WRITING DOCTOR'S BLOG by NYHWRITER.COM

Book News for 2009

Between the Recession and Napsterizing books, the sales of new books have plummeted. Even Dan Brown's THE LOST SYMBOL, the much-anticipated heir to his phantasmagoric THE DAVINCI CODE, and Teddy Kennedy's memorable last words in TRUE COMPASS have not garnered the sales that publishers and bookstores hoped for.

As recession-pained consumers cut corners everywhere and such internet file storage sites as RapidShare, Megaupload, and Hotfile spew ebooks without the copyright holder's say so. piracy has become the name of the game.

Meantime, some readers are waiting for Christmas when it's always better to receive. Since everyone is hoping for the best--and waiting for paperback releases, it's a good idea to pick and choose carefully, ignore big bombshells in favor of smaller grenades that might be better reading, go to the library, and drop hints loudly and unsubtley to anyone who's looking for gift suggestions that YOU might like. And even treasure.

It would be nice if Christmas of 2009 could be the book-lovers' celebration of the century. Don't delay. Start hinting now.

JOHN GRISHAM'S ASSOCIATE NOT UP TO PAR

I was waiting in the doctor's office. People came and went. But I sat. Lawrence Durrell's onetime best seller, JUSTINE, sat on my lap with me. But it was failing me. Justine and all the characters around her were unnecessarily complex.

 Bored and restless, I drifted out to the hospital gift shop. A page turner was what I needed. Or wanted. What could be better than John Grisham's THE ASSOCIATE. Grisham was always reliable for sitting on the tarmac or waiting in hospitals. Or so I thought.

But even Grisham can let you down. The machinations of a large law firm, the temptations of a young lawyer, all are Grisham's stock in trade. But for once, they don't click. Kyle McAvoy doesn't choose temptation so much as he is chosen. The characters are all flat. Grisham is a moralist but even the associate can't fight the unfightables of big-time legal beagles.

The book is well-named. It's only qualifies as an associate of such spectacular Grisham offerings as THE FIRM and THE RUNAWAY JURY.

Wondering What Happened: Philip Roth's THE HUMBLING

   My bumper sticker reads, "Inside every old person is a young person wondering what happened." Abandonment is what happened to Simon Axler. The famous 65-year-old stage and movie actor is the ultimate loser in THE HUMBLING, Philip Roth's slim new novella, the 30th of his collection. The three-act story of age's ultimate despoliation is the latest in the recent fictive trio (EVERYMAN and EXIT GHOST) of Roth's ruminations on the destructions wreaked by age.

Everything goes. The book begins where it ends with the line, "He'd lost his magic. The impulse was spent." His disappointed audience and his literary critics abandon him. His wife, unwilling to be his support, the ironically named Victoria, leaves him. After she leaves, he dreams of suicide with his trusty gun, but isn't ready. Instead, he checks into a psychiatric hospital. Ostensibly cured because he can  sleep through the night, he goes home to his loneliness.

His agent understands what it's like in lines that only Philip Roth could have written:

"Let's face it. There's a panic that comes with age. One, you get slower. In everything....My speech is slower. My memory is slower. All these things start to happen. In the process, you start to distrust yourself. You're not as quick as you used to be. ...You start to feel afraid, to feel soft, to feel that you don't have the raw live power that you had. With the result...that you're not free any more. There's nothing happening--and that's terrifying."

After his agent leaves, Axler, consumed by the possibilities of suicide, reviews all the plays in which a character commits suicide from HEDDA GABLER to Konstantin in THE SEAGULL. Always aware of his lost audience, he decides to reread all these plays, for "Nobody should be able to say that he did not think it through."

Into this abyss, Pegeen Stapleford, a 40-year-old lesbian and daughter of his friends, appears on his doorstep. Roth doesn't make clear what brings her to Axler. Whether it is curiosity or opportunism is never clear. Thus begins a 13-month passionate relationship which pulls Axler out of his doldrums until Pegeen has enough. The new life that Pegeen brings is over. She takes the clothes and bookcases he brought her and walks out.

From the "transformation," Axler is catapulted into the last act. Pegeen's leaving is the abandonment he cannot sustain. Hers is the ultimate humbling, the loss of an audience that will not return.

It is no secret that this actor who has wooed suicide throughout the novel kills himself. The ultimate irony is that he shoots himself playing the role of his first big New York success long ago. Even more ironically, he kills himself in the attic where his body is discovered by the only audience left to him, his cleaning woman.

The last line connects with the first: "He had brought it off, the well established stage star, once so widely heralded for his force as an actor, whom in his day people would flock to the theater to see."

The humbling is complete.  The abandonment on the first page ends on the last.

E-Books vs. B-Books: Which reader are you?

Which are better? E-Books, those electronic versions on Amazon's Kindle and Sony's Reader, or the old-fashioned kind between hard or paperback covers? What's more readably enticing? Which is a better bargain costing less with Amazon, Walmart, and Target pricing books at $8.98 and $9.00?

It all depends on your point of view. And the room on your bookshelves. Also, whether you'd rather read in bed, while exercising on your treadmill, or hooked to wireless networks. The New York Times claims "these, which offer a sense of control and customization that consumers have come to expect from all their media gadgets, has created a greater interest in books."

So who are you? Which are you? What would make you read more? Let us know.

SOMETHING FOR THE PAIN DOESN'T HELP

SOMETHING FOR THE PAIN: COMPASSION AND BURNOUT IN THE ER by Paul Austin, MD (Norton: paper, September, 2009)

    What makes a doctor? What undoes a doctor? Time and sleeplessness are the relentless enemies of the person who would become an emergency room (ER) doctor.  Paul Austin depicts himself battling these enemies in this collection of personal essays tracking Austin’s difficult development into an emergency room doctor.  

Sally Austin, Paul Austin’s wife, is the unsung heroine of these stories. The unsung heroes of Paul Austin’s life are his children who get exceedingly short shrift from their egocentric father.

 If you have read Vicki Forman’s THIS LOVELY LIFE (and I hope you have), Paul Austin’s stories stand in stark contrast to Forman’s courage in the face of dealing with the death of one twin and the horrendous physical problems of the other twin. The difference reveals once again how impenetrable is the wall between patients and doctors—as you probably know if you have already tried to climb it yourself.

   Paul Austin’s primary goals are more sleep for himself and very secondarily more time for patients. Without these essentials, he goes through the motions of seeing too many patients, too quickly. Rarely does he see his family.

  A recent JAMA (JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION) focuses on “Resident Fatigue and Perceived Errors” in a recent issue devoted to the problems of developing “great mindfulness—a quality of being fully present and attentive in the moment” as a means of averting physicians’ reported burnout. These articles echo Austin’s book. Nobody, but nobody has any cures for sleep deprivation and better patient care.

  Austin’s choppy stories read much like a night in the ER. Young residents might read them but patients might steer clear.

THIS LOVELY LIFE: A Memoir of Premature Motherhood by Vicki Forman (Mariner Books)

THIS LOVELY LIFE by Vicki Forman            

                Vicki Forman’s life with her twins, Evan and Ellie, born 17 weeks early, isn’t lovely at all. Although she begged her doctors to “let my babies go” because she knew they had no chance to live normal lives, the doctors wouldn’t listen. California law mandated resuscitation. Four days later, Ellie died leaving Evan—and his family—to deal with his many disabilities: blindness, seizures, inability to walk or talk. Mourning Ellie’s death, Vicki and her family somehow learned to cope with Evan’s life, to love him for what he was, to try to help him be better.

                Vicki’s “memoir” of parental vicissitudes with premature children, ironically called “super preemies” is wrenched with loss and triumphs and more loss. Even the alternative healing center in Arizona  doesn’t really help Evan. Yet somehow he learns to walk painfully with a cane, to say a few words, to go to a special school. Somehow, Vicki learns to love him with an intensity that seems to exclude her husband Cliff and her daughter Josie. She dedicates this book to all that she has learned from Evan.

                But life—and death—were not done with her. After Forman’s memoir won the Bakeless Prize, after Mariner Books was ready to publish it, Evan died suddenly just before his eighth birthday.  In the epilogue where Forman shocks the reader by recounting Evan’s death, she wonders if his death symbolizes that he is through teaching her all he can about love and patience.  The family is left at the end of the book where it was in the beginning.  Just Vicki, Cliff, and Josie to pick up the pieces. And as Forman makes clear, they will go on together as part of Evan’s legacy.

                As a result, Forman’s  title remains a mystery. Was it Evan’s life that despite everything was “lovely”? Was it the strength Vicki and her family found together that made it “lovely”?  I’m not sure but nonetheless, Forman’s story is well worth reading as a tale of finding inner strength no matter what happens.

Running from Loneliness by Inventing Lives: RHYMING LIFE & DEATH by AMOS OZ

    My 1984 interview at Kibbutz Hulda with AMOS Oz (published in Southwest Review) was an exercise in avoidance.  He told me a lot. And left out even more. Now, 25 years later, his recent memoir, A TALE OF LOVE AND DARKNESS,  revealed that his mother Fania committed suicide when he was only 12. Even though he seemed to be hiding something about his mother in 1984. he never told me all his truths about his mother and father.

     During the interview, after much hesitation and feinting, the fact that we are both only children established a tenuous bond between us. "Only children," said Oz, "have some urgent need for more contact, proximity with other people. I create my own sisters and brothers. Each develops. Then I quarrel with them...I was a very lonely boy...Everything I have ever written or shall ever write will be autobiographical....There is no way not to write about the self."

    Oz's current novella, RHYMING LIFE & DEATH, embodies what Oz meant when he talked to me so long ago. While the book is only 117 pages, the central character, "the Author" is a man in his 40s as Oz was when we talked. Alone, even with the 37 people he meets during the eight hours of his nocturnal wanderings, he invents lives for each one. An annotated appendix lists them all, including such minor characters as the thickset night watchman and Rochelle Resnik's cat, Joselito, who is Oz tells us is "Jealous. Can tell time. And makes her feel guilty."

    The novella begins and ends with The Author alone. Initially, he is readying himself to meet readers' questions at his lecture at the Shunia Shor Community Center. Since every lecture is all deja vu, he anticipates the foolish questions he knows his audience will ask: "Why do you write? Why do you write the way you do? Are you trying to influence your readers, and if so, how?" Anyone who has ever been to an authorial lecture --anywhere--will recognize the ridiculous sameness and obtuseness of "literary" audience's quiz programs.

    During the night, the Author tries to sleep with Rochelle, the professional reader, but the affair is doomed to failure. Repeatedly, he recognizes that he writes "to touch without touching, so that they touch him without really touching him."

    "Rhyming Life and Death" is also the title of a collection by a once famous, now forgotten poet, with whom the Author identifies. Reading in a newspaper that the poet died in his sleep of "heart failure" (a contagious disease to Oz?), the Author concludes "Once in a while it is worth turning on the light to clarify what is going on. Tomorrow will be warm and humid, too. And in fact, tomorrow is today."

    Oz's light is on. Life and death rhyme in a strange music. The Author and his many characters hear "broken cries of alarm from a parked car that can no longer bear its loneliness, the low weeping of a man in the next door apartment,...the shriek of a nightbird nearby that can perhaps already see what is hidden from you and me." As tomorrow becomes today, Amos Oz looks longingly toward what is hidden in this brilliant novella that speaks for the Author of yesterday, today, and tomorrow. 

    

It's a Gift: GIFTED HANDS by Dr. Seymour I. Schwartz

        Known all over the world for his surgical skills, his must-read surgical textbook SCHWARTZ'S PRINCIPLES OF SURGERY (its 7th edition sold more than half a million copies), Seymour Schwartz is a Renaissance man. Just as well recognized among the mapping conoscenti as are his medical books in the operating rooms, the cartographic brilliance of his works on historical maps dominate the map world. Dr Schwartz is famous for his seminal PUTTING "AMERICA" ON THE MAP: THE STORY OF THE MOST IMPORTANT GRAPHIC DOCUMENT IN THE HISTORY OF THE UNITED STATES.

        Dr. Schwartz's new book, GIFTED HANDS adds one more work to his distinguished output.  For now the historian turns his attention from maps to his first love (I think) surgery. In GIFTED HANDS, Seymour Schwartz looks at the history of surgery from its early barber-shop aggressiveness to the modern-day surgical daring-do of cardiac surgery, organ transplants, and robotics. 

        Extensively researched from Henri de Mondeville's TREATISE ON SURGERY (1260-1320) through pre-Columbian and Colonial times, to modern burn therapy, transfusions, and the late Judah Folkman's findings on vascular biology and anti-angiogenic agents for cancer therapy, GIFTED HANDS is a page-turner. But one with a point of view.

        Quoting de Mondeville, Schwartz establishes his perspective: "The doings of surgery are visible and manifest while those of medicine are hidden, which is very fortunate for many physicians" (italics mine). Schwartz's history portrays "surgery as undoubtedly...superior to medicine." Schwartz depicts the old surgeons and the new as beings superior to "ordinary" internists and family physicians.

        For anyone interested in what makes--and has made--surgery and those special individuals known as surgeons--tick through the centuries, GIFTED HANDS is an exciting book.  You don't have to be a medical student or a surgical resident to care about this story of surgical mysteries and its practitioners. Now it's time for internists and family practitioners to write their own story of doctors looking more inside rather than outside the world of disease.

THE WRITING DOCTOR WILL BE IN ABSENTIA FOR 2 WEEKS

jUST SO YOU WON'T MISS ME TOO MUCH,I'm warning you that I'll be away from Thursday, June 25th to Wednesday, July 8th. From June 29th to July 3rd, we'll be in Napa Valley (in St. Helena to be exact).

If you know someplace we just CAN'T MISS, please 0 please email me today, the 23rd or tomorrow, the 24th, at nywriter@rochester.rr.com or call me at 585-385-1515. From the 25th on, you can reach me on my cell phone at 585-317-3594 or 585-317-3679.

Otherwise, I'll be back at the Rochester ranch on Wed, July 8th.

See you soon.

When Sex is Boring: The East, the West, and Sex by Richard Bernstein

I wish I liked Richard Bernstein’s THE EAST, THE WEST, AND SEX: A History of Erotic Encounters. I wish I knew what he was getting at and why he wrote it. Strangled by sodden prose, apparently a way of being polite about what runs the risk of prurience, Bernstein is instead boring in the extreme.

He states: “For centuries, the East broadly defined to include most of the world’s territory from North and East Africa to South, Southeast, East Asia,  represented a domain of special erotic fascination and fulfillment for Western men.” This territory covers a multitude of men—and of sins.

He begins with a “Chinabounder”’s bragging about trysting with Chinese women and moves over to what Western men can do and want to do with women of the East.  From Cleopatra to Colonialism and “ harem culture”, Bernstein slogs though the possible relationships.  

The reader loses interest quickly never to regain it again in what Bernstein refers to as “the world as it was and is, “ which is, he adds, “testimony to the raw power of the urge that has populated the globe, that drives some men crazy and makes other men wise…free from the judgment of an unsympathetic God and far from the domain of restriction and repression that is home.”

Bernstein’s eroticism is, then, a lost cause –for Western men, Asian women, and longing readers.

Hub Kid Bids Fans Adieu: John Updike's Last Words

Hub Kid Bids Fans Adieu

                In 1960, when John Updike, a lifelong Red Sox fan, was only 27, he wrote lovingly of Ted Williams’s last day at bat in "Hub Kid Bids Fans Adieu."  Talking about Williams’s life (like Updike, Williams was not a born and bred "Hub Kid") as “Youth, Maturity, and Age; or Thesis, Antithesis, and Synthesis; or Jason, Achilles, and Nestor,” Updike concludes , “So he knew how to do even that, the hardest thing. Quit.”

                Updike, another hub kid, despite his nostalgia for his small town Pennsylvania childhood, the town and friends which have deteriorated, has also quit.  Lung cancer, the product of those first cigarettes sold him at the train station when he was 15, has felled him. But like Williams, Updike left us with two home runs, a book of short stories, MY FATHER’S TEARS AND OTHER STORIES and ENDPOINT AND OTHER POEMS.

                “Morocco,” the first story, the only one written before 2000, is about an American family on vacation. Everything goes wrong. Plans and hotels go awry. Updike, the autobiographical narrator, remembers, “We had achieved, in Morocco, maximum family compression and could only henceforth disperse. Growing up, leaving home, watching your parents divorce—all in the decade since, have happened. But on a radiant high platform of the Eiffel Tower I felt us still molded, it seemed, forever together.” The rest of the stories talk about children far away when families are no longer compressed.

                The other stories, written in Updike’s last decade, mainly hone in on men who are aging, hate its encroachments, but know it’s better than the alternative, which he fears—yet know it’s coming.  Older possessions, like aging small towns, are a comfort—and a rebuke—a reminder that nothing ever stays the same. In Morocco and Paris, the family belongs. In these last stories, age has “islanded” the ironically named Fairchild as well as the author of the stories. Travelers no longer belong where they travel—even when, like David Kern, they try to go back where they came from—and can’t find their way. His father-in-law “moved among us…like a planet exempt from the law of gravitational attraction.”

                In the title story, “My Father’s Tears,” the autobiographical narrator learns his father has died suddenly while he was in Paris with his first wife: “She put her arms around me in the bed and told me, ‘Cry.’ Though I saw the opportunity, and the rightness of seizing it, I don’t believe I did. My father’s tears had used up mine.”

In the stories, no one weeps tears except for words of loss. But in “Endpoint,” the poems written on each birthday from March 18^th, 2002 till the last one en route to a hospice in Danvers, Massachusetts cry out in anguish because they feel the end coming. After the birthday poem of 2007, there are poems from his hospital bed at the Massachusetts General Hospital. Referring to our “wastrel lives,” he looks askance at his books as “the piled produce of bald ambition.”

Noting “Age I must, but die I would rather not,” seeing himself as “an Adam being nibbled like old ice,” looking at “A life poured into words—apparent waste/intended to preserve the thing consumed/For who, in that unthinkable future/when I am dead,  will read?” he wonders what it was all about, what his life achieved. Always haunted “How not to think of death?, “ the writing helps. He calls, “Be with me, words, a little longer; you/have given me my quitclaim in the sun.”

The words of “Endpoint, the last ones he wrote before the trip to the hospice, give Updike his quitclaim. Painfully marvelous, they cry out for respite while knowing, as the last poem in the series cries out in an echo of the 23^rd psalm, “Surely—magnificent, that “surely”--/goodness and mercey shall follow me all/the days of my life, my life, forever.”

Tucked away in the end of the book under “Poems, Light and Personal,” among light poems about Monica and a poem “To a Well-connected Mouse” is “Requiem,” the poem that says it all in farewell:

“It came to me the other day:

“Were I to die, no one would say,

“’Oh, what a shame! So young, so full

“Of promise—depths unplumable.’

“Instead, a shrug and tearless eyes

“Will greet my overdue demise;

“The wide response will be, I know,

“’I thought he died a while ago.’

“For life’s a shabby subterfugre,

“An death is real, and dark, and huge,

“The shock of it will register

“Nowhere but where it will occur.”

                Like Ted Williams, John Updike’s poetry knows when to quit. We can only wish that this transplanted hub kid had not quit so soon.

Getting Depression before It Gets You: THE DEPRESSION CURE by Ilardi

THE DEPRESSION CURE: The 6-Step Program to Beat Depression without Drugs by Stephen S. Ilardi (Lifelong Books, Perseus books/DaCapo, Cambridge, Mass) reviewed by Nancy Yanes Hoffman, the Writing Doctor, nywriter@rochester.rr.com

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        When I first looked at Stephen Ilardi’s THE DEPRESSION CURE, I thought it was one more how-to article enlarged to be a book selling to anyone and everyone who felt depressed, which includes a lot of us. But I was wrong. For Ilardi has done a good job at transforming old lifestyle concepts into accessible, workable form. While the stories of his patients’ successes and lifestyle changes are surely not new, what makes his book worthwhile are the organizational skills his book recommends to overcome depression.

His recommended lifestyle changes are not new but worth revisiting:

A diet high in omega-3 fatty acids; concentrating on enjoyable activities;  lots of exercise; plenty of sunlight (a impossibility in the Northeast); forcing yourself to have as much social support as possible; acquiring regular sleep habits.

Ilardi’s difference is in the valuable methods he offers to overcome depression’s problems.  He cites how to tolerate omega3 supplements and buying a 10,000-lux light box to enhance the Northerner’s lack of sunlight.  Further, he suggests increasing intake of Vitamin D daily, and of course, avoiding anti-ruminative activity which fosters and perpetuates depression.

THE DEPRESSION CURE won’t cure depression but it will help little and big sufferers confront and deal with it.

The Other Woman's View: Sometimes Mine by Martha Moody

SOMETIMES MINE by Martha Moody reviewed by Nancy Yanes Hoffman, the Writing Doctor, nywriter@rochester.rr.com,

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Genie Toledo, the 40-ish narrator of Martha Moody’s SOMETIMES MINE, is the Other Woman locked in a 12-year affair with a married man.  Every Thursday, Genie, an invasive cardiologist, and Mick Crabbe, a basketball coach, meet in the same Marriott hotel room. Their initial sexual excitement with each other becomes a deeply passionate, reticulated loving relationship.  But eventually, the Other Woman pays bitter prices.

For Genie and Mick are controlled by their other lives. Genie’s patient monitor, pinned to her belt, calls her away from her daughter Claudia’s need to talk about her own love affair. It imposes on everything except the precious two hours on Thursday with Mick when the monitor is turned off. When prostate cancer strikes Mick, he refuses to give up coaching the team to get adequate medical care. Mick refuses to leave the team and go for surgery which probably could have saved his life. His mantra, “It’ll work out” proves hollow. For Mick, Genie is third on his list of priorities, after the team and his family.

Under Mick’s guidance, the team catapults to national prominence. But the price is egregious. For the cancer metastasizes. No longer are Mick and Genie able to be carefree lovers.  What was “Sometimes Mine” becomes less and less hers as the cancer eats away at Mick.

Meantime, Genie’s medical partners trade greed for good medical care. Cardiologist Moody doesn’t pull punches about the tainting of doctors’ motives.  Genie indicts her partners’ money grubbing: “Proficiency and experience don’t matter. Loyalty doesn’t matter. Giving the best care to our patients doesn’t matter. Only money matters.”

Moody’s page-turner speaks wise and witty volumes to both men and women about the complications of mid-life’s demands and disappointments, the questions about marriage and relationships, the issues about how to raise children. Her earlier novel, BEST FRIENDS, sold 650,000 copies. SOMETIMES MINE, a better book, should sell even more.

Can Doctors and Patients Communicate?

       In 1927, just months before he died of inoperable cancer when he was only 46 years old, Dr Francis Peabody, chief of the Harvard medical service at Boston City Hospital and the Thorndike Medical Laboratory, wrote in “The Care of the Patient” in JAMA (the Journal of the American Medical Association):

 

            “The most common criticism made at present by older practitioners is that young graduates have been taught a great deal about the mechanism of disease, but very little about the practice of medicine—or to put it more bluntly, they are too “scientific” and do not know how to take care of the patient.

 

            “The good physician knows his patients through and through, and his knowledge is bought dearly. Time, sympathy, and understanding must be lavishly dispensed, but the reward is to be found in that personal bond which forms the greatest satisfaction of the practice of medicine.  One of the essential qualities of the clinician is interest in humanity, for the care of the patient is in caring for the patient. (italics mine).”

 

            Advocating the importance of the house call, Peabody advocating seeing patients in their own environment:

 

            “”The clinical picture’ is not just a photograph of a man sick in bed; it is an impressionistic painting of the patient surrounded by his home, his work, his relations, his friends, his joys, sorrows, hopes, and fears.”

 

            Fifty years later, in 1977, Dr. George Engel published his classic thesis advocating the biopsychosocial model of medicine as a means of diagnosing and treating patients—as opposed to the biological model used by so many physicians today. The same year, Dr. Engel asked in “The Care of the Patient: Art or Science” ?

 

Today. many long years after Peabody and Engel—and too many short uncommunicative MD-patient visits--, James C. Harris of Johns Hopkins recalls their work and discusses the importance of patient-centered treatment in caring for patients in “Toward a Restorative Medicine—The Science of Care” in JAMA in April of 2009.

 

            Now, three new books are trying to attack these non-communicative problems bedevilling patients. Their approaches represent three points of view. The first, ONLY TEN SECONDS TO CARE: Help and Hope for Busy Clinicians

is by a physician, Wendy Schlessel Harpham (Philadelphia: ACP Press,  2009), who writes from her own experiences..Harpham is an internist, a veteran of chronic indolent lymphoma which still limits her energies, and a patient advocate.

 As a doctor-patient, she tries to tell practicing physicians, residents, and medical students what it feels like from the other side of the bedside. Her book is filled with stories illustrating ways for doctors to make life easier for patients. Although her advice to physicians on caring for patients is succinct and compassionate, I’m not sure how many rushed and rushing MDs will follow her lead—until they themselves get sick..

 

            The second BREAKING THE CYCLE: How to Turn Conflict into Collaboration When You and Your Patients Disagree

By George F. Blackall, PsyD, Steven Simms, PhD, and Michael J. Green, MD (Philadelphia: ACP Press, 2009) implicitly and explicitly asks whether the much-maligned “difficult patient” blocks good patient care—or whether it is the difficult doctor who is the root of medical conflict. Although the authors’ stance implies helping physicians overcome their own attitudinal problems with patients, the WALL ST JOURNAL review tends to put the onus on patients by asking, “Are you a difficult patient?”

 

            BREAKING THE CYCLE is a valuable little book because it describes the cycle of conflict between patients and physicians, delineates unproductive cycles in relationships, talks about ways to build collaboration and prevent impasses with patients, and ways of responding to difficult medical relationships. It is unique in talking about ways physicians—and patients are forced to deal with the devils of chronic disease and the crises in the ICU. It reminds physicians that many patients have trouble describing their problems. Patients are older. Physicians usually are younger. Patients look forward to the visit and pour too much into their stories. Doctors want to move on to the next patient. Time is everyone’s enemy. So, too, is greed, which often limits the doctor’s time. Although primarily intended for physicians and staff, we will all someday be patients, we all need our doctors—and they—if they would succeed and avoid burnout—need us.. “Doctor” means “teacher” and it is up to doctors to teach patients how to get what they want from the physician by zeroing in on the major problem spurring their medical visit. to the physician.

 

            Kudos to the American College of Physicians’s ACP Press for recognizing the invidious conflicts inherent in                                                                                                                                                                                                      the doctor-patient relationships. But brickbats for charging $39.95 for this paperback with its dated references. The price will drive away many patients, medical students, residents, and even practicing MDs who might benefit from its good advice. Surely, it will make patients wonder.

 

 HOW PATIENTS SHOULD THINK: 10 Questions to Ask Your Doctor about Drugs, Tests, and Treatment by Ray Moynihan and Melissa Sweet (New York: Pegasus Books, 2009) is a lot less expensive at $15.95 and an exceedingly valuable guide—but for patients only . Some of Australian journalists Moynihan and Sweet’s advice is rooted in a healthy skepticism for unhealthy patients but the premise is conflict-building. But advising, “[I]t can be a mistake to sit back and hand over control for our health care” tends to oversimplify.  Asking questions is helpful but a chip on your shoulder is not. The oversimplified guide to questions in each chapter may help and may not. The message is that patients should write down their questions and offer them in a way that opens the doors to information. Warnings about the “dangers” of screening are dangerous in themselves. The value of these questions is in the best way of concluding the visit with necessary information before the examining room door is shut.

 

Despite these clarion calls for communication, despite  many physicians—and lots of patients—begging for better relationships between those two unequals, doctors and patients, not much has changed. One of the best books crossing the Rubicon between doctors and patients in Jerome Groopman’s HOW DOCTORS THINK (Boston: Houghton Mifflin, 2007)., reviewed in this blog.  If I were sick, I’d get on a plane for Boston and sit on Dr. Groopman’s doorstep till he saw me.

 

 

MATCH DAY DOESN'T MATCH

MATCH DAY: One Day and One Dramatic Year in the Lives of Three New Doctors  by Brian Eule (New York: St. Martin’s,  2009). Review by Nancy Yanes Hoffman, THE WRITING DOCTOR, at www.writingdoctor.typepad.com, nywriter@rochester.rr.com, 585-385-1515.

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            I wish Match Day had been a better book. Focusing on three medical school seniors, females all, Brian Eule’s book misses the point.

 

            For the benefit of the non-informed, Match Day matches—ostensibly—the choices of medical students for residencies with the choices that the hospitals make. I remember explaining the exigencies of Match Day to a literary colleague who remarked, “If doctors are going to put up with that kind of random choosing, they deserve what they get.”

 

            It’s difficult to figure out what Eule was trying to do. Even though medical school classes are more than 50% female, even though women students have special challenges, it seems ridiculous to focus only on the problems of three women students coping with their lives, with the successes and failures of matching, and with their follow-up internship year. For Eule’s Match Day is not about the day alone but is about the first year residency.

 

            Match Day is an article padded into a book. Like internships that don’t match the aspirations of medical students, Match Day is a poor fit.

NATURE VS. NURTURE: THE ART & POLITICS OF SCIENCE

THE  ART  AND POLITICS OF SCIENCE  by Harold Varmus (New York: W.W.Norton, 2009).

Review by Nancy Yanes Hoffman, THE WRITING DOCTOR, at www.writingdoctor.typepad.com, nywriter@rochester.rr.com, 585-385-1515.

                   Is it nature or nurture? What factors produce a Nobel Laureate in cancer biology and a helmsman of important scientific establishments? How did Harold Varmus, a onetime graduate student in literature, remake himself into a brilliant medical researcher? How did he get where he is going? And continues to go, marrying science to politics—and the not inconsiderable gift of obtaining scientific funding.

                   We owe Varmus. With Michael Bishop, his medical cohort at the University of California at San Francisco (UCSF), he detected proto-oncogenes, tumor viruses causing cancer. The Nobel prize was Varmus and Bishop’s reward for this seminal discovery which affects much of cancer research today. Although the section on “doing science” is complex, he manages to explain the ins and outs of the ways proto-oncogenes operate and how scientists use this knowledge to target cancer treatment.

                   The book divides into four major sections: “becoming a scientist”; “doing science”; (becoming) a political scientist; and “continuing controversies.” Varmus’s contributions do not stop with oncogenes. Nor was his career always fruitful. Director of the National Institute of Health (NIH), his career was marked by ups and downs. He details the “bad times” at NIH with amazing frankness, a hallmark of the book. He even tells how Harvard Medical School rejected his application, showing that admissions officers are not always so smart.

                   Varmus does not believe that scientists can exist in a vacuum.  Quoting Joshua Lederberg that “Science cannot exist without a community of scientists,” he adds:

                   “Science is an inherently paradoxical activity. Nearly all great ideas come from individual minds, and they are often first tested experimentally by a single person. But validation and acceptance of new information requires communication, convening, and consensus building—activities that involve a community. In many ways, it is this balance between the imagination of the individual and the conviction of the community that makes science particularly interesting and gratifying. Scientists may work and compete as individuals, but the competitive efforts are ultimately directed to the construction of a common edifice, knowledge of the natural world….

                   “…Molecular biology has shown that all forms of life on earth make use of the same basic rules for encoding and transmitting information. ..It is extraordinary to have such dimensions to our knowledge. Doing science to learn these things is the best way I know to live with an incomprehensible universe.”

                   Today, Varmus is president of the Memorial Sloan-Kettering Cancer Center and co-chairs President Obama’s The President’s Council of Advisors on Science and Technology. He is more a man of the community of science than a lone scientist. One wonders where he will go from here.

                   In this regard, Varmus’s book leaves the reader wondering just who this man is. He devotes four lines to his wife and sons, little mention of his mother’s breast cancer as an influence on his cancer research. With wit and self-deprecation, he talks about the roads taken—but tends to omit the whys of the roads not taken, how much was nature, how much nurture.

                   The Art and Politics of Science leaves the reader longing for another volume to pick up where this one leaves off.

Doctoring on the Computer: Doctors Write New Medical Books for 2009

New Books by and about Doctors and Patients By THE WRITING DOCTOR: NY Hoffman, nywriter@rochester.rr.com, 16 San Rafael Dr, Rochester, NY, 585-385-1515 +++++++++++++++++++++++++++++++++++++++++++++++++++++++ Brain Surgeon by Keith Black, MD with Arnold Mann. (New York: Wellness Central, 2009) Rupture by A. Scott Pearson, MD (Ipswich, Mass: Oceanview Publishing, 2009) Beat the Reaper by Josh Bazell, MD (Boston: Little, Brown, 2009) Normal at Any Cost: Tall Girls, Short Boys, and the Medical Industry’s Quest to Manipulate Height By Susan Cohen and Christine Cosgrove (New York:Tarcher/Penguin, 2009) ++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ Medical books are bursting at the booksellers’ seams. Keith Black, a brilliant neurosurgeon, writes about his life, an inspiration from early childhood. Scott Pearson and Josh Bazell write about the tortures of medical training, especially surgical training, which make you wonder why anyone becomes a surgeon. Cohen and Cosgrove warn about the dangers of manipulating children’s height. If you want to inspire the young, have them read Black’s book. If you want them to be satisfied with who they are and what they look like, have them read Cohen and Cosgrove, which should be on everyone’s reading list. If you want to see how doctors write novels, have them read both Pearson and Bazell’s endeavors. Actually, Pearson’s Rupture deserves more attention than Bazell’s, which is filled with footnotes that only interrupt the reader and make concentration a joke. Let me know what you think and I’ll publish your comments.

Sex and Joy--Not Work: The Joy of Sex in Today's World

THE JOY OF SEX by Alex Comfort . The “ultimate Revised Edition” by Susan Quillliam (Crown, 2008).

By THE WRITING DOCTOR: NY Hoffman, nywriter@rochester.rr.com,

16 San Rafael Drive, Rochester, New York 14618. Tel: 585-385-1515.

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“Telling children about sex,” said my mother, her lips pursed, her nostrils quivering, “leads straight to juvenile delinquency.”  Practicing what she preached—or didn’t preach, she never told me anything. Not that as a fifth daughter from Maine in the era of enforced blue laws, she knew so much.

                Juvenile delinquency never really tempted me. I was the good only child from Newton.  How could I veer from the straight and narrow?  Or so I thought. Still,  the Harvard Medical Students I dated tried their best to show me what I was missing.

                At 18, I broke the code. Sort of. When I got myself engaged to a medical resident, he was appalled at how much I didn’t know.

                “How can your mother let you out like that?” he demanded. I didn’t have a clue what I knew or ought to know. So on Valentine’s Day, he gave me a copy of Van de Velde’s  best seller.  Published in the 20’s, before I was born, and replete with insider-gynecological terms, it taught me something.

               Thus began my sex education.  From Havelock Ellis and Margaret Sanger to Theodoor Van de Velde, sexologists’s books  paved the way  for darkened rooms and back seats of cars.

Some sex books were successful – not just for me.   Alec Comfort’s THE JOY OF SEX sold eight million copies in 22 languages. Other sex books languished in the Never-Never Land of outsiders to NY Times Best Seller lists. As though it were an emergency,  we bought three shelves full. We even read a few.

                Comfort’s JOY OF SEX was a winner.   Not just for us.  Recognizing that its popularity remained stalwart even though the times have changed, Crown publishers attempted to resurrect the original  JOY.  They commissioned psychologist-sexologist  Susan Quilliam to update Comfort’s 1972 original for those of us who still look for joy in sex—and who long for clearer instruction and innovative ideas, even some technical recommendations..

Quilliam’s version contains new illustrations. The illustration of how to put on a condom is helpful—if you don’t have a diaphragm.  The greasy, bearded man of the original is no more. The hero is clean-shaven, handsome, and 30-ish. The couple in the frontispiece is kissing primly.  Everybody is relatively young, slender, good-looking, and not in the least passionate.

Although the world of books rich in sexual  explanation is pretty crowded, Quilliam believes, “There’s still a huge need for a straight-talking, informed, inspirational guide to sex.” True. But Quilliam’s modern JOY regrettably doesn’t fill the bill. The section on contraception is only fair. Neither teenagers nor elderly dim Quilliam’s pages.  

Who would buy this book—or to whom would I give it? It’s not for the young. Not for beginners.  Nor is it for older people. “Led” by its disorganized layout, the index is useless. Although “little blue pills” are listed in the index, Viagra, Levitra, Cialis are not!  For readers who yearn for more information, there’s little detail on technique. The links to other resources are inadequate (does Macy’s tell Gimbels?).

Because Comfort addresses the joys, not the dangers, diseases, and disappointments of human sexual congress, so, too, does Quilliam.  As befits a specialist in sexual relationships, Quilliam focuses on relationships to the exclusion of issues facing outsiders. The single, divorced, widowed, obese, and gray-haired apparently stay home, stuck with ESPN and no partners.  Desire, the sine qua non of good sexuality, gets undeserved short shrift in Quilliam’s hands.

Comfort’s book was essentially from a male perspective. Quilliam’s rewrite is essentially from a female perspective. In today’s world, ostensibly we feel freer to talk about sex, even to relegating “orgasm” to the status of a verb (a Freudian error on p.75?).

What Quilliam includes and excludes raises questions. She dropped the section on prostitution, --but adds one on sex shops and another on striptease. She mentions the crucial spots—A, G, and U, if a woman and her partner can find them without resorting to Map Quest.  Oral intercourse, in Quilliam’s hands, becomes “mouth work.” But somehow, sex as “work,” one of Quilliam’s favorite words for sexual action, loses all its joy.

                Alex Comfort’s original JOY was a groundbreaker in an age when the joys of sex were relegated to whispers. Sad to say, Susan Quilliam’s update adds little to what we already know and makes us yearn for more details, more of a how-to in sexual technique.

Young Forever: SOMEWHERE TOWARDS THE END by Diana Athill (Norton, 2009)

                “Growing old,” said Bette Davis, “is not for sissies.” 

                As 91-year-old Diana Athill, never a sissy, travels the roads taken, she reports on how it is from SOMEWHERE  TOWARD THE END (wherever the end may be). Although my mother said, “The golden years are 14-Karat brass,” Athill’s journey is actually golden.

                This is important. For Athill is not the only one on that road. We’re all growing older. Well, maybe not growing. More like getting there.

                With 78 million American boomers hitting 60 with a bang, writers increasingly focus on the dilemmas of older characters. Reviewers and readers grow older by the minute.  As writers get gray—and grayer, they write about what it’s like. Or not to like.

                Lately, many writers in their 70s and yes, their 80s, have turned their magnifying glasses onto what happens or doesn’t happen with age. Philip Roth’s EVERYMAN and EXIT GHOST, Margaret Drabble’s THE SEA LADY: A LATE ROMANCE, Jose Saramago’s DEATH WITHOUT INTERRUPTIONS. Larry McMurtry’s WHEN THE LIGHT GOES all focus on the failures of flesh and spirit, the losses accompanying too many candles on a birthday cake.

                Athill’s  story of what it’s like now and how it’s been doesn’t focus on losses or the failures of flesh and spirit. Yet she doesn’t scant these.  The epigraph to her dispatches from the age front is from Edgar Leslie:  “It ain’t no sin, To take off your skin, And dance about, In your bones.”

                The bones she dances in are alive and well. Even though she lost interest in sex in her 70s (she never says why), the many men in her life fill her memories. She always preferred black men--who always preferred her because she is white.  Some were married, some not. Except for Paul, an early lover whose jilting remained painful after 20 years, her affairs petered out to companionship.

For Barry, her lover in her 40s, she saved – and 50 years later is still saving his life. Despite the string of younger lovers he brought into the home they shared even after their romance died, she cared for all his medical problems. Bedridden, he still remains in her care. Not only did Diana invite Sally, the most important of these women, to live with them but she dedicates her “memoir” to Sally, her husband, and their children.

                When Athill “ceased to be a sexual being,” she concentrated more sharply on her belief that God does not exist, that the nature of the world cannot be grasped, that religion is composed of “fairy stories.”

                She says she is lucky. She is. Always looking on the bright side , she has few regrets about her life.  Still able to drive, not incontinent, enjoying her garden, and most of all, able to find surcease in examining her life and writing about it, Athill is still young. She could give lessons to us all.

                My bumper sticker announces, “Inside every old person is a young person wondering what happened.” Diana Athill's book--and life-- tells you what happened and how to keep that young person alive no matter where you are on that road.       

She may be at the hill, but she still can climb it. Wherever readers are in their own journeys, SOMEWHERE TOWARDS THE END is a must for all of us who need to follow that road.

               

 544 words

Wisdom: What Are You? Where Are You?: HOW TO LIVE: A SEARCH FOR WISDOM FROM OLD PEOPLE (While They Are Still on This Earth) by Henry Alford (Hachette Twelve, 2009)

HOW TO LIVE: A SEARCH FOR WISDOM FROM OLD PEOPLE (While They Are Still on This Earth)  by Henry Alford (Hachette Twelve, 2009)

By THE WRITING DOCTOR: NY Hoffman, nywriter@rochester.rr.com,

16 San Rafael Dr, Rochester, NY, 585-385-1515

+++++++++++++++++++++++++++++++++++++++++++++++++++++++

          I wish I knew how Henry Alford did it.

Selling HOW TO LIVE: A SEARCH FOR WISDOM FROM OLD PEOPLE  to the Hachette Group’s Twelve division was brilliant. Getting Publisher’s Weekly to anoint  his useless undertaking as one of its “Best Nonfiction Books of the Year” was an even greater masterpiece of salesmanship. Would that Alford's book was up to the fulsome comments from reviewers who apparently never read its nattering in the guise of elderly wisdom.

Alford spends the first six chapters talking about how hard it was to corner wise—and famous—old people and why many of them cleverly refused to participate. The book finally turns on his 79-year-old mother’s divorce from his stepfather after 25 years of marriage, which ties it together and breaks it apart:

  “People sometimes ask me if I feel in any way responsible for my mother’s divorce,” he notes, adding, “I don’t. Possibly I feel a small amount of responsibility vis-à-vis its timing. Will’s interview had some of the flavor of a deathbed confession. But obviously the divorce would have happened without me. I was merely yeast.”

Always acting as yeast but never as nutrition, Alford finally gets down to his interviews, first with sociologist  Setsuko Nishi, as he introduces her with “The decisions we make can yield more pain than we expect.”

Yet  his mother and his divorced stepfather Will intrude throughout this blessedly slim collection of empty words from such elders as Sherwin Nuland, Ashley Brilliant, Norman Mailer, Edward Albee, old-time comic Phyllis Diller, and spiritualist Ram Dass, now felled by a stroke.

Their age-acquired “wisdom” varies with their different personalities, what they know, what they remember, how they want to be remembered.  Although literary giant Harold Bloom cautions, “wisdom is a very dark topic,” Alford neither listens nor defines what he’s after or what he finds among people grown older—but not necessarily smarter. Somehow, neither he nor we learn what they have found and what they are still looking for.

The dust  jacket  maintains (in italics, no less), “It makes you actually want to get older.” But it doesn’t . It just makes you want to figure out how Alford sold his book to a publisher and how the publisher convinced reviewers to sing its praises.

THE PATIENT IS NOT SO PRIVATE: MURDER AS COSMETIC SURGERY

THE PRIVATE PATIENT  by P.D. James (Knopf, 2009)

By THE WRITING DOCTOR: NY Hoffman, nywriter@rochester.rr.com,

16 San Rafael Dr, Rochester, NY, 585-385-1515

+++++++++++++++++++++++++++++++++++++++++++++++++++++++

          We’re all growing older. Well, maybe not growing. More like getting there.

          With 78 million American boomers hitting 60, with an even higher percentage of UK denizens trying to figure out what to do about the aging "process," novels increasingly focus on the dilemmas of older characters. For the reading public grows older by the minute. What’s more.  As writers get gray—and grayer, they write about what it’s like. Or not to like.

          Lately, many writers in their 70s and yes, their 80s, have turned their magnifying glasses to what happens or doesn’t happen with age. Philip Roth’s EVERYMAN and EXIT GHOST, Margaret Drabble’s THE SEA LADY: A LATE ROMANCE, Jose Saramago’s DEATH WITHOUT INTERRUPTIONS. Larry McMurtry’s WHEN THE LIGHT GOES all focus on the failures of flesh and spirit, the losses accompanying too many candles on  birthday cakes.

          At 88, P.D. James is older than this crew, an inspiration to keep going for everyone who hates counting birthday candles. In her latest novel, THE PRIVATE PATIENT, James indicts aging as “the amorphous flattening of self.”  Yet Adam Dalgleish, her stalwart poetry-writing detective, seems ageless as far as searching Google can ascertain.  A longtime widower, he’s apparently much older than Emma, his fiancée, or so her distant father believes.

          Yet both James and Dalgleish are coming to the end of their ropes. When Dalgleish looks upon the remnants of Rhoda Gradwyn’s body, strangled after her plastic surgery to remove a childhood facial scar, he thinks, “This was not the most horrific corpse he had seen in his years as a detective," yet he wonders, "Perhaps I’ve had enough of murder.”

          What faces say and don’t say fascinates James.  Dalgleish, who dominates 14 of her novels—including this one-- first appeared in James’s 1962 novel, COVER HER FACE.  Gradwyn, a mudslinging journalistic dredger long known for exposing hidden truths, has decided to have her surgery because she “no longer needed her scar.” Yet the reader, who comes to identify with her, never knows what spawned this decision.

          Who killed Rhoda Gradwyn? And why? The group at Cheverell Manor, the Tudor mansion now converted into a plastic surgery clinic, is rife with potential murderers. From Dr Chandler-Powell, the plastic surgeon himself, to his worried and worrying staff, James depicts each suspect, warts—motives—and all.

           James makes it clear that institutions ostensibly caring for patients whether for facial alterations or getting older are not what they seem. Dalgleish and his team obtain the final clues to youth’s ancient stalking of age from an old lawyer whose last days are barricaded in a nursing facility where “care had been taken not to distress visitors by displaying any notice bearing the words retirement, elderly, nursing, or home.”

          What now? Does Rhoda Gradwyn’s murder signify the end of both Baroness James’s mysteries and Adam Dalgleish’s cerebral solutions? We don’t know.

Still, guessing is an honorable art for mystery readers, whether old or young. THE PRIVATE PATIENT peopled by lonely losers ends with their tidy couplings worthy of Dickens. Future Jamesian readers can only hope that age will not wither James’s infinite variety nor will Dalgleish's marriage spoil her classical detective’s insights.

THE WRITING DOCTOR GETS DOCTORED

Just to let you know, we'll be among the missing till January 15th. Tuesday, December 9th, the writing doctor will be doctored with super-duper double deluxe spinal surgery. It'll be at UCSF in San Francisco. The computer's keys will be silent till January 15th.

Meantime, I'll be reading a slew of books, mostly crime fiction, the best anodyne of them all. What follows is the NY Times list of Notable Crime fiction. As for you, take pity on the writing doctor and send in your favorites. See you in January in between the snow flakes falling.

---

  Jesse Kellerman. THE GENIUS (Putnam, $24.95)

 Denise Mina,SLIP OF THE KNIFE (Little, Brown, $24.99),

 Michael Connelly , THE BRASS VERDICT (Little, Brown, $26.99),

Ian Ranklin, EXIT MUSIC (Little, Brown, $26)

George Pelecanos, THE TURNAROUND (Little, Brown, $24.99).

Debra Ginsberg, THE GRIFT (Shaye Areheart, $23.95), 

Christine Barber’s first novel, THE REPLACEMENT CHILD (Thomas Dunne/St. Martin’s Minotaur)

 $23.95)

Nevada Barr’s WINTER STUDY (Putnam, $24.95).

Thomas H. Cook, MASTER OF THE DELTA (Otto Penzler/­Harcourt, $24),

Andrew Pyper, THE KILLING CIRCLE (Thomas Dunne/St. Martin’s Minotaur, $24.95),

Karen Maitland, COMPANY OF LIARS (Delacorte, $24),

Ariana Franklin, THE SERPENT’S TALE (Putnam, $25.95),

Lawrence Goldstone, THE ANATOMY OF DECEPTION (Delacorte, $24), by Lawrence Goldstone.**

Frank Tallis, VIENNA BLOOD (Random House, paper, $15)** 

Andrew Martin,  LOST LUGGAGE PORTER (Harvest/Harcourt, paper, $14) 

Catherine O'Flynn, WHAT WAS LOST (Holt, paper, $14),

As for old tried and true favorites, take a look at Daniel Silva, Peter Robinson, Donna Leon, Henning Mankel, and Asa Larsen.

 

LEARNING TO SEE: DISCOVERING PATTERNS IN MATHEMATICS AND POETRY by Marcia Birken and Anne C. Coon (Amsterdam: Rodolpi Press, July, 2008)

DISCOVERING PATTERNS IN MATHEMATICS AND POETRY by Marcia Birken and Anne C. Coon (Amsterdam: Rodolpi Press, July, 2008)
++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
Review by Nancy Yanes-Hoffman, THE WRITING DOCTOR, at www.writingdoctor.typepad.com, email: nywriter@rochester.rr.com,

585-385-1515
16 San Rafael Drive, Rochester NY 14618
+++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
      “My aim, above all,” said the novelist Joseph Conrad, “is to make you see.” Conrad’s injunction is the apparent aim of  Marcia Birken and Anne C. Coon in DISCOVERING PATTERNS IN MATHEMATICS AND POETRY (Amsterdam: Rodolpi Press, July, 2008). 

       Birken, the mathematician, and Coon, the poet, want us to see what’s around us, what are the connections between what we think we see and what is actually there. Their book, the product of their 20-year team-taught course,  invites us on an ongoing journey aimed at the act of “discovering” –or learning to discover—mutual patterns in both mathematics and poetry.

       The book shows us how to count patterns, to see, feel, and hear  them if we would only listen. Early on, it moves from traditionally accessible  poetic forms like the sonnet to mathematic shapes such as plane figures and spirals. More complexly, it talks about “shaped poetry” while tying symmetry in poetry to symmetry in mathematics. Deeper—and more difficult yet-- it leads us through the briers of fractal patterns in nature, geometry, and images of words.

        Making the case for the role of analogy in “creating or understanding those patterns,” Birken and Coon focus on what metaphor can teach us if we would only look—and see.  Both the mathematician and the poet require “abstract reasoning and analogous methodologies” to fortify our grasp of their disciplines.

        In defining poetry, John Ciardi asked, “How does a poem mean?” (italics mine). The patterns of both poetry and mathematics, as Coon and Birken work them out, help us  see how and what they mean by themselves and in relation to each other.    

        Coon and Birken define the purpose of their journey: “In this book, we do not intend to make every reader into a poet or mathematician, but instead…we hope to ‘translate’ their languages for a general audience. Likewise, as we make these languages more understandable, we hope that the patterns of each field will become open to appreciation by a wider audience.” But in translating these special languages, they often make us struggle with the challenges of a new language.

         Finally, the most interesting chapter, “Patterns for the Mind” hones in on “the brain-teasing concepts of proof, paradox, and infinity.” It examines the ways that mathematics understands these concepts and then analyzes poetry’s imaginative depictions leading us down the endless road to infinity.

         Supported at every juncture by photographs, diagrams, outlines, and, of course, patterns, this journey across the woods and into the fields of poetry and mathematics lures us into new ways of discovery and recognition.

         Not a book to be read a glance, it repays the considerable effort it demands. For DISCOVERING PATTERNS IN MATHEMATICS AND POETRY offers new visions.  In its pages are a call to see once-ignored “patterns in the physical world and in the world of ideas, whether those patterns are based on numbers or composed with words, captured in a photograph, or exhibited in the faces in a crowd, the outline of buildings against a skyline.”

         A few caveats: First, although right-brain/left-brain explorations are central to the Birken-Coon journey, regrettably they remain undefined. Second, one of my favorite poems about poetic structure, “Patterns” by Marianne Moore, is the face on the cutting room floor.

         And most of all, a book is not a living course. Would that the poet and the mathematician were still offering their course again (are you listening, Academia?). For DISCOVERING PATTERNS IN MATHEMATICS AND POETRY is only a tantalizing way station on the road to discovering the patterns around us.

        As for me:

             I wish
             I knew
             How
             To review
             This book.
             To find
             Patterns
             That speak
         `   While I
       …………………………………………………………follow.

THE SNAKE IN THE GARDEN OF EDEN: THE TAKER by RUBEM FONSECA translated by Clifford E. Landers

       Rio de Janeiro is one of the three or four most beautiful cities in the world.  Blessed by sea, mountains, lakes, and forests, Rio calls itself “Cidade Maravilhosa,” or “Gorgeous City.”

       But in some ways, Rio’s idyllic  beauty is only skin deep. Its crime rate is one of the highest in the world.  In 2006, at least 2,273 people were murdered, for a total of 38 victims per 100,000 persons.  Although London is big and densely populated, its murder rate was 2.2 persons per 100,000 residents (I don’t know where the fraction comes from). Between 1978 and 2000, 49,900 people were murdered in Rio. The police only solved three percent of  these crimes.

         Rio’s poorly paid and ill-equipped  police force compounds the felony. In 2007, the police killed at least 1,330 cariocas (the name for individuals born in Rio).  By contrast, American police “only” killed 347 individuals that same year.

         Why so much crime amidst all this natural glory? The grinding poverty of most of its six million people, the slums of its "favelas" squeezed between its wealthiest neighborhoods set up a vicious contrast between the very rich and the abysmally poor.  Rio is” a city with more people than flies.” But other big cities of the world press the poor against the rich without risking so many random murders on every corner.

            Rubem Fonseca’s THE TAKER depicts a murderous psychopathology bursting out everywhere from everyday lives. Strangely, his gratuitous killers are not escapees from favelas (shanty towns) exacting vengeance upon the rich. More devastatingly, they are middle class haters of their fellow cariocas out to exact revenge upon them for merely existing.

        The business man in “Night Drive” has a luxurious car, his children have cars, and a French.maid serves dinner. Yet his nightly escapes involve going for a drive, spotting a random victim, and killing her with his expert driving. In the title story, “The Taker” and his girl friend give up individual killings, with the exception of Santa Claus on Christmas Eve, for bombing consumers in the supermarket.

        “Account of the Incident” is the only story honing in on the poor. Hungry, they desperately strive to butcher a cow killed in an auto accident. Their violence reflects the omnipresence of death everywhere in Fonseca’s world.

        Although Fonseca steadfastly refuses to discuss the meaning of his stories, he once said of himself, “Perhaps I am ‘The Taker.’” He also says, “A writer should have the courage to show what most people are afraid to say.” Fonseca’s bitterly grim stories, mostly in the first person, show the skull beneath the skin in Rio’s violent world. Tough to read, they analyze Rio’s gratuitous criminality as a symptom of universal hatred among people of every class..

       Who we are, why we hate everyone else taking up space on our earth is Fonseca’s focus. His stories ask questions, point fingers, but have no answers.  The viciousness of his people, their blindness, stands in marked contrast to Rio’s loveliness as we try to figure out whatever happened to Eden, why this haven is the crime center of the world.

THIS JEWEL IS JUST PASTE: THE JEWEL OF MEDINA by Sherry Jones

THE JEWEL OF MEDINA BY Sherry Jones (New York: Beaufort Books, Oct, 2008)
Review by Nancy Yanes Hoffman, THE WRITING DOCTOR, at www.writingdoctor.typepad.com, nywriter@rochester.rr.com, 585-385-1515.

        Danielle Steele beware. Sherry Jones is trying to cut into your territory. Yet despite all the hype about Random House breaking Jones’s contract because Islam might object to her scorcher, Jones's novel  fails abysmally.
 
        THE JEWEL OF MEDINA is frankly boring. Dripping in purple prose, it is replete with uncountable factual errors. Jones's story of A’isha, beginning when she is six years old and drifting through the years when she becomes Mohammed’s favorite wife, feels endless.

         After forcing myself to plod through A’isha’s soap operatic romance with her husband Mohammed, I can only advise my readers of one thing: don’t bother.

         The Random House publishing scandal aside, the novel won’t satisfy your curiosity anout Mohammed. Why Random bought this book in the first place remains a mystery. Why it bumped the contract remains even more mysterious. After all, Random publishes Salman Rushdie against whom a "Fatwa" still exists. When Random's editors compared Rushdie's brilliant new THE ENCHANTRESS OF FLORENCE with Jones's tinselly JEWEL, they must have killed the contract on the spot.

           Just why Beaufort picked up the JEWEL is even stranger. Harlequin Books might have been a more appropriate publising localer.

         One word for Islam's mistaken defenders. Don’t worry about Mohammed. He’s a nice, sexy, fatherly guy who deserves greater kindness than Jones can figure out for him than A’isha’s trashy story. In fact, one of the misplaced foci of this novel is its emphasis on A’isha, rather than on the singular virtues of Mohammed who would have been a much more interesting central figure.

        Meantime, the secret of the Jewel’s “success” bursts from Jones’s safety deposit box which can't contain her new riches.  Curiosity may not have killed the cat--but it surely sells trashy books.
 

WHOSE PETS ARE THESE? THE PETS by BRAGI OLAFSSON translated by JANICE BALFOUR

THE PETS by Bragi  Ólafsson: Translated from the Icelandic  by Janice Balfour (Rochester, New York: Open Letter Publishing, Literary Translations from  the University of Rochester)

Review by Nancy Yanes Hoffman, THE WRITING DOCTOR, at www.writingdoctor.typepad.com, nywriter@rochester.rr.com, 585-385-1515.

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              Five years ago, when I spoke at in Reykjavik, Iceland was riding high. Its financial boom looked as though it would last forever (sound familiar?) Fishermen became bankers.  Rich bankers.  Iceland’s three largest banks, Kaupthing, Landsbanki Islands, and Glitnir were lending wildly.

              The Wall Street Journal reported that “The banks’ assets reach 10 billion pounds, about 10 times the country’s gross domestic product last year, and their foreign depositors …far outnumber the island’s population.”

              But the party’s over. The government has seized the entire banking system. The krona plummeted 40% against the euro in just a few weeks.

              So what? What’s this got to do with  Bragi Ólafsson’s prescient “novel,” THE PETS . Originally published in 2001, THE PETS  was even more presciently translated by Janice Balfour in 2008.

               In the heat of the American financial crisis, the University of Rochester’s newly established Open Door Series has published this strangely cautionary tale of greed, passive-aggression—and frankly abusive aggression while  nobody minds the store. And nobody seems to care.

              THE PETS centers on two ne-er-do- wells with extra money in their pockets, their once-hateful relationship when five years before, they ostensibly took “care” of some pets in London. Failing abysmally, they angrily parted company with one paying off the other.

              The two men are Emil, a prim passive  who narrates most of  this loosely knit tale from under his bed where he has fled to avoid meeting  Havard, the loud lout (are there any quiet louts?). For after a welcome five-year absence, Havard has climbed in Emil’s window to find him once again. Searching the house but not looking under the bed, Havard answers the phone, invites Emil's friends for a party, and bathes in Emil's liquor. 

              Just back from another trip to London, Emil would rather inhale the dust under his bed, feel the springs pushing against him, than confront Havard, who “didn’t seem to  be interested in anything, unless it was forbidden or contained the highest percentage of alcohol.”

             The house fills with the noise of Emil's friends who wonder where he might be. Meanwhile, lying under the bed, Emil, easily annoyed,  recalls all the little irritations of the return flight, particularly his talkative seatmate, Armann, whose glasses Emil forgets to return.  The minor annoyances vanish after he meets Greta, whom he knew fifteen years ago.  Despite the complications of a present girl friend, Emil has arranged to meet Greta once again at his house.

            Initially, the chapters alternate between Emil’s first-person recollections and Havard’s third-person descriptions but the chapters soon shift to Emil’s under-bed perspective, which is pretty dim.

             It’s tough to care about these two. Their futures end as they began. With such characters tending Iceland's meltdown, it's easy to see why its glaciers are now dripping from its financial trees.  THE PETS can only make us wonder what will happen to us as we huddle under our economic beds and ponder our future.

LOSING OUR DESTINATION: DEATH WITH INTERRUPTIONS by SARAMAGO

DEATH WITH INTERRUPTIONS  by José Saramago, Translation from the Portuguese by Margaret Jull Costa ( New York: Harcourt, Oct.6th, 2008)
 
Review by Nancy Yanes Hoffman, THE WRITING DOCTOR, at www.writingdoctor.typepad.com, nywriter@rochester.rr.com, 585-385-1515.

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      The Maestro of What-If is at it again. With his new novel, DEATH WITH INTERRUPTIONS,  Jose Saramago, Nobel Laureate for literature, repeatedly asks “What if?” Just as he has in many of his previous works, he upsets the ostensibly sturdy apple carts holding the structured myths governing our lives and our behavior.

        BLINDNESS, Saramago's novel on which the newly released film is based, shows what happens when an epidemic of white blindness besets an unnamed town, implicitly asking what it means to see—and not to see. In DEATH WITH INTERRUPTIONS, Saramago asks what happens if everyone stopped dying. For on New Year’s Day,  the ten million dwellers in an unnamed land find that death is no more.

          The novel begins in media res with:

           “The following day, no one died. This fact, being absolutely contrary to life’s rules, provoked enormous, and in  the circumstances, perfectly justifiable anxiety in people’s minds, for we have only to consider that in the  entire forty volumes of human history there is no mention, not even one exemplary case, of such a phenomenon  having occurred…New year’s eve had failed to leave behind it the usual calamitous trail of fatalities.”

             Death has stopped but dying has not:

            “There was, however, no shortage of blood. ..One thing was clear, today, the victims refused to die...It was already late afternoon when the rumor began to spread that, since the beginning of the new year, more  precisely since zero hour on the first day of January, there was no record in the whole country of anyone dying.”

             Initially joyous at defeating death, people quickly learn how much they depended on her to keep their lives going.  Hospitals have no empty beds. No longer can they rely on rotating the newly sick with the newly dead. Doctors, funeral directors, insurance companies experience a financial crisis much like the one visited upon us these days.

             Debating the pros and cons of losing death as the ultimate punctuation mark to a life sentence, philosophers argue its pros and cons. Priests protest vociferously, ‘Without death, prime minister, there is no resurrection, and without resurrection, there is no church.”

             For some people, business is good. For a price, the “maphia” (Saramago’s spelling to distinguish it from its more realistic cousin) joins forces with families and the government to export the very old and the very sick to other countries where they can die in peace—and quickly.

              Eternal life turns out to be a curse. After seven months in absentia, Death herself, personified as a lonely, lovely woman sitting in her chilly apartment with her useless scythe and filing cabinets, decides to halt her experiment and return to the hapless citizenry. She mails everyone a letter explaining that she wanted “to give those human beings who so loathe me just a taste of what it would mean to live forever.” Now, she is through.

               Those designated to die will have a one-week warning. A violet envelope will tell them to get ready for Death’s arrival. But one envelope doesn’t work. Three times, it comes back to her unopened..  Astonished, Death seeks out its owner. A 50-year-old cellist lives alone with his dog. Falling in love with the cellist, Death becomes human—another curse.

                As Death lies in bed with the cellist in her arms, the novel ends with as many questions as it raised in the telling.  Was the returned violet envelope intended for Death herself because she succumbs to love?

                The novel’s final words repeat its first ones and ask unanswerable questions about our future if death were no more: “The following day, no one died.” Does love conquer death or will Death finally arise and return alone to her old life? Saramago doesn’t say in this circular fable which ends as it began.

               With Saramago, form follows function. His deliberately endless sentences demonstrate that even words may need an ending  to their journey.

               If you read no other book during this archetypally autumnal season, read—and reread—Saramago’s what-if notes on love and death (capitalized or lower case, depending on your point-of-view). And reread John Donne’s poem “Death Be Not Proud,” which shows that love does defeat death.

730 words

WHERE'S HOME WHEN NOBODY'S HOME? by Dubravka Ugresic, translated from the Croatian by Ellen Elias-Bursac

NOBODY’S HOME by Dubravka Ugresic: Translations from the Croatian  by Ellen Elias-Bursac (Rochester, New York: Open Letter Publishing, Literary Translations from  the University of Rochester)Review by Nancy Yanes Hoffman, THE WRITING DOCTOR, at www.writingdoctor.typepad.com, nywriter@rochester.rr.com, 585-385-1515.

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         Dubravka Ugresic? Who’s she? Well, the Croatian Communist authorities called her a “traitor” and a “public enemy” in 1993 when they threw her out of the troubled land that used to be Yugoslavia—and used to be her home.

        But not until last week when someone gave me Ugresic’s NOBODY’S HOME, her book of essays long and short, had I ever heard of her. Now, this Croatian “witch” has become my mesmerizing friend.

         Joseph Conrad used to say, “My aim, above all, is to make you see.” Ugresic would make us see anew—or old.  For  NOBODY’S HOME guides us on a home-seeking, never-quite-finding journey traversing Europe and New York, pinpointing details and asking questions all the way.

        Ugresic hones in on “the unending, everyday degradation of ordinary human reason, a repetitive degradation of the individual in everyday situations, the opaque mysticism of things that have been banned, the impossibility of dialogue and mediation, the everyday smashing against the blind wall of the absurd.”

        In Ugresic’s world—and in our own, “People looked like sweaty runners jogging in their life race and toting a burden twice their size. Nothing , nothing went smoothly, nothing could be accomplished without friction and anguish.”

         For Ugresic, “doors were often closed.” And yet, she manages to open them for “Ever since I left home, the whole world has become my home.” The title says it  all yet simultaneously asks what it all means. Is the world “nobody’s home” or is nobody home in this world? Ugresic’s vision sees it both ways.

        Both  participant in the cultural diversity she  witnesses so sharply and acting as its sometimes amused, often dismayed observer,  Ugresic lets her ironic double—or triple—vision take over. As an Eastern European writer, Ugresic’s own Balkanized ethnic identity is leery of “culture…as an identity help-kit, …a blank surface onto which meaning may be inscribed and read.”

         NOBODY’s HOME divides into five sections of essays, short and long—she calls them “feuilletons” –written from the early nineties to 2007. Each section asks “who are we?” “where are we going?” Seeming to see her world through female eyes, Ugresic quotes from Virginia Woolf, “As a woman, I have no country. As a woman, I want no country. As a woman, my country is the whole world.” But she deceives us, for her rootless cosmopolitanism—and loneliness—describes us all, women and men.

         Kudos to the Elias-Bursac, the translator, and to the Humanities Project of the newly established University of Rochester’s Open Letter Group for devoting its new press to translations of brilliant, lesser-known novels from the rest of the world. NOBODY’S HOME, the first in this series, is a great harbinger of things to come from Open Letter's editors and translators. Long may it succeed.

APPOINTMENT IN SAMARRA: PHILIP ROTH'S INDIGNATION

INDIGNATION by Philip Roth (Houghton Mifflin, September 16, 2008)
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Review by Nancy Yanes-Hoffman, THE WRITING DOCTOR, at www.writingdoctor.typepad.com, email: nywriter@rochester.rr.com,

585-385-1515
16 San Rafael Drive, Rochester NY 14618
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     I’ve read INDIGNATION , Philip Roth’s 29th novel, three times. I think I’ve figured it out. Maybe.

     Ever since his first novel, GOODBYE COLUMBUS burst on the literary scene, Philip Roth has been an American must-read phenomenon.  Singularly autobiographical, mainly honing in on writers or other luft-menschen as central characters, Roth wrote of  young and horny protagonists  when he was young. They got older when age caught him in its tentacles.

     Now 76, Roth recently seems galvanized by a new burst of energy, publishing a new book almost every year. The list of his prizes is endless. From Pulitzer to the National Medal of Arts, the Gold Medal in Fiction, the National Book Award, National Book Critics Circle award. Only the Nobel is missing.

     But INDIGNATION  is a far cry from Roth’s latest pattern.  Roth’s last two books, the brilliant, moving EVERYMAN, and the disappointing EXIT GHOST  confront the terrifying abyss of aging and dying.  INDIGNATION is also about death, but its prime mover, Marcus Messner dies “three months short of his twentieth birthday,” killed in the Korean War. Messner’s death  is an appointment in Samarra. He’s caught by that which he would escape.

     What kills Marcus? Whose fault is it that  Marcus is killed before he can grow up, dead in that long-forgotten, much-neglected  Korean War? Is it his paranoid, over-protective father who imagines death—and sex--at every corner? Is it Marcus’s flight from Newark to college in Winesburg, Ohio, to run from his father’s rages?

     (Just why Winesburg, the site of Sherwood Anderson’s brilliant group short stories, is Marcus’s unforgiving escape hatch remains one of the mysteries of his tortured tale).

     Marcus’s father is one of  Roth’s love-hate fathers, who drives him away from his bloody, kosher butcher shop to the obviously, “goyish” Ohio world where he can’t find a congenial roommate, where the anti-Semitic fraternities ban him. And where chapel attendance is required. What he does find is a sexually adept, “Blowjob Queen” in the psychologically scarified Olivia Hutton, whom he learns to love despite his mother’s protests. Castigated by the Republican, Red-baiting president of the college for his unwillingness to belong, for his quoting of  Bertrand Russell to the dean, Marcus is thrown out of school—only to be drafted, the one thing he was fighting against.

     Letting Marcus tell his story from the grave, Roth finally answers the crucial question in the novel’s last paragraph of what—or who—killed “Marcus Messner, 1932-1952, the only one of his classmates unfortunate enough to be killed in the Korean War, which ended with the signing of an armistice agreement on July 27, 1953, eleven full months before Marcus, had he been able to stomach chapel and keep his mouth shut, would have received his undergraduate degree from Winesburg College—more than likely as class valedictorian—and thus postponed learning what his uneducated father had been trying so hard to teach him all along: of the terrible, the incomprehensible way one’s most banal, incidental, even comical choices achieve the most disproportionate result.”

     It is, then, Marcus himself, his father, his unwelcoming Winesburg, Ohio school, his warring with the college president (and vomiting all over the dean), that lands him in Korea to meet his death.  For Marcus’s story depicts the powerlessness of individuals as they try to  run from their fates—only to embrace their destinies. No matter what their age, Marcus's impassioned, irrational father was right. Death does lurk just around the corner in Roth’s Samarra. And perhaps in our own as well.

iS THERE A KEY TO MAIMONIDES? HOSPITAL: MAN, WOMAN, BIRTH, DEATH, INFINITY, PLUS RED TAPE, BAD BEHAVIOR, MONEY, GOD, AND DIVERSITY ON STEROIDS by Julie Salamon (Penguin, June, 2008)

HOSPITAL: MAN, WOMAN, BIRTH, DEATH, INFINITY, PLUS RED TAPE, BAD BEHAVIOR, MONEY, GOD, AND DIVERSITY ON STEROIDS  by Julie Salamon (Penguin,  June, 2008)

Review by Nancy Yanes Hoffman, THE WRITING DOCTOR, at www.writingdoctor.typepad.com, email: nywriter@rochester.rr.com,

585-385-1515, 16 San Rafael Drive, Rochester,NY, 14618

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The title of HOSPITAL, replete with a 15-world subtitle, tells it all. Julie Salomon tries to pull her story of one year at Maimonides Medical Center in Brooklyn into one piece. Much as she tries, it doesn’t work. There’s just too much here. The multi-titled plethora shows Salomon’s difficulty in focusing on the problems besetting this big, tension-filled hospital.

Maimonides Hospital has a tall order. Even more than most hospitals. It must translate 67 different languages (if possible) for its patients. It must try to collect money from patients (if possible) who don’t have insurance. It must mend (if possible) the fights between physicians. Salomon asks, “What were the financial, ethical, scientific, sociological, personal, and cultural matters that determined what kind of care people received.” Bewildered, she adds, “What did it mean to care anyway?”

This is her essential question as she tries to figure out, “What did it really mean for a hospital to measure up. What was the bottom line?”

The numbers are overwhelming. With 705 beds, Maimonides is one of the largest five percent of the nearly 5,000 American hospitals. In 2003, the 6230 babies born at Maimonides constituted more births than at any other hospital in New York State. In 2003, nearly 39,000 patients were admitted. 127In 2003, nearly 39,000 patients were admitted and 81,190 crowded into its packed emergency room.

Pulling these statistics together, meshing them into the sort of whole that describes a year in the life of such a hospital is probably an impossible task. Salomon does her best but she digresses too much. There’s too much about the personal lives of doctors and their families. Knowing about Pam Brier’s clothes, even though she is the head of the hospital, is irrelevant.

Further, the history of the hospital counts—but she omits mention of some of Maimonides’s eminent faculty: David Segal, Arthur Perlmutter, Dressler who first identified the Dressler syndrome after bypass surgery, Adrian Kantrowitz, the brilliant cardiac surgeon who pioneered bypass surgery. These all deserve attention—more than the marital romance of oncologist Alan Astrow and his wife.

The beginnings of  Maimonides hospital are worth knowing—but Salomon omits them.  How did it get to be what it is today? It used to be an amalgam of Israel Zion (the current Maimonides) and Beth Moses Hospital, which is now forgotten in the bad neighborhood where it tried to make do.

In 1950, my husband was chief resident in medicine at Maimonides. The life then would have been more important for a book like this than details the romance between Alan Astrow and his wife. While Salomon believes in what Astrow is trying to do to bring humanity to patient care, devoting a chapter to him is yet another  distraction.

Even the death of Clarence Davis, with which she closes the book, seems another lack of focus to the story of this big, complicated institution.

Like Maimonides itself, Salomon tries hard but the task just seems too tough. When Pam Brier sums up what patients go through, she shows the superhuman nature of Salomon’s task: “You have to have someone with you to take notes, to ark questions, to hear. Even if you take notes, it’s hard to focus…For all the care organized around you, when you’re in the hospital bed, I won’t say you’re dead meat, but you’re really in a vulnerable position.”

Like the patients in the bed, Salomon tries but her story is as vulnerable as the patients are. It leaves you wondering if there are any answers to describing a hospital, especially one as complex as Maimonides.

When Do We Call the Game? THE MERCY RULE by Perri Klass (Houghton Mifflin, July, 2008)

THE MERCY RULE by Perri Klass (Houghton Mifflin, July, 2008)
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Review by Nancy Yanes-Hoffman, THE WRITING DOCTOR, at www.writingdoctor.typepad.com, email: nywriter@rochester.rr.com, 585-385-1515
16 San Rafael Drive, Rochester NY 14618
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         Can women do it all? Perri Klass, the multitasking pediatrician-writer and author of THE MERCY RULE (Houghton Mifflin, July, 2008), seems to manage it. But Dr Lucy Weiss, Klass's alter ego and central character, seems less sure what she can and cannot do. As for me, I wonder what Klass is trying to say about how well working women can fulfill their responsibilities to family and patients—or whether they risk losing themselves along the way.

        Rereading THE MERCY RULE, I’m still not sure where I stand. My daughter objects to Klass, arguing that she is smug, that her tone implies that yes, certain women can do it all. But Lucy has so many balls in the air that she finally becomes partially disconnected from her family, from the lost women she works with in her job, and even from herself.

       With THE MERCY RULE, form follows function. Honing in on the complications of balancing the demands of the medical profession with the equally (even more?) demanding  profession of being as good a parent--and a wife-- as possible, THE MERCY RULE  feels more  like a group short story than a novel.
 
        The title asks questions that it does not answer. For the benefit of the non-cognoscenti like me, Wikipedia defines  the “mercy rule” as a sports expression, also known as the slaughter rule. The mercy rule ends the game  “when one team has a very large and presumably insurmountable lead over the other.” It quits when the team is ahead. In the Little League where Freddy, Lucy’s odd, mathematically sharp and socially inadept son, plays, the coach calls the game because of the Mercy Rule. A billionaire father, out to have his son outplay the boys, protests, “In life, there are no Mercy Rules.”  Although she believes that “life is full of Mercy Rules, and I follow them as much as I can,” she doesn’t say a word to the obnoxious billionaire.

          Once a foster child going from hand to mouth and foster home to foster home, Lucy was saved when  her beloved sixth grade teacher adopted her.  Lucy Weiss is then a survivor, a pediatrician  running a Boston clinic for neglected children and their forgetful, abandoning  mothers. The stories are about judging parents and children, figuring out what parents and outsiders can  do to make children’s lives better.

         Although Lucy attempts to balance her family life with her professional job, she suffers from a lack of focus, most disturbingly in the last section where the narrative voice changes and speaks dizzyingly to the reader:

         “If you are in any kind of trouble, call me,” concludes the unidentified narrator, ostensibly speaking for Lucy. “Find a way to call me. Call me from anywhere…I want to know we are connected. I will always answer…always hear…always come. Look what the phones can do, nowadays. Look how that can change the story. And the right connection at the right moment is all it takes.”

         But cell phones don’t always work. Connections falter. As a result, even though Lucy’s group short story might make an interesting selection for a  book club, it gets a little lost on the road. Finally, we don’t know where we –or Lucy—can go from here.

         Klass's Treatment Kind and Fair: Letters to a Young Doctor considers the struggle between medicine and family more clearly than this novel and leaves the reader with much more to think about. It would be a good place for Lucy to go next.

Which Would You Rather? Worry or Die?

WORRIED SICK: A PRESCRIPTION FOR HEALTH IN AN OVERTREATED AMERICA by Nortin M. Hadler (Caravan/Univ. North Carolina Press, June,2008) and OVERTREATED: WHY TOO MUCH MEDICINE IS MAKING US SICKER AND POORER by Sharon Brownlee (Bloomsbury, January, 2008)

Review by Nancy Yanes Hoffman, THE WRITING DOCTOR, at www.writingdoctor.typepad.com, email: nywriter@rochester.rr.com,
585-385-1515, 16 San Rafael Drive, Rochester, NY 14618

       Tim Russert is dead.  Wiped out and gone. Although doctors knew he had heart disease, they didn’t realize it was fatal. Like more than the men felled by fatal heart attacks, Russert had no chest pain. A diabetic, he was overweight.

        In 1998, a CT heart scan found Russert’s calcium was 210, which meant his risk of a heart attack was high. Should he have had an angiogram? His cardiologists didn’t think so. If the angiogram had shown the clots in Tim Russert’s vessels, would bypass surgery have saved him?. Even after his death, doctors differed on what an angiogram would have indicated. After his death, his internist asserted, “The number one predictor of mortality is waist circumference.”  Was that all?

        A week after Tim Russert’s death, Drs Ezekiel Emanual and Victor Fuchs published an article in the JAMA (Journal of the American Medical Association) deploring “The Perfect Storm of Over-utilization.” Arguing for reducing overutilization to control costs by altering the combination of physicians’ training and attitudes and patients’ wishes and worries,  vaguely they say “The best hope for reining in costs is to devise financial incentives for physicians and patients that result in greater health value.”

        In the same vein is Sharon Brownlee's book,OVERTREATED - Why Too Much Medicine Is Making Us Sicker And Poorer (Bloomsbury Press, December, 2007).  Brownlee argues that  “much of mainstream medicine's therapies and treatments are never double-blind tested and the financial structure of the current system is literally killing people.” 

        Worse yet is Nortin M. Hadler’s new book WORRIED SICK: a PRESCRIPTION FOR HEALTH IN AN OVERTREATED AMERICA ( Caravan/University of North Carolina Press, June, 2008).  Hadler’s diatribe s should not be confused with Arthur Barsky’s book of the same name, WORRIED SICK: Our Troubled Quest for Wellness ( Little Brown, 1988). A legion of other polemics on “overtreatment” ignoring undercare crowd the web sites on staying well.                       

        Claiming “they,” doctors, “health“ providers, even medical writers like me can make us sick with worry., these worry wart writers stagger readers’ imaginations.

        It’s up to you. Which would you rather? Be worried sick? Or dead? And would a cacophony of medical advisors, positive and negative, keep you well (or well-er)? Maybe yes, maybe no.

        Still, fair is fair. Warnings are in order. Books like Hadler’s and Brownlee’s, articles like Emanuel’s are hazardous to your health.

        From our point of view (a blogger's privilege), worrying sick is better than dying young. Could Tim Russert’s life have been saved by early, aggressive medical action? .. Like their patients, doctors differ. Some are aggressive, some more passive. Everyone has a point of view. That’s why there are books. And blogs like this one. Read them and see for yourself.

        But reading and warnings aren’t all we need. The night Tim Russert died, we had dinner with a Pulitzer Prize journalist. Shaken by Russert’s death, my pot-bellied husband and our girthy dinner companion skipped bread, potatoes, dessert.

        Until the next day. When the brownie brigade started marching again.

552 words

CAN WORDS REPLACE PROZAC? THE MAN WHO MADE LISTS: LOVE, DEATH, MADNESS, AND THE CREATION OF ROGET’S THESAURUS by Joshua Kendall (Putnam, April, 2008)

THE

MAN

WHO MADE LISTS: LOVE, DEATH, MADNESS,

AND

THE CREATION OF ROGET’S THESAURUS by Joshua Kendall (Putnam, April, 2008)

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Review by Nancy Yanes-Hoffman, THE WRITING DOCTOR, at www.writingdoctor.typepad.com, email: nywriter@rochester.rr.com, 585-385-1515

16 San Rafael Drive

,

Rochester

 

NY

 

14618

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            Can words replace Prozac? Well, maybe. At least, words were the treatment of choice for Scientist-Physician-Wordsmith Peter Mark Roget, creator of ROGET’S THESAURUS.  Born into a family cursed by emotional illness, suffering from an obsessive-compulsive disorder, Roget began making lists when he was only eight years old—long before he grew into the man who harnessed his fetish for order with words and most of all, their categories and relationships.

Joshua Kendall, Roget’s biographer, notes, “As a boy, he stumbled upon a remarkable discovery—that compiling lists of words could provide solace, no matter what misfortunes might befall him.  As an adult, he kept returning to the classifications of words and concepts. Immersion in the nuances of language could invariably energize him and keep his persistent anxiety at bay.”

Obsessed with his desire to impose order upon a chaotic world, trying to classify the strange relationships between language and life, focusing on words “that always constituted a means to an end…disseminating scientific knowledge that ultimately had some useful purpose,” Roget studied medicine and became a successful

London

physician.

But sorrow dogged him. Married at 46 to Mary Hobson, beautiful, smart,  rich, and 16 years younger than he, Roget was crushed by her death from breast cancer nine years later when she was only 38. Still, words supported him. Fifteen years after Mary’s death, he published the BRIDGEWATER TREATISE  “the culmination of his lifelong pursuit, begun in his childhood notebook, to organize the animate world.”

Science and medicine provided insufficient comfort. Even a mistress, whom he preferred to his depressive daughter Kate, was not enough. Finally, retiring in 1848, Roget gave new meaning to the word, “retirement.” In 1852, Roget published the first edition of his THESAURUS.  Until his death at 90, Roget continued to work on his “treasure” (the English definition of the Latin “thesaurus”), modifying, improving, tweaking as he went along.

Roget’s was not the first treatise on “synonymy” and language. Bishop John Wilkins’ 1668 Essay towards a Real Character and Philosophical Language and Hester Lynch Piozzi (Samuel Johnson’s friend)’s 1794 British Synonymy preceded the Thesaurus. But classifying, organizing, categorizing words and their relationship to each other and to experience made Roget’s a first in its own right.

For reasons unknown but guessed at, lists (there’s that word again) of the many doctors who also became writers rarely include Peter Mark Roget’s name. Yet it was his scientific training that helped him harness his penchant for organizing words into the treasure that writers still depend on today.

A glance into Microsoft’s so-called “thesaurus,” a look at the insufferability of the email clogging our computers, makes us realize how today’s world is giving short shrift to Roget’s undertaking.

Words alone do not a communicator make. Roget’s self-enclosed life proved that. But words with thought can enrich our lives and make us look beneath the surface. We owe Roget a debt. For who could ask for anything more?

CAN EMPATHY BE TAUGHT: WHEN DOCTORS BECOME PATIENTS by ROBERT KLITZMAN

WHEN DOCTORS BECOME PATIENTS by Robert Klitzman (Oxford, March, 2008)

Review by Nancy Yanes Hoffman, THE WRITING DOCTOR, at www.writingdoctor.typepad.com, email: nywriter@rochester.rr.com,
585-385-1515, 16 San Rafael Drive, Rochester, NY 14618

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       When Harcourt bought CHANGE OF HEART: The Bypass Experience, my book interviewing 1100 veterans of coronary bypass surgery, I was elated. Flush with my success, I tried to convince them to publish my next book of interviews with 100 doctors who were veterans of coronary bypass surgery.

        “Nobody will be interested,” retorted the editor. But he was wrong.

         Robert Klitzman’s important new book, WHEN DOCTORS BECOME PATIENTS, proved just how wrong one editor can be. 

         Klitzman interviewed 70 physicians, male and female, young and old—from 25 to 87, all victimized by a variety of chronic and acute diseases including lymphoma, breast cancer, skin cancer, Huntington’s disease, heart attacks, depression, bipolar distress, and an overly high incidence of HIV.

         Whatever their illnesses were, disease was isolating. Even though their different illnesses mandated a variety of diagnoses, treatment, responses,  and coping mechanisms, many sick doctors felt left on their doorsteps by calloused and unsympathetic colleagues. Since 34 percent of  doctors in Klitzman’s study were HIV positive or suffered from frank AIDs, most opted for secrecy. But the four women physicians killed by metastatic cancer within a year after Klitzman finished his book also faced “peripheralization and discrimination.”  One physician reporting that her colleagues “treated me as if I were dead.”

          Even if these doctor-patients wanted to talk to their physicians, communicating  with physicians was a tough ball game.  Here, the doctor who is sick confronts the same barriers as the non-doctor who wants to communicate with his or her physician.

          A Berlin Wall blocked the two sides of the bedside. Perhaps fearful of their own futures, healthy doctors acted threatened by their sick colleagues. Many healthy MDs expected the sick to continue toting work loads despite their diseases. Some sick physicians, denying the inroads of illness, carried their share of patient care for as long as possible. Others gave in, willingly or unwillingly, to patienthood’s unwelcome passivity. Checking up on their doctors along the way, some found better doctors to care for them, others were distressed by the MDs they found.

           Like the rest of us hit by illness, these doctors hated being sick, hated the world of patienthood, hated being burdens, hated how disease had changed them in the eyes of other doctors. Hospital gowns, patronizing paternalism, humiliated them. Superspecialists ignored them. Colleagues turned their backs.

           What did sickness teach these doctor-patients? Written on their flesh was the truth behind Kafka’s words: “To write prescriptions is easy. To come to an understanding with people is hard.”

           Klitzman believes that doctors who have been sick can learn from the ways their own doctors treated them. As a result, they “assessed this treatment with more knowledge and higher standards of comparison than do other patients…In doing so they offered insights and epiphanies that could help both other patients and providers.”

           Learning empathy from their own experiences, most of these doctor-patients became better doctors, gentler, more understanding after they had battled with illness. They learned to “put myself in my patients’ clothes, “ to ask themselves, “How would I  react?”

           For every doctor is a possible patient. No one is immune. The white coat is not a shield. It’s just a white coat, stained with the blood of others, with the striving, successes, and defeats of caring for others. Medical school, internship and residency, rarely teach physicians that patienthood lies waiting for each of them, ready to pounce when least expected.

          The doctors in Klitzman’s book are special.  They were willing to trust Klitzman with their stories, albeit occasionally glossed over with denial. Their illnesses taught them “that they, too, will one day be patients, that the boundary between physicians and patients is, in the end, nonexistent.”

           Readers, patients, doctor themselves must wonder: Do doctors have to be sick to understand what it means to be a patient? Is sickness a mandatory course in every physician’s education. Klitzman asks, “Can empathy be taught?” It’s a good question.

          Physicians are victimized by the same invasions of the flesh as those striking their patients. Some physicians sicken and die at an early age. Others live long but the infirmities of age, chronic disease, or acute illness beset them.

          How do physicians, trained to help others, deal with their own physical illness? Do they continue to practice? Do age or disease limit their ability to care for sick patients? Do they or their colleagues recognize what is happening to them? Does anyone help them?

           Klitzman’s study raises many questions. How do physicians deal with their medical problems? Does being a physician exacerbate their physical problems? Do colleagues help—or hinder? How do care-providers treat physician-patients? The same as other patients? Better? Worse? What do physicians learn from going through major surgery or critical illness? From living with a chronic disease? How do these experiences affect their dealings with patients? Are they better doctors? If so, why?

           Looking back, how well—or poorly—do physician-patients believe they were diagnosed, treated, monitored, and mentored? How well or poorly did they treat themselves? Will their experiences help other physicians? Help patients? Help themselves?

          The medical literature contains little about physicians trying to cope with physical disease, whether chronic or acute. Almost no studies examine the dilemmas of physicians who are care-“providers” of physician-patients. Few medical schools adequately address clinicians’ well-being. These educational lacunae  waste our most precious medical resource. For students, residents, and senior physicians all need to learn about the special problems of doctors confronting acute or chronic diseases—or even the not-so-“golden years” inflicted by the aging process.

         Physicians providing care to physician-patients need special guidance. They need to unlearn the myths about doctor-patients that might compromise their care.

          Klitzman’s book opens the door to the particular problems of sick or aging physicians. Readers everywhere, non-doctors and doctors alike should take it to heart.

SUBTITLES AND TRUTHS--PUPPY CHOW IS BETTER THAN PROZAC: THE TRUE STORY OF A MAN AND THE DOG WHO SAVED HIS LIFE by Bruce Goldstein

PUPPY CHOW IS BETTER THAN PROZAC: THE TRUE STORY OF A MAN

AND THE DOG WHO SAVED HIS LIFE by Bruce Goldstein (DaCapo Press,

Perseus Books Group, March 15, 2008)

+++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
Review by Nancy Yanes-Hoffman, THE WRITING DOCTOR, at www.writingdoctor.typepad.com, email: nywriter@rochester.rr.com, 585-385-1515 16 San Rafael Drive, Rochester NY 14618
++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++

          Nowadays, most books have subtitles (I should talk; my books do, too). It’s as though writers are dissatisfied with the bare bones of their titles. They want to reach out from the hidden bottom shelf of a crowded bookstore and grab you by the sleeve. “Stop!” the subtitles order. “Don’t go into somebody else’s would-be masterpiece. Read me instead!”

        Bruce Goldstein’s adoring memoir, PUPPY CHOW IS BETTER THAN PROZAC: THE TRUE STORY OF A MAN AND THE DOG WHO SAVED HIS LIFE (DaCapo Press, Perseus Books Group, March 15, 2008), is a perfect example of the popular subtitling genre. If you’re a dog lover, the subtitle will convince you to grab this book. Bend down, drop your umbrella and purse on the way, and see what Goldstein has to say for himself about his love affair with a Labrador retriever puppy.

        Victimized by a virulent bipolar disorder, out of a job, dumped by his girl, and unable to respond to psychiatric therapy and a parade of such drugs as lithium, Paxil, Wellbutrin, and, of course, Prozac, Goldstein was well on his way to giving up. He calls one early chapter before he  meets his puppy, “Mom, I Don’t Want to Go to Life Today.” And he doesn’t.

       At last, heeding his psychiatrist’s desperate recommendation to get a dog, he braves a hurricane to adopt the last (and best?) of a Labrador litter. Black as the proverbial ace of spades, his dog is dubbed “Ozzy” after heavy metal’s Prince of Darkness, the Satanic figure who haunts Goldstein’s imagination. Soon, this furry bundle takes over Goldstein’s life—while calming his lonely fears.

         With Ozzy at his side, Goldstein is lonely no more. Ozzy magnetizes women on the streets of New York. His “puppy harem” oohs, aahs, and “stuck to me like the New York Knicks defense.” Walking his dog followed by a caravan of women, Goldstein realizes, “I finally had an epiphany of sociological and biological proportions. I had finally solved the puzzle man had been trying to figure out since the beginning of time: all of these years the key to meeting beautiful women was picking up a bag of fresh puppy poop.”

          Ozzy is not only “man’s best friend,” he turns out to be “Manic’s best friend,” returning the frantic, obsessed Goldstein to the world he would leave behind. Goldstein gives Ozzy, “my mood-swing messiah” all the credit for keeping him on an even keel. “Thanks to Ozzy, I was really looking forward to my future—the place I thought I’d never get to see.”

         Goldstein ends his story with a poignant prayer, “I thank God this book was written by Bruce Goldstein. Not in memory of.”

        Is PUPPY CHOW overly sentimental? Maybe. But humor saves it. Is it for dog lovers only? Maybe. And then again, maybe not. Because the subtitle is right. Ozzy does save Bruce’s life. More, it’s about what we all, sick and well, must learn to expect from ourselves, no matter what. And finally, it’s about how the magic of love, even a dog’s love, can save us when we’re lost.

WHY CAN'T A WOMAN BE MORE LIKE A MAN? SEX DIFFERENCES IN THE BRAIN: FROM GENES TO BEHAVIOR ed by Jill B. Becker, Karen J. Berkley, Nori Geary, Elizabeth Hampson, James P. Herman, Elizabeth A. Young

SEX DIFFERENCES IN THE BRAIN: FROM GENES TO BEHAVIOR ed by Jill B. Becker, Karen J. Berkley, Nori Geary, Elizabeth Hampson, James P. Herman, Elizabeth A. Young
+++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
Review by Nancy Yanes-Hoffman, THE WRITING DOCTOR, at www.writingdoctor.typepad.com, email: nywriter@rochester.rr.com, 585-385-1515--16 San Rafael Drive, Rochester NY 14618
+++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
       “Why can't a woman,” moans MY FAIR LADY’s Professor Henry Higgins, “be more like a man?” Proffering his accepted superiority of men, Higgins’s litany complains, “Women are irrational,  Can't a woman learn to use her head? Why do they do ev'rything their mothers do? Why don't they grow up- well, like their father instead?” Finally, Higgins throws up his hands, ““Why can't a woman take after a man? Why can't a woman be like me?”

        Higgins isn’t the only one who wonders about sex differences. From time immemorial (and even before), the differences between the brains and behavior of men and women have teased and tantalized academicians and researchers. Husbands, wives, and lovers have all protested the hollow emptiness of “Vive le difference.” 

        Despite this, the crossroads between sex, brain, and behavior have only recently become a field for serious exploration. Sherry Marts, vice president of scientific affairs for the Society for Women’s Health Research, states in her preface to the seminal new guidebook, SEX DIFFERENCES IN THE BRAIN: From Genes to Behavior, edited by Jill B. Becker, Karen L. Berkley, Nori Geary, Elizabeth Hampson, James P. Herman, Elizabeth R. Young (Oxford U Pr, Dec, 2007): “Scientific evidence of sex differences in the brain is only regularly emerging now.”

         And emerge it has. For questions continually nag: Why are men and women so different? What factors, biological and cultural, account for their divergences and disparities? How will new and better knowledge help men and women understand each other, build better relationships in the future? How will it translate into better health care for both men and women?

        Recognizing the need for bridging the chasms in our knowledge of the health discrepancies between men and women, Doctor Becker and her five colleagues have written and edited a brilliant, long-overdue guidebook leading us to better understanding, treatment, and care of men and women.

        SEX DIFFERENCES divides in three parts, what we already know, what we need to know, and how our knowledge will affect the neurobiology of disease and the treatment of neurological disorders.

        In the very first chapter, Turk Rhen and David Crews ask the crucial question: “Why Are There Two Sexes?” After that, Margaret McCarthy and Arthur Arnold sum up what we know about sex differences in “What’s old and what’s New.”

        This introductory section examines research and methodological issues, insights and challenges, as they affect both “Hormone-Behavior Relations,” in non-human animals and most specially in human animals. Understanding and monitoring the menstrual cycle is then essential information for grasping the way that  male and female brains, stress systems, and pharmacogenomics function. Jill Becker has tellingly focused her attention on these subjects for the last two decades.

        The fascinating second section zeroes in on the interaction between neurobiology and behavior. Chapters hone in on steroid receptors and their influence on sex differences in behavior, another Becker specialty. Other topics include dissimilarities in affiliative behavior and social bonding; motivation, movement; energy, obesity, and eating;  children’s play; neurocognition of language (“why don’t you ever talk to me?”); and visuospacial perception. If they do nothing else, these researches prove how different we really are. And how important it is for us to understand those differences.

         Devoted to the neurobiology of disease, the last section covers male and female responses to infectious and autoimmune disease (why is fibromyalgia visited upon more women than men?), pain (which gender is more likely to become addicted?), anxiety, mood, Parkinsonism. As Boomers and their parents join the aging multitudes in the future that awaits all of us, the penultimate chapter on aging and Alzheimer’s diseases (yes, plural) is a particularly important resource for casual readers, clinicians (neurologist and non-neurologists), patients and families.

        One caveat: We hope the Becker group will continue listening carefully to men and women and recording their findings. Certainly, we hope they are at work on a companion volume to fill the lacunae in this text.  For what about such other common autoimmune diseases as arthritis and diabetes which the book does not mention? What about a more detailed discussion—apart from steroidal and hormonal levels--of the differences between male and female sexual desire, fulfillment, satisfaction, and oncomitant tendencies to infidelity (not limited to governors of New York).

        In the meantime, the inquiring reader will find it helpful to consult the plethora of books on genes (Tower lists 28 for 2008 in its catalog!). Turning to the March 18th, 2008 issue of the JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION (JAMA), which is devoted to genes, genetics, and genomics, will add a world of information to the Becker group’s excellent guidebook.

       While scientists and researchers have long needed a book like SEX DIFFERENCES, its readership should not be limited to academia. The questing student of any age will find answers to many thorny questions—as well as more challenges to his or her perspectives and relationships.

WHOSE BLOOD MATTERS MOST? WHAT DO GENES TELL US? BLOOD MATTERS by Masha Gessen

BLOOD MATTERS: From Inherited Illness to Designer Babies: How the World and I Found Ourselves in the Future of the Gene  by Masha Gessen
(Harcourt, April, 2008)

Review by Nancy Yanes Hoffman, THE WRITING DOCTOR, at www.writingdoctor.typepad.com, email: nywriter@rochester.rr.com,
585-385-1515, 16 San Rafael Drive, Rochester, NY 14618

++++++++++++++++++++++++++++++++++++++++++++++++++++++++++

       In this “Information Age,” what do we do with our so-called “knowledge.” How can we use it to make the best decisions? Or, at the very least, better decisions? How does the bursting, ever-changing world of genetics inform us about what we should do? Or what we can do?

        Tower Books lists 28 books about genetics and genomes coming  out this year. On March 18th, 2008, the Journal of the American Medical Association (JAMA) will publish a group of theme issues in its own pages and in its Archives of Dermatology, Neurology, Ophthalmology, and Surgery on Genetics and Genomics. Gearing its focus to “Personalized Medicine in a Variety of Specialties,” it aims to examine “the challenges that medical breakthroughs engender.”

         Two years ago, a UK publishing house commissioned my book, GENETICS FOR THE NON-GENETICIST PHYSICIAN.  Although the book is already outdated, it shows how underprepared physicians feel about integrating genomics into the everyday practice of medicine.

          Where can all this research, all these publications, lead us? Can they help us decide what to do about our own thorny medical problems?

          Although one of Tower's 28 books, Masha Gessen’s BLOOD MATTERS is subtitled From Inherited Illness to Designer Babies: How the World and I Found Ourselves in the Future of the Gene (Harcourt, April, 2008), her text disagrees with the promise—and ostensible premise--of her subtitle. By the end of the book, the reader is left still wondering what she would do were she in Gessen’s shoes.

          In 2004, Gessen learned  she had inherited the BRCA1 gene, predisposing her to breast and ovarian cancer.  Bitterly blaming her mother and grandfather for visiting this “deleterious mutation” upon her, she set out to avert the evil decree, which is, she tells us, more common among Ashkenazi Jewish women.

          What should she do? Should every at-risk individual for hereditary disease undergo testing? If the test is “positive” for disease—meaning that the future may be negative, should she opt for major surgery? In Gessen’s case, should she undergo prophylactic removal of her breasts and ovaries? Should she wait and see?

           Is it a blessing or a curse to know about a predisposition to breast cancer? What about other diseases that Gessen discusses, such as Huntington’s disease, where nothing can be done? What about the very rare “maple syrup disease” found among Mennonites, where the future is so bleak for its victims?

           Gessen hones in on her own life and choices, which are the primary focus of her book. Yet the sections about the choices facing Huntington disease’s sufferers are the most telling. Although breast cancer is not universally fatal by a long shot, Gessen seems most able to identify with individuals who might have inherited the viciously fatal Huntington disease gene. 

           When she talks about designer genes, she seems to leave her subject behind. Gessen would have done well to concentrate on four major areas surrounding common chronic adult-onset diseases: outcomes of genomic medicine; aspects of consumers’ needs for  information; physicians’ delivery and counseling of genomic medicine; and communication barriers to integrating genomic medicine into useful preventive care and treatment.

          In her JAMA study (2008:299 [11]: 1320-1334) Maren T. Scheuner asks seminal questions that Gessen never addresses: “do patients who receive counseling and testing have better clinical outcomes in terms of mortality, decrease in incidence of disease, and better clinical responses to pharmaceuticals? And at what cost?"

BLOOD MATTERS is regrettably too self-involved to take the reader along with Gessen on her journey. The interested reader would learn more about what genes mean to our own medical care--our own futures-- by examining the provocative set of articles in the Genetics/Genomics Theme Issue of the JAMA.

650

NEW PARTS FOR OLD--CHARLATAN: America’s Most Dangerous Huckster, the Man Who Pursued Him, and the Age of Flimflam by Pope Brock (Crown, Feb,

CHARLATAN: America’s Most Dangerous Huckster, the Man Who Pursued Him, and the Age of Flimflam by Pope Brock (Crown, Feb, 2008)

Review by Nancy Yanes Hoffman, THE WRITING DOCTOR, WWW.WRITINGDOCTOR.TYPEPAD.COM, email: nywriter@rochester.rr.com, 16 San Rafael Drive, Rochester, NY 14618. 585-385-1515

++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++

        What makes a quack run? What drives a pseudo-doctor, “Dr” John R Brinkley, to practice  quack medicine rather than trying to heal the sick? What makes his nemesis, a power-hungry, AMA quack-buster, Dr Morris Fishbein,  pursue this charlatan for more than 25 years? And what drives countless patients, men and women, “as guileless as the wide-mouthed shad.” to the charlatan’s door for help from whatever ails them?  What turned an era, into “the golden age of quacks”  And finally, is that era it over yet?

          Ostensibly the story of one of America’s greatest quacks, “Dr.” John R Brinkley, Pope Brock’s ironic, witty chronicle of CHARLATAN (Crown, Feb, 2008) is about all the forces, individual and cultural,that contributed to Brinkley’s medical “successes” and finally, his downfall.

         Playing upon the American dream of endless youth, of  “rejuvenation,” (still alive-and-well as America’s favorite pipe dream) Brinkley’s greatest triumphs initially sprung from embedding billy goat testicles into the human scrotum and later even into women’s ovaries.

        But in 1931, medicine caught up with him.  After the Kansas State Medical Board tallied 42 countable deaths at Brinkley’s hands, with untold numbers of deaths after patients left Brinkley’s “hospitals,” it revoked his medical license. At the same time, the Federal Radio Commission, revoked his radio license. Undaunted, Brinkley ran for governor of Kansas—and almost won. His campaign pioneered airplane whistle-stops all over Kansas aided and abetted by radio promotion. In case you hadn't noticed, these innovations are still alive and kicking today.

         After the licenses' revocations and the loss of the governorship,Brinkley got the Kansas message. He moved to Texas. In Del Rio, Texas on the Mexican border, he built a mansion fit for a charlatan and a hotel-like “hospital” for prostate surgery patients. Ever the innovator, he used Mexican-based radio to promote himself and his medicine.

         And he made money. Lots of money.  He charged $750 for “gonad surgery,” but his fee for prostate surgery was only $250 a pop. Always, it was cash on the barrelhead—before the operation—just as present-day surgical offices insist on insurance cards and co-pay before the visit.

          Money made money. He bankrolled “Border Blasters,” his high-potency radio shows emanating from his million-watt station, XERA, in Villa Acuna, Mexico into the most powerful station broadcasting on American air waves. Patients heard and flocked to Del Rio for glandular injections—and later, bargain-basement prostate surgery.

         One of XERA’s claims to fame was Brinkley’s Medical Question Box. Listeners sent in letters detailing their health problems. Brinkley prescribed treatment bought from pharmacists hired to kickback percentages of sales. Something like Senator Bill Frist’s long-distance diagnosis of  Terry Schiavo’s problems. As the song goes, “ainsi c’est toujours le meme chose.”

         Del Rio was good to Brinkley. During his five years of broadcasting and prescribing, he pocketed about $12 million. But in 1938, another Del Rio doctor began stealing Brinkley’s thunder by selling the same operations for a lower fee.

          So Brinkley moved to Little Rock, Arkansas in 1938. But Brinkley's Midas touch had become tin. Things were going wrong. In 1939, he lost a libel suit against his obsessed Ahab, Dr. Morris Fishbein. Not only was Fishbein the longtime editor of the American Medical Association (JAMA) and AMA president, but he was an equally egotistical firebrand, who had spent much of his professional life committed to bringing Brinkley down.

          Brinkley’s testimony inadvertently helped Fishbein’s case. On the stand, Brinkley admitted that his surgery was something like a vasectomy. Further, his celebrated Formula 1020 for rejuvenating male desire and performance was only dressed-up colored water.

          After Brinkley lost his appeal, the judge  accused him of being “a charlatan and a quack in the ordinary,well-understood meaning of the words.” Hearing this, disgruntled patients filed civil suit after civil suit. Down on his luck, declaring bankruptcy in 1941, Brinkley was indicted for mail fraud. With the suits pending and dogged by ill health, Brinkley died alone of a blood clot in 1942.

          What made Brinkley run? CHARLATAN, despite its wondrously deft insights isn’t sure. Whether greed alone powered his engine or a healthy (word used inadvisedly) dose of egotistical narcissism fueled his exploits remains unknown. In fact, what made Fishbein run? Fishbein was so much a mirror image of Brinkley—albeit law-abiding and medicine-upholding—that the two were American medical twins.

        If Brinkley himself was dross, CHARLATAN is gold. Brock’s history of American medicine’s feats and flaws, achievements, anecdotes, and trickery invites the reader to compare medicine then with medicine now. In one of the many nuggets of little-known Americana sparking his tale, Brock reports that more than 400 of the 526 radio stations accepted no advertising because “Radio Czar Herbert Hoover, the secretary of commerce, declared it ‘inconceivable that we should allow so great a possibility for service to be drowned in advertiser chatter.’”

         Hoover was, of course, right. Radio, television, email, the internet are awash in "advertiser chatter," offering an open-sesame to the "flim-flam" of 2008. Reading Brock's tales of these medical machiavellis is not only fun, but it  should sound a much-needed alarm about medicine's present-day gimmick-providers.

NEW PARTS FOR OLD--CHARLATAN: America’s Most Dangerous Huckster, the Man Who Pursued Him, and the Age of Flimflam by Pope Brock (Crown, Feb,

CHARLATAN: America’s Most Dangerous Huckster, the Man Who Pursued Him, and the Age of Flimflam by Pope Brock (Crown, Feb, 2008)
Review by Nancy Yanes-Hoffman, THE WRITING DOCTOR, .writingdoctor.typepad.com, email: nywriter@rochester.rr.com, 585-385-1515,

16 San Rafael Drive

,

Rochester

 

NY

 

++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++

        What makes a quack run? What drives a pseudo-doctor, “Dr” John R Brinkley, to practice  quack medicine rather than trying to heal the sick? What makes his nemesis, a power-hungry, AMA quack-buster, Dr Morris Fishbein,  pursue this charlatan for more than 25 years? And what drives countless patients, men and women, “as guileless as the wide-mouthed shad.” to the charlatan’s door for help from whatever ails them?  What turned an era, into “the golden age of quacks”  And finally, is that era it over yet?

          Ostensibly the story of one of America’s greatest quacks, “Dr.” John R Brinkley, Pope Brock’s ironic, witty chronicle of CHARLATAN (Crown, Feb, 2008) is about all the forces, individual and cultural,that contributed to Brinkley’s medical “successes” and finally, his downfall.

         Playing upon the American dream of endless youth, of  “rejuvenation,” (still alive-and-well as America’s favorite pipe dream) Brinkley’s greatest triumphs initially sprung from embedding billy goat testicles into the human scrotum and later even into women’s ovaries.

        But in 1931, medicine caught up with him.  After the Kansas State Medical Board tallied 42 countable deaths at Brinkley’s hands, with untold numbers of deaths after patients left Brinkley’s “hospitals,” it revoked his medical license. At the same time, the Federal Radio Commission, revoked his radio license. Undaunted, Brinkley ran for governor of Kansas—and almost won. His campaign pioneered airplane whistle-stops all over Kansas aided and abetted by radio promotion. In case you hadn't noticed, these innovations are still alive and kicking today.

         After the licenses' revocations and the loss of the governorship,Brinkley got the Kansas message. He moved to Texas. In Del Rio, Texas on the Mexican border, he built a mansion fit for a charlatan and a hotel-like “hospital” for prostate surgery patients. Ever the innovator, he used Mexican-based radio to promote himself and his medicine.

         And he made money. Lots of money.  He charged $750 for “gonad surgery,” but his fee for prostate surgery was only $250 a pop. Always, it was cash on the barrelhead—before the operation—just as present-day surgical offices insist on insurance cards and co-pay before the visit.

          Money made money. He bankrolled “Border Blasters,” his high-potency radio shows emanating from his million-watt station, XERA, in Villa Acuna, Mexico into the most powerful station broadcasting on American air waves. Patients heard and flocked to Del Rio for glandular injections—and later, bargain-basement prostate surgery.

         One of XERA’s claims to fame was Brinkley’s Medical Question Box. Listeners sent in letters detailing their health problems. Brinkley prescribed treatment bought from pharmacists hired to kickback percentages of sales. Something like Senator Bill Frist’s long-distance diagnosis of  Terry Schiavo’s problems. As the song goes, “ainsi c’est toujours le meme chose.”

         Del Rio was good to Brinkley. During his five years of broadcasting and prescribing, he pocketed about $12 million. But in 1938, another Del Rio doctor began stealing Brinkley’s thunder by selling the same operations for a lower fee.

          So Brinkley moved to Little Rock, Arkansas in 1938. But Brinkley's Midas touch had become tin. Things were going wrong. In 1939, he lost a libel suit against his obsessed Ahab, Dr. Morris Fishbein. Not only was Fishbein the longtime editor of the American Medical Association (JAMA) and AMA president, but he was an equally egotistical firebrand, who had spent much of his professional life committed to bringing Brinkley down.

          Brinkley’s testimony inadvertently helped Fishbein’s case. On the stand, Brinkley admitted that his surgery was something like a vasectomy. Further, his celebrated Formula 1020 for rejuvenating male desire and performance was only dressed-up colored water.

          After Brinkley lost his appeal, the judge  accused him of being “a charlatan and a quack in the ordinary,well-understood meaning of the words.” Hearing this, disgruntled patients filed civil suit after civil suit. Down on his luck, declaring bankruptcy in 1941, Brinkley was indicted for mail fraud. With the suits pending and dogged by ill health, Brinkley died alone of a blood clot in 1942.

          What made Brinkley run? CHARLATAN, despite its wondrously deft insights isn’t sure. Whether greed alone powered his engine or a healthy (word used inadvisedly) dose of egotistical narcissism fueled his exploits remains unknown. In fact, what made Fishbein run? Fishbein was so much a mirror image of Brinkley—albeit law-abiding and medicine-upholding—that the two were American medical twins.

        If Brinkley himself was dross, CHARLATAN is gold. Brock’s history of American medicine’s feats and flaws, achievements, anecdotes, and trickery invites the reader to compare medicine then with medicine now. In one of the many nuggets of little-known Americana sparking his tale, Brock reports that more than 400 of the 526 radio stations accepted no advertising because “Radio Czar Herbert Hoover, the secretary of commerce, declared it ‘inconceivable that we should allow so great a possibility for service to be drowned in advertiser chatter.’”

FIGHTING THE GOOD FIGHT: CANCER ON $5 A DAy**(CHEMO NOT INCLUDED): HOW HUMOR GOT ME THROUGH THE TOUGHEST JOURNEY OF MY LIFE by Robert Schimmel with Alan Eisenstock

CANCER ON $5 A Day (*chemo not included): How Humor Got Me Through the Toughest Journey of My Life by Robert Schimmel with Alan Eisenstock (DeCapo Press, Lifelong, Perseus Books, March 15th, 2008).

Review by Nancy Yanes Hoffman, THE WRITING DOCTOR, at www.writingdoctor.typepad.com, nywriter@rochester.rr.com, 585-385-1515.
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         “If you live long enough,” my father used to say, “a little rain has to fall on your parade.”  But it wasn’t a little rain that hit Robert Schimmel, the cheerfully bawdy, stand-up comedian. It was a tsunami. Actually, not one tsunami, but four (so who’s counting?).

         In one decade, Schimmel’s beloved son, Derek died of a brain tumor; a heart attack hit Schimmel when he wasn’t looking; and his 22-year marriage with his first wife, Vikki split acrimoniously. Finally, cancer sidelined him on the cusp of a big break in his career.

         Yet, Schimmel managed to keep his head above water and move on. Struck by stage-three non-Hodgkins lymphoma, he hit the treatment trail head on.  Though cancer is no laughing matter, Schimmel tried to make a joke—or several jokes—about what even he admits was “the toughest journey of my life, ” which he records in his brave new book,CANCER ON $5 A Day (*chemo not included): How Humor Got Me Through the Toughest Journey of My Life (DaCapo press, Lifelong Books, Perseus Books, March 15th, 2008).

         As Alan Eisenstock, Schimmel’s co-author observes, “Cancer gave Robert Schimmel more material to write about. But it also gave him more heart. The disease made him see the world through wider, wiser eyes. He became more patient, more resolute, and more conscious of the power of the moment…cancer taught him how to love what he has…and his gift, making people a laugh; to love every day he’s alive.”

        With cancer as their ill-gotten muse, Schimmel and Eisenstock wrote CANCER ON $5 A DAY. Their mission, they say, was to cheer the spirits of everyone—and anyone—fighting “the Big C.”

        Although Schimmel is one of Comedy Central’s 100 Greatest Comics, and although the publisher says that “he keeps us laughing by riffing” about all the battles engendered by fighting cancer, his book is actually not funny. Instead, it’s a tribute to the resilience of the human spirit when it refuses to give up.

         Aiming at the jokey side of cancer (if such there be), Schimmel reports on the ironies of cancer's travails, peculiar events like a wig salesman trying to sell him wigs for every spot denuded by chemotherapy (yes, every spot). He can’t get over his overwhelming desire for sex during chemotherapy. “Feeling horny,” says Schimmel, “is life-affirming.”

         But cancer’s dark night of the soul keeps breaking into the tale of his long, stormy treatment. So, too, does Schimmel’s predilection for erasable, deletable (not delectable) adjectives, which might make his journey a less appropriate trip for some cancer veterans.

         Raw language or not, Schimmel’s courage is inspiring.  For CANCER ON $5 A DAY aims at making cancer victims believe that “Schimmel got through it. Maybe there’s a chance that I can make it, too.” Of course, there are no guarantees.

        But Schimmel maintains,. “It’s those things that define who you are. That was Job’s test. Flee or fight. I chose to fight.” CANCER ON $5 A DAY is an invitation to the fight with no holds barred.

SUFFERING ISN'T LIMITED ONLY TO MAINE: A HEALING TOUCH: TRUE STORIES OF LIFE, DEATH, AND HOSPICE ed by Richard Russo

A HEALING TOUCH: TRUE STORIES OF LIFE, DEATH, AND HOSPICE, ed. Richard Russo (Down East Books, April, 2008)

Review by Nancy Yanes Hoffman, THE WRITING DOCTOR, at www.writingdoctor.typepad.com, nywriter@rochester.rr.com

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The impulse behind A HEALING TOUCH: TRUE STORIES OF LIFE, DEATH, AND HOSPICE, ed. Richard Russo (Down East Books, April, 2008) is salubrious—or as salubrious as tough times will permit. Its purpose is to awaken long and short-term sufferers of chronic and acute illness—and their caretakers—to the help, the surcease available from hospice care.

In its pages, Richard Russo and five other writers from Maine depict the dark worlds of individuals beset by the demons of death and disease. The stories vary from parents attempting to recover after their son’s sudden death in an auto accident to a couple trying to live with Alzheimer’s disease's depredations.

The skills of the authors also vary, with Russo's writing leading their ranks. Still, their messages are the same. They show how smart Socrates was (actually, nobody except his son ever doubted Socrates's brain power) when he said, “Count no man happy until he’s dead.” Each tale shows people flourishing only to be cut down by the evil spirits lurking on the edges of life.

This little book hones in only, albeit nobly, on the Hospice Volunteers of the Waterville (Maine) Area. The proceeds from its sales will go to the Waterville Hospice. As such, it serves the world of an individual hospice in Maine. It even seems to be a marketing tool for this specific hospice.

But tragedy doesn't limit itself to Waterville, Maine. The rest of us sufferers and caretakers  who live outside Waterville’s gray skies, may find A HEALING TOUCH’s focus too narrow to offer us the helping hand we crave. The possibility of awakening non-Maine dwellers to the varieties of surcease offered by their own local hospices is then regrettably limited.

It might be worthwhile for Down East Books to consider publishing a companion volume along these lines. Such a book would include other hospices and writers from all over the country. Individuals everywhere who have been victimized by life’s depredations could then find resources and support that they need so badly.

Meantime, readers of A HEALING TOUCH may unearth suggestions about where to find help from their local hospices. We hope so.

IT'S NOT SUCH A SECRET: THIS COMMON SECRET: MY JOURNEY AS AN ABORTION DOCTOR by Susan Wicklund (New York: Public Affairs, Jan, 2008)

Susan Wicklund. THIS COMMON SECRET: My Journey As An Abortion Doctor (New York: Public Affairs, 2008) Review by Nancy Yanes Hoffman, THE WRITING DOCTOR, www.writingdoctor.typepad.com, www.nyhwriter.com, nywriter@rochester.rr.com 585-385-1515

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There’s an election going on (in case you hadn’t heard). Listen to Obama and Clinton, even to McCain and Huckabee perching restlessly on the cusp of the presidency. But with all their talk about CHANGE vs EXPERIENCE, what do they think when nobody’s listening? What will they do if elected? Does anyone except McCain, Bush's "true conservative," whisper a word about ABORTION? About stem cells? Or, perish the thought, about the Supreme Court repeatedly eroding Roe vs. Wade, as it "celebrates" its 35th birthday?

Yet at least 40 percent of American women—voters all--have had an abortion. Nobody talks about it although abortion is more commonly performed than tonsillectomy or pulling wisdom teeth.

Dr. Susan Wicklund’s memoir of her life, THIS COMMON SECRET (New York: Public Affairs, January, 2008), reveals the huge sacrifices demanded by her life as an abortion provider  As an innocent high-school graduate, Susan Wicklund began her fight in the abortion battles reacting against the cruelty of in her own abortion provider. Whenever the young Susan asked a question, the doctor replied, “Shut up!”

Ever after, she couldn’t shut up. She resolved to provide better care for other women in the same boat. Somehow, this feisty young girl, "poor as a church mouse," managed to become a midwife, go to college, obtain her M.D., cope with an internship's rigors, and open a general practice.  All this, while caring for her only child, Sonja.

THIS COMMON SECRET bursts with stories of Wicklund’s life (“Call me Sue,” she instructs patients) and the lives of her patients of all ages, religions, classes, backgrounds. The abortion barricades fill its pages: protesters’ omnipresent intimidation and violence stalk her. Her daughter needs a police escort to go to school.  The protesters scream imprecations at women coming to her clinic. They follow Dr. Wicklund to the airports where she travels endlessly from one remote Western clinic to another.

But she never gives up, never shuts up. She talks to, listens to every woman coming to her distant clinics. If a woman is ambivalent about abortion, if it seems she is doing this because other people are coercing her, Wicklund advises her to wait and be sure before she goes ahead.

Nonetheless, she makes a case against the 24-hour waiting period, the rules about obtaining parental consent, the Supreme Court’s increasing restrictions. The Court asserted that government  needs “to protect women from their own decisions.” This from a Court and a political party ostensibly devoted to interfering less in people’s lives.

Wicklund particularly fears “professional protesters, "mostly men, for whom protesting is a full-time obsession. They target different regions in the country or particularly vulnerable clinics. They bring their hate-filled slogans, their planes that fly over towns and cities pulling banners depicting bloody babies, their confrontational tactics. When they come to town, I wear my bulletproof vest and carry my gun. Unfortunately, their views have infiltrated the laws and policies of our country and the lives of my patients.”

Wicklund’s life is devoted to her patients, her own choices in the war over choice. But fighting battles for women deserving the right to safe, legal abortions has been enormously costly.. The prices she paid—and those paid by people she loves and who love her—were and are egregious. Depicting them honestly, she admits her losses, without regret.

Abortion protesters have been increasingly successful in corroding women’s rights. Between 1982 and 2000, the number of abortion providers has dropped 37 percent from 2,900 in 1982 to 1,819 in 2,000. The “graying of providers,” 60 percent are older than 50, is a serious problem. Even Dr. Wicklund, now 53, had to close her abortion clinic, the only one in Montana, to help care for her ailing parents.  Lonely and alone, fighting the abortion battle, takes its toll.  Wicklund sounds as though she, too, is suffering from burnout.

Worse yet, medical schools, like politicians, are simply not addressing these trends. “Most physicians are graduating with little more than circumstantial knowledge of abortion,” reports Medical Students For Choice (MSFC.org), an organization of 10,000 medical students. trying to “stand up in the face of opposition, work to destigmatize abortion provision among medical students and residents, and persuade medical schools and residency programs to include abortion as a part of the reproductive health services curriculum. “ MSFC aims at “training a new generation of pro-choice doctors in leadership, advocacy, and organizing skills.”

THIS COMMON SECRET should be required reading for medical students, residents, patients (aren’t we all),families, and politicians waving their election flags. That’s pretty much all of us.

THE SEARCH FOR THE FATHER: MY FATHER'S HEART by Steve McKee

         “A man,” said Freud in Mourning And Melancholia, “doesn’t become a man till his father dies.” But as Wall Street Journal reporter Steve McKee tell his father’s story—and his own--, he does not become a man until he wrote My Father’s Heart (Da Capo Press, Perseus Books, January, 2008) nearly 40 years after his father’s death.

          Steve McKee’s father “dropped dead,” as they call it, in 1969, when Steve was 16 and his father was only 50. Ironically, he and his father had just finished watching “The Immortal,” a television movie about a man whose blood gave him immunity to disease, including heart disease. After that, another medical show, “Marcus Welby, MD” was beginning.

         These medical televisionaries were no help to John McKee, Steve’s father. “A heart attack slammed him off the back of the couch while we were watching television.” As simply as that. Days before, a doctor’s checkup had “declared him fine.” Nothing new here. The family’s cardiac curse had killed all the McKees in their 40s or early 50s often after a doctor’s verdict had announced a clean bill of health.

          When Steve told his sister Kathy that he’d finished the book about their father, “Kathy let a short silence hang between us on the phone. ‘I hope,’ she finally said, ‘I hope that when you’re done with this that you’ll like Dad more and think better of him...And I hope you can forgive him for dying when he did, and the way he did.’”

          McKee quickly changes the subject. He reports that 80 million Americans have some form of cardiovascular disease, that 325,000 individuals “will die from what is termed ‘out-of-hospital’ or ‘emergency room’ sudden cardiac arrest.” 

          Repeatedly he joins statistics with the personal adding, “the classic heart attack of popular lore, just like Dad’s on September 30, 1969.” Again and again, McKee says, “It was just the two of us at home that night. He was fifty. I was sixteen,” a fact he cannot get over as he tries to figure out how and why his father had to die.

         In McKee’s search for the father, for finding out who his father was and by extension who he is, the son left behind,  he tries to learn why his father did so little to prevent his second heart attack  He portrays his father as a chain-smoking, hard-drinking, job-hating Type A, reminiscent of Willy Loman in Arthur Miller’s Death of a Salesman. It seems to the son that the father gave up the fight after his first heart attack. But why?

        Again and again, pegging statistics to the personal, McKee reminds himself  that every heart attack happens to a someone who is a husband, a wife, a father, a mother, a checkout clerk, or someone at the gym…”The lives and then the deaths of every one of these people will affect millions, millions, millions of others…. I know. It happened to me. It is the story I’ve been writing all my life. The father leaves; the son remains.”

        Why does it take McKee almost four decades “to finish the story I have been writing all my life. Finally.”? He has to grow up --and older--before he can forgive his father for dying. He has to learn on his own flesh how little his obsessive self-discipline and exercising did to avert the evil decree. Until he recognizes his genetic complicity, until he sees that he never knew his father—and his father didn’t know him, he can’t forgive his father for dying—for leaving him to learn on his own.

         Once he is older than his father was when he died, he can come to grips, at least partially, with his father’s death.. Early on, his coach tells him, “Your father just died and you will never get over it…but you will get used to it.” Kind as the coach may have been, neither Steve McKee nor the rest of us who lost a father to a sudden heart attack, ever “get used to it.”  McKee says of his father’s witnessing his own father’s heart attack, “Maybe Dad never got used to it.”

          My Father’s Heart rambles. The writing sometimes lapses into unfortunate, everyday Buffalo-York vernacular. But when the story returns to McKee’s father, to his empty life, his early death, to what his death has taught Steve McKee, the writing tightens and reaches out poignantly across the page.

         In writing about his father’s heart after learning that he, the son, is also a prisoner of heart disease, McKee finally realizes that his father’s death gave him life and taught him how to live. “The night I watched Dad die, I watched me die, too. My life began the night his ended. Learn from me, he said. And so I did. I have become who I am because of him…And I am alive.”

         This book, “an attempt to share the memory of my father,” helped Steve McKee grow up. As My Father's Heart ends, Steve McKeee can run a five-kilometer race with his adopted son Patrick. Freed from the McKee curse, Patrick is a victim of juvenile diabetes. Patrick's diabetes taught Steve "we are who we are, whoever that is."

        As they race together, McKee rejoices, “Father and son, shoulder to shoulder.” My Father's Heart may be the talisman keeping Steve alive to race into the future with his son.

JUDAH FOLKMAN, ANGIOGENESIS PIONEER, IS GONE

Judah Folkman was too great a human being, too generous-spirited a physician, too humane a man, too brilliant a creative researcher in the field of angiogenesis and anti-angiogenesis for www.writingdoctor.typepad.com to let his death go unremarked on our pages.

Only 74, Dr Folkman was working on his computer in the Red Carpet Lounge of the Denver airport while waiting for his plane to Vancouver, where he was scheduled to give one of his unforgettable lectures. Suddenly he keeled over and died of an apparent heart attack.

He lived a long life--but not long enough. The son of a Reform rabbi in Columbus, Ohio, Judah Folkman went to Ohio State University when he was only 16 years old. There, he became the protege of Dr Robert Zollinger, an old-time surgical great. When he told Dr Zollinger that he wanted to go to medical school and become a surgeon, Zollinger put him in his surgical lab to do surgery on animals.

"You don't become a painter when you're 21," snorted Zollinger. "You don't become a composer when you're 21. You begin honing your skills when you're very young. And that's the way it should be with you and surgery."

So Judah Folkman began doing surgery in Zollinger's lab when he was 16. Four years later, when he applied to Harvard Medical School, Zollinger sent Folkman to Dr Francis Moore, the eminent chief of surgery at Boston's Peter Bent Brigham Hospital for an interview. Moore took Folkman into his lab and watched him operate on the animals there. Within minutes, Moore called the admission office to say, "Accept Folkman to the school. Now."

Thus, began his 40 years in Boston. Eleven years after begin graduated from Harvard Medical School in 1957, Folkman, at 34, became its youngest Professor of Surgery and Chair of the Department of Surgery at Boston's world famous Children's Medical Center. Director of the Vascular Biology Program at Children's Medical Center, Folkman's innovative research and unyielding determination led him to found the fields of angiogenesis and antiaangiogenesis despite the nay-saying of other physicians discounting his early theories.

His work on angiogenesis and antiangiogenesis lead to the development of many drugs that have saved the lives of patients with cancer and restored the vision of people with degenerative retinal diseases. Many cancer survivors are alive today, many victims of retinal disorders can see today because of Dr Folkman's dogged research and creativity.

But what the patients remember best is the kindness and communication of his patient care. He was always available, never cut patients short, listened, listened, and listened, and then advised and followed through afterwards. Dr Folkman found no detail too small, no chore too great a burden. He was never too busy for anyone's questions or problems.

Even though Judah Folkman had been on the short list for the Nobel Prize for several years, death beat the Nobel Committee to the punch.

We shall not see his like again. We can only hope that the countless medical students, residents, and researchers throughout the planet who were mentored and inspired by Judah Folkman, the man, and Dr Folkman, the great medical visionary and research activist, will burnish his memory by following in his very big footsteps.

Buying a Cure--What Business Know-How Can Do for a Disease--Jerome Groopman, NEW YORKER, 1-28-08

Check out Jerome Groopman in Jan 28, 2008 New Yorker on Kathy Giusti's organization. "Buying a Cure--What Business-Know-How Can Do for a Disease. It's an inspiration--as is most of Groopman's writing.

The Writing Doctor Changes Her Tune

So much medicine, so much health care, so many people sick, so many people offering advice. So-oo, the Writing Doctor has decided to specialize. From now on, we will only be reviewing books about medicine, be they by physicians, medical students, interns (see our latest offering), patients, and possible patients, which includes all of us.

If you're an author, a publisher, or a veteran of illness, send us your book for review ASAP. Be sure to include the pub date and any and all pertinent info about the author, the book, and what it will mean to the reading public.

Doctor's Baptism under Fire: Sandeep Jauhar's INTERN: A Doctor's Initiation (Farrar Straus Giroux, Jan, 2008)

INTERN: A Doctor's Initiation by Sandeep Jauhar (Farrar, Straus, Giroux, Jan, 2008) Review by Nancy Yanes-Hoffman, www.writingdoctor.typepad.com, www.nyhwriter.com, nywriter@rochester.rr.com, 585-385-1515, NYH Communication Group, 16 San Rafael Drive, Rochester, New York 14618

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         By what magic alchemy is an ambivalent, doubting, overworked, overwhelmed , guilt-ridden, exhausted, experimental physicist--complete with a doctorate in physics-- transformed into another sort of a doctor--a practicing physician? How do we who will all be patients someday, no matter how much we try to escape our fate, define a doctor? What do we expect from him or her? How do they live up to our expectations? How do they fail us? How can doctors and patients break down the wall between them?

          What does the boot camp known as “internship”-- or more recently as “residency”-- do to change fourth-year medical students into thinking, practicing, deciding, questioning, questing doctors? How can we ascertain which doctors will be there when we need them to do the best they can for us?

          In 21 chapters pairing medical anecdotes with crucial questions about his own medical journey, Dr. Sandeep Jauhar’s INTERN: A DOCTOR'S INITIATION (Farrar Straus Giroux, 2008) traces the brier-strewn path of his painful initiation into medicine’s rigors. In these 21 chapters, he achieves a medical adulthood, characteristic of 21 years of  growing up into a man and a doctor.

          The book divides into three sections. ”Switching Horses” incorporates Jauhar’s leap from quantum physics, a “hard” science, to medicine, not always a science, but still much harder to serve than physics' research. “Cracking Up” depicts his near-drowning in the slough of his own physical disease and psychological despair. Finally, “Reconciliation” records the tormented young doctor, Lazarus-like, somehow learning to compromise and cope with the demands and vicissitudes of the medical “culture.”

           Dr. Jauhar covers a lot of bases that most  medical students, interns, and yes, attending physicians might be unwilling to recognize, admit, or try to change. As an example, he talks about “informed consent,” that myth governing our decisions no matter what the choices, healthy or sick. For how can we ever be adequately informed about consequences of our decisions—especially when we’re sick?

           In some ways, medicine, but particularly internship as Dr Jauhar depicts it, is a crap game where the dice are always loaded against the players. For patients differ. Age, sex, desire for life, yearning for surcease all play a role. Doctors differ in their ability, willingness, or unwillingness?—to understand, to communicate, to care.  The Jauhar brothers differ in their attitudes toward medicine and patients. Time is the eternal enemy. Its winged chariot always ready to abandon a telling detail, hurry by a last word that might push the hapless patient into a waiting grave.

           For whom did Dr Jauhar write this book? “My hope," he writes, “is that readers, on their own journeys—many of them in the medical profession—will draw lessons and perhaps even inspiration from my experiences (which) will be especially relevant to medical students preparing to make their own forays into the hospital.” Perhaps. But Dr Jauhar’s strengths and weaknesses differ markedly from those of many other green residents. Struggling with his own limitations, his sharp-eyed observations, and the fierce strictures “of the strange new culture I found myself in,” he  feels “buried in a waking hell of my own (and others?) expectations.”

           What about patients? How will they react to Dr Jauhar’s stories? The chaos and indifference he depicts is frightening. Early on, another intern remarks of their teachers: “It’s strange that all week they’ve hardly mentioned the patients….These are the people we’re going to be learning on. It’s like they’re already invisible.” Looking back, Dr Jauhar comments “I don't think the tales should frighten patients--just make them more aware of doctors' fallibility and the importance of advocating for themselves.”  But his memoir of a young doctor coming to terms with his own inadequacies and those of his profession does not show patients how to find an advocate somewhere in the greyly echoing, antiseptic corridors of a hospital.
       
            INTERN focuses on the growth process of an individual intern. Occasionally it touches too lightly on points that deserve far more attention.  The discussion of the "Night Float” notes that “errors due to faulty transfer of information are at least as frequent as those due to fatigue from being on call overnight." True. But it's worth examining that argument in the light of the current trend in staffing with "hospitalists." The myth of Informed Consent deserves more details on Jauhar's concept of "soft" vs. "hard" paternalism.

            The second edition deserves a glossary, showing the nuances of such ugly, house officers’  slang as "gomer." One of my least favorite words in the language, “gomer” means “get out of my emergency room,” but it is never defined in terms of the barriers between patients and doctors. Even a word such as DNR isn’t defined for the non-conoscenti.
       
            Dr. Jauhar has taken many controversial stances in his articles for the NY TIMES, many of which are chapters in his book. Medicine should be all the better for it. Interestingly, the book—and the man--change in the middle when he becomes sick and learn how a patient feels. Something happens.  It's as though the doubting Thomas (or Sandeep) begins to compromise his high ethical standards with the exigencies of day-to-day medical pressures.

             His mentors grade his development. “Residents were judged in seven categories: clinical judgment, medical knowledge, clinical skills, humanistic qualities, professional attitudes and behavior, medical care, and overall clinical competence. The ratings were on a scale from one to nine plus written descriptions for each scale like “indecisive in difficult management situations” or “reasons well in ambiguous situations,” ”pedestrian diagnostic ability,” “establishes sensible differential diagnoses””not giving into the urge to put down patients.” Scoring sevens, eights, and nines, he is pleased even though most patients would want a solid nine-point scorer.

         INTERN stops short after the internship. It doesn’t include Jauhar’s specialty training in heart disease at Bellevue or what’s happening now that he is in practice specializing in heart failure. It doesn’t compare doctors’ personalities. The differences between Sandeep, the thinker, who treats heart disease medically and his brother, Rajiv, the activist doer, an invasive cardiologist at the same hospital are worthy of Sandeep's analysis.

         A missing last chapter should have reflected  on the man he became as a doctor. It needs to expand on his introductory assertion that “so much about medicine still troubles me; sometimes I still want to muddle through things; sometimes I’m still not sure cardiology was the right choice.” In other words, where is he now?

         Caveats aside, having experienced Sandeep Jauhar’s baptism under fire during his internship, wondering medical students, worried doctors of all ages, and strong-stomached patients can only hope that Sandeep Jauhar is saving this material for another book. With all his energy and his sharp-eyed perspectives, he ought to be hitting his computer soon.

Not Such a Hot Meal: FREE LUNCH: How the Wealthiest Americans Enrich Themselves at Government Expense (and Stick You with the Bill) by David Cay Johnston (Portfolio, Dec 27, 2007)

December 20, 2007

Not Such a Hot Meal: FREE LUNCH: How the Wealthiest Americans Enrich Themselves at Government Expense (and Stick You with the Bill) by David Cay Johnston (Portfolio, Dec 27, 2007)

FREE LUNCH: How the Wealthiest Americans Enrich Themselves at Government Expense (and Stick You with the Bill by David Cay Johnston (Portfolio, December 27th, 2007)
Review by Nancy Yanes Hoffman, www.writingdoctor.typepad.com, nywriting@rochester.rr.com.
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         “The rich,” said F. Scott Fitzgerald, the Roaring Twenties’ chronicler of corruption, “are very different from us.” Now,  80 years later, David Cay Johnston’s brilliant new book, FREE LUNCH: How the Wealthiest Americans Enrich Themselves at Government Expense (and Stick You with the Bill) (Portfolio, December 27th, 2007), demonstrates how much the richest of the rich are different from you and me.

          Yes, “They have more money,” as Hemingway, unimpressed, replied to Fitzgerald.  But Johnston, Pulitzer Prize-winning tax expert of the NEW YORK TIMES and Rochester resident, makes clear how much  money the super-rich steal from the rest of us--and what they cost us. Addicted to money, the rich buy themselves ever-bigger chunks of political power--and we must pay the bill.

         Who are these super-rich? How do they fill their already bulging pockets? In 2005, 300,000 individuals, constituting the top tenth of the top one percent of Americans, had incomes greater than the poorest 150 million Americans struggling to make ends meet at the bottom of the economic pyramid. The much-squeezed middle class--you and me?-- squirm between them. Our pockets are increasingly empty, picked by political and corporate grabbers to make the very rich even richer. The poor, middle classes, and even the moderately rich (the group that my mother called “comfortable”) have neither hors d’oeuvres nor a place at the super-rich’s free lunch buffet. Never sated, the super-rich think their billions aren’t enough.

          Feeding the ever-hungry super-rich at the campaign finance table  takes a high-powered team. More than 35,000 lobbyists crowd Washington’s K Street. They act as free lunch’s waiters, sommeliers, and maitre-d’s.  This horde of lobbyists doesn’t act alone. They require chefs--politicians all-too eager to serve access and influence to the highest bidder.  Without their connivance—and contrivance, there would be no free lunch.

         Johnston reminds us how Ronald Reagan asked prospective voters  “Are you better off now than you were four years ago?” Their resounding “no” elected Reagan. Three decades later, the bottom 90 percent of Americans, Johnston’s “vast majority,” living models for Edward Hopper’s paintings, must answer with another  “NO.”  “Getting by on about $75.00 less each week than it did a generation earlier,” their annual income continues to skid downhill.

         With the economy flourishing--at least ostensibly, what happened to everybody at the bottom of the pile?  “Where,” asks Johnston, “did all the money go?”  It went to the top, where super-rich money usually goes. Ready to be skimmed, it soared into corporate profits, options, CEO’s salaries. It went to the top tenth of the top tenth of Americans (got that?). Their portion of the economic pie was the greatest since 1929, just before the Twenties stopped roaring and fell flat.

        In its rampantly unequal distribution of unbridled wealth, Johnston finds the United States unlike its democratic colleagues, Canada, Europe, Japan, Australia, and New Zealand. Our wild concentration of money at the top follows in the footsteps of three major nations: Russia (yep, Russia), Mexico, and Brazil. Like us, these countries have an explosively burgeoning class of billionaires at the top mirrored by an even more explosively growing poor class and an increasingly stressed—and downwardly spiraling middle class.  Even though “these four countries are societies in which adults have the right to vote,” says Johnston, “…real political power is wielded by a relatively narrow, and rich segment of the population.”

         Johnston, a Socratic gadfly, makes the case for restoring old-fashioned rules, which “define a civilization.” For “Without rules, there is no civilization…Wherever the world has civilizing rules based on some moral or practical principle, we see prosperity and freedom.” But the rule book has changed. At least, in this country: “In America, the long expansion of who plays a role in deciding the rules has ended. The base of influence has begun to contract. In part, because of the campaign finance system, which transfers power to those who donate and who steer donations.”

         Selling power to the highest bidder invites abuse: “To those who lust for power, of what use is acquiring power unless they can abuse it? …The philosophy of the power monger is no different from that of the cancer cell, which mindlessly seeks growth for the sake of growth until it overwhelms its host.”

         Johnston is a great phrasemaker. His supporting cast covers the waterfront from Aristotle, Plato, and Virgil,  to Jeremiah, Adam Smith, John Locke, and the Founding Fathers.  Every page brims with quotable lines: “Karl Marx never envisioned commercial sports as the opiates of the masses.” “Cheating, like pregnancy, is not a halfway condition.” In “Selling the Furniture of Modern Society,” Johnston seeks solutions to where the money goes, “Instead of a Whodunit, this one is a Whogotit.”

          FREE LUNCH is replete with nauseating examples of political sales crying out for moral Prilosec—or better yet, Ipecac. Johnston indicts governmental actions that deliberately enrich irresponsible corporations and individuals. He arraigns the rich for steering American jobs to less expensive workers in other lands. The list of corporate, individual, industrial predators is endless: HMOs, big Pharma, “Goldman Sachs, Lehman Brothers, MBNA, Citibank…exploit the poor, the unsophisticated, the foolish”; Donald Trump, Warren Buffett, Steve Jobs, John Snow, Kennie-boy Lay, George Steinbrenner (before the Mitchell Report on steroids), Mike Keiser, builder of the most expensive golf courses in America, Tom DeLay, Dennis Hastert, Thomas Scully (head of Medicare), Bush, Cheney, and their minions, the golden parachutes of Jack Welch and Bob Nardelli, and a host of followers.

          After all that, what can we do? How can we get the country back on track? Tellingly, FREE LUNCH contains 26 chapters accusing the super-rich buyers and political sellers of stealing the power rightly belonging to the rest of us. Yet only one chapter details what we might do to stop free lunches for the super-rich and anyone else pigging out at the trough.

          Still, Johnston has faith in arousing Americans to participatory democracy. In both PERFECTLY LEGAL: The Covert Campaign to Rig Our Tax System to Benefit the Super-Rich—and Cheat Everyone Else and FREE LUNCH itself, he argues that we have a moral obligation to be active members of society.  He urges us to remember that “when they invented taxation based on ability to pay, they invented democracy…We are not the United States of Me or the United States of You. We are the United States of America. We are a society.”

          Apparently worried that Johnston's current litany of super-rich political cheating may be a Christmas “downer,” the publisher delayed its release till December 27th.  Yet the timing of this must-read book is perfect. For Johnston’s  call to arms is a great way to begin 2008, to “get us thinking as a nation about how every single free lunch cheats us all (because) in the end, we must be the ones who make our government work, fulfilling the preamble to our Constitution. No one else,” concludes Johnston, “is going to do it for us. Reform begins with you.”

          It’s a tall order, but with FREE LUNCH’s exhortations at hand, we may awaken to ways of proving Johnston right. 2008 may be a better year--because we will finally try to make it so.

FREE LUNCH: How the Wealthiest Americans Enrich Themselves at Government Expense (and Stick You with the Bill by David Cay Johnston (Portfolio, December 27th, 2007)
Review by Nancy Yanes Hoffman, www.writingdoctor.typepad.com, nywriting@rochester.rr.com.
*****************************************************************************
         “The rich,” said F. Scott Fitzgerald, the Roaring Twenties’ chronicler of corruption, “are very different from us.” Now,  80 years later, David Cay Johnston’s brilliant new book, FREE LUNCH: How the Wealthiest Americans Enrich Themselves at Government Expense (and Stick You with the Bill) (Portfolio, December 27th, 2007), demonstrates how much the richest of the rich are different from you and me.

          Yes, “They have more money,” as Hemingway, unimpressed, replied to Fitzgerald.  But Johnston, Pulitzer Prize-winning tax expert of the NEW YORK TIMES and Rochester resident, makes clear how much  money the super-rich steal from the rest of us--and what they cost us. Addicted to money, the rich buy themselves ever-bigger chunks of political power--and we must pay the bill.

         Who are these super-rich? How do they fill their already bulging pockets? In 2005, 300,000 individuals, constituting the top tenth of the top one percent of Americans, had incomes greater than the poorest 150 million Americans struggling to make ends meet at the bottom of the economic pyramid. The much-squeezed middle class--you and me?-- squirm between them. Our pockets are increasingly empty, picked by political and corporate grabbers to make the very rich even richer. The poor, middle classes, and even the moderately rich (the group that my mother called “comfortable”) have neither hors d’oeuvres nor a place at the super-rich’s free lunch buffet. Never sated, the super-rich think their billions aren’t enough.

          Feeding the ever-hungry super-rich at the campaign finance table  takes a high-powered team. More than 35,000 lobbyists crowd Washington’s K Street. They act as free lunch’s waiters, sommeliers, and maitre-d’s.  This horde of lobbyists doesn’t act alone. They require chefs--politicians all-too eager to serve access and influence to the highest bidder.  Without their connivance—and contrivance, there would be no free lunch.

         Johnston reminds us how Ronald Reagan asked prospective voters  “Are you better off now than you were four years ago?” Their resounding “no” elected Reagan. Three decades later, the bottom 90 percent of Americans, Johnston’s “vast majority,” living models for Edward Hopper’s paintings, must answer with another  “NO.”  “Getting by on about $75.00 less each week than it did a generation earlier,” their annual income continues to skid downhill.

         With the economy flourishing--at least ostensibly, what happened to everybody at the bottom of the pile?  “Where,” asks Johnston, “did all the money go?”  It went to the top, where super-rich money usually goes. Ready to be skimmed, it soared into corporate profits, options, CEO’s salaries. It went to the top tenth of the top tenth of Americans (got that?). Their portion of the economic pie was the greatest since 1929, just before the Twenties stopped roaring and fell flat.

        In its rampantly unequal distribution of unbridled wealth, Johnston finds the United States unlike its democratic colleagues, Canada, Europe, Japan, Australia, and New Zealand. Our wild concentration of money at the top follows in the footsteps of three major nations: Russia (yep, Russia), Mexico, and Brazil. Like us, these countries have an explosively burgeoning class of billionaires at the top mirrored by an even more explosively growing poor class and an increasingly stressed—and downwardly spiraling middle class.  Even though “these four countries are societies in which adults have the right to vote,” says Johnston, “…real political power is wielded by a relatively narrow, and rich segment of the population.”

         Johnston, a Socratic gadfly, makes the case for restoring old-fashioned rules, which “define a civilization.” For “Without rules, there is no civilization…Wherever the world has civilizing rules based on some moral or practical principle, we see prosperity and freedom.” But the rule book has changed. At least, in this country: “In America, the long expansion of who plays a role in deciding the rules has ended. The base of influence has begun to contract. In part, because of the campaign finance system, which transfers power to those who donate and who steer donations.”

         Selling power to the highest bidder invites abuse: “To those who lust for power, of what use is acquiring power unless they can abuse it? …The philosophy of the power monger is no different from that of the cancer cell, which mindlessly seeks growth for the sake of growth until it overwhelms its host.”

         Johnston is a great phrasemaker. His supporting cast covers the waterfront from Aristotle, Plato, and Virgil,  to Jeremiah, Adam Smith, John Locke, and the Founding Fathers.  Every page brims with quotable lines: “Karl Marx never envisioned commercial sports as the opiates of the masses.” “Cheating, like pregnancy, is not a halfway condition.” In “Selling the Furniture of Modern Society,” Johnston seeks solutions to where the money goes, “Instead of a Whodunit, this one is a Whogotit.”

          FREE LUNCH is replete with nauseating examples of political sales crying out for moral Prilosec—or better yet, Ipecac. Johnston indicts governmental actions that deliberately enrich irresponsible corporations and individuals. He arraigns the rich for steering American jobs to less expensive workers in other lands. The list of corporate, individual, industrial predators is endless: HMOs, big Pharma, “Goldman Sachs, Lehman Brothers, MBNA, Citibank…exploit the poor, the unsophisticated, the foolish”; Donald Trump, Warren Buffett, Steve Jobs, John Snow, Kennie-boy Lay, George Steinbrenner (before the Mitchell Report on steroids), Mike Keiser, builder of the most expensive golf courses in America, Tom DeLay, Dennis Hastert, Thomas Scully (head of Medicare), Bush, Cheney, and their minions, the golden parachutes of Jack Welch and Bob Nardelli, and a host of followers.

          After all that, what can we do? How can we get the country back on track? Tellingly, FREE LUNCH contains 26 chapters accusing the super-rich buyers and political sellers of stealing the power rightly belonging to the rest of us. Yet only one chapter details what we might do to stop free lunches for the super-rich and anyone else pigging out at the trough.

          Still, Johnston has faith in arousing Americans to participatory democracy. In both PERFECTLY LEGAL: The Covert Campaign to Rig Our Tax System to Benefit the Super-Rich—and Cheat Everyone Else and FREE LUNCH itself, he argues that we have a moral obligation to be active members of society.  He urges us to remember that “when they invented taxation based on ability to pay, they invented democracy…We are not the United States of Me or the United States of You. We are the United States of America. We are a society.”

          Apparently worried that Johnston's current litany of super-rich political cheating may be a Christmas “downer,” the publisher delayed its release till December 27th.  Yet the timing of this must-read book is perfect. For Johnston’s  call to arms is a great way to begin 2008, to “get us thinking as a nation about how every single free lunch cheats us all (because) in the end, we must be the ones who make our government work, fulfilling the preamble to our Constitution. No one else,” concludes Johnston, “is going to do it for us. Reform begins with you.”

          It’s a tall order, but with FREE LUNCH’s exhortations at hand, we may awaken to ways of proving Johnston right. 2008 may be a better year--because we will finally try to make it so.

Not Such a Hot Meal: FREE LUNCH: How the Wealthiest Americans Enrich Themselves at Government Expense (and Stick You with the Bill) by David Cay Johnston (Portfolio, Dec 27, 2007)

FREE LUNCH: How the Wealthiest Americans Enrich Themselves at Government Expense (and Stick You with the Bill by David Cay Johnston (Portfolio, December 27th, 2007)
Review by Nancy Yanes Hoffman, www.writingdoctor.typepad.com, nywriting@rochester.rr.com.
*****************************************************************************
         “The rich,” said F. Scott Fitzgerald, the Roaring Twenties’ chronicler of corruption, “are very different from us.” Now,  80 years later, David Cay Johnston’s brilliant new book, FREE LUNCH: How the Wealthiest Americans Enrich Themselves at Government Expense (and Stick You with the Bill) (Portfolio, December 27th, 2007), demonstrates how much the richest of the rich are different from you and me.

          Yes, “They have more money,” as Hemingway, unimpressed, replied to Fitzgerald.  But Johnston, Pulitzer Prize-winning tax expert of the NEW YORK TIMES and Rochester resident, makes clear how much  money the super-rich steal from the rest of us--and what they cost us. Addicted to money, the rich buy themselves ever-bigger chunks of political power--and we must pay the bill.

         Who are these super-rich? How do they fill their already bulging pockets? In 2005, 300,000 individuals, constituting the top tenth of the top one percent of Americans, had incomes greater than the poorest 150 million Americans struggling to make ends meet at the bottom of the economic pyramid. The much-squeezed middle class--you and me?-- squirm between them. Our pockets are increasingly empty, picked by political and corporate grabbers to make the very rich even richer. The poor, middle classes, and even the moderately rich (the group that my mother called “comfortable”) have neither hors d’oeuvres nor a place at the super-rich’s free lunch buffet. Never sated, the super-rich think their billions aren’t enough.

          Feeding the ever-hungry super-rich at the campaign finance table  takes a high-powered team. More than 35,000 lobbyists crowd Washington’s K Street. They act as free lunch’s waiters, sommeliers, and maitre-d’s.  This horde of lobbyists doesn’t act alone. They require chefs--politicians all-too eager to serve access and influence to the highest bidder.  Without their connivance—and contrivance, there would be no free lunch.

         Johnston reminds us how Ronald Reagan asked prospective voters  “Are you better off now than you were four years ago?” Their resounding “no” elected Reagan. Three decades later, the bottom 90 percent of Americans, Johnston’s “vast majority,” living models for Edward Hopper’s paintings, must answer with another  “NO.”  “Getting by on about $75.00 less each week than it did a generation earlier,” their annual income continues to skid downhill.

         With the economy flourishing--at least ostensibly, what happened to everybody at the bottom of the pile?  “Where,” asks Johnston, “did all the money go?”  It went to the top, where super-rich money usually goes. Ready to be skimmed, it soared into corporate profits, options, CEO’s salaries. It went to the top tenth of the top tenth of Americans (got that?). Their portion of the economic pie was the greatest since 1929, just before the Twenties stopped roaring and fell flat.

        In its rampantly unequal distribution of unbridled wealth, Johnston finds the United States unlike its democratic colleagues, Canada, Europe, Japan, Australia, and New Zealand. Our wild concentration of money at the top follows in the footsteps of three major nations: Russia (yep, Russia), Mexico, and Brazil. Like us, these countries have an explosively burgeoning class of billionaires at the top mirrored by an even more explosively growing poor class and an increasingly stressed—and downwardly spiraling middle class.  Even though “these four countries are societies in which adults have the right to vote,” says Johnston, “…real political power is wielded by a relatively narrow, and rich segment of the population.”

         Johnston, a Socratic gadfly, makes the case for restoring old-fashioned rules, which “define a civilization.” For “Without rules, there is no civilization…Wherever the world has civilizing rules based on some moral or practical principle, we see prosperity and freedom.” But the rule book has changed. At least, in this country: “In America, the long expansion of who plays a role in deciding the rules has ended. The base of influence has begun to contract. In part, because of the campaign finance system, which transfers power to those who donate and who steer donations.”

         Selling power to the highest bidder invites abuse: “To those who lust for power, of what use is acquiring power unless they can abuse it? …The philosophy of the power monger is no different from that of the cancer cell, which mindlessly seeks growth for the sake of growth until it overwhelms its host.”

         Johnston is a great phrasemaker. His supporting cast covers the waterfront from Aristotle, Plato, and Virgil,  to Jeremiah, Adam Smith, John Locke, and the Founding Fathers.  Every page brims with quotable lines: “Karl Marx never envisioned commercial sports as the opiates of the masses.” “Cheating, like pregnancy, is not a halfway condition.” In “Selling the Furniture of Modern Society,” Johnston seeks solutions to where the money goes, “Instead of a Whodunit, this one is a Whogotit.”

          FREE LUNCH is replete with nauseating examples of political sales crying out for moral Prilosec—or better yet, Ipecac. Johnston indicts governmental actions that deliberately enrich irresponsible corporations and individuals. He arraigns the rich for steering American jobs to less expensive workers in other lands. The list of corporate, individual, industrial predators is endless: HMOs, big Pharma, “Goldman Sachs, Lehman Brothers, MBNA, Citibank…exploit the poor, the unsophisticated, the foolish”; Donald Trump, Warren Buffett, Steve Jobs, John Snow, Kennie-boy Lay, George Steinbrenner (before the Mitchell Report on steroids), Mike Keiser, builder of the most expensive golf courses in America, Tom DeLay, Dennis Hastert, Thomas Scully (head of Medicare), Bush, Cheney, and their minions, the golden parachutes of Jack Welch and Bob Nardelli, and a host of followers.

          After all that, what can we do? How can we get the country back on track? Tellingly, FREE LUNCH contains 26 chapters accusing the super-rich buyers and political sellers of stealing the power rightly belonging to the rest of us. Yet only one chapter details what we might do to stop free lunches for the super-rich and anyone else pigging out at the trough.

          Still, Johnston has faith in arousing Americans to participatory democracy. In both PERFECTLY LEGAL: The Covert Campaign to Rig Our Tax System to Benefit the Super-Rich—and Cheat Everyone Else and FREE LUNCH itself, he argues that we have a moral obligation to be active members of society.  He urges us to remember that “when they invented taxation based on ability to pay, they invented democracy…We are not the United States of Me or the United States of You. We are the United States of America. We are a society.”

          Apparently worried that Johnston's current litany of super-rich political cheating may be a Christmas “downer,” the publisher delayed its release till December 27th.  Yet the timing of this must-read book is perfect. For Johnston’s  call to arms is a great way to begin 2008, to “get us thinking as a nation about how every single free lunch cheats us all (because) in the end, we must be the ones who make our government work, fulfilling the preamble to our Constitution. No one else,” concludes Johnston, “is going to do it for us. Reform begins with you.”

          It’s a tall order, but with FREE LUNCH’s exhortations at hand, we may awaken to ways of proving Johnston right. 2008 may be a better year--because we will finally try to make it so.

NBCC RECOMMENDED LISTS OF BOOKS TO READ

We're joining the crowd. We'll be posting the NBCC's Recommended Lists of Best Books to Read.

Take a look, see what PW had to say, then start reading the ones you missed. Send us comments if you'd like. They and you will be welcome. You always are.

PW COMMENTS: "'Bestseller lists just capture what people are buying, not reading. My hope was to create a list to show what people are recommending to each other—saying, ‘you must read this’—which is how books really travel,' said John Freeman, president of the National Book Critics Circle, which, today, launched its Most Recommended List, a monthly list of book recommendations compiled from votes cast by NBCC members as well as famous writers and critics, including John Updike and Cynthia Ozick. Every month, the NBCC plans to poll its membership, as well as many other well-known writers and critics, for their recommendations in fiction, nonfiction and poetry, listing the top five books with the most votes.

"The first list, which is posted in full below, includes many of the usual suspects—such as Philip Roth, Junot Diaz, and NBA winners and finalists Denis Johnson, Edwidge Danticat, Tim Wiener, and Robert Hass—but also a few surprises, like indie press success Out Stealing Horses by novelist Per Petterson, and Next Life by experimental poet Rae Armantrout.

"As far as how the word about the list will get out, according to Freeman, most of the publicity will be online. Powells.com and Amazon.com have agreed to post the list on their blogs, the Academy of American Poets and the Poetry Foundation will post it on their sites, and, said Freeman, “several dozen newspapers will run it," including Star Tribune in Minneapolis, Harford Courant, the Las Vegas Weekly, the Seattle Times, the Alibi in New Mexico, and the Sacramento News & Review.  Also, "some independent bookstores are passing it among their buyers and a few will post it on their sites, and it will appear on blogs of individual NBCC members."

Here is the first installment of the list received 11-28-2007:

Fiction

1) Junot Diaz, The Brief Wondrous Life of Oscar Wao (Riverhead)
2) Denis Johnson, Tree of Smoke (Farrar, Straus & Giroux)
3) Michael Chabon, The Yiddish Policeman’s Union (HarperCollins)
4) Philip Roth, Exit Ghost (Houghton Mifflin)
5) Per Petterson, Out Stealing Horses (Graywolf)

Nonfiction

1)Edwidge Danticat, Brother, I’m Dying (Knopf)
2)Alan Weisman, The World Without Us (St. Martin’s)
3)Noami Klein, The Shock Doctrine (Metropolitan)
4)David Michaelis, Schulz and the Peanuts (HarperCollins)
5)Tim Weiner, Legacy of Ashes (Doubleday)

Poetry

1) Robert Hass, Time and Materials: Poems 1997-2005*
2) Zbigniew Herbert, Collected Poems: 1956-1998 (Ecco)*
3) Robert Pinsky, Gulf Music (Farrar Straus & Giroux)*
4) Rae Armantrout, Next Life (Wesleyan)
5) Mary Jo Bang, Elegy (Graywolf)

*These three titles tied for first place in the poetry category.

Deceptions of a Brown Paper Wrapper: Peter Sagal's THE BOOK OF VICE

Peter Sagal, THE BOOK OF VICE (Harper Collins, Nov, 2007).

Review by Nancy Yanes Hoffman, www.writingdoctor.typepad.com,
nywriter@rochester.rr.com, 585-385-1515, 16 San Rafael Drive, Rochester, NY 14618

++++++++++++++++++++++++++++++++++++++++++++++++

       Peter Sagal’s THE BOOK OF VICE (Harper Collins, Nov, 2007) comes in a brown paper wrapper.  Tempting? Maybe. For it’s a come-on. Despite its subtitle’s promise of “Very Naughty Things (and How To Do Them),” there’s nothing inside that you couldn’t show your mailman—or even your mother, who probably knows lots more than you do. Besides, its chapter on lying doesn’t even tell you how to use white lies convincingly, which might have been helpful.

         Sagal depicts modern VICE  (since he capitalizes it, so will I) as robotic and  depressing. Whether at “the Swingers’ Shack,” “Dinner Parties Gone Horribly Wrong, “ “Sodom’s Restaurant,” “Strip Clubs” (“Sure, they like you. Really.”), or casinos from Atlantic City to Las Vegas, their habitués are all having a rotten time.

         To prove a point, Sagal advises, “Next time you go to a casino, look around at all the people, screaming at the craps tables, sweating at the blackjack tables, staring sullenly at the slot machines,” and lighting cigarette after cigarette.  Vegas, like every other casino from small towns to glitter cities, is a “neon hell,” nothing but “Virgil’s City of Dis with better lighting.”

         But you can be miserable without dice and smoke. While moralizing cleverly about the emptiness of his litany of conspicuous consumption, Sagal, host of NPR’s “Wait, Wait, Don’t Tell Me,” is witty—but finally tiresome. Although his chapters read like SMART MONEY’s Christmas issue (in a white wrapper) on the “The Best of Everything,” subtitled “Nine New Splurges You Deserve,” Sagal’s indulgences are more pornographic and less marketable than the magazine's. After all, even an overpriced cashmere sweater will keep you warm.

        Sagal concludes, “God knows, there are people who are having more fun than you, who are having more and better and frequent and more gymnastic sex than you are, who are enjoying adrenaline thrills and indulgences you can’t even imagine. But you have one thing in common with those people: they, too, are wondering if there’s something that they’re missing….Maybe, when you turn up the work lights, that’s all any of these vices are: just ways of gussying up meat. Sometimes, the meat is us.”

        With Sagal’s VICE, a little goes a long way. For he’s too good to spend his talents and time on a book that only demonstrates that the meat is us (dare I say, “we”?).

FOR IMMIGRANTS ONLY: FORGOTTEN ELLIS ISLAND: THE EXTRAORDINARY STORY OF AMERICA'S IMMIGRANT HOSPITAL by Lorie Conway

FORGOTTEN ELLIS ISLAND: The Extraordinary Story of America’s Immigrant Hospital by Lorie Conway (Smithsonian Books, Oct 16, 2007)

Review by Nancy Yanes Hoffman, NYCommunications, 16 San Rafael Drive, Rochester, New York
www.writingdoctor.typepad.com, nywriter@rochester.rr.com,585-385-1515

**********************************************************************

           Immigration is a dirty word. At least, in our time.  Echoing the anti-immigrant furor of the 1900s, teens, and 1920s, today’s politicians duck the problem, afraid to say where they stand. Yet we are immigrants all. Or the offspring of immigrants who came here long ago.

           How did your forebears get to these shores?  Knowing the answers helps you know who you are today.  Did they hit Plymouth’s rocky shores after fighting for a place on the overcrowded Mayflower, which never could have held all its claimed descendants?  Did they, like my husband’s family, take the long way through Siberia, China, Japan, Canada, and Seattle? Or did they, like my family, land in Boston, the second largest immigration entry point? 

           No matter where or how our families arrived, most Americans view Ellis Island as a metaphor for the long-ago gateway to hope and success, no matter how darkened by defeat and loss. For although sixty immigration sites lined our coasts and southern ports at the beginning of the 20th century, Ellis Island was the busiest. In its first year, 1892, three out of every four immigrants coming to this country went through “the Island.”

            More than 490 books depict the Ellis Island “experience,” jostling for space in Amazon’s lists. Do we really need yet another book about the hordes of immigrants coming through Ellis Island? Yes. Especially when the book is Lorie Conway’s FORGOTTEN ELLIS ISLAND: The Extraordinary Story of America’s Immigrant Hospital (Smithsonian Books, Oct 16, 2007). Amassing photographs and interviews about the old hospitals, now more disabled than their patients, Conroy has brought the old, tattered General hospital and Contagious Disease Hospital, which have received almost no attention, back to life.

           Ellis Island was not an unmixed blessing. Even though Americans welcomed extra hands for industries booming at the beginning of the 20th century (how times have changed), they feared these strangers. Americans believed they could be infected by the armies of Russian Jews, Slavs, Italians, Irish on their Island doorstep. They feared these newcomers might be carrying cholera, tuberculosis, measles, scarlet fever, whooping cough, and diphtheria. They feared their brain power and inability to support themselves. For many immigrants were deemed “mentally defective,”  considered “feeble-minded” because they could not answer the questions bombarding them in a language they didn’t understand.

           The immigrants’ first stop –possibly their last stop if they were rejected-- was medical screening within the forbidding walls of Ellis Island’s Great Hall. Within these walls, in view of the Statue of Liberty just next door, the huddled masses aching for Lady Liberty’s open arms were often held and sent back to their European homelands. But some needed medical care in the here and now.

           As the immigrant load soared, the Island’s administrators realized they needed a hospital and other medical facilities to warehouse its minions of  the sick—and possibly sick.  By 1902, Ellis Island had expanded. Islands No.2 and No.3 sprouted from the adjoining landfill. The General Hospital with 120 beds (it later enlarged to 275 beds) was built in 1902 from tons of rocks excavated from New York City’s new subway system. Nine years later, the 450-bed Contagious Disease Hospital became the most advanced infectious disease facility in the world. For the ensuing three decades, it was the outstanding hallmark of the Ellis Island Hospital complex.

           Few patients spoke English. As the U.S. Public Health’s Dr. Milton Foster observed in his marvelous 1916 memoir,  GENERAL HOSPITAL FOR ALL NATIONS, the hospital had to cadge interpreters from the Immigration Service because it had none of its own.  From 1907 to 1910, Fiorello La Guardia, worked as a Yiddish, Italian, and Spanish interpreter while attending law school at night. Patients recall La Guardia bringing them chocolate bars to comfort them during their seemingly endless hospital stays.

         Conway traces the ups and finally, the downs of immigration barriers through the first half of the twentieth century. By 1915, Frederick Howe, then Commissioner of Immigration, noted that “Ellis Island is a good-sized city. Some days there are as many as 10,000 people temporarily or permanently upon the island.”

         But Ellis Island did not have so long to live. In 1921, while the hospital admitted 16,666 patients, Congress stringently limited immigration by upping the ante for exclusion. The list contained such new categories as people opposed to owning private property, communists, utopians, and socialists(!). In 1924, Congress passed the National Origins Act, which reduced immigration to 3 percent of the 1890 census, thus opening the door to English, Swedish, and German immigrants and banging it shut against Italians, Poles, Hungarians, and European Jews. By 1925, James Davis, Secretary of Labor and ironically a Welsh immigrant himself, avowed that “the regulation of immigration is about the most important issue facing the country.” Sound familiar?

          Conway’s book is about more than just the building of our first Public Health Hospitals. Conway shows the hospitals' apogee in caring for poor immigrants’ health, their nadir in 1954, when the government abandoned the medical complex to the depredations of rain, salt air, broken windows, the nests of pigeons and gulls, rot and decay.

           FORGOTTEN ELLIS ISLAND is the story of  the forever-with-us Catch-22 of medical care, idealism, public welfare, and the politics of immigration.  Recent interviews with onetime patients, ward matrons, physicians, and nurses fill the pages of FORGOTTEN ELLIS ISLAND.  Their stories remind me of the tales my father, a Naval Officer stationed on Ellis Island in 1916 and 1917, used to tell me about the lonely, frightened immigrant children he befriended at the hospital—and what became of them.

         Christopher Barnes’s many photographs of people and places, in many ways the legacy of Lewis Hines’s early Ellis Island pictorial portrayals, illuminate Conroy’s saga of the rise and fall of the hospitals at the Gateway to Promise.

          If you are of immigrant stock, you need to own this book and follow the trail of its notes and photographs.