Risk, by Rachel MacKenzie (1971)

Cover of first US edition of "Risk"

Risk, Rachel MacKenzie’s brief account of her hospitalization and initial recovery from open-heart surgery to repair an aneurysm of the left ventricle of her heart is one of the shortest books covered on this site, just 59 pages in all.

Adapted from an article she published in The New Yorker in November, 1970 as “fiction,” it’s a model of the ultra-efficient narrative. There is nothing unnecessary in her account. A student of the progress of heart surgery could easily trace the entire course of her diagnosis, examinations, surgery, and post-operative difficulties, including the game of drug roulette her cardiologist plays until settling on Dilantin as the most effective treatment for arrhythmia, yet no individual element of her medical care gets more than a few lean paragraphs’ attention.

And her choice of the third person allows her to be ruthlessly selective in what she mentions of her own emotions and sensations. She notes pain–when it comes, where it stays, how long it takes to leave. The widely different abilities of doctors and nurses to insert catheters–quickly, barely noticeably or ineptly, leaving bruises and soreness from repeated assaults–gets special notice.

Risk takes its title from the fact that open-heart surgery was still a new field in 1970, one where full recovery could not yet be taken for granted. Her surgeon tells her,

“I have to tell you that we could get your chest opened up and I might decide the risk was too great to proceed. It’s large. The men who did the arteriogram figure between fifty and sixty. They think nearer sixty. I still think fifty. It will depend on our judgment of the strength of what’s left of the ventricle to carry on.”

Later, another doctor puts the situation in starker terms:

“Dr. Jamison,” she [MacKenzie] said, “I’ve been thinking. Are there particular risks and complications in this surgery I ought to know about? Do you really aprove of my having it?”

The expression of special pleasure that had been on Dr. Jamison’s face gave way to one of reserve. “Nobody’s rushing you into this,” he said. “It’s entirely your decision.”

“That isn’t what I mean. My decision was made before I ever came in here. But I would like to know what the risk is.”

“It makes no sense to talk about risks in a thing like this,” Dr. Jamison said. “Risks are statistics. Averages. So far as you’re concerned, they’re on hundred per cent or they’re zero.”

The surgery itself is successful, but MacKenzie experiences a number of post-operative complications that leave her variously frustrated, depressed, and impatient. But she progresses from ICU to Cardiac Care and finally to a normal recovery ward, and is able to return home.

Months later, discussing her case with her cardiologist, she is able to put the risks into human terms:

“How many of those operations have they done?” she asked.

“Between fifteen and twenty–seventeen is the exact number, I believe.”

Dr. Rudd had said the risk was thirty-five per cent or a little more. She figured. Had they lost six? Seven?

Looking back on her own experience, she thinks, “Dear God, the miracle.”
Rachel MacKenzie at The New Yorker
Rachel MacKenzie was a editor at The New Yorker from 1956 until just before her death in 1980, and worked with some of the magazine’s most intimidating contributors–Saul Bellow, Isaac Bashevis Singer–and fostered the early work of Philip Roth, Muriel Spark, and Bernard Malamud. Born in a small town in Ohio in 1909, she spent over twenty years as a teacher, first at Ginling College in Nanjing, China, then at the College of Wooster, Radcliffe, Wellesley, and the Bread Loaf Writers’ Conference. The American Heart Association presented her with the Blakeslee Award “for lasting service to physicians as well as laymen” in honor of Risk. Her one novel, The Wine of Astonishment, published in 1974, tells the story of two spinster sisters and their lives in the tight-knit and strictly conventional community of a small upstate New York town.

Ironically, one of the earliest of her few published pieces was a short story titled, “The Thread,” which appeared in Harpers in September 1947. Relating the experience of Ellen, a young girl hospitalized for injuries that require some surgery, it greatly foreshadows Risk, even down to the constant refrain of doctors and nurses warning, “Just a pinprick” before giving another of her countless injections. Harpers subscribers can read “The Thread” on the Harpers Archive (link).


Risk, by Rachel MacKenzie
New York: The Viking Press, 1971

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