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

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 

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 

The story, “A Jury of Her Peers” by Susan Glaspell (1876-1948) tops the list of all the classic fiction pieces I used in more than three decades of teaching in a medical school. It is vivid, accessible, and moving – and it conveys important historical messages while also holding up a mirror to current affairs and professional identity. 

The Pulitzer-Prize winning-author, was inspired to write this powerful tale, following her coverage as a journalist of the 1901 trial of woman who had murdered her husband. First she wrote it as a play, “Trifles,” in which she played a role when it opened in Providence RI in 1916. The following year she adapted the play as a story. A moody thirty-minute film was produced and directed by Sally Heckel in 1980, making use of Christina Rossetti’s poem “In the Bleak Midwinter,” set to the music of the Gustav Holst. A rather blurry version can be found on youtube. 

On a cold winter day, Mr. Hale has found his neighbor, Mr. Wright, strangled to death in his own home. Mrs. Minnie Wright claimed not to know who killed her husband, but she had already been arrested and was awaiting charges in jail. County Sheriff Peters brings Hale, his wife Martha Hale and his own wife Mrs. Peters to the isolated. Wright home. The two wives are to gather Minnie’s clothing and see to her preserves. The men mock women’s “trifles” and jokingly tell them not to miss any clues, before they turn to the “more serious,” manly work of finding a motive. In a basket of patches destined for a quilt, the women find a strangled canary. In quilt-like fragments, they piece together the difficult life of the absent third woman. The kitchen contains many signs of Minnie Wright’s life of abuse and violence, signs that are clearly visible to the women and ignored by the men. With silent understanding, they destroy the evidence that could incriminate her.  

Considered to be one of the earliest examples of feminist literature, this story is a wonderful teaching tool. Written before women could sit on juries, it raises important issues about the discriminatory aspects of justice, the contingency of laws, and the construction of psychiatric diagnoses, especially insanity in criminal defense. Minnie’s “peers” are her female neighbours who scarcely knew her, but who easily imagine the hardship of her life and the abuse that she (and perhaps they too) suffered.  

Over many years, I had the unforgettable experience of reading this story with a combined class of law students and medical students co-taught with my law-school colleague Mark Weisberg.ⁱ All the students believed that Minnie deserved to be acquitted. But their reasons differed along professional lines, and this same difference appeared every year we taught with the story.  

The future lawyers wanted her to find pardon in a medicalized solution: they longed for an insanity defense in the battered wife syndrome, a diagnosis which did not become available until the 1970s.  

The future doctors believed that Minnie was far from insane; her actions, they thought, were taken in reasonable self-defense; they wanted a legal fix that would change the laws to allow women to sit on juries and to recognize the harm of domestic abuse. In fact, women as jurors evolved slowly over many more years at different times and places and involved several legal cases on appeal.  

The class discussion centered on why members of each group sought to preserve the rightness of their own professional canon even when they understood that the rules expressed in the story were decades out of date.  

1, Mark Weisberg and Jacalyn Duffin, 1995. “Evoking the Moral Imagination: Using Stories to Teach Ethics and Professionalism to Nursing, Medical, and Law Students”; Journal of the Medical Humanities 16. 4: 247-263 Reprinted in Change, The Magazine of Higher Learning, 27. 1: 20-27.

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

A Jury of Her Peers from Internet Archive (Open in New Window)

A Jury of Her Peers Directed by Sally Heckel in 1980

For more than a decade, I kept running into the Emperor of All Maladies at various bookstores, book shops, and libraries. Siddhartha Mukherjee’s Pulitzer Prize winning biography of cancer would glare at me from its position on the bookshelf, daring me to read it, but each time I saw it, I would mull over the idea of reading a 450 page history of medicine book, shake my head, and move on to something lighter and less strenuous. Mostly, tired from my day job as a family doctor, I just wanted to read something less medical.

Last fall, it happened yet again. I ran into the Emperor of all Maladies once more, this time at my local library’s annual used book sale. For the princely sum of $1, I picked up the book, flipped through it, and thought, why not?

What I discovered was a book that was all that I had expected it to be, and more. Yes, it’s a long, exhaustive read. Yes, it contains long sections of exposition, explaining the details of how protein kinases and mRNA work on a molecular level. But it’s also eye opening and moving and manages to make the connection between what happened in hospitals and clinics a hundred years ago with the state of not just modern oncology, but modern medicine as a whole.

Last fall, I joined MedHum and before long, we realized MedHum needed a podcast. But what would we talk about? And that’s when I realized that Mukherjee’s book, with its vast scope, and comprehensiveness would be the perfect starting point for the show.

Then I thought, I needed to convince someone to read this book with me. And who better than my literary podcast buddy, Mr. Luki Danukarjanto. Luki is a career coach, writer and the founder of Focus Inspired, a service dedicated to helping people achieve meaningful career change. He also lives in Toronto.We’ve been talking about books on the W5H Book Club podcast together for the last several years. Why not read about medical humanities?

The result is two dudes who love to read talking about a great book.

Welcome to the premiere episode of Apollo On Call. Enjoy.

Dr. David Hsu

Transcript from this episode

Paul Harding uses this disquieting episode as the basis for his latest novel, The Other Eden. Harding is the author of Tinkers, his debut novel which was published in 2009 by Bellevue Literary Press. That book was awarded the Pulitzer Prize, a unique achievement for a book that had been published well outside of the mainstream. His setting is called Apple Island, and the founders are Benjamin Honey, a freed slave, and his Irish wife Patience Raferty who arrive on the island in 1792. They survive a monstrous storm and flood in 1815 and together with a handful of families build a community that over the next 100 years is able to endure and thrive in the face of the harsh elements that confront them.

The descendants of the Honeys are the most prominent characters in Harding’s narrative. The current matriarch, Esther, spends most of her time brooding in a rocking chair, keeping watch over her family, and vigilantly guarding a secret about her son, Eha. Eha is a carpenter, who partners with another resident on the island to build all of the homes for the residents; this partner is an older man who lives alone sheltered inside a hollowed-out tree and who has carved an intricate circular mural that coils upward along the trunk of his home.  Ethan, Eha’s 15-year old son, is a precociously talented artist who is alert to nature and his surroundings and constantly putting images to paper. His two younger sisters are always on the go and playing with the children of three other families.

The outside world intervenes in this quiet secluded world when a team of officials from the neighboring town of Foxden on the coast comes to Apple Island with a mission — to investigate the health and well-being of the inhabitants. They are primed by an entrenched belief that there are certain people in society who are innately better and the consequent dangers of mixing races and inbreeding over several generations. With this in mind, the town representatives conclude that it is in the best interest of all concerned to condemn the Apple Island village and disperse its inhabitants. This is the only solution that they believe will prevent future generations from being adversely affected by the downward spiral of human intellectual and moral capacity and that will avoid the spread of this social contagion beyond the confines of the island. Interwoven with this depressing storyline, there is an effort by a local minister to rescue Ethan from Apple Island because he is very fair-skinned. He may be able to pass as White and his artistic talent may enable him to overcome his “flawed” racial beginnings. Needless to say, the path to a tragic ending is patiently laid out by the author. But Harding’s genius is to make us appreciate the deep humanity and abiding love that the inhabitants of Apple Island sustain even though they cannot escape the colony’s ultimate demise.

A plot summary cannot do justice to the beauty and power of Harding’s prose. His principal characters are simple people living  a subsistence existence. But they are embedded in a lushly evoked environment, and they are attuned to the rhythms of nature and the cycles of daily human life. The emotions are deeply felt, and the action rings true; the inhabitants of the island are not cardboard heroes or angels. There is a threat of violence lurking just below the surface that can emerge with shattering force when triggered by unexpected events.

Ethan’s story is presented as a complex mixture of personalities and motivations. The minister who comes to Apple Island to tutor the children and who devises the plan to rescue Ethan from life on the island recognizes the remarkable native intelligence of his school-age pupils, one who is literate in Latin, another who has mastered geometry. But he painfully admits in his private journal to deep feelings of revulsion when he is surrounded by the black and mixed race children in school. When Ethan is relocated to the home of a wealthy family on the mainland to continue his art education, he becomes more than friends  with one of the servant girls, Bridget. There is a familiar element to their story, but the last stage is surprising and moving in its depiction of devotion and steadfastness in the face of love and separation. Ethan’s fate is mysterious, but his drawings live on in museum exhibitions.

The underlying motivations of the mainlanders who come to survey the living conditions of the people on Apple Island are clothed in their seemingly noble aspiration of improving the lot of humanity.  They use the language of social Darwinism to defend their eugenics agenda, and this is no simple literary plotline. The eugenics movement in the United States was widespread and widely accepted; the nation became obsessed with the concept of “fitter families” and the dangers of reproduction of the unfit, and over 60,000 “feeble minded” individuals were involuntarily sterilized in early twentieth century America. The horrible consequences of flawed science and mistaken beliefs about biology and intrinsic human worth are made abundantly clear. But Harding’s writing rises above formulaic condemnation or pedantic instruction to the reader. He makes you live the experience and the suffering of the islanders whose humanity is so grossly ignored by the team of experts sent to learn about them and then deal with them.

Many reviewers of The Other Eden have commented on the mythic nature of the book. I think they sell Harding short. I think his accomplishment is far greater. His writing is almost Biblical in nature,  in the sense that Marilynne Robinson describes biblical writing in her recent book Understanding Genesis (Farrar, Strauss, and Giroux, 2024). In that work, Robinson marvels at how all of the events that unfold in Genesis occur under divine guidance and plans, yet  the men and women maintain their independence to act and influence their fate. God and  humankind are in a covenantal relationship. Each has the capacity to surprise, to rise above their circumstances, defy expectations and even act out of love and forbearance when circumstances might dictate revenge and retribution. Similarly, Harding’s literary world is infused with the powerful belief in human agency and decency, concepts in direct counterpoint to the biologic determinism to which the mainlanders subscribe

The Other Eden evokes many Biblical narratives and themes. Apple Island grows out of a flood and the inhabitants are dispersed after the decision is made to end the colony. There is demonic evil and the threat of servitude, with the image of an enslaving Pharaoh lurking over the heads of the investigators from Foxden. There is branding at birth, deception of elders, scheming to save a favored child, and banishment of a disgraced woman. Noah, Abraham, Jacob, Moses, Pharoah, and Ruth are hovering over the residents of Apple Island. Harding uses all of these archetypal tropes and personalities. But like all good Biblical narratives, the images serve to construct a human world that speaks to all of us. The Other Eden is more than a foundation myth. It is a chronicle of living.

THIS OTHER EDEN
Paul Harding
W.W. Norton and Co.
2023
221 pp (paperback)

Web Photo by Seth Dewey

We feature four different angles addressing the opioid crisis, mostly as the opioid product OxyContin is involved and as the Appalachian region is affected. Our objective is to show how realms outside Biomedicine—the Humanities, in this case—can provide a range of perspectives suited to preferences, interests, and needs for understanding a particular issue. The four angles we feature are: nonfiction investigative journalism; nonfiction dramatization; narrative nonfiction; and literary fiction. We consider different approaches to selecting the best choice or the best order among available options.

Source Citations:
Macy B. Dopesick. New York; Little, Brown, and Company, 2018
Strong D. Dopesick. John Goldwyn Productions, 2021 (streamed on Hulu)
Keefe PR. Empire of Pain. New York; Doubleday, 2021.
Kingsolver B. Demon Copperhead; Harper, 2022. (Winner of the 2023 Pulitzer Prize for Fiction)

Links:
Russell Teagardens According to the Arts blog pieces mentioned in the podcast: 
Dopesick (nonfiction book – investigative)
Dopesick (TV miniseries)
Empire of Pain (narrative nonfiction)
Demon Copperhead (novel)

Russell Teagarden’s article in The Pharos comparing Dopesick (the book and the TV miniseries) with Demon Copperhead

Recommendations:
De Quincey T. Confessions of an English Opium-Eater. New York; Penguin Classics, 2003. (See Russell Teagarden’s blog piece on this book here.) 
Daudet A. In the Land of Pain. (Translator Julian Barnes) New York; Alfred A. Knopf, 2002. (See Russell Teagarden’s blog piece on this book here.)

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 ANTIPOLYGON