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

The time has come when the existence of a private pestilence in the sphere of a single physician should be looked upon, not as a misfortune, but a crime; and in the knowledge of such occurrences the duties of the practitioner to his profession should give way to his paramount obligations to society.

— Oliver Wendell Holmes, “The Contagiousness of Puerperal Fever”

It would have been cold on February 13, 1843, when the Boston Society for Medical Improvement convened. But anyone who heard Oliver Wendell Holmes’s fiery speech about puerperal fever would have forgotten about the chill outside immediately.

Holmes stood just 5’ 3”. And he was young, only 34 years old. But he was hot with moral authority. He was so sure that puerperal fever was contagious that he accused his skeptical colleagues of murder. He knew that in order to make them listen, he had to do more than lay out the facts. He needed a persuasive story.

As I’ll show presently, it was precisely this approach that allowed Holmes to win Nathaniel Hawthorne’s trust as personal physician to the great author near the end of his life. No mean feat, since Hawthorne was terrified by medical science.

The Crowd Puller

In those days, you had to speak well publicly to make a name for yourself. Oratory was required in school. In New England, the rhetorical standard was set in the pulpit, and public discourse followed. So it wasn’t an insult if someone said your speaking or writing felt sermon-like. Good sermons could awaken, convict, inspire, and transform even the most uneducated souls. The best professors and the best doctors fit the ministerial mold.

In New England, good speakers were a dime a dozen. But Holmes stood alone.

One of Holmes’s students recalled how he could hold a crowd:

He always makes people attentive, and I have been told that there is no professor whom the students so much like to listen to. In one of his books he says that every one of us is three persons, and I think that if the statement is true in regard to ordinary men and women, Doctor Holmes himself is at least half a dozen persons. He lectures so well on anatomy that his students never suspect him to be a poet, and he writes verses so well that most people do not suspect him of being an authority among scientific men.

This was also a time when science was retreating from the public sphere. Hawthorne was writing short stories about the terrors of the lab, where Rappaccinis and Chillingworths played God. As Michel Foucault said, it was a time when some doctors took the patient into account “only to place him in parentheses.”

Holmes was a scientist, but he hated how science made some of his peers “think only in single file.” And so he tried to wake his colleagues up on that cold day in Boston with facts, but also with panache and metaphor.

The Case for Contagion

Attention spans were different in 1843. The full text of Holmes’s speech, which he later published in essay form, was over 12,000 words. It would have taken him at least an hour to deliver it. He had to review many cases in depth, not just spin fetching tales.

But that’s why everyone in the Boston Society had gathered that day. They wanted to get better as doctors, for medicine itself to improve. So they listened.

Holmes points out that William Dewees’s A Treatise on the Diseases of Females, published in Philadelphia in 1833, explicitly denies that puerperal fever is contagious and that the Philadelphia Practice of Midwifery (1838) omits mention of the disease entirely.

Unthinkable now, but it was commonplace for a doctor or midwife to deliver one baby and then move to the other without washing their hands. Holmes’s words for such a physician? A “death-carrying attendant.”

He also opens with a logical list, a kind of syllogism, something he’d have learned from his humanities education. If all these things are true, then there’s no room left for opposing views.

1. Not all forms of puerperal fever may be equally contagious. But evidence shows the disease appearing again and again among patients of a single practitioner, even when no epidemic is present. That pattern demands explanation.
2. Whether infection travels through the air a physician carries into the sick-chamber or passes directly from his unwashed hands, the practical result is the same. We need not settle the question to act on it.
3. Contagion does not guarantee infection. Even the smallpox vaccine, fresh and carefully administered, sometimes fails. Same for scarlet fever. But no one doubts those diseases are contagious.
4. Seasonal and regional influences may trigger or worsen the disease. But smallpox follows the same patterns of rise and fall, and no one doubts it spreads by contagion. Why should puerperal fever be different?
5. If physicians can be shown to carry death instead of health, no excuse will absolve them. “[W]henever and wherever they can be shown to carry disease and death instead of health and safety, the common instincts of humanity will silence every attempt to explain away their responsibility.”

It made Holmes angry that colleagues could explain the deaths of new mothers as Providence, using God’s will as an excuse for their own failures to stop preventable deaths. 

We do not deny that the God of battles decides the fate of nations; but we […] are particular that our soldiers should not only say their prayers, but also keep their powder dry. We do not deny the agency of Providence in the disaster at Norwalk, but we turn off the engineer and charge the Company five thousand dollars apiece for every life that is sacrificed. Why a grand jury should not bring in a bill against a physician who switches off a score of women one after the other along his private track, when he knows that there is a black gulf at the end of it, down which they are to plunge, while the great highway is clear, is more than I can answer.

I’ll not reprise Holmes’s full review of cases (he painstakingly covers more than half a dozen). You can read the full text that he reprinted in Medical Essays here.

What I want to emphasize is how storytelling was much more than a way to “sell” science for Holmes. He knew that story piqued an emotional understanding of science, which was how doctors could be persuaded to act, and also how public trust could be earned and held.

Here’s his passionate conclusion in full:

It is as a lesson rather than as a reproach that I call up the memory of these irreparable errors and wrongs. No tongue can tell the heart-breaking calamity they have caused; they have closed the eyes just opened upon a new world of love and happiness; they have bowed the strength of manhood into the dust; they have cast the helplessness of infancy into the stranger’s arms, or bequeathed it, with less cruelty, the death of its dying parent. There is no tone deep enough for regret, and no voice loud enough for warning. The woman about to become a mother, or with her new-born infant upon her bosom, should be the object of trembling care and sympathy wherever she bears her tender burden or stretches her aching limbs. The very outcast of the streets has pity upon her sister in degradation when the seal of promised maternity is impressed upon her. The remorseless vengeance of the law, brought down upon its victim by a machinery as sure as destiny, is arrested in its fall at a word which reveals her transient claim for mercy. The solemn prayer of the liturgy singles out her sorrows from the multiplied trials of life, to plead for her in the hour of peril. God forbid that any member of the profession to which she trusts her life, doubly precious at that eventful period, should hazard it negligently, unadvisedly, or selfishly!

I read recently that we respond much more powerfully to troubled characters in fiction than we do to stock types who move from one adrenaline-spiked obstacle to the next. That’s because our deepest emotional responses are driven by three chemicals (dopamine, cortisol, and oxytocin). These brain responses are strongest when we truly care about someone else.

Holmes was trying to do something similar by creating a moral dilemma within the physicians he addressed. The doctor who cared nothing about exposing his patients to risk had no soul. But the doctor who could imagine a family’s grief and wrestle with his own culpability was more complex, more colorful, more worthy of trust.

If you’d been listening to Holmes on that February day, you know which doctor you’d have wanted to be.

Converting the Chief Skeptic

Despite his charms, it took time for Holmes to push his reforms. People thought he looked too young. One woman ordered him out of her house when he accompanied a senior physician during his medical training. “Take him away!” she cried. “This is no place for boys.”

Holmes’s colleagues respected his medical skill, but thought him “impaired” for writing poetry. And not all readers of The Atlantic loved him. To some he was a “tiresome little man.”

As one biographer explains, Holmes “disarmed criticism…by courageously persisting in the same method which had originally produced it, namely, by the most fearless intimacy with his audience, never keeping back any jest or any expression of confidence.” In a word, he was not afraid to make himself vulnerable in his writing. 

Holmes and Hawthorne shared pages in The Atlantic Monthly and also knew each other through the Saturday Club, a gathering of literary celebrities that included Ralph Waldo Emerson, Henry Wadsworth Longfellow, and Harriet Beecher Stowe hosted by the publisher James T. Fields. Hawthorne was quiet and shy, brooding around the edges, but Holmes loved to regale the group. As Annie Fields recalled, “with Dr. Holmes sunshine and gayety came into the room.”

The two writers developed a close intellectual relationship, commenting on each other’s manuscripts and commiserating with one another over the dangers of pseudoscience and careless experimentation. So it was no surprise that when he grew ill in 1864, Holmes was the only doctor that Hawthorne would see. Hawthorne had watched a friend die of pneumonia while a quack prescribed a variety of ineffective drugs, poultices, even cupping and blistering, to no avail.

As the two men walked the Boston streets, Holmes conducted a “talking exam,” listening while Hawthorne reported his symptoms of indigestion and fatigue. Holmes recognized that Hawthorne suffered from a profound sense of despondency which signaled imminent death, that there was no cure but compassion. This was an intimate moment—as vulnerable as the introverted Hawthorne had ever allowed himself to be with anyone—and it illustrates Holmes’s ability to reassure even this great skeptic of his good intentions. 

Hawthorne’s simultaneous fear of alternative medicine and medical science left him nowhere to turn as his own death approached. On the one hand were the mesmerists who sought to control the individual through pseudoscientific means. On the other were the Rappaccinis whose misappropriation of science was equally hostile to the privacy of the soul.

Only Holmes could rescue Hawthorne from those two nightmares. He did it as a man of science, as an indefatigable optimist, as a caring friend, and, yes, as a storyteller who knew that passion is one form of understanding.

Web image of A young Oliver Wendell Holmes from PBS.

Field Guide to Falling Ill: Essays by Jonathan Gleason 

New Haven, CT: Yale University Press, 2026, 256 pages 
ISBN 9780300282948

In these ten exemplary essays, Gleason mingles illness memoir, the challenges of caregiving, and loss (of health and spirit). Disease is portrayed not only as an aberration of the body’s normal homeostasis but also a distinctive event with social, cultural, and possibly historical meaning. Contagions (viruses, prejudices, even love) receive special attention as catalysts of uncertainty, anxiety, and sometimes terror. Spaces – inner, close, distant, and built – are similarly scrutinized. In 1623, the English poet John Donne declared that “the greatest misery of sickness is solitude.” The narrator of the title essay echoes that sentiment, describing “loneliness” as the world’s greatest sorrow. He volunteers as a part-time medical interpreter at a free clinic but suddenly becomes a patient himself with a blood clot in the left arm. These experiences lead to an understanding of the power and limitations of both language and empathy. Other essays explore organ donation, AIDS, mental illness and the demise of large psychiatric hospitals, Tay-Sachs disease and xenophobia, pain, addiction, and the trial of an Ohio doctor charged with multiple counts of murder. Throughout these pages, Gleason points out the hubris of medicine as well as its shortcomings. He writes, “We like to believe we know the vastness of the world, that everything can be explained through our current models of understanding” (p3). At some point (or maybe many times), however, we will all fall ill and become a patient. And that immense world with all its scientific knowledge will dramatically contract to our single suffering body longing to be comforted and cherished by others. 

“An Eye in the Throat” in Good and Evil and Other Stories (pages 57-96) by Samanta Schweblin, translated by Megan McDowell  

New York, NY: Knopf, 2025, 192 pages 
ISBN 9780593803103 

It’s every parent’s nightmare: a serious (and potentially preventable) injury to their child that occurs right in front of them. Here, the setting is Argentina in the 1990’s. Inquisitive two-year-old Elías chokes on a lithium battery from his grandmother’s digital calculator while his father is in charge of watching him play. A visit to the ER and then an appointment with the family doctor the next day offers little reassurance for the parents. On the third day, Elías begins coughing and develops a fever. An operation is performed to remove the lodged battery and repair tissue damage to the esophagus. A tracheostomy is performed, and he undergoes four operations in a span of six years. He is unable to speak. At one point, he mysteriously gets out of his car seat and briefly becomes lost at a gas station. Soon after, a landline phone at home eerily rings each night. When the father answers, there is no voice at the other end. The parents eventually separate. Elías comprehends that all family members are casualties, and with an amazing capacity for empathy concludes, “There is a hole in my throat, a hole in my body that hurts in theirs” (p79). He is enrolled in a special school for deaf and mute children and becomes an outstanding student who is enthralled by language and mathematical physics. Schweblin’s searing story about parental guilt and grieving, failed communication, and the remarkable resiliency of youth is guaranteed to leave you with a lump in your throat. 

A Prescription for Burnout: Restorative Writing for Healthcare Professionals by Carolyn Roy-Bornstein 

Baltimore, MD: Johns Hopkins University Press, 2026, 208 pages 
ISBN 9781421454733 

Burnout among physicians and nurses, accelerated by the emotional and physical crush of the Covid-19 pandemic, continues to be an urgent problem. Causes of burnout among health professionals include an erosion of autonomy, truncated time allotted for patient visits (but increased time required for inputting data into the electronic medical record system), feeling underappreciated, unrealistic expectations from patients and employers, and the daily exposure to the suffering of others. Roy-Bornstein, a pediatrician and a former RN, enthusiastically endorses reflective writing as an effective remedy for dealing with burnout (or perhaps preventing its occurrence). While not a new concept, her discussion includes research on the utility of restorative writing, some commentary on narrative medicine, and most importantly, more than 85 writing prompts (or Rx’s as she refers to them) for reflection and as a kind of therapeutic exercise. Organized into three sections – Addressing Emotional Exhaustion, Countering Cynicism, and Restoring Self-Efficacy – the book addresses issues of vulnerability, self-compassion, self-awareness, resilience, and optimism. There is no doubt that reflective writing can be healing and hopeful. Roy-Bornstein offers a helpful pathway to reducing the risk of professional burnout.  

Vesalius’s illustration, “Skeleton Contemplating a Skull” from Wellcome Collection

Hours later, after she has tried all the methods known to her, Agnes is asleep next to Judith’s pallet. Hamnet, overwrought that he is about to lose the “other side to him,” crawls from his pallet to Judith’s side, beginning to feel poorly also. He arranges himself next to Judith in a way that made it almost impossible for people to tell them apart, hoping as Death came to take her, it would be fooled into taking him instead. “And if either of them is to live, it must be her. He wills it. He grips it…He, Hamnet, decrees it. It shall be.” (p. 169) 

When Agnes awakens, she eventually discerns that “her daughter has been spared…but, in exchange, it seems that Hamnet may be taken.” (p. 208) She reinitiates the treatments she had tried on Judith, but nothing works. Hamnet takes his last breath. Agnes wonders how she could have saved him, how she could have missed Hamnet being at risk before she is able to comprehend: “he is dead, he is dead, he is dead.” (p. 219) 

From this event on, O’Farrell constructs the trajectory of the family’s grief with a particular focus on Agnes. Her grief is amplified by resentment and incredulousness over her husband’s return to London soon after the burial because he feared his work as an actor and playwright would lose irretrievable ground with a prolonged absence. These emotions and grievances reach a crescendo over a period of years before understandings are reached and catharsis experienced. 

The Plague Comes for the Twins 

Easily lost in the gripping story O’Farrell tells and the emotional torrents she evokes is the chapter explaining how the plague reached the twins. She takes the modern-day, biomedical understanding of the complex chain of events involved in the spread of plague and weaves it into how she imagines it could happen amidst everyday life in the countryside outside London during the 1590s.  

A basic biomedical reference O’Farrell could have consulted in piecing together a credible sequence of events leading to the twins’ infections would likely include the same details provided in a summary of plague spread published in the 2021 volume of the American Journal of Medicine*: 

An ancient disease, its bacterial agent (Yersinia pestis) is an aerobic, gram-negative coccobacillus in the family Enterobacteriaceae. Its primary vector for transmission is the Xenopsylla cheopis flea, although roughly 80 species of fleas can carry it. During the Black Death, the flea was transported by the black rat or Rattus. A controversial new theory argues that ectoparasites such as human fleas and lice also spread the disease during the second plague pandemic [1347-1665]. Fleas can also survive in infected clothing or grain. The bacteria multiply in infected rodents and block the fleas’ alimentary canal, causing the fleas to regurgitate the Y. pestis bacteria into its animal host…Plague transmission is generally from infected fleas by rodent vectors or, rarely, in clothing or grain but may also occur through ingesting contaminated animals, physical contact with infected victims, or direct inhalation of infectious respiratory droplets. 

O’Farrell could also find plenty of well-researched historical accounts of the plague impacts at the time and place she set the novel. The plague affecting Stratford then is thought to have first entered England in 1348 from ships docking in cities along the southwestern coastline. England struggled with it almost constantly for more than 300 years until it dissipated after 1665. From this biomedical and historical background, O’Farrell created a realistic framework for the story, and a reasonable representation of the all the factors needed for the infection to find the twins in 1596 Stratford.   

She starts her explanation of how the twins got infected by specifying that,  

two events need to occur in the lives of two separate people, and then these people need to meet. The first is a glassmaker on the island of Murano in the principality of Venice; the second is a cabin boy on a merchant ship sailing for Alexandria on an unseasonably warm morning with an easterly wind. (p. 140) 

The glassmaker is filling an order for decorative glass beads received from a dress shop in Stratford, England. But, because of a recent hand injury, a fellow worker is given the job of packing the order. This worker doesn’t know that the glassmaker “usually pads and packs the beads with wood shavings and sand to prevent breakage. He grabs instead a handful of rags from the glassworks floor and tucks them in and around the beads.” (pp. 140-141).  

Meanwhile, the merchant ship has docked in Alexandria, and the cabin boy has been sent ashore for provisions. He quickly encounters a man with a monkey, and the monkey quickly jumps on the cabin boy, and then all over the boy, passing along three infected fleas. One of them accompanies the boy back onboard ensconced “in the fold of the red cloth tied around the boy’s neck, given to him by his sweetheart at home.” (p. 144) The flea doesn’t stay there long. It jumps into the fur of one of the ship’s cats the boy picks up and nuzzles. Soon after the cat is sickened by its passenger and seeks comfort on the hammock of a midshipman, who upon approaching his hammock for a night’s sleep, finds a dead cat. The flea, now needing a new place to live “makes its way, by springing and leaping, to the fecund and damp armpit of the sleeping, snoring midshipman, there to gorge itself on rich, alcohol-laced sailor blood.” (p. 144) Three days later, the midshipman is dead. 

The ship arrives in Murano to pick up cargo including the glass beads. The cabin boy and the glassmaker come eye to eye as the glass beads are loaded onto the ship. And at that moment, the monkey flea, which had found a way back to the boy after time with some of the ship’s rats and its chef, leaped onto the glassmaker. He and many others in his factory subsequently succumb to “a mysterious and virulent fever.” (p. 149) 

In the hold of the ship now heading to England, the progeny of the monkey flea leap from dying rats to cats lying on top of the boxes filled with the glass beads until the cats die. The fleas eventually “crawl down into these boxes and take up residence in the rags padding the hundreds of tiny, multi-coloured millefiori beads (the same rags put there by the fellow worker of the master glassmaker…)”. (p. 148) The ship arrives in London and the boxes of glass beads are taken to a wharfhouse where they are stored for about a month before picked up for further transport. 

O’Farrell ends her tale of how the plague found the twins through the delivery of the box with infected fleas to their final destination. The box of beads “still wrapped in rags from the floor of the Venetian glassworks” is transported to an inn located near the northern reaches of London. (p. 149) Then, a messenger collects the box and takes them by horseback on a two-day journey to another inn near Stratford. O’Farrell adds how during this ride the mass of infectious plague vectors and organisms intensifies. 

The fleas in the rags crawl out, hungry and depleted by their hostless stay in the wharfhouse. Soon, however, they are recovered, rejuvenated, springing from horse to man and back again, then out on to the various people the rider encounters along the way…By the time the rider reaches Stratford, the fleas have laid eggs: in the seams of his doublet, in the mane of the horse, in the stitching of the saddle, in the filigree and weave of the lace, in the rags surrounding the beads. These eggs are the great-grandchildren of the monkey flea.  

The box with the beads and the fleas is now in the town where the twins live. An innkeeper there has it, and gives a boy a penny to deliver the box to the dress shop that ordered it many months before. The fleas have found Hamnet. 

Judith is at the dress shop helping out when the box is delivered.  

The seamstress holds aloft the box. ‘Look,’ she says to the girl, who is small for her age, and fair as an angel, with a nature to match. 
        The girl clasps her hands together. ‘The beads from Venice? Are they here?’ 
        The seamstress laughs. ‘I believe so.’ 
        ‘Can I look? Can I see? I cannot wait.’ 
The seamstress puts the box in her counter. ‘You may do more than that. You may be the one to open them. You’ll need to cut away all these nasty old rags. Take up the scissors there.’ 
 She hands the girl the box of millefiori beads and Judith takes it, her hands eager and quick, her face lit with a smile. (pp. 150-151) 

The fleas have found Judith. 

When Literary Narrative Serves as Biomedical Text 

O’Farrell’s narrative, fictional model of plague spread embedded in her story imagining what could have caused the death of an eleven-year-old boy in 1596 takes into account both the virulence of the infection and the many and varied ways it can spread. To make that point, she, much as would any epidemiologist, tells of others killed as the fleas made their way from Murano to Stratford, such as workers in the glassmaker’s factory, midshipmen on the boat, and various people encountering land-based messengers carrying the box of beads to those awaiting it. In that way, her model also explains how the mortality estimates of one-tenth to one-third of the populations from frequent plague visitations over three centuries could be generated. 

O’Farrell could have left this part out of the novel without losing much of the core storyline or emotion and drama of it. Indeed, the movie version gives it only a few seconds of attention showing the twins’ father walking by a street puppet show during a scene representing the spread of and death from plague delivered from a ship. By including the chapter, however, O’Farrell compounds the drama and emotion, and reveals the complexities involved in our fates.  

And, as I recall the drudgery of reading and mastering the intricacies of infectious disease spread and pathology such as those of bubonic plague, I wish I had O’Farrell’s novel Hamnet at the time. The experience would have been enjoyable and memorable where the experience with biomedical texts were not in either way. Perhaps this application was not in O’Farrell’s mind for the book, but it could go a long way in ridding us of the plague of turgid, mind-numbing, and indecipherable biomedical prose. Whether or not she knows it, O’Farrell has in this novel brought attention to a plague of another house.  

Hamnet
Maggie O’Farrell
Alfred A Knopf; 2020

*From: Glatter JA, Finkelman P. History of the Plague: An Ancient Pandemic for the Age of COVID-19.  American Journal of Medicine 2021; 134(2): 176–181. 

Image Credits

The path of infection of plague from rats via fleas to man, by A.L. Tarter from the Wellcome Collection. Attribution 4.0 International (CC BY 4.0). 
A rat on board a ship, carrying the plague further afield, by A.L. Tarter from the Wellcome Collection. Attribution 4.0 International (CC BY 4.0) 
The word plague hovers above a victim’s face, by A.L. Tarter from the Wellcome Collection. Attribution 4.0 International (CC BY 4.0) 

Although his story opens with the establishment of the Johns Hopkins Hospital in 1876, Barry immediately takes a detour into the history of medicine dating back to Hippocrates, and traces the history of medical/scientific thought from Ancient Greece to the end of the 19^th century. He then introduces a series of physicians, scientists, and medical researchers who will play their parts in the story of the pandemic (this first section is called “The Warriors”) and outlines their training, research, and interactions.  

It isn’t until page 91 that he takes us to the rural Kansas county in which the story of the pandemic begins. For although it was called the “Spanish Flu,” that was actually an eponym of convenience; in fact, the first cases of pandemic flu seem to have arisen on the American prairie. However, newspaper reporting on the new pandemic was felt by the Allies and Central Powers alike to be contrary to the public interest (the war was still raging), so it was left to neutral Spain, whose king had come down with the disease, to publish the early reports. In this section, “The Swarm”, Barry also briefly reviews the basic (not to worry, very basic) microbiology of viruses and the history of some prior pandemics. He follows this with the section called “The Tinderbox,” in which he traces the events leading up to the entry of the United States into World War I, and the importance of that war and the political and social conditions surrounding it in the history of the pandemic. From here on in the influenza itself takes center stage; in sections called “It Begins,” “Explosion,” “Pestilence,” “The Race,” and “The Tolling of the Bell,” the rapid and lethal course of the pandemic is described in gripping (no pun intended) detail. The last two sections discuss the scientific advances (and some false starts) brought about by the cadre of researchers working day and night to tame the outbreak, and then Barry finally turns to the retreat of the virus and ultimate end of the pandemic. The book ends as it began, returning to the stories of the individual men and women of science who engaged in the battle to beat the disease of which it had initially been said by many that “[t]his was, after all, only influenza.”  

For anyone seeking to understand the 1918 influenza pandemic not only from a scientific and medical historical standpoint, but also with an appreciation of the political and sociocultural milieu in which it took place, you can’t do much better than Barry’s work. It is not short—it clocks in at 461 pages, with another nearly 40 pages of endnotes and a 20 page bibliography—but it is well-paced and reads smoothly; the narrative carries you along, a testament to the author’s writing style. Barry succeeds in putting a human face on the pandemic and creates a mental image of the horror of pandemic disease which can stand up alongside those we have of the Black Death of the mid-fourteenth century, with which it is often compared. For those of us who know the flu as a seasonal visitor, (for most of us a major annoyance, but nonetheless a disease that kills tens of thousands each year), the images of massive and rapid death—villages abandoned except for piles of corpses, trains that “left one station with the living…[and]…arrived with the dead and dying”—seem surreal. Barry paces the book in such a way that one can almost hear the stopwatch ticking in the background; The Great Influenza is scientific and historical reporting done with great attention to detail and to getting the medical facts right, but it is reporting done with a novelist’s flair.  

Even as the pandemic begins to recede, leaving in its wake not only the dead but those living with its sequelae, such as post-encephalitic syndromes (the Woodrow Wilson/Treaty of Versailles anecdote is particularly striking), the helplessness of medical science is reaffirmed; the pandemic recedes of its own accord, because the virus mutates to less virulent forms, and the very large number of those who have survived helps to create herd immunity.   

In the book’s Afterword, added in 2018, the author discusses and compares influenza pandemics which followed the 1918 experience, talks about some of the antiviral drugs introduced over the years and how they work, and speculates about what the next great influenza pandemic might look like and how it might be prepared for. His concern was prescient, although it would be a coronavirus, rather than influenza, that would cause widespread death and societal disruption. In fact, one of the most jarring aspects of this story is the fact that, if one changes the dates and the names, the tale bears an uncanny resemblance to the COVID-19 story, right down to the attempts at minimization by the government and even the isolation and victimization of an ethnic group (in 1918 the Germans, who were the enemy in the world war, rather than Asian-Americans, as it would be during COVID).  

The Great Influenza is a detailed, highly readable, and sobering account of an episode which demonstrated once again that despite what we may think, we are not the masters of the world in which we live, and that a microbe could rapidly kill on a devastating scale and upend society—again—and there was initially little that could be done to stop it.  

THE GREAT INFLUENZA: A Story of the Deadliest Pandemic in History
John Barry 
Penguin Books, New York, 2004 (reissued with new afterword, 2018)
461 pages 

A previous version of this review was published in the NYU Literature, Arts, and Medicine Database.
Web image by Medhum.org

The Secularization of Medicine: Ritual, Salvation, and Prophecy by Nathan Carlin 

New York, NY: Oxford University Press, 2025, 264 pages 
ISBN 9780197574003 

Once upon a time, religion and medicine were quite close. Even now, parallels between the two are notable. Churches often have a spire pointing towards heaven. Modern medical centers are increasingly towering structures that reach to the sky. Churches have an altar, and hospitals contain operating tables. Clerics don distinctive vestments. Doctors have their own traditional attire – a white lab coat or scrub suit. Hearing a confession (whether in a hushed booth or a clinic exam room) is integral to both vocations. Some churches have holy water fonts for spiritual cleansing. Physician offices have readily available hand sanitizer. Carlin (an ordained Presbyterian minister and the Director of the McGovern Center for Humanities and Ethics at UTHealth Houston) explores the relationship between medicine and religion by focusing on secularization theory and the idea of transposition. His aim is to provide “a more critical understanding of the rituals, myths, and stories of and in medicine” (p20). In the book’s best section titled “Ritual,” the Hippocratic Oath (which invokes Greek gods) and the purpose of the White Coat Ceremony (a kind of “ordination”) are considered. “Salvation” examines the process of dying. A brief analysis of Tolstoy’s “The Death of Ivan Ilych” (preoccupied with the soul) and Roth’s Everyman (concentrating on the body) is included. Carlin also spotlights cardiothoracic surgeon Dr. Denton Cooley and muses whether specialty physicians – surgeons, cardiologists, oncologists, psychiatrists – might be today’s “high priests”? “Prophecy” focuses on Stephen Bergman, MD (pen name Samuel Shem) and his novels including The House of God. Regardless of religious preference (or atheism), readers will find enlightenment in this intriguing inspection of the links between medicine and religion.
 

Every One Still Here: Stories by Liadan Ní Chuinn 

London: Granta, 2025, 160 pages 
ISBN 9781803513270 

The protagonists of these six short stories (largely set in Northern Ireland) have so many serious questions. But when they sometimes do get answers, the information is hardly good news. The narrator of “We All Go” is an empathetic teenager who has watched his wheelchair-bound father wasting away (probably from a neurodegenerative disease) and dying. He enrolls in a Human Anatomy class (perhaps to better understand his dad’s condition) but finds the lab itself and the required dissection disgusting. Other characters in these tales tend to be sympathetic, off-beat, or both: a psychic who isn’t adept at predicting the future but instead offers an effective form of psychotherapy, an unemployed woman taking night classes in creative writing who encounters a child (unaccompanied by parent or other adult) riding the same bus as her every week, a man who tries to commit suicide after learning his pet dog has metastatic cancer. Struggle, trauma, grieving, or some secret are prominently featured. A character wonders, “Isn’t the truth that we all do terrible things?” (p64). Indeed, acts of cruelty impact the lives of multiple individuals in these tales. For a few of them, compassion from others and the passage of time might ease the pain a bit but cannot completely erase it. 

Water in the Desert, Fire in the Night by Gethan Dick 

Dublin, Ireland: Tramp Press, 2025, 268 pages 
ISBN 9781915290168 

Long before the onset of Covid-19, Pandemic Lit was already an established subgenre of speculative fiction. For example, The Last Man by Mary Wollstonecraft Shelley was published in 1826. Like most novels about pandemics and other apocalyptic events, fear and hope are tightly intertwined in Water in the Desert, Fire in the Night. But this story’s journey thru the end of the world – about the things we leave behind and the qualities we stubbornly cling to – feels much more optimistic than most. An estimated 90% of the world’s population has expired, and a “raging sadness” has washed over most of the survivors. Details about the contagion are vague. The deaths it causes are devoid of drama or gore: “just a cold, a fever, some difficulty breathing, then no more breathing” (p236). Six people, afraid of being infected, hide in London for two months. Four of them decide to bicycle much of the way to an Edenesque-sounding town in France. The story’s narrator, Audaz is a young woman firmly tethered to memories of her younger life and her mother. She is also pregnant. Sarah, a retired midwife trains Audaz as her apprentice (since someone will have to know how to care for women’s health and deliver babies – if there is to be a future for humanity). Pressure Drop is a weed-smoking mystic, and Adi is a young man who succumbs to sepsis along the way. A variety of challenges test them throughout their trip. Survivors they encounter can be violent, suspicious, or kind. A fisherman transports the group in a borrowed boat across the English Channel to France where they eventually reach their destination. While survival remains their highest priority, these characters understand that compassion, resilience, and childbirth foreshadow a promising new beginning for them and perhaps the rest of the remaining world as well. 

Additional recommended new or soon-to-be published books in 2025: 

Seminal: On Sperm, Health, and Politics edited by Rene Almeling, Lisa Campo-Engelstein, and Brian T. Nguyen  

Replaceable You: Adventures in Human Anatomy by Mary Roach 

Web image by  Rachael Ren