In her memoir Smile: The Story of a Face (Simon & Schuster), Sarah Ruhl tells the story of her ten-year struggle with Bell’s Palsy. Ruhl was (and is) a successful playwright when she and her husband discover they are having twins. That news, coupled with the fact they already have a daughter, leads Ruhl to worry she will struggle to write again because of the time and energy needed to balance a growing family and the high-stakes professional demands and drama accompanying her profession. That concern becomes even more complicated when she is diagnosed with cholestasis of the liver, where bile seeps into the bloodstream causing itchiness, but also possibly leading to the death of the children.

Thankfully, Ruhl carries the twins to term and delivers them both. Before she is able to go home from the hospital, though, she develops Bell’s Palsy, causing the left side of her face to become largely paralyzed, and the twins both have to spend time in the NICU, one for jaundice and one who is struggling to breathe. While the twins recover enough within a week to go home, Ruhl lives with Bell’s Palsy for the next decade.

Happy ending alert: This is not a story with any sort of dramatic healing, no grand breakthrough from an heroic doctor or patient (or both) by the end of the story. Ruhl even titles the final chapter of the book “A Woman Slowly Gets Better,” and that’s largely a summary of this moving work. What she means by “gets better,” though, is much more complicated than any sort of physical healing, as her lack of ability to control the left side of her face—especially to smile, as the title conveys—affects her mentally, emotionally and spiritually.

What Ruhl conveys in her autobiography engages readers on its own merit, but some have complained about the way she deviates from her linear story into tangents or digressions (she has a chapter titled “A Brief Digression on my Catholic God,”) even thinking the playwright is padding her story of struggle to make it more believably book-length. I had the other response, though, as I thought her reflections were the strongest part of the work. Given the slowness involved in her healing, her ability to think about her condition and all of the effects of it were the most propulsive part of the work for me.

Medical memoirs don’t always explore spiritual themes, but Smile is a more layered narrative. Ruhl explores her religious background and religion in general, as she draws from her Catholic upbringing and her growing interest in Buddhism. She struggles with prayer, especially in asking for healing for herself, as well as guilt and shame, but she also uses Buddhism to help her begin to accept herself as more than what her face can and can’t convey. She draws on one of the most famous (at least in the West) Buddhist koans: “What was your original face, the face you had before your parents were born?” to help her realize she had been looking for her previous face, not her original one, but who she actually is.

It’s no surprise she also brings in literature and the visual arts to talk about her physical struggles, given that she’s best known as a playwright These elements add to a richly textured story dramatizing her plight and make it relatable to anyone contemplating the mind-body connection after a life-changing operation, illness or disability. In one chapter, for example, she begins by exploring the recurring question of the smile in the Mona Lisa, moving from there to Lucy Snowe in Jane Eyre’s Villette, then on to Vietnamese Buddhist master and poet Thich Nhat Hanh to Susan Sontag’s Illness as Metaphor before ending with William Blake’s poem “The Tyger.” Weaving these points of inspiration together, she connects back to her life by the end of the chapter when she is finally able to blink her left eye.

That visual breakthrough is a sort of victory, but Ruhl greets it with a significant amount of hesitancy, writing in her expressive and reflective prose:

And so I did not try to smile widely. To have the face not match the self is a disturbance. But to create a flat inner landscape to match the flattened outer landscape of the face was in retrospect a bad alternative. I attempted to make myself invisible, like Lucy Snowe. the most flamboyant facial expression I attempted in public was to curve the right side of my mouth slightly up, like the Mona Lisa (93).

That contrast of inner self and outer self, drawn from literature and from her life, is a powerful theme throughout the book.

One of the strongest ideas explored in Smile is gender, especially how it relates to the many ways society perceives men and women. Early in her narrative, she writes about when her play In the Next Room, or the vibrator play is about to open, there is concern about her use of male nudity at the end of the play. Ruhl wonders if the concern comes from the rarer approach of her play—that of viewing male nudity through a female lens—unlike the more predictable inverse, which is usually the case. Often, Ruhl returns to how it feels to be seen as a woman in our society, especially a woman who lacks the ability to smile or a woman who simply isn’t smiling. As she reflects on her inability to smile and men who tell her she should do so, she points out that men did that to her well before she suffered from Bell’s Palsy. She then reflects on that expectation:

And I realized that a man’s injunction for a woman to smile as she walks down the street is not an injunction for that woman to experience joy, but for the woman to notice the man walking towards her. The man feels left out of her interior experience—and he feels entitled to tell her what to feel, to describe how she should show her feelings (59).

Ruhl goes beyond her personal plight to the wider societal implications of presenting a face to the world when she ruminates on what women’s smiles signify, the idea of resting bitch face (for which there is no male equivalent), and the story of a neurosurgeon who says he will help her because she’s good-looking (she doesn’t work with him, not surprisingly). However, she also complicates this idea by pointing out the importance of others’ gazes, how others see us in ways we can’t see ourselves, which can often be helpful.

More germane to her profession, Ruhl questions how well women, especially mothers, are able to navigate the world of the theater, especially, but not exclusively, playwrights. She tells the story of an artistic director who chastises her for not being present enough during the rehearsal process without asking or realizing she needed to be home with a sick child (Ruhl’s husband Tony is a doctor and capable of handling the situation, but she makes the choice to be with her child). She talks about the challenges in finding a space and the time to breastfeed during rehearsals and how a photographer for American Theatre wants to photograph her and two other female playwrights, suggesting it would be a warmer look if they took off their sweaters to “show some skin.” While her fear of not writing again is never realized, the theater world didn’t make it easy for her to remain a part of that community.

In the end, Ruhl doesn’t give the readers any feel-good moments to walk away with, though for her own emotional well-being, she celebrates the newfound ability to control the left side of her face by the conclusion of the book. She knows, though, life might have more challenges in store for her, greater ones even. She knows that the end of this book is not the end of her story, and she, like all of us, is unable to predict what comes next. She leaves us by reminding us that “maybe” is a better way to live. Maybe what has happened has led us to just where we need to be, but maybe it has led us to the worst place, but we don’t realize it yet. At the end of her memoir, for me, at least, that was enough.—Kevin Brown

Kevin Brown is an English teacher, reviewer and freelance writer in Nashville, TN. He has published three books of poetry: Liturgical Calendar: Poems (Wipf and Stock); A Lexicon of Lost Words (winner of the Violet Reed Haas Prize for Poetry, Snake Nation Press); and Exit Lines (Plain View Press). He also has a memoir, Another Way: Finding Faith, Then Finding It Again, and a book of scholarship, They Love to Tell the Stories: Five Contemporary Novelists Take on the Gospels. Discover more about his work on Twitter @kevinbrownwrites or at http://kevinbrownwrites.weebly.com/.