Dawn of the New Everything by Jaron Lanier

Hardcover, 304 pgs, Pub Nov 28th 2017 by Henry Holt and Co., ISBN13: 9781627794091

The ideas in this book are so refreshing, thrilling, amusing, enlightening, and sad that they had me eagerly looking forward to another session with it whenever I got a chance. I found myself fearing what was to come as I read the final chapters. If I say I wish it had turned out differently, it wouldn’t make much difference. I am just so relieved & reassured that such people exist. We share a sensibility. I suppose such people forever be shunted aside by more talky types, louder but not more capable. Anyway, this kind of talent shares a bounty that accrues to all of us.

Everyone knows Lanier was exceptional for his ideas about Virtual Reality. He created, with others, an industry through the force of his imagination. What many may not recognize was that amid the multiple dimensions that made his work so special was his insistence on keeping the humanity—the imperfection, the uncertainty…the godliness, if you will—central in any technological project. It turns out that slightly less capable people could grasp the technology but not the humanity in his work, the humanity being the harder part by orders of magnitude.

It was amusing, hearing such a bright light discuss ‘the scene’ that surrounded his spectacular ideas and work in the 1980s and ‘90s, the people who contributed, the people who brought their wonder and their needs. He gives readers some concept of what VR is, how complicated it is, what it may accomplish, but he never loses sight of the beauty and amazing reality we can enjoy each and every day that is only enhanced by VR. Much will be accomplished by VR in years to come, he is sure, but whether those benefits accrue to all society or merely to a select few may be an open question.

While ethnic diversity is greater now in Silicon Valley than it was when Lanier went there in the 1980s, Lanier fears it has less cognitive diversity. And while the Valley has retained some of its lefty-progressive origins, many younger techies have swung libertarian. Lanier thinks the internet had some of those left-right choices early on its development, when he and John Perry Barlow had a parting of ways about how cyberspace should be organized. It is with some regret that we look back at those earlier arguments and admit that though Barlow “won,” Lanier may have been right.

Lanier was always on the side of a kind of limited freedom, i.e., the freedom to link to and acknowledge where one’s ideas originated and who we pass them to; the freedom not to be anonymous; or dispensing with the notion that ideas and work are “free” to anyone wishing to access it. he acknowledges that there were, even then, “a mythical dimension of masculine success…that [contains] a faint echo of military culture…” Lanier tells us of “a few young technical people, all male, who have done harm to themselves stressing about” the number of alien civilizations and the possibility of a virtual world containing within it other virtual worlds. He suggests the antidote to this kind of circular thinking is to engage in and feel the “luscious texture of actual, real reality.”

In one of his later chapters, Lanier shares Advice for VR Designers and Artists, a list containing the wisdom of years of experimenting and learning. His last point is to remind everyone not to necessarily agree with him or anyone else. “Think for yourself.” This lesson is one which requires many more steps preceding it, so that we know how to do this, and why it is so critical to trust one’s own judgment. There is room for abuse in a virtual system. “The more intense a communication technology is, the more intensely it can be used to lie.”

But what sticks with me about the virtual experience that Lanier describes is how integral the human is to it. It is the interaction with the virtual that is so exciting, not our watching of it. Our senses all come into play, not just and not necessarily ideally, our eyes. When asked if VR ought to be accomplished instead by direct brain stimulation, bypassing the senses, Lanier’s answer illuminates the nature of VR:

“Remember, the eyes aren’t USB cameras plugged into a Mr. Potato Head brain; they are portals on a spy submarine exploring an unknown universe. Exploration is perception.”

If that quote doesn’t compute by reading it in the middle of a review, pick up the book. By the time he comes to it, it may just be the light you needed to see further into the meaning of technology.

Lanier is not technical in this book. He knows he would lose most of us quickly. He talks instead about his own upbringing: you do not want to miss his personal history growing up in New Mexico and his infamous Dodge Dart. He talks also about going east (MIT, Columbia) and returning west (USC, Stanford), finding people to work with and inspiring others. He shares plenty of great stories and personal observations about some well-known figures in technology and music, and he divulges the devastating story of his first marriage and subsequent divorce. He talks about limerence, and how the horrible marriage might have been worth it simply because he understood something new about the world that otherwise he may not have known.

All I know is that this was a truly generous and spectacular sharing of the early days of VR. It was endlessly engaging, informative, and full of worldly wisdom from someone who has just about seen it all. I am so grateful. This was easily the most intellectually exciting and enjoyable read I've read this year, a perfect summer read.

Here is a link to a conversation with Jaron Lanier conducted by Ezra Klein for his podcast The Ezra Klein Show, available on iTunes or Stitcher.

Tweet

Dreamland: The True Tale of America's Opioid Epidemic by Sam Quinones

Hardcover, 384 pgs, Pub Apr 21st 2015 by Bloomsbury Press (first published April 15th 2015), ISBN13: 9781620402504, Lit Awards: PEN/John Kenneth Galbraith Award for Nonfiction Nominee for Shortlist (2017), Los Angeles Times Book Prize Nominee for Current Interest (2015), National Book Critics Circle Award for General Nonfiction (2015)

The spectacular public service reporting Sam Quinones does in this nonfiction is so detailed and many-faceted that it left me feeling a little voyeuristic, not having been visited by the scourge of opioid addiction myself. Good lord, I kept thinking, so this is what we are dealing with. I knew something was different, I just didn’t have any conception of the size, scope, method, and means of this problem.

Quinones starts his story in the early 1980s when the first ranchero Xalisco marketers came up from Mexico with an innovative method for just-in-time drive-by selling of drugs to rich white kids in the suburbs. They explicitly avoided cities and black people because they admitted they were afraid of them, their violence and their gang activity. Besides, the thinking went, blacks never had any money. They’d just as soon steal from a dealer as pay him. The white kids had money and wanted convenience above all.

At almost the same time, and a cultural habitat away from small-time drug dealers of black tar heroin from Mexico, a drug company owned by the Sackler medical empire released an opiate derivative in pill form meant to alleviate pain. Early on, it is possible that creators, marketers, and prescribers of this plague did not know what they had unleashed. But within a couple of years, it is difficult to avoid the conclusion that great numbers of people within and without the company sold the product in full knowledge of its wicked potency and addictive properties.

Quinones has been researching and reporting on this topic for a couple of decades, and lived in Mexico for ten years, observing the supply-side. Before having a comprehensive understanding of the subject, Quinones thought the heroin problem began with U.S. demand for drugs. After researching the situation in the heartland United States, he has decided that our problem now with heroin and fentanyl overdoses was paradoxically caused by a huge supply of opioid pills, prescribed by doctors in legal clinics, and condoned at every level of society and government in our country.

The story Quinones shares is un-put-down-able and truly remarkable, particularly his discussion of the marketing techniques for black tar heroin used by the small farmer-seller systems first set up by residents of Xalisco. Their method of growing-packaging-selling expansion into the heartland of America should make us sit up and pay attention. Ground zero for the meltdown of middle America is identified by Quinones as Portsmouth, Ohio, a middle class town at the center of a web of major cities like Cincinnati, Cleveland, Louisville, Indianapolis, Pittsburgh. The first known vector of the opioid infection was an unscrupulous doctor who overprescribed pills, knowing they were addicting his patients. Aided by ordinary well-meaning doctors who listened to marketing spiels by the drug makers, and who believed the pills to be non-addictive, the infection spread rapidly. Quinones tells the tale as it unfolded, involving Medicaid scams and cross-state purchases and sales.

What Quinones tells us gives us lessons for many other supply-side problems (marijuana? guns?) we may face in our society, now or in the future. When asked in an interview why restrictions on Class A prescription pills or opiates of any sort would produce the better outcomes, Quinones points out that when prohibited liquor was once again allowed to be sold openly, it was classified as to strength and sold differently. He warns that we are rushing to sales of marijuana with potency levels unknown fifty years ago and may wish we’d instituted some restrictions or controls before it becomes socially acceptable.

This nonfiction is dispassionate enough to allow us time to adjust our thinking around the problem of young people—entire families, really—losing their place in a productive society, with almost no way out. Now, with the recognition of the problem being forced upon our politicians, teachers, medical personnel, and law-enforcement officers, some changes are being instituted which may help after the fact of addiction, never a good time to try and solve a problem. With discussion and buy-in by ordinary citizens it may be possible to attack this problem before it begins.

There are at least seven interviews with Quinones free on Soundcloud, ranging in length from 15 minutes or so to an hour and a half. You have to hear some of these stories. It's mind-blowing. I listened to audio version, very ably read by Neil Hellegers, and produced by Bloomsbury. It is a must-read, must-listen.



Tweet

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.



You can buy this book here: Tweet

Hope for a Cool Pillow by Margaret Overton

Many end-of-life discussions have been popular these past couple years, but this one is a little different. It comes at the discussion from a different angle, and it is an angle I have not seen well-articulated, certainly not by a doctor.

For one thing, it is intensely personal, especially in the beginning. Overton claims to be an introvert, but she does an awful a lot of reaching out in this book. I laughed aloud at one joke she told on herself:

At her nursery school, they often played musical chairs, “which I loathed and which may have scarred me for life. I still worry about adequate seating. Usually some poor kid who was not paying attention got stuck without a chair. Then he stood awkwardly and felt blazingly stupid while everyone else sat comfortably and looked smug. It was a terrible game.”

It is hard not to like this woman flinching yet at a child’s game. But, in a way, this book is about paying attention so you can lie as comfortably as possible on your own deathbed.

As a doctor, Overton has the viewpoint, motives, and reaction to incentives of a doctor. But here she is talking about the health care system and why it doesn’t seem to work for everyone (according to statistics, we might say anyone) in this country. I have never personally seen a doctor question in detail the incentives of the system, but Overton does here. She is very thought-provoking, particularly because she doesn’t give us easy answers. She acknowledges the questions, and asks us to do the same.

”The last six months of life accounted for roughly twenty-five percent of our Medicare spending….We try really hard to revive the people least likely to benefit….doctors often operate to fix something that will not save a dying patient, and in doing so avoid the difficult conversation with patients and caregivers about their prognosis and what they want.”

So, it is not so different from Atul Gawande’s Being Mortal, except that she gives a little responsibility to doctors, many of whom are not trained nor equipped for this conversation.

If a person with good health insurance and a terminal disease is in the hospital, is there any reason to limit treatment? She suggests that a for-profit private system of healthcare may not give us the kind of incentives, treatments, and quality of life (or quality of death) we desire.

”I find the concept of for-profit hospitals appalling. There’s an inherent misalignment of motives in the “business” of medicine. Physicians have a moral and financial incentive to provide excessive care to people who can pay for it as long as they have a heartbeat.”

She interleaves her narrative about taking a three-part post-graduate course at Harvard on hospital administration with the declining health of her father and her mother, and with experiences she is having in the hospital. Mostly she wants to share her grief, her expertise, her thinking, and her care. She seems the best kind of friend to talk with about end-of-life issues.

Her father had urged on her the need for preparation, and attention to these matters. He managed very well, until his cancer diagnosis. After many treatments meant to extend his life rather than cure his cancer, things got grimmer. He decided he’d had enough, and his preparation meant his family did not have a hard time of it.

Overton’s mother was a different story, and many of you will recognize the more lingering death of a dementia patient. However, even this wasn’t as painful as some of us experience, due to that planning again. The real problem comes when someone has no family to help, as is the case with many patients Overton sees in the hospital at the last stages of their lives, treated callously by an ever-changing roster of medical care personnel, and unable to make clear decisions.

I find it fruitful to hear the experiences of a doctor, and note she says “Personally, I don’t want to live into my nineties.” Her recommendation is that we do not wait on thinking about these things because life is fragile, and you don’t want to be one of the 45% of patients without advanced directives. Your life, in that case, would no longer be your own.

Totally inappropriately, I am adding a note that Overton introduced me to the Dunning-Kruger effect, which is something I thought I'd invented, frankly. It is the notion that incompetent folks may be too incompetent to know how incompetent they are. It is a very useful construct, particularly in these times.


You can buy this book here: Tweet

When Breath Becomes Air by Paul Kalanithi

Hardcover, 228 pages Published January 12th 2016 by Random House

What makes human life meaningful? Kalanithi, a thirty-six year old neurosurgeon, tried to locate the nexus of language between science and philosophy to answer the question. “Literature provide[s] the best account of a life of the mind, illuminates another’s experience, and provides the richest material for moral reflection.” There is messiness and weight in real human life that is not accounted for by science, says Kalanithi. Science and analytics (and atheism) cannot encompass all the mystery of human life. He gives the best argument I have heard for religious faith, suggesting that no one human has any answers because each individual has only piece of the puzzle. It is only in human connection that we can start to put the pieces together, making sense of the world. “Human knowledge grows in the relationships we form between each other and the world.”

Science, created by human hands to make sense of the world, cannot contain the world. It doesn’t account for those things that make literature, and life, so compelling and so meaningful: “hope, fear, love, hate, beauty, envy, honor, weakness, striving, suffering, virtue…sacrifice, redemption, forgiveness…justice...goodness…mercy.” Questions without answers. Pieces of a puzzle.

Kalanithi died of lung cancer shortly after writing these words. But he strove every day, in his work, in his studies, in his family and friends, to find meaning in life. He thought it might reside in words. Language. As a neurosurgeon he was taught, and he believed, that if a person lost the capacity to communicate--to speak or to understand language—their life became no life at all. He was a student of literature besides being a neurosurgeon, and in language was meaning.

This memoir is Kalanithi’s attempt at connection. The Foreword is written by a Dr. Abraham Verghese, author of the unique and unforgettable novel about medicine and Africa, Cutting for Stone. The Epilogue is written by his wife, Lucy Kalanithi, also a doctor. Their words fore and aft add heft and a kind of imprimatur: this man really existed and, yes, he was as thoughtful as he appears. His life had meaning.

Kalanithi changed my mind about something, and showed up a deficit, a smallness in my own thinking. I have always been suspicious of people who spend their lives in school, even though they might be concurrently working, piling up more and more degrees. Anybody can do that, I thought. Kalanithi completed a Bachelor's in English literature and human biology, a Master's in English literature, a degree from Cambridge in the history and philosophy of science and medicine, a medical degree with neuroscience and neurosurgery specializations. He was in his mid-thirties when he finally finished. And then he died. That last year he wrote this book and he managed to show me that, if one is focused and serious and seeks the critical nexus between life and death, one may begin to perceive the outlines of a moral philosophy that might help answer the large questions. We only have a lifetime to find meaning, and sometimes that lifetime is short.

When Kalanithi talks of his 8-month old daughter shortly before his death, how she is all future and he is all past, we see what he sees: that their circles just touch, but don’t significantly overlap. She will never know him. This has the poignancy, truth, messiness, love, and tragedy of literature. Of life.

I listened to the audio of this book, read by Sunil Malhotra and Cassandra Campbell. I have encountered Malhotra before and he is one of the best narrators in my experience. His pacing is perfect and he makes the reading very easy to follow. I ended up buying the hardcover because the book was so meaningful for me and because it is easy to pass around.

“One key to managing a terminal illness is to be deeply in love, vulnerable, kind, generous, grateful.” –Lucy Kalanithi

You can buy this book here: Tweet

To Rise Again at a Decent Hour by Joshua Ferris

Ferris, as you might be able to tell from the title, is all about religion in this novel. His main character, Paul C. O’Rourke, is a dentist—a dentist with a taste for the absurd. He is funny, especially when he is trying not to be. His practice in New York City keeps him crazy busy, so he allows himself only a few indulgences. He is a Red Sox fan in New York, which means he must watch every game (except the 6th inning), taping them to watch later if he has something else on his schedule. The ritual is one which gives structure, and a kind of meaning to his life. He wants something. He still has desire of a sort.

O’Rourke tries to be normal, just so that he can get along with other folks, but he is like a space bot acting human: it’s all wrong. O’Rourke is having a crisis. He doesn’t get the point “of it all,” and he especially doesn’t see God acting in the world. So when a patient tells him he is part of a long-lost race of non-believers in God (any god), O’Rourke wonders if perhaps it isn’t just possible: To be genetically indisposed to believe in God.

O’Rourke wants something to be everything: absorbing, challenging, meaningful. His girlfriends had close family ties, and O’Rourke found that to be meaningful for awhile: he wanted to be a part of their families as much as he was interested in the women themselves. But their religious affiliations always proved a barrier. O’Rourke didn’t believe in God.

One night O’Rourke wakes in the middle of the night and the city outside his window is completely quiet. Not a person could be seen, though earlier the streets were filled with people.

"I felt so forgotten, so passed over, so left behind, so lost out. I was sure not only that everything worth doing had already been done while I was asleep but also that, now that I was awake, there was no longer anything worth doing. My first instinct was to reach for my me-machine. It put me in instant touch, it gave me instant purpose…No one had called or emailed or texted. I would do practically anything, I thought, to have them back—I mean the strollers and lovers of a few hours earlier, so that I might have another chance to stroll alongside them…and, after awhile, to leave the Promenade, off to bed for a good night’s sleep—or to that one vital thing among the city’s offerings that night, that one unmissable thing that makes staying up all night a treasure and not a terror—and then to rise again at a decent hour—to walk the Promenade in the light of a new morning…oh, come back you people lost to darkness! Come back, you ghosts, the day is hard enough. Don’t leave me alone with the night…There was the hum of the river, and the last desultory traffic of the night washing by on the expressway below. I can only suggest the effect it had one me, that is the feeling that my life, and the city’s, and the world’s every carefree, winsome hour, were perfectly without meaning."

In the final pages of the novel, O’Rourke finds himself understanding a little of how others manage to get through their days. If it doesn’t hurt, there is no reason to worry about it. "What’s the point of dwelling on all the shit and the misery?" He’d like to do as others do, but one senses his melancholy. He is lonely and there is no God.

Finally, O’Rourke concludes that there is no certainty, no freedom from doubt, “there is only will.” We may retain the doubt, but we must still act, and in the acting, we may have enough to sustain us spiritually. It makes sense to me what Ferris says about religions: that they are less concerned about God than they are about the religion itself. And all religions have this problem. They can sometimes even lose sight of morality itself, a failing no involved God should permit.

O’Rourke was free to change his affiliation from the Red Sox to the Chicago Cubs, and take a swing with a cricket bat at a ball that came in fast and low one day in Kathmandu because while he still had doubt, he also had hope. The pitcher was his patient, a patient with perfect teeth.

I had to work hard on this book for many days before I caught glimmers of Ferris' meaning. I don’t think it is because I listened to it rather than read it. The listening helped because the reader, Campbell Scott, was drier and funnier than the voice I had in my head as I read, but it is true I couldn’t mark the sections that wove the religious quest together. They got buried under the avalanche of extraneous associations the story of the dentist practice provoked.

There is nothing wrong with a little existential angst, especially if it makes one doubt and not be an arrogant prick. But Ferris is right. It doesn’t get one anywhere and itself has no meaning. One can only do what needs to be done and go on with it. Unless, of course, you don’t. Go on with it, I mean. That's the other option.


You can buy this book here: Tweet

The Prank: The Best of Young Chekhov by Anton Chekhov translated by Maria Bloshsteyn

This collection of all-new stories by the young Anton Chekhov published this summer by New York Review of Books @nyrb reveals an artist desperate to make a living. He was twenty-two years old and collected these stories hoping to launch his career, but they were never published. Illustrated by Nikolay Chekhov, Anton’s older brother, it was censored before it could come out.

When you read the stories you may be surprised, as I was, at what the censors deemed subversive. The stories are broad comedy, slapstick satires, and absurd parodies of Jules Verne and Victor Hugo. The story “St Peter’s Day” reminds me of Jerome Jerome’s Three Men in a Boat, it is so filled with manly boasting and ridiculously goofy repartee. But there is a razor streak of criticism in there and Chekhov gives no quarter. An old peasant accompanying a hunting party drifts off while the other men, middle class and aspiring, buffoonishly discuss where to avoid other rotters who were meanwhile taking the best spots. I kept expecting the old peasant to show up with a hunting bag full while the others expounded, but he never did. The others just left him there.

Translator Maria Bloshsteyn in the Introduction puts these early stories into a perspective that includes Chekhov’s later works. The old peasant left by the hunting party, Bloshsteyn tells us, appears again in Chekhov’s last play The Cherry Orchard. And the social critique of marriage, Russian life, and social strictures that appears in “Artists’ Wives” and “The Temperaments” foreshadows all of Chekhov’s work. A quick look through The Complete Plays by Chekhov, translated and annotated by Laurence Senelick (2006), shows only the late plays of Chekhov not to be “comedic anarchy.” When Chekhov dropped the broad humor for his late plays, his work still had bite but was even more damaging than his humor. “Uncle Vanya,” for instance, exhibits many of the broad categories of personality shown in his early stories but seems almost despairing.

A quote of Chekhov’s chosen for the cover of the above-mentioned collected plays shows his resistance to government interference in daily life:

”My holy of holies is the human body, health, intelligence, talent, inspiration, love, and the most absolute freedom imaginable, freedom from violence and lies, no matter what form the latter two take.”

Chekhov trained as a doctor in the 1880s. During his residency he began publishing short humorous pieces in magazines as he was the economic mainstay of his extended family. Knowing of his extensive education adds to our enjoyment of his snide observations, and may explain the quote in which he expresses "the human body" and "health" first among his holy of holies.

In “Artists’ Wives,” a short story in The Prank, Chekhov takes a swipe at those living the bohemian life, which included himself:

”Madam Tanner’s vice consisted of eating like a normal human being. This vice of his wife’s struck Tanner to his very heart. 'I will reeducate her!' he said. Once he set himself that goal, he got to work on Madame Tanner. First he weaned her off breakfasts and suppers, and then off tea, A year after her marriage, Madame Tanner was preparing one course for dinner instead of four. Two years after her marriage, she learned to be satisfied with unbelievably small amounts of food. Namely, during the course of twenty-four hours, she would ingest the following quantities of nourishing substances:
1 gram of salts
5 grams of protein
2 grams of fat
7 grams of water (distilled)
1 1/23 grams of Hungarian wine
Total: 16 1/23 grams
We do not include gases here because science is not yet able to determine accurately the quantities of gases that we take in."

In “The Temperaments (Based on the Latest Scientific Findings)” Chekhov describes the “humours” of man, that is to say, how the “Sanguine Temperament in a Male” exhibits:

“The Sanguine male is readily influenced by all his experiences, which is the cause…of his frivolity…he is rude to teachers, doesn’t get haircuts, doesn’t shave, wears glasses, and scribbles on walls. He is a bad student but manages to graduate…”

We read on for two pages and then get the description of “Sanguine Temperament in a Female.”

“The sanguine female is the most bearable of women, at least when not stupid.”

That’s all. We learn about the “Choleric Temperament” ("the choleric man is bilious with a yellow-gray face…" and “the choleric female is a devil in a skirt…”), the “Phlegmatic Temperament” ("the phlegmatic male is a likable man…He is always serious because he is too lazy to laugh."), and the “Melancholic Temperament,” none of which reassure us that human life is worth the resources needed to sustain it.

In “Papa,” the mother of a son failing in school sounds remarkably current:

”Papa, go to the math teacher and tell him to give the boy a good grade. Tell him that he knows his math but that his health is poor. That’s why he can’t cater to everyone’s whims. Force him to do it!”

In “Before the Wedding,” a father speaks with his daughter, the bride to be:

”And, my daughter…European civilization got women thinking that the more children a woman has, the worse for her. How wrong! It’s a lie! The more children, the merrier! No, wait! It’s just the opposite! My mistake, sweetie. Less children—that’s what it is. I read it in some journal the other day—something someone named Malthus came up with.”

Anyway, this is Chekhov unbound, young, exuberant, and silly. His parody of Jules Verne is classic while the one of Victor Hugo sounds more like Chekhov than Hugo. It may have been the translation he had, no? This is Chekhov’s take:

”Then thunder rolled. She fell upon my chest. A man’s chest—it is a woman’s fortress. I clasped her in my embrace. Both of us cried out. Her bones cracked. A galvanic current ran through our bodies. A passionate kiss…”

You can buy this book here: Tweet

Morphine by Mikhail Bulgakov

Mikhail Bulgakov was trained as a doctor and went to the front in the First World War where he was badly injured twice. [Wiki] To curb his pain, he began taking morphine. His addiction grew, and though in 1918 he gave it up altogether, the torture of that addiction never left him. In 1926 he published a short fictional pamphlet or monograph about a doctor in the backwoods who succumbed to morphine addiction. This work, translated by Hugh Alpin and published in 2013 as part of the New Directions Pearl series, is that account.

A doctor happily residing in a small provincial town receives word that a colleague in the backwoods clinic where he once worked is in a perilous state of health. As he readies himself to go to his assistance, he learns from further communication that the ill man is dying of a gunshot wound. The doctor rushes to the remote village only to be in time for the man’s death. Before he dies, the man presses upon the doctor his diary, which tells the confusing and harrowing story of a slide into morphine addiction.

The pamphlet is not long, only 53 pages, and yet we understand the agonies of increased dosages, the paranoia, the regression into solitude, the despair experienced by the man. It was impossible for him to become free of the drug. The gunshot was self-inflicted.

Bulgakov was raised as a Christian (his father was a priest), one of seven children. He began publishing stories and plays after several years working in war-torn areas, but his work was often repressed by censures. He became “a satirist at a time when true satire is absolutely impossible in the USSR.” (from the Intro to The Master and Margarita by Mirra Ginsburg). He was reduced to producing librettos for opera and dramatizing the works of others. He continued to write, however, and from 1928 to 1940 when he died of inherited liver disease, he worked on his masterpiece, The Master and Margarita, which was not published in the Soviet Union until 1966.


You can buy this book here: Tweet

Being Mortal by Atul Gawande

”The only way death is not meaningless is to see yourself as part of something greater: a family, a community, a society. If you don’t, mortality is only a horror.”

I wonder if Gawande doesn't have that a little bit wrong. It is life that is meaningless and a misery without a larger connection, not death. Death may be a balm to those with no one to tether them, to tend to them.

My great aunt lived to be 102 years old. She would often say, looking at the younger generations, “It’s wonderful to get old.” Gawande touches on this in his memoir chronicling the death of his father and in his discussion of dying well. Older folks have more moments they classify as happy than do younger folks. Oldsters generally experience less anxiety, too, perhaps from having “seen it all before,” but perhaps also because they know bad times do pass. Usually.

I still think my great aunt was being just a little facetious, since the rest of Gawande’s book tells us pretty explicitly that old age is not for wimps. In fact, as Elizabeth Gilbert suggested in her novel The Signature of All Things, we do better when we turn towards “the great changes that life brings” rather than turn our wills away. Gawande tells us how it is possible in some cases to choose less treatment rather than more when faced with life-threatening illness and experience a better quality of life in our final days.

This is pretty grim stuff but Gawande is graceful, as graceful as he can be when the choices are so limited and so frankly horrible. When a loved one (or we ourselves) must make choices, it is wise, he counsels, to ask ourselves a few questions: What do we fear most? What do we want most to be able to do? What can/can’t we live without? What will we sacrifice so that we can accomplish what it is we want? Our choices may change as circumstances change, so one has to revisit occasionally, to make sure we (and our family and our doctors) are proceeding along the path we have chosen for ourselves.

It is almost, but perhaps not quite, enough to make one wish for a sudden, early death. We all must go through it, so we’re not alone. It’s just that medical knowledge, technology, and skill can do only so much, and after that we still have to face the inevitable. Gawande gives lots of examples of patients and of people he has known who have these choices thrust upon them. On balance, he concludes, those who accept, rather than thoughtlessly fight, a terminal prognosis have a better death.

This book is worth reading, maybe more so before you need it. Filling out the hospital’s required “health care directive” is actually difficult unless you have someone like this to explain what it actually means. No intervention may mean weeks instead of months; it may also mean calm instead of recovering from radical surgery. It may just be unbearably depressing. I get that.

One interesting study Gawande talks about is one in which people who know their time horizons are short, or who experience life-threatening conditions (e.g., living in a war zone, 9/11, surviving a tsunami) change their view of what they want out of life, their "hierarchy of needs" as defined by Maslow. People with unlimited horizons put a high premium on growth and meeting people who are interesting and influential. Those with foreshortened horizons look to their closest friends and family for sustenance and comfort. War zones may not grant you friends or family, but certainly intense, highly-charged, and memorable relationships result from them. Little is expected, much is granted. And I guess that is key. There is more generosity to go around when one is in the final days and it may be best not to occlude that blessing with a confusion of treatments that do not mean a better life.

Gawande addresses some of the most difficult questions we have to decide in a lifetime. It is not easy to read. But it helps, I think, to know what choices we can make when the time comes for someone we love or for ourselves.


You can buy this book here: Tweet

The Chimps of Fauna Sanctuary by Andrew Westoll

Years ago I lived a long time in a populous third-world country. I remember saying to a friend living in the U.S. that a focus on animal rights seemed a distraction in view of human living conditions around the globe. She gave me a look I can still see to this day and have thought about many times since. "Why are we more important than every other living species?" and "What would our lives be like without other species?" she could have asked. There is no doubt in my mind that we must be more mindful of species living on the planet around us and treat each with great care and respect. That is also the theme of this fine documentary about research chimps living out their final days on a farm in Canada.

Westoll was a scientist first, but changed his focus to writing later in his career. He urges us to look at the evidence and acknowledge that we have a duty to restrict testing of animals in the name of science. And he urges us to insist Congress pass the Great Ape Protection Act (GAPA) which has been on the roster for discussion and passage for years now. Once again we lag behind other Western nations who long ago restricted the use of primates for research. Apparently studies using primates have determined that primates are sufficiently different from humans as not to be of great use in providing useful information for medical use. But the studies continue, Westoll suggests, perhaps because they are so lucrative to the grantees receiving federal monies.

In the meantime, social animals of great intelligence and emotional range are subjected to lives of captivity and the cruelties of isolation; are introduced to disease and treated with disregard. This story tells us mostly of what it is like to live with the animals now, their research days behind them (several were smuggled out of research facilities by sympathetic caregiver scientists). One is struck anew how little we know, and how barbaric we seem. Surely the rights demanded by groups of the disenfranchized over the years should have taught us how cruel and thoughtless we seemed before finally recognizing the rights of different groups (the poor, women, blacks). This is not a screed, nor a diatribe. It is a man reflecting on meeting some unusual characters who have a history, and with our help, a future.