Showing 21 - 30 of 2973 Literature annotations

Annotated by:
Trachtman, Howard

Primary Category: Literature / Fiction

Genre: Novel

Summary:

Among the many binaries that can be used to describe people, an easily observable one is how seriously they take the games they play. There are those who play basketball or Scrabble to simply relax and enjoy the camaraderie of their playmates. And then there are others for whom games are invested with considerably more significance, where winning in rotisserie baseball or a golf match becomes a statement about their core values, the meaning of life itself. Gabrielle Zevin’s wonderfully engaging novel, Tomorrow and Tomorrow and Tomorrow, is dedicated to those who proudly include themselves in the latter category.

The novel spans nearly thirty years and centers on three exquisitely drawn characters who are brilliant and appealing and whose raison d’etre is to design and promote the best computer games. Sam and Sadie are intellectual outliers from vastly different backgrounds. Sam’s Korean single parent mother is an actress wannabe, and he is actually raised by loving grandparents who own a pizza store in Koreatown in Los Angeles, while Sadie grows up in a supportive family of high achieving professionals.  They meet by chance while Sadie is in junior high school. As part of her required community service, she visits Sam while he is hospitalized to treat a horrific leg injury (I am leaving out crucial details about how that happened). Sadie is drawn to Sam – her  more than 900 hours of visits break the record of service time donated – and he in turn is able to overcome the chronic pain he endures and to open himself up to someone else.

A genuine bond is forged between the young adolescents that resurfaces a few years later when they bump into each other unexpectedly in a Cambridge subway station. Sam is a student at Harvard and Sadie is studying at MIT. They are both computer geniuses and in the early 1990s there is no better way to leverage their knowledge than to design innovative and complicated computer games. They are able to program games that combine literary structure, musical background, and state-of-the-art color graphics in the service of a narrative environment that  challenges the intelligence and sustains the interest of the player. Joined by a common friend, Marx Watanabe, Sam’s roommate at Harvard, who becomes their devoted and creative producer, they develop a game called Ichigo, a tale of a child lost at sea who must find his/her (a key part of the game) way home. The game is based on the famous wood block print, “The Great Wave” by Hokusai and becomes an international bestseller. They are vaulted into the world of the rich and famous.

The novel chronicles their professional struggles over the following decade to maintain the same high level of creativity and mass appeal. Conflicts arise about assigning credit for their creations and dividing up the public accolades and recognition. There are the expected strains that are bound to develop in such a closely knit team of creative collaborators who are working 24-hour days to meet unrealistic production deadlines. And of course, there are complicated interpersonal relationships that develop that in such a high-pressure workplace. There is true joy, but it is always mixed with intense feelings of envy and nostalgia for simpler times. Other partners and love interests enter the story. But among this intriguing cast of characters, Sam is singularly complex, and his leg  injury and chronic disability are crucial elements in the plot; he suffers from severe phantom limb pain and ultimately he is forced to have his damaged lower leg amputated. How he copes with his disability, real and imagined, alters the arc of the story to a significant degree. Sam cannot escape his feelings of being an outsider, even as he feels himself drawn to Sadie. The imaginary computer game world leaks into reality. Violence dramatically intervenes in the story and ineradicably alters the course of events (no spoiler alert). The novel that focuses on the creation of a virtual reality has a lived-in texture and fullness. I anticipate that most readers will find the ending to be satisfying, an exquisite expression of the complexity of human fate and interpersonal relationships.

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Annotated by:
Duffin, Jacalyn

Primary Category: Literature / Nonfiction

Genre: Memoir

Summary:

Through ten short chapters, family doctor Susan Boron explains the origin of her neologism, “tokothanatology,” the study of common practices that surround both birth and death, events that “bookend” our existence. Daughter of an obstetrician who pioneered family-centered birth and spouse of a man who worked in palliative care, Boron noticed the tremendous similarities in the gestures, rituals, and obligations of dealing with both the beginning and the end of life. The obligations extend to the loved ones in the sphere of patients in care--a practice, she writes, “from pre-cradle to post-grave.” 

One chapter reviews the rituals emerging from many different cultures and religions; another examines portrayals of birthing and dying in image and word; yet another addresses the impact of sudden and unanticipated outcomes. Ethical and legal dilemmas and the contingencies imposed by time and place are discussed frankly.  

Recognizing the advantages of medical technologies, she is nevertheless skeptical of their utility in every case and includes practical advice for dealing with pain, showing that midwifery techniques could enhance palliation. Throughout, she acknowledges that things have changed, are changing, and will change again. Sources are referenced in footnotes. 

In the end, the repeated message is one we’ve heard many times before, offered in a refreshing way: the importance of empathy and of listening to the patient's wishes in birthing and in dying. 

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In Medical Bondage: Race, Gender, and the Origins of American Gynecology, Owens argues that the emergence, practice, and professionalization of American gynecology in the 19th century were inextricably enmeshed with the institution of slavery and discourses of biological racism. “Modern American gynecology,” writes Owens, “could certainly exist without slavery, but slavery’s existence allowed for the rapid development of this branch of medicine, and especially of gynecological surgery” (6). As she shows, gynecology developed as quickly as it did only because white American physicians had access to women’s bodies marked as racially inferior. That gynecology’s maturation accelerated in the American South is no indication that its practitioners had a humane interest in enslaved women’s health (66). On the contrary. Owens argues that slave owners were invested in maintaining the reproductive health of enslaved women in the interest of increasing the size of their population: “Thus the repair of any medical condition that could render an otherwise healthy slave woman incapable of bearing children further strengthened the institution of slavery” (39). Additionally, there were broader implications, as medical research using enslaved women’s bodies produced knowledge about how to treat, in turn, white women: “Black lives mattered medically because they made white lives healthier and better” (107).

This leads Owens to argue why enslaved women should be esteemed as the maternal counterparts to the oft-celebrated white ‘fathers’ of American gynecology: “. . . black women, especially those who were enslaved, can arguably be called the ‘mothers’ of this branch of medicine because of the medical roles they played as patients, plantation nurses, and midwives. Their bodies enabled the research that yielded the data for white doctors to write medical articles about gynecological illnesses, pharmacology, treatments, and cures” (25). This is especially true, as she points out, when examining the medical research of the lauded gynecologist, James Marion Sims, who opened and operated a “sick house” for enslaved women suffering from gynecological ailments (36). Sims operated this clinic to devise a surgical solution to a serious and commonplace gynecological issue among enslaved women, vesico-vaginal fistulae. As an enterprising young physician, Sims took advantage of enslaved women’s bodies to conduct his surgical trials. Eventually, he triumphed and cured an enslaved woman, and published the results in a respected medical journal, thus enshrining his reputation (39). The point, Owen emphasizes, is that “[t]hanks in large part to his experimentation on enslaved black women, Sims had established himself as one of the country’s preeminent gynecological surgeons less than a decade after he began his gynecological career” (39). Medical Bondage thus strives, in part, to restore the lives and contributions of these enslaved women to the story of American gynecology’s genesis.

Owens’ study takes a surprising turn, arguing that “. . . the later development of modern American gynecology can no more be disentangled from Irish immigration than it can be separated from its roots in slavery” (90). This shift in racial and geographic focus parallels the similar roles of enslaved black women of the South and poor, immigrant Irish women of the urban North in the development of gynecology. Owens shows how racial alterity was “mapped onto” poor Irish immigrant women living in major urban centers, such as New York City (20). As many Irish immigrant women suffered poverty, inadequate (if any) medical care, sexual assault, and were drawn into prostitution (and the attendant onslaught of venereal diseases), they became ideal medical subjects for gynecologists. Physicians eventually published their Irish patient case studies, which “. . . helped to create the foundation for the racist laws that colored the Irish as not quite white and sometimes placed them alongside black people as biological models for racial inferiority” (90). Just as Southern gynecologists had access to enslaved women’s bodies, their Northern counterparts treated and experimented on racially othered immigrant women. In this way, Owens argues, “[t]he scientific and medical beliefs that doctors held about Irish women were nearly indistinguishable to [sic] those they held about African women” (115). Overall, Medical Bondage articulates a well-researched and sobering retelling of the dominant accounts of American gynecology.

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Physician-Assisted Suicide and Euthanasia, edited by Shelton Rubenfeld and Daniel Sulmasy, is an unusual collection of scholarly essays in that it combines essays about Nazi euthanasia with others that deal with contemporary PAD (Physician Aid in Dying) and questions whether there might be a relationship between the two. This perspective is understandable, given the book’s origin. The Center for Medicine after the Holocaust, an organization with the mission “to challenge doctors, nurses, and bioethicists to personally confront the medical ethics of the Holocaust and to apply that knowledge to contemporary practice and research,” invited a group of North American and Israeli palliative care specialists and medical ethicists in 2018 to visit German sites associated with Third Reich euthanasia programs.  The intensive discussions that followed resulted in this provocative collection of papers.  

Dr. Timothy Quill is among the writers supporting the moral probity and legalization of PAD, while Drs. Diane Meier and Daniel Sulmasy present strong arguments against the practice.

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Station Eleven

Mandel, Emily

Last Updated: Oct-27-2022
Annotated by:
Duffin, Jacalyn

Primary Category: Literature / Fiction

Genre: Novel

Summary:

In the not-too-distant future, Arthur Leander, a famous actor, suddenly collapses and dies on a Toronto stage in the final act of King Lear.. That same night the deadly and highly contagious Georgian Flu reaches North America from Russia. Within days, civilization, as we know it, collapses: no electricity, no gasoline, no water, no travel, no Internet, no information, no medicine, and no escape. A handful of survivors hide in their separate lairs, until their resources are depleted and then they flee on foot, at first alone, stealing and foraging for food, trusting no one, and learning to kill. Surviving. The story takes place in Year 20 after the collapse with frequent visits to the past. 

Without realizing it, the protagonists are all connected to Arthur– his ex-wives, young son, best friend, a child actor, the paramedic who tried to resuscitate him at the theatre. Older people remember and mourn the “before time” and its marvels that are lost, perhaps forever. In oppressive heat, a troupe of musicians and actors, called the Traveling Symphony, moves from place-to-place around the Great Lakes, performing music and Shakespeare’s plays because “survival is insufficient.” Usually, they bring pleasure and diversion. But they must take care, as some villages are led by cult-like prophets, intent on control by theft, rape, and murder. Only at the end do they reach Severn City, where a fledging community has created a semblance of peace and respect in an abandoned airport with a museum devoted to all that is lost.

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Annotated by:
Glass, Guy

Primary Category: Literature / Nonfiction

Genre: Memoir

Summary:

When Rachel Aviv, the author of Strangers to Ourselves, was six years old, she simply stopped eating.  She said she got the idea from the Yom Kippur fast.  She was promptly checked into a psychiatric hospital where she became one of the youngest-ever patients to be given the diagnosis of anorexia.  Through associating with older, more seasoned anorexic girls she became a sort of “anorexic-in-training” (p.13). Fortunately, after a few months she snapped out of it, and was discharged.  She never suffered from the same symptoms again.   

As an adult, Aviv began to think about what had happened to her.  The only remnant of her experience was a diary entry from age 8: “I had a diseas called anexexia” (p.231).  Had she even had the disorder, or had the diagnosis been a mistake?  Why had she not gone on to have “an anorexic ‘career’” (ibid.), while one of the girls who had mentored her ultimately died of anorexia-related causes?   In order to answer these questions for herself, Aviv meets with the therapists who treated her more than thirty years ago as well as with the family of her deceased copatient.   

As a result of Aviv’s introspection, she becomes intrigued by people whose psychiatric diagnoses do not fully capture the complexities of their situation.  Strangers to Ourselves presents detailed case histories of several such individuals.  Bapu is an Indian woman whose visions have caused her to be diagnosed with schizophrenia.  Are they delusions, or is she a mystic?  Naomi is a socially disadvantaged black woman who has struggled unsuccessfully to get ahead.  During a manic episode, she jumps into a river with her young twins, one of whom dies. Her claim that “white people are out to get me” (p. 146) is ignored because her doctors insist that “delusions couldn’t on some level make sense” (p. 150). Yet another woman, Laura, bounces from diagnosis to diagnosis, and sleeps fourteen hours a day because of all the medication she is on.  She becomes one of these people who no longer even know if their lack of functioning is “due to their underlying disorder [or] the heavy medications they’d taken for it” (p. 203).      

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Hurdy Gurdy

Wilson, Christopher

Last Updated: Oct-14-2022
Annotated by:
Duffin, Jacalyn

Primary Category: Literature / Fiction

Genre: Novel

Summary:

Brother Diggery, formerly called Jack Fox, tells us that he was given to the monastic order of St Odo at the age of seven in 1341. For another seven years, he is raised in innocence within the strict rules of the community, serving the brother healer, learning herbal remedies, and playing the hurdy gurdy.  

As plague arrives in 1349, he is assigned to help care for the anticipated sick – and immediately falls ill. The brothers seal him inside his cell, where he suffers greatly, narrowly escaping death; however, when he recovers and forces himself out of confinement, he discovers that everyone else has died or fled. After filling a mass grave with the remains of his brothers, he sets out on a picaresque series of adventures, blithely unaware that he and his fleas spread illness wherever they go.  

Like a fourteenth-century Candide, Brother Diggery’s gullibility and curiosity lead him to discover the wonders of good food, sex, and marriage, the cruelty of lies, theft, and wrongful imprisonment, and the corruption of the church (p. 164). He closes his account in 1352, age 18, already twice widowed, but set for life as a lay physician and father of a young boy whom he plans to give to the monastery of St Odo when he reaches age seven.



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The Way of All Flesh

Parry, Ambrose

Last Updated: Oct-04-2022
Annotated by:
Duffin, Jacalyn

Primary Category: Literature / Fiction

Genre: Novel

Summary:

Will Raven is a medical student beginning his apprenticeship with Dr James Young Simpson. He has been involved with a prostitute Evie whom he finds murdered. Simpson’s housemaid, Sarah Fisher, takes a dislike to him, not least because of his educational and social privileges. She is barred from such opportunities because of her gender and class, despite her greater intelligence. Sarah studies medicine on her own. Coming from poverty, Raven is nevertheless, pompous, chauvinistic, quick to fight, and desperate to earn money and status. 

Like Evie, other young girls are being brutally murdered in the Old Town of Edinburgh, and Raven and Sarah are separately motivated to find the killer. Their master, Simpson, is conducting experiments with anesthesia and suspicions are cast upon him. Although Raven and Sarah are part of his household, they find his behavior mysterious. Eventually they collaborate to solve both mysteries.

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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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