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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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 08.27.26 271

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

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 09.05.26 569

A visual form of storytelling comes into its own. 

Two hidden stories by two famed authors written decades apart in two countries eventually became widely known. One, Anton Chekhov’s, At the Pharmacy, was translated into English in 1998, about one-hundred years after it was published in Russia. The other, Raymond Chandler’s, It’s Alright–He Only Died, was unearthed from its unpublished state by Strand Magazine in 2018, about sixty years after it was written. Though written in different times, and using different scenarios, both stories warn of the barrier money creates to urgent and necessary health care, and of the corrosion in professionalism it causes in providers. They tell of what was to become a defeating feature of Western health care because of financial incentives, social prejudices, and human folly.

Six Kopecks or Your Life

Peter Constantine reached back from the 1990s into the 1880s to assemble a translated anthology of some Chekhov short stories not available to English-speaking audiences. Among the chosen stories in The Undiscovered Chekhov: Thirty-Eight New Stories, is At the Pharmacy.

The story begins when Egor Alexeyitch Svoykin becomes sick. His physician prescribes medicine that a pharmacy would need to prepare. Svoykin felt some relief being in a large Russian city during the late nineteenth century that would have pharmacies he could count on. This feeling of relief dissipated just after entering the pharmacy and coming before the imperious pharmacist there. 

The pharmacist eventually raises his head from a newspaper, looks at the prescription, shouts instructions to his assistants, and then returns his gaze to the newspaper while at the same time informing Svoykin the prescription will be ready in an hour. Svoykin is the only person waiting at such a late hour as it was, and he was deteriorating.

His mouth was on fire; there was a drawn-out pain in his arms and legs; foggy images tumbled about like clouds and shrouded human figures in his heavy head. He looked as if through a veil at the pharmacist, the shelves of jars, the gas burners, and the cabinets. The monotonous pounding in the marble mortar, and the slow ticking of the clock seemed to him to be coming not from the outside but from inside his head. (p. 129)

When Svoykin reports to the pharmacist that he is becoming feverish and feeling weaker, “the pharmacist “remained stock-still and, leaning his head farther back, kept on reading his newspaper. He didn’t respond to Svoykin with word or movement—it was if he hadn’t heard him.” (p. 130) When Svoykin subsequently approaches the pharmacist pleading with him to hurry the prescription, the pharmacist again brushes him off saying, “It’ll be ready soon enough…excuse me, but there’s no leaning on the counter.” (p. 131)

The next half hour was “unbearable” before the prescription came and then made more so by the dubious rituals the pharmacist performed in adorning the prescription container. The pharmacist charged one ruble and six kopecks, but Svoykin was short the six kopecks. 

Under the circumstances…I would be grateful if you would let me bring you, or maybe send you, the six kopecks tomorrow…

I’m sorry, we don’t accept credit here.

What am I supposed to do?

Go home, get the six kopecks, and then you can have your medicine.

But…I’m having difficulty walking, and I don’t have anyone I can send…

That’s your problem.

pp. 132-133

Svoykin returned home, though with difficulty. The Kopecks were there on the table, but his illness kept him from returning to the pharmacy.

Just Drunk

Strand Magazine is a source for “unpublished works by literary masters.” The October-February (2017-2018) issue includes an unpublished Raymond Chandler short story. Chandler wrote crime fiction for the most part, and the stories usually involved the fictional detective, Phillip Marlowe. This story, however, written between 1956 and 1958, is about a person brought to a hospital emergency room and denied service for financial and social reasons.

As the story opens, a man who has been hit by a truck is brought into the emergency department at General Hospital. He arrives just before shift change and so the admitting clerk is already annoyed about having to assess him. The clerk checks the patient’s pockets for the required $50 deposit and finds nothing, so she could now send the patient to the county hospital, and that would be that. But, before she initiates the transfer, she asks a passing private attending physician to look at the patient. He sees that the patient is dirty, smells of alcohol, and would cost a lot to work up. Mindful of an admonition from a major donor that the “hospital is not run for charity,” the physician surmises the patient is “just drunk,” and agrees the patient should be moved to the county hospital. Off the patient goes.   

The next day, the same admitting clerk at General Hospital gets a call from the county hospital. She’s informed that the patient they transferred had a head injury requiring surgery, and that the patient had $4,000 in a money belt inside his undershirt. The patient couldn’t be saved, however, because of the delay involved in the transfer to the county hospital. “It’s all right—he only died.”

Fast Forward

If they could have foreseen the current time when they wrote these stories, 140 years ago for Chekhov and 70 years ago for Chandler, they would have realized that the scenarios they created became commonplace and institutionalized in many ways.

Pharmacists may not go unseen behind a newspaper as Chekhov’s pharmacist did, but they may be buried under insurance company paperwork or piles of prescriptions needing to be filled. And certainly in a few situations, perhaps only independents, do pharmacists have ways to cover costs when patients are short on cash, credit, or insurance coverage. They are very likely to send patients away to get money even when they are very sick.

Hospital personnel do not now actually reach into the pockets of unconscious patients to see if there’s enough cash for admission as Chandler conjures in his story, but he would see them still check for money in the form of insurance cards or proof of sufficient financial means. He would also see that the scenario he described in which patients without money get transferred to county hospitals had progressed to a degree that people are moved around among different health care providers based on health care insurance plan coverage or lack thereof. But the poor treatment of patients in need of emergency care can even occur in the “right” hospitals when they are held for hours to days in hallways or holding wards for beds to become available.

Scenarios such as these can and have been addressed to varying degrees through government welfare programs, regulatory requirements, technology advances, and professional practice standards among other responses. The two stories, though, also expose human folly not so amenable to these actions. What can be done about the pharmacist who won’t put the newspaper down to address the needs of a person seeking help for an acute illness? What can be done about the physician who after a cursory evaluation brushes off an unconscious patient as “just drunk?”

Chandler makes an attempt at addressing the human folly he and Chekhov reveal by describing how it fails humanity on both professional and personal levels, and in shaming the character, who is ostensibly standing in for those behaving as this doctor in the story did.

All he had done was disgrace himself as a person, as a healer, as a saviour of life, as a man required by his profession never to turn aside from anyone his long–acquired skill might help or save…Why should a doctor in such circumstances be better than other men? The answer is simply, that if he isn’t, he is not a doctor. The $4,000 would have made quite a difference in this case, wouldn’t it?  Should it?  

Chekhov and Chandler are perhaps hoping that those in the care of others will exhibit more humane and professional behaviors when they ask themselves many decades later: “Am I a doctor?”“Am I a pharmacist?” “Am I a human being?” Would it make a difference? Should it?

Notes

Title image:
A young girl waiting for a pharmacist to make up a prescription.
Photogravure, 1912, after J. Jendrassik, 1896
Licensed under the Creative Commons Attribution 4.0 International

End image:
Nurse Aide Rocky FordHospital CO
Mennonite Church USA Archives, No restrictions, via Wikimedia Commons

Back when I was doing my internship at Pennsylvania Hospital, I was so surrounded by history I felt like I was working in a museum. Even the china we dined on in the hospital cafeteria sported the original historic pattern. And when we finished our training, a brass plaque with our names went up on the same wall as the plaques of our predecessors going back to the 18th century.

At the time, none of this was widely known. But fortunately, Pennsylvania Hospital now has an actual museum, open to the public just in time for the nation’s 250th anniversary. The Pennsylvania Hospital Museum is compact yet chock-full of art, architecture, artifacts, and documents, and has at once become a must-see destination in Philadelphia.

Although Bellevue Hospital has roots that go back to 1736, it started out as an almshouse. Pennsylvania Hospital was the first institution in the colonies founded specifically as a hospital, established in 1751 by Benjamin Franklin and Thomas Bond. The 1756 building housing the museum is a National Historic Landmark. Not only is it considered an important example of Georgian architecture, but its cornerstone even bears an inscription by Franklin referring to King George II.

The landscaped grounds are a serene oasis in the middle of Philadelphia’s Society Hill neighborhood and include a Physic Garden containing herbs and plants used for medicines in the 18th century.

As one enters the building, the first room encountered is the pharmacy, which remained in use until 1927 and now contains interactive displays. A fire engine purchased in 1803 sits in the foyer at the base of a grand staircase. After ascending to the second floor, visitors enter America’s first medical library, a handsome wood-paneled room containing more than 13,000 volumes from floor to ceiling, including one of the nation’s most complete collections of medical books published between 1750 and 1850.

The third floor houses the nation’s oldest surgical amphitheater. In the era before electricity, it was illuminated by skylight, so surgeries could only be performed on sunny days. (I must confess that we interns used to sneak into this room when on call. It was spooky in the middle of the night!)

For me, as a psychiatrist, the highlights of the museum were the exhibits on mental health. I have previously written in MedHum about Benjamin Rush, often called the father of American psychiatry, whose portrait is on view here. Rush served on the staff at Pennsylvania Hospital from 1783 until 1813 and was known for his groundbreaking and humane treatment of the mentally ill. Metal shackles once used as restraints are also on display, although hopefully they predated Rush’s tenure.

Another psychiatric pioneer whose portrait hangs in the museum is Thomas Story Kirkbride, who came to Pennsylvania Hospital for residency training in 1834. When the psychiatric wards exceeded capacity and a satellite facility was built on 101 acres in West Philadelphia, Kirkbride was named superintendent. His ideas about the layout and design of mental institutions became highly influential, leaving an imprint on hospitals throughout the country.

Initially called the Pennsylvania Asylum for the Insane, the new campus eventually became known as the Institute of Pennsylvania Hospital. I completed my residency training there, but over time it was no longer financially viable, and it closed in 1997.

How fascinating to learn that Francis Scott Key, of “The Star-Spangled Banner” fame, wrote a poem titled On Visiting the Pennsylvania Hospital. And to see 18th-century anatomical casts used for teaching at a time when formal dissection was illegal.

There is so much history in this museum that I could not absorb it all in one visit. With its addition, Philadelphia further demonstrates its role as the cradle of American medicine. Indeed, one would have to travel to London to find a larger assemblage of medical historical sites.

In one very busy day—or a more leisurely two-day trip—a visitor can now experience this museum, plus the College of Physicians of Philadelphia and its famous Mütter Museum, while also stopping to see The Gross Clinic by Thomas Eakins. (The painting alternates between the Philadelphia Museum of Art and the Pennsylvania Academy of the Fine Arts, but will spend 2026 at the latter.)

Bravo, Philadelphia!

Benjamin Rush:  Reflections from a Psychiatrist 

Guy Glass 09.02.24 0

A founding figure in American psychiatry, known for pioneering reforms, but also controversial for his treatments and complex contradictions in beliefs and practices.

For more information about the museum, visit Pennsylvania Hospital Museum.
Web image from Wiki Commons

A Most Unexpected Path Laid by a Most Unexpected Disease

Dr. Ross Slotten chose family medicine to serve patients from cradle to grave. But, as he was entering practice, the AIDS virus was entering the community where his practice was situated, and he found himself serving patients much closer to the grave than the cradle. 

In June 1981, a few weeks before I began my internship in family practice [at Saint Joseph Hospital in Chicago], the Center for Disease Control in Atlanta had published the first report of a strange lethal infection among a cohort of gay men in Los Angeles. I had no clue then that the disease would soon kill friends, former lovers, colleagues, and patients; devastate tens of millions of people and their families worldwide; and consume my entire professional life and more than half my chronological one. (p.14)

From both the circumstance of time and place he found himself in, and the sense of necessity and compassion that claimed him, Slotten’s professional trajectory unexpectedly shifted away from traditional family medicine towards specializing in AIDS. His interest in AIDS, however, extended to personal considerations, because as a gay man, he was part of the population at risk, and harbored the same anxieties and fears he saw in his patients and throughout his social circles. His patients were principally gay men because of his geographic location in an established gay community and the resulting referral patterns. The book chronicles both his experiences as a physician taking care of gay men with AIDS, and his experiences as a gay man at risk for AIDS. For Slotten, these experiences were not independent of one another, which makes for rich insights on the complexities of both. 

Slotten spent a lot of time at Saint Joseph Hospital because his patients required intense medical support and specialized services. He tells how he and his practice partner pushed for establishing a specialized AIDS unit in the hospital. They bumped up against usual bureaucratic obstacles, plus a few more concerning issues specific to AIDS patients, but they ultimately prevailed. Slotten “was to spend the next fifteen years there, often heartbroken, occasionally inspired.” (p. 109) In contrast to his commitment, he recounts how some specialists he called for help with particular patients refused when told they had AIDS. Those occurrences stuck with him: “I couldn’t forgive those other physicians for abandoning me and my patients in the hours of our greatest need.” (p. 108)

With whatever little time he had left for volunteer and advocacy work, Slotten stayed local. He talks about the volunteer-run health clinics where he worked (e.g., the famed Howard Brown Clinic), and the housing facility he helped set up for homeless people with AIDS. He left protesting at the Food and Drug Administration, the National Institutes of Health, and the annual International AIDS Conference to others while he focused on his patients, his studies, his volunteer work, and his own safety.

The 2020s are approaching when Slotten writes about the preceding three-and-a-half decades. As he finishes the book he is still caring for people with HIV, but the horrible complications of AIDS are now infrequent since the availability of effective medications. His practice had been reliably stable and predictable for some time, a circumstance he could only dream of when he first started. That dream ended abruptly just as the book was released on July 15, 2020: Covid was surging.

Moments of Horror, Relief, Calm, and Then…

Slotten’s perspectives correspond with the trajectory of AIDS over the thirty-five years his memoir spans. Particular periods are discernable, beginning when gay men were presenting with illnesses associated with profound immunodeficiency of unknown cause. Another is the time of peak AIDS death and destruction represented by the moment in 1992 when Slotten hears from the Chicago Board of Health, “that no one had signed more death certificates in Chicago than I had.” (p. 122) The next moment arrives at the turning point when highly active antiretroviral treatment (HAART) became available, transforming HIV/AIDS for him “from a universally fatal disease…into a chronic one like diabetes…it was almost beyond belief.” (p. 186) Then the prolonged period of relative calm when AIDS became controllable—even preventable—with Slotten noting during a moment in 2016 that, “It had been almost a decade since I’d cared for someone with advanced HIV infection, and I hadn’t lost a patient to AIDS since 2004.” (p. 202)

The AIDS epidemic is known for and measured by the number of deaths that occurred. Slotten wants us to remember the misery the disease causes.

For those who didn’t experience that terrible time, or who’ve forgotten how terrible it was, let my chapters serve as a warning to the complacent and the ignorant: untreated HIV is as ruthless as any terrorist and as destructive as a nuclear device. (p. 3)

He drives this point home when he recounts the stories of individual patients tortured by Pneumocystis carinii pneumonia, Kaposi’s sarcoma, cytomegalovirus retinitis, herpes simplex infections, cryptosporidium dysentery, AIDS wasting syndrome, AIDS dementia complex, and progressive multifocal leukoencephalopathy among other medical horrors, and who often suffer many at the same time. And, all the while, he had little to offer but his wits and his compassion. 

Both attributes would be called upon again in 2020 as Covid struck. Though those with Covid did not produce nearly the fatality rate of AIDS, not nearly the severe comorbidities of AIDS, not nearly the stigma and prejudice as AIDS, and not any of the governmental insouciance seen with AIDS, it still caused a lot of death, suffering, grief, and misinformation at a time when only supportive care was available. Like AIDS, though, the Covid pandemic was transformed into a manageable syndrome with the availability of an effective vaccine, new antiviral agents, and better clinical management regimens.

Complacency remains a threat to the reemergence of any infectious disease. Indeed, AIDS is reportedly rising in poor and developing countries in 2026 as funding for AIDS treatment and prevention programs has been withdrawn from donor countries, mostly that from the United States. Lessons from Slotten’s book may thus be called upon again.

Notes

Book citation:
Slotten, Ross A. Plague Years: A Doctor’s Journey through the AIDS Crisis. University of Chicago Press, 2020. 224 pages

Plague Years is a good companion to the documentary film, 5B, which reports on how San Francisco General Hospital coped during the early years of the AIDS epidemic, and Rebecca Makkai’s novel, The Great Believers which features the stories of a group of gay men in Chicago also during the early years of the AIDS epidemic.

Dr. Slotten was a guest on an episode of The Clinic & The Person podcast to discuss his experiences during AIDS epidemic as he reported them in his book, and how well they match up with what we see in 5B and read in The Great Believers.

Web image by Medhum.org

Out of the gay rights activism in the 1970s came AIDS activism in the early 1980s. By then, the incidence and severity of AIDS had become evident and caused enough fear to generate social backlash against those with the disease. This, along with federal government insouciance at the time, made it necessary for gay rights activists to extend their remit into advocacy for health care specialization and research advancements for AIDS. The expanded activism was visible on the streets and at governmental research institutions (e.g., National Institutes of Health). Where it was also taking place, and not in such an obvious way, was within certain hospitals.  

San Francisco General Hospital answered the call first in 1983 when it created a special unit for the care of people with AIDS in “Ward 5B.” The unit was in operation through its move in 1986 into Ward 5A to accommodate more patients, and until 2003 when advances in antiretroviral treatment of AIDS made the unit no longer necessary. But throughout, the struggle to maintain and advance the unit medically, socially, and politically persisted. The documentary film, aptly named “5B,” covers the struggles, successes, and failures of the unit, and the activism required of the staff and advocates for its creation and ongoing viability.  

From the Inside 

The story is told from various perspectives through interviews with key figures in the unit’s development and operation, and with archival footage of the unit and AIDS activism in the community. The most prominent among the key figures is Cliff Morrison, a clinical nurse specialist who spearheaded the idea for the unit and then managed it. Several other nurses who served in staff and supervisory positions are also featured. Participating physicians include Paul Volberding, an oncologist at the time who became pivotal in the development of effective HIV treatments, and Julie Gerberding, a physician treating patients on the unit who later became the Director of the Centers for Disease Control (CDC). Lorraine Day, the chief of orthopedic surgery at the hospital when the unit opened, is heard often as an opposing voice. Hank Plante, a local television news reporter, also appears frequently to offer his perspectives on many of the social and political issues swirling around the unit. Among other participants are AIDS activists, volunteers, and family members of unit patients. 

Several storylines frame the documentary including how nurses drove the unit’s inception and then were instrumental in running it. “Nurses were in charge,” said Volberding, admiringly. Interwoven throughout the film are the experiences of the patients and individual nurses, including one nurse who was infected with HIV from a needle stick. “Those nurses were the real heroes,” said one activist.    

Rare is the story, though, about heroes who aren’t confronted with daunting challenges, and thus this documentary includes a storyline involving attacks the unit nurses encountered from inside the hospital. The nurses of this unit practiced in ways they considered safe but not in such a manner that would preclude them from touching patients or require them to don so much protective gear they become unseeable. Nurses and clinicians from other units objected and did not want to be compelled to adopt practices they thought endangered them on the occasions they took care of AIDS patients. The film follows this story through union grievances and public debates to their conclusion, which sided with the unit nurses and their advocates. The spirit of activism among the unit staff was pivotal in fending off the many challenges they faced. 

Keeping in Touch 

The documentary reveals stark juxtapositions that can manifest in the midst of an infectious epidemic, and in particular when an epidemic selects an identifiable group that is unwelcome in mainstream society. Two juxtapositions that stand out are the emotion of love with that of fear, and those who are deemed worthy with those who are considered disreputable. 

No treatments for the HIV infection or for the many horrid and lethal diseases resulting from AIDS were available when the unit opened—it was “a very, very unpleasant death” as one nurse put it. The nurses saw a big part of their role as offering love: “Here you were allowed to love your patients.” They offered it through human touch. Morrison’s view was, “If we can’t save these folks, we’re going to touch them.” To touch the patients in this way required that they balance it with the risk of exposure to infection and still comply with universal precautions. Nevertheless, fear was prevalent—some people were “truly hysterical” according to Gerberding—and it touched off conflict among the health care staff. “People were afraid…we found ourselves attacking each other…everyone was so stressed,” is how Volberding described the situation. This balance is one that is continuously negotiated in health care settings, but it was more pronounced during the early years of the AIDS epidemic, and at San Francisco General, it had to be mediated by hospital and union officials. 

At the time unit opened, and for a long while after, people with AIDS were scorned. The gay lifestyle was linked to the disease and so a view held by many was that the gay community deserved to be struck down by this plague. They were not worthy of all the human resources, technology, and money the disease required. The documentary brings this sentiment to life by showing the actions some people took to prevent getting these patients help, and the actions governments didn’t take to help them. Also shown, however, was how the activism of health care professionals and others in Ward 5B helped to overcome these obstacles. Without it in the case of the unit in Ward 5B, the activism in the streets outside the hospital alone may not have been enough.  

But Then 

These fevers abated some when medical advances produced treatments that obviated the need for AIDS units, and changes in societal attitudes led to more acceptance of gay lifestyles. The next epidemic that targeted marginalized and susceptible groups would determine whether lessons learned from the time of this unit had been incorporated in response protocols. That opportunity came the year this documentary was released in 2019 when Covid struck elderly people first and hardest, and especially those in communal living arrangements.  

Note: 

The documentary was featured on the podcast episode, How Terrible It Was: Three Takes on the AIDS Crisis with Dr. Ross Slotten, which can be accessed here on medhum. In addition to the documentary, the podcast episode included the novel, The Great Believers, and the memoir, The Plague Years: A Doctor’s Journey through the AIDS Crisis were discussed. The author of the memoir, Dr. Ross Slotten, joined the podcast as a guest. 

Title image credit: 
James Steakley, CC BY-SA 4.0 <https://creativecommons.org/licenses/by-sa/4.0>, via Wikimedia Commons 

Documentary information: 
Film title: 5B
Directors: Paul Haggis, Dan Krauss 
Studio: Vertical Entertainment 
Viewing source: Amazon Prime 
U.S. release date: June, 2019 
Run time: 134 minutes  

Trailers from 5B Film

If there was ever an ironic title for a book about the best ways of achieving a long and healthy life, it’s this one: Eat Your Ice Cream. That’s because a major conceit of the book is that if we are to incorporate all the recommendations for achieving good health into our lives, some balance—tradeoffs—will be necessary. Eating ice cream exemplifies that balance: when consumed in moderate amounts, it offers some nutrients and a lot of happiness.  

The author, Dr. Ezekiel Emanuel, known to all in his many circles by the mononym “Zeke” (think: Sting, Prince, Oprah), points to a couple of motivations for writing the book. One is in the service of his life-long quest to “improve Americans’ health.” (p. 11) He has gone about this in many ways including his service as a medical oncologist, chief of the National Institutes of Health Bioethics department, medical school professor, health policy researcher, author of many books and articles on a range of health care subjects, and as an architect of the Affordable Care Act (aka, “Obamacare”). His other motivation arises from his view that current wellness advice makes it “nearly impossible to differentiate the valid, reliable, and effective from the speculative, deceptive and just plain stupid.” (p. 4). His aim, then, is to “provide a concise, clear, and authoritative synopsis of what health experts know works best to bring the biggest health benefits—without extraneous, speculative, or absurd additions.” (p. 11) 

Getting a Six Pack 

Running through the book is Zeke’s insistence that wellness behaviors and practices will be most effective when they become part of daily life and not something separate or extracurricular, and as such wellness rules “become an invisible part of lifestyle, sustained by habit.” (p. 10) He gives himself the task of cutting through the jungle of wellness advice and providing “a distillation of the evidence to simplify doing the right thing” for a healthy life. (p. 9) 

In keeping with his theme of simplicity, he breaks down wellness advice into “the six wellness behaviors that yield the maximum benefits with the least work.” (p. 9) They are: 1) avoid self-destructive behavior; 2) cultivate family, friends, and other social relations; 3) stay mentally healthy; 4) consume healthy food and drink; 5) exercise well and regularly; and 6) get the rest you need. He hastens to add that these six behavior categories reflect the thinking of ancient times among Greeks, Chinese, and Indians.  

Each of the wellness behavior categories constitutes individual chapters. In each, Zeke covers both obstacles to attaining good health (e.g., heavy alcohol consumption) and practices that facilitate attaining good health (e.g., getting vaccinated). His recommendations are based on evidence from credible sources and are time tested. He presents them in more of a conversational form in plain language and not much in the way of strict protocols or mechanical algorithms.  

While Zeke considers all six wellness behavior categories crucial to a healthy and long life, he does not rank them in importance or priority. He does, however, form two groups from them and makes a distinction between the two, noting that “risk management, friendship and social interactions, and mental engagement have a measurably greater impact on your wellness than diet, exercise, and sleep.” (p. 8) This may come as a surprise to hardcore health advocates who put a major emphasis on, if not obsess about, exercise, diet, and sleep. Zeke goes further to say about the zealots: 

They ignore the importance of family, friends, and social relations—the emotional wellness behaviors—which have a remarkable impact on the quality and length of one’s life. And it’s a dangerous fallacy that a deficit of emotional wellness behaviors can be remedied with a surplus of physical wellness behaviors. No amount of kale or number of steps or hours of sleep can replace the importance of building and maintaining good relationships for wellness and longevity.  
(p. 54) 

He comes back repeatedly to the greater importance of social over physical components for good health. He seems a bit obsessed with it, though convincingly so.  

Neither Extremist nor Scold 

Distinguishing this book from others in the field is how Zeke does not scold people to abandon all behaviors that can work against achieving a healthy life, nor does he advocate people push themselves to extreme levels of compliance and sacrifice. Neither is sustainable and both can result in futility and abandonment. He urges us to find the mix of behaviors and levels of commitment that can be woven “into the fabric of your everyday life so they become automatic and easy, not a chore, burden, or all-consuming fixation. (p. 187) 

Zeke offers ways to moderate specific recommendations or to make trade-offs. One example is alcohol consumption. He realizes that although alcohol should be avoided, that’s not likely. When it can’t, he advises that people at least not drink alone because some of the risks of a daily drink “is probably outweighed by the benefits of time with friends.” (p. 34) As another example, Zeke advises that exercise is essential, but when excessive, diminishing returns can result. “Exercising 2 or 3 hours a day will not improve your longevity more than 45 minutes a day.” (p. 164) Furthermore, in this regard, he says, “There’s something to be said for living fully and being present, not constantly monitoring our activity tracker or feeling guilty for not achieving every wellness goal.” (p. 10) Don’t obsess, and toss the wearables.  

So, go ahead, eat your ice cream, but not too much, and do it with family and friends. Then walk home safely and get a good night’s sleep.  

Photo attributions: 

Hubert Opperman eating an ice cream next to a Peter’s Ice Cream Reo truck, 1936 
Sam Hood  
State Library of New South Wales collection, No restrictions, via Wikimedia Commons 

Melba Phillips Eating Ice Cream 
Emilio Segrè Visual Archives  
CC BY-SA 4.0, via Wikimedia Commons 

Modern medicine’s emphasis on extending the human lifespan has, in some cases, transformed dying, once a communal and spiritual event, into a cascade of arduous procedures. Deftly synthesizing the wisdom of many experts with his own insights and experiences, Palmer offers compelling, accessible, and refreshingly honest advice on how to shape our lives and legacies so that we are better prepared to die as we see fit—highlighting agency in aging in the face of ageist norms. 

Just last week, New York Governor Kathy Hochul announced that the state will join 11 others and Washington, D.C., in legalizing medical aid in dying (MAID), or when physicians prescribe a lethal dose of medications to patients with fewer than six months to live. 

“New York has long been a beacon of freedom,” Hochul said, “and now it is time we extend that freedom to terminally ill New Yorkers who want the right to die comfortably and on their own terms.” 

The governor’s rhetoric emphasizes a collective cognitive dissonance: As physician (and fellow politician) Dan Morhaim observes, “our culture celebrates personal autonomy,” but when it comes to death and dying, “we collectively abdicate” that value. 

Citing Morhaim and others, Palmer provides valuable context for our relationship with mortality (along with additional information about MAID). During the nineteenth and early twentieth centuries, the average death was relatively quick and happened at home, with little involvement from healthcare providers and medical technology. Today, dying is protracted and tends to take place in hospitals or nursing homes; healthcare providers and medical technology are highly involved; and life can be prolonged with organ transplants, chemotherapy, and more. 

“There is a significant difference between dying peacefully in your bed at home and dying yoked to tubes and machines in an ICU,” Palmer writes, “receiving futile care that only prolongs the dying process for perhaps a few days while providing a horrendous quality of life.” 

Drawing on surgeon Atul Gawande’s [1] work, Palmer argues that, at best, physicians are uneducated about aging and dying and what might matter to patients approaching the end of their lives. At worst, they are financially motivated to perform aggressive interventions that may do more harm than good.  

According to numerous studies, frail patients do poorly in hospitals, and Palmer points out that doctors nearing death tend to eschew the very treatments they give to their older patients, such as surgeries and radiation. 

“I don’t want my last conscious thought to be of doctors stabbing needles into my veins, my ribs breaking from chest compressions, and a large-bore tube thrust into my throat and lungs,” the end-of-life activist writes. “When a patient is young and robust, such curative measures may make good sense despite their violence, but not for an old, debilitated, frail patient.” 

But we have choices: “where to die, how much treatment to have, and how to spend the limited time we have left.” 

“While, in a real sense, no death is ever ‘good,’” Palmer underscores, “planning and preparation can make death less awful and painful.” 

Legislation to make MAID available to the terminally ill is one step in that direction. However, critics argue that MAID may endanger the elderly and disabled, who might feel pressured to end their lives out of fear of causing hardship to their families. Opponents also contend that such policies reinforce the toxic notion that a life with a disability or chronic illness is not worth living. Also, some individuals may seek MAID due to high treatment costs, but MAID should not substitute for accessible care and support. 

Racial inequities in healthcare are also relevant; Black people might opt for MAID because they are more likely to receive inadequate pain management due to stereotypes that they are drug-seeking or pain-tolerant.[2] Palmer could have engaged more fully with these valid concerns. Fortunately, the Medical Aid in Dying Act in New York has a number of guardrails meant to ensure the patient’s decision is informed and voluntary, including a conflict-of-interest prohibition and a mandatory mental health evaluation. 

Well before we are terminally ill, we need to be having routine conversations about dying with our loved ones and physicians. To that end, Palmer endorses The Conversation Project. He also suggests creating an advance directive, or a legal document outlining your healthcare wishes, and choosing a healthcare proxy—not necessarily your closest relative—when you’re young or in good health. One way to think about your healthcare wishes is to complete the sentence “I would want to live as long as I could still…”, as recommended by physician Eleanor Tanno. Another is to consider an “exit strategy,” or an illness for which you would decline treatment.[3] 

Some other tips from Palmer for a “good” death: 

• Write a personal mission statement; letters of gratitude to loved ones; and legacy letters, also known as ethical wills, that capture your essence, beliefs, and stories to pass on to future generations. 

• Make a folder containing everything your children must handle when you die. 

• Join a “village,” or “virtual retirement community.” 

The author also illuminates the benefits and limitations of palliative and hospice care, delineates various eco-friendly alternatives to embalming (reader: as of writing this, I’d like to be affordably composted), and presents ideas for making funeral and memorial services more substantive—and even fun. 

Achieving a Good Death is a touch dogmatic, but Palmer demonstrates in the book’s rich appendices that he practices what he preaches. In a letter to his family about his own end-of-life wishes, he shares the pain of witnessing his mother’s final years in a nursing home: “I want to prevent what happened to her from happening to me.” 

“If my mental function is seriously compromised with little chance for full recovery, please seek opportunities to encourage death’s approach… Are my kidneys faltering? Let them,” he writes, giving new meaning to author Mel Robbins’ self-help concept. 

The book’s main flaw—one the author himself acknowledges—is that it is primarily aimed at those with friends and families. Readers without such connections may feel less comforted than grimly recognized by Palmer’s planned memorial service playlist featuring the Beatles’ “Eleanor Rigby.” 

Ultimately, Achieving a Good Death is a stimulating must-read for mortals that will leave you equipped for a more peaceful, dignified, and meaningful end. 

Achieving a Good Death: A Practical Guide to the End of Life
Chris Palmer
Rowman & Littlefield, 2024

[1] Gawande, Atul. Being Mortal: Medicine and What Matters in the End. Metropolitan Books, 2014. 
[2] Substance Abuse and Mental Health Services Administration. The Opioid Crisis and the Black/African American Population: An Urgent Issue. Publication No. PEP20-05-02-001, Department of Health and Human Services, Office of Behavioral Health Equity, 17 Mar. 2020, samhsa.gov/sites/default/files/meeting/documents/csap-nac-presentation-03172020.pdf.  
[3] Harrington, Samuel. At Peace: Choosing a Good Death After a Long Life. Hatchette, 2018. 

Web image by Medhum.org.

Directed by Anne Kauffman, the play features “Primes,” or holographic simulations of the dead intended for therapeutic use by the living. June Squibb—who, at 96, is making history as the oldest performer to open a Broadway show—astonishes as Marjorie, an impish 85-year-old with dementia using a much younger version of her husband Walter (an uncanny yet tender Christopher Lowell) to regain and retain her memory. Marjorie’s daughter Tess (the incredible Cynthia Nixon) is skeptical and fearful of the technology, whereas Tess’s husband Jon, played by a standout Danny Burstein, is a fan—until an on-the-nose change of heart in the penultimate scene. 

Marjorie Prime’s central flaw is that it favors concepts over dramatic depth. The characters are well-acted but underdeveloped, and almost all they do is talk; the biggest event may be Marjorie urinating herself. Yet, despite its slow pace and formulaic structure, Marjorie Prime is intelligent and poignant. 

Marjorie’s memories are embellished and sanitized for her comfort and convenience. The fallibility of memory is hardly a novel concept, but the Primes enable this reconstructive process and also become a stand-in for genuine connection in the wake of grief, preventing the family from confronting painful realities and repairing their relationships.  

By the time the truth fully surfaces in the unsettling final scene, which makes adroit use of a stage turntable (props to scenic designer Lee Jellinek), there are no humans left to heal. When storytelling is delegated to AI, truth becomes archival rather than relational; however, truth must be witnessed between living people in order to be ethically and therapeutically meaningful.  

Playwright Jordan Harrison’s Primes, like flesh-and-blood clinicians, absorb and co-construct patients’ accounts of self, yet they are disembodied, unfeeling, and ultimately unable to act with compassion, turning dynamic stories into datasets.   

Marjorie Prime, through Feb. 15 at the Helen Hayes Theater in New York; 2st.com/shows/marjorie-prime.  

“Much of healthcare happens in interpersonal moments,” write Maura Spiegel and Danielle Spencer in the first chapter of The Principles and Practice of Narrative Medicine—and machines are good at many things, but participating in a truly interpersonal moment is likely not one of them. Several studies have suggested that models perform worse for underrepresented groups because they are trained on datasets that lack racial, cultural, and linguistic diversity. Additionally, AI may miss subtle emotional cues and fail to interpret tone, context, and metaphors, which, one bioethicist [1] predicts, could “fundamentally alter” how trust is practiced in healthcare. Others [2] have underscored that “AI should be viewed not as a replacement for the physician, but as a partner in delivering empathetic, patient-centered care.” 

However, AI is not wholly bad. For example, a recent systematic review [3] found that applying natural language processing (NLP) to unstructured text in electronic health records (EHRs) can detect signs of cognitive impairment. Some [4] have found solace in text-based simulations with lost loved ones. And perhaps technology should be viewed as a vehicle for strengthening partnerships between clinicians and patients. Designed by Gabriela Gomes, the video game Healing Spaces aims to help those with neurodegenerative diseases connect with their caregivers. It is a multisensory experience: an app with beach and forest scenes, and a box with aromatherapy that smells like pine trees. Healing Spaces may evoke memories or even create new ones between caregiver and patient, unlike the Primes’ hollow curation. 

Healing Spaces also includes sunscreen-scented lotion that caregivers can use to massage the hands of those in their care. Needless to say, holograms and lotion don’t pair well. “You can’t touch a hologram. So there’s something about them looking so much like your loved ones, but not being able to quite achieve intimacy with them,” said Harrison during Marjorie Prime’s Off-Broadway run about a decade ago. “The loneliness can never be quite extinguished, never satisfied, because they’re just pixels.”  

[1] Kerasidou, Angeliki. “Artificial Intelligence and the Ongoing Need for Empathy,  Compassion and Trust in Healthcare.” Bulletin of the World Health Organization, vol. 98, no. 4, 2020, pp. 245-250. pmc.ncbi.nlm.nih.gov/articles/PMC7133472/. 

[2] Ghenimi, Nadirah, et al. “Integrating AI with Narrative-Based Medicine: Enhancing Patient-Centered Care in Primary Practice.” Perspectives in Primary Care, 5 Dec. 2024, info.primarycare.hms.harvard.edu/perspectives/articles/integrating-ai-with-narrative-based-medicine.  

[3] Shankar, Ravi et al. “Natural Language Processing of Electronic Health Records for Early Detection of Cognitive Decline: A Systematic Review.”npj Digital Medicine, vol. 8, no. 1, 2025, p. 133. pubmed.ncbi.nlm.nih.gov/40025194/. 

[4] Fagone, Jason. “The Jessica Simulation: Love and Loss in the Age of A.I.” The San Francisco Chronicle, 23 July 2021, sfchronicle.com/projects/2021/jessica-simulation-artificial-intelligence/. 

Web image from 2nd Street Theater.