Bellevue by David Oshinsky

Hardcover, 384 pages Published Sept 20 2016 by Doubleday ISBN13: 9780385523363

Many Americans, even those who have never lived in New York City, have heard of Bellevue Hospital, certainly of some patients, and probably some of its doctors. Its storied history captures our imagination: it has fearlessly and insistently treated epidemics for centuries, as well as the widest range of disease in our nation’s largest city. For most of its history, Bellevue was a teaching hospital associated with two IV League medical schools, Columbia and Cornell, along with that of New York University. In 1966, Columbia and Cornell turned over their commitment to NYU, who produced distinguished physicians trained on some of the world's most difficult and unusual cases.

Land situated on the banks of the East River, about 3 miles from downtown Manhattan, called Bel-Vue, was leased in 1795 to serve as a hospital for those afflicted with yellow fever. It could be reached by boat, on horseback, or by carriage. It was meant to enjoy cooling breezes and yet be far enough away from the city to avoid spreading infection. Ever since that time, Bellevue has served as a public hospital open to handle the contagious cases for which there is no cure.

"I don’t think there is a disease in Osler’s Textbook of Medicine that I didn’t see," said Bellevue medical intern Dr. Connie Guion in 1916.

Bellevue was the center of the AIDS epidemic in New York beginning in the 1980 and in 1990 Bellevue’s Infectious Disease Specialist Dr. Fred Valentine was instrumental in finding a cocktail of drugs that would keep the infection from progressing. Most recently in 2014, Dr. Craig Spencer, a volunteer with Doctors without Borders, arrived in Bellevue to be treated for Ebola, New York’s only Ebola patient. Aggressive treatment and early diagnosis helped to assure his survival, and he was released three weeks later.

The story of Bellevue is in many ways the story of medicine in the United States, plagued by lack of understanding of the role of sanitation in perpetuating disease, and discovering how lack of family or opportunities might lead to poverty, madness, and despair. Almost from the start, Bellevue had patients unable to pay for their care or explain their malady, and yet they could not be turned away. It has always been a refuge for those who had no where else to go: the homeless, the indigent, the immigrant. Today Whites rank last in ‘patient race.’

Bellevue not only handles disease, but has always handled catastrophic injuries from the city and environs. Oshinsky describes the aftermath of the 1863 Conscription Act riots, riots which began because the poor were drafted to serve in the Union army: the city erupted in mob violence, poor on rich, white on black, native on immigrant, Catholic on Protestant. More than one hundred died, and injuries were grievous.

"This is war zone medicine," a Bellevue emergency room doctor observed in 1990. "You'll never go anywhere in the world and see something we haven't seen here."

In 2001 Bellevue ramped up to take victims of the World Trade Center attack, only to discover an unusual sense of helplessness when few treatable injuries resulted from the incident.

Oshinsky is careful not to whitewash Bellevue’s history. His descriptions can be shocking in what they tell us of conditions there throughout the years. Never particularly well-funded, this public hospital was at the mercy of state budgets and political jockeying, and yet it attracted outsized medical talent by dint of its size, location, and affiliation. The worst bits--doctors operating before antibiotics or anesthetics, or psychotic homeless camping in unused closets—cannot keep the reader from finishing this read in absolute awe of the place.

Bellevue has been rebuilt several times, the latest ribbon-cutting in 1973 after two decades of construction to the tune of $200 million. Twenty-five floors for patients, each an acre or more in size, with stunning views of the river or the Manhattan skyline. Twenty elevators service the space, and the 1200 patient beds. The I.M. Pei-designed (Pei Cobb & Fried) atrium completed in 2005 connects the old buildings with the new.

Bellevue has had famous patients (including exposé-writing journalist Nellie Bly), and famous doctors (Dr. Andre Frederic Cournand and Dr. Dickinson Richards won the 1956 Nobel Prize for their work on cardiac catheterization). The ambidextrous surgeon Dr. Valentine Mott "performed more of the great operations" at Bellevue "than any man living," in the words of Sir Ashley Cooper, England's leading surgeon at the end of the eighteenth century.

Any day at Bellevue is positively epic in scope, novelistic, operatic even. When Oshinsky talks about NYC's Office of Medical Examiner being headquartered at Bellevue in the early part of the twentieth century and managed by Bellevue's chief pathologist, the powerful combination of politics, criminality, medicine, and forensics feels explosive. This is Life writ large, in all its manifestations, and Death, likewise. It is a gigantic, voracious story.

For those interested in the history of medicine, this is a must-read. The heroic pieces of the story are difficult to resist. David Oshinsky won the 2006 Pulitzer Prize for History for Polio: An American Story and knows how to tell a big story. There can't be that many who could do what he has done with this magnificent effort.



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Bleeding Edge by Thomas Pynchon

Hardcover, 477 pgs, Pub Sept 17th 2013 by Penguin Press, ISBN13: 9781594204234, URL http://www.us.penguingroup.com/nf/Book/BookDisplay/0,,9781594204234,00.html? ,Lit Awards: The Kitschies Nominee for Red Tentacle (Novel) (2013), National Book Award Finalist for Fiction (2013), International DUBLIN Literary Award Nominee (2015)

Okay, here’s what I think: more women need to read this book. Looking over the reviews I note that most are from men who have read everything Pynchon has written. I hadn’t read anything by him (no, not even Gravity's Rainbow) and I thought the time was right for me to begin. He is considered a writer of great stature and I couldn’t remember why I ignored him.

This is a valentine to women. Even the title refers to women, in all its interpretations: The bloody edge of a knife held against the neck of the forces that will subjugate us; the (monthly) bleeding forward edge of an insurgency resistant to control; the bleeding heart of a mother's love for her children and the fury that unleashes itself when they are threatened. This story is about cool (mostly), calculating (sometimes) resistance against the machine. And it is so funny. I found myself shaking with laughter about three-quarters of the way through. His humor is cumulative. At some point you have to crack a smile, snort at a joke, choke out a guffaw.

I also didn’t know Pynchon was reclusive. My first thought that came to mind when learning this was that he doesn’t like the rest of us very much and can’t stand to interact. But that doesn’t appear to be the case from reading this book. Don’t think for a moment that because he is not in view, we are not in view. He is relentless in his observation, prodding and measuring our postures and attitudes. He apes us, “cans” us for future use. Now I know why he insists on anonymity: the better to catch us at our unconscious most. (best?)

But he likes us. He is gentle with his characters and the characters are us. Except Gabriel Ice. Pynchon is not nice to Ice, the cold industrialist who will collaborate with the forces of evil to achieve power at any cost to others. There is a thick vein of paranoia pushing the narrative forward: “paranoia’s the garlic in life’s kitchen…you can never have enough.”

Pynchon is described in articles about him as an ”incomparable mimic,” which may be why, reading this latest novel, I thought he was Jewish. The novel in set in New York in 2001 and he has captured the speech patterns, the attitudes, the atmosphere precisely, though perhaps with more wit and humor than we usually enjoy there. This is a man who mines deeply what he encounters in his experience.

The first 85 pages or so may have been deliberately obscure--to keep out day-trippers perhaps--but starting any book is complicated, and this has lots of characters to introduce, including the Deep Web. We all get lost there the first time in. He tells us to hold on: “'It's all right, the dialogue boxes assure her, 'it's part of the experience, part of getting constructively lost.'” After this point, he becomes positively lucid.

He helps us along by including a woman for those of us “whose eyes glaze over” without a woman in the story. In fact, he makes her the lead: Maxine. She is a fraud investigator who’s had her license revoked, leaving her free to use slightly-less-than-perfectly-straight methods to find out about her clients and the objects of their scrutiny. She can also pack a Beretta. (I told you forensic accounting was hot: check out the Ava Lee series by Ian Hamilton.)

Maxine is a mother first and last, wife, and skeptic with antennae for a scam. She enjoys a wide circle of dubious contacts on the margins, and has an erotic liaison with an ambiguous hosiery-shredding King Lud Windust, a government (double?) agent. In the post internet boom of the nineties one firm, hashslingrz, the brainchild of Gabriel Ice, has come on her radar.

This feast of symbols has a larger message that is not too difficult to understand, but mostly it is just a fun ride. Not having encountered Pynchon before gave me an advantage, perhaps. I certainly didn’t think he was more difficult than others I have read, Bolaño for one, Pamuk for another. And he was a lot funnier. I did find myself wondering who is this guy?

Little is known of Pynchon the man, but a few souls have attempted to share what they’ve found out, including a 2013 vulture.com article by Boris Kachka: “For much of his life he would flee crowds and cities, dipping a toe into cultures and communities and then leaving and skewering them in turn.”

So this is what I’ve been able to glean about him from reading the book: he watches a lot of movies; he listens to music; he has a wide circle of friends who preserve his deliberate inconspicuousness. He listens. He observes. But does he read? Voraciously. Everything. But does he read novels? Recent novels? I think he does. I trust he does.

I like to think Pynchon has a measure of stability and pleasure in his home life now. Bleeding Edge doesn’t have the emptiness and alienation I associate with someone who is completely outside the life the rest of us enjoy. He is one of us.

I wish him well. Good vibes, coming your way.

The following writings will help immeasurably with your understanding of the novel. For a writer, Pynchon has a remarkably small body of published work, but he is consistent.

Pynchon on Sloth

Pynchon Review of Love in the Time of Cholera

Is it OK to be a Luddite?

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The Flamethrowers by Rachel Kushner

Hardcover, 383 pgs, Pub Apr 2nd 2013 by Scribner, ISBN13: 9781439142004, Lit Awards: James Tait Black Memorial Prize Nominee for Fiction (2013), Women's Prize for Fiction Nominee for Longlist (2014), Folio Prize Nominee (2014), National Book Award Finalist for Fiction (2013), International DUBLIN Literary Award Nominee (2015)

I had a second opportunity to review this title and my second attempt was published in the online journal Avatar Review. The link is here. Below was my first attempt after reading the novel in 2013.

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”The flamethrowers with their twin tanks, and their gas mask were Sandro’s favorite of the assault company dolls. The asbestos sweater and balloon pants and gauntlet gloves you could outfit them with so they could not carbonize when they set a woods on fire. A woods or bunker or enemy machine gun nest, depending. A supply line of trucks or a laddered stack of bodies, depending.

The flamethrowers could have been from a different century, both brutal and ancient and at the same time horribly modern. The flame oil in the twin tanks they carried was five parts tar oil and one part crude, and they had a little canister of carbon dioxide and an automatic igniter and a belt pouch with spare igniters. The flamethrower was never, ever defensive. He was pure offense…a harbinger of death…

But then his father told him the flamethrowers were…cumbersome and heavy and slow-moving targets and if they were ever caught they were shown no mercy. That’s not a thing you want to be, his father said…”

This astonishing meditation on art, rebellion, wealth creation, love, truth, and friendship kept me rapt throughout, but I am not going to lie to you. This is a big work, with lots of moving pieces, and it takes more time to process than others might. I’m not sure I got it all. If art is meant to inspire, to challenge, or to change the viewer, this work succeeded on all counts.

“Difficult to even talk about…I feel changed. Like, say my mind is a sweater. And a loose thread gets tugged at, pulled and pulled until the sweater unravels and there’s only a big fluffy pile of yarn. You can make something with it, that pile of yarn, but it will never be a sweater again. That’s the state of things.”

It is the late ‘70s. Reno is a young drifter with pretensions to art. She lands in New York and hangs at the edges of a group whose composition changes with the inclinations of Sandro and Ronnie. Sandro, Ronnie, and Gianni, the men Reno spends her time with and learns from, are central but elusive figures in this drama. Sandro’s father, the man who teaches Sandro about how life really works, is also a central but elusive figure.

Reno is, literally and figuratively, a printer’s reference, a human Caucasian face against which film color corrections could be matched to a referent. Subliminally viewed, if at all, her face might sometimes leave an afterimage. Only filmmakers and projectionists knew of her existence. “Their ordinariness was part of their appeal: real but unreachable women who left no sense of who they were. No clue but a Kodak color bar, which was no clue at all.”

When we first see her, Reno is riding a fast motorcycle in the desert and later photographs her tracks. Sandro elevates her work by calling this a type of ‘land art.’ She wipes out, smashing the motorcycle, but her efforts lead to a larger success in setting a land speed record—more sport than art. She travels to Italy to promote the bike she rode in the Southwest desert.

I have seen references to this as a “feminist” novel. It would not have occurred to me to say that, though there is some movement of a young, untried woman towards a greater understanding of her place in the world who then begins to take charge of her freedom. She also has a glimpse, towards the end of the story, of the men in her life not merely as simple stock images or disposable short outtakes of a larger film. “Cropping can make outcomes so ambiguous…” These are men with all the feelings and dreams, histories and futures of men and she is growing up.

Reno as a character is particularly attractive in that she is able, in the course of this novel, to go off without a lover, rent an apartment on her own, and ride a motorcycle about New York City. This may be the dream of any young person anywhere: it is not feminism, but life. But what held me were the ideas about art, about looking, about believing, about making the effort.

Reno’s friend Giddle believed herself to be a performance artist of sorts, but somewhere along the way she lost the thread, the point. Sandro made empty boxes. Ronnie photographed beat-up women. Reno made short films of street life. The art created by these folk, and the folk themselves when we first meet them, are stock images, referents for life. But by the end we have had growth and all are in the process of becoming.

Sandro’s father has a critical role in this novel. The backdrop of his powerful and moneyed world of making tires for racing vehicles represents the old guard against which the artists and Italian Red Brigade demonstrators were rebelling. Yet he was a rebel in his time. The father taught Sandro important truths about the world: that there is evil and greed; that power matters; that guns don’t always fire as advertised; that Flamethrowers can be clumsy targets rather than objects of envy. Flamethrowers’ fire often ran back up the hose and consumed the perpetrator.

Kushner held me spellbound with her descriptions of New York’s art scene in the ‘70s. Using Patti Smith’s National Book Award-winning Just Kids as a referent, we get a similar feeling of a young, edgy, trial-by-error art scene. I can’t help but wonder how closely she captured the riots in Italy in the same period.

Something happens in this masterwork that is all internal. It left me looking about myself, contemplative, silent. The poet Marianne Moore wrote that “the deepest feeling always shows itself in silence.” I reread most of it to see if I could untangle it in my mind. I got bits and pieces straightened, but ended up with more questions. But to me this is a sweet confusion. We don’t often have the opportunity to enjoy works of this quality.

A lot of this book is concerned with film. I can imagine this book as a film done in the European tradition—lots of long, slow panning shots and minimal dialogue—following the storyline, such as it is. Would be as confusing and absorbing as the book, I imagine. Kudos to Kushner.


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Rules of Civility by Amor Towles

“Old times,” as my father used to say, ”if you’re not careful, they’ll gut you like a fish.”

Debut novelist Amor Towles has captured a moment in the life of a woman when she was up for grabs—emotionally, spiritually, physically.

1938. New York. Two twenty-something women from very different backgrounds meet in Mrs. Martingale’s boarding house located on the lower East Side of Manhattan. They party by their wits and their beauty for they have no money. Together on New Year’s Eve 1938, they run into Tinker Grey, a wealthy enigma who becomes part of their lives.

Lush, literate language channels the period: jazz saxophonists have a “semblance of rhythm and surfeit of sincerity;” Midwestern beauties are “starlight with limbs”; Indiana-born Eve Ross could be a “corn-fed fortune hunter or a millionairess on a tear.” Towles seems to really enjoy choosing words that express locales, movement, inflection. The language glitters, though the larger job—meaning—seemed to lack depth.

Spring turns to summer and when autumn comes, our narrator Kate has compressed the usual time it takes to develop a grown-up sensibility, and has evolved into someone cautious, calculating, focussed. There were moments in this novel when I discovered I didn’t admire nor even like these people very much. I had a sense of distance from events, and meeting our narrator years later didn't reassure me that she'd developed whatever character or grace her younger self had lacked.

This Books on Tape audiobook was performed by Rebecca Lowman with considerable skill. She may have made our narrator slightly colder than strictly necessary, but it was ably done.




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Sunset Park by Paul Auster

In Sunset Park the characters are drawn with the swift, sure strokes of a master and are immediately accessible, and likeable. As it happens, I began reading this shortly after I'd begun Franzen's Freedom, on which I was struggling to concentrate. I was struck by the similarities and differences between the beginning of this book and Franzen's. Franzen's novel seemed an overstuffed suitcase, the contents of which we pick up in wonder and put back, curious how these vignettes will become relevant in the long course of the story. Auster's story is more like a briefcase of a story, each item within it immediately obvious in its usefulness to us, the readers. The writing is spare, elegant, propulsive.

The novels are similar in that they tell us of an American family, and a young person becomes an adult as we read. The descriptors echo, one book with another, but I had trouble grabbing hold of Franzen's, while Auster's grabbed ME and kept me up late into the night. Books on fiction writing often say we should "show" and not "tell," but strangely, I felt Franzen was showing and Auster was telling, which is one reason why Franzen's was longer, and more digressive. There seemed nothing extra in Auster's. Franzen's is simply a different style, and yields similar truths about the human condition.

If I had one regret with Sunset Park, it is that we did not see more of Pilar, who, while the youngest person in the story, in the end was the most adult. She seemed extraordinary, and we wanted to see more of the woman who could make grown men laugh, cry, sigh, and lie.