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The Ballad of Typhoid Mary

Federspiel, J. F.

Last Updated: Apr-07-2020
Annotated by:
Belling, Catherine

Primary Category: Literature / Fiction

Genre: Novel

Summary:

The novel's narrator is a widowed 58-year-old Swiss-born physician, Howard J. Rageet, who lives in New York City. His son is a pediatrician, his daughter a medical student. Rageet himself is terminally ill. He is writing a "little biography," of Mary Mallon, the infamous "healthy carrier" also known as Typhoid Mary. Rageet's grandfather, also a doctor, had kept a journal about Mary and his rivalry with his friend, (the real) George A. Soper, whose life's work became tracking Mary and proving that she was responsible for the typhoid outbreaks. Elaborating on the journal, Rageet recounts Mary's life in America.

Born Maria Anna Caduff in the same part of Switzerland as Rageet's ancestors, she arrives in New York Harbor in 1868, aged 13, on a crowded immigrant ship, a fifth of whose passengers had died en route from Europe. The dead include Mary's family. She had been taken care of by the ship's cook, who evidently both taught her to cook and used her for sex. When the ship docks, Mary tries to jump overboard, but is stopped by a physician, Dorfheimer, who smuggles her through Ellis Island and takes her home with him. He is also a pedophile, and he has sex with her. Rageet calls this kidnapping a "humane, benevolent crime." Not long after, Dorfheimer dies of typhoid fever.

Rageet's "ballad" then traces Mary's various positions as a cook (and, often, sexual object), most of which end quickly when the household is infected. She has two relationships that do not lead to the disease. One is with a small girl who has Down Syndrome. Once her connection to typhoid is suspected, the child's family hire Mary to live alone with the child and care for her, hoping the child will be infected and die. The child never becomes ill. The other is with a disillusioned anarchist, Chris Cramer. She lives with him and falls in love with him, but he is not sexually interested in her.

Soper encounters Mary when he is asked by a wealthy Oyster Bay family, her former employers, to investigate a typhoid outbreak in their household. He manages to track her down and eventually, after much resistance, she is arrested, tested, and quarantined. She escapes and continues to work as a cook until her re-arrest. Promising to try and imagine Mary's motives, Rageet breaks off his narrative. He is dying. The novel ends with a postscript written by Rageet's daughter. Implying that her father committed suicide, she tells of Mary's stroke and the last years of her life as a paraplegic, and she provides a final document, the menu for one of the very elaborate meals Mary would have cooked.

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Weather

Offill, Jenny

Last Updated: Apr-03-2020

Primary Category: Literature / Fiction

Genre: Novel

Summary:

Weather is a strange, disturbing, and important book. Offill uses fragments of prose—typically a few lines or half a page—to present a small group of characters in New York City who experience dread, unhealthy behaviors, and many difficult choices. The fragments jump from topic to topic and points of view, suggesting chaos in the characters, in much of modern life, and even in the structure of this novel. “Weather” suggests “whether”: whether humans can survive not only from one day to the next but also in the long term that includes the climate crisis threatening our earth. 

The cast of characters is small and carefully arranged. Lizzie (our main focus) is married to Ben; they have a son Eli. Lizzie’s brother Henry is married to Catherine, and they have a baby girl, Iris; Ben and Lizzie have problematic mothers. A genogram of these and other related characters looks like the cast of a Restoration comedy, full of harmony and good will, but in Weather conflicts swirl and grow chaotically. Catherine divorces Henry. Ben suddenly goes on a three-week trip. Widespread complications include street drugs, alcohol, diet abnormalities, sleep deprivation. There are also mental problems such as confusion, hallucination, loneliness, delusions, and panic, as well as economic difficulties. Only Catherine has a career path, but, at the end of the book, she appears to be “tilting into the abyss too” (p. 179), according to Lizzie. 

While some fragments describe thoughts and actions of the characters, others present a giant whirlpool of cultural, environmental, and historical topics, including doomsday preppers, Rapturists, and the end of civilization, also gun rights, multicultural frictions, popular religion, a need for a strongman to govern, noticeably sick people and loss of medical services. Other topics touched on include hate literature, mob rule, suicide, torture, as well as references to Fukushima, the Holocaust, and 9/11. Many of these worry our characters; others are simply mentioned as “the surround” for all people around the world. Our characters have fantasies of hope but usually feel panic, dread, loneliness, guilt, or despair. Sylvia (Lizzie’s former professor and sometime boss) is an academic who appears to understand climate change and the need to warn people, but she gives up, saying “there’s no hope” (p. 133).  

The first 127 pages swirl around the characters with little progression of story. The next section (4) accelerates the craziness among them all. The last two sections seem more “stable,” but with no actual resolutions. Lizzie says “I will die early and ignobly” (p. 187). In the very last pages, she takes the boy Eli (the only normal major character) to a playground. Later she kneels by her bed and prays for “Mercy” (p. 197). Following the last page, we see only a one-line URL: www.obligatorynoteofhope.com. Is this part of the novel? Do we click on it? 


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Mercy

Montgomery, Judith

Last Updated: Mar-27-2020
Annotated by:
Davis, Cortney

Primary Category: Literature / Poetry

Genre: Poetry

Summary:

"Mercy," winner of the Wolf Ridge Press Narrative / Poetic Medicine Prize, contains nineteen powerful poems--poems that provide an intimate look into the author's role as caregiver to her husband who is living with, and being treated for, liposarcoma.  But the poems in this small volume are not just about husband and wife.  Cancer becomes a third character, one who is often addressed as a presence lingering in the same house, sleeping in the same bed, never absent from every moment of struggle or from any moments of joy.  In the opening poem, "Cozy" (page 1), the couple has "escaped" to a remote rented cabin.  They slip "from love-rumpled featherbed and sheets" feeling "safe" within the sturdy cabin walls that "keep out driving rain or freeze."  For those hours, nothing can spoil their happiness, "even Cancer, who squats on our stoop, / flipping his gold coin in lazy arcs."  At the close of "Cozy," as the couple drives home from their respite, Cancer rides with them, sitting between them "as he hums and nods / pleasantly--first to you, then to me, // one hand lightly resting on each near thigh."  The author weaves this threatening image of Cancer as an ever-present entity throughout the poems that follow.

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Annotated by:
Galbo, Sebastian

Primary Category: Literature / Nonfiction — Secondary Category: Literature / Nonfiction

Genre: Criticism

Summary:

In Death is But a Dream, Christopher Kerr, MD, PhD, the Chief Executive Officer and Chief Medical Officer of Hospice & Palliative Care Buffalo, shares his patients’ end-of-life dreams and visions. The content and intensity of these dreams vary, but often center on patients’ transient meetings with predeceased loved ones, offering a deeply spiritual sense of peace during periods of physical suffering. 

Using patient interviews, Kerr’s book does not fetishize dream events as ghostly commotions or in terms of pseudo-mysticism, or insist on using a religious framework for their interpretation, explaining rather that bearing witness to and legitimizing end-of-life dream experiences constitute a new ethical imperative in the practice of palliative care: “A true holistic approach to patient care must also honor and facilitate patients’ subjective experiences and allow them to transform the dying process from a story of mere physical decline to one of spiritual ascension” (Kerr 28). Case after case, his research documents that because end-of-life dreams provide patients with a singular emotional and psychological comfort that no palliative medication can simulate, hospice professionals need to validate patient dreams by listening carefully and compassionately. 

With this in mind, end-of-life dreams serve as a kind of counter-narrative to dominant cultural understandings and representations of human experiences in hospice, specifically stereotypes of terminally ill individuals as being incapable of meaningful communication, creativity, and understanding. Kerr’s patients’ narratives reveal that end-of-life dreams and visions are not trauma-inducing experiences or instances of religious prophecy, but “help reframe dying in a way that is not about last words and lost love but about strengthened selves and unbreakable bonds across lives” (142). 

Death is But a Dream 
upends medical research, or certain “limitations of science,” that oversimplifies end-of-life dreams by attributing them to neurological deterioration, oxygen deprivation, and the side effects of pain management medication (11). The general lack of rigorous, serious-minded research in end-of-life dream experiences is inseparable, in part, from institutionalized medicine’s “inability to see dying as anything but a failure” which has produced a healthcare system that “reflects a limited view of the totality of the dying experience” (7). The patient accounts that Kerr documents, however, reveal an undeniable dimension of human experience at life’s end whose complexities may be well beyond the reaches of full scientific understanding. End-of-life dreams seem to be part of an elaborate system of compensation (to borrow a term used by Siddhartha Mukherjee), as the mind works overtime to activate and animate certain memories to diminish the physical realities of dying. “There is an adaptation—substantive, spiritual yet cognitively meaningful,” writes Kerr, “a mechanism through which the patient can emerge from the dying process with a positive psychological change” (69). Indeed, the mystery of end-of-life dreams—their visions of loved ones; of seeking forgiveness, healing, and understanding within weeks, sometimes days, of one’s death; of comforting apparitions and visitations—points to a miraculous capacity within the human heart that eases the life-to-death transition.

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Time Out of Mind

Moverman, Oren

Last Updated: Mar-06-2020
Annotated by:
Bruell , MS, Lucy

Primary Category: Performing Arts / Film, TV, Video

Genre: Film

Summary:

A construction crew enters an abandoned apartment in NYC and finds an older man in a wool overcoat asleep in the bathtub.  He can’t tell them his name or how he got there, just that he’s waiting for his friend, Sheila, to come back to the apartment.  The building manager (Steve Buscemi) throws him out of the building and into a life on the street, drinking, sleeping wherever he can, and riding the trains.  His name, we later find out, is George (Richard Gere), and he is one of NYC’s homeless men.  George can’t seem to remember much about his past, only that his wife died of breast cancer, he lost his job, and he has a daughter (Jena Malone) who works at a nearby bar but wants nothing to do with him.  After nights trying to find a warm place to sleep, George ends up at the Bellevue Men’s Shelter where he is befriended by Dixon (Ben Vereen).  Dixon shows George the ropes—how to apply for assistance, where to get a copy of his birth certificate, where they can get a shower up in the Bronx.  But Dixon disappears, removed from the shelter ostensibly for being disruptive. George is left on his own.

We don’t know who Sheila is, or even whether she is real.  George sees a woman (Kyra Sedgwich) pushing a shopping cart by the river and calls out to her.  She’s not Sheila.  They share a couple of cans of beer and spend the night in a park near the river. “ You’ve got to get along to get along,” she tells him.  Your real friends will look out for you on the street.”  But in the morning she is gone- George wakes up to laughter from boys who are snapping photos of him under his blanket.  On his own again, in and out of shelters, George drops by the bar to see his daughter, hoping to overcome their estrangement. 




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Man's 4th Best Hospital

Shem, Samuel

Last Updated: Feb-28-2020
Annotated by:
Miksanek, Tony

Primary Category: Literature / Fiction

Genre: Novel

Summary:

Most of the group are reunited in this sequel to the 1978 blockbuster, The House of God: narrator Dr. Roy Basch and his girlfriend (now wife) Berry, former fellow interns (Eat My Dust Eddie, Hyper Hooper, the Runt, Chuck), surgeon Gath, the two articulate police officers (Gilheeny and Quick), and the Fat Man (a brilliant, larger-than-life former teaching resident). As interns, Basch and his comrades were a crazy, exhausted, cynical crew just trying to survive their brutal internship. Years later, the midlife doctors have changed but remain emotionally scarred.

The Fat Man (“Fats”), now a wealthy California internist who is beginning a biotech company targeting memory restoration, is recruited to reestablish the fortunes – financial and prestige – of Man’s Best Hospital which has slipped to 4th place in the annual hospital rankings. He calls on his former protégés to assist him in an honorable mission, “To put the human back in health care” (p34). Fats enlists other physicians (Drs. Naidoo and Humbo) along with a promising medical student (Mo Ahern) to staff his new Future of Medicine Clinic (FMC), an oasis of empathic medical care that strives to be with the patient.

Every great story needs a villain. Here the main bad guys are hospital president Jared Krashinsky, evil senior resident Jack Rowk Junior, and CEO of the BUDDIES hospital conglomerate Pat Flambeau. The electronic medical records system dubbed HEAL is a major antagonist, and the FMC docs wage war against it and the “screens.”

Poor Roy Basch works long hours, deals with family problems, has trouble paying bills, and experiences health issues (a bout of atrial fibrillation, a grand mal seizure, and alcohol use). Fats has warned of a “tipping point when medical care could go one way or another, either toward humane care or toward money and screens” (p8). Alas, the computers and cash appear victorious. A major character is killed. Many of the doctors working in the FMC including Basch leave the clinic. And fittingly, Man’s Best Hospital plummets in the latest rankings from 4th to 19th place.

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BPM (Beats per Minute)

Campillo, Robin

Last Updated: Feb-20-2020
Annotated by:
Zander, Devon

Primary Category: Performing Arts / Film, TV, Video

Genre: Film

Summary:

BPM is a fictional, French film about ACT UP Paris in the 1990s.  Directed by Robin Campillo, himself a veteran of Paris’s ACT UP, the film details the realities of being an HIV/AIDS political action group during an era of governmental inaction and lack of recognition of those most impacted by HIV and AIDS.  Initially, BPM focuses on the collection of individuals who make up ACT UP Paris and how they organize themselves to protest and advocate for greater media attention, better sexual education, and more access to new pharmaceutical data, among a myriad of other causes.  The film eventually shifts its focus from ACT UP as a group to two of its members, a couple, one of whom, Sean, is struggling with AIDS and Nathan, his partner, who supports him together with the the rest of ACT UP. 

In addition to its presentation of HIV activism, BPM documents what it meant to be HIV positive in a world without highly active antiretroviral therapy and where those most affected were largely ignored or even viewed with disdain.  Historical references ground the film firmly in the 1990s, including allusions to France’s infected blood scandal when hemophiliacs were knowingly given infected blood products, discussions that led to the initial development of protease inhibitors, and ACT UP Paris’s 1993 protest on World AIDS Day when a large pink condom covered the obelisk in the Place de la Concorde.  Contrasting with these larger historical references are daily moments of living with HIV in this era. Members of ACT UP are shown taking AZT and DDI around the clock (including ensuring to pack water during a protest, in case of arrest, when they may need to take medication in jail), regularly attending the funerals of friends who died of AIDS, and enduring moments of homophobia from those outside of ACT UP.



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Summary:

A dramatic prologue depicts Joan Kleinman screaming and hitting her husband Arthur in bed. She is ill with Alzheimer’s disease and does not, for that moment, recognize him. The following chapters provide a long flashback, beginning with Arthur’s family background, his youth as a tough street kid in Brooklyn, his medical education, and his marriage to Joan. We learn of their work in China, travels, and professional success. Arthur gradually realizes that the US health care system has become “a rapidly fragmenting and increasingly chaotic and dysfunctional non-system” (p. 126). Further, he sees a reductive focus on patients as mere biological entities, ignoring their personal, familial, and cultural natures. As a result, “Caregiving in medicine has gone from bad to worse.”

Joan suffers from an atypical kind of Alzheimer’s that increased over “that dismal ten years” (p. 156) with Arthur providing care to her, at cost to himself. There is no home health aide, no team approach with doctors, indeed no wider interest in her care other than the state of her diseased brain. Kleinman vividly describes the toll on her and on him.

Kleinman is aware of the privilege he has as a Harvard doctor, well known for his psychiatric work, his teaching and writing, and his wealth—in contrast to other patients and families. Some patients go bankrupt from medical bills.

Visits to nursing homes reveal a wide range of social conditions, contexts, and levels of care; the best have a sense of “moral care” (p. 200). Joan’s final days are hard. Supportive family members agree to her living will and healthcare proxy for morphine pain control only. She dies, apparently “at peace” (p. 232).

In the last pages Kleinman introduces the notion of “soul” as “essential human interactions” (p. 238). He discusses some of the limits of medicine (see paradoxes below) but also praises local efforts to improve humane care, such as team approaches, uses of narrative medicine, and medical/health humanities programs.  

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Tree, Broken Tree

Mortimer, Dylan

Last Updated: Feb-03-2020
Annotated by:
Lam, MD, Gretl

Primary Category: Visual Arts / Visual Arts

Genre: Multimedia

Summary:

A tree, colored in pink glitter and outlined in red, stands alone. Two of the main branches are cleaved apart, and green glitter oozes from the wound. This does not look like normal tree sap; the yellow-green color is purulent, and the glitter gives it a toxic glowing effect. Two of the three branches droop weakly towards the ground.  The tree is sickly, possibly dying.  

Because the tree is mounted on a white background, with the tips of branches curling lightly off the panel, the piece also recalls a scientific specimen mounted on display. Those who are familiar with lung anatomy will note how the tree trunk recalls the trachea, and the branches recall bronchi. The pink and red coloring reinforces the idea that this isn’t merely a tree, but also lung tissue.

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The Edge of Every Day

Sardy, Marin

Last Updated: Jan-25-2020
Annotated by:
Glass, Guy

Primary Category: Literature / Nonfiction

Genre: Memoir

Summary:

The Edge of Every Day is the memoir of a woman who comes from a “multiplex” family, in which schizophrenia is manifested in successive generations.  

The book consists of a series of essays.  Some, on topics ranging from gymnastics to building altars, were first published independently and do not appear (at least at first glance) to be linked. The choppy effect this produces speaks to the disorganized thinking that psychotic persons experience.  Other essays propel the tragic narrative of family members slipping into psychosis. At the age of ten, the author Marin Sardy, watches as the “shapeless thief” of schizophrenia steals her mother’s personality away.  Later, as she reaches her thirties, she witnesses her younger brother succumb to an even more pernicious illness.   

Despite Sardy’s mother’s conspicuous symptoms, (she advises her daughter to move to Pluto and informs her that her father has been swept away in a tsunami and replaced by another man), she functions just well enough to avoid being compelled to accept treatment. Thus, no one can stop her from going through a large inheritance and becoming destitute.  

Sardy’s brother Tom suffers his first psychotic break in his 20’s and then rapidly deteriorates.  He repeatedly “cheeks” his meds and falls through the cracks of Anchorage’s mental health system. The author and her family scour the streets, hoping to lure him inside for a shower or hot meal. As the weather worsens, they can only hope he will land in prison if it means not being exposed to the Alaskan elements.  Ultimately, the young man, who once sailed through college with A’s, commits suicide in the bathroom of a psychiatric facility. 

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