Summary:

The movie opens with an idyllic, bright, summer beach scene at a seaside resort somewhere along the French coastline. The beach teems with waders and sunbathers enjoying the weather and each other. Ava, a thirteen-year-old girl vacationing with her single mother and baby sister, is napping on a rock wall. A large, black dog makes its away along the beach and encounters the sleeping Ava. She awakes, startles, and the dog runs off. She follows the dog to its owner, Juan, who is in the midst of a lover’s spat. The police come and take Juan away—he doesn’t have “papers.” This is not the last time Ava meets both Juan and his dog.

While on this holiday, Ava sees her ophthalmologist who informs her that her eyesight is worsening—she has retinitis pigmentosa, and a form that progresses to blindness more rapidly than other forms. The ophthalmologist tells Ava: 

Your field of view will shrink and you’ll lose your night vision before the circle closes. It can happen very young...Soon you won’t see well in low light...at night when a place is poorly lit, say...You’ll lose your sight soon.

Ava is shattered. She wishes that the ophthalmologist was dead: “He ruined our summer,” she says to her mother, who in response pledges, “we’ll have a great summer. We have two weeks. That’s good. They won’t spoil our summer. Screw them.” What happens during these two weeks comprises most of the movie.

Ava sees her prospects for the future vanish as her vision deteriorates. She needs to get as much life in as possible before then, and it begins with the time she has left at the beach. Feeding this urgency is Ava’s concern that the end of civilization could be nearing based on evidence a recreation staff member provided, and the approval her mother gives for engaging in sex: “My first time was very early. I was thirteen like you. I understand you wanting to try. I couldn’t stop you. You’ll do as you want, I know.” With this permission from her mother and feeling “My mother is probably unhappy with a daughter like me,” little pressure is left that could counter Ava’s desire to accelerate the accumulation of life experiences, no matter how risky. 

And so Ava is off and running, making her first act stealing Juan’s dog. This eventually brings them together. Juan is older, looking like he’s in his late teens, and he’s on the lamb. She joins him and experiences sex, plunder, violence, and close calls with police. We are left wondering what will happen to Ava; the circle is closing. 

View full annotation

Summary:

Dr. Ross Slotten chose family medicine to serve patients from cradle to grave. But, as he was entering practice, the AIDS virus was entering the community where his practice was situated, and he found himself serving patients much closer to the grave than the cradle. 

In June 1981, a few weeks before I began my internship in family practice at [St. Joseph Hospital in Chicago], the Center for Disease Control in Atlanta had published the first report of a strange lethal infection among a cohort of gay men in Los Angeles. I had no clue then that the disease would soon kill friends, former lovers, colleagues, and patients; devastate tens of millions of people and their families worldwide; and consume my entire professional life and more than half my chronological one. (p.14)

From both the circumstance of time and place he found himself in, and the sense of necessity and compassion that claimed him, Slotten’s professional trajectory unexpectedly shifted away from traditional family medicine towards specializing in AIDS. His interest in AIDS, however, extended to personal considerations, because as a gay man, he was part of the population at risk, and harbored the same anxieties and fears he saw in his patients and throughout his social circles. His patients were principally gay men because of his geographic location in an established gay community and the resulting referral patterns. The book chronicles both his experiences as a physician at Ground Zero taking care of gay men with AIDS, and his experiences as a gay man at risk for AIDS. For Slotten, these experiences were not independent of one another, which makes for rich insights on the complexities of both. 

Slotten spent a lot of time at St. Joseph Hospital because his patients required intense medical support and specialized services. He tells how he and his practice partner pushed for establishing a specialized AIDS unit in the hospital. They bumped up against the usual bureaucratic obstacles, plus a few more concerning issues specific to AIDS patients, but they ultimately prevailed. Slotten “was to spend the next fifteen years there, often heartbroken, occasionally inspired” (p. 109). In contrast, Slotten recounts how some specialists he called for help with particular patients would not avail themselves to AIDS patients. Those occurrences stuck with him: “I couldn’t forgive those other physicians for abandoning me and my patients in the hours of our greatest need” (p. 108). 

A blending of wanderlust, intellectual curiosity, and an urge to understand “the AIDS epidemic as a public health problem, not just a medical condition” (p. 154), motivated Slotten’s pursuit of formal postgraduate education in public health. He supplemented this education with a trip to Namibia, and reports the observations he made there, among them how “an epidemic like AIDS would be unstoppable” (p. 165), given the factors he saw at work then.

With whatever little time he had left for volunteer and advocacy work, Slotten stayed local. He talks about the volunteer-run health clinics where he worked, and the housing facility he helped set up for homeless people with AIDS. He left protesting at the Food and Drug Administration, the National Institutes of Health, and the annual International AIDS Conference to others while he focused on his patients, his studies, his volunteer work, and his own safety.

The decade of the 2020s is approaching when Slotten writes about the preceding three-and-a-half decades. As he finishes the book he is still caring for people with HIV, but the horrible complications of AIDS are now infrequent since the availability of effective medications. His practice had been reliably stable and predictable for some time, a circumstance he could only dream of when he first started. Alas, that dream had ended by the time the book was released on July 15, 2020, when Covid was surging.

View full annotation

Summary:

This novel recasts Charles Dickens’ David Copperfield for modern day as a literary take on the opioid addiction crisis in the U.S. during the 1990s and 2000s with apparent connections to Beth Macy’s nonfiction book, Dopesick, and the eight-part TV miniseries of the same name it spawned. The author, Barbara Kingsolver, assures potential readers that having read David Copperfield is not a prerequisite for comprehending and appreciating Demon Copperhead.   

Demon Copperfield, a name that evolved naturally enough in early childhood from his birth name, Damon Fields, was born into entrenched poverty in the heart of Appalachia, Lee County, Virginia. He tells his story starting from when he drops out of his drug-addicted mother’s womb onto the floor of a rented trailer, to when as a young adult, he makes a last-chance effort at breaking loose from the life-threatening clutches of Lee County. In between, his stepfather frequently beats him bloody, his mother dies from a drug overdose, he enters foster care, attends school off and on, and works assorted jobs, many of which involve illegal, unethical, and dangerous activities. All the while he is variously abused, starved, and exploited.  

Demon shares his plight with many others in the community, and though they help each other as best they can, nearly all of them become ensnared in the same traps—drug addiction, alcoholism, unemployment, hazardous occupations, unfinished education, familial disintegration, and societal abandonment. For Demon, these conditions and experiences obliterated any vision of a future free of entrapments, let alone one of prosperity and happiness. “Here, all we can ever be is everything we’ve been. I came from a junkie mom and foster care,” is how he assessed his prospects (p. 461).  

Amidst all this suffering and bleakness, an observant and caring teacher discovers Demon’s talent in graphic arts, and he gets a peek at a path to commercial success. He has to first fight off what he knows of “Lee County being a place where you keep on living the life you were assigned” (p. 460). His story turns to this fight and onto this path. 

View full annotation

Summary:

“Can you take your mother home? There’s no point our keeping her here,” the doctor says to Phillipe about his mother, Monique. Her breast cancer has spread to her spine and probably her brain. Monique had been staying with Phillipe and his wife, Nathalie, in their cramped apartment in Paris during her treatment. They took her to her home in Auvergne, and there she remained, confined to her bed, until she died. 

Monique’s husband, Roger, cared for her while also managing the family retail clothing store beneath their apartment. He spoon-fed her, cleaned her, and tried to make her comfortable with the aid of visiting nurses. Phillipe and Nathalie came from Paris to help care for Monique and provide some relief for Roger. As Monique deteriorated, she required more and more of their attention, which was made all the more difficult when she lost her ability to speak. Fatigue set in and nerves frayed. Nevertheless, when Monique died, tears were shed, hugs were shared, and memories were recounted. 

Through it all, though, not one of three family members exhibited a bit of grace. As they had before Monique became ill, they lied to each other, cheated on each other, and stole from each other while caring for her. None were above physical abuse—“you slapped me for no reason,” Nathalie reminds Phillipe, Roger paws his female customers just below where Monique lies ill in her bed. Monique, no angel herself, had behaved similarly before cancer crimped her style. After the funeral, Roger returned to his store, and Phillipe and Nathalie to Paris, where they ostensibly would pick up where they left off with their lives of banal wantonness.  

View full annotation

Summary:

In the opening dialog, the author, Samantha Harvey, tells a friend what this book is about. 

Friend:    What are you writing?
Me:         Not sure, some essays. Not really essays. Not essays at all. Some things. 
Friend:    About what?
Me:         Not sure. This and that. About not sleeping, mainly. But death keeps creeping in. (p. 1)

That’s as good a description of the book as could otherwise be offered.

As unstructured as the book’s content is, so is the book’s format. The only breaks in the text are distinguished by infinity signs. Time stamps are placed within the text between some of these breaks. The times are sequenced during a night (or a composite of nights) when Harvey is awake between midnight and 7:30 am. Texts following the time stamps describe the acute effects of insomnia on her at those particular moments and could be read as diary or journal entries. 

Harvey’s insomnia came suddenly at the age of forty-three and morphed into an unrelenting assault that at times made her wonder if the only sleep available to her is the sleep of the dead. 

When I don’t sleep and don’t sleep and don’t sleep, I don’t want my life; neither do I have in me the propulsion (courage? know-how?) to take it. So I have to endure my life when it’s unendurable, and this is an impasse. (p. 33)

Can I escape this? The sword hangs. There is nothing to put my mind at rest – every day presents a new threat: the night. Every night is a battle, most often lost, and any victory is one day long, until its challenger comes along: the next night. I understand why people kill themselves, or break down. (p. 82)

Throughout the book, across all the text sections, and following all the time stamps, Harvey details what insomnia does to her physically, psychologically, and existentially. She desperately explores the possible causes such as menopause, fear, traffic noise, and Brexit among others, and heartbreakingly tells of all she has done to get sleep such as seeing doctors, smiling more, counting blessings, and changing behaviors. None come to any effect, as she reports to her unhelpful doctor. 

I do these things, they don’t help.
Over time they will.
Over time they haven’t.
I feel unhelpable.
Nobody is unhelpable.
I am.
Nobody is. (p. 139)

Just as Harvey had informed her friend, she takes up other topics in other forms that directly or indirectly relate to her insomnia, and sometimes do not relate at all. Among the various forms are vignettes; thoughts and obsessions; meditations; and a short story. Topics include deaths in the family (including a dog’s); peculiarities of different languages; why so many TV shows have the word “secret” in their titles (she spends “nights spent thinking about this”) (p. 67); what fuels insomnia; how worry, anxiety, and fear differ from one another; writing; time; and the relationships between science and religion, and between reason and faith. Harvey’s  background in philosophy shows. 

A year on, Harvey discerns a cure for insomnia. Using a metaphor involving swimming against waves and currents or with waves and currents, the cure is to be derived from the “wisdom in knowing that we are sometimes the cause and influencer of our own currents and tides, which we make in otherwise still waters.” She further elaborates on this idea and how it leads to a moment when “you’ll drop each night into sleep without knowing how you once found it impossible” (p. 175).

View full annotation

Summary:

Before it happened there was the dread of it. “They were brittle, those veins that sprouted from my retina and coiled and snaked through the transparent humor of my eye,” says Lina Meruane, the first-person narrator and main character. If those veins burst, Lina could go blind. All that can be done to prevent such a disaster she’s told, “is to keep watch day by day over its millimetric expansions...keep watch over the sinuous movement of the venous web advancing toward the center of my eye.” Adding to her dread are “impossible admonitions to follow.”

Stop smoking...don’t hold your breath, don’t cough, do not for any reason pick up heavy packages, boxes, suitcases. Never ever lean over, or dive headfirst into water. The carnal throes of passion were forbidden, because even an ardent kiss could cause my veins to burst. (p. 5)

And then, “it was happening. Right then, happening” (p. 3). She had only bent over to retrieve a syringe for her scheduled insulin injection. She’s paralyzed. “I didn’t straighten up or move an inch, didn’t even try to breath while I watched the show. Because that was the last thing I would see, that night, through that eye: a deep, black blood (p. 4).

Lina is in the dissertation stage of a PhD degree at a New York City university. The story veers from this pursuit to one of restoring her eyesight. The other primary characters are Lina’s Galacian love interest and fellow academic, Ignacio, who shepherds her through this journey, her New York retinal specialist, Dr. Lekz, and her parents who are both physicians—her father a cardiologist, her mother a pediatrician—practicing in Lina’s native country, Chile.

Soon after the bleeding incident, Lekz tells Lina that at least a month would be needed for her eyes “to clear up so I can take a look at this mess” (p. 32). “Weren’t you going to go to Chile to see your family? Go to Chile. Take a vacation” (p. 33). The story relocates from New York to Santiago, and from Lina’s medical problems to her familial dynamics—“I never wanted you to be my doctor, it’s enough for you to be my father” (p. 50). The visit also becomes a time for Lina—and Ignacio—to see what life might be like if she never regained full sight, and to contemplate options for such an eventuality. She had become “an apprentice blind woman” (p. 20).

Lina and Ignacio return to New York city for the hoped-for reparative surgery. The procedure produces promising signs, but Lina must wait at least the four weeks it takes for Helium gas bubbles to dissipate so Lekz can see the results. During this period, Lina tries to keep her head position down and her spirits up. Often the opposite resulted. Before four weeks passes, however,

Blood, again, in my eye. A fine thread of blood that comes from I don’t know where...I’m watching as the eye watches its thread of blood, looking at everything without ceasing my cries: I’m bleeding I’m bleeding again. (p. 142)

Futility looms, “knowing they were going to operate on me but that no cure existed” (p. 113).  Lina and Lekz consider their options. After Lina’s initial bleeding incident, Lekz had “dropped the phrase transplants in experimental stages” (p. 5). The idea stuck with her. She had spoken about it separately with her mother and Ignacio. Both were fraught conversations. Nevertheless, Lina and Lekz return to the topic.

View full annotation

Summary:

The eight-part TV miniseries, Dopesick, is a nonfiction, scripted drama inspired by Beth Macy’s nonfiction book of the same title. The creator, Danny Strong, was a writer of all but one episode, director of two, and an executive producer of them all. Beth Macy served as an executive producer and contributed to the writing and updated the reporting. 

In a Kaiser Health News (KHN) panel discussion about the series with Danny Strong, Beth Macy, and three KHN staff members, Strong said his original goal “was to dramatize all this, was to create a clear record of what Purdue Pharma did.” But when Macy joined, his goal expanded “to show the victims and to hopefully redefine the stereotype of addiction...[and] ultimately our goal was to show a path forward.”

The miniseries conforms to these goals. Across the eight episodes, the drama mostly swirls around the direct connections among Purdue Pharma, one physician, one particular patient (and family), one small town in coal mining country, a Drug Enforcement Agency (DEA) investigator, and a U.S. Attorney (Western District of Virginia). In hewing to Strong’s original goal of portraying Purdue Pharma’s responsibility for igniting and fanning addiction to its product OxyContin® (oxycodone HCl), the drama reaches its climax when the company agrees to criminal charges for named executives and a financial settlement in 2007. 

Different episodes touch on other goals about the stigma associated with addiction and access to medication-assisted treatments. While Strong met his goals, he acknowledges the real-life drama didn’t end with the 2007 settlement. He previews what was to come: Purdue Pharma redoubling its sales efforts, the addiction crisis worsening over the subsequent fourteen years, and the continuing efforts to bring Purdue Pharma and its owners (the Sackler family) to their knees.

View full annotation

Summary:

 A sudden cramp shoots down the spine and then, stillness... (p. 9)

An unbearable stinging had settled into her shoulder neck ember... (p. 10)

She felt an invisible wound wrapping her up and suffocating her... (p.10)

A slight numbness that starts in the shoulder and extends along the arm to the elbow until it reaches the back of her right hand, the fingers where it all started. (p. 12)

Inflammatio. In flames. En llamas. Ardor without romance. (p. 10)

Quickly, then, the story shifts from Ella’s dissertation odyssey to her diagnostic odyssey. As she makes her way along this journey during the first chapter, other characters come into the picture: El, Ella’s long-term boyfriend and forensic scientist, is one. The others in her family history are “the Father,” “the Mother,” “the Brother,” and “the Twins”—none are ever named (neither, really, is Ella or El because they are “she” and “he,” respectively in Spanish). Except for the Twins, each of the subsequent four chapters center on one of these characters and how they figure into the family history. Just as in the first chapter, the stories are told through and around the health challenges each character faced; all harrowing, many life-threatening, and some metaphorical.

Ever present in these histories is the story of Ella’s birth mother,“genetic Mother”. She died giving birth to Ella. Ella’s stepmother, “the Mother,” is called at different times, “the volunteer Mother,” “the replacement Mother,” and “the living Mother.” The Brother, alternatively known as “the Firstborn,” shares with Ella her birth mother and was born nine years before her. The Twins, known separately as “the Boy Twin” and “the Girl Twin,” came after the Father remarried. Another dimension shaping the stories is both the Father and the replacement Mother work as practicing physicians. 

Ella’s prominence in each chapter makes her our witness to El’s recovery after an explosion rips through his mass grave excavation site, and his many surgeries for separate gastrointestinal troubles; the Mother’s aggressive and brutal breast cancer treatment; the Firstborn’s recurring bone fractures (an “osseous enigma”); and the Father’s bleeding ulcers and life-threatening hemorrhagic complications from prostate surgery. 

The author, Lina Meruane, structured the book in a somewhat unconventional form. She delineates sections within each chapter with asterisks centered on the page (“***”), and these sections rarely comprise more than two paragraphs. Dialog is neither separated from other text nor signaled with quotation marks. The text moves back in forth in time, from here to there in place (presumably somewhere in South America), and sometimes takes the form of pensées rather than plot narrative. But, overall, the book moves towards resolving some mysteries surrounding family history.

View full annotation

Summary:

In a 1976 Archives of Neurology essay, the neurologist Robert Katzman successfully argued for relabeling “senility” as “Alzheimer’s disease.” He urged rejecting various forms of dementia and senility as common consequences of aging, and accepting them as a disease requiring all the attention any other important disease deserves. Now medicine and society had a problem—"The Problem of Dementia,” the famed physician Lewis Thomas called it in a 1981 essay published by the popular magazine Discover, and he noted that, suddenly, “a disease of the century” had arisen (p. 3).

Forty years on, Jason Karlawish thinks there is still a problem, but in keeping with Katzman’s call, he refers to “The Problem with Alzheimer’s.” Based on the history he covers and the experiences he shares in this book, nothing of much significance has occurred since “The Problem of Dementia” became the “The Problem of Alzheimer’s.”

Karlawish is a physician who cares for people with Alzheimer’s and a researcher delving into “issues at the intersections of care, ethics, and policy” (p. 5).  He draws on his experiences in this book, which he describes as “the story of how once upon a time, Alzheimer’s disease was a rare disease, and then it became common, and then it turned into a crisis.” Karlawish wants to answer why during the time between Thomas’ essay and the year 2010, “nothing really changed,” and how that could be the case in “the richest and most powerful nation.” (p. 6) He tells this story in four parts.

The first part concentrates on efforts clinicians and researchers were making following Thomas’ call to distinguish Alzheimer’s disease from normal aging, other dementia types (e.g., frontotemporal, Lewy body), and precursor syndromes (e.g., minimal cognitive impairment). They were looking for definitive clinical patterns, imaging studies, diagnostic tests, and pathologic markers for the disease. 

In the second part, Karlawish goes back in time to when Alois Alzheimer first found what are known today as “plaques” in the brain of a patient who had an early onset of severe, progressive dementia. He traces the attention this finding drew to eventual advances in imaging and biochemistry aimed at diagnosis. Karlawish also covers how a cascade of events over the decades following Alois Alzheimer’s finding disrupted the pursuit of a pathophysiological basis for dementia. These events included the rise and dominance of Freudian psychology; followed by two world wars; the cold war; the overshadowing of AIDS; Medicare political and funding constraints; tussles among patient advocacy groups; loss of asylums where care and research had coexisted; clinical failure of the first drug; and the continued debate over whether dementia is a consequence of aging or is a disease. 

Karlawish moves on in the third and fourth parts to cover what “we will have to learn to live with the disease so as to improve the lives of persons...to provide the care they need to live well at home...and repair the broken system” (p. 171). Success in his view requires integrated biological, psychological, and social components. He reports the progress on each of these three fronts: some failed approaches continue to fail (such as drugs targeting amyloid); some psychological interventions show promise (though at times causing moral tension); some of the social configurations engineered for Alzheimer’s patients, families, caregivers, and society have produced triumphs and some disasters. He has much to say about why and how this search must go on, but with some much-needed course corrections. 

View full annotation

Summary:

Michael Pollan is curious about human consciousness and how humans alter it using a variety of molecular compounds. This curiosity took him first to three mind-altering psychedelic drugs: psilocybin, lysergic acid diethylamide (LSD), and 5-MeO-DMT (“The Toad”). He reported his findings and personal experiences in a 2018 book, How to Change Your Mind. His curiosity yet untamed, Pollan expands his project to three mind-altering compounds found in plants: opium, caffeine, and mescaline in his latest book.

Pollan’s investigation is born of his vocation as a gardener “fascinated by our attraction to these powerful plants as well as by the equally powerful taboos and fraught feelings with which we surround them.” He’s further attracted to them for the way in which when “we take these plants into our bodies and let them change our minds, we are engaging with nature in one of the most profound ways possible” (p. 3). The sources he chooses are the opium poppy for opium; coffee and tea for caffeine; and peyote and San Pedro cacti for mescaline. 

Opium, caffeine, and mescaline represent the range of mind-altering properties available from plants of interest to Pollan. In opium he saw a sedative, in caffeine a stimulant, and in mescaline a hallucinogen, or as he characterizes them, the “downer, the upper, and the outer,” respectively (p. 4). Their effects on consciousness do not feature dissolution of the ego, as is the case with psychedelics, and indeed, they can solidify ego. Seemingly most important to his selection, however, was that,

Taken together, these three plant drugs cover much of the spectrum of the human experience of psychoactive substances, from the everyday use of caffeine, the most popular psychoactive drug on the planet; to the ceremonial use of mescaline by Indigenous peoples; to the age-old use of opiates to relieve pain. (p. 4)

The book comprises an introduction and a chapter each covering opium, caffeine, and mescaline. The introduction describes his dual interest in the ancient human drive to fool with consciousness, and in plants that produce mind-altering substances as evolutionary features. Pollan also touches on how civilizations, ancient and current, aid and combat the use of these substances, at times simultaneously. In the chapter on opium, Pollan updates his April, 1997 Harper’s Magazine article about his experience growing opium poppies as the war on drugs peaked in the mid-1990s; in this version he reconstitutes the section he left out for fear of arrest and conviction that has since abated. In the next two chapters, Pollan separately reports on how caffeine and mescaline affected his consciousness. Because he was already a heavy caffeine user, Pollan had to give up coffee and tea if he was to discern its mind-altering effects, but for mescaline’s mind-altering effects, he had to find a source, a setting, and a guide through the maze the Covid-19 pandemic created.

View full annotation