Book Reviews

Book Reviews – NO. 12: We Are All Perfectly Fine, by Jillian Horton

“Failure to cope. It sounds like a hashtag, not a diagnosis.”


We Are All Perfectly Fine, by Jillian Horton

“Failure to cope. It sounds like a hashtag, not a diagnosis. Yet it’s what we’re taught to write on the charts of people with cancer pain that hasn’t been adequately managed, or elderly men who are mixing up the twenty medications that eight different physicians have prescribed for them in the last sixteen months.” (We Are All Perfectly Fine, Harper Collins Publishers Ltd. page 181).

It is these types of scenarios, ones that are wrapped in both professionalism and empathy and are familiar to us all, whether it be relative to our grandparents, our parents, children or friends, that doctors deal with on a daily basis as they practice their medicine.

What many of us don’t have insight into is the actual making of our doctors, the grit and determination, the crazy long and sleepless hours, the untold days, nights and weeks of studying until it’s eyes wide shut, and the ongoing ubiquitous anxiety, stress and worry about making fatal mistakes relative to a patient’s health care.

“We have to be perfect,” Dr. Jillian Horton says in We Are All Perfectly Fine.

An in-depth accounting of what it takes to both become and then be a doctor, Jillian’s book is an intertwined canvas of both personal and patient stories. Woven throughout those accountings Jillian’s attitude, toughness, resilience and self-deprecating humour, not to mention her empathic and human overall dedication to her craft, makes for a read that is both intriguing and captivating.

Jillian earned her creds for toughness and resilience at a very young age, being intimately acquainted with the consequences of a missed diagnosis and hurtful non-compassionate medical care.

Wendy, Jillian’s oldest sister, was diagnosed with brain cancer before Jillian was even born. She sustained post-operative meningitis which left her with the “most complex cluster of disabilities imaginable.” Wendy’s condition both tore the family apart while at the same time making them a stronger family unit. There were, as can be imagined, a myriad of repercussions attached to Wendy’s condition. However, the Hortons refused to commit their eldest daughter to an institution and instead became lifelong advocates for her. Added to the family grief was the sudden on-set psychosis of Jillian’s brother when he was fifteen, a condition that made him a permanent resident of a psychiatric hospital.

So with a sister in a wheelchair and a brother in a psychiatric ward, every success that Jillian achieved, and there were many – she is an accomplished musician and earlier in her career she turned down a full scholarship in doctoral-level English literature at Oxford so that she could study medicine at McMaster –there was always a deep cloud of guilt attached to those triumphs. How did she get to be the lucky one in life, blessed with so many talents and successes, especially with siblings who were suffering so much, is a question that would haunt her.

Inevitably, when a person achieves so many successes, the efforts and hard work tied to them is often wrapped in outsized fatigue and stress, particularly in the medical profession where the demands for complete perfection and intuitiveness is a daily requirement. With a growing family and a demanding career something had to give in Jillian’s world.

Married and with three young children, Jillian was well into her practice as a general internist, “the kind of doctor who looks after people with medical problems that sound made up:  Typhlitis. Neurocysticercosis. Ankylosing spondylitis, when feelings of a flaming burnout hit Jillian.  Hard.

On the brink of a two-level collapse, both at home and at work, Jillian signed up for a five-day spartan-like interactive meditation retreat that was being run specifically for doctors under duress at Chapin Mill in New York.

What starts out as a keep-to-yourself practice quickly becomes an intimate and interactive sharing of doctors from all walks of medicine- surgeons, psychiatrists, internists, oncologists, and paediatricians, all bowed and bowled over by the unrelenting fatigue and all-consuming guilt and fear of not being good enough.

And while this may sound like a heavy read, Jillian, who adds accomplished writer and author to her credentials, fills the pages of We Are Perfectly Fine, with wonderful and humourous stories of her interactions with the other doctors at the retreat – speaking honestly about her first impressions and judgemental opinions of her fellow practitioners – that is, until she gets to know them on a more intimate and supportive level.

Not one to mince her metaphors, Jillian is not the least bit afraid to use the ‘F’ word when it is called for, and that adherence to her straight up approach deepened my engagement while at the same time fostering a ‘you go girl’ grin.

 Along the way, Jillian’s honesty and advocacy towards fixing the currently flawed medical system, a frame of reference that pushes residents to the breaking point of deep anxiety and depression as a result of overbearing expectations, one that encourages medical students and residents to compartmentalize their fears and most troubling emotions in order to move on – to keep going – is a story that needs to be told, understood and changed.

There is also some major cool cred in Jillian’s life that is worth the share.

Alan Alda, who played Hawkeye Pierce on the popular television series, M.A.S.H., is one of Jillian’s idols. Serendipitously, when an op-ed article of Jillian’s appeared in the Los Angeles Times and Alda read it, he was so impressed that he asked her to send him a copy of We Are All Perfectly Fine. After reading it, Alda sent Jillian an unexpected endorsement, which became the top quote on her book jacket. It reads, in part, “Maybe the best thing about this book is that Jillian Horton allows you to grow as she grows, while saving you the pain of the struggle. But you will grow.”

We Are All Perfectly Fine is a humourous and heart-felt read, one that gives each and every one of us the permission to be honest about what is really going on behind the curtains of our individual ‘perfectly fine’ demeanors.

Cece is the feature cover writer for several prestigious publications and is an informed, connected and enthusiastic book blogger at  Her first book, The Love Story, was published in 2019. Her second book will be coming out in the spring of 2021.

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