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The Names by Florence Knapp and Flashlight by Susan Choi

Howard Trachtman — Mon, 22 Sep 2025 17:34:13 +0000

These two books share a common point of departure. Both begin abruptly on the first few pages with a discrete life-altering event and then follow through on the extended ramifications of the narrative trigger. But despite the similar beginning and framing device, the novels differ markedly in structure and emotional tone.

The Names opens with a woman, Cora, accompanied by her very talkative 9-year-old daughter Maia, on her way to register her newborn baby son and officially name him. She is married to an abusive husband who expects her to name him Gordon, the name that has been given by long-standing family tradition to every first-born son. Knapp immediately confounds expectation by then splitting the narrative into three distinct streams. She creates a novelistic triptych based on whether Cora, in fact, submits and names the baby Gordon, uses a charming alternative, Bear, offered by her chatty daughter, or substitutes a name of her own choosing, Julian, that she hopes will honor and be appreciated by her husband even if it represents a break in the line of Gordons. The choice of each one of these three names results in a distinctly different narrative arc that emerges over the 35-year span of the book. In the Gordon stream, Cora and her children remain trapped in the tense and hostile domestic environment. In the second, Bear version, Cora accepts her daughter’s suggestion for a name. When her husband returns from work that day, he goes berserk and, in a rage, commits a savage murder. He is imprisoned and the mother and children achieve some degree of independence. Finally, in the third, Julian, narrative, where Cora gives the baby the name of her choosing, the husband grows increasingly violent and kills his wife a few years later. The children end up being raised by their maternal grandmother in Ireland and are forced to grapple with the untimely loss of both parents.

Flashlight is the story of a Korean man, Serk, who leaves his native country as a child with his family for a better life in Japan and grows up there. He moves to the United States as a young man, marries a beautiful but mysterious woman, Anne, from the Midwest, and is hired to join the science faculty of a small mid-level college. They have a precocious daughter, Louisa, who is an amalgam of her parents’ genetic input and more than match for both of them. The novel opens with Serk and the 10-year old Louisa walking along the beach in the early evening. The following morning, the girl is found unconscious and hypothermic at the water’s edge, and the father has vanished. The presumption is that he slipped among the rocks jutting into the ocean, was swept away by the waves and drowned at sea. All is not, however, as it seems. There is international skullduggery involved, though it would be unfair to disclose more. Regardless of the cause of the father’s disappearance, just as in The Names, the lives of all the main characters in Flashlight are irrevocably changed by the sudden unexpected event at the beginning of the narrative. The mother-daughter relationship, which can be fraught in the best of circumstances, is profoundly disturbed. The mother, who suffered for many years from undiagnosed multiple sclerosis, is unable to overcome her own physical disability and achieve inner peace. The daughter, despite her obvious intellectual and physical gifts, is incapable of empathizing with others and develops a nearly feral persona. Serk’s story resurfaces in a surprising turn of events. Although there is constant switching of viewpoints and time frames, Flashlight has a more conventional structure than The Names.

Why review these two books together? Doctors are taught and are obligated to treat patients one at a time. The guiding principle is that each person who seeks care should be evaluated and managed as an individual. The underlying cause of disease should be identified as precisely as possible, and the therapy should be prescribed that has the highest likelihood of success and matches each patient’s expressed life goals and priorities. However, patients are almost never seen in isolation. Doctors are trained to compare and contrast the men, and women and children that they encounter, to find commonalities and differences among them in the hope that this wider, more nuanced field of vision will sharpen their diagnostic acumen and improve their therapeutic recommendations for each patient that they treat.

I suggest that reading these two novels together provides a literary example of how an analysis of two books that at first appear to be similar reveals different insights about the ramifications of sudden, life altering occurrences. This is concretized by the contrasting authorial tone, warm and fuzzy in The Names versus cool and detached in Flashlight, and how we as readers engage with these two books.

The Names details the consequences of Cora’s impulsive decision about what name she should give to her newborn son. Flashlight recounts the unspooling of the characters’ lives after one of them disappears while walking along the beach with his daughter. In The Names, the fateful event is a personal human choice, in Flashlight it is an inscrutable act by an unseen, hostile foreign government. This stark difference is manifest in the way readers experience the subsequent stories. As one moves through the 35-year span of The Names, each 7-year interval in which Knapp picks up the story of the “three” sons feels organically linked to preceding period. The actions of Cora, her children, and the supporting cast of characters follow a trajectory that feels smooth and organic. It is true that while unexpected events intrude into each named narrative – Bear, Julian, and Gordon – the global sweep feels grounded and recognizable. There is admittedly a temporary sense of disorientation and a need to regain one’s footing in the plot as Knapp switches gears and advances to the next 7-year interval in the story of the triply named son. The narrative scenery and settings are abruptly changed, and it can take the reader a few pages to get oriented and mentally settled. But within each tale, there is pervading tenderness and a sense of human initiative.

In contrast, Flashlight has a staccato disjointed feel. The novel changes location and time period without clear reason. The nature of the characters, why they do what they do, and the basis for the choices they make, seem inexplicable, as if they are acting randomly and have no control over their lives. Unlike the protagonists in The Names, who one wants to see overcome their difficulties, and for whom one subconsciously roots for their well-being, there is a reluctance to embrace or even sympathize with the characters in Flashlight. They feel remote and distant until nearly the end of the book. It is Choi’s brilliance as a writer that maintains the cohesiveness of the composition and ensures that the reader remains fully committed to the novel and motivated to ultimately understand and come to grips with the plight of the people who populate the literary world she has created.

Occasionally, as readers, we may encounter two novels that complement one another. The Names and Flashlight fell into that circumstance for me. As a pediatrician, I was taught to try to understand the impact of primordial events on the life trajectory of my patients, how singular experiences can have long lasting repercussions for health and disease. But these events are not all the same. Some are internal, reflecting private human decisions, and others are external, reflecting trials and challenges imposed unpredictably by the outside world. The warmer narrative of The Names reflects the former circumstance while the opaque tone of Flashlight mirrors the arbitrary and cruel act that launches the story. For physicians, appreciating the disparate impact of vastly different life events on people will improve our understanding of patients’ experiences and help us provide more compassionate care. These two books, taken together, illustrate the underlying objectives of MedHum, namely, to explore how humanities can meaningfully shed light on the human experience and the practice of medicine.

The Names
Florence Knapp
Pamela Dorman Books/Viking, New York
2023, 328pp

Flashlight
Susan Choi
Farrar, Straus, Giroux
2025, 450pp

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Mental Cases by Wilfred Owen

Carol Donley — Mon, 11 Aug 2025 13:08:42 +0000

The narrator in this three-stanza poem observes men in a mental hospital who suffer from what at the time (World War I) was called shell shock and now might be labeled post-traumatic stress disorder. In any case, they are insane; they relive the “batter of guns and shatter of flying muscles.”

For these tortured souls, “sunlight seems a bloodsmear” and “dawn breaks open like a wound that bleeds afresh.” They cannot escape their hideous memories of the warfare. The narrator sees them as living in hell, and he accepts for all society the blame for what has happened to them–we, he says, have “dealt them war and madness.”

Wilfred Owen is recognized as the master poet of the First World War. Writing from firsthand experiences, both in combat and in a hospital recovering from battle fatigue, Owen gave us image after image of how horrible this war was — how the idealized notions of heroism and manly valor meant next to nothing when one was trying to survive gas attacks and bombs dropped from planes. Owen was killed a week before the armistice.

In this poem he opens with a series of questions about who these mental cases are, why they rock back and forth in some kind of purgatory, why they are so tortured with panic and misery. In the second stanza, he answers the opening questions: these are the men whose minds have been ruined by their war experiences, for whom the grotesque carnage of the war was “rucked too thick for these men’s extrication.”

In the final stanza, he explains why these men are so tortured by their memories. And, typical of Owen, he points out that everyone who supported the war contributed to the madness of these mental cases.

📖 Read the poem

The Poems of Wilfred Owen
Wilfred Owen
Publisher: W. W. Norton
Edition: 1986
Editors: Jon Stallworthy
Place Published: New York

A previous version of this review was published in the NYU Literature, Arts, and Medicine Database (Litmed).
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An Awkward Business by Anton Chekhov

Jack Coulehan — Wed, 11 Jun 2025 14:40:22 +0000

Chekhov 1898 by Osip Braz

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

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

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

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

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

Reviews of Chekhov’s Stories

A Jury of Her Peers by Susan Glaspell

Jacalyn Duffin — Tue, 20 May 2025 15:10:18 +0000

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.

Susan Glaspell

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

Lights, Camera, Deny

Russell Teagarden — Mon, 20 Jan 2025 14:47:18 +0000

When Managed Care Rage Went to the Movies

Public reactions to the fatal shooting of a health care insurance company executive in front of a hotel in Midtown Manhattan on December 4, 2024, revealed a deep, seething antipathy across the country directed at the health insurance industry, an antipathy that has existed for at least thirty years. Its persistence brings to mind four movies: As Good as It Gets, Critical Care, and Rainmaker, released in 1997 and John Q in 2002, each depicting scenarios where rage against the healthcare system play a key role.

As creators in the arts often do, the makers of these movies were picking up on trends and signals before they were appreciated throughout society, and envisioning how they might play out in real life

How it starts

“Fucking HMO bastards, pieces of shit…sorry.”

This is how Carol reacts to the pediatrician who tells her the HMO should have covered certain tests for her suffering, asthmatic son. “Actually, I think that’s their technical name,” is the doctor’s response. This is from a scene in the 1997 movie, As Good as It Gets, directed by James L. Brooks. The movie won major awards from the Academy of Motion Picture Arts, Hollywood Foreign Press Association, and Screen Actors Guild. It also drew attention from the mainstream press for revealing a building rage about to boil over.

Ruthe Stein, from the San Francisco Chronicle, sensing the importance of the scene, wrote on December 23, 1997,

As Good as It Gets may be the first movie to take on HMOs…Brooks strikes a chord when he has Carol use four-letter words to describe the HMO that has mangled her son’s case. The audience hoots and claps its approval.

Then- President Clinton pointed to the scene as representative of real life while speaking at an event involving the Health Care Bill of Rights.

Movies Raging Against the Managed Care Machine

As Good as It Gets (1997, director – James L. Brooks). The movie mostly concerns the relationship between an author with obsessive compulsive disorder and a waitress whom the author depends on for a routine set of practices around his breakfasts. A side story involves the waitress’ young son who has severe asthma. At one point he needed certain tests done, but his health plan refused coverage. This situation led to the scene in which the boy’s mother reacted to this news in a way that attracted widespread public attention. The scene lasted for less than a minute, yet its effect on the image of managed care activities continued for years.

The Rainmaker (1997, director – Francis Ford Coppola). The movie plot involves a scam operation posing as a health insurance company. A young lawyer, fresh from passing the bar exam, takes on the company through the case of a plaintiff. The plaintiff is a young man who has a form of leukemia that can be successfully treated but will kill him otherwise. The insurance company denies coverage for the needed treatment and denies seven subsequent appeals. The lawyer eventually ascertains that the company denies all claims as a matter of course. Although a judgment is made against it, the company declares bankruptcy and goes out of business, thereby vitiating the settlement awarded. The patient dies. The movie is perhaps best-known for a line said by the lawyer’s assistant which fueled the growing public sentiment at the time: “There’s nothing more thrilling than nailing an insurance company.”

Critical Care (1997, director – Sidney Lumet). The setting for the movie is mostly in a hospital critical care unit. As in As Good as It Gets, a particular scene feeds the fury to come about managed care. A resident physician taking care of a terminal patient who has been clear about not wanting to continue treatments that only prolong suffering, argues with a senior physician and mentor about the advisability of putting the patient through yet more futile interventions. With his guard down from a combined state of inebriation and dementia, the senior physician tells the resident that the patient is fully insured and is thus a source of guaranteed revenue. He goes on to explain the economics (and immorality) driving these decisions.

[With HMOs] we get paid not to perform medical procedures. It’s a little like when the government pays the farmers not to grow crops. However, with insurance we get paid to perform medical procedures. Do you understand the difference?

On that basis, and that basis alone, he demands that the resident proceed full speed ahead.

With this scene, the moviemaker is going further than pointing to just the managed care organizations as the source of rage, but also to the health care providers who can spot opportunities for self-dealing. Viewers already sensitized to managed care activities could become even more worried, incensed, or nihilistic about the situation.

John Q (2002, director – Nick Cassavetes). About the same time John Q. Archibald’s full-time factory job is cut in half, along with his health insurance, his son collapses from heart failure while playing in a Little League baseball game. After a cardiologist tells John about his son’s need for a heart transplant and the financial requirements which he can’t meet, a nurse he asked why his heart condition had not been detected before tells them, “HMOs pay the doctors not to test. That’s how they keep costs down.” This comes up again when John asks the cardiologist how it could be that his son’s condition had never been discovered. An accompanying intern chimes in saying,

HMOs pay their doctors not to test. That’s their way of keeping costs down. Let’s say Mike did need additional testing and insurance says they won’t cover them. The doctor keeps his mouth shut and, come Christmas, the HMO sends the doctor a fat-ass bonus check.

The surgeon qualifies the intern’s assertion as possible but unlikely.

Try as he might, John Q cannot come up with the $75,000 down payment. The hospital administrator will not put his son on the transplant list, and he is released to be taken home where he will die. John pulls out a gun and takes the emergency room hostage. No one is killed, no one is shot, and a solution is found in the end. However, the movie raised the level of rage to one that produced the possibility of gun violence.

How It Ends?

Nearly thirty years have passed since these first movies depicted the rage that came in response to aggressive measures directed at managing health care costs, especially when they involved restrictions on certain products and services health care providers ordered and patients expected. Did these movies get it right? In large measure, they did. Management activities got more aggressive over the years and indeed many of those portrayed that were particularly egregious became a reality for some. As a medical affairs executive in a large pharmacy benefit company before, during, and after these movies were released, I witnessed (and fought against) the scenarios they depict as well as many others as bad or worse (with the exception of gun violence).

Where the movies helped to identify the problems early and possibly stoked the existing rage by bringing attention to them, they, along with professional health organizations, news media, and consumer advocates, pushed legislatures and regulatory agencies into creating laws and rules concerning how these activities are managed. These measures helped some, but media stories, books, and movies highlighting the problems appear regularly, keeping the rage alive, and maybe even intensifying it to the level anticipated in John Q. Maybe, even, to the level that played out on an early morning Manhattan street in December 2024.

Podcast: The Clinic & The Person

Film Trailers

As Good as It Gets Trailer

John Q Trailer

The Rainmaker Trailer

Critical Care Trailer

Web photo by Christian Harb