Archive for the ‘medicine’ Category

walter-white-and-jesse-pinkman-breaking-bad-movie (Small)
A glamorized photo image of a drawing of our two heroes — becoming a father-and-son pair in the second season

Dear friends and readers,

I’ve now begun the second season of Breaking Bad and will carry on as the series grips and fascinates me. I was able to view only the first four of the second season because I rent the DVDs from Netflix one disk at a time. Aesthetically it remarkably is still one continuous story with no sub-plot: this is not a multi-plot mini-series. We move back and forth between Walter White (Bryan Cranston) and Jesse Pinkman (Aaron Paul) but their story is one and intertwines.

The story line: Walter thinks he realizes he will need to make a great deal of money before he dies to provide for his wife, Skylar (Anna Gunn) and Walt Junior (RJMitte), the son disabled from cerebral palsy for the rest of their lives. Something like $737,000. He and Jesse must therefore carry on dealing with the homicidal sociopathic Tuco Salamanca (Raymond Cruz). They witness Tudo brutally beat to death a man who works for him on a whim, and scare and offend one of his sidekicks.

Waltjessecornered (Custom)

Tuco murders the sidekick and then kidnaps Walter and Jesse and takes them out to a desert where he threatens to murder them — not before Jesse realizes their danger, tries to persuade Walter to arm themselves, but Walter with his usual over-cleverness says they will make up a poison which will kill Tuco. In the desert place they cannot use this poison, and only by luck and momentary insult, manage to unnerve Tuco, grab a gun out of Tuco’s hand and shoot him sufficiently that he falls and they run off. Threaded in we see Hank (Dean Norris) has been pressuring his wife Marie (Betsy Brandt), Skylar’s sister to see a psychologist for her kleptomania which she will not acknowledge and we watch Skylar refuse to pick up the phone or see her sister. She has though snitched on Marie to Hank. She is utterly self-righteous in her moral stance.

Meanwhile Hank (Dean Norris), Walter’s brother-in-law, investigating Tuco manages to find Tuco’s lair in the desert, and comes upon Tuco just as Walter and Jesse are fleeing (it does not seem improbable as one watches as time moves slowly); Hank shoots to kill Tuco and succeeds.

Here he is shooting; afterward telling of the incident he appears shaken: he is intensely sympathized with

To account for his absence, Walter strips himself naked and appears in a supermarket and is taken to a hospital where he pretends to have had many hours of amnesia. Jesse is to claim he spent the whole time with a local addict and building manager, Jane Margolis (Kristin Ritter): Hank somehow discovers the relationship between Jesse and Tuco and has both Jesse and Jane in for questioning. He grills them mercilessly; he is especially insulting to Jane who he treats as a despicable prostitute. She holds out against him. But Hank has contacted Jesse’s parents who go into Jesse’s house and find his meth laboratory and resolve to throw him out of the house; they will have nothing more to do with him. They present frozen faces to this son, telling him to put his life together; he is now homeless. He had given his huge van and much of his equipment to someone to sell, and his bike is stolen; he manages after filthying himself with vile fluids from an outside John, to wrest the van back and drive to Walter’s house as the only refuge he knows.

Walter has been having troubles of his own. He discovers that the doctors in the hospital have the authority to keep him there — like a prisoner — because they deem him “unsafe” (to whom it’s not clear). He thus has to tell in confidentiality a doctor something of the truth to get the man to release him. Perhaps this will be part of what makes Hank start to suspect him. The suspense is that Hank is coming closer to Walt as involved in the new meth people in the area all the time.

Winning an abilty to come home Walt finds Skylar will have nothing to do with him; will not talk to him unless he reveals to her what he has been doing during the many absences from home. She was set off by being told that he has a second cell phone she does not know about. He cannot tell her about how he has been making money as he suspects (knows very well) she will be shocked and may well turn him in. We have seen how judgmental and treacherous to Marie she is over Marie’s shoplifting. She behaves utterly obnoxiously to Walt now — a cold hard mean face, out for hours; he begs her to be humane to him, she will not. The son has changed his name to Flynn (a gesture), but she has throughout behaved in a semi-alienated askew way.

During the time Skylar is out, Walter becomes aware of Jesse’s presence and after insulting and berating Jesse, demanding Jesse leave with no more money, Walter relents, gives Jesse his share of the money, and then offers him breakfast. Unlike Skylar and Walt Junior, Jesse gratefully accepts the meal.


Jane Margolis, browbeaten and exhausted by Hank — who is ultra-respectful of Skylar

What I think is of genuine interest here is the story’s meaning is the reverse of what the “creator” (Vince Gilligan) and some of the other film-makers (directors, actors themselves, cinematographers) claim it is. In the feature they stick to the idea this is a story about a man becoming a criminal, an antagonist, a bad guy.

Anna Gunn as the self-satisfied rigid wife (harridan is the feel of this still)

Especially startling is the way they and Anna Gunn talk about the wife: they all talk of how she has “boundaries” and begin by saying she doesn’t “leave him” because she’s pregnant and has a disabled son. why should she leave him and so quickly at all? No one in this series has read E.M. Forster’s “Two Cheers to Democracy” where he declared if his loyalties were torn he hoped he would have the courage to chose his real friend over what he is told is his country’s interest or norms. I was appalled at how when early in the second season, he was suffering, her first reaction was he had no right to take his illness out on her. No one in this show seems to have heard the word “love” or understand what it might mean. She has no loyalty to Walter whatsoever; her intrusions would be bearable were they done in his interest but they are not; they are done because she asserts she has the right to direct his destiny and choices — as in the first season she pretended to take his wishes into account but really successfully demanded he do the chemotherapy for huge sums. Without a care who would pay or how. As if it didn’t matter. She refuses to admit she expects him to come up with the money. How angry she’d get if she were thrown out of her house for non-payment.

Jesse homeless, broke, his bike is stolen from him

Jesse’s parents are a parallel. Not once throughout 11 episodes have they tried to see what their son is, backed him when he tried to get a real job (at a desk, wearing a suit, with respect), did not a thing to help him; and now they throw him out because they found a lab and walk away. They think only of their fear of the law and what others may think of them. Throughout the first and second season Jesse is the only person to undercut the values of the system his life story thus far shows us he is marginalized out of, forced to be a person doing absurd things for money if he remains legal. He is witty and actually talks to Walter, occasionally giving him good advice or comments which thus far Walter fails to take.

We have seen Walter charged outrageous sums for what he is told to his face are probably useless treatments for a fatal disease; these same doctors have the power to imprison him in a hospital if they decide his illness is a threat in some way to the way they want people to behave. He is driven to tell one person a truth to avoid immurement. In the US ordinary people are deprived of liberty for crimeless behavior.

It is troubling the way the disabled son is continually treated as semi-alienated, sarcastic, suddenly asserting power when he can. It’s a combination of stigmatizing and making him behave as badly by intuition as anyone around him.

Hank is the only person thus far to show any compassion for someone close to him: to Marie. She calls him indestructible. Is he (we are therefore to ask)? At the same time he is a ferocious bully who behaves to those he perceives as low in status as despicable animals, especially Jane (she is to bought off with a root beer).

I’ve been told and read that Breaking Bad is worth watching for its indictment of US values and life and it’s been asserted that the film-makers know this. If they do, they don’t understand what it is they are indicting.


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Breaking Bad: Walt (Bryan Cranston) and Skylar (Anna Gunn) and their “dream” Dr Delcavoli (David House)

Dear friends and readers,

I finished the first season (Episode 7, “A No-Rough-Stuff-Type Deal”) and then watched the features where Vince Gilligan talks seriously about what he thinks this first season is about, and a good deal of what he said seemed to me accurate. Gillgan suggested the one character who is emerging as having a grasp on reality is Jesse Pinkman (Aaron Paul): he does not lose sight for a moment that Walt early on turned two men into “raspberry sauce,” that he and Walt are dealing with monstrous “scumbags”, that it takes huge sums of money and time and effort to get equipment to make meths, and if he had some alternative remunerative occupation he’d be better off: “count me out; I’m leaving town; I’m going to Oregon.” To this and other sudden abrasively funny retorts Walt either says nothing, or it’s not an obstacle, or (supposedly a key moment in the episode) that if Jesse agrees to go into a full-scale business, “this [will be] the first day” of Jesse’s life, exhorting him “Will it be a life of fear, of no no, of never believing in yourself?”

Walt pouring while Jesse cries out “Chemistry yah Mr White yes science …” but is dubious about the moral benefit to himself


Walt is of course (according to Gilligan) going bad; we watch him turn from a sympathetic into an “antagonistic” character. Just look at how sinister he begins to appear — with his bald head, his thinning body, the sunglasses, the increasingly rough man’s clothes. I noticed (Gilligan doesn’t say this) that a motif idea is attributed to Walt more often than his brother-in-law: that things feel good, are deeply pleasurable because they are illegal. Thrilling. Now while Walt listens to the principle talk of how the janitor will be fired and never get another job because looking for who stole the lab equipment exposed the janitor’s marijuana habit, Walt has surreptitious sex with Syklay under the school table by using his hands.


He gets a real high from taking her out to the car and having sex on the backseat. Hank Schrader, the macho-cop brother-in-law (Dean Norris) repeats this idea when Hank shares illegal Cuban cigars (“Sometimes forbidden fruit tastes sweetest”), but he demurs when Walt wants him to say that there is a thin line between the illegal and legal: at one time meths Walt reminds Hank that meths were part of what was ordinarily prescribed to people. Hank immediately swings round to say some things are foul; “they came to their senses on that one” (when meths was declared illegal).


We are to see the hypocrisy here as we were in the earlier episodes to see the parallel between the brutal violence of the drug dealers and Hank’s to those he arrests. Hank does not murder people or beat them to insensibility, but he enjoys roughing them up bad and frightening and yes putting them in jail for a long time to come. What he does not know (not mentioned by Gilligan) is his own wife, Marie (Betsy Brandt) is a shop-lifter and gets great thrills herself by stealing super-expensive tiaras for not-as-yet born babies. Marie gives one to Skylar during a baby shower for Skylar’s coming child where Skylar is surrounded by as many extravagant and silly gifts as Gretchen and Elliot Schwartz (the super-successful couple who had access to health insurance which would have paid for Dr Delacavoli and his chemo treatments (($95,000 on the open market) had tossed at them at their house-warming party; all of which is filmed by an expensive video camera with an eye to ten years from now when said baby (called Esmeralda by Marie, but corrected to Holly by Skylar) will be an adolescent watching these people cavorting about.


Skylar discovers it’s a theft because she goes to the jewelry store to return the object (she can think of many more practical things she might need for the sum she’ll get) and is herself accused of shoplifting and escapes only by pretending to go into labor — the great sancrosanct act of childbirth.

The critique of American bourgeois life is of course unmistakable; and lest we think the series is soft on the illegal drugs the actors are trotted out to confirm it’s not. And the scenes are as redolent of middle American life as any in the previous six episodes. We see the bright cheerful real estate agent bringing the (naive) couples to see Jesse’s house and coo over the “possibilities” of his basement; the kitchen needs only to be extended. Aaron Paul again gets the funny lines as he tells Walt he sees people “only by appointment” (as his realtor does) and mocks her pretensions.

Also well done — and comical — are the scenes of Walt and Jesse stealing needed barrels of compounds from a plant with barbed wire about it and armed guards. They wear knitted clown hats and like some verison of Laurel and Hardy stumble across the screen with their ill-gotten chemical materials:


Scary and powerful are the scenes where Walt and Jesse meet the psychopathic drug-distributor in the most appropriate of places: a junkyard, filled with junked cars. Jesse mocks this as a child’s idea of where to negotiate crimes. Why not a mall? But of course we are there for the symbolism.


Does Gilligan not know his mini-series is about a man developing an inoperable cancer? does he not know the real villain of the piece is the super-expensive doctor who stands in for a medical establishment which can do nothing and has the nerve (because the whole society conspires to allow them to) to sit before clients complacently and correct them if they so much as suggest his “treatments” will for sure help or cure Walt; or deliver horrible treatments that as just likely can make them worse, and collect huge checks which the victim has politely to say must not be cashed “before next Monday please.” Among the extraordinary moments of this last episode occurs when Walt and Skylar visit the doctor (see stills at the opening of this blog) and the (idiot) wife (I have to say it) kittenishly tells the doctor how Walt is ever so “frisky” since getting “chemo.” I cringed. She wants this man’s approval. I wondered if the scene was unconsciously meant to rouse racism: the doctor is black, American black and that is not common because the viewer is put in the position of the helpless patients having to obey, not to question. Skylar tells of Walt’s supposed use of alternative medicine (it’s an alibi for him to go off and cook meths with Jesse) and the doctor says, well as long as it doesn’t interfere with the scientific treatments.

Does he not know he is sending up science? not just how it’s misused in the society (for prescribed drugs too) but useless for creating anything humanely good. All Jesse’s comical remarks about science are part of this thread.

Watching desperate extractions from unlikely objects:


As I watched the scenes with the doctors, technicians, receptionists taking the checks, trips to the bank, rolls of money clutched to the chest, I knew why the show doesn’t attack who it should. The AMA would get after them. The thorough anthology Quality TV, ed McCabe and Akass, includes essays explaining how most film makers for TV don’t even think of attacking anyone who is a big funder of the programming — those who do don’t get their films made or distributed. The film exists to present the commercial (ironically often pedaling psychological drugs which make huge sums). The whole corrupt system is normalized, as if the “way it is” is natural, not evil.

Why do I carry on watching it and blogging about it. While it displaces Walt’s real nightmare of cancer, useless scientific medicine, killing costs, with masculine clown antics of violence and shows the wife to be complicit (thus far helpless because without a real grasp of what her life has depended on — the luck of her birth position, and of his health and job), nevertheless its origin is the cancer epidemic about which nothing is being done (nothing fundamental, nothing preventative) — the hook of the show is when Walt is told he has inoperable cancer; each plot point is some happening that is screwed back into the cancer, whether his bald head, his thinness, his explosions of violence, as he grows more and more supposedly amoral. He is not accurate on the thin line between legality and illegality: what he is missing and the series never says is what is legal, self-righteous, complacently collecting checks, money from credit cards, extorted from drugged misery, is what’s seriously causatively criminal.


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The writer and cast of Breaking Bad (HBO, 2008-13)

Dear friends and readers,

As I’m six years late for this Breaking Bad (a regional southern Virginia phrase meaning “raising hell” — male macho reveling?), having just watched the first three episodes of the first season a year after the fifth and final season of 16 episodes in 2014 brought this mini-series to an end; I see nothing wrong in photos of writer, cast, director, whoever is connected to the film as a frame for an opening blog on the first 3 of 7 episodes of the first season. Belated as this will be, as I proceed through the series my remarks may perhaps some interest as I am not going to go for awed wild screams of praise (such as I find everywhere on various sites).

I was absorbed by the opening three episodes; I recognize, appreciate, respond to quality TV when I see it: high production values, intelligently naturalistic script, verisimilitude and local accuracy in the small things (just like in costume drama), subtle intelligent acting, cinema like camera work, the latest things in film are there. As important, this series has become a sociological event: enormous numbers of people have watched and talked of it and praised it too. So it’s worth it to watch and try to think about the first and second season, and at least begin the third, which I may stop at, as (from the descriptions) the episodes become wildly physically as well as deeply emotionally violent. No need for recaps (see thorough retelling on wikipedia).

The motivating cause is quietly intensely significant as the cancer epidemic (and all the horrors in pain and humiliation that cancer brings) is known everywhere even if the news media stalwartly will not bring it out in the discussably open. Equally misery-producing are the extravagantly exploitative charges people are pressured to pay for medicine; and while in the last year it seems there will be a respite through the Affordable Care Act, the medical establishment, drug industry, corporate industrialism (protecting its right to pollute the environment if their huge profits call for it) are going to keep costs as high as they can. So Walter White (Bryan Cranston) in his forties is diagnosed with inoperable lung cancer and has not sufficient insurance to pay for treatments, much less leave his family, which includes Walter Jr (R.J. Mitte)a son with cerebral palsy, Walter Jr, and Scyler (Anna Gunn) a pregnant wife with any assets to getting on in a hard world with.

A many year under-appreciated chemistry high school teacher, White decides to make money by making and selling drugs (meth is the going abbreviation).


As can be seen in this early shot of him after an initial disaster has landed him in the desert, he is a Casper Milquetoast type who quickly finds himself in over his head in trying to cope with Jesse Pinkman (Aaron Paul), an ignorant, coarse, ruthless self-destructive, stupid ex-student of his become drug addict and seller himself and the drug dealers to whom they mean to sell their product. Jesse fails to understand that chemistry knowledge tells truths about products and a plastic container of the type White wanted Jesse to buy could have been used to dissolve a corpse while his home bathtub dissolves along with said corpse, its flesh, blood, waters.


Scyler has refused to (paraphrasing Walter) “get off his ass,” and her talk has led her nosy sister, Marie Schrader (Betsy Brandt) to think Scyler’s son is smoking marijuana; when Scyler sees her hitherto mild-mannered husband whose idea of a joy happiness seems to be a surprise birthday party given him by his family, has not come home for several nights in a row, she jumps to the conclusion he is smoking marijuana. She enlists her brutal brother-in-law, cop, DEA, Hank Schrader (Dean Norris). She immediately (no shriving time allowed) threatens to leave Walter.

As the worrying wife

Meanwhile out of fear and casting aside his better impulses to save an articulate sympathetic sensible sounding drug-seller, White strangles a second drug dealer. After he disposes of the body far more efficiently than Jesse did, he returns home to tell his now suspicious wife that he has lung cancer and what he is going to do about it.

End of half of season 1.

Why is the reader not asking, is this not perverse? The last thing the action swings around is Walt’s cancer; the only person he tells is the man he strangles whose calm sensible mind immediately sees the connection between this dread disease, money and meths. We have but the briefest scene of diagnosis — an in ambulance which takes Walt form his part-time second job in a garage where he fell suddenly to the hospital, from which Walt goes home as quickly (spending as little) as he possibly can.

This film is enacting (as its title suggests) the inward and outward violence of US life as continually acted out by aggressive and desperate males. It’s not (as yet) Quentin Tarintino stuff, but the violence of real life. The violence is of the implicit bullying sort, and also close to the surface, it’s easy to bring it to the fore and make people act on it; a kind of continual abrasive atmosphere exists. Just that menace from men of a certain kind all the time and not far from the surface. Women in the US too. Yes it is obviously an implicit inditement of US society: we see how little teachers are valued, how little they are paid. Mr White is devoting his life to a subject he loves and knows a lot about, and the irony is for the first time he is turning it to account — cooking meths ever so expertly.

The violence is sexual — our Casper Milquetoast is not just a virile male from the get-go (pregnant wife) the first episode ended with him buggering his pregnant wife and her enjoying it. Take it from me, it hurts backwards, a lot. Her birthday present to him is to lay beside him in bed, he at rest, doing nothing, while she jerks him off under the covers (while browsing the internet). The voice-over commentary on the DVD of the first season is mostly frivolous, but here and there are some revealing features: the men all laugh at the actresses’s acquiescence in the sexy enacted on the screen. As I remarked, the wife’s snitching and pressure tactics makes the point that wives are a pain in the butt; her wrong guesses show her naive ideas about what drugs people take.

The series is racist — perhaps consciously so. Walter White is Mr White, the white man. Jesse Pinkman, he’s pink, the flesh-colored crayon in a child’s crayon box in the 1950s. The drug dealers are of course dark-skinned, eyed, Spanish speaking. The racism never goes away. The series takes place in New Mexico; across the border are these Mexicans who are animal-like. All are struggling for power and the whites have the big advantage.

It’s continually funny at times too. House of Cards has humor too, but it’s witty, sardonic lines, ironical speeches. Breaking Bad is more in the mode of the action coming near to be clown like — a weird black optimistic even sort of humor — as the two men work hard to haul a dissolving body through a broken ceiling, or they stumble and fall over the filth they create. Aaron Paul is especially hilarious – the character is so unself-consciously ludicrous with his gestures of pride, his self-esteem, his complacency as he smokes pipes of meth. The humor built up and Episode 3, the most murderous, was the funniest.

It’s important to see how Breaking Bad relates to British quality TV products too. It’s politics are as reactionary in that it has no acknowledgement there is such a thing as political thought or ideas in life. House of Cards and Downton Abbey both realize the stories are taking place in a larger political context. The difference is Breaking Bad simply has no outer political world, no perspective. The Brits give us reactionary Toryism (Fellowes) or desperation and pessimism from a humane standpoint but just as paralyzing (Andrew Davies in this case); the Americans give us nothing, a vaccuum. In Downton Abbey we are in a fantasy land of benign aristocracy (how they never were), in House of Cards we sidle along the corridors of high power.

Dean Norris as Hank Schrader, White’s brother-in-law, cop (from a later season)

Breaking Bad — there are only the brutal police, more violent and with more impunity than anyone else. We are with the lower middle class and desperate working people who are policed. No NAFTA, no congress, no political or civic or human rights. We have to remember that the reason for the show is the advertisement; the program is filler in whose ideology is not allowed to be different from the ideology of the advertisement. No one is allowed any ideals to help them out of their mess at all; yes the family should hang together — literally as well a figuratively.

I am told the mini-series pulls you in as it goes, you become involved in the characters and the story takes telling, intriguing turns. Does it do more than the crude exposure of the monetary and sexual terms of the suffering (for they do suffer) male hegemony. Well I will try the next disk from Netflix, another 4 episodes to see.


P.S. Among the good books to read on quality TV: Quality TV, edd. Janet McCabe and Kim Akass, subtitled: contemporary american television and beyond. It has an excellent essay by Sarah Cardwell in it.

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Ekaterina Gordeeva and Sergei Grinkov: husband & wife, he died suddenly, age 28, of a heart attack during a practice workshop

Dear friends and readers,

I find irony in my reading, finding some shared thought, and now passing part of the night by writing about Didion’s A Year of Magical Thinking, which like, the apparently naive My Sergei: A Love Story tells of the sudden death of the author’s beloved husband. Some of the intense distress, exasperation and justified anger I have experienced the last two weeks derives from my husband’s death not having happened with the same single night or moment suddenness as Didion’s husband, John Gregory Dunne, and Gordeeva’s husband, Sergei. We’ve experienced 3 and 1/2 months of partial truths told us sufficiently to lead our natural desire to clutch at anything to escape malignant esophageal cancer, no matter how horrendous — like an operation to remove someone’s esophagus and re-arrange his digestive tract and other nearby organs which in itself has nothing whatever to do with what causes, spreads, contains, stops the cancer. And equally 3 and 1/2 months of many medical people’s carefully calibrated behavior controlled fundamentally by each person’s desire to protect & advantage his or her career/job while pretending some other motive paramount. From my vantage point today I almost (not quite) feel as I never thought I would before: as the blow was (as one begins to see as one reads) foreseeable, to fall, the four people (husbands & wives) were lucky to have it fall this way.

Didion, Dunne & their adopted daughter, Quintana (ca. 1970s)

Didion’s considered thesis throughout, and Gordeeva’s natural perspective (just at the outset of her book) is “life changes fast, Life changed in the instant.” This is the refrain of Didion’s book sudden instant transformation of everything upon the death of a beloved partner. As she well knows however (this is in the book) her thesis is thin. She tells of how for a year previously her husband had insights and hinted to her he felt he was at risk of death at any time — and that at least a year before he’d had a bad heart attack and was now living by using an implanted pace-maker. So (like say Causabon in Middlemarch or “young” Jolyon in To Let of the Forstye Saga) she did know he was in danger – or ought to have taken seriously a doctor’s outright warning.

Didion’s book is initially, and every time she recurs to the shock of the scene of Dunne’s sudden keeling over during dinner, powerful. Her book is recursive. She has two further traumatic sudden near deaths incidents to retell. Twice in the book her daughter comes near death: it escaped everyone that a viral infection of a few days before Xmas, because not x-rayed in the hospital the night Quintana came (as it ought to have been) was a serious flu which then (as Dunne said) morphed into an episode of pneumonia that came near killing Quintana too. Quintana later collapses on an airport tarmac as she is being triumphantly coming home; a paralyzing seizure nearly carries Quintana off. It’s one of those real shocks often talked of (“in comparison” to what we usually watch on TV), including the death before your own of your own child.

After the initial power of the husband’s death, there is this falling off as if Didion’s casting about for what to say next and repeats herself, and I feel there is too obvious a sense of this is another occasion for making a book. It picks up roaring as she moves back to her daughter’s two encounters.

Speed of transformation through illness is important, even if common. We do not go about expecting a hammer to come down on our heads. ON one level, my husband Jim seems to have been transformed from recovering slowly from a drastic operation and and then recurrence of cancer diagnosis (liver, “the worst” someone said) inside a week — to man seemingly near death, weak, frail, fatally ill; then I could say it’s been only 3 months since the initial diagnosis, but I know that before that last autumn he had stopped going to the gym gradually and I saw was somehow not himself, not physically well, suddenly looking older. We had no clue to run to the doctor to check with — though he did go for his legs and other things but the problem was not where he was feeling. Engineering term: the point of origin is often not the same as the place of manifestation; one’s bottom body is tired (manifestation) because a cancer is growing in one’s throat (origin, cause).

Her second theme is her magical thinking: once her husband dies, she plays games with her mind. After his death, she asks him for advice and pretends he’s there. She stays away from places which will evoke deep emotional reactions; or if she goes, she plays games in her mind to avoid thinking about that. She can tell us the next morning magical thinking relieved from having to be realistic. Myself I think the term is capable of wider application. Because a hospice person is in the house, you might feel your relative or beloved is safer. He or she isn’t, statistically. We think magically when we rely on rituals. My grandmother tied onions to my feet when I was 3 and came down with a high fever; she was drawing the evil spirits out of the foot. I had a hard time removing the apnea monitor off my younger daughter because I had begun to believe it was saving her. If we do X, Y will surely occur. Make a rain dance, and it will rain. Pray for X, and you may get it (prayers are magical thinking). Human beings attempting to control the natural world.

Yet we do this faced with imminent or present death. But she does not adequately explore kinds of magical thinking (nor the dangers of atavistic behavior they bring), though she shows her wisdom in she defending those people who in need use magical thinking.

Joan, John, and Quintana at home

Other superficialities: She’s not deep about anything beyond these moments. Beyond no real truth-telling about troubles in her life, she presents hers as a life of utter privilege upper class American (she can commandeer a plane and helicopter to take her daughter across the US from California to NY), all the right schools are gone to by all three people (husband, wife, daughter). In the middle of the book she does not want to talk frankly about her family and its realities so she is without matter since she has no criticism to make of attitudes or the medical establishment either.

It reminds of Carolyn Heilbrun’s autobiographical essay in not being willing really to tell and like Heilbrun Didion presents her life as simply happy; Didion tells more but not enough so there’s nothing gripping. We hear of the dinners she goes to (with famous names dropped). She never questions the values that support her privileges; apparently she lived very conventionally inside a small circle of wealthy family and semi- and famous friends. Hints of darker interpretations here and there of their privileged lives, of antagonisms within her relationship with Dunne, especially from her husband’s remembered words, are left on the surface of the narrative. This problem did not arise in the earlier masterpieces (e.g., Salvador) since she was not personally involved.

Life-writing is demanding in ways many writers won’t submit to. They’re afraid – maybe rightly – of the public.

But then her strengths: her style is as marvelous as I remembered it (in Salvador). She never forgets the literal meaning of her words and so has quiet ironic fun with the language medical personnel use. At Xmas she is told Quintana “may not leave the table.” Of course she must leave the table; what she may not do is be taken off it alive. She makes quiet fun of the stilted euphemistic jargon language, the sticking to a high enough level of generality so nothing is acknowledged. Since contained in her words are a thoughtful critique of this language one can’t fault it, but looking at it tonight from my perspective I’d say she can do this since she did not suffer directly from it beyond the “mere” having useful information withheld, nothing explained. Neither she nor her husband were dependent on the medical community as except afterwards (and then he was dead).

It’s not many people who can write of their intimate thoughts while grieving. In the later parts of the books she talks of how she tried to compensate and cope; she speaks of her memories that were good and she helped me sitting there here in my workroom last night to try to relive happy memories. I mentioned some to my husband much later at night (3 am when we were in the front room) who was sitting across from me in his now usual half-stupor and bewildered, unconscious, hallucinating (from all the drugs he’s given for this and that) and he appeared to understand what I was saying. He smiled and corrected a song I said I liked from the 1970s which came to me at that moment as about us:

Only he attributed it to the The Who.

A Year of Magical Thinking is mostly a superb book, deeply felt in many ways, but what makes it is the feeling that what she tells of the traumatic incidents (three) in the book are literally authentic, true, how it happened and her usual bag tricks of style from her interest in literal and playful words (and names), in ironies, and ability to write windingly graceful involved kinds of sentences that are yet readable.


I did not know until I finished and looked at some reviews that Didion’s Quintana whose near-death experiences (two of them, frantic emergencies coming “out of the blue”) provide some ballast for her book — she can include the girl’s childhood through memory flashbacks too – her daughter died in a third seemingly bizarre episode before The Year of Magical Thinking was published. She would not change her book, but instead wrote about the daughter’s calamitous fatal experience of pancreatitis in her next book. I can’t help wondering if there are not aspects of her daughter’s situation that led to 2 times getting to the hospital nearly too late (the 3rd, in the book) is more than the result of errors and infections/blood clots caused by hospital people not doing or doing their job, in this case too cautiously.

So Blue Nights is about her loss of the daughter, an adopted only child. I’ve bought a copy for $3.45 despite several vows to buy no more books now that I’m not going to have someone with me to shoulder the burden of so many or read and use them together in a universal of our own making. I’ll get to it after Ekaterina Gordeva’s My Sergei, co- or ghost-written by E.M. Swift.

Ekaterina was left with a small daughter by Sergei: Daria


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Geographies of the Book

Dear friends and readers,

During the all too short time (about a day’s length) I was able to be at the Sharp conference this year, held at the University of Pennsylvania, in Philadelphia, I enjoyed myself and heard some engaging informative papers — and gave one myself. Although I was able to attend the conference only briefly (as my husband was still recovering from an operation), I would still like to remember and share the gist of what I heard and experienced (as I did two years ago) and what I wish I could have been there for.

I arrived on Saturday, July 20th, around 2:00 pm, in time to attend two panels and in the evening go to a scrumptious banquet (at which there were Philadelphia mummers) and walk around the campus.

No surprise when I decided on “studies in the long 18th century” (e-7, 3-4:30 pm) and “the circulation of 19th and early 20th century genres of medical knowledge” (f-1, 5-6:00 pm). I’m originally an 18th century literary scholar, and for more than 20 years I regularly taught Advanced Composition in Natural Science and Technologies where I devoted a third of the course’s reading to texts on medical science as it’s really practiced in the US today.

Studies in the long 18th century covered shaping French and Polish georgraphical contexts. Elizabeth della Zazzera suggested how the different locations in which literary periodical production occurred Restoration Paris can teach us what were the social worlds and different political agendas of these locations — and how the periodicals in question reflected this. There were many geographic centers in Restoration Paris, some had students, others the rich, clubs here, and booksellers in commercial areas. Ms Zazzera studied and explicated imaginative geographies too. Lorraine Piroux argued Diderot’s Natural Son should be reprinted as it was in the first edition with its preface, 3 conversations, and 2 dramatic narratives as part of a contextualized text. Diderot was trying to establish a new kind of bourgeois authentic drama. A play should be played as if it were life, not art. He was writing experimentally and offering a novelistic contextualization for his play. These texts are today printed separately, divided into different genres.

Partitioned Poland — 1795-1918

Teresa Swieckowska described the difficult position of Polish authors in the 18th and 19th century — and compared the situations in Germany and England. Poland had been cut up into different terrorities dominated by other national courts and companies; and copyright (a system of privilege with a contradictory evolution) was not an effective except as it aroused interest in a work’s author(s). Most Polish writers of this era were aristocrats, for there was no money to be made. Literary books were not profitable and not respected. Commodification in Poland starts in the later 19th century.

Medical College of Virginia also a library

The papers on how medical knowledge reached physicians and patients too showed how entangled were social, gender, and racial politics in deciding who could get information, what was available, and how presented. Brenton Stewart’s paper was on 19th century southern medical an surgical journals. He described and discussed specific medical colleges and hospitals (some meant just for “negroes”) & how the dynamics of local power politics shaped knowledge. To disseminate and share medical information across the south physicians and surgeons turned to highly politicized medical journals whose findings included examinations of medicine and surgery forced on slaves. (Afterwards I asked and was told that The slaves were named as well as their “owners”).

Early health magazine published by the AMA

Catherine Arnott Smith told of the early invention, spread and codification of the Layman’s Medical Journal (a kind of consumer health magazine) by women. She began by saying libraries were places where people could find information, but medical journals were written for other physicians; the earlier policy of associations like the AMA was to withhold information from patients (in order to control and make profits from them). She described the lives & roles of Addie and Julia Riddle who became physicians; of Jessie Leonard who censored movies; hygiene was their goddess; of later titles (Journal of Preventive Medicine, 1910), of political complications, like a Race Betterment League (contraception seems to lead back to eugenics, and women (Martha [?] Stearns Fitts Jones; Lady Cook; Virginia Woodhull) whose class and political positions (especially on the question of prohibition) made it difficult for them to work together. Both scholars studied ads and diaries.

Sunday I went to the session I was giving a paper at, “imaginary geographies iii” (g-3, 8:30-10:00 am), and Ian Gregory’s plenary lecture on using GIS to map and analyze geographical information within texts (10:30-noon).

Winnie-the-Pooh world mapped

Elizabeth Frengel gave a charming paper on the ideas about, illustrations and lives of Walter Crane and Ernest Shepard. She began with the history of end-papers (where from the later 19th century maps are often found), told of Crane’s writing on the importance of harmonizing text and illustration, and how described Shephard’s maps and illustrations realized the imaginary worlds of Milne’s Winnie-the-Pooh and Graham’s Wind in the Willows.

I gave my own paper, Mapping Trollope: Geographies of Power where I argued Trollope’s visualized maps are central means by which he organizes and expresses the social, political and psychological relationships of his characters and themes, that they names places important to him personally; & that through his Irish maps he aimed to put Ireland into his English readers’ imagined consciousness. I show also how his use of maps changed in the later stages of his career to become minutely studied and sceptical geographies of power and take the reader well outside the corridors of power to show that what happens in ordinary places matters too.

The session concluded with Iain Stevenson on the life and “achievements” of a remarkably nervy entrepreneurial crook (soldier, husband of rich wives, Ponzi-scheme initiator), Gregor MacGregor who (among other things) was able to set up and enact crazed schemes of emigration (see my review of The Acadian Diaspora by Christopher Hodson) by exploiting the delusional dreams of independence and wealth among the ignorant abysmally poor and lower middle class. Gregor invented and produced imaginary money as well as countries and Prof Stevenson brought along some original specimens of his Poyais notes.

It was a well-attended session, and there was much stimulating talk for the half hour of time we had. As I wrote, people thanked me for the packet of maps — I gave out old-fashioned good xeroxes of maps from Trollope’s novels instead of doing a power-point presentation. During the discussion on my own paper I raised a note of doubt: Trollope’s maps are not accurate portrayals of the real worlds of Victorian England: for a start, they omit the prevalence of the abysmally poor, the huge industrial complexes (which here and there in his novels he does describe, like St Diddulph’s in He Knew He Was Right, an imagined version of London East End docklands), and thus erase and mislead modern readers and can function as propaganda. I quoted Orwell: “Who controls the past controls the future: who controls the present controls the past.” People defended the escapist aspect of these imagined worlds. Many more were interested in the history and development of end-papers (which Ms Frenkel had gone over in some detail), and maps for children’s books and mysteries in general. One woman had given a paper earlier in the conference about the practice by one company of putting maps (automatically it seems) on the back covers of published mysteries.

Posy Simmons map of Cranford for the book that accompanied the TV mini-series adaptation of Gaskell’s short stories — just the sort of end-paper map people were discussing

Ian Gregory showed the conference how analytical and pictorial mapping of the frequency of specific words in paired (Wordsworth and Grey’s written tours of the lake district) or comparative texts (19th century official reports of the incidence of diseases like cholera and small pox in cities in England) can enable a researcher respectively to grasp unexpected emphases and large trends, and suggested the understanding gained this way can be added to close and/or deconstructive readings of texts. He made a lively wry talk out of philosophical, somber and abstract material.

It was then noon and as I had a 1:30 pm train to catch to return home to Washington, it was time for this Cinderella to leave imagined maps and return to her hotel and modern pumpkin coach (a cab) and head back for the 30th Street train station. What I wish I could have heard: more discussion on how maps are exercises in imposing power. I would have gone to session a-2 about maps and reading habits of soldiers and poets of WW1 (especially the paper on Edward Thomas reading Shakespeare); a-8 about why imaginary geography matters to book history; b-6, “books down under”, Australian convict memoirs, radical publishing and schoolgirl books (the Australian session probably included a paper on Ethel Handel Richardson); c-5 which had a paper on Chaucer’s portrait; d-4, the survival of WW2 concentration camp publications and letter culture; d-5, erotics of family books like Jane Eyre’s German daughters in the US (“emigrating books”). But fancy had had to be reined in.

Wind in the Willows illustration by Shepard


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Simon Keenleyside as Prospero

Dear friends and readers,

Lest it be thought I’ve gone over-the-top in my praise of so many of these Met Operas transmitted by HB, my reaction to the first act of Ades’s and Oakes’s Tempest was it’s so still, and “there’s nothing doing.” I didn’t like the (to me) screetch-y high notes of Ariel, nor the lack of long melodic arias. The costumes were trying too hard. Keenleyside with his skin tattoos, feathers on his head, was still not US Indian-like; Ariel in pink fluff with ludicrously heavy-make-up – all green eyes; the lovers far too well-fed and smooth, he like something out of When Knighthood was in Flower, she like some fairy tale maiden in the Blue Fairy Book. Robert LePage’s re-building of aspects of La Scala on stage could have made for a disconnect, it added nothing.

What took time to emerge was the focus on an ethical-psychological relationship between Caliban and Prospero: when Prospero loses Ariel, he’s left without consolatory dreams. Ares really gave us an adaptation, serious interpretation of Shakespeare’s play (Enchanted Island was more Dryden/Davenant).

Audrey Luna as Ariel

The play-story does not depart from any of the hinge points of Shakespeare’s; Meredith Oakes’s script brought over to operatic music Shakespeare’s austere visionary core with its intimations of dream aspiration and realities of brute animal creatures and vicious envious evil (Caliban and the Milanese apart from Ferdinand). The young lovers were appropriately innocent for their short beautiful songs and their and all the music was like Debussy (Pelleas et Melisande) — ever there quietly beautiful. After a while the set also turn of the century, with its conceit the people are in an opera house grew tiresome. Yes there was a computer island, soft sea, and we began to see the slow emergence of Prospero’s character as regretful, remorseful, bitter yet in act willing to forgive began. That’s part of the play’s naturalistic miracles.

The last part or act was so moving to me. Keenleyside showed how well he can act: I identified with him as the older person having to give over, to let go, and I liked the presentation of Caliban as an aspect of the solitary Prospero. None of the really powerful lines were omitted, and Prospero’s response to Miranda’s “O brave new world,” was plangently disillusioned.

Alan Oates as Caliban

I’d like to see it again so I could enter into Act 1 from the perspective of what is to come.

As to the interviews, Deborah Voight can carry these off. To some extent she asks real questions about singing technique. You could see in Ades’s eyes a moment’s oh I wish I didn’t have to do this hype but he managed and gave eloquent interviews where he spoke more simply and directly about writing and putting on the opera and his relationships with the singers. He said that he saw himself as their support.

Some reviews: this review particularly insightful and with good photos and stills. See New York Times review. Another review.


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New Yorker Cartoon

The right to privacy encompasses a woman’s decision whether or not to terminate her pregnancy [but] a woman’s right to terminate her pregnancy is not absolute … Roe v Wade, 410 US, p 154

Dear friends and readers,

This morning I read a thoughtful questioning blog by a friend who maintains a journal of her reading online: Margaret Sanger and the Planned Parenthood Rally. I got all fired up, felt strong emotion as I have before when it’s pointed out that, hard as it seems to believe, a sufficiently large percentage of the population in the US is against letting people have the liberty to buy and use contraception to vote in congressmen who will fight to pass laws to destroy women’s health organizations, specifically and most notoriously (see the name) Planned Parenthood, in order to stop the women from having access to safe contraception.

I wrote about this on my blog once before when I had a sudden insight into this apparently destructive aim: after all who would force on families endless children, the enormous work, the inability to care for children individually, the dire poverty, the exhaustion of a woman’s body and a man’s ability to support her and the family that would result: The woman from Planned Parenthood: what is hated is a woman’s access to contraception:

I’ve noticed in mainstream media the determination to de-fund Planned Parenthood has not been treated with any clarity or truthfulness. What has been repeated is the mantra of the Republican group refusing to sign the budget is the objection to Planned Parenthood is they support abortion and do abortions. The reality is a tiny percentage of Planned Parenthood’s efforts are about abortion (different figures are quoted, one that’s repeated is 3%).

The real animus against Planned Parenthood is they enable women to have sex without getting pregnant. The whole thrust of the organization (as seen in its name) is to spread contraception, to give women control of their bodies — and inexpensively. It’s a legacy of Margaret Sanger. The real objection of the republicans is such places enable women to have sex without anxiety.

As I wrote my friend in my comment I’ve gone beyond this insight I had (Katha Pollit saw it too) as I’ve watched and listened to the public media’s reporting of this anti-contraceptive care movement. I still see that republicans and their quiescent allies want to prevent women from having control over their reproductive functions. By stopping access to contraceptives, they also make sex risky so the woman can no longer have an adult sex life of her own choosing.

But the reasoning goes beyond this. They want to subject women to men who they think have the right to demand of a woman they have a relationship with that she produce a child, preferably a son for them — to prove or act out their “manliness.” Romney’s nomination and all he stands for, now coupled with Ryan enforces this lesson: the people heading this movement don’t want to pay any taxes for anyone else’s need. Yes they know very well that Planned Parenthood also provides cheaply for women’s health care in other areas: for antibiotics, for psychological help, for operations (say if you have endometriosis). But every one must be on their own, everyone keep every penny he or she earns except for the minimum of taxes to have wars and say build sidewalks and roads. Poor people deserve whatever happens to them; they are meted out discipline and punishment this way.

The last part of the agenda (not to pay anything for anyone, not to share and take responsibility for anyone but yourself and only pay into what you get an equivalent out of) is not in John Riddle’s Eve’s Herbs. But the rest of the agenda emerges as he tells the history of contraception and abortion in the west.


Riddle opens his book with the quotation that heads my blog and a full account of the Roe v Wade decision which he says troubled him because not only the were the judge’s arguments but much of even the intelligent discourse around it was riddled (pun intended) anachronistic misconceptions of the previous history of abortion, for example, that the Hippocratic oath implied a physician could prohibit or refuse to help a woman produce an abortion, that the idea that a human life begins with conception is an ancient widespread one, that scientific studies were central to women and their physician’s decisions about how she should go about treating her reproductive system. Says Riddle in the first chapter (with witnesses in print to demonstrate this) many ancients accepted not only abortion but suicide, not condone but accept.

He decided he would write a book which would demonstrate clearly that until the 19th century in Europe and the cultures the spread from Europe (through emigration) it was acceptable to abort a fetus before quickening, and that few believed a human being was created at the time of conception. I wish he could have proved all that he set out to prove. Alas, he does not. It is true but only generally speaking that until the later 18th century until quickening a woman could obtain an abortion and not be punished or ostracized as long as she kept her act private — as she would most of her sex life. But very early on (3rd century conferences and their publications like the Bible) the church’s hostility to sex and to women demonstrated a strong disposition to stop any control of reproductive functions by either men or women, and there emerged the corollary idea that a human life or soul began at conception. And even earlier than Christianity, from Roman times on we see the persistent idea that a man has a right to have children, especially a son, and that such a right trumped the woman’s right to abort the fetus in her body. In fact much of the discourse that got into court when cases involving marriage, children, pregnancy outside marriage, stillborn babies (with accusations of murder often flung at a woman) was about how a man had been deprived of a possible heir (a son was wanted).

But along the way, about 2/3s of the book demonstrates something as important to the contraception, abortion debates — and let us include here debates and a lack of real common knowledge about miscarriage, stillborn and deformed fetuses and babies, artificial insemination and technologically-induced pregnancies, induced parturition (bringing on childbirth before the full term or 9th month), and choosing a child’s sex. From the beginning of recorded time women have wanted to control their reproductive functions to protect themselves and control their destiny and, together in earlier times with midwives and “healing” women, done everything they could to help themselves in these areas. Riddle has a hugely long chapter where he lists and describes all the herbs and concoctions used (as far as we can tell) from medieval to later 18th century time to bring about fertility, prevent contraception, or cause termination (abortion) or early birth, or somehow control and aid a woman who seemed to be sick because of the pregnancy. Riddle keeps saying many of these did work, some were also toxic, and of course some probably had little effect at all.

So for centuries women were left alone to deal with their pregnancies and reproductive functions more or less. If it was not at all acknowledged as her right to chose, because much was invisible, not mapped publicly, she could exercise her own judgement and follow her desires insofar as herbs could help. They did all they could for themselves. The strongest motive for control was a man’s right to have a child by his wife.

A group of men, an iconic copy of Roland of Parma’s Surgery depicting a context in which surgery is not simply professionalizing but masculinizing quite thoroughly.

It’s important to know that medicine was seen as a woman’s province until the later 17th century when it became part of medical science and began to be a paying licensed profession. Groups of women together. Barbara Ehrenreich and Deirdre English argue in a their Witches, Midwives and Nurses that a large majority of women burnt as witches were women who practiced medicine, and that some of this stemmed from the animus of men who wanted to repress them. It’s no coincidence that the largest number of such burnings took place in the 17th century too. It also came from fear as if a woman is granted this power to heal, she is blamed if something goes wrong (and who better to blame than an aged ugly old woman, an easy scapegoat). Riddle concurs that midwives were subject to ostracizing and anathematized and burnt (together with, as Doris Lessing and Stevie Smith say, their helpless hapless cats).

He also demonstrates that until the 19th century laws ignored this fraught and important part of women’s lives, and that attitudes across many levels of society about when you could abort and when human life began were multiple and flexible and endlessly ambivalent. He shows that the recourse to “science” as a rational or explanation for what a woman chose to do only began in the mid-20th century,and then (as science often is used) only those parts of scientific explanation were brought forward which enforced a particular group’s previously held cultural beliefs or agenda.

19th century photo: doctor in charge, nurse his servant, and woman patient subject to them

The last third of the book is the most troubling. We see how easy it is to lose knowledge. Riddle demonstrates that the rise of evangelicism and Victorian determination to control sexuality itself led to the repression of earlier traditional knowledge about herbs. Middle class women no longer had access to or handed down knowledge of herbs. Physicians also did all they could to ridicule and stigmatize as silly or dangerous all means of self-medication that they did not themselves invent or see as scientific. Women’s wombs become a sort of public territory — women had never managed to have the right to control the space about their bodies and their right not to be searched or invaded bodily by members of the community if they have transgressed sexually. Now their reproductive functions were seen as producing important commodities: children. This is another version of men wanting children, but now with the growing understanding of conception, development of fetuses, and physicians’ apparent right to bring babies into the world using socially approved of methods, one could make laws about conception, and childbirth and enforce them by punishments.

Riddle cites new kinds of bills, like Lord Ellenborough’s 1803 omnibus bill which covered various kinds of murder, and this law included a demand that a court determine whether a child who was born dead or alive, to see whether the mother should be accused of murdering it if it died soon after and she had not told anyone it had been born (this hit at women who had babies outside wedlock). It included language like:

It is a crime of murder for anyone to unlawfully administer to, or cause to be administered to or taken by any of his Majesty’s subjects any deadly poison, or other noxious or destructive substance or thing, with intent [for] … his Majesty’s subject or subjects thereby to murder, or thereby to cause and produce the miscarriage of any woman, then being quick with child.

There may still be glimpsed the assumption that no human life or baby is there until quickening, but someone who understood these words or act would be foolhardy to administer any herbs at all, lest she be accused of having done it after the quickening. Quickening is ambiguous and occurs differently for different women and not at exactly the same time.

The last chapter takes us back to modern America, and we find a melange of extraordinary punitive and repressive laws, including attempts to stop women from using any drug that is not prescribed by a certified physician, attempts to prevent women from regulating their menses, prohibitions against the sale of contraception or any drug for female use only. We have arrived at the time of Griswold v Connecticut when the US Supreme court invalidated a Connecticut law that forbade the sale of contraceptions on the grounds of a right to privacy. (Scaglia thinks this hilarious, this right to contraceptive privacy, does not find it in the Constitution.)

At the same time women continued to, albeit quietly, hiddenly, secretly (and thus with shame and fear and anxiety) avail themselves of what help they could get outside the medical profession (and inside when it came to by then illegal abortion). Among popular medications supported by women’s groups was Lydia Pinkham’s Vegetable Compound, advertised as a “blood purifier” but actually known (as herbs once were known) to have anti-fertility properties so sold as a means of birth control. There were attempts to take it off the market, its ingredients were investigated and changed (fenugreek seed was removed), vitamins were added. It is still sold today. The AMA has of course been tireless in damning such bottles as quack and charlatan stuff.

As Riddle shows all along, one text discussing this preparation is probably partly right when it suggests that abortifacients like this could also be placed in “a volume on toxology.” Drugs that terminate pregnancies are often toxic. The Republican congressmen who likened the product of rape to a product of sex outside marriage and said US people should consider the cases as parallel and consider the feelings or rights of the father takes us right back to the age-old assumption that a woman’s body is only a container for a man to have children through. Plus ca change, moins ca change.


Jill Townsend as Elizabeth in very bad pain after inducing a premature birth, Michael Cadman as Dwight Enys, the doctor (Poldark 1977-78)

I read this book because I wanted to answer a question I had about a key incident in the Poldark novels. In the fourth novel Ross Poldark rapes Elizabeth Chynoweth Poldark in order to assert his right over her body and stop her from marrying George Warleggan. Events and feelings transpire such that she goes ahead and marries Warleggan and gives birth to a baby 7-8 months afterward and claims it was premature. But it was not, it was full term baby, the child was Ross’s. Warleggan is told that the child was not born prematurely, and his savage jealousies are aroused; he torments her and the boy and when she becomes pregnant again (by him), after a terrible scene of his corrosive bullying, she takes a herb compound a London physician has given her to induce an early birth. She wants to persuade Warleggan that she naturally gives birth early so that he will accept the son. She is told the herb or drug is dangerous and should call a physician immediately upon bad cramps. But she does not call a doctor immediately and by the time a doctor is on the scene who recognizes a smell from her increasingly rigid and cold body as gangrene-like it is too late to save her. I wanted to know if there was a compound from herbs which could prompt early parturition, but then kill the person by causing gangrene. Riddle does not descend to that level of detail.

Lest my reader find this story melodramatic, I should say that Charlotte Smith’s Romance of Real Life includes court cases where a woman has a child prematurely and the husband accuses her of trying to foist another man’s child on him. Jim suggested that if the trajectory here is probable, perhaps the specification of gangrene-like is fantasy.

But if I did not have my question answered, I learned about an aspect of women’s history far more important generally. From a book I reviewed Josephine McDonagh’s Child Murder and British Culture, 1720- 1900, I did know that women were routinely accused of infanticide when their babies were born dead, especially if they were poor, powerless, or unwed, that laws were written which made them guilty until they could prove themselves innocent and that as late as the 1980s one can find a case of a girl prosecuted for murder when she was found to have hidden her pregnancy and the baby was stillborn. Well, now I have the larger picture and I have shared it with all who read my blog.

Another New Yorker cartoon on behalf of women


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Those who are left are different people trying to live the same lives — Winston Graham speaking as Demelza, Warleggan

Give sorrow words — Shakespeare, Much Ado About Nothing

William John Garbus (1944? age 23), my father

Evelyn Garbus (1943? age 21?), my mother

Dear friends and readers,

My mother died this past Friday afternoon, between 4 and 5 in the afternoon in a room in what was once called Booth Memorial Hospital, now New York hospital, located in eastern Queens county, NYC. My mother’s younger sister, my Aunt Barbara (77); me (65) & Jim (63); Barbara’s two sons (my mother’s nephews), Paul and Mark (in their early 50s); Paul’s wife, Kathy (straight from the airport by cab); and my mother’s paid home-companion-attendant, Neli, were in the room. The nurse came in and said “We are unable to find a heartbeat.” I asked, “Does that mean she’s dead?” The nurse replied that we must wait for the doctor to come in and see and he was on his way. He came in and said yes (the exact wording escapes me) and proceeded to direct a set of questions to me as the “next of kin.” My mother would have been 91 this November.

More than a month before (mid-July), six of us, this time my aunt, her husband, Erwin (78), Paul & Mark, Jim & me had met in my mother’s apartment to discuss whether she would like to go into assisted living. The next Saturday Paul had driven my mother to a place called Bear Creek to see the buildings, living quarters, costs, activities. My mother had appeared to be delighted with the place. We all made plans to help her re-settle, expecting her to live for several more years. Paul thought she might begin to thrive in a place with a social life with people like herself. In the event, about a week and a half before (August 8th?), when I called to ask my mother when she was going (so as to figure out when Jim and I could go see the place, which was not far from my aunt), my mother asserted that she did not know what was happening (something she had said before), and then when I pressed, that she did not want to change her arrangement of living in a largish rent-stabilized apartment with Neli to care for and companion her 24/7. She was unwilling to explain further (I should call my aunt), but appeared determined, & was going with Neli to sign a lease for another year in her apartment (!). They had reached a new understanding. They had not been getting along: my mother hated paying the large sum 24/7 care cost, Neli had been paying someone else to work for the weekend in order to keep a secondary job as back-up, but now my mother agreed to be pleasanter and Neli to stay all 7 days & nights. So I called my aunt, told her what my mother had said, and we left it I would now be the one to phone my mother and cope. My aunt would send me the paperwork I needed.

Then sometime this past Thursday (the afternoon of the 18th), I phoned my mother thinking to be on the phone briefly and be told all was fine. But no, she was breathless, bewildered and said she had been in pain for two weeks. She could not keep in her mind who I was. I asked if she had phoned my aunt and she asserted they phone every day. I asked for Neli to get on the phone, and Neli said, this was not so, but the pain only started the day before and was the result of diarrhea, and (as usual) my mother would not eat, this time not even rice which would help. (Neli later said my mother had stopped taking her vitamins since the last time I called — on grounds of expense.) I stayed on the phone with my mother for a while and felt something was profoundly wrong, but didn’t know what to conclude was happening as her stories didn’t make sense. I began to think I would phone my aunt the next morning after 11 am after all.

I get up early and at 7 my aunt phoned me. It seemed Neli had become badly frightened around 3 am (my mother often had bad nights) and phoned my aunt (as Neli often did), and both my aunt and uncle said “Call an ambulance.” My mother was taken to the hospital, and the people there said she’d die within the hour if they did not put a tube down her to make her breath and perform other resuscitation measures. My mother had signed a Do Not Resuscitate order long ago, but they needed someone to confirm. My aunt and uncle both were unwilling to confirm the DNR alone so they phoned me. I have spent literally years teaching a course called Advanced Composition in the Natural Sciences & Technology and devoted 1/3 of it to the practice of medicine today, read many books & essays about what happens to a person when the breathing tube is put in (it’s very painful and they must be under continual heavy sedation to endure it), the violence of real resuscitation. I know what happened to my father who endured this as the climax of his dying at 68 (his heart wall’s crumbled), remembered Wiseman’s Near Death, Mike Nichols & Emma Thompson’s Wit, and they were telling me about how frail she was, and her various systems shutting down. I confirmed.

Tellingly my aunt called back, saying the hospital was asking us to re-confirm. Were we sure? We were told that an oxygen mask was on her, she was now in an ordinary ward (not ICU), and sleeping. I reconfirmed. Then my aunt said that Paul, who lived the closest, was going to the hospital to see what’s happening. She began to make funeral arrangements and we began to call back and forth, with me talking on the phone to a cousin of mine, Carol, my father’s niece. My mother had made plans to be buried next to my father and Carole had the name of the funeral home, and cemetery. A little while later, my aunt Barbara called again, and Paul’s news was my mother had rallied soon after she arrived in the hospital and when he first saw her. Blood tests had turned up nothing, no reason for all this, and they were doing more tests. I asked Barbara would she re-open her talks with the woman at Assisted Living, and she replied she had beat me to this idea. She’d phoned the AL lady about 10 minutes ago.

I got off the phone and remembered this was a group of people who probably never saw my mother before in their lives, and thought to myself, maybe she’ll end up going home with Neli at the end of the day. Too many times I’ve seen and read of medical people wanting to do something now and proposing all sorts of technical solutions (injections whose power lasts a year) to someone they’d talked to for 10 minutes. (I recently met a psychologist of the new socially coercive pill-administering school who after 20 minutes talked absurdly to me in knee-jerk textbook fashion.) But I phoned again (I forget why) and then asked my aunt if I should come, and she thought I should this weekend, so after securing a room at the Princeton for one night, Jim and I set out for a 6 hour drive. Perhaps if I saw her, I could withstand the panicked nagging with a calmer conscience.

In the event when I got there, my aunt and Mark and Paul’s wife were there (something I didn’t expect) and my mother looked unconscious. She was also every bad color (discolored, yellow, all shrivelled), and Paul began to talk the way I’d heard people in Wiseman’s Near Death talk. I can’t remember the spiel, but it seemed her lactic acid was up very high, her kidneys shutting down, criteria about her breathing alarming (he has a degree which makes him partly a physician, an MD and Ph.D. in psychology too) and after he finished his technical talk, he looked at me and said awkwardly style, “She’s not doing so well.”

I walked over to her and tried to make contact but all I could see what one eye looked a bit open, slit, I told her I was there, who I was, tried to hug her a bit, but no response. I got closer but no response. I went over to the other side of the (small) room area where my aunt and the others were. Jim told me to notice the machine was breathing for her and making her chest move up and down. Her neck was not moving. So I asked Paul some more questions and got the same kind of response, and then I asked, “Are we watching her dying?” Well, he wasn’t sure, he couldn’t say, but then he said, “yes, probably.”

And so it was.

A nurse had come in to ask us questions as if she was going to take care of my mother. She asked me if she should take the catheter out. I didn’t know. She asked again, and after she said maybe my mother would be more comfortable, I said yes, but then Paul said he thought that was a bad idea since she could soil herself. So I agreed with him. I asked the nurse if my mother was dying. The nurse said she was not God. I replied I knew that but from her expertise in natural happenings, what were the probabilities. She said something to the effect it could turn around. She couldn’t say. She asked me what should she do. I said I had no idea. She was the nurse. She said it was up to me. I repeated I didn’t know what she should do. Meanwhile other nurses and technicians appeared to come and go and do things with the IV and machine and listen. At one point Paul’s wife left and we began to talk about how long we would stay that night and when we’d return tomorrow. I asked if the oxygen mask was prolonging this. Paul said, no, it made no difference. It just made it easier for her to breathe when she tried. (So it was a comfort measure.)

Around then the nurse came in with her comment that they were unable to find a heart beat. (Not that it had stopped. How careful all the language was throughout.) But then when the doctor came and left, the machines were turned off, things disconnected and tossed about, and we knew. The changes in her corpse were an unnerving sight (as had my father’s embalmed remains when I had seen them 23 years ago). A dry wizened body, a frozen face, expressionless. Look down and see what death is doing.

We didn’t very much. We all went in and out of the room, discussing the funeral arrangements which my aunt said we should do on Sunday. We would have a Jewish ritual, a rabbi. She and Paul got on the phone using the numbers my cousin, Carol, gave us, and since Paul again lived nearest (he lives on Long Island and the cemetary and funeral home are in Wading River, near Riverhead, Suffolk), he would go discuss what we’d do and what would be the cost face-to-face, but keep in continual contact by phone with my husband, Jim. I phoned my older daughter, Laura, to ask for her and my younger daughter, Isobel, to come tomorrow.

Neli began to cry. She had had a hard year (though well-paid) and was in shock. On Tuesday she and my mother had gone for a walk, dressed up, all seemed well.

A doctor came in and talked and told us the body would be taken down to the morgue within an hour. I asked him “What did she die of physically?” He said the tests showed she had had a viral infection, and because of her age and weak state, the infection had overwhelmed her.

What did she die of, how did she come to this beyond age? A year ago her handbag had been grabbed from her as she stood outside her apartment house. She had (in character this) chased after the man, yelling at him, but was no match in speed or strength. When she came upstairs to her apartment, unnerved, she fell off a stool. She broke some part of her ankle but not badly. But when she was taken to a hospital and told she could go home that night with a boot on the ankle, she refused. Suddenly after 22 years of living alone (from the time my father died), apparently fearlessly, going to spas, to colleges for adult ed classes, at first traveling to see cousins, and now at least staying lively (shopping even driving), something welled up within, an intense sense of vulnerability, loneliness and she refused to go home alone. The only way she could stay was to have her leg put in a cast. Alas, she decided on that and was put into a rehabilitation home for six weeks. She began to lose a lot of weight.

When she came out, she was too weak to walk, needed physical therapy, help at night (really care 24/7 — someone to cook for her, dress her, clean for her); the cleaning lady who had come 4 times a week was dismissed (my aunt and mother did this) and Neli found, hired 24/7. She never accepted Neli as a companion (in my presence called Neli “the aid”), but sat in a corner of the room, not watching TV or listening to the radio with Neli (claiming Neli did not understand it when she did, enough at any rate). She would not turn it on. She did not like the two options (home companion or assisted living), she obsessed over her money and what things cost her, gave my aunt migraine headaches and Jim and I frantic conversations in which he’d demonstrate to her she had tons of money. Sometimes she did seem better physically but basically over the course of the year she would say she was depressed & just continually declined & deteriorated. And so the thing went on until she made the recent decision she found she couldn’t live with.


Photo take by Laura with her ipad

The funeral. I had been to this place before, 23 years ago to be precise: when my father died (aged 68). Again the death had been unexpected if you looked at it from an immediate standpoint or long over-expected, in his case at least since he was 62 when he had experienced cardiac arrest, been advised to have open heart surgery and refused. The surprise was not that he had died, but that he had been enabled to live so long with a heart that beat irregularly since he was 47, and 20 years of gradually accumulating symptoms, each one worsening the other, and medicines that themselves caused multiple problems. I do not mean to imply he made the wrong decision when he decided against the surgery; he had too much imagination to live with the statistics which he said were near 50% death on the table or soon afterward.

Again an aunt (this time my father’s eldest sister) had taken charge. My aunt Helen had arranged for a Catholic ceremony of sorts for him. She said that if she didn’t, the relatives would not be satisfied, and as for cremation (which my mother to give her credit here brought up), it was out of the question. No one would come. Later my mother regretted the amounts of money she had been led to spend, feeling her sense of shame had been exploited for absurd things like “eternal care” and inner steel in the casket. We had discussed Jessica Mitford and she said she knew all that about the American way of death and yet could not help herself somehow. It was apparently a somewhat shorn or short one since he had not been in a church since an adolescent. He had been an atheist and so some things were lacking that were used in the ceremonies.

I had been traumatized by grief and unable to take in what I was seeing, but I had vivid memories of little bits. I had not been in control and at one point during the ceremonies inside the funeral home, got up and just talked plainly about how much I and others had valued my father and recited a litany of all the generous and good things he had done for others in his life and I described a little of what he was. I just could not stand the ritual which did not seem to talk about him as a person or our missing him at all.

At graveside I was much worse. It was a freezing cold day in December and the ground could not be dug up. A large crowd of people seemed to be there, but not much was said and the funeral director said (rightly enough), that it was so cold we should go back. But when I saw the others turn to leave, I lost it. I cried out, crazily, “We’re not going to leave him here, like this!” I made hysterical gestures, but the funeral director (I realized later) must have been watching me and was prepared. First he handed me this gold cross and said, my father wasn’t there. I didn’t insult the man or the other people around me, held the cross (in law silence is construed as consent) in my hand, but while I was perhaps thinking of something to say against this object and hand it back, there was Bobby, my father’s youngest sister’s youngest son, coming over, hugging me, and saying something or other, and putting his arm around me to pull me away. The funeral director had somehow found out something of my relationship with my cousin. He couldn’t know that I had slept in a crib with Bobby as a baby, and my father, fond of Bobby, helped Bobby now and again over the years, and would joke “let’s go rescue Bobby” when Bobby would arrive at the airport. But he had found out enough from someone. My uncle Erwin said something sensible too, was on the other side of me, and I did walk away.

This time I was determined to do better. I asked Laura to bring Tennyson’s poems but upon looking at “Crossing the Bar,” I decided against it: the feeling was right, but the words mushy, and it ended with religion. Stanzas from In Memoriam were too particularized. And then I thought of the poem R.L. Stevenson had engraved on his gravestone and Jim found it using his ipad, I wrote it out and practiced it and decided I’d read it before or after (or at some time during) the rabbi’s speech. I’d be careful to ask first and make sure it was understood I’d do this by the rabbi. After all I was paying for this ($8260). Unlike my mother I didn’t and don’t regret the money; I was doing it for everyone else as the daughter, providing this, sort of a minimum I could do as I knew and know there is much I couldn’t do and others had done in my stead. It was understood (or thought) I would inherit ample to cover it. Still American-like I was paying and indeed the Rabbi asked me several times what I wanted, and I kept saying, do what my aunt would want and as he seemed to be dissatisfied with this, I told him, I was an atheist and my aunt Jewish and he should do all the Jewish things regularly done, which she would want. I added that for she was central to was my prime motivation at this ceremony.

But this time I did want to say something appropriate for my father which I had not last time, and I knew, know my mother was not a practicing Jew; though she was a Jewish person in culture and shared many American Jewish attitudes, I never in all my life saw her do any ritual that could be called religious. She never claimed to pray. She told me that once when she and my father thought I was near death after giving birth to Isobel, she asked him if she should pray. He said something about the uselessness of such behaviors, and so she didn’t.

The rabbi did leave an interval for me to say the poem. I got up and said that my mother and father were buried in one grave appropriately as they had shaped one another’s existences since the time they married (in November 1945 about a year or more after the photos at the head of this blog were taken). I didn’t say for better or worse (though I meant this to be understood). I did say it was short, strong, and they would probably find lines in it familiar:

UNDER the wide and starry sky
    Dig the grave and let me lie:
Glad did I live and gladly die,
    And I laid me down with a will.

This be the verse you ‘grave for me:
    Here he lies where he long’d to be;
Home is the sailor, home from the sea,
    And the hunter home from the hill.

Continued in the comments. See also my description of our walk in High Line Park and Sondheim’s Into the Woods.


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Dear friends and readers,

I have been given pause what we should call ourselves. Last night I watched the most horrifying film I’ve ever seen and I’ve seen some horror. It’s a 1974 Frederick Wiseman film called Primate where he filmed the people or scientists who “do” science at Yerkes Regional Primate Research Center in Atlanta. (I hate to call them that but that’s why they would call themselves and would probably be granted that definition because of their methods of documentation) The daily cruelty inflicted on a group of apes unluckily caught and enslaved in cages is terrifying as you watch them do the meanest, most absurd, brutal, exploitation, and useless experiments on these animals. Researching these animals’ sexuality under conditions of extreme imprisonment, drugging, imprisonment inside various kinds of harnesses, versions of chains, includes forcing a chimp to ejaculate while you feed him grape juice; you keep him in cage, starve him so he is hungry and will come to the front and you put your hand in and do this to him. This is minor. I saw one gibbon beheaded slowly. The people wear doctors’ outfits. They are doing science, continually writing down every thing these animals are coerced into doing in these cages

I then read an chapter printed in a 1989 book by Thomas Benson and Carolyn Anderson, Reality Fictions, where I learned as of that year the Yerkes institute was still performing these acts.

To my surprise I discovered it began with Anthony Trollope’s description of his realistic method IN CYFH? where he discussed self-reflexively how he put his “facts” on a page, what he meant to do in his novels: to make us see and face the real details of the world and see their relations and consequences quite apart from what the characters claim these are.

This is what Wiseman does. Benson and Anderson then quoted and discussed James Agee documentary book on sharecroppers in the depression where a similar point is made about political discourse and how to be effective.

Of course the Yerkes and its supporters have attacked Wiseman as unfair, gross, skewing the evidence. They say their talk was not included, their justifications. In fact they partly are. But these are irrelevant.

Look at what people do. I cannot better Benson and Anderson’s straight descriptions and evaluations:

Primate is 105 minutes long-feature length-and contains, according to an analysis by Liz Ellsworth, 569 shots.8 That works out to an average of eleven seconds per shot for Primate, approximately half of the average shot length of twenty-three seconds in Wiseman’s High School, and a third of the average shot length of thirty-two seconds in Titicut Follies. The unusually large number of shots in Primate is not simply a fact, but a clue, both to the rhythm of the film and to its method of building meanings.

The film opens with a long series of shots in which we may first notice the ambiguity of the film’s title, which applies equally well to men and apes. We see a large composite photograph, with portraits of eminent scientists, hanging, presumably, on a wall at the Yerkes Center. Wiseman cuts from the composite portrait to a series of eight individual portraits, in series, then to a sign identifying Yerkes Regional Primate Re­search Center, a bust of a man on a pedestal, an exterior shot of the center, and then a series of four shots of apes in their cages. The comparison is
obvious, though not particularly forceful, and it depends for its meaning both upon the structure Wiseman has chosen to use-at least he does not intercut the apes and the portraits-and upon our own predictable surprise at noticing how human the apes look.
Slightly later in the film, still very near the beginning, a pair of sequences occur that are crucial to how we will experience the rest of the film. Research­ers are watching and recording the birth of an orangutan. The descriptive language is objective, but not altogether free of anthropomorphism: for exam­ple, it is hard not to refer to the female giving birth as the “mother.”

Immediately following the birth sequence, we watch women in nursing gowns mothering infant apes: the apparatus of American babyhood is evi­dent-plastic toys, baby bottles, diapers, baby scales, and a rocking chair. To reinforce the comparison, we hear the women speaking to the infant apes. “Here. Here. Take it. Take it. Come on,” says the first woman, offering a toy to an infant ape. Then another woman enters the nursery, also dressed in gown and mask. “Good morning, darlings. Good morning. Mama’s babies? You gonna be good boys and girls for Mommy?” A moment later she contin­ues, “Mama take your temperature. Come on, we’ll take your temperature. It’s all right. It’s all right. It’s all right. It’s all right.” Then a man enters and hands cups to the infants. He says, “Come on. Come on. Here’s yours.”

The rhetorical effect of this scene is to reinforce our sentimental identifica­tion with the apes. And this scene, by comparison, makes even more frighten­ing a scene that follows close upon it, in which a small monkey is taken from its cage, screaming, as a man with protective gloves pins its arms behind its back and clamps his other hand around its neck.

After these scenes, every image in the film invites us to continue enacting comparisons, as part of the process by which we actively make meanings out of the images.

Wiseman establishes a dialectic between acts that we are likely to perceive as kindness to the apes and acts that we are likely to perceive as cruelty. Do the acts of kindness balance the acts of cruelty? Is there a journalistic attempt at fairness here? Not really. We understand that in this institution, the apes are subject to human domination, mutilation, and termination. In such a situation, the acts of kindness do not balance the acts of heartless research. Rather, kindness is reduced to hypocrisy, a lie told to ease the consciences of the scientists and to keep the apes under control. Far from balancing the harshness of the research scenes, the scenes of kindness turn the research into a cruelty and a betrayal.

Let us examine briefly another sequence in Primate. It is the climactic sequence of the film, a little over twenty minutes and over one hundred shots long. In it, researchers remove a gibbon from its cage, anesthetize it, drill a hole in its skull, insert a needle, then open its chest cavity, decapitate it, crack open its skull, and slice the brain for microscope slides. It is a harrowing sequence. From a structural standpoint, Wiseman uses the techniques we have noticed earlier. The images are often highly condensed, with close-ups of needles, drills, scalpels, the tiny beating heart, the gibbon’s terrified face, scissors, jars, vises, dials, and so on.

We are invited to engage in our continued work of making comparison and metaphors: the gibbon is easy to identify with, in its terror of these silent and terminal medical procedures. We are the gibbon, and we are the surgeons. At another level, we see the gibbons’ cages as a sort of death row and call upon our memories of prison movies when we see the helpless fellow gibbons crying out from their cages as the victim is placed back into its cage for a twenty-five-minute pause in the vivisection.

Wiseman has carefully controlled progression and continuity in this section of the film, first by placing the sequence near the end of the film, so that it becomes the climax of the preceding comedy, and then by controlling its internal structure for maximum effect. The sequence is governed by the rules of both fiction and documentary. We do not know until almost the very last second that the gibbon is certainly going to die. Earlier in the film we have seen monkeys with electrodes planted in their brains, so we are able to hope that the gibbon will survive. We keep hoping that it will live, but as the operation becomes more and more destructive of the animal, we must doubt our hopes. And then, with terrible suddenness, and with only a few seconds’ warning, the surgeon cuts off the gibbon’s head. We feel a terrible despair that it has come to this. But the sequence continues through the meticulous, mechanical process of preparing slides of the brain. Finally we see the researchers sitting at the microscope to examine the slides for which the gibbon’s life has been sacrificed. And for us, as viewers, the discovery ought to be important if it is to redeem this death. The two researchers talk:

FIRST SCIENTIST: Oh, here’s a whole cluster of them. Here, look at this. SECOND SCIENTIST: Yeah. My gosh, that is beautiful.
FIRST SCIENTIST: By golly, and see how localized. No fuzzing out. SECOND SCIENTIST: For sure it does not look like dirt, or-
FIRST SCIENTIST: No, no, it’s much too regular.
SECOND SCIENTIST: I think we are on our way.
FIRST SCIENTIST: Yeah. That’s sort of interesting.

The whole operation, which viewers are invited to experience as pitiable and frightening, seems to have been indulged in for the merest idle curiosity, and, if the scientists cannot distinguish brains from dirt, at the lowest possible level of competence. Our suspicions are confirmed a few minutes later when a group of researchers seated at a meeting reassure each other that pure research is always justified, even if it seems to be the pursuit of useless knowledge.

We have already mentioned the sound-image relationships in this se­quence in discussing the structural uses of comparison and continuity. But let us point to some special issues that relate to Wiseman’s use of sound. At many places in the film, people talk to apes, creating a dramatic fiction that the apes can understand and respond to human speech. But in the vivisection sequence, no word is spoken to the victim. This silence is almost as disturbing as the operation itself, because a bond of identification offered earlier is now denied.

The distortion of sexual behavior, in the name of understanding sexual behavior, sometimes reduces sexuality to mechanics, as in the many scenes where apes are stimulated to erection and ejaculation by means of electrodes implanted in their brains, or the scene in which a technician masturbates an ape with a plastic tube in one hand while distracting the ape with a bottle of grape juice in the other. At other times, the scientists seem gossipy, as they sit and whisper about sex outside a row of cages. The effect of the sex scenes is comic and undermines the dignity of the presumably scientific enterprise we are watching.

But along with the comedy, there is an undercurrent of horror, at times straightforward, at times almost surrealistic. Sometimes the horror occurs in small moments: a technician tries to remove a small monkey from its wire cage. He reaches inside the door of the cage and grasps the monkey, which tries to evade capture by clinging to the front of the cage next to the door, an angle that makes it difficult for the technician to maneuver it out of the door. The technician reaches up with his other hand and releases another catch, revealing that the whole front of the cage is hinged. The front of the cage swings open, and the technician grasps the clinging monkey from be­hind, as our momentary pleasure at the comedy of the impasse gives way to a small despair: there is no escape.

Benson and Anderson found the snipping of the gibbon’s head off the moment the film most made them shudder; for me the cruelty of these people was felt most when Wiseman photographed one of the apes operated on and we see him from the back with no clothes, no fur, just shuddering and not a thing is done to soothe, comfort, protect him. And again when the ape operated on so horrifyingly is brought back to his cell, and just dumped there, and the camera catches the creatures intensely distress confused eyes as he lays on the cement floor, and the keeper locks the door on him and walks away.

Oh the film is rightly called Primate. The creatures in charge in their white coats doing these deeds are primates just as surely as the creatures they torture.

This film more than any other shows the wisdom and decency of Sy Montgomery and the “Woman who walked with apes” (Goodall, Fossey, and Gildikas) whose methods are called “unscientific.” They watched the apes in their real habitat, did not attempt to control or change or manipulate them, took into account the apes’ subjective life and studied them from within as a culture. Theirs is the real way to discover truths about these animals.

Birute Gildikas and an orangutan she is genuinely getting to know and understand


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Dear friends and readers,

A final blog of notes and links on an important book I read with my students this term: Mahar’s Money-Driven Medicine. This remarkable book should be required reading for all adult Americans.

Preface: Her achieved goal to tell the story of health care in the US through the eyes of doctors, patients, hospital administrators, health care executives, economists and Wall Street analysts. She wants to reach uninformed people and does; to show us that competition far from making medicine better and cheaper makes it far more expensive than it need be and deforms the system to the point where it’s dangerous. She teaches us about the messy realities of a world of medicine where a commercial marketplace is a primal motivating force, and show that all its parts and people are driven (or are here to) make a big profit as possible, not to keep people well and enable those who have genuinely become sick become well.

She begins with two maps: who is paying, what are we paying for? and shows that 7.1 per cent of the US gross national product is involved in health care; and increasingly US worker and employers cannot afford the premiums. 1 in 3 households making over $50,000 cannot afford the premium. You are not safe if you are insured because often what you think is covered is not: Michael Moore’s film Sicko was about this: people fooled to think they are covered, when after all they have paid, they are underinsured. Employers are gouged too so that the movement of jobs outside the US to countries where there is national health care is partly the result of not having to pay such health care bills. We are said not to ration care; but we do, it’s rationed by who can afford it; why is there the cost? more treatments? We get shorter stays if more intense care. It’s said malpractice suits are at fault:: they account for 0.5 per cent of spending; costs of defensive medicine impossible to calculate. In this area of life competition and the need to make a profit makes the system much worse: we pay much higher prices for same services; we have much higher administrative costs; we perform far more of complex dangerous specialized procedures than are needed.

The competitive system makes the health care delivered to individuals much worse: the competition makes it wasteful. Why: aggressive duplicate sales and very high high profit margins. The aim of corporations who involve themselves in the area is to make money for stockholders and they do what makes the most profit. One of 3 health care dollars spent on unnecessary unproven procedures, over-priced drugs, devices no better than inexpensive ones they replaced

She asks, What if individuals are being mistreated, over-charged, is this a personal or society’ responsibility? Yes because we cannot exist apart from one another and what others do affects us immediately in the area of health care. We are not individual automatons doing things that don’t affect one another in the area of health care because it is so central to our lives and we cannot do without it. When a for profit hospital lures customer with false advertising non-profit hospitals who are dependent on the money they bring in must change their ways and lure people. Many many people do know this. In 2004 a national coalition of businesses, unions, provider groups, insurers, called for price controls, national health insurance, restricting increases in insurance premiums. We cannot get reform because the system’s lobbyists pay huge sums to politicians to enable them to get into office, and once they need and have taken that money, they dare not vote in the interests of their constituencies.

There is also a film made from book and it too shows how a profit-hungry medical-industrial complex has turned health care into a system that squanders millions of dollars on unnecessary tests, unproven and sometimes unwanted procedures and overpriced prescription drugs; see the interview too.

Chapter 1: The Road to Corporate Health care: how did we get here? this chapter includes history

This is a story about how power trumped reason and ethics: like Gawande, she opens on the problem of uncertainty, how we cannot know the outcome of a visit or medicine, how doctors themselves operate uncertainly; the patient must buy blindly, and recovery unpredictable. Ironically in this system a well person is someone you can’t make a profit on. Medicine is not a commodity like buying a jar of coffee or car; the relationship is one which has to rely on trust and needs the doctor to put the patient’s interests first. If the product will do you more harm than good, you have still to pay for it. In a capitalist driven system doctors and hospitals are not paid to keep people well but treat them when they are sick. A pill or operation is a sale.

She tells the story of now in the later 19th and early 20th century physicians banded together (the AMA) to create autonomy for themselves. They control who gets what medicine, keep the number of schools limited, price high and their authority supreme and fight transparency (p. 4). In most other professions individuals do not remain independent; she thinks the way they did that was just this need for a relationship between a doctor and patient – and the relationship is needed and must be based on trust and honesty. What they did then was took their cultural authority and strategic position to make themselves gate-keepers to everything you might want or need for real.

Insurers stepped in to help pay the rapidly rising costs and that opened the door to endless price inflation; the only check was the patient’s ability to pay; now it’s the employer’s. he AMA allowed Blue Shield/Blue Cross to come in because they did not interfere with the doctor: doctors not required to charge patients controlled fees; they paid hospitals on basis of costs and let hospitals say what these costs were. The pre-deducted sum from the paycheck of the employer the final enabler. In the 1960s medicare, medicaid were brought in to fund the aged and poor; but the problem here is the gov’t pocketbook is open to be fleeced and was and is.

Meanwhile in world of scientific medicine and profit, you saw the rise of the specialist, and the entry of enterpreneurs who saw a world awash with sums if only they could get their hands on these: hospitals began to compete like hotels, and individual uninformed egos and profit motives allowed to control what is on offer and what people can choose.

By the 1970s this invented marketplace was in crisis. The earliest solutions were smaller groups within the system like HMOs: they would rationalize their groups within and apart. They learned they could not exist apart. Paul Starr has written two important books: one on the social transformation of American medicine and the other on how given the present political system, how we cannot change the bad results. He shows in the latter how the HMOs are too small and not in control; the goal is return on investments as corporations began to buy these entities (HMOs, hospitals, drug companies) whose business is one of selling false ideas about what medicine is and can do.

Chapter 2: The Cost of competition

WE have a Hobbesian system where all the players are pitted against one another and the aim of managed competition was not to deliver better care so much as to keep costs within the present system down: the idea was the insurance companies would dictate what a doctor could order for the patient and this would stop.

To save money you have to pay slow careful attention to the processes, and discover ways to really improve the care of individuals first, ask yourself what kinds of basic care are really effective. Medicine because it goes on between a doctor and patient is a cottage industry: doctors practice episodic medicine and if they don’t share what they are doing with one another, a patient ends up the recipient of mistakes.

She shows how hospital are pitted against hospitals; obtain lavish technology which others have because others have it; speciality hospitals take patients from community hospitals (p. 39). If we look at how she treats each individual area we see Gawande omitted important parts of explanations. He says we do so badly with pneumonia becasue no one cares enough for the average adult; Mahar show that that huge margins of profit are there for open-heart surgeries, while only small ones in for pneumonia care (which demands immediate tried antibiotics (p 40). Yet our population has little immediate need for heart-surgery programs (p 40): our real problems are smoking and bad eating habits. She goes over the ordeal of by-pass surgery and how it’s pushed on people (p 43) who have no watch-dog to help them.

Then there’s doctors versus hospitals (p 45): they have to pay unscrupulous doctors what they demand or they go to another hospital

Doctors want to be in control (p 47) and conflicts break out everywhere: the value system is so askew (p 49): drug-maker v drug-maker, insurer v insurer. The knowledge a physician needs to decide whether or not to give someone an operation, the problems and complications, the medicine, are called “trade secrets” and they cannot find out whether what they are doing is helpful or safe.

We see where whistle-blowers and patients are caught in cross-fire and trampled down, basically punished for being active on their own behalf (p 59). It’s a story with occasional decent people (heroes and heroines): Dench and Powers who blew whistle on doctors overseeing more than one surgery (pp. 59-79). The story of Diane Powers (pp. 63-69) — since it’s normal for patients to die people overlook the causes and increasingly autopsies are not done because they are not profit-making.

Still from Bill Moyer’s Journal: discussing movie from book

Chapter 3: The for profit hospital

For profit hospitals lead to higher prices, well, duh, of course they do; study after study shows this (p 127)

This chapter includes a central revealing history of three pirate companies: National Medical Enterprises, Tenet and Health South. It was run by CEOs who she describes as inherently sociopathic types: these are people good at guessing others motives and manipulating that. Three took away huge sums with impunity: Richard Eamer, a story of billing fraud at psychiatric hospitals (p. 87)); he was replaced by Jefferey Barbakow (p. 93); whole centers set up to obtain and gouge customers was Redding’s contribution (p. 102, 104); Trevor Fetter (p. 114); Dr Tommy Frist a dangerous man because he was himself a respected physician, he worked as a front (p 119) and used his position to enrichen his family fantastically (p. 122); Richard M. Scrushy (p. 125) another “empire” builder. Most of these have gotten out with huge sums. Wall street applauds, (p 101).

Outlier payments: the way they gamed the system was to take the patients whose so-called costs were outrageous and actually bill for these (p 100). In reality no one pays these sums; they are notional except when the patient has no insurance. What happens is the institution figures out how much he or she needs to get to make a big profit and then divvies up the costs for individual items so they add up to that price. It’s also a kickback game (p 115) where settlements are a form of coverup (p. 112).

Shanghaii-ing Patients: I’ve seen this kind of grabbing mentally and socially troubled wreaking of people’s lives when parents of disabled children and young adults mistakenly put them in institutions (p 86); you are in absolute danger (p 89). Victims’ stories include John David Deaner, p 69, Christy Scheck (p. 90); Tony Ginocchio (p. 102); Shirley Wooten (p. 103). The psychiatric industry exists within a a climate of pervasive fraud.

Here and there a quiet hero: the new editor of New England Journal of Medicine, Arnold Relman (p 97), an editor; Jim Moriarity, an attorney (p. 90) and his brother-in-law (p. 108); Louis Parisi (p. 96); Robert F. Stuckey (p. 96); Skolnick Sheryl, pp 106-109

An institution that started life as charity ends an irresponsible investment opportunity wrung dry by ruthless operators (p 131); historically hospitals (like schools) were unprofitable institutions (p 132). Problems includes those who work to game the technology; instill fear in patients and an over-confidence in technology; it’s revealing to see a stock market exuberance characterized early phases of “for profit” hospitals

Chapter 4: Not-for-Profit hospitals driven to change their act so they make a profit. Their original mission is lost.

She begins this chapter with an advertising campaign in a hospital to attract patients as if it were a hotel (pp 139-40). They are not emphasizing safety and not setting up what happens with safety criteria in mind, but rather luring patients in. Academic medical centers also need to be scrutinized because increasingly they are operated with a central aim of bringing in money too.

During the first half of 20th century, hospitals not expected to be self-supporting; paid for by progressive taxes. Boards saw themselves as providing a social service; they were not a crew of savvy entrepreneurs, but pillars of the community. There is always a gap between ideal and real, but now it’s exacerbated and central.

Today not-for-profts rely on borrowed money and what they can bring in for themselves. They are (like churches) still exempt from property and corporate taxes. They do provide charity; they must stabilize patients before ejecting them, only we discover that often they do not do this.

Some results: only 20 per cent of community hospitals invest in palliative care; 4 brand new hospitals in one area where wealthy people live; the hospital has to offer handsome bonuses to keep doctors (p 146). A race on to lure well-insured; high-margin services to cardiac patients (p 148); proliferation of Neo-Natal units p 149: yet infant mortality rates no lower; infants with less serious disease put into ICUs. Ironically, the plans set up for people cost more and provide less (to make this profit).

Chapter 5: When More Care is Not Better Care

She begins with the story of Maureen Silverman who made the mistake of calling an ambulance for her father who was again seriously ill (p 156): he had had many operations and he didn’t want dialysis. The family was told this is what we do; this kind of medicine; the doctors were not interested in what Silverman himself wanted. Instead of hugely expensive painful technology, an IV should have been put in the man. In the middle of the night the old man died and escape them all.

There is no business case for learning how to do less: system stubborn, set up to do more even if all is uncertain (p 174): no capacity or teams of people hired to study what truly works; too much thrown at people (pp 176-77). Too many drugs, and people die from therapy — one of 8 stories in Near Death; you are told it’s your only hope for survival when no one knows if treatment actually works (p 177).

The Insured often receive too much care in the forms of newly-patented medicine and expensive technology: 65 billion is spent in overtreatment; but those with this kind of lavish care do not do any better. By not talking about price we don’t discuss why we do what we do: excess capacity then governs (p 170)

The regional variations: Gawande has a long article in the New Yorker on this too: Manhattan and Miami people receive far more and aggressive care than counterparts in Minneapolis and Missouri, Montana (p 159). Underlying competitive and price gouging system accounts for 1/4 of cost. Geography becomes destiny because the values and types of doctors who exist in one place don’t exist in the other: with more intensity of care, the outcomes are often worse: you are being cut up, so you have greater risk of complications or medical errors; hospitals are dangerous places if you don’t have to be there.

Speciality hospitals syphon off expensive patients and leave longterm care to community hospitals. Often the high-tech treatment is worse for the person (like bone marrow treatment plus chemotherapy often kills instead of saves). Non-invasive treatments reap less profits so doctors do more operations and hospitals participate in this over-sale and attempt to make money.

High tech distracts by from going little things that work and that count (p 165) to big things that may not and are dangerous and painful: antibiotics must be immediately to pneumonia patients, beta blockers to people with heart attacks. Patients expect more care; an ago-old instinct is to want to see something done and not understand that sometimes nothing can be done but palliative help (p 173) and comfort.

Story of Dr Donald Berwick whose wife was several times nearly badly harmed and suffered unnecessarily (he comes up in Gawande’s “Bell Curve”). Ann: we see continual mistakes, continual errors, no one caring for her, no one watching to see what others are doing; she experienced long waits with no attention paid to her – and this is the wife of a big doctor in the best institutions (pp. 182-89).

In End of life care: doctors not trained to listen, not paid to listen; team comes to tell you your options; not paid to do that. The ICU; Meier makes $100 an hour to talk; cardiologist brings in $1000; Hsaio’s famous formula leaves out usefulness (p 193). Technology is defining the patient; no one paid to listen; talking to families major part of what’s done in ICU physicians trained to treat specific illness not whole person

Chapter 6: Too Little Too late

So who is uninsured? 1 in 8 children for a start. Veterans. States decide how to allocate money that is given them by the federal gov’t, and when programs are set up without funds, the states respond by making it difficult for individuals to get health care (p 199). When they are forced to give out immediately, they sharply limit future enrollments. They get rid of the list that tells who is not insured.

Who is at risk: 47 million plus: when uninsured you pay gross bills which insurance companies do not pay (see outlier payments); they receive no preventive care and less or no immediate care (p 201). They do turn people away (p 203); screen them, (p 205); hospitals shun and dun people ruthlessly (p 208); no cash, no cure, no research. We see the capricious access to specialists

People in hospitals made gate-keepers who have forced of character not to take you in unless you have the money (p 202), and sometimes not then. Poignant stories of Martin Martinez and Buddy Rich. Mr North (pp 216-22): the terrible suffering of a working man reveals why in political arenas people get so bitter. They or relatives and friends have been badly mistreated.

Shunning and dunning. Hospitals overprice services to the poor and uninsured: first they refuse to treat you if you are uninsured unless you bring money up front; then they charge you the literal unreal price they send the insurance companies. These are the prices they have to get from a procedure based on cost and profit, not what each thing really costs. Then they sell the debt to a collector. So the person experiences ludicrously high costs, is shunned and then dunned. He or she does not return to the hospital.

Finally, the high costs to taxpayers and the system in general of not treating uninsured and the irrational ways things are cut (p 222-224).

For last part of book, see comments. And see also Gawande’s Complications and essays; Marcia Angell on privatizing medical knowledge: harm spreads through globe; Frederick Wiseman’s Hospital.


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