The British author, Eve Garnett (1900-1991) was born in Worcestershire, England, and had a comfortable, middle-class upbringing. She became inspired to write children’s literature after moving to London in the 1920s for art school and witnessing the stark social division and living conditions of London’s poor.[1] These experiences fueled a lifelong mission to bring attention to poverty and to give children from urban, working-class backgrounds stories that reflected their own lives. Her first book, The Family from One End Street, was published in 1937. It is the first of three books about the Ruggles family, consisting of Mr. Ruggles, a town dustman¹, Mrs. Ruggles, a washerwoman, and their seven children, from teenage Lily Rose to infant William. The subsequent books, Further Adventures of the Family from One End Street (1956) and Holiday at the Dew Drop Inn (1962), take place immediately after the first. Set in the fictional English town of Otwell between WWI and WWII, the series describes the adventures and hardships of the Ruggles family with humor and poignancy. 

In the second book, Further Adventures of the Family from One End Street, a measles outbreak is the inciting event that sets the plot into motion. The eldest, Lily Rose, is the first to be stricken as “her head ached, she felt hot and cold by turns” and then she looks in the mirror to find her face is “bright pink, and covered all over with small red spots!” The doctor is called to their small and crowded home, and he advises Mrs. Ruggles, “You can’t keep her here, you know – nowhere to isolate her and no time to look after her if you had; it’s the isolation hospital for measles these days. I’ll have the ambulance round in half an hour and someone to disinfect that room for you. ‘The others?’ no, they certainly can’t go to school, but don’t you worry, they’ll probably all have it in a few days and be off your hands in the hospital too!” 

Management of measles and other infectious diseases was particularly challenging among the urban poor, who lived in crowded conditions. Because the nine Ruggles live in tight quarters in a “very old and very small” house, the remaining six Ruggles children are at risk for catching measles from Lily Rose.² Infection can also easily spread beyond the Ruggles household to the rest of the neighborhood. To help contain the infection, patients were sent to isolation hospitals, which were standalone institutions dedicated to treating infectious diseases in the pre-antibiotic and pre-vaccine era.  

The evolution of isolation hospitals was shaped by public health efforts throughout the 1800s and the medical acceptance of germ theory by the 1880s. The first fever hospital in England opened in 1801.[2] Early fever hospitals were run as private charities for the poor and featured open-planned rooms where patients suffering from different infections were packed side-by-side. These places were mocked as houses of death because someone admitted with a mild case of one fever could catch an entirely different, fatal infection from the patient in the next bed. Over time, laws established public health funding and regulation for isolation hospitals. The Sanitary Act of 1866 gave local authorities explicit power to provide hospital accommodation for infectious disease, a power consolidated by the Public Health Act of 1875.[3-5] Later, the Isolation Hospitals Act of 1893 empowered county councils to build new isolation hospitals where needed, leading to a national network of specialized isolation hospitals designed in accordance with modern germ theory.[3,6] By WWI, there were more than 750 isolation hospitals in England and Wales.[7] These new isolation hospitals emphasized cleanliness and good ventilation, and featured separate wards for different infections.[7] Thus, when Lily Rose develops measles in the 1930s, the doctor recommends she be admitted to a dedicated measles ward of a modern isolation hospital for quarantine and care.³ 

Hypothetically, if Mrs. Ruggles objected to Lily Rose’s hospital stay, the doctor may not have had a pathway to mandate her admission in the 1930s. The Public Health Act of 1936 gave local health authorities a legal mechanism to apply to a justice of peace, who could then mandate the admission of a patient to an isolation hospital if they had a notifiable disease, home isolation was not possible, and they posed a serious risk of infection to other persons.[8] However, measles did not become a nationally notifiable disease in England and Wales until 1940.[9] Before 1940, it was up to individual towns to make measles notifiable and enforce isolation, and Eve Garnett does not specify if such laws existed in Otwell. 

Despite Lily Rose’s prompt quarantine, her younger siblings Jo and Peg also develop measles and are sent to the isolation hospital. Mrs. Ruggles may have been particularly grateful for the supportive care of isolation hospitals in Jo’s case as “the doctor said Jo was a very sick boy, and told Mrs. Ruggles downstairs it was always worse if the spots stayed in, and the sooner Jo was in the hospital the better!” What the doctor is referring to is that the measles rash typically appears 3-5 days after the first symptoms of fever, cough, coryza⁴, and conjunctivitis; if the rash onset is delayed or “the spots stayed in”, it is a signal that the body is struggling to fight the virus. A late, absent, or weak rash is common in immunocompromised, malnourished, and very young children whose immune systems are not fully developed; these patients are at increased risk for severe systemic complications.[10, 11] While Lily Rose is described as a robust 13-year-old girl who only has a “mild attack”, 7-year-old Jo and 5-year-old Peg suffer more serious attacks and have a longer road to recovery. This is especially true as measles is now known to cause immune amnesia, a condition where the virus depletes patients’ pre-existing antibody repertoire, leaving them vulnerable to other infections for two to three years afterward.[12]  

Upon discharge from the hospital, Peg and Jo have clearly lost weight, are still quite weak, and need further treatment. After a conversation with the doctor, worried Mrs. Ruggles updates her husband, “Peg and Jo’s got to be fed up with malt-and-oil when they comes out, and Jo’s that pulled down, the doctor says as six weeks in the country’ll barely set him up”. The oil the doctor recommends to Mrs. Ruggles is cod liver oil, which transitioned from a folk remedy to a mainstream, multi-purpose medical treatment in the 1800s. However, doctors did not know why some patients benefited from cod liver oil until medical research in the early 1900s discovered vitamins and diseases of vitamin deficiency. Cod liver oil was discovered to contain vitamin A in 1913 and vitamin D in 1922.[13,14] And, as discussed in the first part of this MedHum series, the therapeutic value of treating measles patients with vitamin A was demonstrated in 1932.[15] The high caloric content of cod liver oil also helped with malnourishment. Unsurprisingly, children hated the taste of cod liver oil, so malt-and-oil was developed as a commercial pharmaceutical product in the late 1800s, whereby the fishy oil was mixed with thick, sweet malt extract to make it more palatable. Mrs. Ruggles, who has not tasted the malt-and-oil, puts this mixture to the test when she “hold[s] a spoonful out to” suspicious Jo and coaxes him with hopeful reassurances, “It’s not medicine, nor yet oily – more like soft toffee”. She heaves a sigh a relief when he swallows it without resistance, “Thank Heaven he liked it!” 

By sacrificing their meager savings, Mr. and Mrs. Ruggles are able to follow the doctor’s other recommendation to send Jo and Peg (along with their 12-year-old sister Kate) to stay with Mrs. Wildgoose in countryside for recovery. Throughout the 19^th and early 20^th centuries, sending urban children to the countryside to recover from illness was standard practice; the rationale was plausible in cities plagued by industrial smog, poor sanitation, and overcrowding. When Mrs. Wildgoose meets the children, she says “she could see from the look of Peg and Jo how important [malt-and-oil] was, but mark her words, before the three children had been a week at the Dew Drop Inn, eating the eggs from her ducks and hens, good farm butter, and drinking milk from Mr. Digweed’s cows, they wouldn’t know themselves!” It may be universally agreed upon that eggs and dairy are a more palatable way to consume calories and fat-soluble vitamins than cod liver oil. The children do indeed have a marvelous time at the Dew Drop Inn – their countryside explorations and misadventures make up the core of the book – and they make a full recovery attributed to fresh air, sunshine, exercise, and good food. And when they return home, “How [Mrs. Ruggles] hugged and kissed them all, exclaiming again and again at Peg and Jo’s bright eyes and round, fat, sunburnt faces – so different from the pale, skinny little creatures she had seen off six long weeks ago!” 

Although the book focuses on the children’s perspectives, Mrs. Ruggles’ measles experience is worth acknowledging. She is separated from her children for two stressful months because of measles. She is not allowed to visit them during their weeks in the hospital, as isolation hospitals of the time followed strict quarantine protocols. In fact, the doctor warns Mrs. Ruggles when Lily Rose is first diagnosed, “go down to the hospital this evening if you like but they won’t let you see her.” After Peg and Jo are discharged from the hospital, she sends them to recuperate with Mrs. Wildgoose for six weeks because she cannot afford to take time off of work and she needs to tend to her other four children. No wonder those six weeks felt long, and no wonder she is relieved and overjoyed to see her children healthy again when they return from Dew Drop Inn.  

While the isolation hospital and measles recuperation experience would have been familiar to contemporary readers, it likely feels foreign to readers today. The development of a measles vaccine in 1963 and its implementation in Britain in 1968 – about thirty years after this book is set – dramatically reduced the incidence of measles and contributed to the obsolescence of isolation hospitals.[16] Following the development of highly effective vaccines and antibiotics in the mid-1900s, isolation hospitals were systemically closed or repurposed. Measles was declared eliminated by the World Health Organization in the US in 2000 and in the UK in 2017.[17,18] For a period of time, measles was relegated to a bygone era, just like doctors’ prescriptions for malt-and-oil and country air. However, as vaccination coverage has fallen, measles has returned. The UK lost its measles elimination status for a second time on January 26, 2026, and the US is predicted to follow.[18,19] As a result, Further Adventures of the Family from One End Street is somehow pertinent again in its depiction of measles as a contemporary childhood malady.  

¹ Dustman is a traditional British term for garbage collector, which is considered old-fashioned today. 

² This quote is taken from the first book, The Family from One End Street. 

³ The development of isolation hospitals in the US followed a similar timeframe. In the US, the first isolation hospital was opened in Philadelphia in 1801 following a series of yellow fever epidemics. During the late 19th and early 20th centuries, state statutes across the US codified the mandatory construction of municipal isolation hospitals to control epidemics. Because public health powers are granted to states under the U.S. Constitution’s 10th Amendment, individual towns and state boards of health passed the earliest mandatory measles isolation laws in the late 1800s, and measles became a nationally notifiable disease in 1912. 

⁴ Coryza is the medical term for acute inflammation of the mucous membranes inside the nose, commonly known as a runny nose. It is one of the “three C’s of measles”, a traditional medical mnemonic used to teach medical students the standard early clinical presentation of measles – cough, coryza, and conjunctivitis.  

References 

1. Eve Garnett. Penguin Random House. Accessed September 7, 2026. https://www.penguinrandomhouse.com/authors/9731/eve-garnett/ 
2. Currie MR. Fever Hospitals and Fever Nurses: A British Social History of Fever Nursing: A National Service. Routledge; 2005. Accessed September 7, 2026. https://ndl.ethernet.edu.et/bitstream/123456789/9881/1/1072.pdf 
3. Parsons HF. The Hospital Isolation of Infectious Diseases: I. The History of Isolation. Hospital (Lond 1886). 1913;54(1408):357-358. 
4. Great Britain. The Sanitary Act 1866. legislation.gov.uk. Enacted 1866. Accessed September 7, 2026. https://www.legislation.gov.uk/ukpga/Vict/29-30/90/contents/enacted 
5. Great Britain. Public Health Act 1875. legislation.gov.uk. Enacted 1875. Accessed September 7, 2026. https://www.legislation.gov.uk/ukpga/Vict/38-39/55/contents 
6. Great Britain. Isolation Hospitals Act 1893. legislation.gov.uk. Enacted 1893. Accessed September 7, 2026. https://www.legislation.gov.uk/ukpga/Vict/56-57/68/enacted 
7. Currie MR. Fever Hospitals and Fever Nurses: A British Social History of Fever Nursing: A National Service. Routledge; 2005. Accessed September 7, 2026. https://ndl.ethernet.edu.et/bitstream/123456789/9881/1/1072.pdf 
8. Great Britain. Public Health Act 1936, section 169. legislation.gov.uk. Enacted 1936. Accessed September 7, 2026. https://www.legislation.gov.uk/ukpga/Geo5and1Edw8/26/49/section/169/enacted 
9. Public Health Wales. Measles surveillance and epidemiology. Accessed September 7, 2026. https://phw.nhs.wales/reports/measles-surveillance-and-epidemiology/ 
10. Burrell CJ, Howard CR, Murphy FA. Pathogenesis of virus infections. In: Fenner and White’s Medical Virology. 5th ed. Academic Press; 2017:77-104. doi:10.1016/B978-0-12-375156-0.00007-2 
11. Permar SR, Griffin DE, Letvin NL. Immune containment and consequences of measles virus infection in healthy and immunocompromised individuals. Clin Vaccine Immunol. 2006;13(4):437-443. doi:10.1128/CVI.13.4.437-443.2006 
12. Mina MJ, Kula T, Leng Y, et al. Measles virus infection diminishes preexisting antibodies that offer protection from other pathogens. Science. 2019;366(6465):599-606. doi:10.1126/science.aay6450. 
13. McCollum EV, Davis M. Nutrition classics from The Journal of Biological Chemistry 15:167-175, 1913. The necessity of certain lipins in the diet during growth. Nutr Rev. 1973;31(9):280-281. doi:10.1111/j.1753-4887.1973.tb07065.x 
14. McCollum EV, Simmonds N, Becker JE, Shipley PG. Nutrition classics. The Journal of Biological Chemistry 53:293-312, 1922. Studies on experimental rickets. XXI. An experimental demonstration of the existence of a vitamin which promotes calcium deposition. Nutr Rev. 1973;31(5):158-161. doi:10.1111/j.1753-4887.1973.tb05090.x 
15. Ellison JB. Intensive vitamin therapy in measles. Br Med J. 1932;2(3745):708-711. doi:10.1136/bmj.2.3745.708 
16. Sutherland I, Fayers PM. Effect of measles vaccination on incidence of measles in the community. Br Med J. 1971;1(5751):698-702. doi:10.1136/bmj.1.5751.698 
17. Centers for Disease Control and Prevention. History of measles. Updated April 29, 2026. Accessed September 7, 2026. https://www.cdc.gov/measles/about/history.html 
18. Taylor L. UK loses its measles elimination status. BMJ. 2026;392:s172. doi:10.1136/bmj.s172 
19. Bischops AC, Hulland EN, Patzakis M, Majumder MS. Will the USA lose its measles elimination status? Lancet. 2026;407(10540):1679-1681. doi:10.1016/S0140-6736(26)00466-6

Further Adventures of the Family from One End Street 
Eve Garnett 
Puffin Books, 1993. Paperback. 256 pages 
Originally published 1956 

Web image generated by Medhum.org based on the original book cover.

At the height of the HIV/AIDS epidemic, on Nov. 30, 1993, Larry Kramer, the late writer and gay rights activist, sparred with Anthony Fauci, then director of the National Institute of Allergy and Infectious Diseases, on a C-SPAN call-in program over the Clinton administration’s response to the crisis. Journalist Steve Scully moderated the conversation, also taking calls from civilians whose questions and comments revealed varying levels of understanding of the disease and compassion for those living with it and their loved ones. 

Daniel Fish’s Kramer/Fauci offers a verbatim staging of this conversation, starring Thomas Jay Ryan as Kramer, Will Brill as Fauci, Greig Sargeant as Scully, and Jennifer Seastone as the various callers. All four listen to the C-SPAN recording through in-ear speakers. 

Kramer casts Fauci as the face of an indifferent bureaucracy committing a genocide by inaction. “Tony, if you start that business about, ‘Science isn’t done that way,’” he says, “I’m going to come down there and slap your face.” 

“All right, Larry, hang on for a sec,” replies the career public servant. “I love you, Larry.” 

They are equal parts allies and antagonists, their genuine affection bubbling through their disagreements and making their complicated relationship [1] especially compelling to watch. What I found less compelling was the machine that releases a tidal wave of bubbles, enveloping Kramer. At one point, Fauci lies near the foam in a Titanic-style “draw me like one of your French girls” pose. If the suds are meant to represent lives lost to AIDS, this image risks reducing an enormous human toll to a theatrical flourish; the absurdism does little to illuminate the government’s inadequate response. Seastone dons roller skates at one point and an inflatable chicken suit at another. Are these props meant to suggest that the titular characters are skating past each other? Playing some game of chicken? 

I am still glad I saw the hour-long production. It offers a different experience from watching Fauci sit in a studio or Kramer appear via video screen. The actors roam in the cavernous venue, putting the audience physically inside the conversation. But there is more to theater than the theater itself or theatricality for its own sake—than paltry props and a bevy of bubbles. 

Kramer indicates that, despite Fauci’s diplomatic, controlled persona, he is privately frustrated by the political and bureaucratic constraints holding back AIDS research. What if we had seen imaginings of Fauci’s anger behind closed doors? What if we had witnessed how the men’s relationship evolved—how Fauci began working with AIDS Coalition to Unleash Power, co-founded by Kramer, to expand access to life-saving experimental treatments, or how Kramer later shouted at a government hearing, “Tony, I have called you a murderer in the past, but you are now my hero”? 

What if the production had used its visual language to illuminate the toll of the epidemic rather than providing sporadic spectacle? Panels from the AIDS Memorial Quilt. Stories of the 700,000 Americans who died. The more than 1 million Americans living with HIV today, with Black and Hispanic/Latino Americans and men who have sex with men among those disproportionately affected. 

Otherwise, Fish risks reducing AIDS to a metaphor for COVID-19 and its fallout. Kramer/Fauci should not be relevant only because COVID-19 has reshaped the public’s relationship with science, or because Fauci, three decades later, has once again been called on to defend his work during a plague. It should be relevant because the history it depicts remains unfinished. 

C-SPAN recording of the Fauci/Kramer call-in show  

Fauci remembers Kramer 

[1] Fauci, Anthony. “Anthony Fauci on Larry Kramer and Loving Difficult People.” The New York Times, 4 July 2023, https://www.nytimes.com/2023/07/04/opinion/anthony-fauci-larry-kramer.html.  

Web image generated by Medhum.org

The book has a Biblical quality. The story unfolds in present day Australia, but the atmosphere is ancient and premodern. Wood incorporates a frightening plague of mice who infiltrate every element of the women’s home and terrify the nuns. Also, a woman who knew the narrator in high school and who was the victim of a horrifying adolescent gang attack surfaces unexpectedly. She is now a famous nun charged with returning the bones of a murdered sister to the community for burial. Her sudden appearance unsettles everyone. It all sounds like “A Children’s Bible” by Lydia Millet. But it is unmistakably a tale of adults living today in a world that we recognize. These mythical events play out in the setting of grounded people caught up in regular everyday challenges and missteps – miscommunication between couples, adolescent conflicts, failing to realize unintended slights, evenings spent comforting ill friends. The narrator is surrounded by nuns, neighbors, and friends whose activities and conversation are routine. Against this backdrop, her voice sounds timeless and prophetic.

This is an extraordinary book. It is not an easy read but a rewarding one that would be meaningful to any doctor trying to become a better care provider. For example, there is an intense effort underway to incorporate quantitative rigor into medical practice. With that as the point of departure, absent evidence to support one treatment over another, it might seem that restraint would be the best path for a doctor to follow. But illness calls for action. And if doctors are honest, they will acknowledge that errors are made in the course of action that they choose. Patients can be injured and their deepest hopes may be ignored. There is plenty of room for misunderstanding and hurt in both directions — patient to doctor, doctor to patient. How does a thoughtful, mature doctor manage this inescapable burden?

Wood’s novel speaks to doctors who have to address mistakes and conflicts every day in their practice. The setting is religious, but the scope is human. She does not offer an evidence-based one-size-fits-all solution to the chaos of life. The interdependency of people and the connectedness of people and nature are central features of the book and key to its emotional integrity. With that backdrop, she has created a narrative that sensitively details the burden of pain and despair when people cannot get past these challenges. This is balanced by the serenity that is achieved when people honestly confront their mistakes and receive forgiveness for misdeeds. The individual stories in the novel vary and the outcomes differ. The endings are often imperfect and reflect our human limitations. But there are moments of deep connection between characters, a willingness to accept how life played out. The feelings that are created are real and genuine. And they speak to doctors.

This is the season in the Jewish annual calendar when one is commanded to take stock of one’s life and conduct. The underlying theme is atonement, to frankly acknowledge personal flaws and misdeeds and seek forgiveness from that one has hurt. The religious framework is an opportunity to address mistakes of the past and map a path to a healthier more moral future. Ideally, it builds on true memory to create a new future history for our personhood. I would recommend Wood’s book as a human companion text to traditional Jewish prayer books. It is a challenging read, unsettling in its directness, and implacable in its honesty. It is an irreplaceable guide to genuine forgiveness, acceptance, and compassion, whether or not you are a doctor, regardless of your faith.

Stone Yard Devotional
Charlotte Wood 
Riverhead Books, 2023, 293 pp 

Web image generated using the original book cover.

In Christopher Nolan’s adaptation of The Odyssey (2026), this entire sequence is conspicuously absent. Waking up on the beach, Matt Damon’s Odysseus only sees Athena, played by Zendaya. Zendaya’s Athena reappears at times in the story, watchful and from afar, such as during conversations. On the beach, Athena is seen in the distance, and Odysseus is stoic. There is no court of Alcinous. Athena’s inclusion also stands out against the rest of the film in that she is the only god personified. As has been criticized by Emily Wilson, the translator of the popular 2020 translation of The Odyssey that Nolan took inspiration from, it is a godless film ¹. Rather, the gods are often vaguely referenced in terms of evoking natural phenomena (e.g., the storms in the distance representing Zeus). So why then does Athena appear time and time again, wordlessly watching?

To understand Athena’s role in the film, it is useful to return to earlier interpretations of the poem. The story of The Odyssey is many things, not the least of which is a story of post-traumatic stress disorder (PTSD). Jonathan Shay’s (2002) Odysseus in America: Combat Trauma and the Trials of Homecoming has most authoritatively used the original text as a framework to understand the poem through the lens of PTSD. Shay argues that Odysseus’ mistrust, lying, explosive violence, and emotional concealment mirror the real-world symptoms seen in combat veterans. He further argues that unlike Odysseus, for whom the titular odyssey of 10 years acts to process his trauma, modern soldiers go from the battlefield to civilian life via a quick plane ride, removing the ability to process trauma. Yet, Nolan’s film refines this allegorical parallel to PTSD beyond the original poem. Many of these qualities Shay touches upon, including the mistrust, lying, and emotional concealment, have been stripped from Odysseus in Nolan’s version, rendering him an “uncomplicated man,” per Emily Wilson. Yet, a new trait, core to PTSD, is introduced: avoidance.

Understanding Nolan’s The Odyssey as allegorical for PTSD fundamentally alters how several scenes are read. For much of its runtime, it feels far removed from the commentary on PTSD of the original poem; Odysseus seems unbothered by the passage of time. Contrarily, it also diverges from the poem in directly calling attention to Odysseus’ role in the Trojan War, which remains relatively implicit in the original poem. The film’s third act reconciles this contradiction by rendering the film’s past events as an exercise in avoidance of trauma. It is only in the finale of the film that the function of these visions of Athena is revealed. Odysseus finally tells the story of his sacking of Troy, and in it, the desecration of a statue of Athena is juxtaposed with the execution of an innocent Trojan, played by Zendaya. This parallel invokes Quran 5:32 (“Whoever kills a soul unless for a soul or for corruption . . . he had slain mankind entirely”) and other religious traditions holding that to kill an innocent is equivalent to killing a god. Simultaneously, it recontextualizes the recurrent appearances of Athena across the film as a type of living embodiment of the guilt that Odysseus holds with him. Athena never intervenes in the film as gods do in Homer’s original poem; rather, she watches, materializing at exactly the moments Odysseus would otherwise be flooded by memory of Troy. This parallels the sense of being watched that trauma survivors describe (Sims & Sims, 1998). While in Homer’s original poem Odysseus breaks down in recounting his journey, in Nolan’s film, instead, he remains stoic while seeing Athena in the distance, avoiding the memories of the war.

So, returning to Book 6 of The Odyssey, Odysseus cries on the beach, overcome by trauma. But in the film, something just as characteristic of PTSD occurs. Odysseus sees Athena, analogous to the innocents he killed in the Trojan War, and he looks away. He avoids reckoning with the regret that comes with such a vision. In Nolan’s The Odyssey, no gods remain to offer Odysseus solace from PTSD. Rather, Athena, the only god that remains, serves only as a reminder for him of his combat trauma.

Footnote:
1, https://www.lrb.co.uk/the-paper/v48/n14/emily-wilson/an-uncomplicated-man

References:
Shay, J. (with Internet Archive). (2002). Odysseus in America: Combat trauma and the trials of homecoming. New York : Scribner. http://archive.org/details/odysseusinameric0000shay

Sims, A., & Sims, D. (1998). The Phenomenology of Post-Traumatic Stress Disorder: A Symptomatic Study of 70 Victims of Psychological Trauma. Psychopathology, 31(2), 96–112. https://doi.org/10.1159/000029029

The Odyssey
Director: Christopher Nolan
Universal Pictures, 2026: RT 2hr 52 min
Web photo courteous of Universal Pictures

Felix is a gifted director at an Ontario theatre festival. He plans an exciting new interpretation of The Tempest but is unfairly ousted from his beloved position by a jealous and inadequate rival. Worse, he is haunted by grief over the loss of his daughter, Miranda who died twelve years ago. 

Struggling financially, he accepts a low-paying position to promote literacy in a local prison—and hits upon the idea of using his newfound but incarcerated protégés to mount his long-planned Tempest. The project encounters financial difficulties that begin to seem insurmountable, as his hostile rival assumes an influential government position. 

Moments of hilarity abound. For example, Felix convinces hardened criminals that they might crave and compete to portray such unlikely roles as the ethereal sprite, Ariel, or even the enslaved, monster, Caliban (Hag-seed), with whom the prisoners feel a special connection. Felix forbids swearing, except those oaths used by Shakespeare and the prisoners delight in creating a glossary of antiquated expletives, which they apply to everyday life. The “Correctional Players” embrace digital technologies, and choreography and plan to video their performance. Bringing a meaningful project to his initially uncomprehending, new friends becomes a reward in itself, inviting him to reconsider and move beyond his previous losses.

The result exceeds all expectations, helps to heal his grief, and with its unorthodox staging provides a delicious revenge. 

Hag-Seed
Margaret Atwood 
Penguin Random House, 2017: 320 pages 

AI image created with prompts by MedHum.

For thousands of years, the value of medical treatments of the day was disparaged with some frequency mostly in the form of quips from prominent people in health care, the arts, government, and social commentary. More recently, the quips evolved into formal philosophical arguments conveying a view that the likelihood of any new medical treatment becoming a major breakthrough is low. The term “medical nihilism” is now associated with this view. 

In this episode, with the physician and philosopher Dr. Ross Upshur, we cover medical nihilism conceptually and assess how well the term fits the arguments underlying it. We discuss some of the components comprising the arguments, which are generally real, and how they can contribute to medical nihilism, and validate the uncertainty existing in medicine for some. We talk further about how to accept this uncertainty and manage our health care decisions as providers, educators, and consumers without falling into the despair of medical nihilism. 

Note that throughout the episode, we mention Jacob Stegenga and his book, Medical Nihilism, and also Jonathan Fuller and his book, The New Modern Medicine. We mention Ross Upshur and Maya Goldenberg’s article, Countering Medical Nihilism by Reconnecting Facts and Values in Studies in History and Philosophy of Science. Citations for each are listed below.

Primary Sources
Upshur, Ross, and Maya J. Goldenberg. “Countering Medical Nihilism by Reconnecting Facts and Values.” Studies in History and Philosophy of Science Part A, vol. 84, Dec. 2020, pp. 75–83. (Available as pdf at Maya Goldenberg’s website.)
Stegenga, Jacob. Medical Nihilism. Oxford University Press, 2020.

Fuller, Jonathan. The New Modern Medicine: Disease, Evidence, and Epidemiological Medicine. Oxford University Press, 2025, academic.oup.com/book/61541. (Available as open access at Oxford University Press.)

Links
Biosketch for our guest Dr. Ross Upshur 
FDA list of recalls, market withdrawals, and safety alerts.

Attributions
For audio clip: From Atonement by Ian McEwan, read by Jill Tanner. Audiobook. [Recorded Books, 2002]. Accessed via Spotify.

Episode image: 
Oliver Wendell Holmes, Sr 
Credit: Oliver Wendell Holmes. Colour lithograph by Sir L. Ward [Spy], 1886. Wellcome Collection. Source: Wellcome Collection. License: Public Domain Mark.

Thanks to Dr. Ross Upshur for his interesting and insightful contributions to this episode. 

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Literally thousands of books have been written about Pompeii, scholarly tomes and novels, from Edward Bulwer-Lytton to Robert Harris. It has also inspired operas, fictional movies, documentaries, and entrepreneurial tours. Does the world need yet another book about Pompeii? The answer is “Yes!”

The Buried City is the elegantly translated and beautifully illustrated work, originally published in German, written by the site’s most recent director. Born in 1981, educated in classical studies at Berlin’s Humboldt University, Zuchtriegel came to Pompeii in 2021 from his position, further south, at the UNESCO World Heritage Site of Paestum. His selection benefited from a 2015 change in Italian regulations that finally allowed foreigners to take up prestigious museum jobs. That did not stop 140 professors and curators signing a petition against his appointment – too young, too inexperienced, they claimed. One wonders if they also objected to his German nationality. (Since 2023, the regulation change is being walked back under the right-wing Meloni government.) But Zuchtriegel does not tell us that miserable story until near the end of his book, more with bemusement than rancor.

Some of Zuchtriegel’s critics complain that his enthusiasm for communicating the archeological finds to a wider public is facile popularizing; and they fret over his desire to grant greater access to the sites for risking damage to ancient stones or injury to visitors. He believes that if the public purse supports digging into the past though archeological endeavor, then the public deserves to know, understand, and contemplate the findings in a way that allows for human connection. That agenda welcomes the multidisciplinary approach to interpretation that goes beyond the bare findings of stones and bones to include written sources and the technological traditions of farming, cooking, and building.

His book is a captivating blend of history, guide, and memoir. Each chapter explores the interpretation of a recent discovery that evokes life in those fateful days and connects it to our own reality. A series of frescoes brings alive Roman interpretations of Greek myths. The small size of dwellings invites a reconsideration (upwards) of estimates of the city’s population and the vast number of casualties. A slave bedroom speaks of the fear and daily suffering of those who were unable to flee. A pre-eruption grave with an intact skeleton challenges assumptions about changing burial and religious practices. The looting of the site in the immediate aftermath of the disaster made an impact on what is found and not found now.

Pompeii reminds us that mass casualties are a terrifying yet constant feature of human existence. Wikipedia offers a list of natural disasters by chronology and death toll. Volcanoes, earthquakes, tornados, and tsunamis cannot be prevented, but now many can be predicted, warnings provided, relief prepared. But other “unnatural” disasters result from deliberate human action, especially in war; a disturbing realization that led two doctors – a Russian (Evgeny Chazov) and an American (Bernard Lown) — to create the International Physicians for the Prevention of Nuclear War. They reasoned that medicine could do nothing faced with the mass casualties of an atomic bomb; medicine must therefore prevent it.

Humanity is also responsible for climate change. As I write, Nepal is grappling with a sudden flash flood that has suffocated several villages with thousands missing and dead, buried in dense mud and clay, just as the victims of Pompeii were entombed in volcanic rock. Will the lost eventually be recovered as plaster casts in some remote archeological future? Could this disaster have been predicted and lives saved, as some are now suggesting? And in connecting the horror of two thousand years ago to our own time, will we use our growing understanding of those brutally arrested lives to fully embrace our responsibility to adapt to and restore the waning health of our planet?

The Buried City: Unearthing the Real Pompeii
Gabriel Zuchtriegl
Translated by Jamie Bulloch, University of Chicago Press, 2025. 

Destruction of Pompeii and Herculaneum from Wiki Commons

While the prospect of entering old age, say beginning when we hit seventy, comes with some serenity, so too does it come with fear. Those of this age group have seen the ravages and indignities that could befall themselves having witnessed the experiences of their families and friends, as well as their exposures to cultural and social representations (movies, novels, art, TikTok, Facebook). Their fear ranges from mild concern to outright panic, and their reactions range correspondingly. Those with mild to moderate fear might take up exercising or some brain work, see their doctors regularly, and adopt wearables. Those in utter panic will consider much more drastic actions. In all cases, the reactions to these fears boil down to fighting destiny. 

Lionel Shriver, in her novel, Should We Stay or Should We Go, takes on the case of the panicked, and imagines what they might be willing to do to avoid the horrors that can attend old age and how their actions could turn out. She does this through the story of Cyril and Kay Wilkinson.  

The Pact 

Cyril Wilkinson and his wife Kay make a pact. On Kay’s eightieth birthday, when Cyril is already eighty-one, they will commit suicide together. Cyril, a physician in the British National Health Service (NHS) secured a supply of secobarbital as the means to their ends. It was 1991. They have planned well ahead; another twenty-nine years will pass before Kay’s eightieth in 2020. 

Motivating the pact was the death of Kay’s father after “a good four years of steady deterioration, followed by a solid ten of nothing but degradation” from dementia. (p. 7) Kay recalls “how he was physically so unpleasant,..managing the nappies alone was such a trial, because he fought and kicked a great deal, and sometimes, which was mortifying, got a soft little erection—honestly,  my own father.” (pp. 2-3) Then “the chasing and corralling and undressing…I was halfway between a daughter and a sheepdog. And in between these and many like events, pictures of Kay’s father kept popping up in her head, such as one showing him “naked below the waist, purple with rage, and covered in feces.” (p. 9) 

They had just arrived home from his funeral service and were reflecting on what they had been through. At one point, Cyril says, “Your father frankly made me suicidal—or homicidal—or both. Half an hour in his presence passed like a mini ice age,” and then promises Kay, “I will do almost anything to keep the two of us from acceding to such a fate.” (p. 12) Kay is dubious. 

That’s what everyone says…Everyone looks at what happens to old people and vows that it will never happen to them…Somehow they’ll do something so their aging will proceed with dignity…Everyone thinks they have too much self-respect to allow a stranger to wash their private parts…Then it turns out that, lo and behold, they’re exactly like everyone else! And they fall apart like everyone else, and finish out their miserable end of their lives like everyone else. (pp. 12-13) 

Cyril counters, “in order to retain agency over your own end of life, you have to be willing to give up some small portion of it that’s not particularly rubbish.” (p. 31) But, he admits the plan amounts to “placing a high-stakes wager.” (p. 32) Kay dithers over the next few months, but then her mother begins showing signs of dementia; “I’m all in,” she tells Cyril. (p. 17) 

The Pact Wobbles 

Cyril and Kay proceed through the subsequent twenty-nine years, with Kay raising their three children, retiring, finding new work and passions; Cyril going on and on about politics, the NHS, old people; and both watching their remaining parents pass on, traveling to far-flung locations, becoming grandparents, aging. Then the day arrives; happy birthday, Kay? 

The four years preceding Kay’s eightieth birthday overlap both the decision of the United Kingdom (UK) to leave the European Union (“Brexit”) and the Covid-19 pandemic. Thus, during the time Cyril and Kay are beginning to wonder whether they will actually leave or remain on Earth, the UK is deciding whether to leave or remain in the European Union. And while Cyril and Kay are seemingly willing to die rather than fight the ravages of old age, millions of people are willing to fight the ravages of Covid-19 rather than die. These juxtapositions pop up often giving the Wilkinsons’ decision added poignancy, and play a part in their newly manifesting doubts about the pact as the established date of its execution nears.  

At this juncture, Shriver conjures twelve different endings that still take the form of high-stake wagers. Through these alternative paths, we see if the wagers are well placed. We also gain insights on common and contemporary issues concerning aging, as well as on some hypothetical and futuristic possibilities. Among them are these: 

• The surprises still left between people after more than forty years of marriage 
• The possibility of a person with dementia as happy 
• Whether being sensible and prepared for old age is always rewarding 
• The prospect of outliving enjoyment, purpose, or interest in life 
• What life might be like when a drug reverses aging and makes elderly people twenty-five years old again, forever 
• Elder abuse within an institution and within a family 
• The adventurousness and desperation people approaching old age can exhibit 

Though each of the alternative endings comprise individual chapters, they are not wholly independent of one another as they each borrow ideas, paragraphs, dialogs, and sentences from the others. Some of them peel off into separate tales. Shriver does not limit these through lines to just those within the book. In one case Shriver samples another of her books, So Much For That, and in another, she riffs on an American in England who bloviates on BBC 4 and in a widely-circulated newspaper, who happens to be Shriver in real life. These interminglings make for more dynamic prose, and add some coherency to all the different alternatives presented. 

Destiny’s Grandparents 

None of the alternative endings stand out as the one they should follow. Shriver, though, offers other ways of accommodating the challenges and frights of approaching old age. Throughout the chapters, and with mostly dialog between Cyril and Kay as they think through their choices and decisions, she puts an emphasis on destiny, risk, and bravery.  

When Kay is arguing against the pact, she tries to impress upon Cyril that destiny has a part in what becomes of them, and that they cannot control all of it. “Our destiny isn’t wholly in our hands. I realize you don’t like that about the world, but there’s an upside: our destiny isn’t wholly our responsibility, either. Or, if we end badly, our fault.” (p. 241) Shriver emphasizes the point by making destiny a component of each alternative path they take. Destiny can’t be completely controlled, so embrace it, or at least accept it, Shriver may be saying.  

As they did with their original plan for Kay’s eightieth, the Wilkinsons would have to wager that the outcomes of any of their alternative paths would be more preferable than the status quo. Kay acknowledges that this reality has been the case throughout their life when she asks Cyril, “every decision we make is a gamble, isn’t it?” (p. 202) So, why not give them a go? 

The pact Cyril and Kay make can seem brave, but Shriver is not having it, and especially not when compared to the bravery needed in old age. “Real bravery and nobility,” Kay tells Cyril, “entail losing everything you love by degrees like everyone else, and taking what comes like everyone else, and dying when you least expect it and when you don’t want to, like everyone else.” (p. 75) “Buck up,” Shriver could have added. 

We should stay: it’s destiny, with risks, be brave, eat your ice cream.  

Should We Stay or Should We Go
HarperCollins, 2021: 266 pages 

Image Credit
Title: The Voyage of Life: Old Age 
Artist: Thomas Cole, 1842 
Source: Obelisk Art History  Public domain 

For a growing number of artists whose work falls under the umbrella of graphic medicine—and the readers who make up their audiences—words and drawings in short- or long -form works, the genre provides an effective platform for not only exploring these questions, but for understanding and education, advocacy and activism. In publications that include single frame cartoons, self-published zines or “floppies” (comic-book-style publications) as graphic memoirs and novels, the message is often both less and more complex than text alone. In a single cartoon frame portraying, for example, the relaying of a prognosis, the expression on the face of a patient, the body language of a physician, and even the choice of lettering in the thought or speech bubbles that accompany the drawing, can create an emotional impact that resonates deeply and immediately. (For some graphic medicine cartoonists, what’s left unsaid appears to be just as important as the language they include.)

Those newer to the art form, may find the Graphic Medicine Manifesto (Pennsylvania State University of Press, 2015 and 2025) a fine place to start. Authored by a group of six creators* made up of clinicians and caregivers as well as those working in the medical humanities, the volume serves as a kind of bible for the community. Co-author Ian Williams, a physician and graphic novelist, coined the term graphic medicine to describe comics and graphic novels with medical content. The field is variously described by other members of the informal collective behind the manifesto as including, but not limited to, “the intersection of the medium of comics and the discourse of healthcare”, a “movement for change that challenges the dominant methods of scholarship in health care offering a more inclusive perspective [on medicine and caregiving]” and comics that “give voice to those who are not often heard”. While a significant segment of the work produced focuses on the physical and emotional aspects of illness, medicine, and caregiving, graphic medicine also serves as a means of demystifying disease and injury, professional and lay education, and even patient advocacy.

Creators in the broader graphic medicine community frequently cite its reputation for friendliness and inclusivity; numbered among their ranks are clinicians, researchers, allied health professionals, educators, public health experts, patients, medical illustrators, and others.

A quick survey of the virtual or actual graphic medicine bookshelves reveals the seemingly inexhaustible array of subject matter, with entire sub-genres devoted to specific diseases and conditions. For those on either side of the healthcare divide – providers and patients—these documents can create a bridge to understanding.

Drawing styles employed in graphic medicine are as various as in other art forms. Political cartoonist Peter Dunlap-Scholl, for example, uses a “jangly” drawing style in My Degeneration, which depicts life with Parkinson’s and the effect the illness has had on the way he makes art. Moka Onmae’s graphic novel, Good Morning, Good Night, and See you Tomorrow, based in part on her experience as a cancer patient, adheres to many of the conventions of manga (Japanese comic books and graphic novels with distinctive visual characteristics) to great effect.

Complementing the vast body of patient narratives is an abundance of graphic medicine content that focuses on medical education and clinical practice, including memoirs specific to illnesses that were once thought to be untreatable and diagnoses/conditions that have recently emerged or been identified. Graphic medicine pioneer, MK Czerwiec’s Taking Turns, for example, describes her experience as a nurse in a Chicago hospital caring for patients on an AIDs unit, and includes oral accounts from patients, family members, and staff. The book serves as a historic document as well as a memoir. Palliative care physician Nathan A. Gray’s forthcoming graphic memoir, The Human Remains: Drawing Out Compassion in Medicine, addresses the author’s efforts to maintain his humanity through residency in a system that doesn’t always allow the time and space to do so, and his continued striving while working with patients approaching the end of life.

Use of graphic medicine in the medical school setting has also grown in recent years. Penn State physician and bioethicist Michael J. Green, was among the first group of educators to teach graphic medicine; in his case, introducing the curricula to fourth year medical students in 2009. Writing on this topic in the Graphic Medicine Manifesto, Green elaborated, “[Comics] can tell compelling stories about illness and demonstrate the complexity of medical culture. Reading comics can help students think critically about the environment in which they learn and work, and making their own comics can help students communicate more clearly and precisely.” Moreover, Green wrote, “Being challenged to tell a story by drawing pictures can be an uncomfortable and often daunting exercise…. a reminder that they (and doctors in general) seldom have all the answers or skills to solve every formidable problem that comes before them.”

The relatively recent explosion of graphic medicine comics, zines, novels and memoirs, notwithstanding, it’s worth noting that there’s also a much earlier tradition of cartooning that centered on illness, the medical profession and the public. British caricaturist James Gillray’s The Cow-Pock—or—the Wonderful Effects of the New Inoculation (1802) memorably depicts the wildly imagined consequences of inoculation against smallpox among contemporary anti-vaxxers. William Hogarth (1697-1764), who famously skewered politicians, the upwardly mobile, and the morally dissolute, did not spare physicians his merciless critique in his engravings. In A Consultation of Physicians, or The Company of Undertakers, the artist depicts a gathering of doctors led by three notorious “quacks”, including John Taylor, the “oculist” said to have performed botched eye surgeries on Handel and JS Bach. More on Hogarth and his role as a member of the board of governors and muralist at St. Bartholomew’s Hospital in London, can be found on www.drawing-blood.org, a website associated the Billy Ireland Cartoon Library & Museum at Ohio. Those wishing to go even farther down the rabbit hole on the history of medical cartoons, may be fascinated by Professor Jared Gardner’s piece on the Gumps (a long-running comic strip from 1917 to 1959) in which family members contend with the threat of the Spanish flu epidemic.

State of the Art

Among those graphic medicine creators approaching the complexity of the human body, disease, and delivery of care from a distinctive perspective, are Kriota Willberg and Gianna Paniagua. Willberg, who has worked as a dancer, massage therapist, and anatomical illustrator, and holds certificates in bioethics, medical humanities, and gerontology, is the creator of numerous pieces including the Cadaver Diaries, in which she documents her experience as a student and later as a co-teacher of a drawing class for medical students in a cadaver lab. The booklet not only offers a nuanced description of this work, but also explores how Willberg grew to view bodies in other contexts, as when she sat at her father’s bedside at the end of his life, her understanding of anatomy and physiology making his death more real. “Learning …from textbooks and models taught me perfect anatomy. Dissection taught me how a body’s anatomy can vary and survive illness,” she notes in Cadaver Diaries.

Currently a part-time adjunct professor at Parsons School of Design and an instructor for Art and Anatomy at NYU Langone, Willberg’s time as the Artist in Residence at the New York Academy of Medicine led to the creation of her comic, Silver Wire. Placing herself in the story as a character, a technique that allows her to represent the naïve and curious layperson, Willberg gets a hands-on lesson on ligatures and suturing techniques (her use of fruit as “patients” makes for some intentionally humorous moments) from her friend Mollie, a palliative care physician. Throughout this section, Willberg draws the parallel to stitching techniques used for centuries by needleworkers.

The narrative then advances to a discussion of medical knowledge acquired via unethical and sometimes deeply disturbing practices over the centuries, including experiments on servants, enslaved people, and prisoners by Galen, Paré, and Bell. Willberg’s focus on J. Marion Sims and his experimentation on enslaved women—which included surgeries performed without anesthesia—in his work on vesico-vaginal fistula, serves to illustrate how the surgical techniques and advances that benefit so many women grew out of this history. The title of the comic refers to the silver wire Sims used during surgery to reduce infection. “Because Sims findings were shared internationally, individuals of all genders in countries where there was no legacy of slavery benefited,” Willberg notes. “In fact, he probably saved the lives of some of my ancestors. I think it’s important to share this information.”

Gianna Paniagua, an artist who has been both a painter and a papercutting sculptor, and is a two-time heart transplant recipient, is making another unique contribution as a graphic medicine cartoonist and patient advocate. In both mini-comics and several pieces published in Bonus Days, a magazine by and for transplant patients, among other publications, Paniagua has documented her complicated history. After receiving an initial transplant at 14 months of age due to hypertrophic cardiomyopathy, she then required another as a young adult to address transplant coronary artery disease that developed after a period of non-compliance with her treatment.

Finding an institution that would approve her for a second surgery proved challenging, and it took a great deal of perseverance to find the team at Vanderbilt University where her second transplant surgery was performed. Even with the highly supportive team in place, Paniagua says, “I thought I would die in the surgery, because it was very high risk. I was trained for years not to expect something good to happen [and] I was trying to find something where I could quickly leave a legacy and tell a story others could learn from.” Although she had focused on oil painting as an art major at the University of Pittsburgh, it was important to avoid exposure to toxins in the medium. Paper cutting was also too strenuous at the time. Graphic medicine turned out to be the natural fit for someone who had spent much of her childhood drawing. Her comic about life after surgery and the expectations of others regarding her health are powerfully shown in “Are We Ever Really Recovered?” published in Literature and Medicine in 2023.

With her second heart surgery now five years behind her, Paniagua is still immersed in the transplant world, not only as an artist, but as a patient coping with chronic pain and the demands of remaining vigilant against rejection. Her work as an advocate for other young adult heart transplant patients also takes center stage. “Dealing with the side effects of immunosuppressive drug regimens and noncompliance remain major concerns [for this population]”, Paniagua says. She also notes the importance of adequately educating female transplant recipients about issues specifically related to gender, including the impact of their condition on childbearing.

“I think there are creative solutions for this. It’s important to hear true stories about other transplant patients. It’s a way of feeling less isolated. Graphic medicine breaks barriers of education and language,” Paniagua adds. “If you see an image, it can cling to you. There’s a magic in it.”

Her commitment to helping clinicians communicate clearly and empathetically to those in their care is another driving force behind her comics. When possible, she attends conferences and participates on panel discussions on graphic medicine as well as on care for young heart transplant patients.

Paniagua also acknowledges the role of graphic medicine comics in helping her process a lifetime spent in the medical world. While enrolled at Columbia University in the Narrative Medicine program, Paniagua conceived of a capstone project depicting a heart transplant surgery for a Medical Education comic that would benefit other young transplant patients. Already in the process of founding a support group for this population, she had maintained a connection to her own transplant team and with strict adherence to HIPAA guidelines she was granted permission to be present during a transplant surgery. Although one of her advisors had expressed some reservations, thinking that Paniagua might be unsettled by the experience, she was amazed and inspired and plans to co-create more work in the future with other transplant recipients. She is also deeply gratified to know that the patient whose surgery she observed is doing well.

Owing in great part to the efforts of Graphic Medicine International Collective (www.graphicmedicine.org), comic artists like Willberg and Paniagua, among numerous others, continue to receive exposure and opportunities to network with their peers in cities around the world, both through the organization’s conferences and on their website. The widely attended Comic-Con in California has also hosted programs in graphic medicine, bringing awareness to mainstream comics audiences, while smaller conferences hosted by universities and professional societies are proliferating.

As many in the graphic medicine community will acknowledge, there is still resistance to the value of the genre in some quarters. But this, too, appears to be changing, as demonstrated by the online exhibition maintained by the National Library of Medicine: Graphic Medicine: Ill-Conceived and Well Drawn! With the imprimatur of the National Institutes of Health lending support for graphic medicine – and a growing number of published titles by physicians and other healthcare professionals receiving glowing reviews, there’s surely more widespread acceptance to come.

Selected Notes and Resources
The book alluded to in the beginning of this article is Memento Mori by Tiitu Takalo, which chronicles the artist’s recovery from a ruptured cerebral aneurysm, its effect on her life as an artist and on her personal relationships. In her introduction she also notes that citizens in her home country of Finland are spared the added burden of medical debt as they recover from a serious medical event.

The Graphic Medicine Manifesto was authored by M.K. Czerwiec, Ian Williams, Susan Merrill Squier, Michael J. Green, Kimberly R. Myers, and Scott T Smith

More of Kriota Willberg’s work can be viewed at http://kriotawelt.blogspot.com and on Instagram at @kriotawillberg. Her full-length memoir, Over My Dead Body, will be published in 2027 by Fantagraphics.

Gianna Paniagua’s website, https://giannapaniagua.squarespace.com, showcases her work in various media. She is on Instagram as @tragicdarling.

Web image created by Medhum.

AIDS in the Comics: The Graphic Memoir Taking Turns with MK Czerwiec

Russell Teagarden 08.27.26 326

A nurse’s graphic memoir reveals the human stories, suffering, and compassion behind the AIDS crisis.

I learned of Lawlor’s book in an engaging essay in a recent issue of The New Yorker. She is Henry Waldgrave Stuart Professor of Philosophy at Stanford University. The review was intriguing and a book only 213 pages long sounded plausible. I am here to confirm that it is a beautifully written book, one that does not pull punches and that does not hide behind academic terminology. It is of the moment and I hope it gets wide circulation and readership.

Let me explain why. The force driving Lawlor’s book is to analyze the relationship between rational and reasonable thinking and to make the case for restoring value and prestige to the second cognitive style. Lawlor addresses the difference in multiple contexts – in law, in personal identity, and social values. Rational man has had several names including Homo economicus and has been studied in clever models such as the response to the Prisoner’s Dilemma (read the book for details). She points out that greater emphasis was traditionally placed on being rational, namely, making intellectually valid decisions about ourselves and the world around us. Reasonableness was dismissed as a lesser virtue, one that was poorly defined and incapable of promoting good behavior.

The book is rich in stories. Lawlor starts the book with a court case that occurred in Louisiana in 1992. A 16-year old Japanese exchange student was invited to a Halloween party but unfortunately went to the wrong house. After a confused and ominous exchange with the owner, even though the student started walking away from the door, the owner of the house became anxious for his safety and well-being and fatally shot the student. A criminal jury acquitted the homeowner and considered the shooting a reasonable response to a perceived threat to life. A driver in Ohio is issued a summons for exceeding 85 miles per hour in his vehicle, above the reasonable limit. Governor Pataki and Mayor Guliani argued whether it was reasonable for the mayor to violate the standing law and run again as a candidate for another time after the September 11^th attack.

Lawlor’s book begins with the standard view, namely that a rational person is “logical, smart, and unemotional” while a reasonable person is “honest, kind, and fair.” But her central thesis is that this characterization overstates the value of rationality and misrepresents the importance of reasonableness to meaningful interpersonal interactions and the stable function of society. She assembles a wide selection of psychological data and real and theoretical circumstances to redefine the meaning of reasonableness and to identify its key components. She makes a compelling case that to be reasonable means to be sensitive to the needs and views of others, be willing to recalibrate one’s own view in response to the concerns of others, and to be willing to change your course of action if pressed by someone who thinks differently from you. These are not features that are generally invoked when describing a rational person and she makes the claim that this indicates that reasonableness is more important than rationality in grounding society.

The link to the current political environment is clear and acknowledged. Without mentioning any names, Lawlor vividly chronicles how loss of reasonableness is the underlying defining feature in our polarized argumentative world. The fact that political parties articulate programs that fail to account for the needs of the other and the inability to acknowledge any value to the views of others are signs of rampant unreasonableness. It is unclear whether reasonableness has a biological basis and whether it was favored by evolution. But anyone reading the news or monitoring the policy objectives of the current administration cannot escape the notion that reasonableness is a “misunderstood” and clearly undervalued virtue.

One gap in Lawlor’s narrative is medicine. She does not have a chapter on reasonableness in patient care. To me this is an area in need of attention. A case can be made that the movement towards evidence-based medicine is a move to incorporate more rationality into medical care. To be sure, incorporation of the patient voice and patient-related outcomes in the assessment of treatment efficacy is a sign of attention to the other and recognition of the need for reasonableness. But I fear that this information may be prone to quantitative analysis that undermines a genuine commitment to listen to the patient and treat that person on their own individual terms. Clinical research is urgently needed to learn whether exciting novel therapies are being utilized in a reasonable way, namely with genuine attention to the needs of the patient, a willingness to change the plan if the clinical course does not meet expectations, and a realization that medical care is just one component in the total scope of social wellbeing. That research team would be wise to include Lawlor as a consultant.

In closing, books often have an impact because they are read by a receptive reader at just the right moment time. In the beginning of May, I was on vacation with my wife. After a day biking and hiking, I accidentally fell and suffered a head injury. I lost consciousness for two days and needed to be hospitalized in an unfamiliar place for six days. On my return to New York, I was cared for by wonderful people and I think, or should I say I hope, that I am getting back to “normal.” But one thing was clear to me. I am not sure how I usually think and behave but over the last two months, I am sure I was not as reasonable as I should be. But one good and reasonable decision I made was to read this book. It has helped me appreciate what I lost and offered guidance about what I should pay attention to as I get back to myself. I cannot think of higher praise for any philosophy book.

Being Reasonable: The Case for a Misunderstood Virtue
Krista Lawlor
Harvard University Press, 2026. 213 pp 

Web image by Medhum.org.