There Is Nothing For You Here -- a decent memoir that needs trimming

An enthralling book about growing up as an outsider

The Emancipation of Evan Walls, by Jeffrey Blount

An enthralling story. Evan Walls is a nerdy young black boy in a deeply segregated town in the South. Well written scenes of his family life and Evan's dramatic estrangement from his harsh father and submissive mother, who want an ordinary black boy as their son. Evan's ostracism from his family and the black community (except for a few heroes) because of his commitment to his intellectual pursuits and habits (he's accused of being too white, abandoning his black heritage and brothers) is painful to read. And it reads true to some of my own memories of young black children I knew growing up. The book is a page turner. However, about three quarters of the way through, the story gets a little strange for me, when Evan is revealed to be a tremendous athlete who, even when he wins football games for his high school, is still hated and persecuted by black teammates and townspeople. There's an odd disconnect here. The hatred from fellow blacks is unending, and I just don't sense that's right or true anymore. Also, like a number of other readers, I took the book to be an actual memoir, but it's not. It's a novel in the form of a memoir. The book cover doesn't identify it as a novel.

It makes no sense that the villagers hate and kill the widow in Zorba the Greek

 Recently, I read Zorba the Greek by Nikos Kazantzakis. Amazing that I've gone so long without reading that novel. I have mixed feelings about it. Alexi Zorba is no doubt a great fictional character. And the story keeps you turning the pages. The problems come when we see the attractive widow. The narrator, the boss, is attracted to her because she's so beautiful. The villagers hate her because...because of what? Because supposedly she doesn't attach herself to any of the free village men. She stays aloof from them. Supposedly, that brings disgrace on the village. She eventually has an assignation with the narrator, which triggers the horrible scene of her death. Her murder comes at the hands of an angry father whose son killed himself for being rejected by the widow. Not only does he kill her, but he cuts her head off in front of the baying villagers. Zorba, who had shown up in time to defend her and fight off her attackers, is taken unawares and unable to save her.

None of it makes sense to me. That a widow would be despised for not taking a man -- where does that happen? In Greece? If anything, such a church-going widow would be admired. Would she be blamed for causing the suicide of a young man? Perhaps, but only by the insanely envious. None of it would rise to the status of a deserved, justifiable murder, as the villagers feel in the book.

Athens, a History, by Robin Waterfield: the universal city and symbol of democracy and freedom

Athens: from Ancient Ideal to Modern City, a History, by Robin Waterfield (Basic Books, 2004)

The assault on the Capitol in Washington, and other events of this past week, have made it a bit difficult to concentrate, but a few notes are worth preserving on this very readable, insightful, and witty history of Athens, the city-state of Greece. Most of the book deals with Athens in the 5th and 4th centuries BC, when it was at the height of its power and influence. 

- Athenian democracy (literally people power) and its changing structure is too complicated to go into here (Waterfield describes it in the book, and even there, it takes close reading to understand it), but the underlying principle of democracy is equality -- the poor citizen had the same vote as the rich citizen. 

 - Democracy was messy. There were a number of bodies, and they could arrive at unjust directives and actions. Still, the Athenian constitution provided for unjust judgements to be overridden by other bodies.

- Ostracism could be brought up at any time by any citizen against an official. It was a check on the power of individuals, intended to prevent Athens from ruled by tyrants.  I suppose ostracism is a form of impeachment, though in Athens the target had to be physically removed from Athens itself (he did, however, get to keep his property), and he did get to once again run for office.

- The Athenians named their first-born children after the name of the father's father. The same practice is still in use today among Greeks.

- Only adult men could be full citizens. Slaves outnumbered citizens. To our modern sensibility, it seems obviously strange that a city-state whose government was founded on the principle of equality would recognize slavery. Yet, it was a hundred fifty years ago that we still had slavery here in the United States.

- What's amazing is how long Athenian democracy was seriously maintained -- it lasted hundreds of years, even after the city shrank and declined in power until it was not much more than a crumbling university town, around the time of Christ.

- Waterfield's treatment of World War II Athens and Greece, the departure of Nazi German troops, the arming of former Right-wing collaborators by the British, the participation of British forces brutally suppressing Athenian crowds, the clashes between Right and Left forces in December 1944, the preamble to the catastrophic Civil War that was to follow, is some of the best, clearest, and most succinct writing I've read on that complicated period. 

- The modern city of Athens is treated the last portion of the book. Waterfield does show how the city -- the name itself "Athens" -- has become a universal symbol of democracy and freedom to the entire world, not simply the Western world. 

Inferno: a powerful chapter about victims in this great history of World War II

Inferno, by Max Hastings (Alfred A. Knopf: New York 2011). A great, insightful history of World War II. This post is taken from my recent Facebook post, about the Victims chapter within the book.

I've been reading "Inferno," by the excellent British historian and writer Max Hastings. It's a well-written history of World War II, a week by week, sometimes hour by hour account. I feel compelled to share a little of the book with you. 

 

Hastings includes a 27-page chapter called "Victims," an overview of what the different subjugated populations suffered during the war. Mass deportations, massacres, hunger, and misery were inflicted on tens of millions in Europe and Asia. 1.5 million Poles were deported to Siberian exile by the Russians. 350,000 of them died of starvation, about 30,000 were executed. Hastings writes, "In addition to almost 6 million Jews murdered by the Nazis, over 3 million Russians died in German captivity, while huge numbers of non-Jewish civilians were massacred in Russia, Poland, Yugoslavia, Greece and other occupied countries." (In Greece, a Wikipedia article estimates 500,000 to 800,000 deaths during the war, out of a pre-war population of 7,222,000.)

 

The Victims chapter naturally includes an account of the Holocaust. The Jewish holocaust exists "in its own dimension," in Hastings's words. Hitler and the Germans pursued the annihilation of European and Russian Jews even at huge costs to themselves and their ability to fight on many fronts. Almost all levels of German society, and most of the subjected countries under German control, willingly contributed to the deranged effort. 

 

I was especially moved by several accounts Hastings gives of the "ordinary Germans" who carried out the early executions of the Jews. "On 13 July 1942, Reserve Police Battalion 101 arrived in a convoy of trucks at the Polish village of Josefow, whose inhabitants included 1,800 Jews. Mostly middle-aged reservists from Hamburg...they gathered around their commander, fifty-three year old Maj. Wilhelm Trapp, a career policeman...In a choking voice, and with tears in his eyes, he told them they had a most unwelcome assignment...to arrest all Jews in the village, remove to a work camp men of working age, and kill the remainder...He then invited any man who felt unable to perform this unpleasant task to step aside...At least twenty were permitted to return to barracks...Yet a sufficiency of others stayed to do the business. Georg Kageler, a thirty-seven year old tailor, killed his initial batch easily enough, but then fell into conversation with a mother and daughter from Kassel, who were destined to die next...he appealed and was sent instead to guard the marketplace while others did his share of the shooting...One member of the battalion, Walter Zimmerman, later gave evidence: 'There were always some comrades who found it easier to shoot Jews than did others, so that the respective commando leaders never had difficulty finding suitable shooters.'"

 

Not all Germans were complicit. "A small minority displayed high courage in succoring the persecuted, at mortal risk to themselves. A young Berlin shoemaker named August Kossman, a communist, hid Irma Simon, her husband and son in his little apartment for two years. The teenager Erich Newmann's mother, a cafe owner, sheltered a young Jewish family friend in Charlottenburg for five months...Rita Kirsh's mother sheltered a young man named Solomon Striem, a family friend...'I cannot just turn the poor hunted man away.' Such extraordinarily courageous people sustained a shred of the honor of German civilization."

So, after reading this chapter, I thought I should share a bit of it with you. These events took place about eighty years ago. May those described here who suffered and died always be remembered. May we also remember always those who sheltered and helped the hunted at great peril to themselves.

The Great Influenza, by John M. Barry: a primer for today's Covid-19 crisis

 The Great Influenza: The Epic Story of the Deadliest Plague in History, by John M. Barry (Penguin Books, 2004).

 

Finished reading John M. Barry’s 2004 book, The Great Influenza. It is about the 1918 influenza pandemic that killed an estimated 675,000 people in the United States, and perhaps 25 to 50 million people worldwide. Here are some things that stayed with me as I read. 

 

1. Barry subscribes to the theory that the 1918 strain of influenza began in Haskell, Kansas, jumping from pigs to humans. Other contemporary scientists dispute this, offering Britain, France, and China as possible source sites. There’s no way to be sure.

 

2. Influenza killed about 675,000 Americans. The population then was one third what it is today.

 

3. It was called the Spanish Flu because Spain was the only Western country where journalists were free to write about the spread of the flu since Spain was not involved in World War I. All other countries censored newspapers on the subject because they feared it would hurt national morale. The name Spanish Flu has nothing to do with the origin of the epidemic.

 

 4. The Woodrow Wilson administration harshly censored bad news about the pandemic. Mostly positive news was allowed. Wilson was focused on one thing — the war effort. He himself was silent on the flu. His administration’s efforts to fight the epidemic in America came second to the war effort. The censorship of bad news about the flu — it was often reported that the flu was almost over when in fact it was just beginning — fed the terror in American cities and towns as it became obvious that thousands were dying from a mysterious plague. “'Don’t Get Scared!' was the advice printed in virtually every newspaper in the country.”

 

5. Typical symptoms were severe headaches, high fevers, severe coughing that did not stop, severe fatigue, lungs fillings with fluid until breathing was impossible. “Blood poured from noses, ears, eye sockets; some victims lay in agony; delirium took others away while living."

 

6. About 45,000 American soldiers and seamen died of influenza and pneumonia in 1918-1919. Total American combat deaths in the War were 53,402. The military establishment was very slow to deal with the problem, often ignoring doctors and specialists even when the magnitude of the problem was clear. For months, commanders continued to concentrate soldiers and staff by the thousands in camps and trains despite the outcry from doctors and researchers. Colonel Charles Hagadorn took command of Camp Grant in Illinois on August 8, and ignored the entreaties of his medical staff not to move men into crowded barracks. By October 8, 452 men had died at Camp Grant. After hearing the current death toll on that day, Colonel Hagadorn, a soldier with a long career in the Army, ordered his subordinates out of the building to stand for inspection. He shot himself as they stood outside, waiting for him. 

 

7. The influenza was especially hard on young healthy people, aged 20 - 40 years old, like those soldiers. They had relatively healthy immune systems, and something about that strain provoked a massive immune response which often overwhelmed the victim, even without pneumonia being involved. 

 

8. In Philadelphia, the Director of Public Health, Dr. Wilmer Krusen, a political appointee, declared in early September 1918 that the victims that had up till then died had suffered from “old-fashioned influenza or grip.” There was no need for alarm. On September 28, officials promoted a Liberty Loan parade to sell war bonds. Hundreds of thousands attended. In the week of October 16, 4,597 people in Philadelphia died from influenza or pneumonia brought on by influenza. Probably many more died indirectly. Ghastly scenes. People dying in houses and apartments by the hundreds, bleeding from their noses and mouths, never making it to a hospital or doctor or nurse. Hospital wards impossibly overcrowded, corpses in the streets around the hospitals. Nurses and doctors dying themselves. Homeless orphans in every neighborhood. These assurances and scenes were repeated in many cities.

 

9. Many Americans saw the suffering right in front of them in 1918. In 2020, the very sick are quickly taken to hospitals and confined to ICU and Coronavirus wards. The vast majority of us now never see what the most severe patients go through.

 

10. Barry does not mention any organized protests against the quarantine measures that were eventually taken in the hardest hit cities.

 

11. Some of the most haunting scenes were from Alaska and other remote areas. “In Nome, 176 of 300 Eskimos had died…One doctor visited ten tiny villages, and found ’three wiped out entirely; others average 85% deaths…survivors generally children.'” Of course, all over the world, millions died in villages far from any doctor or nurse.

 

12. Woodrow Wilson was said to suffer from a stroke at the Versailles Conference which determined the peace terms for Germany. It is now believed by many researchers and historians that Wilson had influenza, which may have brought on his stroke. He was a changed man. After his illness, he abandoned his plans for an equitable peace with Germany, and completely acceded to the demands of French Premier Georges Clemenceau to harshly punish Germany. It’s often said that the punitive measures agreed to at Versailles sparked the beginnings of Nazism in Germany, and led to World War II twenty years later. 

 

13. Pg. 396. “Whoever held power, whether a city government or some private gathering of the locals, they generally failed to keep the community together. They failed because they lost trust. They lost trust because they lied.”

 

14. Barry is summing up the strenuous work of the handful of best American scientists and doctors, and he mentions this: “They had always proceeded from well-grounded hypotheses...they had not given quinine or typhoid vaccine to influenza victims in the wild hope that because it worked against malaria or typhoid it might work against influenza. Others had done these things and more, but they had not.” Curious to read this echo from 2004 and 1918 to the recent controversy we’ve had with Chlorquinine.

 

15. Writing in 2004, Barry says in the Afterward, “The CDC estimates that if a new pandemic virus strikes, then the U.S. death toll will most likely fall between 89,00 and 300,000. It also estimates a best case scenario of 75,000 deaths and a worst case scenario in which 422,000 Americans would die…If a new pandemic struck, people suffering from ARDS [Acute Respiratory Distress Syndrome] would quickly overwhelm intensive care units.”

 

Next on my reading list: The Plague, by Albert Camus.

Breaking free from an insane family and still loving them: Educated, by Tara Westover

Educated, by Tara Westover (Random House, New York 2018). This memoir is the story of Tara Westover's childhood and young adulthood in a family headed by her fanatical Mormon father in a remote Idaho town. The father is a paranoid religious zealot who demands that his wife and children follow his peculiar ideas of family life. An older brother sadistically abuses Tara throughout her growing up. She eventually breaks free of the family and discovers a new life in the academic worlds of Oxford and Harvard universities. She's a very smart, talented woman. It's a tortuous path. Each step is a struggle against the bonds of -- remarkably -- family love and devotion.

Westover is a good writer. The scenes of her childhood working in dangerous conditions in her father's enormous junkyard are nicely detailed and vivid. Imagine a 14 year old girl surrounded by sharp rusted metal, and a father who routinely drops tons of debris near his children, often injuring them. She has no choice but to work here. She is injured numerous times by the actions of her schizophrenic, abusive father. The father is forever afraid the federal government will come and take his children away. He has good reason to fear this. By any reasonable standard, his behavior toward his family is criminally negligent and abusive. This is not about Mormonism per se, but about religious and political fanaticism to the point of serious delusion.

Then there's the old brother Shawn. A psychopath who enforces the father's strange ideas of proper behavior for girls. He routinely demands obeisance from Tara, and if she resists, he physically tortures her.

"I was yanked to my feet. Shawn grasped a fistful of my hair--using the same method as before, catching the clump near my scalp so he could maneuver me--and dragged me into the hallway...'Now the bitch cries,' Shawn said. 'Why? Because someone sees you for the slut you are?'" He savagely beats her. This was Shawn's punishment for her having an innocent date with a boy in town her age. Shawn begs her forgiveness afterwards. Which doesn't prevent him from doing the same thing a few weeks later. These scenes are repeated in one form or another until Tara manages to escape the family.

Where is her mother in all this? A midwife, a maker of homeopathic remedies (snake oil, basically), but a shrewd businesswoman, the mother is herself browbeaten by her husband. She fails to protect her daughter and children from their father and Shawn. Amazingly, she builds her remedies into a successful business, hiring other women from the town to create the bogus formulas.

It's sickening. And yet Tara loves these people. She's devoted to them. She believes them.

Despite her parents' objections, Tara manages to go to Brigham Young University. There she begins to sense that a different life, a different sense of womanhood, is possible. The last third of the memoir is about her struggle to be educated, to live apart from her family. Her talent as a writer and thinker are recognized by a number of professors (all men), and almost improbably she goes to Oxford and then Harvard, where she eventually completes a PhD in History. This last part of the book is not as complex and riveting as the earlier chapters. But she does create an effective portrait of the devastating struggle to be educated, to think for herself free of her family.

To detect cancer when it first appears: The First Cell, by Azra Raza

The First Cell, and the Human Costs of Pursuing Cancer to the Last, by Azra Raza. Basic Books, New York 2019. Dr. Raza is professor of Medicine and MDS Center Director at Columbia University. She also was an oncologist for several years at Roswell Park Cancer Institute in Buffalo.

In this moving and complicated book, veteran oncologist Dr. Raza argues for shifting research and clinical resources to the prevention and early detection of cancer, as opposed to aggressive treatments for and research into advanced stage cancers. She explains that for many of the deadliest cancers (lung, pancreatic, leukemia), the outcomes for most patients today are barely better than they were fifty years ago. In many cases, patients have their lives prolonged by new and experimental treatments for a matter of only weeks or months (though some do achieve much longer remissions). But they often achieve these incremental improvements while in agony and pain from the treatment side effects.

She demonstrates the awful torments of advanced stage cancers with narratives of a handful of her own patients, as well as of her husband Harvey (himself an oncologist). All of these patients died. I was very moved by the plight of these patients. They of course reminded me of my wife Marilyn's painful treatment for Non-Hodgkin's Lymphoma, and her sudden death from the side effects of her chemotherapy.

Araz argues that mouse studies and other laboratory research for drugs development often fail produce drugs that have any useful effect on actual human patients. She wants to move money from the work on advanced-stage therapies, arguing that we may be fifty or more years away from truly dramatic advances or cures. And she wants that money shifted to prevention and early detection. She believes we may be close to being able to detect cancers in their earliest appearance in the body -- in the first cell (or group of cells) of the book's title. I found her detailed analysis of various therapies difficult to follow; there are lengthy passages where she seems to be addressing fellow oncologists and members of the medical establishment.

Yet, shifting resources in this way means cutting back on money and research for drug trials that hundreds of thousands of frightened and desperate terminal patients are clamoring for. She acknowledges that this won't be popular, and that is one of the major hurdles of her approach. Furthermore, we have a huge and profitable cancer drug industry that won't easily give up their stake in the way cancer is currently fought.

My knowledge of cancer research and treatments is not deep. Most of what I know I learned in the terrible months following my wife's diagnosis. As a non-expert, I appreciate Dr. Raza's approach. It makes sense to prevent and detect cancer in its earliest possible stages, and thus decrease the numbers of patients who suffer its physical, emotional, and financial consequences.  

Good play, good production: Mockingbird at Kavinoky Theater

Harper Lee's To Kill a Mockingbird, at the Kavinoky Theatre in Buffalo. Adapted by Aaron Sorkin, directed by Kyle LoConti. Has the usual uniformly strong cast assembled by Kavinoky. Saw the performance Friday night, November 29, 2019. Worth seeing. Good play, good production.

Sometime around 7th or 8th grade, around 50 years ago, I read Harper Lee's novel and liked it. About that same time, I remember seeing the movie with Gregory Peck playing a sage and saintly Atticus Finch. The play is a decent takeoff on the story, compressing the narrative into 2 3/4 hours (which of course has consequences). A lot of Americans who grew up in the 60s and 70s know the story. You can't help but seethe over Tom Robinson's fate as the black man falsely accused and convicted of raping a white woman in a sleepy Alabama town in the 1930s (Tom is played by Xavier Harris in a modulated, controlled performance). Unfortunately, the play says almost nothing about Boo Radley, the mysterious neighbor who comes to the children's rescue, until the very end, thus making the ending difficult to understand if you don't know the book.

The play emphasizes Atticus Finch (well played by Chris Avery) as a moral crusader. Tom wants to plead guilty to the charge of raping a white woman, and is willing to accept a 15 year prison sentence. Tom knows the score, and knows a jury of twelve white farmers will surely convict him, and execute him. But Atticus convinces Tom to plead innocent. So we have a trial. The play seems to show Atticus as being in a conflicted, ambiguous moral position. He gets flack for it from his black maid Calpurnia, and while the Judge Taylor and Sheriff Tate seem to support Atticus, the townspeople condemn him for being a "nigger-lover".

The play takes some theatrical liberties that bothered me. The loathsome Bob Ewell (menacingly played by Patrick Moltane), is given long lines that too neatly describe his racism. Ewell sounded "scripted" on the stand, as if the playwright blared at the audience that Ewell represents racism in general. And I found Calpurnia's mocking of Atticus for his own possibly racist assumptions hard to understand. She does it with a sort of 2019 irony that I don't see in the 1936 story line. It sticks out as jarring and false.

We know how it goes. Tom is shot five times trying to escape a prison he should never have been in to begin with (we get the allusion to the police shootings of black men of the last few years). And Boo Radley pops out of nowhere to save the children. Good play. Good production. 

Speed the Plow at Roads Less Traveled Productions: two problems the play can't get around

Speed the Plow, a play by David Mamet, seen Saturday, October 27, 2018 at Road Less Traveled Productions theater. Directed by Scott Behrend.

I have a problem with this play. I have no problem with the production itself. Matt Witten and Kevin Kennedy are very good as Bobby Gould and Charlie Fox, two full-of-themselves Hollywood producers who've been promoted. They play the profanity-crammed buddy dialog pretty well. Mamet does the profanity quite realistically. Having worked in corporations most of my career, I've heard men talk this way many times (mostly salesmen, and sometimes women), though never quite this non-stop. Laura Barriere is also good as the temporary secretary with schemes of her own. Nice stage set. The whole production moved with a snappy verve, as a Mamet play should.

My problem is with the play itself. There are two holes in the story for me.

1. The courtesy read book (whatever it's titled) is so bad, it's hard to imagine any producer being interested in it as a movie. Yes, I understand that it's Mamet's intention that the book (as presented through the segments read aloud by Karen and Bobby) is supposed to be comically ridiculous. But the book is too ridiculous. Bobby decides to promote the book as a movie thanks to being won over by Karen (who wins him over by having sex with him). Bobby Gould, and men like him, can have all the sex they want with the Karens of the world. A night of sex with Karen is not enough to make anyone like Bobby Gould dump his longtime ally and friend Charlie and even temporarily promote this absurd movie idea. To me, it simply doesn't make sense.

2. Then there's Karen. Why would Karen promote this book? What's in it for her? That's never clear. We are made to believe that Karen is not as innocent as she presents herself at the beginning. Fine. She turns out to be ambitious. Okay. She wants to be in a movie. Great. But she could have more easily wormed her way into the movie that Charlie was promoting with that mega-star director as this stupid. And what is it about Karen that gives her so much power over Bobby? That's never clear either.

Together, these two problems make this otherwise taut, well-shaped play puzzling and nonsensical. That's my problem.

Postscript
From a Facebook post, I replied to a friend: "...yes, as I was listening to the read-aloud excerpts of the courtesy-read book, I had the feeling that in the 70s or 80s, such a book may not have seemed quite so ridiculous to many in the audience. And perhaps Karen might have seemed more plausible as a sort of peace-love crusader. In that sense, the play is kind of 'dated'."

The nearness of death being a certainty: Atul Gawande's book, Being Mortal

Being Mortal, by Atul Gawande. Metropolitan Books, New York 2014.

Being Mortal is a complicated book to summarize. It's a good book. Gawande concentrates on the last period of our lives, when we or our legal surrogates decide on how we live those final days and months. We may be either in failing health because of old age, or are in the last stages of a painful terminal disease, such as a cancer. The medical and life decisions to be made are often excruciating. Either way, those last days are often spent in suffering and torment. The nearness of death is a certainty.

Gawande focuses the first part of the book on how the elderly live their lives as they become weaker. Usually, it's in an institution, an assisted living center where the staff follows an economical and efficient regimen. Medicines are dispensed, rooms and "residents" or "patients" are checked, meals are served, and healthy approved activities are organized all on a schedule decreed by management. All of this is at great financial expense, but worse still is that many of the elderly are deprived of what they want most -- to live meaningful lives doing the things they enjoy doing, on their own schedule. My father-in-law bitterly resented his years in a highly rated, comfortable assisted living center. He hated the loss of his privacy (staff nurses would knock on his room door once and immediately unlock his door with their keys and enter). He called himself and the other residents "inmates", as if they were incarcerated. "Believe me, John", he frequently said, "Half the people here, they'd like to just not wake up tomorrow morning -- but they won't let you die because they keep barging in".

The remedies, which Gawande wholly supports, is to return autonomy, decision-making, and the elements of normal everyday to the elderly. Gawande reports on several assisted living centers that are experimenting, both architecturally and programmatically to make this possible. My favorite was the hilarious experiment in New Berlin, New York, bringing pets into a nursing home to live with the residents -- dozens of parakeets, dogs, and cats. The delightful chaos and crises alone of feeding and caring for these creatures transformed the place. The point of all the experiments he details is that they brought a normal life back to the residents -- life was worthwhile.

Gawande is a bit light in telling us the long-term effects of the experiments. Do they actually work financially, administratively? I agree they sound like better alternatives (I'd much rather be in a place with parakeets, dogs and cats), but I didn't learn enough about whether actual large-scale changes have taken effect because of these experiments. Nor does Gawande really delve into situations where elderly patients have declining mental abilities. The examples he gives of elderly and cancer patients near the end of their lives are of people who still have all their moral and mental capabilities. Yet, when you enter a nursing home, you immediately see many patients who don't have the capacity to decide for themselves, or who are very confused. The Alzheimer's ward is a very difficult place.

The second focus of the book is on the central dilemma facing a dying man or woman: should we employ medicine to fight the onset of our deaths in the hope of a cure or of extending our lives? He shows how that often relegates us to even more intense suffering from medical side effects, impaired mobility and communication, and often brings no cure or extension of life. Or should we choose to accept death as imminent, forego medical interventions, and concentrate on living the last period of life as pain free as possible, so that we can enjoy this period as much as possible and communicate as much as possible with loved ones?

Another way of putting is -- do you want to let your disease take its course and live a worthwhile, bearable life in your few final days, or do you want to attempt to lengthen those final days by continuing the struggle against your affliction, which is likely going to kill you no matter what you do?

Gawande examines a number of patients who faced heart-wrenching choices because of their diseases (including the touching story of his own father, who was afflicted with terminal spinal cancer in his last years). He carefully records his own fumbling attempts as a surgeon to help patients with their difficult choices, and demonstrates how ill-prepared doctors are to talk about these issues with their patients. He repeatedly argues for helping the patient to spend the remaining time in his or her life in control of their mental faculties, in control of moral decision-making, to get whatever enjoyment is left to them without struggling against the inevitable. Some would call this "giving in" or "surrendering". He acknowledges that each case is individual, that seemingly miraculous cures do occur, but the arc of his argument tends towards palliative care, to reduce the suffering of the patient and allow as much dignity to the patient while their disease works its course.

Here is a quote from page 141, which I think is at the heart of the book. "The battle of being mortal is the battle to maintain the integrity of one's life -- to avoid becoming so diminished or dissipated or subjugated that who you are becomes disconnected from who you were or who you want to be. Sickness and old age make the struggle hard enough. The professionals and institutions we turn to should not make it worse."

Gawande does not bring up children who are faced with the ends of their short lives. I suppose that's a different book. Children, or very young people, who are near death because of disease or accident, would have raised another set of moral issues. Can the children make their own decisions? Who makes the decisions for them?

Murderously insane and likeable at the same time: Sweeney Todd, at the Kavinoky Theater

Sweeney Todd, the Demon Barber of Fleet Street. Music by Stephen Sondheim, book by Hugh Wheeler. At the Kavinoky Theater, directed by John Fredo.

The complicated Victorian-era story is about a man who was wrongly accused of a crime and sentenced to prison in Australia for fifteen years. On his return to London, he is told his beautiful daughter has become the ward (actually, concubine) of the evil judge who sentenced him, and that his wife has since poisoned herself. To wreak his revenge, he takes the name of Sweeney Todd, sets himself up as a barber above a meat pie shop and the friendly woman who helps him, and murders a slew of customers, ultimately murdering the judge himself.

I had never seen this musical before. I love Sondheim. This is of course a macabre, grotesque story, full of sometimes humorous songs that belie and are dissonant to the murderous events. That's Sondheim. If it's possible to enjoy a play where you like and feel moved by people who are insanely murderous, then this is that play. Todd is insane. Mrs. Lovett, who makes meat pies out of the corpses of Todd's victims, is insane. They cold-bloodedly murder people who have done them no harm. Yet, we like them, their songs are about love, affection, overcoming hardships. How can we not like them and feel moved by their complicated stories?

There is that central falsehood in this play. The lyricist can give Todd and Mrs. Lovett these songs. The playwright can put reasonable words in their mouths, and give them actions that show them to be compassionate, caring people. Yet they are monsters who cut the throats of innocents as well as evil judges. In what reality can such a story take place?

The cast and the entire production were great. Matt Witten's Todd was controlled and restrained. Todd is seething with rage, and yet we see a quiet, almost contemplative Todd on the stage (up until the instant he slits the throats of his victims). Witten's restraint, and the music, heightened the tension leading up to the two attempts on the judge's life -- almost unbearable, Sweeney Todd wielding the razor, we know what he's about to do, and he's singing. Anthony Lazzaro was exceptional as the young innocent sailor Anthony Hope (great name).