The Corpse Exhibition

downloadHassan Blasim, 2009
Translated from the Arabic by Jonathan Wright, 2013

Gruesome. Macabre. Visceral. Telling.

The words needed to describe this collection of stories of Iraq by the expatriated Hassan Blasim all share a common theme. These aren’t stories for the faint of heart. These aren’t tales of sweetness or beauty. These are tales that communicate a blunt disregard for life by those that must live amidst a ravaged and crumbled society. As alluded by the title story, these stories exhibit the corpse, not life.

And yet, despite the grit and brutality on display in this body of fictional works, there is an eye-opening importance to this collection. Art serves many necessities, and at its best the written art-form inspires the reader with a new perspective that increases empathy and understanding. Blasim has succeeded in that endeavor; for despite the display of brutality in these stories, he is a writer capable of penning with a narrative voice that remains in touch with both humanity and consideration. For example consider this passage:

“The magic of words was like rain that quenched the thirst in my soul, and for me life became an idea and a dream.” (117, A Thousand and One Knives)

That passage was from a semi-magical tale about a group of unique friends that include a paraplegic soccer coach name Jafar who lost his legs in the Iraq-Iran war, Jafar’s sister-in-law, a butcher, and the narrator who was once a player on Jafar’s soccer team. The group each possess unique abilities to cause knives to disappear, with the exception of the sister-in-law’s ability to make knives appear. Jafar makes a living selling pornography on the black market, but he is inevitably arrested and tortured by the police for his secular profession. As the police attempt to cut off his arms (to punish him since he apparently did not learn god’s message when he lost his legs) he causes their knives to disappear, rending them unable to cut him. The police profess him a devil and ultimately amputate his arms with bullets instead of knives and then set fire to him. The reflection of his torture is told with a straightforward sincerity, reflecting that this is something that just happens to men such as him. Rather than succumb to sorrow for his lost friend, the narrator gives him new life by naming his newborn son Jafar.

Not all of the stories in this collection use magical devices to achieve an effective narrative impact. Many of the stories are blunt in their realism, while others have an otherworldly voice.

The opening and title story, The Corpse Exhibition, begins the collection from the otherworldly realm. The Corpse Exhibition is a first person monologue that spoken to a voiceless listener petitioning to step down from his role as artistic murderer. As the narrator describes with pride, the artistic murderer profession is a class of men who kill and put their victim’s bodies on display in unique situations, such as cutting off limbs and hanging them from electrical wires or using colored thread to hang organs in different and ironic locations. These murderers aren’t terrorists or fanatical Islamists, they serve a higher cultural need since they have an artistic pleasure in their work. As the narrator ultimately expresses his displeasure at the listener’s desire to quit the profession, it becomes apparent that the listener is the next victim to put on display.

The fantastic realm of The Corpse Exhibition is contrasted by the very real story presented in The Iraqi Christ, which reveals a man who is forced to set off a suicide bomb in order to spare his mother’s life. The straightforward progression of The Iraqi Christ is more chilling than the gruesome nature of the otherworldly narration of the The Corpse Exhibition because the existential choice to use a bomb to kill oneself and bystanders in order to save the life of a loved one is somehow believable and real.

There are a total of fourteen stories in this slim book and each tale is captivating with page-turning intensity. The few words I have shared above are only vague expressions of the grim, but necessary feelings that came over me as I read these stories. Why is it that the gruesome words in print can affect the mind so greatly and why did I succumb to the compelling need to return to Blasim’s vision again and again? The answer to that may be catharsis or thanksgiving that I live in a more peaceful world unable to imagine the horrors expressed in this book. But somehow that visceral horror is necessary and satisfying through the realization that these stories are fictional and artistic representations intended as reflections of a life unlived.

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Warlock

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Oakley Hall, 1958

The western genre is a funny thing. The genre is a uniquely American mythology populated by noble and ignoble characters that stand for idealized notions of right and wrong. This mythology of the great American west of the latter 19th century stands for a time and place when men and woman sought out the last possibility of the American dream: to grab a piece of land that was still untouched and pure and to make something of that purity in that vast expanse of unpopulated desert beyond the reach of governance and country.

As is often told through the many stories of the western genre, the frontier spirit of the good natured prospecting and cattle ranching citizens were often troubled by the wild natured and free shooting outlaws of the wild west. The gunslinging hero is generally a loner that wanders into town to redeem the helpless citizens from the constant pressure of outlaw terrorization. I am not particularly a fan of this romantic idealization of the genre because it is often told from a black and white perspective that simplifies reality. In my opinion, there are a few books that do the genre well, and some of the best westerns are actually anti-westerns that destroy the simplified romantic mythology by revealing the complex human nature beyond the celebrated stories of the wild west. Cormac McCarthy’s Blood Meridian does this particularly well, however many reader will admit that McCarthy takes the anti-western to the nth degree by murdering the genre in a blood-bath of gruesome proportions. Conversely, Oakley Hall’s Warlock is an impressive anti-western that expands the possibilities of the genre through the development of an existential perspective towards the western mythology. Yes, Warlock is populated with plenty of murder and deceit, but unlike McCarthy’s writing that brings the violence into focus, Hall’s Warlock focuses on the complexity of human emotion and philosophy.

The novel’s title namesake, Warlock, is a small, but growing town just out of reach of the neighboring county seat and therefore lacks a court or sheriff. Warlock is faced with a bureaucratic conundrum as its population swells due to the neighboring silver mines and it must make due with a sequence of ineffective deputies that lack the authority to maintain order as rowdy cowboys have bullied the townsfolk with vandalism and murder. What makes this conundrum worse is that any criminal sent to trial in the neighboring Bright’s City get set free on acquittal as the juries of Bright’s City’s courts are often stacked by or threatened by the leader of the cowboy hooligans. Therefore, the deputies are often murdered or run off by the “innocent” men they had arrested. The bureaucratic complexities run even deeper since Bright’s city is run by an uninterested and fattened sheriff remaining subservient to a dementia-crazed governor/general more interested in reliving his military past chasing off Apaches than he is in developing the mining town of Warlock.

Mixed in all of this is the development of a miner’s union that additionally complicates the politics of the township, further limiting its influence with the county seat. So, with few options available to protect them, the civil minded people of Warlock develop a questionably legal Citizen’s Committee that pools together the money to hire a fast-shooting Marshal to protect the townspeople from the rowdy hooligans. What makes this scenario all the more interesting, is that the people of the Citizen’s Committee are troubled by their choices and often find themselves in deep philosophical discussion about the legality and moral rational behind their decision to hire a gunslinging marshal, as depicted in the letters that one of the Citizen Committee members writes:

“We do not break so simply as some think into the two camps of townsmen and Cowboys. We break into the camps of those wildly inclined, and those soberly, those irresponsible and those responsible, those peace-loving and those outlaw and riotous by nature; further into the camps of respect, and of fear – I mean for oneself, and for all decent things besides.” (172)

With moral questions such as this, the plot sounds pretty thick doesn’t it? Well, it gets thicker as the new deputy, John Gannon, a former friend of the cowboy leader McQuown, is not trusted by either the town or the gang of cowboys, especially since his hot-headed brother, Billy Gannon is running with McQuown’s cowboy gang. His brother eventually is “posted” out of town, or in other words, marked for death by the gun-slinging marshal if seen within the borders of Warlock. This causes all sorts of moral dilemmas for the deputy who must uphold the law and save face with his family, friends and love-interest; however, when faced with this dilemma Gannon is troubled to the point of ineffective lassitude. He spends most of his time observing rather than enforcing the law, and is of the mind capable of pondering the following:

“It seemed to him that hate was a disease, and that he did not know a man who didn’t have it, turned inward or outward.” (66)

If Gannon, the deputy, were to seek out a moral compass in his town, it would be difficult to find. Despite the lack of a courthouse, Warlock is judiciously served by an accusatory alcoholic judge that does little but criticize the marshal and the Citizens Committee with a harsh voice frequently drowned by free flow of whiskey. There is also a gambling card-shark who happens to be a close friend with the marshal and somehow behind the scenes of many of the town’s troubles. Although the town is sparsely populated by women, the few women characters are complex with well developed and complex motivations. Throughout the book the narrative voices weaves back and forth from each character’s perspective, expressing different character’s personal view of their neighbor’s actions and beliefs. This form of storytelling, creates a forward progressing narrative that reads easily with an engaging drive. It is as though everyone that populates Warlock is a central character, each with their own weaknesses and strengths that are both tragic and comic, fully human and believable. This is not the stuff of romantic writing, as demonstrated by this passage from the doctor’s monologue about his involvement as a union organizer:

“He gazed at his world through inward eyes and saw all his ideals and aspirations crumbling gray and ineffectual…He had deluded himself with his ideals of humanity and liberality, but peace came after war, not out of reason…So it had always been, and revolutions were made by men who conquered or who died, and not by gray thoughts in gray minds. Peace came with a sword, right with a sword, justice and freedom with swords, and the struggle to them must be led by men with swords rather than by ineffectual men counseling reason and moderation.” (435)

As I have expanded upon above, Warlock is a wonderful character driven novel, but I must acknowledge that it is also beautifully written with poetic passages of scenery that have an intoxicating allure. For instance, reference this passage about the gambler sitting in the local pub watching the sun through the slats of the swinging doorway:

“He watched the thin slats of sun that fell through the louvre doors, destroyed each time a man entered or departed, in a confusion of shifting, jumbled light and shadow as the doors swung and reswung in decreasing arcs. Then they would stand stationary again, and the barred pattern of light would reform.” (378)

This book pleased me greater than any book I had read in quite some time. It had long been on my to-read list because it was noted as a favorite and influential work of Thomas Pynchon’s. Oddly, the style and subject matter is unlike anything that Pynchon wrote, with the use of multiple character perspectives being the only similarity to Pynchon’s style. Pynchon’s admiration for this book is understandable because Warlock succeeds as an engaging work of art through its use of multiple views from several distinct characters to develop a universal story that isn’t simply about the American wild west. Warlock is a human story, the moral and bureaucratic scenarios that drive its plot are not merely the problems of some forgotten western town, they are the problems faced by societies across this globe, societies populated by peoples attempting to make right amidst the wrongs suffered at the hands of their peers and neighbors. This is a powerful story that raises its ante in each chapter invested by the reader and the payoff is immensely enjoyable and memorable.

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The Man Who Walked Through Walls

41htyqi02blMarcel Aymé, 1943
Translated from the French by Sophie Lewis, 2012

This collection of short stories by Marcel Aymé was a total pleasure that I slowly savored in between some of my other readings. Several of the stories had a dream-like magical quality that was both intoxicating and jarring. Of the ten stories, four were phenomenal and only one was a total dud (The Proverb) and all but that one dud captured my attention completely, preventing me from doing anything other than finish the story in hand. These writings possess both the quality of the bizarre and the profound with a whimsical and enjoyable artistic realism. And they were fun too!

The first two stories, the collection’s title namesake of the The Man Who Walked Through Walls and Sabine Woman both felt like blunt superhero stories told within a world that takes no notice of super hero powers. The first story was literally about a man that possessed the power to walk through walls and the second story was about a woman who was able to multiply her physical self infinitely. These plot scenarios could easily be subtexts for any Marvel X-Men story lines, but Aymé wrote these stories not to explore these powers as would a comic book writer who exploits the childlike wonder of superhero possibility, but rather to explore the moral and ethical choices of people granted unusual attributes.

The man who could walk through walls first found annoyance with his ability, going to a doctor to figure out what was wrong with him, but as he finds trouble at his work he soon exploits his ability to toy with his boss and then he later becomes a criminal and escape artist. Just like the man who could walk through walls, the woman with the ability to multiply herself is at first suspicious of her ability, only using it to expedite the completion of her household chores, but she later finds the enjoyment of comfortably living out an affair while remaining chaste to her husband. She later becomes addicted to the excitement of living multiple lives at once as she multiplies herself again and again. In both stories, the title characters become corrupted by their unique abilities, breaking both moral and legal laws, yet their corruption is told from a light and playful narrative voice that speaks with a practical tone. The practical voice portrays the characters’ stories with believability, as though their outcomes would be the expected outcomes of people with these abilities in our world.

My favorite stories from the collection were two stories that explored the concepts of time. Tickets on Time told the story of an overpopulated world where the elite decided that the days of the month would be granted to individuals that were most productive, thereby creating days when unproductive individuals would disappear from existence until the subsequent month. This created an unusual barter system where the poor sell their tickets on time to others and the wealthy are able to live extra days each month. In The Problem of Summertime it is determined that time will be moved forward by seventeen years for society to skip over the turmoil of the second world war and the German occupation. One individual finds himself in a strange time warp when he was once in 1960 and then back in 1943 occupied France, yet with all his memories of the peaceful future intact. As he tries to understand the truth of his reality he rather profoundly states the following:

“It seems, and it might just be my imagining, that my memory of the future is already less certain.” (134, The Problem of Summertime)

Astute and philosophical statements such as this are interspersed throughout Aymé’s writings. Just as both Tickets on Time and the The Problem of Summertime bend the reader’s perception of the concepts of time and The Man Who Walked Through Walls and Sabine Woman toy with the reader’s expectations of human abilities, all of the stories in this collection are presented as a playful twist on reality to provide the reader with an altered perspective on truth, morality, and human relationship. These stories, written when France was occupied by Nazi Germany, come from a voice that knows the potential for, but denies the cynical perspective. After having stated that, I must acknowledge that there were a couple of stories with a darker perspective such as The Proberb, which portrays a stern and short-sited father and While Waiting, which tells the story of several destitute survivors of a never-ending war. However, despite those two outliers, most of the the stories in this collection are from a voice that portrays a playful perspective on life; it is a voice that questions moral, philosophical, and physical laws to prompt the reader to better enjoy the reality lived through reading.

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Wild

download (1)Cheryl Strayed, 2012

Last fall I spent three days biking alone through Oregon’s Willamette valley. I road through a day of heavy heat sandwiched between two days of torrential rain carrying little but my camp gear on my bike. Leading up to the trip I had spent a few months researching the route, picking out gear, and even took a test-ride in the Bay Area with a friend to safely get a feel for what it was like to ride with a fully loaded bike. My trip was actually far less ambitious than I had originally planned because I had to cut the trip short due to the wet weather.

Despite the shortened route, that trip remains up there as one my most memorable and rewarding experiences. Prior to my solitary bike trip I have enjoyed numerous multi-day biking, backpacking, and river rafting trips through beautiful and scenic wilderness and backcountry roads. Although each of those trips has given me great joy and lasting memories, those prior trips were all group expeditions comforted by the support of reliable friends. My Willamette trip was special because it was a solitary trip, led by, organized, and completed completely by my own design and determination. On the final day of that brief trip I road 65 miles through a ceaseless down-pore that wore down my spirit. Half way through that day and far beyond any point of return I thought myself crazy for ever embarking on such a wet and wearying ride. Beyond my self-doubts I wouldn’t give up. At the end of that long and draining day I was rewarded with the pure bliss of knowing that I had made it. I had made it on my own and purely for myself.

I speak about this trip in opening my review of Cheryl Strayed’s Wild to provide some context towards my deep respect for Cheryl’s accomplishment. I had biked nearly 160 miles in three days and although I had carried my breakfast and dinner and all my camp gear on my bike, I had the luxury to fill my water at parks and gas stations, the luxury of stopping for lunch, the luxury of using my GPS phone for guidance, the luxury to call or email my wife at the end of my long days or during my rest breaks. Cheryl had no such luxury as she backpacked nearly 1,100 miles of the Pacific Crest Trail (PCT) on her own relying on her compass and the trail and the infrequent kindness of strangers she stumbled upon from week to week. Though my ride was solitary and powered by my own energies, it was along a paved road and if I ever ran into trouble I didn’t have too long to wait before a car would pass me by. Cheryl’s hike was truly solitary with several days passing before anyone crossed her path and she ran the risk of dehydration since safe watering holes could be as far as 35 miles down the trail. Although her original plan was sidelined by snow, as mine by rain, she persevered and continued on, making her way to the Washington border from the Mohave desert while rediscovering herself in the depths of wilderness.

Despite my respect for her journey, despite my acknowledgment that her book is an accomplishment in itself, I haven’t been so annoyed at a book in as long as I can remember. From the opening prologue that depicted Cheryl losing one of her hiking boots at the edge of a cliff and then throwing the other I knew I was in for a raucous ride.

Much can be said about Cheryl’s ridiculous unpreparedness, how she never even packed her bag for a test run before her first day on the trail, how she assumed hiking was simply walking and therefore she didn’t practice her strength or endurance training, how she packed the wrong fuel for her stove, and how she clogged her water filter. These foolish actions are forgiven due to her youth and naiveté. Much can be said how she spent the months prior to her hike dabbling in heroin, completely distracting herself from a practical approach towards long distance preparation. This can also be forgiven since the purpose of her hike was prompted by her realization that her life choices had drifted her far from her roots. What can’t be forgiven is her ceaseless self degradation and whining about her life. Yes, I understand that her story has purpose, she did have a challenging and unique upbringing and her mother’s sudden and unexpected death impacted her greatly, but in reading about it, I wanted her to move on beyond her personal history and tell me more about the PCT and how its beauty impacted her. She did this on several occasions, but too often she turned back to herself with such navel gazing proclamations as the following:

You should see a therapist, everyone had told me after my mother had died, and ultimately – in the depths of my darkest moments the year before the hike – I had. But I didn’t keep the faith… I had problems a therapist couldn’t solve; grief that no man in a room could ameliorate.” (134)

I will say that Cheryl writes well, her style is engaging and despite my annoyance with her story, I finished the book: but that endeavor felt like an accomplishment in itself. This book should have been about 100 pages shorter to make it a fantastic book, but too often it returned to Cheryl’s self-analysis and felt more like a written therapy session than an adventure in the wild. I guess what distracted me was that I enjoy stories that have a universal quality to them, but Wild fails to reach out with a universal voice. Strayed speaks from her singular personhood, often repeating her regrets towards her adulterous behavior that ruined her marriage, her self destructive use of heroin, and her recurrent sorrow for her mother’s loss. I have no problems with anyone dealing with personal struggle and writing about it, but what fazed me by Wild was its complete lack of applicability to the human story. Even when Cheryl appears to move on and reach new achievements, she strays off the trail with a boy she just met to enjoy a few nights of relaxation and pleasure on the Oregon coast, hundreds of miles from the PCT.

Cheryl’s achievement as a young woman on her own is without a doubt an accomplishment, but after reading her story, I was disappointed in the book, because it felt less about being wild and more about being tamed by the trail in the wilderness. I wish that the book was filled more with the passages such as the following and less with the navel-gazing self analysis that so frequently annoyed and frustrated this reader:

“I was crying my first tears on the PCT. I cried and I cried and I cried. I wasn’t crying because I was happy. I wasn’t crying because I was sad. I wasn’t crying because of my mother or my father or Paul. I was crying because I was full. Of those fifty-some hard days on the trail and of the 9,760 days that had come before them too.” (234)

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The Rise and Fall of Modern Medicine: Reader Criticisms

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Jame Le Fanu, 1999, 2012

In my last post I was inspired to reflect upon my personal experiences relevant to a patient I had cared for.  I don’t read a lot of medically inspired books and this blog is primarily an outlet for my own memories and inspirations pertinent to the many books I read. I was reading James Le Fanu’s book, The Rise and Fall of Modern Medicine during a challenging period in my nursing career and felt that it was appropriate to apply some of the discussion material of the book to a patient case that had deeply affected me.

If you, reader of this blog aren’t aware, I am a registered nurse at a large medical institution. And if you know me well, you are aware that I have been intimately involved with medicine most of my life since my career prior to nursing involved work at several large and small biotech companies associated with the “big” pharmaceutical industry. In many ways I have been self-aware for several years about the double edged nature of my involvement in the medical field. Medicine does great good but the business and high cost of medicine is slightly unsettling because the efforts of profits distract from my altruistic intent in being involved in medicine. I had left the pharmaceutical industry primarily because my ten plus years working in the industry failed to fulfill my inherent desire to help my fellow human kind. At the end of my workday I knew that despite the indirect knowledge that the my workaday efforts assisted the patients in need of the drug therapies my companies had manufactured, my daily efforts were ultimately and directly best serving the corporation and the shareholders of the companies that I had worked for. The choice to pursue nursing was one of the best and most formative choices of my life. However, I am not naive to think that in becoming a nurse I have morphed into an idealized altruist. As I have taken on leadership roles within my profession I am all to aware of the influence of reducing costs of care and lengths of stay, but these are necessary realities that are married to the great reward of working in a profession that intimately touches the lives of people whom I would never had contacted otherwise.

Now, with that aside and off my chest, I feel that I need to say a few things about The Rise and Fall of Modern Medicine that weren’t appropriate to say in my last post about this expansive book. This book was originally published in 1999 and I read the 2012 updated copy of the book. For a book that argued so much about the lack of integrity in medical science, I was sorely disappointed in the format that Le Fanu had updated his book. The updated copy wasn’t really an updated in as much as Le Fanu had written a few new chapters that were applicable to the 13 years since his original publishing but the original content of the book was completely unedited from its 1999 presentation. This was most notable in the references to costs of medical expenditure in the 1990’s that could have easily been updated with 2012 figures without needing to add on new redundant chapters to cover the last decade.

Another drawback to this book is that in being British and enjoying the benefit of a single-payer medical service, Le Fanu completely omitted any reference to the debilitating influence of American style medical insurers as a downfall to the medical system. Le Fanu did make reference to the overall expenditure of the US economy, but he seemed to completely ignore one of my most influential factors in the US system, that being that a myriad of insurance providers have an overly influential power with regard to dictating care administered because the insurance providers influence the cost of care received. Furthermore, in ignoring the influence of insurance providers Le Fanu takes no notice of the plight of the uninsured who do not receive the benefits of preventative medicine because they avoid the cost of seeing a medical provider. Shannon Brownlee’s OverTreated provides a much more thorough analysis of the labyrinthian influence of the American medical system and I would recommend that book over Le Fanu’s if you have interest in the cause for the high costs of medicine.

On less of a criticism of content and more a criticism of style, I did feel that The Rise and Fall of Modern Medicine was an easy and approachable read. I was able to breeze through its 500 pages in just under two weeks. However, after reading it I found my dissatisfied with the personal substance of its subject matter. Le Fanu’s book is fact heavy on the historical development of modern medicine and he does make reference to many of the key players that participated in the defining moments of medicine. However, as a story teller, Le Fanu stuck to the simple facts without adding any sense of personal appreciation for the characters that were the people involved in the development of modern medicine. Siddhartha Mukherjee’s Emperor of All Maladies was a much more touching book that sought to achieve many of the same goals as Le Fanu’s he Rise and Fall of Modern Medicine. Mukherjee’s Emperor was entirely focused on the history of cancer and therefore its scope was not as encompassing as Le Fanu’s exploration of all of modern medicine, yet Mukherjee’s book was far more satisfying as a read due to the numerous personal anecdotes and interviews that were included in the text.

Despite these criticisms, The Rise and Fall of Modern Medicine was a worthwhile and informative book that I would recommend as a good point of reference to anyone with interest in the applications of modern medicine.

 

 

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The Rise and Fall of Modern Medicine

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I love my job, but it isn’t perfect. Nothing is.

Over the past two months there had been a patient on my unit with a poor prognosis of thrombocytopenia, a condition that chronically wastes the body’s platelets, one of the components of the blood associated with clotting.  She developed this condition secondary to the treatment of her breast cancer diagnosis which had progressively metastasized to several of her organs, including her brain. She was on our nursing unit not for the management of her cancer, but for the thrombocytopenia as well as the cognitive decline as a result of her brain cancer.

I had admitted this patient to the nursing unit the first day she arrived and over the weeks and months that she was with us I watched her progressively decline. On admission she was very frail and week, but she was able to walk with assistance and communicate freely but several weeks later she was unable to walk and had developed uncontrollable and impulsive fidgety movements as she constantly rolled around her bed due to lack of cognitive focus and loss of motor control. Ultimately she became non-communicative, had experienced a fall in an attempt to get out of bed and was at high risk for aspirating the food that here family provided for her. Her dedicated husband and father were always at her side and her father stayed overnight six out of seven nights a week.

During the many weeks that I and my colleagues cared for her I found myself questioning the ethical principles of the care we were providing her. I saw a woman that was suffering a slow and prolonged death whereas her family saw a woman that was battling for survival. Her case was a challenging conundrum for all of my colleagues, both nursing and medical doctors alike. The medical team had conducted several ethical meetings to discuss and evaluate her plan of care because there was little diagnostic evidence that showed that her prognosis would do anything but deteriorate. Despite the medical recommendation to withdraw treatment and to focus on palliative care, the patient’s family adamantly maintained hope that she would improve and were unwilling to comply with the medical team’s proposed plan of care. They had even threatened to sue if the treatment plan was modified. So, for weeks on end she continued in a state of progressive decline that may have ended much sooner with far less suffering as we continued to administer chemotherapy and daily infusions of platelets. Each time I entered her room I found myself lost in her deeply engaging eyes: the eyes of a soul trying to reach out and communicate after her voice had long since failed.

The feeling communicated through those eyes will remain with me for years to come.

Many a night I walked home from work after having looked into those eyes burdened with thoughts that questioned the philosophy behind the care provided to her. I saw a women that deserved the right to die whereas her family argued for the right to continue treatment indefinitely. My perspective is obviously from the other side of the patient’s bed since the right to die is not something that is often considered by the patient or family members that seek medical care. The modern medical system has developed technologies that prolong life far beyond the limits of the physiological time table. The presence of these technologies has altered our cultural perception of death to the point that the dignity of the inevitable end of every living soul is often exchanged for an artificially prolonged existence that can hardly be considered life. Because we can prolong life, the cultural expectation is that we must.

Now, don’t get me wrong, I’m not questioning my career nor am I lambasting medicine in general. Modern medicine has given many individuals a second chance at a life that would never have been possible without the drugs and technologies available and care provided. However, there are always going to be difficult cases such as this woman with thrombocytopenia that I had cared for, and these difficult cases stretch the limits of what it is that providers of medicine can do and what it is we should do. When faced with cases such as this woman’s, I find myself questioning who it is that ultimately receives the benefit of the medical care provided. Is it for the patient or is it for her family? And if it is for her family, is the extreme cost of keeping this woman in the hospital for two months the best that our society has to offer to appease their emotional and spiritual needs? Have we reached a point in our societal evolution that delaying a family’s inevitable grief of loss is the best good that can be provided for them?  Such questions are difficult to answer, especially when medicine’s goal is to do good and not harm. The root of these ethical questions are buried in our society’s definitions of those words: good and harm.

It was with these thoughts in my mind that I turned to James Le Fanu’s expansive work, The Rise and Fall of Modern Medicine, a book that I had first noticed on the shelves of Oxford’s Blackwell’s Books. Le Fanu’s book isn’t exactly a book on medical ethics as it is a book on medical history. However, in its discussion of medicine’s many problems Le Fanu adeptly criticizes the costs associated with medicine, especially the high costs of cancer survival as he notes that “the doubling of survival from one to two years has been accompanied by a 340-fold increase in the cost of treatment” (488). Many may shrink at the mention of cost when considering the care for the ill, especially for those with an unfortunate cancer diagnosis, but the fact remains that by 2010 medical expenditure in the US alone “has soared past the trillion dollar mark to a staggering $2.6 million” (439) with no foreseeable tempering of these rising costs. Looking at the staggering cost from the ground up, it is easy to forget that all of those costs translate to substantial human effort and labor. The question in my mind, and Le Fanu’s is why is so much effort focused on sustaining a low quality of life that is ultimately unsustainable?

Aside from my reflection spawned by challenging care for the patient I discussed above, I found The Rise and Fall of Modern Medicine an informative and engaging read. Le Fanu provides a lengthy prologue that catalogs what he sees as twelve definitive moments in the rise of modern medicine. These moments include commonly understood hallmarks such as the accidental discovery of penicillin, the development of chemotherapies that ultimately prompted the treatment and cure of childhood cancer, and the first open heart surgery. These twelve definitive moments also included not as commonly recognized or celebrated achievements such as the development of corticosteroids and the discovery that peptic ulcers were caused by bacteria and not stress. Without listing all twelve definitive moments ad nauseam, I’ll say that in cataloging them with historical progression, Le Fanu provides a concise synopsis of the significant events and key players involved in the rise of modern medicine in the form that we recognize it today. His discussion of each historical event characterizes a theme that medicine’s rise came about as it rode upon a wave of post-war enthusiasm and serendipitous scientific enquiry that exponentially benefited and prolonged the lives of the developed world.

After presenting a clear argument that celebrates the triumph of modern medicine, Le Fanu proceeds to switch gears and criticize the medical establishment for losing the enthusiasm of post-war discovery and succumbing to capitalistic greed that has stifled the spirit of inquiry. Le Fanu argues that the vigor and excitement that was once thriving in medicine has wained due to the inherent nature that much of the “low hanging fruit” that plagued mankind for millennia such as the infectious bacterial diseases have now been solved by the advent of antibiotics and other such therapies.  “Medicine is no longer as satisfying in the past. Many of the most interesting diseases that tested the doctor’s clinical acumen have simply disappeared” (423). Despite the advancement of genetics and the mapping of human genome, medicine has not received the benefits promised by these achievements due to the difficulty in applying the basic understanding of genetics to the diverse biological complexity that is still predominantly misunderstood.

Medicine’s further “downfall” can be partially attributed to the capitalistic nature of the pharmaceutical industry that reaped enormous profits with blockbuster drugs that are often simply rebranded or reimagined therapies for previously treated diseases. Drugs like lipitor and prozac have become household names and the constant bombardment of advertisements have created a culture of “worried well” that seek treatments for benign symptoms due to the influence of the pharmaceutical industry. These symptom management drugs have become blockbusters but there is a dearth of new drugs that actually cure disease because the pharma industry is more interested in developing drugs that promote health maintenance rather than curing disease simply because medical maintenance requires a long-lasting and profitable reliance on therapies whereas cures do not provide the same level of profit. The cycle of capitalistic influence has also affected the quality of medical science since most research projects are funded by the very industry that benefit from the research, creating a conflict of interest that promotes profit over scientific integrity.

The influence of capitalism and the loss of academic integrity are just some of the merits of medicine’s downfall, as outlined by Le Fanu. The most influential component of the downfall is ironically the cultural influence that medicine’s benefits have achieved. The accomplishments of the past century have the benefit of prolonging life through the prevention of common infectious diseases, but in prolonging life for all members of society, our culture has come to expect medicine to continue the miracle of ever-lasting life. The risk is that a culture that thrives while being removed from the suffering of death may be a culture that is all the more troubled by death’s arrival when it inevitably comes. Doctors and nurses must constantly practice their craft in fear of a litigious backlash because any failure to prolong life is at risk of being misconstrued as negligence.  True negligence does exist, of course, but the expectation that medicine can cure all ailments has falsely influenced the population’s expectations of their provider’s medical powers.

When the women with thrombocytopenia finally did pass away, I wasn’t on shift. I came to work the following day and when I walked past the room that she had lived in for the past two months I did a double take as I recognized that it was not she, but another patient occupying the room that was hers. Based upon the steadfast denial of her palliative state, my colleagues and I were expecting a dramatic scene from her family when the day finally would come, but thankfully, I was told, she passed peacefully when she finally left us and her family accepted her passing with peace as well.

 

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The Adventures of Augie March

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Saul Bellow, 1953

What started as a slow-paced and confusing mess grew into a beautiful and engaging novel depicting the coming-of-age experiences of a young man living through the depression and the beginning of the second World War. The protagonist, Augie March, represents the self-made man who pursues a true and examined life while meandering from job to job and from woman to woman in order to develop his self-realized potential despite several wrong choices and fading interests. My reading was reminiscent of a matured On the Road without all the drug induced spiritual excitement of Kerouac. Bellow’s singular voice offers a sober, introspective view of the wander’s life that is both inspiring and motivating.

The Adventures of Augie March is told from the first-person voice of young Augie March, the second son of three boys raised by their tyrannical landlord-grandmother.  His father is out of the picture and his nearly blind mother is too preoccupied with work to be involved in his life. His elder brother, Simon, is ambitious and conceited. His younger brother, George, is mentally disturbed and is sent to an institution early in his life. Augie must fend for himself and takes up several odd-jobs and floats from one situation to another, including working as an assistant to a crippled millionaire, smuggling Canadians across the border, stealing books and selling them cheap to college students, working as a union organizer, then a union buster, training an Eagle to hunt Lizards in Mexico, joining the Merchant Marines to be shipwrecked at sea, and eventually as a black market dealer in post-war Europe. He experiences several ups and downs such as the luxuries of country-club lifestyle and a penniless cross-country hitch-hiking and train-hopping voyage from Buffalo back to his home in Chicago that briefly lands him in jail in Detroit. Through his experiences he is constantly reading the classics but never quite achieves a formal education as he is more interested in gaining a self-directed education and developing a personal philosophy that is influenced by his life’s experiences.

I indicated above that the book starts off slow and confusing and I say this because the telling of the early days of Augie’s life are more focused upon depicting his family’s and neighbor’s lives with Augie acting primarily as a distracted observer. This perspective is true to a young teenager’s attention but from a narrative voice the story telling for the first one hundred or so pages was disjointed and hard to follow.  However, this line did give me some focus as to what Bellow was doing with these early years of Auggie’s life:

“All the influences were lined up waiting for me. I was born, and they were to form me, which is why I tell you more of them than of myself.” (51)

It isn’t really until the the introduction of Einhorn, the crippled millionaire, that the book begins to find focus. Einhorn is both successful as an entrepreneur and womanizer with a keen interest in literature and history. He acts as a father figure for Augie and helps the young man develop his philosophical identity. We witness Einhorn lose much of his wealth through the depression, but Einhorn’s vibrant spirit is little affected by his material loss since he had already thrived despite his physical weaknesses. Einhorn is but the first of several father-figure advisors to Augie and Augie does eventually turn against him, but I found that this first advisor was the most influential.

My favorite moment of the book was the period when Augie was working with his successful brother, Simon, at a coal yard briefly after Simon had married into a wealthy and influential family. Simon had encouraged Augie to become engaged to his wife’s cousin so that both brothers could partner together. During this period Augie was providing financial assistance to a friend of his who needed to obtain an abortion due to a an unexpected pregnancy from another man. After the abortion, his desperate friend, Mimi, becomes terribly ill and Augie’s increased investment in time with this woman caused both his fiance and brother to grow suspicious and angry towards Augie’s actions and decisions. Augie sets aside their concern to act out of human kindness rather than get overly caught up in his brother’s indulgent lifestyle. The experience influences him greatly and he discovers that what he thought was love for the fiance was only a fleeting emotion and he gladly forgets her to pursue his true love and follow his old flame, the wild Thea, into Mexico. The writing in this period of the book is extremely engaging and uses powerful imagery such as the following to depict the depth of emotion experienced:

“There have great things been done to mitigate the worst human sights and teach you something different from revulsion at them. All the Golgothas have been painted with this aim. But since probably very few people are now helped by these things and lessons, each falls back on whatever he has.” (311)

It is Bellow’s use of beautifully engaging passages such as the one above that makes this an amazing book. In reading the The Adventures of Augie March the reader is presented with a believable depiction of a young man’s growing world view. Augie is self-aware that he is born with inherent imperfections, yet he is capable of making the best of his life’s situation. His world-view grows through the experiences he lives through and only a well-lived and time-weathered soul is capable of stating something such as this:

“Everyone tries to create a world he can live in, and what he can’t use he often can’t see. But the real world is already created, and if your fabrication doesn’t correspond, then even if you feel noble and insist on there being something better than what people call reality, that better something needn’t try to exceed what, in its actuality, since we know so little, may be very surprising. If a happy state of things, surprising; if miserable or tragic, no worse than what we invent.” (430)

This world-view shines throughout the Augie’s retelling of his life’s wandering and there are several notable passages worth savoring, such as the following:

“You invent a man who can stand before the terrible appearances. This way he can’t get justice and he can’t give justice, but he can live. And this is what mere humanity always does. It’s made up of these inventors or artists, millions and millions of them, each in his own way trying to recruit other people to play a supporting role and sustain him in his make believe.” (456)

At 607 pages this is an ambitious and thorough retelling of one man’s life. Bellow doesn’t leave much out, but despite the early pages of the book where I found myself lost and disinterested The Adventures of Augie March was a deeply satisfying read. I feel that I read this at a good point in my life. Most coming-of-age stories feel directed at a younger reader who can identify with the experiences of the protagonists. Augie continues to grow and live on beyond the coming-of-age years of the early twenties and he acts as the representation of a man who lives with the focused desire to live fully without resignation.

 

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