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Wayward: A Novel

Spiotta, Dana

Last Updated: Sep-29-2022
Annotated by:
Trachtman, Howard

Primary Category: Literature / Fiction

Genre: Novel

Summary:

Dana Spiotta is one of my favorite authors, so I was poised to read her latest novel, Wayward, when it was published last year. As expected, it captures the zeitgeist perfectly and is marked by Spiotta’s wide-ranging wisdom, versatile knowledge, and literary creativity.

The book takes place in Syracuse shortly after the election of 2016 (although Donald Trump is never mentioned by name). Sam, the central character in the novel, feels caught in an increasingly unsatisfying marriage. Triggered by her post-election anxiety, she abruptly decides to leave her husband  Matt and daughter Ally. On a whim, she purchases a rundown old-style house in a poor neighborhood in Syracuse and moves in to live as a 53-year-old woman on her own, intent on starting a new life. Matt is disconcertingly understanding and supportive, but Ally cannot abide her mother’s abandonment of the family. It is an unwanted distraction from her single-minded devotion to excel in high school and to go to a top-tier college.

Sam works as a volunteer near her new home at a historical site that is dedicated to Clara Loomis, a fictional woman who left her family (shades of Sam!) to join the Oneida community, an egalitarian retreat based on equality between the sexes but also fuzzy notions of eugenics and human breeding. Sam works her way through some edgy women’s groups in search of friendship. She tries to mingle with her neighbors, who are quite different than the people she encountered in her suburban environment. But Sam’s life is complicated. She realizes that her mother, a self-sufficient creative 80-year-old woman, is probably dying from an undisclosed illness. She feels increasingly distant from the daughter that she loves so intensely, a  problem that her defection to the inner city has only made worse. And Ally has her own precocious story, a secret life, which is told from her perspective, but which is tightly linked with her mother’s narrative of inner growth.

Sam witnesses a police shooting of a Black adolescent, an immigrant from Somalia, while walking near her house during a restless night. While Sam struggles to find a way to articulate what she saw and help achieve some degree of justice for the victim, she experiences an unexpected “assault.” No spoiler alert, except to say that the ending gathers the narrative stands together and is quite satisfying. It is grand in scope and affirms the value of simple human endurance.

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Andrew Mangham’s The Science of Starving in Victorian Literature, Medicine, and Political Economy examines how Victorian writers drew upon the era’s medicine and physiology to represent the physical realities of starvation. Wondering readers, at first glance, might ask if starvation can be described in any terms other than a physical experience; however, Mangham argues that prevailing nineteenth-century political economy theorized population growth and food scarcity in ways that radically obscured the corporeal suffering wrought by starvation. Undergirding Victorian-era political economy was the influential work of the British cleric-economist, Thomas Malthus, and the rise of statistics. Malthus’s well-entrenched theories maintained that starvation, or large-scale famine, was a natural (and therefore inevitable) response to overpopulation. “In Malthus’s thinking,” Mangham clarifies, “hunger is the greatest tragedy in human economics: in the worst of times it rises up as a horrible check on those nations whose resources have been overrun by improvident birth rates” (1). These theories further solidified within religious contexts, which produced the peculiar notion of “salutary starvation” (26) or “the providential law of starvation” (30)—an understanding of famine and other disasters as just consequences for exceeding the material capacities of God’s “natural system” (26). Malthus’s theories, imbued with religious interpretations, were pernicious and far-reaching, seeping into how the British government and affluent classes viewed and (mis)understood poverty. Mangham also maintains that Malthus’s theories were augmented by the emergence of statistics during the first several decades of the century, which enabled the government to measure and evaluate epidemiological patterns, demographic data, and other information about human populations (53). He notes that while statistics were used to collect data about starvation, the data were frequently presented in ways that skewed the prevalence of malnutrition, food scarcity, and diseases and mortality rates related to starvation (56). Using a range of literary and primary sources, Mangham underscores that support for statistics was far from monolithic, that for all the scientific certitude that government officials invested in the discipline, there were critics who vociferated about how statistics were often reductive representations of human experience. In other words, masses of tabulated numbers created a cold, mathematical distance between government authorities and those human lives suffering starvation (56–57). Overall, Mangham outlines a bleak picture of Victorian political economy and its views of material privation.

For Mangham, then, one of the most injurious consequences of political economy was its failure to observe starvation (and its manifold health complications) as a material, indeed physiological, experience. As noted, political economists viewed starvation as anything but a form of bodily suffering, using theories instead to explain the naturalness and necessity of hunger and thus blaming the poor, not government and industry, for their problems (31). While political theorists were preoccupied with these explanations, Mangham traces the era’s concurrent developments in medicine that examined the physiology of hunger and digestion. The gastrointestinal research of Italian Lazzaro Spallanzani influenced Victorian physicians, namely John Hunter, Charles Thackrah, George Henry Lewes, Thomas Southwood Smith, and others, who sought to describe the anatomical workings of the stomach and explain the bodily sensations of hunger (36). Against this backdrop, Mangham argues that Charles Kingsley, Elizabeth Gaskell, and Charles Dickens—united in their “antipathy towards Malthusianism” (17)—recognized the power in articulating starvation using physiological terms, and turned to science to limn “. . . the material sufferings of the starving and, more importantly, on detailed analysis of what it means to go hungry and to observe and to write about it in a way that seeks to be truthful” (16). In chapters that individually examine each author’s literary works, Mangham demonstrates how “. . . physiological ideas offered both an alternative way of thinking about hunger and an exploration of the ways in which it might be interpreted” (47). This volume’s close readings of these authors’ various novels, journalism, and speeches reveal that medical science offered a language that could undermine theories that misunderstood human starvation and the sociopolitical conditions that perpetuate it. Kingsley, Gaskell, and Dickens used new science to depict not only physiologically accurate but humanized renderings of the poor.

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Stuck

Larson, Heidi J.

Last Updated: Sep-20-2022
Annotated by:
Coulehan, Jack

Primary Category: Literature / Nonfiction

Genre: Medical Anthropology

Summary:

Stuck was published shortly before the Covid pandemic when the American vaccine wars, with all their hostility, misinformation, and political baggage, lay more than a year in the future. In Stuck, Heidi J. Larson, Professor of Anthropology and Director of the Vaccine Confidence Project at the London School of Hygiene & Tropical Medicine, approaches vaccine rejection as a complex moral and cultural phenomenon, rather than as a simple issue of ignorance or a marginal point-of-view. In a sense, anti-vaccine rumors are the tip of an iceberg, reflecting and perpetuated by deep underlying concerns, like perceived threats to personal or cultural values, distrust of government, misperception of risks and benefits, or a combination of these. The claim that compulsory immunization violates personal freedom is especially prominent today.  

Rumor is a major source of vaccine rejection. The author discusses in detail the case of Andrew Wakefield and his contention that MMR (measles, mumps, rubella) vaccine causes autism. This belief, based on a 1998 paper in The Lancet (later retracted) has been shown to be false by numerous large-scale studies, but is accepted by perhaps millions of people throughout the world.  

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During the COVID-19 pandemic, a group of curators and clinicians from the Barnes Foundation, Philadelphia Museum of Art, Slought Foundation, and Penn Medicine started the Rx/Museum project with the goal of creating an online medical humanities experience to support healthcare providers. The project championed the role of art in the training and wellbeing of clinicians, and aimed to foster connection, reflection, and humanistic learning during a time of immense trauma and isolation. Rx/Museum began as a series of essays that were originally emailed on a weekly basis from July 2020 to June 2021. These 52 essays were later published together in a book.

The Rx/Museum book features a foreword and afterword by the editors describing the philosophy of the project and explaining the importance of art in medical education, along with the 52 essays published in chronological order. Each essay focuses on an individual artwork including paintings, photographs, and film stills. The essays are structured in a uniform manner, starting with a thematic quote, followed by a description of the artwork that provides an historical context and highlights visual features, then a print of the artwork, and finally a series of reflections which connect the artwork with issues in healthcare.

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Barefoot Doctor: A Novel

Xue, Can

Last Updated: Sep-06-2022
Annotated by:
Miksanek, Tony

Primary Category: Literature / Fiction — Secondary Category: Literature /

Genre: Novel

Summary:

Yun Village, China is a remote town near the mountains. Its 2,438 inhabitants are mostly poor but remarkably optimistic and stoic. Ancestors from the spirit realm visit the hamlet and roam the mountainside. The living and the dead appear to communicate with relative ease. Mrs. Yi (Chunxiu), more than fifty years old, is the village's vibrant "barefoot doctor" - an essentially self-taught healthcare provider with only six months of formal medical training under her belt. Yi's husband is quite supportive of her work. Their only child died at age two.

Yi is revered for her knowledge, patience, and compassion. Most afflictions she treats are chronic diseases, but Yi also delivers babies, cares for children with measles, and counsels a woman who attempted suicide. The therapeutic benefit of attentive, concerned listening along with reassurance are evident in her interactions with patients.

Traditional Chinese herbs, acupuncture, and Western medicine are all in the healer's armamentarium. Yi cultivates herbs and also forages on the mountain for other useful plants. She supposes, "Sickness and herbs are lovers" (p244). As Yi grows older, the need for a successor - a devoted, younger barefoot doctor - is always on her mind. She successfully identifies candidates, then inspires and mentors them.


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Annotated by:
Duffin, Jacalyn

Primary Category: Literature / Nonfiction

Genre: Autobiography

Summary:

All the [medical] world’s a stage! In elegant prose, with Felliniesque flights into whimsical metaphor, physician-historian-playwright Charles Hayter describes his encounters with cancer, as a doctor and as a son, and how the experience changed him as a person. 

Just as he finishes his residency training as a cancer specialist, his stoic physician father develops cancer. The story of that family illness is interwoven with vivid case histories of patients, recounted personally rather than clinically. These patients display many of the characteristic reactions and behaviors of his own father. 

Several other themes are prominent: the losing battle against death – or rather Death--who is a character lurking in the corners of the consultation rooms; the tensions of a son trying to please his difficult parents with advice and understanding that they seem not to want; the bravery of a gay man coming out to his wife and children to find a new place in the world. 
 

These struggles are placed on a background of the nebulous status of radiation therapy, a maligned and misunderstood specialty.

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In 1902, an unusual structure was erected on South Dakota’s windswept prairies. It was not a silo, farmhouse, or barn—buildings that would be perfectly commonplace in that corner of the state. This conspicuously odd edifice, a “two-story building, with its jasper granite foundations,” was called the Canton Asylum for Insane Indians, a first-of-its-kind and federally managed institution based outside of Canton, South Dakota (Joinson 24). The asylum, which operated from 1902 to 1934, was designed to incarcerate and treat Indigenous peoples deemed ‘mad’ by powerful political authorities, such as reservation superintendents and the Bureau of Indian Affairs. According to the historian and disability studies scholar, Susan Burch, the facility “ultimately held four hundred men, women, and children from seventeen states and nearly fifty tribal nations.”

In Vanished in Hiawatha: The Story of the Canton Asylum for Insane Indians, Carla Joinson provides an incisive institutional history of the Canton Asylum, examining the political motivations for its establishment, its different periods of (mis)management, and, ultimately, its demise in the early 1930s due to inspection findings and Indigenous affairs advocacy spurred by John Collier. In writing the book, Joinson seeks to answer her chief research question: “why an institution like this asylum could exist for so many years, and what made it tick as a viable part of the Interior Department” (2). Her research explores the mechanics of institutional longevity, specifically how, despite government inspection reports that revealed appalling evidence of neglect and abuse, the facility remained in operation for over three decades. Joinson’s book also corroborates the staggering fact that many of the asylum’s patients were not, in fact, ‘insane,’ but sent to the institution only so that the federal government could detain and surveil people who may have experienced difficulties with reservation authorities back home. Other Indigenous peoples, such as those with epilepsy and ‘feeblemindedness,’ were also deemed ‘mad’ and in need of medical detention. Many instances of abuse are chronicled: unhygienic conditions, patient restraint, fraudulent diagnoses and misdiagnoses, suicide, and failure to quarantine tubercular patients. Joinson also unearths decades-long dysfunction among the facility’s administration: staff backbiting and high turnover rates, lack of medical treatment, poor medical training and recordkeeping, and refusal to employ translators to communicate with Indigenous patients and understand their different cultures. Vanished in Hiawatha documents that Canton’s patients suffered years of neglect, and those who would have potentially benefitted from psychiatric treatment never received it because the facility was little more than a rural prison for unwanted, troublesome, and chronically ill Indigenous peoples.

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Annotated by:
Duffin, Jacalyn

Primary Category: Literature / Nonfiction

Genre: Memoir

Summary:

The author’s beloved Jewish mother is a great storyteller. A favorite tale describes how her grandmother was shot dead while sitting on the family’s Winnipeg porch nursing her baby. An accomplished investigative journalist, author Hoffman assumes it is fiction but decides to investigate. He is astonished to discover that, indeed, his great-grandmother was murdered, although the details deviate slightly from the family tradition. 

Through official records, the Census, and newspaper accounts he pieces together the circumstances of her life and death and the frustrated search for her killer. In the process, he learns a great deal about his ancestors and the world of Jewish immigrants in early twentieth-century Canada. Eager to share his findings, he is confronted by his mother’s decline into dementia and the poignant difficulties of grasping and reshaping memories, both collective and individual. 

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Two Nurses, Smoking

Means, David

Last Updated: Jul-20-2022
Annotated by:
Miksanek, Tony

Primary Category: Literature / Fiction

Genre: Short Story

Summary:

Two nurses decked in scrubs repeatedly meet outdoors for smoking breaks and banter during the summer and fall months. Gracie, a thin and pale woman, leads an itinerant life as she follows a mobile lithotripsy unit that services "cut-rate hospitals" in New York. She assists with the machine (dubbed "the kidney pounder") that delivers ultrasound energy to smash kidney stones. Marlon, a brawny man and Army vet adorned with a scar on his neck and an arm tattoo, works in the ER at one of the modest hospitals visited by the lithotripsy trailer.

The duo exchange numerous stories about patients they have cared for and eventually details about their own private life including personal hardships. A bond develops and deepens between these two people who "were both damaged, somehow lost" (p50). Their growing relationship is accompanied by physical attraction and culminates later in a night of love-making followed by mutual weeping.


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The Death of Innocents offers an unbelievable but true tale that fulfills the promise of its tagline: Murder, medicine, and high-stakes science. Following prosecutor Bill Fitzpatrick in Onondaga County, New York, journalists Richard Firstman and Jamie Talan unravel the tale of Sudden Infant Death Syndrome, otherwise known as SIDS, in upstate New York in the 1970s. They first reveal the details of the case of Stephen Van Der Sluys, a father convicted of murdering his child for insurance money, establishing that parents don’t always have the best interests of their children at heart; this then lays the groundwork for the story of the successful prosecution of a mother whose children’s deaths had been considered as the basis for the theory of prolonged apnea as the cause of recurrent SIDS. With the prodding of Fitzpatrick, the prosecutor in nearby Tioga County then investigated and called in a slew of local and state investigators and national experts. Waneta Hoyt confessed to and was convicted of the murders, upending the research based on the prolonged sleep apnea theory, millions of dollars of NIH-funded research, and the careers of several research scientists. Although nurses and other pediatricians questioned Waneta’s maternal attachment and even suggested that the deaths were not natural, their voices went unheard. Politicians like Walter Mondale and Ronald Reagan jumped onto a bandwagon led by parents angry that the federal government had not done more to find out why their babies had died without explanation. National conferences on SIDS were held where theories were expounded based on published cases starring the “H” children. And commercial interests entered the stage as apnea monitors, which had never been used at home, became an unproven (and lucrative) recommendation for parents to prevent SIDS.  

In addition to Waneta and Tim Hoyt and their five children (who ranged in age from 1 to 28 months) who were murdered between 1965-1971,  there is a cast of characters out of a Hollywood script. The leading player is Alfred Steinschneider, MD, PhD, a pediatrician and researcher at Upstate Medical University in Syracuse, New York. Others include Drs. Michael Baden, Milton Halpern, Janice Ophoven and Marie Valdes-Dapena. Pediatric luminaries such as Abe Bergman, Jerold Lucey, Frank Oski, and even T. Berry Brazelton played roles.

The book takes us through the story using court and medical records, interviews, television and audio recordings, conference notes, publications and other publically available information, some of which the authors painstakingly retrieved and obtained through the Freedom of Information Act. We hear the sad story of Waneta and Tim, from high school sweethearts to life partners in rural poverty, and of their family members who tried to help but were often rebuffed. The story takes us to early pregnancy and early death, with inadequate evaluations, lack of autopsies or of more than cursory investigation, and wishes to not upset the Hoyts or their community with insinuations of murder. We hear about the years after the deaths, with the Hoyts’ attempts at adoption, mental health treatment and eventually their confession to heinous acts. We also hear about Steinschneider’s rise, fall and eventual ostracism by the medical community.

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