The novel follows Martin Arrowsmith from a small Midwestern town to the upper reaches of American research science. As a boy in Elk Mills he reads anatomy in the town doctor’s office, and at the University of Winnemac he falls under the spell of Max Gottlieb, a German bacteriologist who teaches him to distrust easy answers and love the laboratory above the clinic. Martin’s career moves quickly from medical practice into research as a vaccine discovery vaults him from a small-town practice into a prestigious New York institute, and finally to a Caribbean island where bubonic plague is raging. There he faces an ethical conundrum: whether to withhold his unproven cure from half the population to prove it works, or whether to save as many as he can without conclusive evidence. When his wife Leora dies in the experiment, Arrowsmith throws caution to the wind and immunizes everyone, sacrificing his chance at greatness. In the aftermath, he walks away from money, marriage, and fame to chase pure science in a rural cabin, leaving the reader to decide whether he’s really a hero or just a reclusive crank. 

Lewis wasn’t the first American writer to champion medical science. Willa Cather and Oliver Wendell Holmes laid some of this ground first. But biographer Mark Schorer isn’t wrong in saying that “Martin Arrowsmith was a new hero, scientific idealism a new subject, and scientific individualism a new (and rather unscientific) perspective.” And Lewis was probably the first American writer to coauthor a major novel with a scientist, the bacteriologist Paul de Kruif. 

Arrowsmith won the Pulitzer in 1926 (though Lewis refused to accept the award), and the novel was a major factor in the Swedish Academy’s decision to award Lewis the Nobel Prize in 1930. It represents a hard-fought accord between science and art that has vanished from the literary scene today. But it’s hardly a one-note celebration of science. Lewis suggests that once scientific medicine withdraws from public view, the ominous tropes of the nineteenth century may creep back in. 

Like most of Lewis’s novels,  Arrowsmith is filled with overwritten scenes and dialogue riddled with slang. But I’d be curious, if I could teach it to medical students today, how much of themselves they might see in the character of Martin Arrowsmith, a boy from flyover country who nearly rose to medical immortality but crashed, Icarus-like, on his own hubris. 

A Novelist and a Whistle-Blower 

Lewis was immersed in medical culture throughout his young life as the son of a rural physician, but he was not a scientist himself, and never aspired to a career in medicine. His father, Edwin J. Lewis, began his medical training at Rush Medical College in 1875, graduating two years later as an M.D. and eventually opening a small practice in Sauk Centre, Minnesota, where he advertised himself as a physician and surgeon. Memories of his father provided a general basis for the opening scenes of Arrowsmith, set in rural Winnemac (or Minnesota), but Lewis needed to grasp both the passion and methodology of real scientists to create his medical hero. 

Lewis met his coauthor, Paul de Kruif, at a meeting arranged by his publishers. De Kruif held a Ph.D. in bacteriology from the University of Michigan. He had also worked as a researcher at the Rockefeller Institute in New York, but had been fired after the director discovered that de Kruif had published an anonymous exposé of the Institute’s financial corruption and premature publication of scientific results. He was an ideal partner for Lewis, whose satires of the American Midwest elevated skepticism to an ethical ideal. As E. L. Doctorow observes, “Expecting his countrymen to be more than they were, looking for a resonant truth and righteousness, Lewis had found an American spiritual life that could elicit from him nothing more than bitter derision.” Lewis and De Kruif counterbalanced one another professionally, one steeped in medical science, the other in literary art, but they were both truth-seekers, through and through. 

De Kruif was professionally destitute when he met Lewis, having recently lost his position at the Rockefeller Institute. He had seriously jeopardized his chances of finding work in his field, as university bacteriology departments and pharmaceutical companies balked at hiring known whistle-blowers. He needed Lewis and the stimulus of a major literary project as much as the author needed his expertise. 

Lewis gave De Kruif “assignments” during their travels, such as writing a fictional biography of Gottlieb, Arrowsmith’s mentor. The apprenticeship would later pay off for De Kruif, who became a bestselling author of scientific history just one year after the publication of Arrowsmith. His book The Microbe Hunters, which sold over one hundred thousand copies in 1926, alone, was one of the major nonfiction books of the decade. 

Indeed, De Kruif learned literary craft so well that it’s impossible to know who wrote certain passages in  Arrowsmith. Take, for instance, the scene where Martin realizes that he is about to make a potentially groundbreaking scientific discovery about the behavior of bubonic plague. Late at night, alone at the McGurk Institute (the fictionalized Rockefeller Institute), Arrowsmith simply can’t wait to process his lab results: 

At a hectic run, not stopping for lights, bumping corners and sliding on the too perfect tile floor, he skidded down the stairs and galloped through the corridors to his room. […] 

Then he forgot…war, night, weariness, success, everything, as he charged into preparations for an experiment, his first great experiment. He paced furiously, rather dizzy. He shook himself into calmness and settled down at a table, among rings and spirals of cigarette smoke, to list on small sheets of paper all the possible causes of suicide in the bacteria. 

Lewis and De Kruif collaborated so intimately that the scientist began to write like the novelist and the novelist began to think like the scientist. They should have shared the honors that followed, but Lewis insisted on crediting De Kruif more as a fact checker than as his equal. 

Cruelty or Cure? 

It’s hard to imagine language like this from a doctor now, but Martin Arrowsmith dedicates himself to the search for “the Why that made everything so.” Impatient with memorizing facts, he “wanted to look behind details and impressive-sounding lists of technical terms for the causes of things, for general rules which might reduce the chaos of dissimilar and contradictory symptoms to the orderliness of chemistry.” Arrowsmith believes in precise technique, but he’s also emotionally invested in the work, demonstrating an almost fanatical belief in the scientific method. 

His defining characteristic is his curiosity, which helps him crack riddles others see as mere aberrations. Lewis writes, to this effect: 

Now in Martin Arrowsmith there were no decorative heroisms, no genius for amours, no exotic wit, no edifyingly borne misfortunes. He presented neither picturesque elegance nor a moral message. He was full of hasty faults and of perverse honesty; a young man often unkindly, often impolite. But he had one gift: curiosity whereby he saw nothing as ordinary. 

When he sees something weird in his test tubes, he says, “Now there was some cause for that, and I’m going to find out what it was.” This is how Arrowsmith discovers the X Principle. He tells his wife Leora that it could lead to the cure of every germ disease, which overstates the case, but it is a major scientific breakthrough—not only for Martin, but potentially for humankind. 

Arrowsmith’s X Principle is a remarkable development in the novel. Perhaps for the first time ever in American fiction, Lewis invites a reader to participate in the euphoria of scientific discovery, rooting for the medical scientist as he plugs away in the laboratory. Later he causes a stir among the farmers in Wheatsylvania, the little town where he briefly sets up a private practice, by curing a seemingly unstoppable blackleg epidemic with an original vaccine prepared in the makeshift laboratory at the back of his doctor’s office. The vaccine requires several experimental dry-runs, but Martin works on the project after hours, glad to be searching for the root cause—the Why—of the disease. 

Later, Arrowsmith travels to St. Hubert, a fictional Caribbean island, to test the X Principle on a population besieged by bubonic plague. Verifying the efficacy of his bacteriophage would require a control group, which would mean denying the remedy to a portion of the populace. Is it more compassionate to inoculate everyone with an unproven (but promising) remedy or to withhold treatment for conclusive proof, thereby guaranteeing the health of future generations? It’s an important ethical question, but one that politics ignores. It’s hard to name a doctor today who is both publicly promoting scientific knowledge and defending human rights in quite this way. 

Arrowsmith develops a high-stakes debate over humanitarianism. One doctor argues that temporary cruelty does not justify eventual compassion; accordingly, he refuses to receive the preventive bacteriophage inoculation until the entire population of St. Hubert has been immunized. Arrowsmith’s mentor, Gottlieb, insists that true humanitarianism requires establishing irrefutable scientific facts. Gottlieb corners Arrowsmith before he leaves for St. Hubert and delivers one of his longest speeches of the novel. The St. Hubert experiment is Martin’s chance to become a “Great Man,” and Gottlieb intensifies the pressure: 

Be sure you do not let anything, not even your own good kind heart, spoil your experiment at St. Hubert. I do not make funniness about humanitarianism as I used to […]. So many men, Martin, are kind and neighborly; so few have added to knowledge. You have the chance! You may be the man who ends all plague […]. 

You must not be just a good doctor at St. Hubert. You must pity, oh, so much the generation after generation yet to come that you can refuse to let yourself indulge in pity for the men you will see dying. 

As I write this,  doctors are taking to Instagram to protest insurance companies who deny patients coverage for life-saving procedures. We’re having a hard enough time helping people now; no one is talking about the generation after the generation yet to come. But this is what Lewis imagines in Arrowsmith’s unorthodox heroism: by withdrawing from society into the laboratory, as he does to prepare his blackleg serum or to discover the X Principle, Arrowsmith has a chance to become a legendary benefactor of public health. But is the greatest degree of human compassion possible only through momentary cruelty? 

Arrowsmith’s heroism might have been lost on the popular audience had Lewis seen the St. Hubert experiment through to the end. Instead, Lewis creates a strategic compromise. First, he sets up the conditions of the experiment, outlining arguments for and against denying the vaccine to portions of the St. Hubert population; this lends credibility to Martin Arrowsmith as a scientific physician by highlighting the complexity of his choice. Then Lewis derails the experiment with the accidental death of Arrowsmith’s wife Leora, who dies suddenly of plague. Stricken with grief and guilt (because he had been entertaining adulterous thoughts at the time of her death), Martin begins administering his serum indiscriminately to the people of the island, compromising the scientific integrity of his results, but demonstrating his capacity for emotion. 

After Leora’s death, he returns to the self-destructive behavior of his vagrancy during medical school, drinking heavily and acting as if he no longer cares about knowledge or the accompanying reward of fame. Lewis writes: “[…] all day, Martin injected a line of frightened citizens, in the Surgeon General’s office,” during which time he “had a bitter satisfaction in throwing away all his significance, in helping to wreck his own purposes.” In the end, no one knows whether the plague disappears from St. Hubert as a result of “phage or rat-killing or Providence.” The result is tragic by Gottlieb’s standards, but it further endears Arrowsmith to readers, whom Lewis manages to educate about the ethical quandaries of research science while introducing the research scientist, himself, as a man of passion and human weakness. 

Arrowsmith loses his chance to enter the historical record alongside scientific greats such as Pasteur, but Lewis reinforces his heroic stature on the human level. Alongside characters like Hawthorne’s Rappaccini who becomes so obsessed with science that he forgets humanity, Arrowsmith’s capacity for emotion in the heat of his greatest experiment is extraordinary. In fact, I’d like a little more evidence that grief, for today’s doctors, is as powerful as scientific curiosity, profit, or personal branding. We could use more reminders that science happens in social contexts and that it is vulnerable to the weaknesses and biases of those who do it and the systems that support it. 

A Flawed Hero 

Arrowsmith is a bildungsroman—the first to show how an ordinary person becomes a scientific hero—but it borrows from other literary forms, such as the epic and the portrait of the artist. 

Martin is raised in a small town called Elk Mills, where he is the “unofficial” assistant to Doc Vickerson, the self-styled “plug doc” and alcoholic who has managed to compile the first museum of natural history in the county. In a drunken speech, Vickerson tells the young Arrowsmith to get all the training he can in the sciences in order to realize his full potential as a physician. “Set a high goal,” he admonishes Martin. “Don’t let things slide. Get training. Go college before go medical school. Study. Chemistry. Latin. Knowledge!” A nice little pitch for the liberal arts, even if it sounds quaint to us now. 

The University of Winnemac is Arrowsmith’s portal to opportunity, where preparation for medical school consumes his life. His entire identity revolves around his education, where “the purpose of life was chemistry and physics and the prospect of biology next year.” Arrowsmith’s junior year of college is set in 1904, and the descriptions he hears of Gottlieb, his professor of bacteriology, reflect lingering stereotypes of the medical scientist as a rogue. Rumors about Gottlieb suggest that “he was doing terrifying and costly experiments which probably had something to do with human sacrifice. It was said that he could create life in the laboratory, that he could talk to the monkeys which he inoculated, that he had been driven out of Germany as a devil-worshiper or an anarchist.” 

Gottlieb, whose name translates literally from German as “Godlove” and more accurately as “Beloved God,” recalls the master-apprentice relationship typical of the bildungsroman through his mentorship. From his introduction in the Winnemac scenes, Gottlieb remains the dominant influence on his young protégé throughout the remainder of the novel. When Arrowsmith asks to be admitted into his course before having taken all of the prerequisites, Gottlieb says: 

There are two kinds of students the gods give me. One kind they dump on me like a bushel of potatoes. […] The other kind—they are very few!—wish a liddle [sic] bit to become scientists, to work with bugs and make mistakes. Those, ah, those, I seize them. I denounce them. I teach them right away the ultimate lesson of science, which is to wait and doubt. Of the potatoes, I demand nothing; of the foolish ones like you, who think I could teach them something, I demand everything. (11) 

He goes on to tell Arrowsmith that he must take physical chemistry before he will be ready for bacteriology; this is the difference between true scientists and imitators. Gottlieb’s first public experiment, an inoculation of guinea pigs with anthrax repulses many of Arrowsmith’s classmates, but the young Martin later imagines himself repeating experiment: “as he remembered Gottlieb’s unerring fingers, his hands curved in imitation.” 

But Arrowsmith needs flaws if he is to be taken seriously as a character, and he nearly destroys himself at several crucial moments in the narrative. The same restlessness that fires his curiosity is also his potential undoing—binge drinking makes him careless in the laboratory and lack of sleep makes him belligerent. When Gottlieb reprimands him for a series of avoidable errors, Arrowsmith’s defiant response nearly ends his medical career. The medical dean decides to suspend rather than expel him, and Martin is temporarily exiled from the University that has been the primary touchstone for his identity as a young adult. 

But Arrowsmith’s flaws show that the most promising benefactors of public health sometimes seem the most misanthropic by nature. For Lewis and De Kruif, two idealists who effectively replace religion with science, pure science requires complete devotion. This is a high standard that none of Lewis’s characters fully attains; it’s in their failings that he endears them to readers, unveiling the joys and heartaches of a scientist, making the doctor’s emotional life known. 

Back to the Lab, Out of the World 

If the novel were to end in St. Hubert with Martin Arrowsmith doling out medicine to everyone in sight, it might be a story about compassion defeating cold-hearted science. Leora would be a martyr and Martin would be a widower, unselfishly serving humanity. But the story doesn’t end there: Martin marries Joyce Lanyon, a wealthy woman from New York, and briefly celebrates the birth of a son before divorcing Joyce, abandoning his son, and withdrawing to a remote cabin to dedicate his life to research. Arrowsmith is hard to like as a deadbeat father and cultural isolationist. Why, after taking such pains to help us understand the beauty and importance of science through Arrowsmith’s life, would Lewis turn his hero into such a miserable person? Is that really what science does to the heart? 

Lewis leaves us with a paradox. Nearly all of Arrowsmith’s flaws are scientific virtues: his brutal honesty, his distaste for wealth, his comfort with solitude. But  Arrowsmith’s  most troubling implication is that the medical scientist might give up trying to communicate with the public at all, choosing, instead, the uninterrupted calm of the laboratory, where discoveries happen unseen. When that happens, we’re thrown back to the distrust of the nineteenth century. Are the researchers devoted to unlocking the great Why beneath physical things today doing it for themselves or for humanity? Are they Arrowsmiths or Rappaccinis? 

The public story of medicine is a balancing act. It requires careful translation of facts into culture. It’s hard work, and it never ends. It’s much easier for suspicion to prevail. 

That’s why I see  Arrowsmith as a miracle. Think about what it took for that book to exist. It took a Paul de Kruif: a researcher with enough integrity to sacrifice financial gain for truth-telling. And it took a Sinclair Lewis: a kindred spirit who was willing to make an artist of a lab scientist. 

In Martin Arrowsmith, the scientific physician comes of age as a character, no longer a shadowy villain, but an artist in his own right: a figure whose potential for greatness or failure extends the medical narrative to the full scope of human experience. 

Web photo: Wiki Commons

At age nine, first misdiagnosed and finally identified as having facial bone cancer (Ewing’s sarcoma), Lucy underwent several surgeries and more than two years of intensive chemotherapy and radiation treatments. Pain and nausea, anxiety and fear of more pain and nausea were only part of the ordeal. The young Lucy became aware of what it is to be severely, chronically ill. Her sisters behaved differently toward her: they were polite. “Suddenly I understood the term visiting. I was in one place, they were in another, and they were only pausing.” Even her father felt uncomfortable at her hospital bedside, and Lucy was relieved that he came infrequently.

But being at home was worse: in the hospital the other patients and the staff expected little from her and she felt no guilt or shame; amidst her family, she blamed herself for the tension, arguments over money, and her mother’s depression, even though these elements had existed prior to her illness. Her hair fell out and she became dimly aware that people were staring at her face. Nevertheless, “I . . . was naturally adept at protecting myself from the hurt of their insults and felt a vague superiority . . . . “

Well enough to return to school, Lucy’s disfigured face drew taunts from classmates; she understood finally that she was perceived as ugly and that she would not be loved. Only on Halloween, when she could mask her face, did she feel free and joyful, unconcerned about her appearance, “normal.” Her moods now alternated between despair, determination, and escapism. She became convinced that only facial reconstruction and a restored appearance would make life bearable.

During years of reconstructive surgery Lucy evolved complex rationalizations to give meaning to her suffering. Two anchors had stabilized her existence throughout the misery: a passionate adolescent love of horses, and an adult love of poetry. Eventually outward appearance and inner life became harmonious. “The journey back to my face was a long one.”

Unfortunately, Lucy’s story does not end here. At age 39 she committed suicide. Soon after, her close friend, writer Ann Patchett, wrote a book about their friendship, Truth & Beauty: A Friendship, published in 2003 (HarperPerennial).

Lucy Grealy Interview in 1994 (20 Min.)

Autobiography of a Face
Lucy Grealy
Houghton Mifflin 1994 Boston: 256 pages

1995 Whiting Award Winner in Nonfiction , Poetry: https://www.whiting.org/awards/winners/lucy-grealy
Web image generated from the book cover by Medhum.

One of the most horrifying events of that year was the prisoner revolt at the Attica State Prison in upstate New York in early September. I did not live in New York at the time and have only a vague recollection of reading the newspaper reports of what happened. But ask anyone living in New York who was at least 15 years old at the time and they will tell you that they have vivid memories of what transpired over the five days from September 9-13. In this extraordinary book, Heather Ann Thompson recounts in all its gory detail the prisoner uprising, the bloody retaking of the prison by state troopers, and the nearly thirty years of investigation and legal wrangling that occurred in its wake.

By the late summer of 1971, there had been prisoner rebellions in state penitentiaries across the country including a nearby high security facility in Auburn NY. There was increasing tension and escalating prisoner protests against the inhumane conditions in all prisons including overcrowded cells, limited access to food and fresh air, and routine brutal treatment at the hands of the correction officers. Finally, Attica Prison erupted on September 9 after a minor skirmish between guards and prisoners. The prisoners took 38 hostages and over a thousand prisoners escaped their cells and crowded into the prison yard. They created a communal space to take care of each other that was equipped with meager resources. There was a central meeting area for the leaders of the uprising. They created a human shield around the hostages to protect them from harm.  

Over the next four days, there were intense negotiations between prison officials and the prisoners. A team of observers including Tom Wicker was  brought in at the request of the prisoners to serve as witnesses and act as potential mediators. Finally, after negotiations fell apart over the prisoner demand for amnesty, the troopers, without warning, dropped tear gas cannisters from helicopters and stormed the yard. Tragically, when the dust had settled, 32 prisoners and 11 hostages had been killed by bullets fired by the troopers. This terrifying sequence of events is described in the first third of the book. The remaining part details how prison wardens destroyed critical forensic evidence and collaborated with state politicians up the chain to Governor Nelson Rockefeller’s office to portray the events as a successful suppression of a radical-supported attack against the state. They solicited false testimony and pursued a one-sided prosecution of the prisoners for the murder of one guard and several prisoners. There are too many villains in the story but also some true heroes – a coroner who refused to back down from his post-mortem examination showing that all the victims were killed by gunfire, knowing that only the state troopers had firearms. The prisoners who confronted the legal system, defense lawyers willing to take up the cause of the prisoners, a brave state lawyer who was an essential whistleblower, all were vital in the pursuit of truth. At the end, the justice system failed nearly everyone involved, and Attica Prison remained an important part of the New York State correction system. The only monument is a stone at the entrance to the prison memorializing the hostages who died. 

This book is over 500 pages long. Along with another thick book, titled A Bright Shining Lie: John Paul Vann and America in Vietnam, it sat on a shelf in our apartment forever. For some reason that I cannot explain, I picked the book up recently and could not pull myself away from this intense and horrifying story. For more than a decade, Heather Thompson immersed herself in the archives and interviews with key actors in the Attica uprising story. She unearthed the bloody shirt that had been removed from two victims of the siege. Her research is evident on every page.

There are two deeply disturbing underlying themes in the book. The impact of politics and the sheer desire to retain power had a distorting influence on how the uprising was handled and how it was investigated. After watching Nixon get elected as the law-and-order candidate, Rockefeller felt compelled to take the same stance. Consequently, he refused to get involved in the negotiations or visit the prison, something that may have lowered the temperature and enabled a peaceful resolution of the siege. It is disquieting to read how many politicians and officials put self-interest and survival ahead of the pursuit of truth.   

In the immediate aftermath of the uprising, systemic changes were made to improve the well-being of the prisoners such as limits on the amount of time they could be put in solitary confinement, more time outside each day, better food, and access to legal resources. But over time, things slowly began to revert and look more like 1971 than 2021. There has been a continued growth in the number of prisons and a prison population that is larger than in any other Western country. There is disproportionate incarceration of Black and Hispanic men, often for mild offenses that would not warrant detention in a high security prison. Mistreatment of prisoners, unfortunately, is more the rule than the exception. Many explanations are offered – political positions, self-interest, and institutional inertia. But it does underscore how hard it is to make change real.  

As the country as a whole and the medical profession in particular undergo scrutiny about racist attitudes and practices, this book is a reminder that it will take an extended and concerted effort to achieve equal treatment for citizens in the penal system and in the health system. It may be easy for some to justify harsh treatment of criminals in prison or poor people living in squalid conditions. But we need to remind ourselves that a society can only be judged based on how it treats the most unfortunate within it. This applies across the board, housing, education, and healthcare.

Blood in the Water: The Attica Uprising of 1971 and its Legacy 
Heather Ann Thompson 
Miscellaneous Winner of the 2017 Pulitzer Prize in History 
Publisher Pantheon Books 
Place Published New York 
Edition 2016 
Page Count 724 

Web image by Larry Farr 

Conditions change once Sweet Home’s owner dies of a stroke and his widow brings in her brother-in-law and his young nephews to help run Sweet Home; the small liberties granted to the enslaved people are revoked by the new leadership, and cruelties ensue. The enslaved people, including Halle and a man named Paul D, plot to escape north; however, Sethe and her children are the only ones who succeed in doing so, only after she is violated by the nephews and brutally whipped by the brother-in-law for informing him of the assault. These events and Sethe’s flight are complicated by her near-full-term pregnancy. Approaching death from exhaustion and exposure, she is saved by a white girl who helps Sethe give birth. Her daughter is named Denver after the contextually benevolent white girl.  

Carrying her newborn, Sethe arrives at 124, greeted by her other three children, into the care of Baby Suggs. The bittersweet happiness of her arrival without Halle is marred one month later by the arrival of a team intending to reclaim Sethe and her kids for Sweet Home. Rather than allow herself and her children to be forced back into slavery, Sethe intends to commit infanticide and suicide, succeeding in the murder of her older daughter. This action effectively prevents them from being taken, and Sethe is exonerated of her charges. Despite this, her act of desperation crushes her family, eventually leading to Baby Suggs’ death and to the flight of her sons from the household. Eighteen years later, Paul D arrives at 124. He begins a relationship with Sethe and manages to evict the poltergeist.  

Soon thereafter, a strange woman arrives by the name of Beloved, the word Sethe had engraved on her child’s tombstone. Sethe is initially unaware of the stranger’s origins, and Paul D is effectively forced out by the new arrival. Once Beloved’s identity as the deceased child is understood, she, Sethe, and Denver become wrapped up in each other, blurring the lines of their identity. Sethe loses her job, but Denver manages to extricate herself to find work. Hearing of the family’s plight at the hands of the “unholy” Beloved, thirty black women of the area band together to purge 124 of her presence. Beloved leaves without a trace. Paul D eventually returns to 124, and memories of Beloved slowly fade into oblivion. 

Beloved is a pure work of art. Toni Morrison crafted a brilliant piece fueled by the lived experiences of enslaved people’s descendants in America and informed by the temporal proximity of the ratification of thirteenth amendment. The summary outlined above fails to capture the impact of the work’s nonlinear form, both in time and perspective. Flashbacks seamlessly interweave with the driving plot. Not only are the past and present difficult to distinguish, but this intermingling also elevates the past in status compared to the present, allowing the past to rival––and often exceed––the present in narrative importance. Time becomes a unique character, one whose primary achievement is the marring of other characters’ physical beings. Through this lens, the recapitulation of Sethe’s tree scars mirrors the historical impact of slavery on the modern-day United States. This context is further validated by the work’s inspiration, the life of Margaret Garner, an African- American enslaved woman who escaped, was recaptured, and who murdered her daughter while being returned to the South. 

Toni Morrison’s mastery of figurative language builds upon the nonlinearity of the piece. Her writing is powerfully displayed through allegories, the most notable of which is found on pages 248-252. Through Beloved’s perspective, Morrison blends hell and slave ships into one entity. This same section of the novel further unifies the perspectives of Beloved, Sethe, and Denver through a mélange of emotion and perception.  

The relevance of this piece to contemporary American politics and social issues is profound and disturbing. American history continues to discredit the experiences of people of color, particularly those of who identify as Black or African-American. This novel demands that we confront the United States’ history of racial oppression. Its magical realism provides new dimension to a historical narrative, allowing for greater imaginative accessibility to the meaning behind its story. As a last powerful image, I refer to the biblically paralleled coming of the four horsemen to “reclaim” Sethe: the sheriff assumes responsibility of reinforcing the dehumanization of Sethe and “addressing” her perceived cultural, psychological, and racialized aberrancy through punishment sans reformation.  

Miscellaneous 

Beloved
Toni Morrison

Awards
National Book Award Finalist for Fiction (1987); Pulitzer Prize for Fiction (1988); American Book Award (1988); Anisfield-Wolf Book Award (1988); Frederic G. Melcher Book Award (1988)  

Publisher Vintage 
Place Published United States 
Edition 2004 
Page Count 324 

Originally published on September 16, 1987 by Alfred A. Knopf Inc. 

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

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 
Web image by Medhum.org

I am glad to report that Playground is a success on this count. In this most recent novel, Powers turns to the ocean as a backdrop for his story. He weaves together the narratives of three main characters. Todd Keane, who is the son of a successful businessman, grows up privileged in upper-crust Chicago. As a high school student in a top-tier private school in the 1970s, he is captivated by the relatively crude computers of the time, mounts the technology wave and feverishly rides it to professional success as an adult. Evie Beaulieu is literally and figuratively thrown into the water at a young age by her father, a deep sea explorer, and becomes obsessed with everything watery. She is more comfortable swimming deep beneath the ocean surface than walking on land. With the support of a gentle and self-effacing husband, she becomes a world famous oceanographer who achieves renown because of her ability to convey the magic and mystery of the ocean equally well to her scientific colleagues and young adult readers, echoes of Richard Powers himself. Finally, Ina Aroita grew up on the Pacific island, Makatea, but moved to the United States to pursue studies in the creative arts and becomes a sculptor. In college, she meets Todd and through him she is introduced to an important fourth character, Rafi Young, who pulls together the Keane-Aroita story lines.

Rafi grew up in the Black neighborhoods of South Side Chicago. He is a voracious reader from the first day of school and, defying the odds,  wins a scholarship to attend the same high school as Todd Keane. They meet over intense games of chess, advance to the ancient addictive game of Go, and develop a powerful but vulnerable friendship. They both choose to go to college at the University of Illinois, and Ina is drawn into their orbit.  Powers pulls all of these characters into a tight web that centers on the ambitious plan of an American company  to build a self-sustaining city that will launched from Makatea and will be submerged under the surface of the water. The residents of the island are being asked to weigh the pros and cons of the “seasteading” initiative and decide whether to approve it. The rationale offered by the proponents is that life in such a unique environment will enable the occupants of the submerged city to live in a realm outside the jurisdiction of any company and be free to pursue their intellectual pursuits and dreams about expanding the use of artificial intelligence, free of government interference and restrictions.

Extreme libertarianism meets AI wonderland.

Powers populates his literary world with characters we come to know well and grow attached to. It is a strength of Playground that they are believable and not simply spokespeople for a point of view. Powers explores many themes in this book. Games, those that people play casually for leisure, like chess, and those that they play intensely for success in life figure prominently in the novel. Todd and Rafi’s obsession with the ancient board game of Go, with its infinite number of possible outcomes branching out from a simple 19×19 linear grid, becomes an incubator for their ideas about computing capacity. Go provides an alluring framework to explore human behavior and model it for use by programmers of life-like computer surrogates. The game provides the initial inspiration for Todd to design powerful AI systems that can mimic humans and beat them at their own games. There is an appreciation of the growing potential for unpredictable outcomes as computer systems become more complex, machine learning diversifies, and neural networks become denser. The example that most impresses Keane (and Powers) involves the game of AlphaGo, an actual computer program, which was designed to play Go at championship level. Todd recounts his feelings of awe when the program  made an inexplicable move in a game against Ke Jie, the number one ranked player in the world at the time, that sealed the computer’s victory in a three-game match. This was something that was thought to be beyond the power of any computer (this same episode features prominently in the book Maniac by Benjamin Labatut).

In this novel, the inventiveness of nature and the unpredictability of human interactions far surpasses anything that AI accomplishes. The complexity of the natural world, its wondrous diversity, its unexpected vitality, is captured in incandescent prose as Powers describes the glowing colors of the deep-sea creatures. Can and will computers achieve a sense of stewardship and legacy? Will they develop an attachment to the environment around them and struggle to sustain it and pass it on whole to the next generation of computers in the same way that links people across and with future generations?

The novel reaches a climax and the ending involves an unexpected plot twist. The book is too much of a fun read for me to reveal it and spoil it for you. One hint — keep in mind that Todd Keane is an extraordinarily complex person. That said, what is striking is how marginally AI actually influences the actual outcome of the novel. It is more of a gadget play than an active player in the narrative. It is as if Powers himself is unsure how AI will impact those of us alive today and the generations that will come after us. If this is true for Powers, then it suggests that all of us should stay modest in our predictions of the future of AI. Reading Playground, I think he would remind us to keep in mind that however things turn out with AI, it will probably work out best if we remember the grandeur of nature and the human capacity to care deeply for one another and our environment, qualities that Powers describes with an expansive intelligence and poetic beauty.

Playground
Richard Powers
W. W. Norton & Co.2024.
381 pp (paperback)

Web image by Medhum.org

The nature of phantom limb pain has bedeviled amputees and bewildered physicians and surgeons for centuries; up to 87% of amputees experience it during their lifetime. Consistently effective treatments remain elusive. Biomedical texts on the subject are at once complex and speculative. Olga Tokarczuk, in her 2018 novel, Flights, imagines what phantom limb pain could be like for someone, and the desperate search for relief it can produce. 

Flights centers mostly on the narrator’s travels among different places and across different times. It comprises mostly packets of individual story vignettes and fragments; some short, some long; some fictional; some real, some both. And though many different stories are told with many different characters about many different subjects, something about travel connects them all.  

Certain preoccupations manifest themselves in various parts of the book. One in particular concerns the technical aspects of preserving human body parts, which comes into play in a story fragment involving phantom limb pain. The main character is Philip Verheyen, who is a real historical figure known as a renowned Flemish surgeon and anatomist of the late seventeenth and early eighteenth centuries, and as the author of Corporis humani anatomiae (1710).  

As Tokarczuk tells the story, Verheyen was twenty-eight-years old in 1676 during his second year of university in Leiden when he scraped his left calf on an exposed nail of the stairway leading to his rented lodgings. His pants were torn and his skin broken. Though the injury seemed minor at first, it evolved into a raging infection that later required below-the-knee amputation.  

With the care of his landlady, Verheyen recovered after which he was seen “tapping his peg over the uneven paving stones of Leiden,” to attend lectures on the subject of anatomy at the university medical center.” (p. 195) In a matter of a few weeks after the amputation, however, the pain started. 

The pains came at night as his body was relaxing and slipping across the uncertain boundary between waking and sleep…He would have the impression that his left leg was numb, and that he absolutely had to get it into the right position—he felt his toes tingling, an unpleasant sensation. He fidgeted, half conscious. He wanted to move his toes, but the unperformability of that movement awoke him completely. He would sit on the bed, tear the blanket off himself, and look at the aching place—it was some thirty centimeters below the knee, there over the rumbled sheet. He would close his eyes and try to scratch it, but he touched nothing, his fingers combed the void in despair, giving him no relief. (p. 203) 

In imagining how Verheyen could respond to his desperation for relief, Tokarczuk draws on his intense interest in preserving human body parts. Before the amputation, he begs the surgeon to “preserve the removed leg.” (p. 193) The surgeon followed Verheyen’s detailed instructions for preparing his amputated limb by placing it “in a glass vessel filled with a balm of Nantes brandy and black pepper.” (p. 193) Verheyen kept it “on his headboard or stretched scarily out on the table.” (p. 196) Eventually, he looks to it as a possible source of relief. 

Once, in a fit of despair, when the pain and itching were driving him mad, he stood and with trembling hands lit a candle. Hopping on one foot, he moved to the table the vessel with the cut-off leg [rested]…He extracted the limb and in the candlelight tried to locate in it the reason for the pain…He sat down on the floor, stretched his legs out before him, and laid the amputated limb on the place just below his left knee. He closed his eyes and groped for the painful place. His hand touched the cold piece of flesh—but could not reach the pain. (pp. 203-204) 

Verheyen’s maneuvers and observations did not provide him relief. With his medical training, he begins thinking about mechanisms that could be causing this excruciating and frustrating phenomenon. 

What is it that awakens me, when I feel pain and suffering, since my leg has been separated from me and is floating now in alcohol? There is nothing pinching it, no reason for its suffering, no such pain that can be logically justified, and yet it exists. Now I look at it and simultaneously feel in it, in the toes, unbearably hot, as though I were submerging it in hot water, and this experience is so real, so obvious, that if I were to shut my eyes, I would see in my own imagination the bucket of water overly heated and my own foot submerged from toes to ankle. I touch my bodily existing limb in the guise of a lump of preserved flesh—and I don’t feel it. I feel, meanwhile, something that does not exist, it is in a physical sense an empty place, there is nothing there that might give any sensation whatsoever. The thing that hurts does not exist. A phantom. Phantom pain. (p. 208)  

He comes up empty. 

Tokarczuk cannot imagine Verheyen would let the issue lie and accept it simply because he is without an anatomical or pathophysiological explanation. She knows that before he began his schooling in medicine, he was studying theology towards becoming a Catholic priest. In fact, in the book and in his real life, the amputation disqualified him from Catholic priesthood. So, Tokarczuk brings his theological training into thoughts he could have about this phenomenon that is torturing him from spiritual realms, and in this way leaving Verheyen to contemplate the mind / body relationship. He concludes, “The body is something absolutely mysterious.” (p. 209)  

It still is.  

Web image generated with Dall-E 2

The Eye in the Door, the second in the trilogy, turns its attention to the Home Front, and more specifically describes the rampant paranoia during the war, as the government targets two groups:  homosexuals and “conchies,” or conscientious objectors.  While it too is tethered to historical fact, it is more of a fictional narrative concentrating on the state-sponsored witch-hunt, refracted through the story of Billy Prior, a patient of Dr. Rivers.  Billy is bisexual; he also grew up with childhood friends who became pacifists and objectors, and who may or may not have been involved in a plot to assassinate the Prime Minister, and so he moves in both of these marginalized and persecuted worlds.  He also has fallen in love with a woman whom he wants to marry.  During his ongoing treatment of Billy, Rivers confronts his own repressed childhood memories.   

The Regeneration Trilogy has much to recommend it in considering works of literature in the area of medical humanities.  First—and obviously—it is about the psychological damage suffered by young men pressed into military service during wartime, and the way in which medicine approaches their resultant illness with the tools it has at hand.  Each one of these soldiers has a story, each one has a trauma, and there are no pharmacological options. Much like Freud (a contemporary whose work was well-known to him), Rivers felt that the way to treat the shell-shocked soldiers was a “talking cure,” making the traumatic events unrepressed and having the patients recognize and address them.  The stories of the soldiers’ treatments are engaging, Rivers’ warmth and compassion for his charges is unmistakable, and the nature of physician-patient interaction during treatment is explored.   

Barker also poses questions about gender; more specifically, about the nature of manhood and the role of women in a male-dominated society turned upside down by a cataclysm.  Being a man in England during the war means being in uniform and preferably fighting in France; the conchies and the gay men are seen by many, including many women, as being “less than” men, and in their otherness, as subversive.  Women, for their part, have had to step up and assume the roles in the workforce that men have vacated to go off to fight.   It is supposedly the love of their fellow men that allows the soldiers to fight as a unit, to want to enlist and to want to re-up after they are wounded, and this comradeship is trumpeted by those in command.  But it is crucial that everyone understand that this must be the right kind of love; the wrong kind of love is ferreted out and made example of. 

There are many paradoxes, and many instances of doubling or of opposites, in the novels.  Rivers wants to cure his patients, although curing them will render them fit to be sent back to combat and likely be killed.  Several bisexual men lead bifurcated lives.  And underlying all of it is a society rigidly divided along class lines, with the WC’s—the working classes—distinguished not only by their living and working conditions but also by the idiomatic speech put into their mouths by the author.   The war may be in some ways a great “we’re all in this together” moment, but it can’t erase class distinctions.   

It is worth noting that Barker’s style can range over to the gritty and realistic, as well as the graphic, whether describing the events occurring on a battlefield in Picardy or in a bedroom (or back alley) in London. The writing style is crisp, and the narrative moves along nicely.  The author’s characterizations are on point, especially William Rivers and Billy Prior.  Barker has a great feel for language, although some of the words and expressions several of the characters use are distinctly British and may be unfamiliar to American ears.  She conveys an England—or at least, a segment of England—tired of war, tired of being bombed, often living hand to mouth in cold water flats with faded wallpaper and trying gamely to carry on despite being ground down. 

And underlying it all, The Great War—its idealization, its senselessness.  The three volumes of this trilogy are beautifully written, hold the attention, and move quickly, and its relatively spare language has a lot to say. 

The Eye in the Door
Pat Barker 
Dutton: 1994, 288 pages 

Photo of Chester from  The Cleveland Museum of Art 

Demon Copperhead is nothing if not a novel centered on social concerns. It tells the story of a child born to a drug addicted mother in an oxycontin-ravaged community in western Virginia. He is delivered inside an intact amniotic sac, an anomaly that foreshadows a life-long fixation to see the ocean, any ocean. His mother has abysmal taste in men and repeatedly chooses to live with men who abuse her and physically threaten Demon. When she dies of a drug overdose, Demon is placed in foster care and forced to work countless hours as a virtual slave under horrible circumstances, without any consideration for his safety, by the person who is supposedly responsible for his wellbeing. He runs away and has a miserable encounter on the road with a streetwalker who entraps him and steals the hard-earned money that he has secretly saved and stashed away. Against all expectation, Demon reconnects with his dead father’s family, and they place him in a much more stable and secure environment – the home of the venerated coach of the local high school football team.  

The coach takes a liking to Demon. He recognizes Demon’s hidden strengths and talents and encourages Demon to try out for the football team. Much to his surprise, Demon achieves star status as a tight end, no longer a faceless hillbilly from the back country of mobile homes. But true to the trajectory of the novel, Demon suffers a major injury to his knee. He refuses surgery and tries to tough it out. Pain medication is key to this strategy and, of course, this being Appalachia in the late 1990s, oxycontin is too easily prescribed by doctors and too accessible to patients. A painful decline into addiction and despair ensues. Many of Demon’s peers fall victim to the oxycontin plague. But unlike them, Demon is resilient. He is a talented artist, and from early childhood he would draw cartoon-like sketches to escape from his desultory life.  

With the help and support of an art teacher who takes him under her wing during high school, Demon creates a comic strip that dramatizes life in the backwoods of Virginia and that gains regional notoriety. As the novel nears the end, there is a dramatic passage in which Demon confronts his social nemesis on a mountain ridge during a windswept rainstorm. It evokes a climactic episode in Kingsolver’s earlier prize-winning book, The Poisonwood Bible, where the life of a key character is threatened by an attack of army ants in the middle of the night. Ultimately, Demon enters drug rehabilitation, perseveres through the rigors of withdrawal, and gets clean. Against all expectations, Demon finds love and redemption. The woman of his dreams has been there all along, but when it happens, you cannot help but smile as you watch the two lovers acknowledge their feelings for one another. 

The title of the novel is a dead giveaway of who inspired it and Kingsolver acknowledges her debt to Charles Dickens in the postscript. Like her Victorian predecessor, Kingsolver is writing to protest the neglect and abuse that people, but especially children, living in post-manufacturing America have been forced to endure at the end of the 20^th century and into the next. In her vision, the grim experiences of people like Demon and his family, whose lives are attached to the land, are profoundly different from city dwellers. After their land was stripped of its natural resources, the rural communities in states like Virginia and Tennessee were left to languish economically and fall victim to predatory pharmaceutical companies which promoted the use of drugs that the proprietors knew would increase dependence and addiction.  

There is a relentlessness to this story and Kingsolver’s voice in many respects echoes the Biblical prophets. For some readers, the book is almost too depressing. But I think that fails to give enough credit to her Dickensian style and outlook. The sequence of episodes in different locations and with a revolving cast of characters is reminiscent of the publication of Dickens’ novels in serial installments that can almost stand alone. The narrative pulsates with non-stop action and there is an optimism that Demon will always pull through. He is an engaging character, blessed with emotional reserves and intellectual gifts that enable him to overcome his baleful surroundings. In that sense, his story, like Dickens’ novels, may strike some as unrealistic. Perhaps that is the most effective way a writer can successfully enlist readers to rally to her social cause, by offering a vision of personal triumph over social and cultural adversity. 

Coming back to the question I asked at the outset, can a novel inspired by social protest survive its era and outlive the conditions that spurred the author to put pen to paper, or fingers to keyboard? Novels like David Copperfield and The Grapes of Wrath are affirmative answers. I predict that the artistry of Demon Copperhead will ensure that it will still be read long after the environmental damage incurred by the coal mining industry and the human devastation of the opioid epidemic recede into history. Demon’s voice is so alive, his character is so engaging, and his tale is so moving that I am confident that the book will be on bookshelves or in data storage tools in a hundred years. It may be necessary to add notes to explain the ins and outs of the coal mining industry and how oxycontin was approved and marketed to an unsuspecting population, but those will be details that will not obscure the deep humanity of the book.  

Oprah In Conversation with Barbara Kingsolver

DEMON COPPERHEAD 
Barbara Kingsolver 
Harper Collins Publishers, New York, 2022, 548pp 

Web photo by George Hiles 

View poem from Poetry Foundation

This beautiful poem in The Collected Poems of Theodore Roethke appears in a section called “Sequence, Sometimes Metaphysical.” It is a penetrating rendering, at one and the same time, of “pure despair” and of transcendence; of the curse and simultaneous exaltation of heightened awareness; of the personal experience of “madness,” “my shadow pinned against a sweating wall,” “the edge is what I have,” and of a more profound soul-searching that contemplates union with nature and with God: “I climb out of my fear / The mind enters itself, and God the mind, / And one is One, free in the tearing wind.”

Roethke, a Pulitzer Prize winning poet, suffered from manic depressive illness. This poem is remarkable in conveying a life experienced between extremes and at the edge; we might even recognize elements here that surface from time to time in ourselves. But the poet probes beyond mere personal anguish and that is, perhaps, how he survives.

A Film about Theodore Roethke from PublicResource.Org

Remarkable People – Theodore Roethke by Seattle Colleges Cable Television

The Collected Poems of Theodore Roethke
New York: Doubleday, 1966, 270 pages

An earlier version of this review was published in the NYU Literature, Arts, and Medicine Database (Litmed).
Web image by Anchor Lee