Josh Goldin's happy yet unexamined existence is shattered one morning when his wife, Dori, rushes their eight-month- old son to the emergency room in severe distress. Dr. Darlene Stokes, an African-American physician and single mother, suspects Munchausen by proxy, a rarely diagnosed and controversial phenomenon where a mother intentionally harms her baby. As each of them is forced to confront a reality that has become a nightmare, Darlene, Dori, and Josh are pushed to their breaking points. Darin Strauss's extraordinary novel is set in a world turned upside down-where doctors try to save babies from their parents, police use the law to tear families apart, and the people you think you know best end up surprising you the most.
Dori Goldin is at home with her infant son, Zack, when the baby starts spewing blood and vomit. She rushes him to the nearest emergency room where the child is immediately thrown into a number of tests to try to discover the source of his illness. Meanwhile, Dori's tv advertising executive husband, Josh, gets word of his son's condition and immediately rushes from work to meet his wife at the hospital. Once there, he finds himself startled to discover that Zack's attending physician is Dr. Darlene Stokes, head of the pediatrics unit. She also happens to be black. Weirdly, Josh immediately starts to fear that Dr. Stokes will assume Josh is racist and take it out on his son during his testing and treatment, but Josh tries to assure himself that because Dori is of Turkish blood, no one could call him racist. Even worse, Josh follows up this line of thinking with a comment to his wife later that evening, when he admits that he "didn't trust a thing about that doctor's looks."
While at the hospital, Zack's vitals takes a sudden nosedive. He starts to code. ER staff is able to stabilize him again but the incident sets up the story for all the drama that's about to unfold. While looking into Zack's short medical history thus far, Dr. Stokes starts to suspect Dori Goldin of having Munchhausen by Proxy, a controversial medical condition in which a mother is suspected of intentionally injuring -- whether through physical abuse or internal (ie. intentionally poisoning, but not enough to kill) her child and then presenting the injuries as just mysteriously cropping up. Sometimes this is for the sake of seeking attention, other times the reasoning is more difficult to determine. But once Dr. Stokes vocalizes her concerns with other colleagues, a media and legal firestorm ensues. The hospital fears being held liable for Zack coding while Dori Goldin is outwardly outraged over what she perceives as a kind of defamation of character. Inwardly though, the Goldins fear the hospital coming after them as unfit parents.
A news story breaks that tries to discredit Dr. Stokes' diagnosis. This story latches onto the fact that while in college, Dr. Stokes was involved in a campus group that some could possibly perceive as an anti-white / Black Power kind of party. They also harp on the fact that she was raised fatherless (her father was incarcerated during those childhood years) as well as being once married to a Jewish white man who ended up leaving her. Of course the story leaves out a lot of pertinent details, instead being swayed to vilify Dr. Stokes, but when she tries to talk out her reasoning behind the diagnosis with a colleague, Dr. Weiss (who was actually the doctor on call the night Zack coded), Stokes is surprised to find Weiss skeptical. Weiss points out that most doctors are hesitant to even mutter the words Munchausen by Proxy simply because there's not enough definitive research out there to back up their suspicions. Weiss himself admits to being unsure if he believes it to be an actual disorder or just an unfortunate misreading of patients. Stokes starts to doubt herself somewhat, wondering if maybe she did misread Dori Goldin, even though Stokes reminds herself that she has seen the condition listed in the DSM under "pathology". Still, she can't help but ask herself if she did indeed miss something crucial? Is the hospital actually at fault on this one?
Strauss' novel definitely brings up a subject to ponder on, but I question how well it was done. In some ways this story felt deeply complex and detailed, but in other ways it had a feel of being all over the place. I periodically felt myself wondering if Strauss struggled to decide what story he wanted to tell, because there's more than one major one here -- outside of the drama around the MBP diagnosis, More Than It Hurts You also gets into the struggles surrounding race inequality and how absentee parents during a child's pivotal years can affect that child's personality and sense of who they are right up into adulthood. While all valid and interesting topics for dramatic fiction, I didn't feel like they were always seamlessly woven together here. Dr. Stokes' struggle with racial prejudice was well done and actually did mesh well with the MBP storyline, but I thought the portions with her being reacquainted with her father ran on a bit long, maybe could have been quick interludes, rather than whole large chunks of chapters dedicated to such a small part of the overall plot.
While the MBP storyline was the major reason my curiosity begged me to pick this book up (that and I had read and liked Strauss' novel Chang & Eng), I felt like Strauss struggled to stay on topic when it came to this portion of the novel. The words Munchhausen by Proxy, though hinted at, are not officially said until about 140 pages into this 400 page novel. The suspense around Dori Goldin (you know, the whole "did she or didn't she?") could've been built up so much more. But after a few brief mentions of MBP at that 140pg mark, the story doesn't really focus a spotlight of suspicion on her until another 40+ pages. In the novel's entirety, there are actually only a small handful of scenes that give the reader a glimpse into what might be going on in the Goldin home, which I found pretty frustrating.
As for the Goldins themselves, I personally found them incredibly unlikeable, MBP story aside. Dori comes off as sometimes overly dramatic, very hyper, bull-in-a-china-shop reaction to relatively low key situations (ie, just someone calmly talking / stating facts). Josh seems a little intimidated by his wife when she gets like this, but he's not without fault either. While Dori has moments where she gets upset and goes off on manic, homophobic / racist sounding tirades, the reader is given insight into some pretty disturbing self-realizations of Josh's .... such as him admitting that he actually did not love his son until weeks after the birth ... or how if his son ends up dying, that he "could get over it."
I won't put all the blame on the Goldins though. Honestly, I think Dr. Stokes was about the only character in this whole thing that I DID like... unless you count baby Zack, but since he doesn't actually have any lines... Anyway, this one ended up not being as much of a winner for me as I was hoping. If you're looking to get into Strauss' work, my recommendation would be to start with his historical fiction novel Chang and Eng.