New York, NY: W.W. Norton & Company
2026, 192 pages 
ISBN 9781324105695 

Your body speaks to you every moment of the day. In normal circumstances (good health), we hardly pay attention to those signals – the reassuring metronome-like steadiness of the radial pulse or the soft, regimented inhalations/expirations of respiration. But in bad times (illness and injury), we cannot ignore altered rhythms and abnormal emanations – the miserable throbbing of a migraine or wormlike twitching of the muscles of the hand. Megan O’Rourke, a poet and author of the superb memoir The Invisible Kingdom: Reimagining Chronic Illness (2022), has assembled a pensive and probing anthology of illness poetry that addresses altered states of the body. These 83 poems are organized into five sections: diagnosis, clinical encounters, caregiving, “metaphysical reckoning,” and recovery. A sense of betrayal by the body, shame, helplessness, isolation and loneliness, altered interpersonal relationships, and an inescapable confrontation with mortality are some common effects of illness expressed in these poems. Yet other poems communicate impressive fortitude, resiliency, revelation, receipt of compassion, and hope. Many notable writers are represented in the collection including Emily Dickinson, John Donne, Sylvia Plath, James Dickey, Gwendolyn Brooks, and William Blake. In “lumpectomy eve,” Lucille Clifton eerily depicts the difficult night before scheduled breast surgery where a fear of loss is just one of many emotions felt. Ted Kooser’s “The Urine Specimen” combines imagery and whimsy about the excreted waste product (“the heat of this gold your body’s melted and poured out into a form”) with a bit of scientific prophecy (“for the doctor, who in it will read your future, wringing his hands”). “A Story About the Body” by Robert Hass is a prose poem skillfully and sorrowfully addressing infatuation and imperfection. A single poem cannot reliably rescue us from sickness or other misfortunes, but the best of them are certainly capable of offering connection, illumination, and comfort. 

The Human Remains: Drawing Out Compassion in Medicine by Nathan A. Gray 

University Park, PA: Graphic Mundi (an imprint of Penn State University Press)
2026, 256 pages 
ISBN 9781637791059 

The experience of gross anatomy lab in the first year of medical school has a heavy, haunting presence in this graphic memoir of medical education. Employing primarily grayscale art technique, author and illustrator Nathan Gray (a palliative care physician) holds nothing back in this sometimes grim recollection of his training. He describes the required dissection of a cadaver as “dismantling a human body” (p10) and worries about fainting or vomiting. He has recurrent macabre dreams of dancing with the cadaver. Gray begins having doubts as to whether he even belongs in medical school. Fortunately for him, one member of his dissection team provides a well-needed dose of humor and bravado. In his second year of medical school, Gray gets married. His third year clinical rotations start with the surgery clerkship where feelings of insecurity, uselessness, and fear pester him. Yet Gray is emotionally and psychologically aided by receiving small acts of kindness, his sustained wonder of the human body, and a genuine interest in the patients he treats. Upon completing medical school, he enters an internal medicine residency noteworthy for a strenuous schedule with nights on call and some shifts spanning more than 30 hours in the hospital. He labels residency training as “a cruel matchup that pitted our own sanity and survival against the needs of the people we cared for” (p170). Gray chooses a palliative care fellowship where his compassion and joy for practicing medicine are reinvigorated thus completing the arc of his journey infused with the humanity and empathy he originally began medical school with. The Human Remains is the second graphic medical memoir (See One, Do One, Teach One by Grace Farris is the other.) published in 2026. Both are cautionary tales (albeit with “happy endings”) reminding us that medical trainees are at high risk of having the most important things that propel them to choose to become a physician – compassion and service to others – gradually eroded. 

“The News from Dublin” in The News from Dublin: Stories (pages 67-87) by Colm Tóibín 

New York, NY: Scribner
2026, 289 pages 
ISBN 9781476785141 
[The story was first published in New Irish Short Stories.] 

Maurice Webster, a teacher at a Catholic high school in Ireland, has good reason to worry about the condition of his youngest brother. Stephen has a severe case of highly infectious tuberculosis and is confined to home, (At the time this story takes place – prior to the wide availability of streptomycin in Europe around 1948 – there is no antibiotic treatment for TB.) Maurice is afraid to visit his brother and risk spreading TB to his wife and children. Reports surface of a promising new drug that can cure tuberculosis – Streptomycin. The antibiotic is almost impossible to obtain as it is still being tested and likely won’t be accessible for more than a year. Poor Stephen will not live long enough to receive the medication. Maurice travels to Dublin for a meeting with the minister of health in an attempt to procure Streptomycin for his brother. Although sympathetic, the health official says he is unable to help and recommends that Stephen be admitted to a sanatorium. A morose Maurice returns home understanding that Stephen and family were counting on him to retrieve the antibiotic. He has failed them. The only thing he has brought back from Dublin is bad news. With ever diminishing hope for his brother’s recovery, even a miracle seems out of the question. Maurice decides, “There had been enough prayers said, and they had made no difference” (p86). This compact, touching tale about the effect of serious illness on family members highlights their desperation and guilt, withering hope and reluctant resignation. 

Web photo by Wes Hicks

The Sick Child

The sick child is thought to be the artist’s sister. She is not a child but rather a young girl who is lying down or seated, with a blanket over her lower body and she faces a woman who is seated beside her, clutching the child’s left hand. We cannot see the woman’s face – it is turned down as she is bent over in apparent grief. While the painting’s title names the girl as the subject of the painting, it is the grieving woman and her attention to the girl that is particularly striking.

Death and the Child

Death and the Child depicts the anguish of a child who has been confronted with the corpse of her mother lying in bed. The child faces the viewer, hands pressing against her ears – she cannot bear to “hear”/ absorb what she has encountered; her face has an expression of fear and despair

Death in the Sickroom

In Death in the Sickroom several adults are scattered about, some standing, one woman sitting in the foreground; behind her another woman stands facing us. In the back of the room a figure sits on a chair, a blanket draped over her lap – presumably this is Munch’s sister. With his back to the wall an elderly man has both hands pressed to his chest. These individuals have come to help and mourn but they are isolated from each other, which adds to the grimness of the scene.

Image credits: wiki commons

Painting with Empathy: The Expressionist Art of Edvard Munch with Curator Øystein Ustvedt

Russell Teagarden 12.28.23 1836

Edvard Munch’s emotional portrayal of illness and suffering offers profound insights for health professionals and…

The trajectories of tuberculosis (TB) and opera met in the mid-nineteenth century most notably with the production of La Traviata in 1853, and then La Bohème near the century’s end. With eminent scholars Linda and Michael Hutcheon, we talk about how these trajectories converged and how these resulting two operas then brought attention to the medical effects of the infection and the sociocultural influences on its spread. We also discuss how the discovery of germ therapy during the time between the staging of these operas affected the way social behaviors changed accordingly, that is, from understanding TB as hereditary to understanding it as infectious. We play audio clips from parts of the operas pertinent to perspectives provided. 

A big thanks to Drs Linda and Michael Hutcheon who in addition to providing their expertise and perspectives during the podcast, also contributed ideas for the production. 

Links
– The combined bio for Linda and Michael Hutcheon.
– The New York Metropolitan Opera on-demand video service where you can get access to high-quality video productions of La Traviata and La Bohème among many other operas and performances. (There could be a 7-day free trial available).
– Homer Simpson performing as Rudolpho in La Bohème singing Oh Dio! Mimi!
– We covered the effects of TB as an aesthetic ideal of beauty during the nineteenth century as represented in paintings earlier in episode 5.

Audio Credits
La Traviata
Preludio (National Philharmonic Orchestra; Richard Bonynge cond London Records 1979)
Prendi, Quest’È L’Immagine (Orchestra of the Opera House, Rome; Tullio Serafin cond; Victoria de los Angeles (Violetta); EMI Records Ltd 1960; digitally remastered 1992)

La Bohème
O Soave Fanciulla (Berlin Philharmonic; Herbert von Karajan cond; Mirella Freni (Mimi); Luciano Pavarotti (Rudolfo); Rolando Panerai (Marcello); London Records 1972)
Si. Mi Chiamono Mimi (ibid)
Mimi È Una Civetta (ibid)
Mimi È Tanto Malata! (ibid)

La Bohème photo from wikicommons

Henry’s severe illness and his difficulties accessing treatment prompted Green to contemplate the horrifying statistics of tuberculosis and the paradox of our extensive knowledge about it. More than one million people still die every year from this ancient disease; yet the bacterial cause was elucidated a century and a half ago, and effective treatments have been around since the 1950s. Barring eradication, the germs mutate and become resistant. Given dire living conditions, it spreads. Effective therapy can be prohibitively expensive. “The cure is where the disease is not, and the disease is where the cure is not” (p. 5). People die where cures cannot be obtained. 

History is woven though Henry’s story, but so are politics, culture, and economics: the discoveries, the 19^th-century romanticization of ‘wasting away,’ the hard realities of pharmaceutical development and delivery. Henry has survived, become healthy and an inveterate TikToker and youtuber. He even has an episode on the power of storytelling. But other people that we encounter through this tale have died. 

We still have tuberculosis because statistics de-personify it, and geography allows ignoring it. Green uses Henry’s story to invite us to ‘[t]hink about how rare and precious humans are, and how many of them you get to worry for and care about. Then if you can, find a way to multiply that 1,250,000 times’ (p. 189).  

The book flows easily in language that is clear and accessible, a tribute to Green’s experience in writing young-adult fiction. In the end, without denying the benefits of medical interventions, he calls for a focus on the real cause of tuberculosis: injustice—tolerated and unchallenged. ‘Ultimately,’ he writes, ‘we are the cause’ (p. 184).  

Everything is Tuberculosis: The History and Persistence of Our Deadliest Infection
John Green
New York: Penguin/Crash Course Books
2025
ISBN 9780525556572 

Web image created by Medhum.org

The artist depicts Chekhov as he was in the early 1890’s, soon after he had purchased a small, dilapidated estate and moved there from Moscow with his family. In addition to serving as country doctor and public health official in Melikhovo, Chekhov at that time was composing many of the stories and plays that made him one of Russia’s most well-loved writers and a major influence on 20^th century literature. How was he able to pursue two such different and demanding careers? Several years earlier, at the height of Chekhov’s early literary success, his friend Alexi Suvorin had urged the young writer to give up medicine. Don’t spread yourself too thin, he said. You’ll never reach your potential unless you concentrate on writing. In response, Chekhov wrote, “You advise me not to chase after two hares at once and to forget about practicing medicine. Well, I don’t see what’s so impossible about chasing two hares at once… Medicine is my lawful wedded wife and literature my mistress. When one gets on my nerves, I spend the night with the other. This may be somewhat disorganized, but then again, it’s not boring, and anyway, neither loses anything by my duplicity.” (1) In this famous passage, the 28-year-old writer dances lightly over a fundamental truth of his life and identity. In fact, Chekhov’s career was not so much a matter of jumping from one bedroom to another, as was the case perhaps with the poets Wallace Stevens and T. S. Eliot, or the composer Charles Ives. Rather, Chekhov thrived on the effective, if not always seamless, integration of the arts of medicine and writing, which reinforced one another throughout his creative life. This essay explores that integration, and the manner in which Chekhov’s cold eye (objectivity) and warm heart (compassion) reveal themselves in his medical and literary lives. 

DOCTOR CHEKHOV  

“Medicine Is My Lawful Wife” 

When he graduated from the Moscow State University School of Medicine in June 1884, Chekhov was already earning his living as a professional writer. The grandson of serfs, Anton was the third of six children in a poor merchant family from Taganrog, a southern provincial town on the shore of Sea of Azov. His father had moved the family to Moscow after going bankrupt in 1877. By the time Anton entered medical school on a scholarship in 1879, the Chekhovs were living in squalor. His father had a dead-end job. His older brothers were alcoholics and generally unemployed. Anton soon discovered that he could ameliorate the situation by selling comic sketches to local magazines for eight kopecks per line. This was a type of moonlighting he loved. He wrote obsessively, often knocking off a story or two each night, after spending the day listening to lectures or working in the hospital. Chekhov ultimately published more than 200 pieces while a medical student, most of them under his preferred pseudonym, Antosha Chekhonte. 

Chekhov was a natural storyteller. Thus, it wasn’t surprising that the newly minted Doctor Chekhov continued to write, even after he opened his office and patients began to arrive. “Continued to write” is an understatement. Chekhov published 54 stories in 1885, 76 in 1886, and 57 in 1887. His work evolved from humorous sketches to longer, more serious stories for leading literary journals. In 1888 Chekhov won the prestigious Pushkin Prize and published “The Steppe,” his longest and most innovative story to date. Ivanov, his first full-length play, had a successful premiere in St. Petersburg in January 1889. By that time the young doctor had become one of the best known writers in Russia. 

Yet Chekhov always saw himself as a physician, even though in 1889 he did, in fact, retire from a normal paying practice; after that, he offered his medical services at no charge, even though the generous Chekhov often found himself financially strapped. He took care of the peasants near Melikhovo (as depicted in the painting), donated his services to the government as a district physician, and engaged regularly in public health initiatives. In less than five months in 1891, Chekhov reported seeing 453 patients at a district health center and making 576 house calls, in addition to his home practice. (2) Throughout his life, Chekhov also was heavily involved in grass roots activism, building schools for peasants, raising funds to help famine victims, and, later, near the end of his life, supporting the establishment of a sanitarium for tuberculosis victims at Yalta.  

“My Debt To Medicine” 

One of the best known of these public health efforts was his 1890 epidemiological survey of health and social conditions in the prison colonies on Sakhalin Island. Traveling by himself, Chekhov journeyed six weeks by train, steamboat, and horse-drawn carriage across Siberia to reach the 1000-km long Pacific island on which the Czarist government had recently established a notorious gulag. There, he embarked on a one-man, three-month survey of the population, tenaciously picking his way from settlement to settlement and from house to house, often by foot.  

Biographers have long tried to pinpoint his motivation for this perilous journey. During the year prior to the trip, Chekhov had undergone a crisis of confidence. In a letter to Suvorin, he opined, “I don’t love money enough for medicine, and I lack the necessary passion—and therefore talent—for literature. The fire in me burns with an even, lethargic flame; it never flares up or roars… I have very little passion. Add to that the following psychopathic trait: for two years now, seeing my works in print has for some reason given me no pleasure.” (3) He reported symptoms suggestive of clinical depression, perhaps precipitated by grief over the death of his brother Nicholas from tuberculosis. There was also a literary issue. The master of the short story had promised himself that he would create a Tolstoy-like novel that would confirm his status as a serious writer. But he was unable to do so.  

Undoubtedly a major factor for choosing Sakhalin was Chekhov’s desire to pay his debt to medicine. He had recently developed a scientific interest in penology and had read about the dismal conditions in the Siberian gulag. He saw an opportunity to influence this situation by obtaining accurate data on the health status of Sakhalin convicts. He had never completed the research thesis (the equivalent of a Ph.D.) that would make him eligible to be a medical specialist or professor. Hence, his notion of “my debt to medicine”—he would perform a survey, write his thesis, and become a teacher. 

Ultimately, Chekhov claimed to visit every settlement and survey every household on Sakhalin Island, using a 12-item data collection form. He said he completed over 10,000 of these forms in three months, a feat that (if true) qualifies Chekhov as the speediest shoe-leather epidemiologist of all time. After his return to European Russia, the author found it difficult to organize his data into a coherent study. While he had planned to write a strictly scientific monograph, his creative spirit struggled with the limitations of science. What about his personal experience? What about the interesting stories? After struggling for years, in 1895 Chekhov published The Island of Sakhalin, a curious (but engrossing) mixture of journal, geography, history, medicine, statistics, and travelogue. (4) Unfortunately, the faculty of the University of Moscow was unimpressed.  

“As I Grow Older, the Pulse of Life in Me Beats Faster” 

Picture the mature Chekhov—a middle-aged bachelor, longish face, rather neatly trimmed beard, a prince-nez clipped to the bridge of his nose. His household included his aging parents and his sister Masha, an unmarried schoolteacher who had become his confidant and secretary. His three surviving brothers looked to him for guidance and financial help. Anton was popular, witty, and generous. Among the guests at Melikhovo, there were frequently female admirers. Chekhov’s encounters with women were flirtatious and obviously enjoyable. He had teasing, sexually charged relationships with several women, but whether any of these liaisons are actually “affairs” is uncertain.  

The doctor in the painting already suffered from the tuberculosis from which he would die at the age of 44 years. In fact, he first coughed blood as a medical student. Yet, Chekhov dismissed that episode and each subsequent episode that occurred with disheartening regularity as “influenza” or “bronchitis,” steadfastly refusing to label himself consumptive. As a physician Chekhov must surely have understood the meaning of his symptoms. Was his denial simply a face to show others? Or was his denial so great that it made him unaware? The cat finally came out of the bag in early 1897. While dining at a restaurant in Moscow, Chekhov had a violent spell of hemoptysis that left him critically ill. For the first time, he sought medical treatment and entered the clinic run by Dr. Ostropov, one of his medical school professors. Chekhov’s chronic illness progressively worsened. At the insistence of his doctors, Chekhov left his beloved Melikhovo after 1898 and lived mostly at a new home in the sunny Black Sea resort of Yalta. 

It was also during these last years that the bachelor writer courted and married Olga Knipper, an actress with the Moscow Theater Arts Company. Even after their marriage in 1901, Olga remained at work in Moscow during much of the year, while the invalid Chekhov lived in Yalta, theirs being perhaps one of the earliest examples of the modern two-career commuter marriage. Chekhov found himself able to devote less and less of his waning energy to writing, especially since he refused to give up his social and philanthropic activities. Nonetheless, between 1898 and his death in 1904 Chekhov completed some of his greatest work, including several stories, two novellas (“Peasants” and “In the Ravine”), and his last plays, The Three Sisters (1900) and The Cherry Orchard (1903).  

COLD EYE, WARM HEART 

Chekhov’s Doctors 

Several characteristics of Chekhov’s work reveal the influence of medical training and practice. He used clinical knowledge to lend accuracy to his descriptions of disease and medical situations. This characteristic is perhaps most clearly seen in the characterization of mental disorders. For example, the title character in Ivanov is a subtle portrait of a man suffering from clinical depression, who eventually commits suicide. The young heiress in “A Doctor’s Visit” presents symptoms we would now label as generalized anxiety or panic disorder. The title character in Uncle Vanya appears to have a neurotic depression, a condition that meets today’s DSM 5 criteria for Persistent Depressive Disorder. In the peculiar story called “The Black Monk,” Chekhov describes a psychotic condition, presumably schizophrenia.  

Chekhov also drew from his medical experience in creating a multitude of physician characters. Doctors play significant roles in nearly 30 stories and in all of his major plays, except The Cherry Orchard. The author’s sensibility as a medical insider gives insight and poignancy to these characters, who range from committed altruists to lazy bureaucrats to burned out cases. Chekhov knew too much about the contemporary state of medical science to portray his doctors as curing many people. Thus, they often appear impotent. Yet, at their best Chekhov’s doctors convey the seamless fabric of tenderness (compassion) and steadiness (detachment) that lies at the heart of good medical practice. They also demonstrate courage, altruism, and self-effacement. For example, in “The Grasshopper” (1892) Dr. Dymov dies as a result of contracting diphtheria from a patient. Dr. Kirilov in “Enemies” (1887) demonstrates extraordinary devotion to duty by leaving his distraught wife and dead son in order to make an emergency house call.  

Perhaps Chekhov’s most textured portrait of a good physician appears in “A Doctor’s Visit” (1898). The protagonist, Korolyov, is a young doctor substituting for his boss, the professor of medicine. During the course of the story he moves from being a careful observer (detached concern) who ascertains that his young patient has nothing wrong but a “case of nerves,” to making an imaginative leap by which he connects more deeply with her. This empathic connection allows him to relieve some of her suffering by re-framing her illness. While he cannot solve her existential problems, his demonstration of solidarity leads her to trust him and to gain insight. Korolyov is like Chekhov himself. Dr. Pavel Archangelsky, who supervised Chekhov’s first job as a physician, captured the author’s ability to listen carefully when he later commented: “… he did everything with attention and a manifest love of what he was doing, especially toward the patients who passed through his hands. He listened quietly to them, never raising his voice, however tired he was and even if the patient was talking about things quite irrelevant to his illness.” (5)  

At the other end of the spectrum, some of Chekhov’s doctors are insensitive, incompetent, or impaired. Mayer, the callous medical student in “A Nervous Breakdown” (1889) is a disaster. Mayer can rattle off statistics on the number of whores in London and Moscow, but he is unable to “see” (empathize with) the suffering of the living-and-breathing whores he encounters. Shelestov in “Intrigues” (1883) and the public health doctor in “Darkness” (1887) are examples of self-centered physicians a little further along in their professional lives. The former is superficial and pompous; the latter is narrow-minded and detached.  

Chekhov’s most complete insensitive and acquisitive social climber is found in “Ionych” (1898). Dr. Startsev, when the reader first meets him, is a young physician setting up practice in a provincial town. After surviving an unrequited infatuation with the daughter of a wealthy townsman, Startsev devotes himself entirely to work. His practice prospers and he branches out into real estate. As he grows corpulent and wealthy, Startsev loses touch with his patients (and his own humanity): 

“Probably because his throat is covered with rolls of fat, his voice has changed; it has become thin and sharp. His temper has changed, too; he has become ill humored and irritable. When he sees his patients, he is usually out of temper; he impatiently taps the floor with his stick, and shouts in his disagreeable voice: ‘Be so good as to confine yourself to answering my questions! Don’t talk so much!’” (6) 

“Ionych” traces the progressive destruction of a medical practitioner who finds that medical affluence is more to his liking than the emotionally and physically difficult path of medical virtue.  

Some of Chekhov’s most interesting doctors are tortured by existential or spiritual conflict. Chekhov accurately depicted professional burnout, a syndrome characterized by depletion, detachment, depersonalization, denial, and depression. (7) Dr. Kirilov, who chooses to “go to the office” instead of mourning with his wife, may illustrate the relatively early phase of emotional detachment. Dr. Ovchinnikov in “An Awkward Business” (1888) demonstrates the more advanced symptom of depersonalization when he slugs his assistant in response to the man’s incompetence. The overworked Ovchinnikov reacts to his personal depletion by objectifying and dehumanizing his assistant, a response that compromises the medical care he is trying to protect. Chebutykin in The Three Sisters (1900) illustrates the extreme of alcoholism. Though still employed as a military physician, Chebutykin convincingly asserts that he has forgotten all the medicine he ever learned.   

Ragin in “Ward #6” (1892) and Nikolai Stepanovich in “A Dreary Story” (1889) are complex characters in whom depression and burnout are superimposed on a deep sense of existential failure. Like many of Chekhov’s characters, these physicians suffer from a lack of self-knowledge; they move through life relying on one form of self-deception or another. When they were younger, they committed themselves to noble ideals—Stepanovich to teaching and Ragin to practice in a provincial hospital. But in the long run they never “found” themselves. Professor Stepanovich yearns for a unifying moral principle that would knit together the fragments of his life. Dr. Ragin experiences his failure as emotional numbness. He yearns to suffer, assuming that if he experienced pain, he would be freed from his inability to feel. Thus, the academic physician pines for salvation in the cognitive sphere; the practitioner yearns for emotional redemption. In each case the focus remains inward, rather than turning outward to others, in whom salvation might actually be found.  

Medical Sensibility 

Medical attitudes and methodology play a larger role in Chekhov’s work than does medical knowledge. He believed that his duty as a writer was to present his observations clearly and accurately; in other words, to lay out the data in an objective fashion and allow readers to reach their own conclusions, rather than providing an author’s interpretation. He wrote, “The artist should not be a judge of his characters and what they say, but only an objective observer.” (8) 

This objective attitude put him in conflict with most other Russian writers of the time. It was a major source of conflict with Tolstoy, who was widely revered at the time as a living saint. The two men enjoyed a close personal bond but approached writing with radically different philosophies. After his mid-life religious conversion, Tolstoy viewed literature as a way to communicate his moral vision. He preached the gospel of a radical Christianity, in which all men work together to achieve economic and social equality. However, he rejected the concept of material progress and was particularly skeptical of medicine and doctors. Chekhov, on the other hand, strove to be objective, to present people as they are and the world as it is. His medical training taught him to be a careful observer; his medical attitude made him leery of judging others.  

Other Russian writers and intellectuals spoke out against the czarist government’s repressive social institutions. While this protest was disguised in various ways in order to satisfy the state censors, late 19^th century Russians (like their 20^th century counterparts) learned to speak and understand a subtle code of insurrection. The intellectuals addressed “big issues”—democracy, education, social revolution. They wrote articles, organized meetings, and gave speeches. Here again, Chekhov found himself on a different wavelength. He rarely engaged in theoretical discussion and did not advocate radical social change. Rather, he preferred a pragmatic, case-based approach. His goals were relatively limited, but achievable. Treat the sick patient. Document and publicize the abysmal condition of prisoners. Contain the cholera epidemic. Provide financial assistance to keep farmers afloat during the famine. Raise money for a new school. On and on, but always specific and personal.  

In “About Love” (1898), the narrator speculates on the essence of love. Are there universal characteristics that identify love wherever it occurs? “What seems to fit one instance doesn’t fit a dozen others,” the narrator concludes. “It’s best to interpret each instance separately in my view, without trying to generalize. We must isolate each individual case, as doctors say.” (9) Indeed, Chekhov’s stories and plays rigorously follow this dictum. While many of his Russian contemporaries used fiction to advance moral or social theories, Dr. Chekhov focused on the complexities of human interaction. In Chekhov’s world, biology and circumstance constrain freedom. People often do not listen. Acts performed with good intentions frequently result in hurtful outcomes. And yet occasionally and in unexpected places, one finds a glimmer of love, courage, spirituality, or healing. “Never generalize,” Chekhov tells his readers. “Never theorize. Pay attention to the particulars. Focus on the concrete.” In this respect, the 19^th century physician-storyteller presages the 20^th century physician-poet, William Carlos Williams, who coined the aphorism, “No ideas but in things.”  

In the long run, Chekhov’s objectivity and aversion to theory played a major role in the development of modern literature, as 20^th century writers followed Chekhov in attempting to describe the world of human character and relationship objectively, and allowing that world to speak for itself. To the extent that Chekhov’s “lawful wedded wife” contributed to his sensitivity, skills, and attitudes, perhaps medical education and practice played an unanticipated role in the history of literature, his delightful “mistress.” 

Adapted in part from Coulehan J. (Ed.) Chekhov’s Doctors, Kent State University Press,  2003

Sir Luke Fildes’ “The Doctor,” is in the Tate: File:The Doctor Luke Fildes crop.jpg – Wikimedia Commons 

Portrait of Chekhov: File: Chekhov 1898 by Osip Braz.jpg – Wikimedia Commons 

REFERENCES 
1, Chekhov A. The Selected Letters of Anton Chekhov, translated by Sidonie Lederer, New York, The Ecco Press, 1984, p.  
2, Coope J. Doctor Chekhov. A Study in Literature and Medicine, Chale, Isle of Wight, Cross Publishing, 1997, p.  
3, Chekhov A. The Selected Letters of Anton Chekhov, translated by Sidonie Lederer, New York, The Ecco Press, 1984, p. 81. 
4, Chekhov A. A Journey to Sakhalin, translated by Brian Reeve, Cambridge, Ian Faulkner Publishing, 1993.  
5, Coope J. Doctor Chekhov. A Study in Literature and Medicine, Chale, Isle of Wight, Cross Publishing, 1997, p. 27. 
6, Chekhov A. Ionych. In: The Tales of Chekhov. Volume 3, translated by Constance Garnett, New York, The Ecco Press, 1972, p. 91. 
7, Coulehan JL. Being a Physician. In: Mengel MB, Holleman WL (Eds.) Fundamentals of Clinical Practice. A Textbook on the Patient, Doctor, and Society, New York, Plenum Medical Books Company, 1997, pp. 73-101. 
8, Chekhov A. The Selected Letters of Anton Chekhov, translated by Sidonie Lederer, New York, The Ecco Press, 1984, p. 54. 
9, Chekhov A. About love. In: The Tales of Chekhov. Volume 5, translated by Constance Garnett, New York, The Ecco Press, 1972, p. 290.

Reviews of Chekhov’s Stories

Cold Eye, Warm Heart: Medicine and Anton Chekhov  

Aug 6, 2025 6423

An Awkward Business by Anton Chekhov 

Jun 11, 2025 1543

The Grasshopper by Anton Chekhov

May 11, 2025 1369

A Doctor’s Visit  by Anton Chekhov 

Mar 11, 2025 1837

Ward No. 6 by Anton Chekhov

Mar 11, 2025 3381

Ionych by Anton Chekhov 

Mar 11, 2025 2182

A Nervous Breakdown by Anton Chekhov 

Feb 11, 2025 1604

Enemies by Anton Chekhov

Jan 11, 2025 1678

Painting an Ideal: Luke Fildes’ The Doctor with Hannah Darvin

Dec 28, 2024 1339

Shortly before the outbreak of The Great War, a young engineering student arrives at a tuberculosis sanitorium high in the mountains of Central Europe. Over the course of his visit there he will share many meals (and drinks) with some of the other patients, a group which will include among others a Catholic conservative and a liberal humanist; there will be long, leisurely after-dinner discussions of varied philosophical topics; temperature charts will be compared; and he will become intrigued by a mysterious woman who is also a patient.  

And no, this is not The Magic Mountain. 

The Empusium is the latest novel from the Nobel- and International Booker Prize winner Olga Tokarczuk. The author subtitles her book “A Health Resort Horror Story,” which is exactly what it is. But it is a horror story which the author has cleverly folded into not just the setting of Thomas Mann’s novel, but the setting and certain elements of the plotline, all of them slightly altered, but recognizable. In fact, recognizing them is part of the fun of this well-plotted, rather Gothic tale. 

As the novel opens Mieczysław Wojnich, a young Pole from Łwów, has arrived at the tuberculosis sanitorium at Gӧbersdorf, in Lower Silesia (currently Poland, formerly Prussia), to be treated for his illness. There is no room at the main building, so he is assigned a room at Opitz’s Guesthouse for Gentlemen, where he meets his fellow (male) patients, who come from various Central European cities and differing viewpoints, but who seem to agree on one thing: the general inferiority of women. Philosophical discussions, which often take place over or after leisurely meals and the consumption of a magic mushroom-laced liqueur called Schwӓrmerei, range widely over several topics (war, language, the nature of reality) but most of the time are intensely misogynistic—what is the purpose of women? Do women have smaller brains than men? Do women’s bodies belong to the State? Have any great discoveries ever been made by women? Should women even be educated at all? (Tokarczuk helpfully includes an appendix to the novel in which she notes that all of the quotes of her characters on this subject are paraphrased from quotes by well-known prominent authors of the past, from Augustine of Hippo to William Butler Yeats)  

Things at the sanitorium go badly from the beginning of Wojnich’s stay. He stumbles upon the dead body of a woman laid out on a table, who turns out to be the wife of the guesthouse proprietor, and his companions tell him surreptitiously that she may have been murdered. He hears noises—voices—coming from empty rooms, and cries in the night from outside the guesthouse. An art student who is terminally ill confides that “people die here,” and not just from tuberculosis; every November, apparently, a young man disappears in the surrounding woods, only to have his body turn up ripped to pieces. And what exactly is going on with those woodsmen in the forest, anyway? 

The Empusium works on many levels. It is an homage to The Magic Mountain, but it is definitely not a retelling of The Magic Mountain. The allusions to Mann’s novel are multiple: the pre-World War I setting at a sanitorium in both novels; the fact that both Mieczysław Wojnich and Hans Castorp are engineering students; the philosophies of Settembrini and Naphtha in the Mountain, analogous to the conservative and humanist positions taken in The Empusium; the close childhood relationship between Castorp and Pribislav Hippe (Mountain) and Wojnich and Anatoly (Empusium), in each case bonding over a pencil. And as in The Magic Mountain, there is a narrator who occasionally breaks the fourth wall; verb tenses in The Empusium shift repeatedly from third-person singular past tense to first-person plural present. These are not subtle, nor are they intended to be.  

Allusions aside, The Empusium is its own story, and a totally different narrative. It is a horror story, a revenge story, a wryly feminist tale of the supernatural set in a place hopefully of healing but also of chronic illness and the ever-present specter of death. Tokarczuk builds suspense slowly, bit by bit, with increasing tension. Almost from the beginning there is the undeniable sensation that something is very wrong at Gӧbersdorf, although it’s hard to pin down exactly what it is. Wojnich often has the feeling that he is being watched. The story line draws from a tradition of folk horror, and specifically from the notion that bad things can happen to “city people” when they are out in the country, among the “old ways.”  

The Empusium is also more than just a horror story, and an important aspect relates to the misogynistic attitudes mentioned earlier. Tokarczuk takes a position on the nature of male-female relations (perhaps the use of a sanitorium as the setting is meant to suggest that misogyny is an illness infecting educated society). In this book “civilization” seems to be identified with maleness, and maleness is located in the sanitorium and the guesthouse, a controlled environment with its dining rooms and drawing rooms and intellectual conversation—and in the medical world, since this is a facility for medical treatment— and it is here that women are demeaned. The forest, on the other hand, is the home of the Tuntschi, female figures created by laborers out of sticks and moss and other forest detritus. It is a place both beautiful and enchanting—and dangerous. Men venture into the (female) forest, and the forest—in the form of the Schwӓrmerei, which Wojnich describes as redolent of mushrooms, moss, and earth—is brought into the guesthouse; boundaries are porous. Male and female, the guesthouse and the forest each have their secrets…and Wojnich is the last to know. But Wojnich has a secret of his own.   

And the title? A word created by the author. Empusa, in Greek mythology, was a shape-shifting female spirit who seduced young men, drank their blood, then devoured them.  

The Empusium
Olga Tokarczuk 
Riverhead/Penguin Random House, New York, 2022 
302 pp. 

Web photo by Marek Piwnicki 

We explore two paintings, each rendering one of two different perspectives on tuberculosis (TB). We first take a close look at Alice Neel’s 1940 painting, T.B. Harlem, and focus on how it depicts the suffering and destruction TB caused, and reveals some of the social determinants of TB at the time. We then examine Thomas Lawrence’s 1794 painting, Portrait of Catherine Rebecca Grey, Lady Manners, and work through how it conveys the convergence of TB clinical manifestations with beauty ideals at the time.

Links:
Here are the links for the paintings we discuss:
T.B. Harlem, Alice Neel, 1940, oil on canvas
Portrait of Catherine Rebecca Grey, Lady Manners, Thomas Lawrence (1794), oil on canvas
The Sick Child, Edvard Munch, 1907, oil on canvas 

Background sources:
JAMA issue featuring cover with Alice Neel painting, T.B. Harlem, and William Barclay commentary.
Russell Teagarden’s According to the Arts blog piece on T.B. Harlem.
Hoban P. Alice Neel: The Art of Not Sitting Pretty. New York, St. Martin’s Press, 2010. Day, C. Consumptive Chic. London, Bloomsbury Visual Art; 2017, 189 pages.
Russell Teagarden’s According to the Arts blog piece on Carolyn Day’s book, Consumptive Chic.
Day C, Rauser A. Thomas Lawrence’s Consumptive Chic: Reinterpreting Lady Manners’s Hectic Flush in 1794, Eighteenth-Century Studies, vol. 49, no. 4 (2016) pp. 455–74. (Not open access)
Russell Teagarden’s According to the Arts blog pieces on The Sick Child, and on Munch’s approach to his painting, and podcast episode with Øystein Ustvedt, curator and Munch expert on Munch’s paintings rendering illness, suffering, and grief.
Here’s an image representative of the 1990s fashion trend known as “Heroin Chic” that we referred to during the podcast.

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

Feature image by Bia W. A.