Smile Interrupted with Sarah Ruhl
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What is Sarah Ruhl’s memoir “Smile” about and why did she write it?
This episode of The Nocturnist is sponsored by the Buxbaum-Siegler Institute for Clinical Excellence at the University of Chicago. The institute is dedicated to fostering compassionate doctor patient relationships and advancing clinical care. Each year, the Buxbaum Siegler Institute recognizes extraordinary healthcare professionals through the National Clinical Excellence Award. To learn more about the award and to nominate a deserving clinician, visit bucksbauminstitute. ushicago.edu. Support for the nocturnist comes from the California Medical Association.
At the Nocturinous, we are careful to ensure that all stories comply with healthcare privacy laws. Details may have been changed to ensure patient confidentiality. All views expressed are those of the person speaking and not their employer.
You're listening to the Nocturneist Conversations. I'm Emily Silverman. When I was in college, I went with some friends to see a play called Melancholy Play. And it was about a bank teller named Tilly, whose melancholy mood was strangely magnetic to all the people around her. Her tailor, her psychiatrist, her hairdresser, all of them fell in love with Tilly because of her melancholy. Then one day, Tilly inexplicably becomes happy and all of her admirers are left confused and despondent, one of them even surreally transforming into an almond. It's a whimsical play, it's a beautiful play, it's an evocative play, and it has stayed with me for a long, long time. The playwright, Sarah Rule, eventually went on to pen numerous other theatrical masterpieces, becoming a legend in the theater world and eventually earning a MacArthur Genius Award.
But something else of significance happened to Sarah. Over a decade ago, shortly after giving birth to her twins, half of her face fell down. She was diagnosed with Bell's palsy and suddenly embarked on a long and difficult journey to understand why this had happened to her and how she might navigate the world now without the ability to properly smile. Sarah documented this ordeal in a memoir called Smile: The Story of a Face. And it was truly my honor to have the opportunity to sit down with Sarah and speak with her today about it. In the conversation, Sara describes what it was like to lose her smile. Talks about her direct experiences with clinicians of all kinds, the impact of acupuncture and physical therapy on her recovery, the importance of subtext in the clinical encounter, the way that partial or slow recoveries resist traditional narratives, and the reasons why she chose to tell this story with a book instead of a play.
Sarah is one of the great artists of our time, and it was such a pleasure to be able to speak with her. But before we dive into the conversation, let's first hear Sarah reading an excerpt from her book, Smile.
The next day the lactation consultant came in to see how the babies were feeding. My mother was in the corner holding one baby while I breastfed the other. The patient lactation consultant tried to teach me how to feed both of them at the same time. There was the football hold, that one was tricky, and some other hold. That I do not remember. Then the lactation consultant looked at me curiously. Your eye looks droopy, she said. Taken aback by the apparent non sequitur and comment on my appearance, I try to joke. Yes, my eyes are a little droopy, I acknowledged. I'm Irish. Most of my ancestors, after one or two gin and tonics, look sleepy, so crinkled and heavy do their crescent eyes become. That's not what I mean, she said, kind but firm.
Go look in the mirror. I got up to look in the mirror in the bathroom. The left half of my face had fallen down. Eyebrow fallen, eyelid fallen, lips. Fallen, frozen, immovable. A stroke? I was astonished. My face hadn't felt any different before I looked in the mirror. Before looking in the mirror I was the same person, after looking in the mirror, entirely different. I tried to move my face, impossible. Puppet face strings cut. I came out of the bathroom, my mother saw my face and was alarmed.
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Chapters
8 chapters
1
What is Sarah Ruhl’s memoir “Smile” about and why did she write it?
0:00–6:13
2
How did Sarah first discover she had Bell’s palsy after giving birth?
6:13–10:41
3
What did Sarah’s reading of her memoir excerpt reveal about her early experience with Bell’s palsy?
10:41–16:43
4
How did studying with Paula Vogel at Brown shape Sarah’s approach to storytelling and illness?
16:43–21:44
5
What unexpected diagnostic twist (celiac disease) emerged during Sarah’s medical journey?
21:44–26:48
6
How did acupuncture and physical therapy contribute to Sarah’s partial recovery?
26:48–32:40
7
What role does subtext play in the doctor‑patient encounter, according to Sarah?
32:40–37:31
8
What practical advice does Sarah offer to clinicians treating patients with Bell’s palsy or chronic illness?
37:31–42:44