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Narrative Ethics, Authentic Integrity, and an Intrapersonal Medical Encounter in David Foster Wallace’s “Luckily the Account Representative Knew CPR”

Published online by Cambridge University Press:  04 December 2014

WOODS NASH
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Abstract:

In Wallace’s short story “Luckily the Account Representative Knew CPR,” a vice president (VP) suffers cardiac arrest. As an account representative (AR) administers CPR, he discovers his own impersonality mirrored back to him by the VP—a disturbing vision of himself that the AR wishes to escape. Because modern moral theories would have the AR respond impersonally to the VP, those theories would only exacerbate his existential predicament. In contrast, by regarding the AR’s act as one that he, in particular, should perform, narrative ethics can discern a resolution for his predicament: because the AR still values his diminished capacities for care and spontaneity, this situation offers him an opportunity to revive those former traits. Doing so would give him greater authentic integrity, or narrative continuity with the most important aspects of his past. Authentic integrity can serve narrative ethics as a helpful starting point for understanding how the life stories of patients, clinicians, and others might appropriately unfold.

Keywords

narrative ethicsauthenticityintegrityauthentic integrityDavid Foster Wallace
Type
Bioethics and Literature
Information
Cambridge Quarterly of Healthcare Ethics , Volume 24 , Issue 1 , January 2015 , pp. 96 - 106
Copyright
Copyright © Cambridge University Press 2014 

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References

Notes

1. Wallace, D. Luckily the account representative knew CPR. In: Wallace, D. Girl with Curious Hair. New York: Norton; 1989, at 52Google Scholar. Subsequent references to this story are given parenthetically.

2. Marshall Boswell regards this story as a moral milestone in Wallace’s oeuvre, for “Wallace here first announces a theme that will assume central importance in Infinite Jest, namely that our isolation from one another as well as our inability to access the interior of others causes us the sort of pain that paradoxically joins us together.” Boswell, M. Understanding David Foster Wallace. Columbia: University of South Carolina Press; 2003, at 77–8.Google Scholar

3. Because theirs are the only vehicles in the parking garage, the AR knows that they are the last two executives to leave the office. Furthermore, the AR regularly works late into the evening (p. 45). So the AR could infer that the VP’s poor health and heart attack are partly the result of the “weary” work in which the VP has been engaged, presumably, for decades (p. 48). Given the AR’s professional trajectory, none of this augurs well for his own future.

4. This exposition of the Kantian imperfect duty of beneficence owes much to Karen Stohr, who argues that, even within the framework of that imperfect duty, a person can have a strict obligation to provide aid on specific occasions. Stohr, K. Kantian beneficence and the problem of obligatory aid. Journal of Moral Philosophy 2011;8(1):45–67.CrossRefGoogle Scholar

5. There seems to be a further analogy between the AR and the building in which he works: in preserving the VP’s “minimal-life function” (p. 51), the AR is like the Building, which is anatomized as “autonomic” (p. 52), “vaguely pulsing” (p. 48), and capable of respiration, for it releases a “great breath, a spatial sigh” (p. 45). The suggestion seems to be that, just as the AR barely sustains the VP, the Building likewise does nothing on a daily basis for the AR other than maintain his minimal-life function until something or someone might arrive to help him.

6. Bruner, J. Making Stories: Law, Literature, Life. New York: Farrar, Straus and Giroux; 2002, at 64.Google Scholar

7. See note 6, Bruner 2002, at 65.

8. See note 6, Bruner 2002, at 78.

9. Bruner, J. Narratives of human plight: A conversation with Jerome Bruner. In: Charon, R, Montello, M, eds. Stories Matter: The Role of Narrative in Medical Ethics. London: Routledge; 2002, at 4.Google Scholar

10. See note 9, Bruner 2002, at 4.

11. Frank, AW. Narrative ethics as dialogical storytelling. Hastings Center Report 2014;44(1):S16–S20, at S19.CrossRefGoogle ScholarPubMed

12. By arguing that narrative integrity is a narrative ideal, or a value that is rooted partly in our experience of stories, I am contending with Tom Tomlinson’s claim that only “extranarrative ideals” can be used to evaluate life stories morally. Because narrative integrity by itself confers some degree of meaning and worth on a life—even if it is a meager degree of worth in the case of a deplorable person—Tomlinson errs in regarding “conceptions of the best way to live” as entirely separate from “conceptions of the best way to write a story.” Tomlinson, T. Perplexed about narrative ethics. In: Nelson, H, ed. Stories and Their Limits: Narrative Approaches to Bioethics. London: Routledge; 1997, at 130–1.Google Scholar

13. Elliott, C. Better than Well: American Medicine Meets the American Dream. New York: Norton; 2003, at 29.Google Scholar

14. See note 13, Elliott 2003, at 30–1.

15. See note 12, Tomlinson 1997, at 130–1.

16. See note 12, Tomlinson 1997, at 130.

17. See note 12, Tomlinson 1997, at 130.

18. The AR is “an inveterate thrower of stones at the skins of ponds” (p. 50).

19. The AR’s interactions with the VP are replete with sexual imagery, which gives readers—and perhaps the AR—a further basis for relating this current act of care to his former romance. We are told that the AR is “straddling” the VP (p. 50). The AR also uses “a clean slender finger” to clear the VP’s “cervically pink throat” (p. 50) and gives him mouth-to-mouth breaths “down through the . . . full but faintly blue lips and titled head” (p. 51). Near the end of the story, the narrator’s language also echoes that used in many marriage ceremonies: The VP’s “life” is “now literally” the AR’s “to have and to hold, for a lifetime” (p. 51). Similarly, another of Wallace’s stories in the same collection expresses the idea that the whole point of “love” is to be “permeable,” “to get your fingers through the holes in the lover’s mask.” Wallace D. Little expressionless animals. In: Wallace 1989 (see note 1), at 13, 32. On that point, see Boddy, K. A fiction of response: Girl with Curious Hair in context. In: Boswell, M, Burn, SJ, eds. A Companion to David Foster Wallace Studies. New York: Palgrave Macmillan; 2013.Google Scholar

20. See note 9, Bruner 2002, at 4.

21. Montello, M. Narrative ethics. Hastings Center Report 2014;44(1):S2–S6, at S5.Google Scholar

22. See note 19, Boddy 2013.

23. See note 19, Boddy 2013, at 37.

24. In Wallace’s The Pale King, a substitute instructor for an undergraduate course in accounting (no less!) remarks: “Enduring tedium over real time in a confined space is what real courage is.” So, beyond the courage that our story’s accountant exhibits by enduring the tedium of CPR in the claustrophobic parking garage, perhaps he would also show a kind of courage by returning to the grind of his confined space in Accounts. Wallace, D. The Pale King: An Unfinished Novel. Pietsch, M, ed. New York: Little, Brown; 2011, at 227.Google Scholar

25. Charon, R. The narrative road to empathy. In: Spiro, HM, Peschel, E, Curnen, MGM, St. James, D, eds. Empathy and the Practice of Medicine: Beyond Pills and the Scalpel. New Haven, CT: Yale University Press; 1993, at 158.Google Scholar

26. See note 25, Charon 1993, at 158.

27. See note 25, Charon 1993, at 158.

28. See note 25, Charon 1993, at 158.

29. Wallace, D. An interview with Larry McCaffery. Review of Contemporary Fiction 1993;13(2):127–50, at 131.Google Scholar