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.

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Agnes recognizes William’s unique potential and supports his choice to leave his family and head off to London to make his name in the theater world. Shakespeare rarely returns home to Stratford, and we only learn of his growing success indirectly. Agnes is forced to raise her children as a single parent and has to deal with her overwhelming grief when Hamnet dies. As she mourns the loss of her son, she is overcome with doubt about the fidelity of her absent husband, and her faith in their marriage is threatened. Ultimately, Agnes is given a playbill featuring the production of a new play written by her husband and she sets off on a trip to London to confront him on his own turf. She arrives uninvited at the Globe Theater in time to witness a performance of the play in which her husband has been able to channel his own grief at the loss of his son into one of the enduring literary works in the Western canon.  

I first became aware of this book in a New York Times article that appeared in the early stages of the COVID 19 pandemic shutdown. It was recommended as a worthwhile book to read in quarantine. I had never heard of Maggie O’Farrell but the two-sentence summary captured the book and author perfectly. I do not think O’Farrell is a prophetess, but she was nothing if not attuned to our times and circumstances. Assuming she was writing this novel well before coronavirus escaped the food market in Wuhan, the way she frames Hamnet’s death in the setting of the bubonic plague in Stratford is inspired. Her story captures the explosive fear that envelops the town as the plague spreads — you can feel the wind in your face as the townspeople slam the door shut in the face of anyone suspected or proven to be infected. The story is written in the present tense which heightens the sense of immediacy of events as they unfold for William and his parents, Agnes and her family, and the people living in Stratford. O’Farrell’s prose feels Elizabethan – in the description of glove making, removing honey from a beehive, preparing shrouds for the dead child. As I read, I found myself looking up many more words than usual; the language itself has the power to transport you back in time.  

But, while the choice of bubonic plague as the cause of death may have been fortuitous for book clubs and book sales in the world we lived in during the pandemic, I do not think it is the driving force in this book. The dominant theme is how we deal with grief from any cause. O’Farrell is not the first author to use the death of a child as a vehicle to explore the myriad consequences triggered by the loss of a loved one, especially for parents who lose a young son or daughter. The steady movement of the plot to the climactic scene in London makes Shakespeare’s response seem the more substantive. His literary genius has enabled him to channel his sadness at the loss of the son he adored into the creation of an authentic character into whom he could project all the hopes and dreams that he had for Hamnet.  

Interestingly, O’Farrell never names Shakespeare throughout the novel, referring to Shakespeare always as “he” or “him” I can only speculate what O’Farrell means to convey with this literary device. I think she is acknowledging that it is the truly rare individual who can accomplish what Shakespeare was able to do in redirecting his grief from personal sadness into a timeless literary masterpiece. We are thus like Agnes who must go through our day-to-day routine, try to find meaning in tragedy and the courage and strength to stay on our feet and continue to move forward. That is Agnes’ accomplishment — that she can summon the will to travel to London to confront William, and by her action have the goodness of heart to realize that her husband shares her loss. She is able to appreciate the gift he has been given to transform his personal grief into a meaningful expression that the world can share. With this newfound knowledge, her marriage will be reinvigorated, and their mutual love will be reinforced. Agnes is thus the named character who occupies center stage as the story unfolds.  

O’Farrell has written a truly beautiful book that brings to life the pain of loss and the capacity of men and women to endure. As we coped with the COVID-19 pandemic as individuals and communities, many were forced to deal with unexpected pain, suffering and death. Hamnet is a book for our time. Physicians and all other health professionals do their best to support families and communities as they deal with untimely loss of loved ones. I only hope that it will not set the bar too high on expectations of how to transform grief into meaning. We are not all going to be Shakespeares but we can hope to be Agneses, who can still find joy and meaning in our lived lives in the aftermath of devastating loss.   

Hamnet
Maggie O’Farrell 
Alfred Knopf, 2020: 384 pages 

A previous version of this review was published in the NYU Literature, Arts, and Medicine Database 
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Commonly argued among readers is whether fiction or nonfiction brings the most value to understanding any particular issue. These arguments sometimes end with one interlocutor saying, “I only read nonfiction,” and the other saying, “I only read fiction.” Choosing either one alone, however, can deprive readers of valuable knowledge and perspectives that only both together can provide. Such is the case when reading Laura Spinny’s history, Pale Rider: The Spanish Flu of 1918 and How it Changed the World, and Kathryn Anne Porter’s “short novel”—as she insisted it be called—Pale Horse, Pale Rider. Spinny researches the effects the pandemic had on exposed populations and Porter conjures the effects it had on infected individuals.

The titles for both Spiney’s book and Porter’s story draw from the the Four Horsemen of the Apocalypse in the Book of Revelation (6:8) in the New Testament, and one of the horsemen in particular.

And I looked, and behold, a pale horse! And its rider’s name was Death, and Hades followed him. And they were given authority over a fourth of the earth, to kill with sword and with famine and with pestilence and by wild beasts of the earth.

Both books speak of death, not as the natural course of human life, but resulting from an apocalypse of a biblical scale, of a vengeful god, and of a plague in form. Spinney applies the apocalypse metaphor to peoples and Porter to persons.  

Spinny’s account focuses on how the 1918 flu pandemic altered history.

The flu resculpted human populations more radically than anything since the Black Death. It influenced the course of the First World War and, arguably, contributed to the Second. It pushed India closer to independence, South Africa to Apartheid, and Switzerland to the brink of civil war. (p. 8)

She also describes how national public health and global health organizations reorganized and generated momentum towards today’s more sophisticated agencies. She suggests further that the flu pandemic affected literature and art as well, and speculates about why it’s not remembered in any way like the two world wars of the same century. The bulk of the book, though, describes what happened to populations, and how this pandemic could be considered an apocalypse.

The number of dead could have been as high as 100 million—a number so big and so round that it seems to glide past any notion of human suffering without even snagging on it. It’s not possible to imagine the mystery contained within that train of zeroes. All we can do is compare it to other trains of zeroes—notably, the death tolls of the First and Second World Wars—and by reducing the problem to one of maths, conclude that it might have been the greatest demographic disaster of the twentieth century, possibly of any century.(p. 171)

This is where Porter’s literary contribution to capturing “any notion of human suffering” comes in—the personal apocalypse. Based to a degree on her own experience surviving a case of the 1918 flu, her short novel follows Miranda, a reporter for a local newspaper in Denver, Colorado, during a time when she is early in a courtship with Adam, a soldier on leave from camp but who is soon to be shipped overseas to the battlegrounds of WWI. Together they start to see the flu engulf the area.

“I wonder,” said Miranda. “How did you manage to get an extension of leave?”
“They just gave it,” said Adam, for no reason. The men are dying like flies out   there, anyway. This funny new disease. Simply knocks you into a cocked hat.”
“It seems to be a plague,” said Miranda, “something out of the Middle Ages. Did you ever see so many funerals, ever?” (p. 281)

Then, the flu engulfs Miranda, and Porter helps us imagine what a personal apocalypse could be like when an individual succumbs to it. She imagines the Pale Rider pulling her away from her physical moorings on Earth.

I must give up, I can’t hold out any longer. There was only that pain, only that room, and only Adam. There were no longer any multiple planes of living, no tough filaments of memory and hope pulling taut backwards and forwards holding her upright between them. There was only this one moment and it was a dream of time, and Adam’s face, very near hers, eyes still and intent, was a shadow, and there was to be nothing more… (p. 304)

Eventually the Pale Rider tries to pull her away from even any vestige of her corporeal being itself, and were it for a mere particle of life force would have done just that.

Silenced she sank easily through deeps under deeps of darkness until she lay like a stone at the farthest bottom of life, knowing herself to be blind, deaf, speechless, no longer aware of the members of her own body, entirely withdrawn from all human concerns, yet alive with a peculiar lucidity and coherence; all notions of the mind, the reasonable inquiries of doubt, all ties of blood and the desires of the heart, dissolved and fell away from her, and there remained of her only a minute fiercely burning particle of being that knew itself alone, that relied upon nothing beyond itself for its strength; not susceptible to any appeal or inducement, being itself composed entirely of one single motive, the stubborn will to live. This fiery motionless particle set itself unaided to resist destruction, to survive and to be in its own madness of being, motiveless and planes beyond the one essential end. Trust me, the hard unwinking angry point of light said. Trust me. I stay. (p. 311)

Many published histories of the 1918 flu pandemic concentrate on the devastation visited upon nations and populations. Most stop at the individual, because historians rely on tangible and verifiable facts, but literary fiction writers can turn personal narratives into stories that render pictures of what individuals could experience with particular illnesses. These two books referencing Pale Horse, Pale Rider in their titles—one a nonfiction history and the other a literary fiction—work well in combination to capture the experiences and consequences of this flu on both populations and individuals. Further, these two books show why fiction and nonfiction accounts of particular subjects should not be considered a choice, but rather as opportunities to get fuller accounts of diseases on populations and individuals.

Revelation 6:8, English Standard Version (ESV). © 2001 by Crossway; text edition: 2025.
‘Pale Horse, Pale Rider’ In The Collected Stories of Katherine Anne Porter, Harvest, 1979.
Spinney L. Pale Rider: The Spanish Flu of 1918 and How it Changed the World. New York; Public Affairs, 2017)
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Rumor is a major source of vaccine rejection. The author discusses in detail the case of Andrew Wakefield and his contention that MMR (measles, mumps, rubella) vaccine causes autism. This belief, based on a 1998 paper in The Lancet (later retracted) has been shown to be false by numerous large-scale studies, but is accepted by perhaps millions of people throughout the world.    

In Stuck, Dr. Larson makes a strong case that vaccine hesitancy and rejection are widespread and growing global problems. The book is much weaker in proposing effective solutions. It’s clear that simple solutions, based on the premise that resistance will fade away as soon as public health agencies “educate” people, have failed.  Dr. Larson recommends listening more carefully to antivaxxers’ concerns and developing creative pro-vaccine messaging. Since the publication of her book, the massive initiative to vaccinate the American population against Covid has confirmed the extent and multiplicity of antivaccine beliefs in our society. It has also led public health agencies to develop more sensitive and engaging messaging than in the past. Nonetheless, the core problem remains.  

Stuck
Heidi J. Larson 
Oxford University Press, New York, 2020:  155 pages. 
A previous version of this review was published in the NYU Literature, Arts, and Medicine Database.
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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.
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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 

It is one thing to read about bipolar disorder in a textbook, and another thing to observe it firsthand. Some of us have friends or family members whom we have seen in the throes of a manic episode. As a psychiatrist, I have witnessed mania at close range literally hundreds of times. But to be an audience member and to experience it in a way that manages to be both educational and entertaining is a rare privilege. And to do so as a multimedia event, fusing theater with visual arts, is surely unique.  

Sam Kissajukian’s one-man show 300 Paintings is a must-see that is currently enjoying a return engagement at the Vineyard Theatre in New York. (It is purely a coincidence that the theater, just off Union Square, is a block away from my former psychiatric office of eighteen years.)  

Kissajukian is an Australian stand-up comic. In 2021, during the pandemic, he experienced a five-month bipolar manic episode. During that time, despite having no previous background in visual arts, he decided to become a painter. Moving into a warehouse, he began to paint. He barely slept, frequently turning out multiple works a day. By the end of the episode he had created three hundred paintings, documenting his mental state.  

Kinssajukian has created the show he calls 300 Paintings as the culmination of his personal and artistic journey. The show has won numerous awards, including Best Comedy at Sydney Fringe 2022 and 2023, and the Mental Health Awareness Award at Adelaide Fringe 2024. It has played at the Edinburgh Fringe Festival, and it first came to the Vineyard last fall. He has also had several exhibitions of his paintings, and has come out as a strong advocate for mental health awareness. 

While 300 Paintings calls on the author’s experience as a comic, it is no mere stand-up routine. At 80 minutes it has the dimension and scope of a play. There are serious undertones, yet there are many undoubtedly funny parts: We hear how at his most grandiose Kinssajukian thinks of himself as a “Pisscasso” who goes through a blue period in days, rather than years. At another point he describes how he affected a beret. Funny or serious, he is always charming and engaging, and he breaks it up by showing projections of his work.  

There are times when the dialogue takes on the rapid, pressured speech of a person who is manic, and his thought process shows the jumping from topic to topic that a psychiatrist refers to as “flight of ideas,” But this feels intentional. At no time do you worry that the performer does not have it under control. And he readily attributes this to his rapid diagnosis and treatment by a psychiatrist.  

At the end of the performance, Kissajukian announces that a curated exhibition of his paintings is on view in the lobby, and that he will be available to meet the audience.  

Two Paintings by Kissajukian

Podcast

Web image provided by Sam Kissajukian

The narrator has enjoyed a mostly healthy life. He has traveled to Europe and once was treated for syphilis while there. He has been together with L for seven years. Both men are writers who teach at the university. Now, the pain that grips him defies exact description (even for a professional writer). The closest comparison that he can conjure is having someone’s hand plunge into his body and twist his guts along with the sensation of being kneed in the groin. He’s reluctant to seek medical attention since medical facilities are especially risky during the pandemic. So he waits and hurts. The pain is soon accompanied by fever, chills, and aching of the limbs. 

He decides to go to urgent care. After a brief evaluation, he’s referred to the university medical center ER. Covid testing is negative. A CT scan reveals an aortic dissection (tear in the aorta) associated with aortitis (an inflammation of this large blood vessel). He is told that such a tear is frequently fatal. He’s lucky to be alive. The narrator is placed in the ICU and treated with IV antibiotics, fluids, and antihypertensive medications. The vascular surgeon recommends holding off on any operation (either a stent or a graft), hoping the tear and inflammation will stabilize and heal. 

Hospitalized for a week and a half, the narrator confesses his feelings of helplessness, shame, bewilderment, and fear. He is intrigued by the bustle of the hospital – almost electric with human energy – but despondent over the seemingly omnipresent suffering there – his own, that of fellow patients, and even the distress of healthcare workers. He is most impressed by and appreciative of his ICU nurse, Alivia. As for the physicians involved in his care, the narrator notes the stark clinical detachment of many doctors. Reflecting on a visit from a rheumatologist, he concludes, “I was nothing to her, really, I was her job, she would clock out and enter her real life” (p124). He craves to sense some vulnerability and genuine concern emanating from his physicians. As for empathy, the narrator reveals some of his own when he decides, “it must be hell to be a resident” (p129) in training. 

The search for possible rare etiologies of his condition comes up empty. As his condition slowly improves, the narrator still worries about his current predicament and the future: “I was an enigma, they said, a conundrum, they were running out of ideas” (p121). The waiting for and indecision about any kind of surgical intervention wears on him. He wonders if it might be best to have an operation. 

But the narrator never has surgery. A repeat CT scan confirms stability of the aorta and resolution of all inflammation. He is discharged home on oral medicines and continued IV antibiotics. Frequent follow-up appointments with his doctors and imaging studies of his aorta are scheduled. His partner L lovingly tends to his needs. His sister G arrives to help too. The narrator’s prognosis is murky. Did he dodge a bullet? Or are further problems with his aorta inevitable? How does a person cope with such chronic uncertainty. Although the narrator is weak and emotionally rattled, he is happy to be alive, pain-free, ambulatory, and home with his lover. Shouldn’t that be enough? 

The novel reads more like a memoir than a work of fiction. It is impressively authentic and accurate about medical matters – the lingo and professional behavior of physicians, nursing care, clinical procedures, what it feels like to be a patient. Readers will rightfully consider whether the book’s author is perhaps recounting his own experience with a serious health problem.  

In this novel, the human body is depicted in many ways: sensuous, serviceable, surrendered to others, surreal when sick. The narrator’s experience of illness includes a warping of time, the pull of memory, the weight of regret, the need for truth, and the magic of love.  

The poet-protagonist is occasionally irritated by the language and metaphors spewed by doctors and nurses. The use of broad-spectrum antibiotics is explained to him as a “carpet bomb approach.” He is warned about the caustic effect of IV drugs and that his veins might “burn out.” This medical lexicon prompts the narrator to ponder “who taught these people, who gave them their vocabulary, their stock of images” (p86).  

We don’t need a novel (even an exceptional one like Small Rain) to remind us about the randomness and chaos of ordinary life, the uncertainty of health in the future. But we can look to great literature for inspiration, to help us understand and cope with those looming, difficult experiences. The word rain is both a noun (drops of moisture or a spiritual blessing) and a verb (something sent down in abundance). Whether it is tears (of pain and emotion), love, or gratitude, the rain in this story is hardly small.  

Small Rain: A Novel 
by Garth Greenwell 
New York: Farrar, Straus and Giroux, 2024, 320 pages 
ISBN 9780374279547 
Web photo by Pawel Nolbert 

Four years after the Covid pandemic began, as daily life has returned in large measure to its pre-pandemic shape, assessments and reflections about how the pandemic was able to wreak such havoc and how it could be prevented from occurring again are coming forth. Many are technocratic in nature and assume our aims and pursuits will remain the same as before. Micheal O’Siadhail (pronounced mee-hawl o’sheel), in his new book of poems, Desire, says that in addition to technocratic responses to the pandemic (and other threats to civilization covered in the book), we should give serious thought to what we desire. We talk to O’Siadhail about this idea and he reads selected poems from the book that characterize many aspects of what the pandemic put people through collectively and individually. He also talks about how the forms of his poetry convey his thoughts just as his words do, and how poetry, through syntax, sound, meter, and intensity, can add clarity and effectiveness to prosaic prose communicating complex concepts.

Citation:
Micheal O’Siadhail. Desire. Waco, Tx; Baylor University Press, 2023.

Links:
Micheal O’Siadhail’s website.

Russell Teagarden’s relevant blog pieces in According to the Arts:
—  Desire
— One Crimson Thread

Previous podcast episode with Micheal O’Siadhail featuring his poems recounting his late wife’s final years with Parkinson’s disease.

Thanks to Micheal O’Siadhail for bringing his enlightened perspectives on what we experienced with Covid through the piercing poetry in his book, Desire.

The Clinic & The Person is a podcast developed by our editor Russell Teagarden to summon or quicken the attention of health care professionals, their educators, researchers and others to the interests and plights of people with specific health problems aided through knowledge and perspectives the humanities provide.

Feature photo by S&B Vonlanthen

Human behaviors in many segments of society during the Covid-19 pandemic could have been predicted based on literary texts from the past and right up to the moment the pandemic began. In this episode, we compare excerpts from selected literary texts imagining or depicting human reactions to plagues ranging from as far back as 700 years to just one month after the pandemic began with statements made or actions taken during the pandemic. The similarities are uncanny. Russell is inclined to think this means we’re doomed; Dan is not so inclined.

Links:
Links to Russell Teagarden’s blog pieces in According to the Arts on the sources discussed in episode:
— The Decameron, Giovanni Boccaccio, New York, Penguin Classics, 1972 (written in 1351-1353) 
— The Pandemic’s Impact on NYC Migration Patterns, New York City Comptroller Scott M. Stringer, Bureau of Budget, November 2021.
— Arrowsmith, Sinclair Lewis, In: Sinclair Lewis: Arrowsmith, Elmer Gantry, Dodsworth, Library Classics of the United States, New York, 2002 (first published in 1925)
— The Betrothed, Alessandro Manzoni, Penguin Books, New York, 1972 (first published in 1827)
—The End of October, Lawrence Wright, Alfred A. Knopf, New York, 2020

Links to sound clips:
Contagion (2011) – Steven Soderbergh, director; Scot Z. Burns, writer

The Clinic & The Person is a podcast developed by our editor Russell Teagarden to summon or quicken the attention of health care professionals, their educators, researchers and others to the interests and plights of people with specific health problems aided through knowledge and perspectives the humanities provide.

Feature image by CDC