Apollo On Call

In this episode of Apollo on Call, Dave is joined by Luki Danukarjanto to discuss Atul Gawande’s book on end-of-life care, as well as relate it to their aging parents and their own experience getting older. They also examine the medical perspective to the situation is well-being or survival the goal of end-of-life care?

Check out Dave’s Substack for more! https://davidmhsu.substack.com/

Web image by Age Cymru 

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Carrie Coon, Letts’ wife, plays Agnes White, a lonely server living in an Oklahoma motel who falls in love with Peter Evans (Namir Smallwood), an AWOL Gulf veteran. Peter becomes increasingly convinced that he is the subject of clandestine experiments, and that he is infested with government-planted bugs. These bugs are, of course, invisible, yet he drags Agnes with him into a seeming folie à deux—a bedlam of flypaper, aluminum foil, and bug zappers.  

Peter’s delusions (and, in turn, Agnes’s) eventually cross a line into a realm in which logic no longer applies. By spilling so far into excess, even occasionally veering into bizarre spoofiness, Bug risks trivializing Peter’s paranoia—a risk especially fraught now that the part is played for the first time by a Black actor.  

Initially, Peter cites a real case of government experimentation: the Tuskegee Syphilis Study, in which poor Black sharecroppers were never told they had syphilis. The experiment ran from 1932 until 1972—long after penicillin became the standard treatment in the mid-1940s. To observe how the disease naturally progressed, researchers deliberately withheld the antibiotic, ending the study only after a press leak. 

This gross violation of ethics is widely believed to have damaged Black Americans’ trust in the medical establishment. But according to medical ethicist Harriet A. Washington [1], “that narrative is flawed and untrue.” While Tuskegee certainly contributes to that distrust, the larger impetus is “four centuries of abuse in the medical arena,” which Washington chronicles in her 2007 book Medical Apartheid: The Dark History of Medical Experimentation on Black Americans from Colonial Times to the Present. “In fact, one study indicated that African Americans who had never heard of Tuskegee were more likely to fear vaccine administration and medication design.” 

What if Bug had dialed down Peter’s paranoia and explored it within this broader historical context instead of reinforcing the singularity of Tuskegee? Overemphasizing Tuskegee because of its infamy (or because of one’s ignorance) serves to obscure other historical ethics violations as well as systemic racial inequities that persist today. For instance, what if Peter struggled to access mental healthcare because of structural barriers? 

In her 2021 book Carte Blanche: The Erosion of Medical Consent, Washington mentions an experimental anthrax vaccine that soldiers were required to receive beginning in 1998. “Soldiers of all races were affected,” she writes, “but Blacks were overrepresented because they constituted 12.3 percent of Americans, but were 24.5 percent of the 1.7 million ground troops deployed to the Gulf in 1990 and 26.2 percent of Army reservists in 2001—twice their representation in the population at large, and so at twice the risk of being forced into military research.” 

Many service members reported autoimmune conditions after getting the jab, but the Pentagon attributed their symptoms to “emotional issues,” Washington continues. “The military subsumed vaccine-related illnesses under the nebulous symptomatology of ‘Gulf War Syndrome.’” What if Bug had dramatized that ‘nebulous symptomatology’? 

Peter also references another example of government research: the Edgewood Arsenal experiments. After World War II, the U.S. Army Chemical Corps tested chemical weapons on American soldiers at a secluded research facility on the Chesapeake Bay, exposing volunteers to more than 250 different chemicals, including LSD, mustard gas, and sarin. The studies ended after researchers were accused of ethical transgressions, including issues with informed consent and recruitment. Archival footage, unearthed in a 2022 documentary, shows men “going temporarily blind, reduced to babbling or completely dysfunctional logs, or worse, ready to commit violence upon themselves.” [2] 

Washington argues in Carte Blanche that “the medical crimes that were denounced and punished at Nuremberg have American analogues.” 

“Although not perfect parallels,” she notes, “they share a violent, nonconsensual, and largely racial disparate nature, as well as the frequent invocation of military expedience.” 

In this light, Peter’s condemnation of his doctors as neo-Nazis feels less outlandish than the play permits. Letts may hint that Peter is not entirely psychotic—that his madness holds some truth. But that seed never grows.  

The play ultimately bubbles over (spoiler alert: self-harm, violence, and fire). A future iteration of the three-decades-old play, if there is one, might benefit from taking Peter’s delusions more seriously—and leaving open the possibility that they are, in fact, real. 

Bug will get under your skin, but to what end? 

Bug, through March 8th at the Samuel J. Friedman Theatre in New York; manhattantheatreclub.com/shows/2025-26-season/bug/.  

[1] “Harriet A. Washington on the Narrative Around Vaccine Hesitancy in the African American Community: In Conversation with Andrew Keen.” Keen On from Literary Hub, 19 Mar. 2021, lithub.com/harriet-a-washington-on-the-narrative-around-vaccine-hesitancy-in-the-african-american-community/. 
[2] Simonpillai, Radheyan. “‘It Affected a Great Number of People’: Inside the World of Shocking Military Drug Experiments.” The Guardian, 9 June 2022, theguardian.com/tv-and-radio/2022/jun/09/dr-delirium-and-the-edgewood-experiments-documentary. 

Web image by Matthew Murphy.

Esther, daughter of a native healer who has some familiarity with and respect for Western medicine, envies and longs for Antonia’s Western training and attaches herself to her as a disciple. In her encounters with patients, Esther finds that she has an inexplicable gift for healing which baffles her as well as Antonia and complicates their already tenuous relationship. Esther’s gift forces Antonia to reexamine some of her most basic assumptions about what constitutes healing. 

The novel raises complex questions about the cultural, religious, and institutional contexts of medicine in a delicately drawn portrayal of relationships among characters whose divergent frames of reference complicate trust and understanding. One of the questions the novel addresses is not only how to heal the body, but how to heal the breach between cultures. In the development of the friendship between the American doctor and the African healer these questions are worked out in concrete particulars that fully honor both the pain and the hope involved in authentic cross-cultural dialogue. 

Antonia Saw the Oryx First
Maria Thomas 
Soho Press, New York 2007: 296 pages 

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

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An Awkward Business by Anton Chekhov 

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For more than twenty years, Dr. K worked in a hot town in the Middle East yet never got to know or understand its people. His only friend was a troubled hospital anesthetist, Biju. Dr. K was employed by the local hospital and assigned to the Accident and Emergency department. The hospital administrator, Sir Farhad (a man Dr. K feared and revered) was an enigmatic figure of authority. Dr. K was obsessed with accumulating wealth. When Farhad offered him an opportunity to earn extra money, Dr. K had no qualms accepting the new part-time position: punishment-surgeon. He would supervise criminal sentences requiring physical mutilation that were imposed by a judge. 

Biju sarcastically told his friend, “You are at the cutting edge of your profession, Dr. K” (111). Yet there was no humor or humanity at presiding over the amputation of the hands of a father-son team of thieves or a maid convicted of stealing jewelry who underwent a similar clinical maiming. The hospital routinely accepted these “punishment cases” referred from the Corrections department and constructed a special operating theatre on the top floor for these “special ops.” Over a decade, Dr. K figured his involvement in this injurious punishment amounted to at least twenty cases.  

Raucous Biju gets accused and convicted of stealing drugs from the hospital. His penalty was removal of a hand. Dr. K pleaded on behalf of Biju with the hospital administrator but to no avail. Dr. K was not convinced of Biju’s guilt and would not participate in the amputation of his friend’s hand. Dr. K resigned his post as punishment-surgeon and eventually settled in England with plenty of money for a comfortable albeit lonely life.  

This disturbing and at times dastardly story displays more than a slight hint of Franz Kafka’s influence including the brutal application of “justice” and a byzantine bureaucracy. Even the physician-narrator’s nickname, Dr. K, appears to be a nod to Kafka.  

The novel illustrates the personal and professional downward spiral that can occur when empathy and morality are subjugated to the pursuit of wealth and status. The story raises troubling questions about the participation of doctors in the legal system’s punishment of criminals.  

The reliability of the narrator is tenuous. He may be in denial or perhaps his memory has grown fragile and corrupted. Remorse seems mostly absent. The story warns of the preponderance of lies we tell – to oneself and to others. Dr. K will not be mistaken for a model doctor or a good man. He has participated in hideous acts of cruelty, been an absent father, and placed the acquisition of money as his main priority. The opening line of the novel is a blunt confession and a succinct conclusion: “I did it for money” (3).

Tell Her Everything
Mirza Waheed
Melville House, Brooklyn, NY, 2022: 234 pages 
A previous version of this review was published in the NYU Literature, Arts, and Medicine Database. 
Web image by Medhum.org

Book Launch at the Lahore Literary Festival: 

A country doctor, Gregory Ovchinnikov, begins his daily rounds in the hospital. He soon notices that his assistant, Smirnovsky, is drunk. When the assistant refuses to obey an order and verbally snaps back at him, Ovchinnikov hits the man in his face. The angry physician then rushes out of the ward and goes back to his lodgings, abandoning his patients.  

At first, Ovchinnikov considers demanding that the town council fire Smirnovsky. Later, after he calms down and goes back to work, he begins to appreciate the enormity of his unprofessional act — perhaps the town council will fire him for assaulting his assistant. Strangely, when the assistant comes to apologize, the doctor indicates that it is he, the doctor, who has behaved inexcusably. The assistant is stunned but decides to report Ovchinnikov to the council. Of course, the council demands that the lower-class Smirnovsky apologize to the upper-class Ovchinnikov. 

This story illustrates both a conflict of conscience and a conflict between social classes. With regard to the latter, it is quite clear that the town council would never rule against the gentleman-physician in favor of the drunken, lower class medical orderly. The physician, however, struggles with his own conscience: was he justified in hitting the man? If not, what should he do to make amends?  

Originally Published 1888 
Jack Coulehan (Ed.) Chekhov’s Doctors, Kent State University Press, 2003. Translated by Ronald Hingley.  

A previous version of this review was published in the NYU Literature, Arts, and Medicine Database (Litmed).

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