Obesity & Attenberg's The Middlesteins

From last week's BBC article "Rise in obesity poses dementia time bomb:"

Ever-growing waistlines could result in a big increase in the number of people who develop dementia in the future, researchers have warned...

Nobody knows exactly what causes dementias such as Alzheimer's disease, but body weight appears to be a risk factor. One study of 8,500 Swedish twins showed that those with a body mass index (BMI) greater than 30, who are classified as obese, were almost four times as likely to develop dementia as those with a normal BMI.

For a novel about obesity, try Attenberg's The Middlesteins:

For more than thirty years, Edie and Richard Middlestein shared a solid family life together in the suburbs of Chicago. But now things are splintering apart, for one reason, it seems: Edie's enormous girth. She's obsessed with food--thinking about it, eating it--and if she doesn't stop, she won't have much longer to live.

When Richard abandons his wife, it is up to the next generation to take control. Robin, their schoolteacher daughter, is determined that her father pay for leaving Edie. Benny, an easy-going, pot-smoking family man, just wants to smooth things over. And Rachelle-- a whippet thin perfectionist-- is intent on saving her mother-in-law's life, but this task proves even bigger than planning her twin children's spectacular b'nai mitzvah party.

Through it all, they wonder: do Edie's devastating choices rest on her shoulders alone, or are others at fault, too? With pitch-perfect prose, huge compassion, and sly humor, Jami Attenberg has given us an epic story of marriage, family, and obsession. The Middlesteins explores the hopes and heartbreaks of new and old love, the yearnings of Midwestern America, and our devastating, fascinating preoccupation with food.

If you'd prefer a young-adult novel, you might like Blubber by Judy Blume:

Sometimes a writer will make a character fat as a political tool, in order to convey their own intended message, be it one of size acceptance, tolerance, or other. This seems most prevalent, logically, in children's books - Judy Blume's Blubber is the strongest example that comes to mind.

Written realistically from the point of view of an average-sized, ordinary child named Jill, Blubber tells the story of the merciless, constant taunting of Jill's obese classmate, Linda. Jill struggles to reconcile her own feelings of guilt and her need to not be cruel with her fear of falling victim to the same cruelty as her overweight peer.

This is one of the few children's books I can think of that deals honestly with the kind of bullying fat (and other noticeably 'different') kids are subject to, and its brutality. Blume makes her point, without coming off as preachy or judgmental or bonking the reader over the head with obvious, overblown clearcut endings.

(The review above is from the excellent essay "The Skinny on Fat in Fiction.")

Cancer & Edson’s Wit

From yesterday’s Reuters article “Angelina Jolie has double mastectomy to elude cancer:”

Hollywood star Angelina Jolie has had a double mastectomy to reduce her chances of getting breast cancer and says she hopes her story will inspire other women fighting the life-threatening disease.

Jolie wrote in the New York Times on Tuesday the operation had made it easier for her to reassure her six children that she will not die young from cancer, like her own mother did at 56.

"We often speak of 'Mommy's mommy', and I find myself trying to explain the illness that took her away from us. They have asked if the same could happen to me," wrote Jolie, 37. "I have always told them not to worry, but the truth is I carry a 'faulty' gene."

The Oscar-winning actress said her doctors had estimated she had an 87 percent risk of breast cancer and 50 percent risk of ovarian cancer.

For a work of fiction about dealing with cancer, try Margaret Edson’s Pulitzer prize-winning play Wit:

As the play begins, Vivian Bearing, a renowned professor of English who has spent years studying and teaching the intricate, difficult Holy Sonnets of the seventeenth-century poet John Donne, is diagnosed with advanced ovarian cancer.

Confident of her ability to stay in control of events, she brings to her illness the same intensely rational and painstakingly methodical approach that has guided her stellar academic career.

But as her disease and its excruciatingly painful treatment inexorably progress, she begins to question the single-minded values and standards that have always directed her, finally coming to understand the aspects of life that make it truly worth living.

Cosmetic Surgery & James' The Private Patient

From last week's Daily Mail article "Hundreds of women with faulty breast implants jeer French businessman as he goes on trial for making millions 'selling leaky PIP silicone':"

A French businessman who made millions by selling faulty breast implants was booed by his victims as he appeared in court today charged with fraud.

Jean-Claude Mas, 74, who founded and ran implant-maker Poly Implant Prothese, is among those on trial in Marseille. The now-defunct company had claimed its factory in France exported to more than 60 countries and was one of the world's leading implant makers.

The implants, which officials say are prone to rupture and leaking, were not sold in the United States, but more than 125,000 women worldwide received them until sales ended in March 2010. Of those, more than 5,000 are joining the trial as victims, saying the executives misled them into believing the implants were safe.

For a novel set in a cosmetic surgery clinic, try P.D. James' mystery novel The Private Patient:

In James's stellar 14th Adam Dalgliesh mystery (after 2006's The Lighthouse), the charismatic police commander knows the case of Rhoda Gradwyn, a 47-year-old journalist murdered soon after undergoing the removal of an old disfiguring scar at a private plastic surgery clinic in Dorset, may be his last; James's readers will fervently hope it isn't.

Dalgliesh probes the convoluted tangle of motives and hidden desires that swirl around the clinic, Cheverell Manor, and its grimly fascinating suspects in the death of Gradwyn, herself a stalker of minds driven by her lifelong passion for rooting out the truth people would prefer left unknown and then selling it for money. Beyond the book's central moral concern, James meditates on universal problems like aging (the amorphous flattening of self)...

Medical School & Shem's House of God

I've previously posted about the difficulties of caregiving.  How about the difficulties of being a doctor -- or even just training to be one?

From today's Boston Globe article "Empathy gap in medical students:"

Flint Wang was eager to start his third year of medical school, when he would finally break free of the classroom and treat patients. But once in the hospital, Wang, like many classmates, felt insecure and discouraged. Doctors don’t hesitate to point out students’ knowledge gaps. And neither do some patients. Medical training can be so stressful that it is sometimes difficult to connect with those being treated. “Your knowledge is shaky and you walk around the wards frazzled,’’ said Wang, 25, who nonetheless is glad he decided to become a doctor. 

The third year of medical school can be particularly bruising. But growing research suggests that something about this formative but punishing experience may harden students toward patients — a transformation that could persist years down the road. At Boston University School of Medicine, where Wang is now in his fourth year, Dr. Daniel Chen has found in studies that students’ empathy scores fell between the time they started medical school and the time they graduated. The most significant drop occurred in the third year, just as students started caring for their first patients.

For a novel about medical school, try The House of God by Samuel Shem:

The hilarious novel of the healing arts that reveals everything your doctor never wanted you to know. Six eager interns -- they saw themselves as modern saviors-to-be. They came from the top of their medical school class to the bottom of the hospital staff to serve a year in the time-honored tradition, racing to answer the flash of on-duty call lights and nubile nurses. But only the Fat Man --the Clam, all-knowing resident -- could sustain them in their struggle to survive, to stay sane, to love-and even to be doctors when their harrowing year was done.

And according to the 2009 NYT article "A Book Doctors Can’t Close," the book is still frequently read among the medical community:

It was a raunchy, troubling and hilarious novel that turned into a cult phenomenon devoured by a legion of medical students, interns, residents and doctors. It introduced characters like “Fat Man” — the all-knowing but crude senior resident — and medical slang like Gomer, for Get Out of My Emergency Room. Called “The House of God,” the book was drawn from real life, and 30 years after its initial publication, it is still part of the medical conversation. Written by a psychiatrist, Stephen Bergman, under the pseudonym Samuel Shem, M.D., the novel is based on his grueling, often dehumanizing experiences as an intern at Harvard Medical School’s Beth Israel Hospital in 1974... 

What makes “The House of God” singularly compelling is its brutally honest portrayal of the absurd tragedies and occasional triumphs of hospital life; the once-common abuse of young physicians by their superiors; and the anger and frustration these interns directed at themselves and patients. The novel introduced many derogatory terms to the medical culture. Gomer referred to the elderly, chronically ill patients no intern wants to deal with. The shorthand LOL in NAD (Little Old Lady in No Apparent Distress), was for patients needlessly admitted by their private physicians for expensive work-ups...

Possible HIV Cure, AIDS, & Brunt's Tell the Wolves I'm Home

From Monday's New York Times article "A Cure, in Essence, for H.I.V. in Some Adults:"

Two weeks ago, American doctors reported that they had “functionally” cured a baby infected with H.I.V., the virus that causes AIDS, with an aggressive treatment of drugs starting some 30 hours after the baby was born. Experts hailed the feat but cautioned that the findings might have little relevance to adults. Now French researchers have identified 14 adults whose treatments with antiviral drugs began within a couple of months of infection, continued for one to seven and a half years, and then stopped. Their immune systems have been able to control their H.I.V. infection for years after the end of their treatment. The patients are not fully cured, which would require eliminating all traces of the virus from the body. Rather they are in remission, with extremely low levels of the virus that their immune systems keep in check. This is referred to as a functional cure. The researchers estimate that as many as 15 percent of adults who start treatment early and continue for at least a year may then be able to stop their drug regimen and live healthily without the drugs. Whether the virus will be held at bay forever or will reassert itself many years later is not known.

For a novel about HIV/AIDS, try Tell the Wolves I'm Home by Carol Rifka Brunt:

1987. There’s only one person who has ever truly understood fourteen-year-old June Elbus, and that’s her uncle, the renowned painter Finn Weiss. Shy at school and distant from her older sister, June can only be herself in Finn’s company; he is her godfather, confidant, and best friend. So when he dies, far too young, of a mysterious illness her mother can barely speak about, June’s world is turned upside down. But Finn’s death brings a surprise acquaintance into June’s life—someone who will help her to heal, and to question what she thinks she knows about Finn, her family, and even her own heart. At Finn’s funeral, June notices a strange man lingering just beyond the crowd. A few days later, she receives a package in the mail. Inside is a beautiful teapot she recognizes from Finn’s apartment, and a note from Toby, the stranger, asking for an opportunity to meet. As the two begin to spend time together, June realizes she’s not the only one who misses Finn, and if she can bring herself to trust this unexpected friend, he just might be the one she needs the most.

Another highly acclaimed HIV/AIDS novel is The Blackwater Lightship by Colm Tóibín:

It is Ireland in the early 1990s. Helen, her mother, Lily, and her grandmother, Dora have come together to tend to Helen's brother, Declan, who is dying of AIDS. With Declan's two friends, the six of them are forced to plumb the shoals of their own histories and to come to terms with each other. Shortlisted for the Booker Prize, The Blackwater Lightship is a deeply resonant story about three generations of an estranged family reuniting to mourn an untimely death. In spare, luminous prose, Colm Tóibín explores the nature of love and the complex emotions inside a family at war with itself.

For non-fiction, try the classic And the Band Played On by Randy Shilts:

By the time Rock Hudson's death in 1985 alerted all America to the danger of the AIDS epidemic, the disease had spread across the nation, killing thousands of people and emerging as the greatest health crisis of the 20th century. America faced a troubling question: What happened? How was this epidemic allowed to spread so far before it was taken seriously? In answering these questions, Shilts weaves the disparate threads into a coherent story, pinning down every evasion and contradiction at the highest levels of the medical, political, and media establishments. Shilts shows that the epidemic spread wildly because the federal government put budget ahead of the nation's welfare; health authorities placed political expediency before the public health; and scientists were often more concerned with international prestige than saving lives. Against this backdrop, Shilts tells the heroic stories of individuals in science and politics, public health and the gay community, who struggled to alert the nation to the enormity of the danger it faced. And the Band Played On is both a tribute to these heroic people and a stinging indictment of the institutions that failed the nation so badly.

For a newer AIDS/HIV non-fiction account, try My Own Country: A Doctor's Story by Abraham Verghese:

Nestled in the Smoky Mountains of eastern Tennessee, the town of Johnson City had always seemed exempt from the anxieties of modern American life. But when the local hospital treated its first AIDS patient, a crisis that had once seemed an “urban problem” had arrived in the town to stay. Working in Johnson City was Abraham Verghese, a young Indian doctor specializing in infectious diseases. Dr. Verghese became by necessity the local AIDS expert, soon besieged by a shocking number of male and female patients whose stories came to occupy his mind, and even take over his life. Verghese brought a singular perspective to Johnson City: as a doctor unique in his abilities; as an outsider who could talk to people suspicious of local practitioners; above all, as a writer of grace and compassion who saw that what was happening in this conservative community was both a medical and a spiritual emergency.

UPDATE:  there's a good review of Brunt's novel over at the Insatiable Booksluts blog.

Caregiving Difficulties & Evison's The Revised Fundamentals of Caregiving

 From last month's NYT editorial "The Reluctant Caregiver:"

Now and then, I refer to the people that caregivers tend to as “loved ones.” And whenever I do, a woman in Southern California tells me, I set her teeth on edge. She visits her mother-in-law, runs errands, helps with the paperwork — all tasks she has shouldered with a grim sense of duty. She doesn’t have much affection for this increasingly frail 90something or enjoy her company; her efforts bring no emotional reward... “It’s important to acknowledge that every relationship doesn’t come from ‘The Cosby Show,’” said Barbara Moscowitz when I called to ask her about reluctance. Ms. Moscowitz, a senior geriatric social worker at Massachusetts General Hospital, has heard many such tales from caregivers in her clinical practice and support groups... For a reluctant caregiver, “the satisfaction is, you haven’t turned your back,” Ms. Moscowitz said. “You can take pride in that.”

Okay: interesting moral quandary that I hadn't previously considered. And the debate only gets deeper in the comments section. Here's the most popular comment:

I strongly disagree with Ms. Moskowitz's claim that there's satisfaction in knowing you haven't turned your back, and you can take pride in that. I'm looking back with resentment and regret at the two years I've already spent in the caregiver role, and I can't imagine that I'll look back in 5 or 10 years or whenever it's over and feel anything but greater resentment and greater regret. I'm never getting these years back, after all, and by the time it's over it may be too late even to get a reasonable level of health back. I think it does caregivers a disservice to sugar-coat the reality, and claim that even for the reluctant caregiver, there's a benefit there at that end. I'd much prefer to hear the unvarnished truth - that many of us are simply unfortunate enough to be conscripted into a lengthy period of life-wasting, soul-sucking servitude for which there is no compensation and no benefit. I think if more people started telling the truth about this, it might make a dent in everyone's expectation that adult children (daughters and daughters-in-law, in particular) should and will just suck it up and do it.

Pretty heavy themes.  For a novel about difficult caregiving, try Jonathan Evison's The Revised Fundamentals of Caregiving:

Benjamin Benjamin has lost virtually everything: his wife, his family, his home, his livelihood. With few options, Ben enrolls in a night class called The Fundamentals of Caregiving, where he is instructed in the art of inserting catheters and avoiding liability, about professionalism, and on how to keep physical and emotional distance between client and provider. But when Ben is assigned to tyrannical nineteen-year-old Trevor, who is in the advanced stages of Duchenne muscular dystrophy, he soon discovers that the endless mnemonics and service plan checklists have done little to prepare him for the reality of caring for a fiercely stubborn, sexually frustrated adolescent with an ax to grind with the world at large. Though begun with mutual misgivings, the relationship between Trev and Ben evolves into a close camaraderie, and the traditional boundaries between patient and caregiver begin to blur as they embark on a road trip to visit Trevor's ailing father.

NB:  article focuses on difficult caregiving for parents, while the book focuses on (initially) difficult caregiving for a client who is not a relative.

UPDATE:  some well-written reviews of The Revised Fundamentals of Caregiving are available on The Book Reporter, the Fiction Writers' Review, and the Next Best Book Blog.