you describe both in generally positive terms. Meg’s treatment isn’t quite that: it’s at times traumatic and bordering on the unethical. Too, the experience of her hallucinations (if indeed they are that) seemed painfully accurate to me, having watched a loved one suffer a traumatic brain injury. I’m wondering, therefore, what inspired the horror in this book?
CS: My natural storytelling impulse is always towards the horrific, particularly losing touch with reality/being unable to verify what is real or not, and being trapped in a place where you have to grapple with that fundamental uncertainty. In some ways, the hospital setting is just that: a setting. I love getting into the systems of things, and hospitals are fantastically systemized (but irregular) institutions. Coming out of my own hospitalization, I knew I wanted to write a story with nurses as major characters, and the medical system as a very tangible, very consuming setting, while also trying to avoid the pitfalls of a lot of medical horror: making the medical staff entirely evil, unhinged, or apathetic. It’s always more interesting to me to get into the nuance: we have shady pharmaceutical representatives, burnt out nurses, busy doctors, and the ever-present reality that even outside of a horror story, hospitalization is hard and dangerous.
LSJ: The blurb for The Graceview Patient describes it as “hospital gothic” and yes, gothic was the first word that came to mind when I started reading. Was that a deliberate stylistic choice on your part, or was it just how the narrative developed? Is there something about the gothic tradition, that idiom, that lends itself to describing modern medicine?
CS: Absolutely deliberate! From the very beginning, I wanted to structure Graceview Patient like a traditional gothic novel. The hospital stands in for the crumbling old house; the staff are the inhabitants of that house; the pharmaceutical rep is the seductive yet dangerous scion of the house. Meg is broke, socially disadvantaged, and trapped in what is nominally a respite (the VIP wing of a paid medical trial), but is also mysterious and potentially deadly. Whether the ghosts are real or hallucinations, whether the occupants of the hospital are gaslighting Meg or otherwise protecting secrets, all of that is in service of creating a great gothic tale.
As for its intersection with modern medicine in general, outside of this specific fictional hospital, some of that has to do with the byzantine structure of insurance coverage, specialist referrals, and continuity of care, I think. Individual caregivers can be deeply human and want the best for us, but ultimately, the system is indifferent. Call your insurance provider three different times, get three different answers, and you start questioning your own sanity. And when you get into hospitalization, there’s so many disruptions of the rhythms of life—5 am phlebotomist visits, endless noise on the ward, medication-induced disorientation. Through it all, too, you’re being observed. You’re being measured. I think that feeling of always being watched is crucial to a gothic story.
LSJ: As the story progresses, what is real or true becomes increasingly problematic. While this is squarely in keeping with the gothic tradition, I tend to think of gothic stories as primarily psychological horror; The Graceview Patient is certainly that, but I would also call it body horror. What Meg undergoes has very distinct, and debilitating, physical effects, which in turn lead her to conclusions that may be completely hallucinatory … or may be a different kind of truth. Do you think, perhaps, that the body can lead us to a different, yet valid understanding of what we call “real” or “true”?
CS: One of my favorite passages in the book is:
“Am I my consciousness? Or am I my body, with its record of interventions and injuries and illnesses, this thing I’ve divorced myself from so fully out of necessity? The thing in the bed. Is that me?”
Is it?
We all, for obvious reasons, would prefer control and knowledge over our physical self at all times. When I’m sick, I keep track of my symptoms, what medications I’ve taken, etc. But when I had my kid, I got to have a Fun Dose(tm) of various sedatives and hypnotics because my epidural failed mid-c-section; there’s a block of missing time, and when I was myself again, my body didn’t behave the way I was expecting it to. I knew what had happened to me—I had it explained to me, and I have a good amount of medical literacy to back it up and fill in gaps—but it’s still deeply disorienting to have to retake inventory of your body and figure out what’s changed.
That’s peanuts compared to what Meg goes through. She has evidence that her memory has unverifiable gaps. She has no way of filling those in. And she’s had years of practice dissociating her sense of self from her body, even as her body has increasingly trapped her. Her body becomes the “true” record of what’s happened to her, something that can’t be erased as easily as her thoughts and memories, but how much does that truth actually matter? Does it matter what happened objectively, whether she perceived it or not? Or does it only matter how she experiences it now looking back on it? And that’s before you get into how the state her body is in directly impacts her understanding of the world …
LSJ: As I read, I found myself wondering what other fictional antecedents you may have drawn upon in writing The Graceview Patient. I kept thinking of the works of David Cronenberg, for instance, and certainly The Yellow Wallpaper. Were there any specific works you looked to as you began this project?
CS: Oddly, Tana French mystery novels. Without reading In The Woods, I’m not sure I would have felt comfortable doing the frame narrative/retroactive narrative style. The Graceview Patient is Meg telling us what she’s put together of her story from near the end of it. I had a lot of fun dropping those Little did I know … moments ominously throughout the book, which is not my usual approach, and something I felt a little self-conscious about at the time. Tana French helped.
Aside from that, and in the nonfiction world, I’ve read several memoirs of people either working in or interacting with hospitals. Cassandra Alexander’s The Year of The Nurse, which is her memoir of working in the ICU during the height of the first COVID wave, was absolutely revelatory, and a lot of the nuance of Meg’s nurses (particularly Isobel) came from that. In Shock by Dr. Rana Awdish was a great bridge between the experience of a patient and the disorienting nature of being hospitalized and a physician’s perspective of the same.
LSJ: Is there anything else you would like readers to know about The Graceview Patient?
CS: If Meg had had access to a social worker and/or care coordinator, she probably would have had a much better time. 🙂
The Graceview Patient comes out on October 14th. You can learn more about the book and preorder from your favorite retailer here.
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