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 90

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.

We return to the subject of how terrible the HIV/AIDS crisis was at its peak. The first time (Episode 9) we drew from a memoir, documentary film, and a literary novel. This time we feature the graphic memoir, Taking Turns: Stories from HIV/AIDS Care Unit 371 with the author MK Czerwiec. She created a memoir of her time as a nurse in an HIV/AIDS using the comic medium. Since then, Czerwiec has become a leading figure in Graphic Medicine. We talk to her about the Graphic Medicine field and its many applications, and about the many illustrative and poignant insights her book offers about the AIDS crisis in ways biomedical texts and few of the other arts can do nearly as well.

Thanks to MK Czerwiec for opening our world to graphic medicine and expanding our understanding of the AIDS crisis through your graphic memoir.

Executive producer: Anne Bentley
Web image regenerated from MK Czerwiec’s website

Graphic Medicine: A Path for Understanding, Education, and Advocacy   

Nancy Novick 09.05.26 437

A visual form of storytelling comes into its own. 

Despite Virginia Woolf’s (12) famous proclamation that a “poverty of the language” exists in the description of illness, the most common form of pathographies is likely literature. Woolf’s essay On Being Ill argues that illness, compared to topics such as grief and love, remains rarely written into narratives due to the vocabulary itself. Yet, Carel’s work focuses on a more acute limitation. Language in books inherently offers limited bearing on temporality and pacing. While it is true that skilled authors can decide the pace of paragraphs, quickening tension with staccato and parataxis, the reader is ultimately given control regardless. As Roland Barthes (11) writes in The Pleasure of Text, “the author cannot predict tmesis: he cannot choose to write what will not be read.” In other words, the writer’s intentions matter little if a reader decides to skim over what they deem to be unimportant. Thus, the act of writing itself involves a willful relinquishment to the reader, and this act of surrender betrays a core tenet of the illness-experience: removal from control, particularly over time and space.

Video games complicate this dynamic, since some strip the very control Barthes describes back out of the player’s hands. Perhaps no game better exemplifies this removal of player control, especially over time, to depict illness than Before Your Eyes, released in 2021 by GoodbyeWorld Games. Before Your Eyes is not a typical video game. At no point does the player use their hands to control the game. Rather, the opening minutes require the player to set up an eye-tracking system, which lends itself to a simple conceit: with each blink in real life, once a metronome-object appears, time passes rapidly within the video game.

The first half of the game acts as a type of memory play. The main character, Benjamin, whose eyes the player inhabits, awaits judgment after death and must recount their life story to a mythical Ferryman to continue to the afterlife. The scenes begin playing out. Blink – Benjamin, as a baby, playing with rubber ducks. The scene plays out, then a metronome begins ticking down. Blink – watching parents argue about money. Blink – a piano recital. Blink – nervousness about talking to a crush. Evoking how memories work in real-life, each of these moments has a fleeting quality to them, as these scenes can only last if the player does not blink. Life goes by in a blink of an eye, literally.

While this perspective on memory alone makes Before Your Eyes an intriguing musing on memory, the second half of the game recontextualizes what comes before it in the context of medical humanities. As the scenes continue to play out, eventually Benjamin becomes a highly successful musician and artist, garnering worldwide acclaim. Yet, the story increasingly becomes fantastical, until it’s revealed that the story up to this point has been false. Rather, Benjamin died at 12 years old due to an unspecified terminal illness. The game plays out again; this time, the scenes are of Benjamin confined to his hospital bed. Blink – a growing illness. Blink – his parents visiting him at the hospital. Blink – dreaming of playing the piano. Blink – a fading interaction. In this second half, the scenes become ever more fleeting as the metronome signaling the scene is ready to pass appears more rapidly, triggering in the player a desire to avoid blinking. Often, before a moment can conclude, one blinks; time progresses, closer to death.

Before Your Eyes demonstrates the ability of other mediums, particularly video games, to use interactivity to disrupt typical temporality. This technique is not unique to Before Your Eyes by any means; the works of Samuel Beckett employ a similar technique of stripping audience control to simulate the constricted present Carel describes. For example, Beckett’s Not I (1972) features a disembodied mouth that delivers a fragmented monologue about past trauma at a pace too fast for an audience to fully process, let alone control. In video games, Red Dead Redemption 2’s protagonist, Arthur Morgan, develops tuberculosis over the game’s final chapters, which alters gameplay mechanics, including reducing stamina. As Marshall McLuhan famously argued, a medium’s structure shapes the way it delivers experience, independent of its content. Removing description of illness in favor of depicting its phenomenology, whether that is through Beckett’s compression of time or Red Dead Redemption 2’s diminishing of gameplay abilities, aims to cause the audience to experience illness. Before Your Eyes heightens both of these experiences, for time and space are tied to the player’s physical body, as occurs in sickness. In binding the passage of time to the player’s own involuntary blinking, the player’s body becomes a mechanism of failure. Thus, the player is made to inhabit Carel’s claim that illness is lived from within the body rather than observed from outside it. While literature can recapitulate the experience of symptoms, it cannot impose the conditions of it. Before Your Eyes suggests that the truest representation of illness may not be a representation at all, but an imposition of the phenomenological conditions of illness.

References:

Barthes, Roland. The Pleasure of the Text. Macmillan, 1975.

Carel, Havi. Phenomenology of Illness. Oxford University Press, 2016. Silverchair,
https://doi.org/10.1093/acprof:oso/9780199669653.001.0001.

McLuhan, Marshall. Understanding Media: The Extensions of Man. MIT press, 1994. Google Scholar,
https://scholar.google.com/scholar?cluster=4603169387763961023&hl=en&oi=scholarr.

Woolf, Virginia. “On Being Ill.” Family Business Review, vol. 6, no. 2, June 1993, pp. 199–201. SAGE Journals,
https://doi.org/10.1111/j.1741-6248.1993.00199.x.

Web image by medhum.org

The book became, unwittingly it seems, the first of a trilogy ultimately concerned with what conscious is and does. The second book, This is Your Mind on Plants (2021), extends Pollan’s project to three mind-altering compounds found in plants: opium, caffeine, and mescaline, and the third, A World Appears (2026), is his attempt to discern consciousness itself. Here I cover Pollan’s investigation into consciousness across the three books, the results of which frustrated him and required a reconciliation.

The Trips Begin

In How to Change Your Mind, Pollan gives a brief summary of the bumpy history of psychedelics. He recounts how the intense and well-supported interest in them as therapeutic agents during the 1950s was almost completely snuffed out in the 1960s when “a moral panic about LSD engulfed America, and virtually all psychedelic research and therapy were either halted or driven underground” (p. 185). The panic reached its apogee when counterculture movements and their leaders, among them Timothy Leary of “turn on, tune in, drop out” fame, were seen as threats to mainstream society in general. The few remaining embers, though, reignited in the 1990s and by 2006 serious interest in psychedelics revived and research into clinical use resumed through legal means. Structures were in place allowing psychedelic use for specific purposes, opening the way for Pollan’s investigation.

Pollan arranged three separate “trips,” one each for the psychedelics LSD, psilocybin, and 5-MeO-DMT (i.e., “The Toad”). He carefully chose a tour guide for each one. He came through these sessions with what he interpreted as a dissolution of his ego, which made more room for his consciousness: “I was present to reality but as something other than my self” (p. 264). After these experiences and interviews with many scientists, psychologists, counselors, and users, Pollan constructed an argument about how the altered consciousness states psychedelics produce can offer benefits to individuals who are healthy or sick, and to societies that are stable or fractious, by sending “a life or culture down a new path” (p. 407). He is inspiring, vague, and fantastical at times; he gets more so in his follow-up book, Your Mind on Plants.

There’s No Place Like Home

Pollan expands his investigation of consciousness-altering substances by marrying it with his passion for plants and gardening. Therefore, he need not look further than his kitchen and garden for sources serving his interest at this stage: opium (poppy), caffeine (coffee and tea), and mescaline (San Pedro cacti). He explained his rationale for choosing these three mind-altering agents:

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

Pollan received guidance and supervision for his trials of opium and mescaline. As a self-described “heavy caffeine user,” he withdrew from it by giving up coffee and tea, thinking he could make inferences about caffeine effects through reverse engineering the experience.

While Pollan describes the effects these three agents had on his consciousness, he went further morphing from his role as an investigative journalist into roles of historian and anthropologist. Pollan covers how opium, caffeine, and mescaline altered the consciousness of millions of people through the millennia, and in doing so, says they figure in world history and human development, often in rather breathtaking terms. Opium spurred “the Romantic revolution in poetry” (p. 31). “Caffeine was the perfect drug not only for the age of reason and the Enlightenment but for the rise of capitalism, too” (p. 119). “The sins of slavery and imperialism, in a global system of production…could only have been fueled by caffeine” (p. 138).

While he does not credit mescaline with having contributed to human progress in such grand scales, Pollan speaks of its power in healing the most devastating wounds. But insofar as affecting consciousness, for him, mescaline does “what all psychedelics do—not so much change how we feel inside as imbue the world around us with never-before-appreciated qualities” (p. 217).

Pollan may have imbibed too much caffeine while writing this book judging from some of the conclusions he makes, but it may have fueled his subsequent quest to understand just what consciousness is rather than just what it does to his mind and its impact on world history. What he found on this quest, or more appropriately, what he didn’t find, became the basis for his next book, A World Appears.

Pollan Trips into a Cave

If psychedelics and mind-altering plants can change consciousness, then, as Pollan surmises in describing his objective with A World Appears, “consciousness is, at its core, a material phenomenon…[or there is] at least some credence to the idea” (p. xx). So off he goes on more trips, this time to experts working on finding a discernible form of consciousness, a trip that in the end fails, but still produces some value towards the way we think about artificial intelligence.

Pollan’s trips takes him to four ports of call, or “four different dimensions of consciousness” (p. xxxi). His first stop is “sentience,” which refers to consciousness as where in living beings sensations are perceived and responses to them generated. The next stop is “feelings,” the awareness of biological phenomena, the communication link between the body and the mind, serving homeostasis, for example. “Thought” is Pollan’s third stop, accounting for “the stream of thoughts that all of us experience every waking moment” (p. xxxii). His trip ends at “self,” or the ’I’ that takes in all of our experiences.

Each trip constitutes a chapter comprising what is known about consciousness from a particular dimension. Pollan describes and evaluates them with the help of people involved in their development. Across the four dimensions, he consults or references a wide range of experts including among others: neuroscientists, physicists, biologists, philosophers, psychologists, screenwriters, novelists, poets, and Buddhists. He combs through their theories, constructs, data, analogies, stories, and metaphors. Pollan, nevertheless, comes up empty, and is “abashed to say I know less now than I did when, naively, I set out to unravel the mystery of consciousness” (p. 225). It took several days in a cave at a Buddhist retreat high in the mountains of New Mexico for Pollan to reconcile with this outcome, “to let go into not-knowing.” He wound up accepting consciousness “as less a scientific or philosophical puzzle to be solved and more as a practice…Consciousness is a miracle, truly, and remains the deepest of mysteries” (p. 239).

So be it, but what then are we to make of the artificial intelligence industries’ determined attempts to integrate or discern consciousness in their machines? Pollan might say they will need a miracle.

Citations:
Pollan M. How to Change Your Mind. Penguin Books; 2019. 464 pages
Pollan M. This Is Your Mind on Plants. Penguin Press; 2021. 288 pages
Pollan M. A World Appears: A Journey into Consciousness. Penguin Press; 2026. 320 pages

Links:
My blog post elaborating on Pollan’s How to Change Your Mind is here, and on Your Mind on Plants is here.

Along with cohost, Dan Albrant, here’s a link to our podcast episode in which we focus on: consciousness, spirituality, and mysticism as what is at work in the effects psychedelics produce, and how they may delineate limits to biomedicine (rational or not), that is, how they brighten or blur the line between classic biomedicine and whatever isn’t. 

Edited by Lucy Bruell.
Web Image: Cave Man, Tim Brown, CC BY 3.0 <https://creativecommons.org/licenses/by/3.0>, via Wikimedia Commons

The hand’s importance in daily activities is often overlooked even as I look down at my fingers typing these very words. Rudimentary at first glance, the expansive nature of the hand is as complicated as its anatomy and not in the palm reader sense. Its complexity manifests in the intricate duties it performs when acted upon by the user’s brain, and yet there is so much to learn by its simple examination in its resting splendor. The beautiful dichotomy of the hand is illustrated in the simple gesture of hand-holding, a parent’s single finger grasped in their infant’s small palm contrasted with the loose grip of the dying parent with their child. It is in the soft caress that hands are capable of, but also the solid fist of a hard punch, and the complexity of playing instruments, weaving, programming AI and painting.

My office visits begin and end with a post-COVID handshake if the patient is agreeable. The essential job of the clinician begins with listening followed by thorough examination. For it is in examination that the patient map unfurls. From the initial handshake, to how one holds their hands during the visit, little clues are imperceptibly directed at me. The wringing of the patients’ hands is the tip off for anxiety, along with tightly picked nails or scars. The slight hand tremor can be the giveaway of Parkinson’s disease, alcohol withdrawal or thyrotoxicosis. Then there is the yellow-stained thumb and index finger of the habitual smoker. The tiny muscle fasciculations below the skin are the tip off for advanced carpal tunnel syndrome, advanced neck arthritis, amyloidosis or the more devastating amyotrophic lateral sclerosis. The feel and look of the callus distribution on the palm of the construction worker as opposed to the soft and supple feel of the secretary’s palm or those of the computer programmer are all documented subconsciously, while noting the fissuring and hyperkeratotic papules and scale of the mechanic’s hand, or the similar changes on the non-mechanic’s hand suggesting dermatomyositis or anti-synthetase syndrome. Tell me how AI could perceive most of this without the input of touch and observation?

Whether in the office, grocery store or at dinner, examination proceeds whether the person is willing or not, or even aware. Examining the hand is like picking up an oak leaf in the fall with its midrib, venules and variegation all telling you about the health of the tree from which it has fallen. We won’t discuss ornaments that adorn the hands such as rings or nail paintings as this is quite illustrative in and of itself. Rather, I am more interested in scars, irregularities and deformities. Each small finger joint so intricate and important in function, working simultaneously together like the worker bees in a hive or an orchestra.

From the fingertip alone, Terry’s nail, with its loss of the crescent half-moon, ground glass white appearance, and the darker line at the very tip of the nail, suggests underlying liver issues. Move that line of demarcation proximally to affect half of the nail, it transitions into Lindsay’s nail and communicates underlying kidney dysfunction. Should that half-moon crescent change to a blue tinge or even completely change to blue, the patient may be being slowly poisoned by silver or copper. The pale nail bed alone is a tip-off for anemia. A murky longitudinal dark stain, like a comet and its tail tracing from the cuticle to the free nail edge, can be the forewarning of a melanoma. Smaller dark stripes distributed throughout the nail are the potential signs of endocarditis, lupus or vasculitis. Should the patients’ nails look like a pock-marked battlefield, the likelihood of psoriasis as a verdict is greater, especially if they are accompanied by joint aches or a reddish-silver raised skin rash. If the same patient did not choose to paint their nails yellow, and it spontaneously occurred, my pondering moves to lung pathology or autoimmune issues. Lastly, horizontal linear grooves on the nail, named after our friend Joseph Beau, tells me the patient is zinc deficient or enduring chemotherapy. While AI can certainly catalogue each of these physical exam signs and what they indicate, my examination can transpire on a soccer field, train or exam room and without the need for a computer.

Ascending from the fingertips, I look at the profile of the fingers. Do they keep their standard characteristic orientation, straight as an arrow or do they angle? Simply the direction of that angle can tell me so much, as the rearrangement of the interphalangeal joints offers countless clues. Should the patient get angry at all the meddling with his finger and point that finger at me, does his finger hyperextend backwards from the middle joint while the fingertip itself bends forward? Quickly I am carried pondside to see the swan neck of rheumatoid arthritis, lupus or scleroderma. However, should that fingertip hyperextend while the middle joint flexes, this represents the boutonniere deformity of injury or other connective tissue disorders. Moving from the quaint pondside to the opera house, I consider the shortened collapsing finger joints crumpling in a telescoping manner like an erstwhile opera-glass. This is the finger joint destruction of arthritis mutilans or advanced psoriatic arthritis. Now envision that same finger, fat and round like a sausage, and you have the less than delectable exemplar of dactylitis, which may be another sequelae of psoriatic arthritis, lupus or even tuberculosis.

Lest we forget the palm, it can serve as a mirror into superficial and deeper matters both physically and professionally. If there are a collection of cords slowly stealing a digit’s extension, you’ll find the fascial condensations of Dupuytren’s contracture. This patient has either had a long career of intense work with their hands or has been long afflicted with diabetes or may just have one more thing to thank a parent for. Should one of the fingers flex and become locked, trigger finger is now the diagnosis, although no marksmanship is required.

Both AI and I could go on for pages with the exam findings of the hand if necessary, particularly if we wanted to discuss congenital hand deformities or telltale characteristic findings on x-rays such as the appropriately named boxer’s fracture or the hand surgeon’s bane of the scaphoid given its peculiar blood supply. Oh, the many amusing mnemonics to remember the bones of the wrist can be quickly recited, both from AI and by the medical student! Ultimately, the power of observation is vital and a trusted companion of the doctor alone. The world is the clinician’s exam room and once one puts on these glasses and truly observes, it is hard to unsee the pathology vexing us humans. So, I say go forth and learn. Always start with a handshake as this key unlocks so much during the visit and then sit and watch. We physicians are a fortunate few beholden in full to our patients, who are granted access to this vast vocational milieu and this is what sets us apart from machines.

Web image by Medhum.org

New York, NY: W.W. Norton & Company
2026, 192 pages 
ISBN 9781324105695 

Your body speaks to you every moment of the day. In normal circumstances (good health), we hardly pay attention to those signals – the reassuring metronome-like steadiness of the radial pulse or the soft, regimented inhalations/expirations of respiration. But in bad times (illness and injury), we cannot ignore altered rhythms and abnormal emanations – the miserable throbbing of a migraine or wormlike twitching of the muscles of the hand. Megan O’Rourke, a poet and author of the superb memoir The Invisible Kingdom: Reimagining Chronic Illness (2022), has assembled a pensive and probing anthology of illness poetry that addresses altered states of the body. These 83 poems are organized into five sections: diagnosis, clinical encounters, caregiving, “metaphysical reckoning,” and recovery. A sense of betrayal by the body, shame, helplessness, isolation and loneliness, altered interpersonal relationships, and an inescapable confrontation with mortality are some common effects of illness expressed in these poems. Yet other poems communicate impressive fortitude, resiliency, revelation, receipt of compassion, and hope. Many notable writers are represented in the collection including Emily Dickinson, John Donne, Sylvia Plath, James Dickey, Gwendolyn Brooks, and William Blake. In “lumpectomy eve,” Lucille Clifton eerily depicts the difficult night before scheduled breast surgery where a fear of loss is just one of many emotions felt. Ted Kooser’s “The Urine Specimen” combines imagery and whimsy about the excreted waste product (“the heat of this gold your body’s melted and poured out into a form”) with a bit of scientific prophecy (“for the doctor, who in it will read your future, wringing his hands”). “A Story About the Body” by Robert Hass is a prose poem skillfully and sorrowfully addressing infatuation and imperfection. A single poem cannot reliably rescue us from sickness or other misfortunes, but the best of them are certainly capable of offering connection, illumination, and comfort. 

The Human Remains: Drawing Out Compassion in Medicine by Nathan A. Gray 

University Park, PA: Graphic Mundi (an imprint of Penn State University Press)
2026, 256 pages 
ISBN 9781637791059 

The experience of gross anatomy lab in the first year of medical school has a heavy, haunting presence in this graphic memoir of medical education. Employing primarily grayscale art technique, author and illustrator Nathan Gray (a palliative care physician) holds nothing back in this sometimes grim recollection of his training. He describes the required dissection of a cadaver as “dismantling a human body” (p10) and worries about fainting or vomiting. He has recurrent macabre dreams of dancing with the cadaver. Gray begins having doubts as to whether he even belongs in medical school. Fortunately for him, one member of his dissection team provides a well-needed dose of humor and bravado. In his second year of medical school, Gray gets married. His third year clinical rotations start with the surgery clerkship where feelings of insecurity, uselessness, and fear pester him. Yet Gray is emotionally and psychologically aided by receiving small acts of kindness, his sustained wonder of the human body, and a genuine interest in the patients he treats. Upon completing medical school, he enters an internal medicine residency noteworthy for a strenuous schedule with nights on call and some shifts spanning more than 30 hours in the hospital. He labels residency training as “a cruel matchup that pitted our own sanity and survival against the needs of the people we cared for” (p170). Gray chooses a palliative care fellowship where his compassion and joy for practicing medicine are reinvigorated thus completing the arc of his journey infused with the humanity and empathy he originally began medical school with. The Human Remains is the second graphic medical memoir (See One, Do One, Teach One by Grace Farris is the other.) published in 2026. Both are cautionary tales (albeit with “happy endings”) reminding us that medical trainees are at high risk of having the most important things that propel them to choose to become a physician – compassion and service to others – gradually eroded. 

“The News from Dublin” in The News from Dublin: Stories (pages 67-87) by Colm Tóibín 

New York, NY: Scribner
2026, 289 pages 
ISBN 9781476785141 
[The story was first published in New Irish Short Stories.] 

Maurice Webster, a teacher at a Catholic high school in Ireland, has good reason to worry about the condition of his youngest brother. Stephen has a severe case of highly infectious tuberculosis and is confined to home, (At the time this story takes place – prior to the wide availability of streptomycin in Europe around 1948 – there is no antibiotic treatment for TB.) Maurice is afraid to visit his brother and risk spreading TB to his wife and children. Reports surface of a promising new drug that can cure tuberculosis – Streptomycin. The antibiotic is almost impossible to obtain as it is still being tested and likely won’t be accessible for more than a year. Poor Stephen will not live long enough to receive the medication. Maurice travels to Dublin for a meeting with the minister of health in an attempt to procure Streptomycin for his brother. Although sympathetic, the health official says he is unable to help and recommends that Stephen be admitted to a sanatorium. A morose Maurice returns home understanding that Stephen and family were counting on him to retrieve the antibiotic. He has failed them. The only thing he has brought back from Dublin is bad news. With ever diminishing hope for his brother’s recovery, even a miracle seems out of the question. Maurice decides, “There had been enough prayers said, and they had made no difference” (p86). This compact, touching tale about the effect of serious illness on family members highlights their desperation and guilt, withering hope and reluctant resignation. 

Web photo by Wes Hicks