Anna DeForest’s first novel, A History of Present Illness (2022), follows an unnamed medical student through tension-filled classroom and clinical years among more privileged classmates in New York City. DeForest’s follow-up novel seems a segue from the first. Our Long Marvelous Dying (2024) also features an unnamed narrator–one further along in their medical career– seeking a fellowship in palliative care during the COVID pandemic. Physician writer DeForest is also a palliative care doctor. Having completed a Master of Fine Arts in writing fiction prior to attending medical school, it hardly seems surprising that their novels are saturated with healthcare themes.
In Our Long Marvelous Dying, the narrator begins her 12-month fellowship, noting wryly the absurdity of chasing mastery in taking care of the seriously ill within one calendar year: We have one year to learn to care for the dying, one year and then the rest of our lives (DeForest,10). While she learns the mechanics of titrating opioids and leading goals of care discussions, she struggles with the recent death of her distant and dismissive father. Homelife is further complicated by a return to a cramped city apartment after living in the suburbs, unexpected caretaking when her brother, who struggles with substance use disorder, drops off his young daughter to stay, and resentment from her trailing spouse, his life uprooted and ever at the mercy of where his partner’s next training assignment will land them.
Both novels from DeForest share a first-person intimacy, a journey that prioritizes interiority over dramatic conflict resolution. During a clinic encounter in Our Long Marvelous Dying, the narrator describes a re-calibration of the senses when gathering history from a patient with lung cancer who is also suspected of having a personality disorder: I listen with two ears, two minds, one for what is real and one for what is true (DeForest, 38). When the patient reveals disbelief in the efficacy of masks to prevent the spread of COVID and that patients on ventilators are victims of a healthcare industry scam to make money, the narrator maintains a quiet, empathic presence: I understand the appeal of conspiracy, that someone, anyone, is controlling all of this (DeForest, 38).
No doubt many permutations of that kind of encounter have played out in various healthcare spaces over the last several years, providing no shortage of material for a reflective clinician mining their art. Deforest certainly hints at a thin space between practicing medicine and writing fiction. In an essay on their craft for Literary Hub, DeForest shared: “Writing, how I do it, is not inventive or imaginary, it is merely a means of paying attention” (DeForest). That vantage point—as a palliative care doctor—is particularly relevant in this post-COVID pandemic landscape, where in the United States alone, more than 1.2 million deaths have been attributed to the virus (Centers for Disease Control). That position is also a rare and, arguably, rarified perspective.
Those who practice palliative care, a relatively new specialty devoted to attenuating the suffering of seriously ill patients—body, mind, and spirit—comprise a tiny percentage of the physician workforce, roughly 0.008 percent (Workforce Statistics; FSMB Physician Census) and do so in a milieu of perplexed healthcare consumers. According to a scoping review, only 14 percent of those surveyed could define palliative care correctly (Grant et al., 50). Further complicating the work of a palliative care team is societal aversion to thinking about death and dying, a theme echoed by DeForest’s narrator: But of all the things on offer, no one wants straight talk. We are trying to treat a condition we are not allowed to diagnose (DeForest, 23). DeForest’s slim novel belies its potential impact to encourage healthcare workers to lift that societal gag order and consider the most universal of experiences—death—even if triumphalist themes in medicine are more satisfying than taking a stroll along the melancholy periphery of mortality.
One reviewer decried a lack of plot in Our Long Marvelous Dying in the midst of the narrator’s stream of consciousness (Short, Dark, Stylish). Even as the reader resides in the narrator’s headspace, the inner chatter is neither long-winded nor gratuitous. In fact, DeForest seems to write not with a pen, but with a scalpel. In this passage, they simply cut to the bone sans flourishes as the narrator has traveled toward an acceptance of death:
A few months in, I have seen the end come for so many people, all ages, all ethnicities, from all social strata, that when I walk down the street, I can look at most of the people and have a reasonable sense of what they would look like dead or dying. Maybe this sounds as if it would cause some kind of despair, but it does not (DeForest, 65).
When it comes to plot points, what could be more climactic than grappling with such large-scale finitude in such a granular way? Action within is still action and almost subversive in a healthcare industry that prizes procedures and treatment over connection and conversation.
Our Long Marvelous Dying bears no resemblance to television’s medical dramas, where the stories unfurl in tidy sequences with glossy-haired actors and where death may be portrayed but rituals related to death and expressions of grief have been sanitized or avoided altogether (Chartrand & Lazaro, 1011).
In contrast, the narrator in Our Long Marvelous Dying leads readers right to the charnel ground. Those in the health humanities have many opportunities to hone the moral imagination here in multiple liminal spaces: during a physician’s training, on the threshold of a patient’s death, in the midst of a pandemic, and in the space between clinician and patient. The latter offers the opportunity to deconstruct the notion that the interaction between a doctor and patient is unidirectional—a patient describing an ailment to a white-coated automaton without a personal life–which DeForest rebuts on every page.
One can only wonder if the title of DeForest’s second novel is a tongue-in-cheek marketing ploy—hence the marvelous?—to journey through an often melancholy and sometimes absurd healthcare landscape. It’s a pitch worth making; imagine gravitating toward all those uncertain spaces and residing there together, turning toward, rather than away, from death and suffering.
Works Cited
Centers for Disease Control and Prevention. “Provisional COVID-19 Mortality Surveillance.” 25 September 2025, https://www.cdc.gov/nchs/nvss/vsrr/covid19/index.htm,
Chartrand, Louise, and Janelle Lazaro. “Entertainment-Education: What Are Grey’s Anatomy and Saving Hope Teaching Us About Death?” Omega vol. 91, no. 2, 2025, pp. 997-1016. doi:10.1177/00302228221146345
DeForest, Anna. “Anna DeForest on Writing Without Artifice.” Literary Hub, 19 July 2024. https://lithub.com/anna-deforest-on-writing-without-artifice/
DeForest, Anna. A History of Present Illness. Little, Brown and Company, 2022.
DeForest, Anna. Our Long Marvelous Dying. Little, Brown and Company, 2024.
“FSMB Physician Census Identifies 1,044,734 Licensed Physicians in U.S.” Federation of State Medical Boards, 20 July 2023. https://www.fsmb.org/advocacy/news-releases/fsmb-physician-census-identifies–1044734-licensed-physicians-in-u.s/#:~:text=Key%20findings%20of%20the%202022,23%25%20larger%20than%20in%202010.
Grant, Marian S et al. “Public Perceptions of Advance Care Planning, Palliative Care, and Hospice: A Scoping Review.” Journal of Palliative Medicine vol. 24, no. 1, 2021, pp. 46-52. doi:10.1089/jpm.2020.0111
“Short, Dark, Stylish, Sui Generis. An Idiosyncratic Form of Fiction, Stimulating Yet Not Entirely Satisfying.” Review of Our Long Marvelous Dying by Anna DeForest. Kirkus, 17 May 2024. https://www.kirkusreviews.com/book-reviews/anna-deforest/our-long-marvelous-dying/
“Workforce Statistics.” American Academy of Hospice and Palliative Medicine. Accessed 5 October 2025, https://aahpm.org/career-resources/workforce-study/
