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Book & Cinematic Reviews

Current Issue

Gulp: Adventures on the Alimentary Canal

By Mary Roach

CURRENT BOOKS: Chewing the Fat

By Jeff Sugarman, MD

Gulp, the new book by science writer/humorist Mary Roach, offers an entertaining if somewhat meandering and tangential tour of the alimentary canal. From top to bottom Roach takes us to places we never knew existed, and she digs down deeply into the often odd and esoteric research of those committed to exploring where no one has wanted to go before.

Roach reminds us that taste is all about smell, especially if you are a dog. As a dog owner, I found her expose of the Palatability Assessment Resource Center (PARC), a pet food tasting research center, fun and interesting. She opens a strange and charming window into the life of a professional pet food taster. Who knew that if a pet food manufacturer wants to make a claim that dogs prefer brand X of kibble, the manufacturer must actually get data to support their claims at a lab like PARC?

Roach’s exploration of the science of saliva is quite entertaining as well. I was startled at the strangeness of some of the scientific projects she describes. For example, how does salivary breakdown of starch enhance flavor? Subjects in one study had to rate the taste of custard samples. Sounds like a great study to volunteer for, right? What the subjects did not know was that a drop of saliva was secretly added to their meal. Roach does not go into detail as to how the saliva samples were actually obtained. 

The indefatigable Roach amasses so many fun facts that weaving them together into any kind of coherent story at times proves too difficult. The transitions from fact to factoid are often forced and create a zigzagging story line that dilutes from the theme she is attempting to illustrate. Her extensive footnoting, which in places seems to take up nearly as much text as the main body of the book, allows her to weave even more tangents into her story. They are often more entertaining than the stories in the main text.

The historical vignettes that provide the backdrop to our knowledge of certain digestive processes are quite compelling. In pursuing the digestive properties of the stomach, Roach explores the relationship between Alexis St. Martin, a trapper who was accidentally shot, leaving him with a fistula between his stomach and his skin, and William Beaumont, a researcher who experimented on St. Martin for several decades. The reader may forgive Roach for describing their relationship as “acid” because the interplay between these two and the resulting digestion experiments are so entertaining.

Starting with Moby Dick, Roach spends many pages on the historical pseudoscientific studies regarding the survivability of being eaten alive. “Would a man in a whale forestomach be crushed or merely tumbled?” she asks. The whole discussion seems ridiculous, but she does include some interesting research, including the work of 18th-century French naturalist Rene Reaumur, who studied raptor gizzard pressures using a small tube carrying meat.

My 15-year-old son would probably enjoy the sections describing the curiosities of the rectum. Here, Roach footnotes the work on gastrointestinal gas by Drs. Terdiman and Fardy. Similarly, the section on flatulence research would provide Daniel Tosh plenty of fuel for his stand-up jokes on “Tosh.0.” Of course Roach also can’t resist the stories of objects found by emergency department physicians that are stuck or lost in the anus.

Roach is also strangely attracted to macabre events, which she describes and embellishes with pithy details. In her section on the compliance of the stomach, she describes a woman whose stomach ruptured from overeating and the man who ate 18 pounds of cow brains. There is much to be learned here, although most of it may be utterly useless.

On the back cover, the book carries the label “science,” which is true in the loosest sense only. Gulp is not a serious book, notwithstanding the extensive referencing. However, how interesting could the alimentary canal really be to the lay reader? Roach cleverly solves this problem with humor, effectively holding our interest in areas that are often off limits. She approaches the very end of the alimentary canal, for example, by relaying interviews with prison inmates about the details of smuggling cell phones in their rectums. I can imagine Roach laughing to herself as she wrote this, and for that matter every page in this book, from the origins of fire-breathing dragons to the Bristol stool chart (complete with diagram).

Dr. Sugarman, a Santa Rosa dermatologist, serves on the SCMA Editorial Board.

Email: pediderm@yahoo.com

This book review is found at http://www.nbcms.org/AboutUs/SonomaCountyMedicalAssociation/Magazine/tabid/747/language/en-US/pageid/677/winter-2014-digestive-health-current-books-chewing-the-fat.aspx  

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Book & Cinematic Reviews

Previous Issue

The Bookshelf by Barton Swaim, WSJ

Book Review: 'Poems That Make Grown Men Cry,' edited by Anthony and Ben Holden

You don't need a degree in creative writing to be brought to tears by verse.

Terry George, the Irish screenwriter and director, chokes up whenever he reads Seamus Heaney's "Requiem for the Croppies." The sonnet is an acutely condensed retelling of the 1798 Irish rebellion, a series of battles in which an army of mostly peasants—"the pockets of our greatcoats full of barley"—tried to throw off British rule. He's right; the last three lines, recalling the rebellion's final battle on June 21, catch in the throat:

The hillside blushed, soaked in our broken wave,

They buried us without shroud or coffin

And in August . . . the barley grew up out of our grave.

Mr. George is one of the 100 men Anthony and Ben Holden queried for their anthology of "Poems That Make Grown Men Cry." The editors aren't trying to make the case for poetry—perhaps a hopeless task in our time—but the book does it anyway. Poetry, so easily assumed to be merely weird self-expression since the death of rhyme and meter, isn't that at all: It's the arrangement of language into rhythmical structures to make it say what it can't say otherwise. The Holdens remind us that you don't have to be an academic or a postgraduate in creative writing to be moved by verse. Or, indeed, brought to tears by it.

The editor Harold Evans couldn't fight them back reading Wordsworth's "Character of the Happy Warrior" at a colleague's funeral. The critic Clive James sheds them for his parents at "Canoe" by Keith Douglas. The novelist Sebastian Faulks cries over Samuel Taylor Coleridge's "Frost at Midnight" (a marvelous poem—though not, I would have thought, one likely to induce tears). Despite the slight hokeyness of the whole idea, the overall effect is to make excellent poetry seem like what it is: a wholly accessible language with its own range of expression and its own pleasures. . .

Read the entire book review found in the WSJ . . .  

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Book & Cinematic Reviews

Past Issue

The Lost Cause: The Trials of Frank and Jesse James

by James Muehlberger, Esq, Kansas Alumni Magazine, No 3, 2014

True Crime

A lawyer’s successful search for a missing court case sets straight the crooked tale of Frank and Jesse James

By Steven Hill

“The Ballad of Jesse James”

Jesse James we understand
Has killed many a man
He robbed the Union trains
He stole from the rich
And gave to the poor
He’d a hand and a heart and a brain.

James Muehlberger was down to the final day of his three-month sabbatical, and the county clerk’s office in Gallatin, Mo., was due to close in 5 minutes. He had spent the past week hunkered down in the dusty office, rifling through drawer after drawer of legal files. Now it was 4:25 on a Friday, and he still hadn’t found the document he was searching for. In fact, he’d been told he wouldn’t find it.

“The clerk told me I was crazy, that it didn’t exist,” says Muehlberger, c’78, l’82, “and if it had existed it had been stolen or preserved [elsewhere] because anything related to Frank or Jesse was long gone from their files.”

But Muehlberger—a former Johnson County prosecutor who now defends corporate clients as a partner at Shook, Hardy & Bacon (SHB) in Kansas City—looked anyway. As Theresa Hamilton, deputy for the Circuit Court of Daviess County, began buttoning up the office for the weekend, he raced to finish one last file drawer. There, at the very back of the drawer, he recognized the prize he sought, a dusty, barely legible folder that he’s convinced no one has seen since 1870: the lawsuit file for Daniel Smoote v. Frank and Jesse James. 

“Finding that was probably the most exciting thing I’ve done as a lawyer,” he says. “Part of what I do is spend months or years looking for the smoking gun document that’s going to make my case, or trying to find witnesses who don’t want to be found. Basically I used the same sort of skills I developed over 30 years of being a lawyer and applied it here.”

The find confirmed a story Muehlberger had heard around SHB’s Kansas City headquarters, that a lawyer named Henry McDougal, associated with a founding partner of the high-profile firm, had once sued the notorious Missouri outlaws.

The case and the crime that spurred it—the murder of a former Union officer and Gallatin bank clerk named John Sheets—marked the first time the James brothers gained notoriety for their crimes, and the media attention was the beginning of the enduring Wild West legend of Jesse James as a “noble robber,” a chivalrous farm boy who fought for Southern honor during the Civil War and after was driven to crime to battle corrupt pro-Union politicians.

The discovery of the lost lawsuit was one in a series that led to Muehlberger’s book, The Lost Cause: The Trials of Frank and Jesse James, a thoroughly researched and carefully argued chronicle of the decade-long quest to bring to justice one of the most feared—and revered—outlaw gangs in the West. The Kansas City Star named it one of the best 100 books of 2013, and the New York Times Book Review credited Muehlberger for creating a story that is “equal parts violent melodrama and meticulous procedural, wrapped in vivid packages with enough bloody action to engage readers enthralled by tales of good versus evil.”

Don’t be fooled by the book’s cover: The jacket features a sepia-toned photograph of a fierce, pistol-brandishing Jesse James, but the true heroes are the lawyers who took on the infamous Missouri outlaw and his brother Frank. . .

Jesse James had a wife
To mourn for his life
Three children, they were brave
But history does record
That coward Robert Ford
Has laid poor Jesse in his grave

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Book & Cinematic Reviews

Past Issue

What Doctors Feel: How Emotions Affect the Practice of Medicine

by Danielle Ofri, MD

Sonoma Medicine | The magazine of the Sonoma County Medical Association

CURRENT BOOKS: Hoping for More: a review by Deborah Donlon, MD

It seems the American public is yearning to figure out what makes doctors tick. First came How Doctors Think (2008) by Dr. Jerome Groopman, followed by What Doctors Feel (2013) by Dr. Danielle Ofri. According to Amazon.com, these two books are “frequently bought together.” They represent the ying and the yang of the physician psyche, one a guide to how our minds work, and the other a road map to our innermost feelings. From a patient’s perspective, there should be some powerful insights offered here. Based on the coordinating titles, one wonders if Drs. Groopman and Ofri got together over coffee one morning to decide who should publish first. His quote graces the cover of her book, endorsing it as the place “where science and the soul meet.”

Dr. Ofri has an MD and a PhD, and she completed a residency in internal medicine. She is the mother of three children, a working physician and writer, and an associate professor at New York University School of Medicine. Her inspiration for What Doctors Feel comes from patients she has cared for as a faculty member at NYU’s internal medicine residency at Bellevue Hospital. From her writing, it is clear that she has charged herself with teaching the psychosocial side of medicine to her students and residents. Rather than treating a patient with alcohol and drug withdrawal as just another admission, she probes to discover the exact moment in the past when the patient knew he was an addict, and she gets a moving response. Her underlings treat the patient with more concern and compassion as a result.

To a primary care physician in the trenches, Dr. Ofri’s book has enormous potential and appeal. How do we feel, anyway? Every 15 to 20 minutes, we walk into the next patient’s exam room. Each one has a chief complaint, or more likely, many complaints. It is our job to elicit information, show compassion, cure, heal, fix. And in family medicine, which many of us practice and teach in Sonoma County, there is always more than one patient in the room. The accompanying child, parent or partner also has a complaint, but not an appointment. How do we feel? Rushed, overwhelmed, concerned, altruistic, and often fortunate to be doing such challenging and beautiful work. Surely this book can offer us a road map for how to get in touch with our emotions, avoid burnout, remember the psychosocial perspective in caring for patients, and carry on . . .

What Doctors Feel seems to be written more for the lay public than for a physician readership. There is a lot of detail about the process of medical school and residency training. We physicians remember those days like they were yesterday, and the memories are visceral. But residency, as intense and exhausting as it was, had a finite aspect that made it survivable. The practice of medicine over decades is something else entirely.

Here are four examples of what I hoped to get out of reading What Doctors Feel, but didn’t. First, when I see the name of my most challenging patient on my schedule for the day, or on a telephone message, I have an unpleasant internal reaction. However, I still need to provide the best care possible for this person and to put my feelings about them aside. Is this possible? Second, my clinic has just adopted a new patient portal, through which all my patients can contact me via email. What if a patient emails me with an urgent concern when I am not close to the computer? Also, do I wish to spend my leisure time, already limited, responding to emails from my patients? Third, there are work-hour restrictions for residents, but not for attending physicians. When one has been up all night working in the hospital, it is nearly impossible to show empathy to patients by the next afternoon. Fourth, our healthcare system has incentives in all the wrong places, leading to poor outcomes, poor care and poor morale among physicians. What will it take to turn this around? . . . Read the entire book review. . .

Dr. Donlon, a Santa Rosa family physician, serves on the SCMA Editorial Board. debbied@swhealthcenter.org

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Book & Cinematic Reviews

Past Issue

A Tale of Two Steve’s

Sonoma Medicine

The magazine of the Sonoma County Medical Association

CURRENT BOOKS

By Rick Flinders, MD

Steve Jobs, by Walter Isaacson, Simon & Schuster, 656 pages.

Perhaps the first clue to how much Steve Jobs thought of himself is his choice of biographer: Walter Isaacson, the same man who wrote biographies of Albert Einstein and Benjamin Franklin. Did Jobs consider himself in the same league, innovatively and historically, as these two? Yes, he almost certainly did. Perhaps the ultimate measure of his grandiose audacity is that he was probably right.

Few individuals have altered and shaped the fabric of our daily lives more than Steve Jobs. We’re talking here of an impact on the scale of people like Thomas Edison and Henry Ford. Look around and you’ll see, within arm’s reach, products of his creation that literally touch everything we do. The laptop. The cell phone. How we listen to music. How we communicate.

Jobs didn’t do this alone. But as he stood at the convergence of information technology and the creative arts, during an historic moment as transformative as the industrial revolution, he more than any other gave expression to the products of information technology that have become embedded into our daily lives. 

How did he do this? And who was the man who did it? The answers, as revealed in Abramson’s biography through hundreds of hours of interviews with the people who knew him, are predictably complicated.

Jobs had a ferocious, even obsessive, will that could drive him to the exclusion of everything else, including reality. Those who worked with him all speak familiarly of what came to be called “Steve’s reality distortion field.” Often if a fact or situation interfered with his vision, he simply wouldn’t acknowledge its existence. This became a double-edged sword. On the one hand it led him to achievements others in the industry considered “impossible,” such as wresting control of recorded music from Sony and repackaging it as iTunes. On the other, it allowed him to deny and virtually abandon his daughter born in 1978, curious behavior for a father who resented his own biological parents for putting him up for adoption at birth.

As with most genius, there comes idiosyncrasy. Jobs’ creations all bore the same signature characteristics. They were elegant, durable and extraordinarily functional. But he went beyond that. They had to be aesthetically pleasing inside the locked compartments that were never visible to consumers. Even the machinery with which they were manufactured had to be of a certain color and decor.

. . . He once defended his disdain of focus groups by saying they were irrelevant: “People don’t really know what they want until I show them.”

The mark of Jobs’ personality persists in all his creations. Every Apple product is a “closed system.” No hardware may be added. No screwdriver can take it apart. . .

To work for Jobs was a mixed blessing. At meetings he could rant, cry, berate and belittle employees publicly, sometimes all at once. His intensity was legendary. He would sometimes hold a person in an unnerving gaze, without blinking, for several minutes at a time. To employees he was often not merely rude or dismissive, but cruel. Curiously, he carried Yogananda’s Autobiography of a Yogi with him most of the time, and he reread the book once a year. It is said, by those who knew Yogananda, that he could enter a room and fill it with calm. It is also said, by those who knew Jobs, that he could enter a room and fill it with ego.

And yet, those who did work for Jobs are in almost unanimous agreement: “Without Steve we could never have risen to our best work, and would have never accomplished what we did.” For me, a baby boomer, the book is not just the story of a fascinating contemporary, but a fascinating story of our contemporary history.

My favorite parts are of the early Steve Jobs. While seniors in high school, Jobs and his wonk friend Steve Wozniak posted computer-generated banners all over campus one afternoon saying, “Remember: Tomorrow is Bring-Your-Pet-to-School Day.” The following day such a menagerie of diverse and squabbling creatures descended on the unsuspecting campus that classes were cancelled, students sent home, and Jobs and Wozniak were suspended.

The two became inseparable. As Jobs recalls, Wozniak was “the first guy I ever met who knew more electronics than me.” Their first collaboration was the Blue Box, a device that replicated the tones that routed signals on the entire AT&T network, and allowed users to make long-distance calls anywhere in the world for free. The two friends once called the Vatican from a phone booth. Wozniak pretended to be Henry Kissinger and asked to speak to the pope. What began as pranks, however, became the template for an enduring partnership. Wozniak was the gentle wizard, coming up with inventions he was happy to give away. Jobs would figure out how to make them into a user-friendly package, market them, and make millions.

Jobs attended Reed College in Portland. He dropped out during the first semester, but he remained there for the next 18 months, auditing courses in Japanese calligraphy and Zen meditation. It was there that he acquired the aesthetic style that shaped all his future creations. The multiple fonts that were part of the graphic interface for the very first Apple computers, for example, Jobs attributes directly to his studies and experiences in Portland. The fonts became standard in the industry.

I find an inherent irony in Jobs’ life and legacy. He was a Zen Buddhist, dedicated to the philosophy and practice of being fully focused in the ever-present moment of here and now. The irony is that he created a technology that virtually guarantees nearly constant distraction in the hands and ears and lives of an entire generation. The average 20-year-old checks his or her handheld device for new messages every 27 seconds. Watch a group of high school students at a table in Starbucks “engaged” in conversation, for example, and see how often their eyes and attention are diverted from the one who is speaking to the palms of their hands.

How many young people are attuned to the sounds of their immediate environs or the world around them? Compare this group to the number sealed off from the world by earphones, and carried by sound to anywhere but the here and now. I was recently blind-sided by a young cyclist who turned, not in front of my car, but into my car. As he bounced off my passenger side door and sped away, I noticed the signature white earplugs that rendered him oblivious to surrounding traffic and the rest of the world. . .

Here’s a guy who goes to Reed College, drops out, takes LSD, studies calligraphy, travels to India, practices Zen, and then returns to the Bay Area to found a company that revolutionizes the practical use of information technology and becomes the richest company in the world. Ultimate poster child of the sixties?

To Steve the genius, I say, “Kudos. You were a master at putting together ideas, art and technology in ways that invented the future. You were living proof of your own motto: The people who are crazy enough to think they can change the world are the ones who do.”

To Steve the jerk, I say, “Why’d you have to be so mean?”

Dr. Flinders, a hospitalist who teaches in the Santa Rosa Family Medicine Residency, serves on the SCMA Editorial Board.

Email: flinder@sutterhealth.org

Notis Brevis: My daughter found Steve’s confirmation record at Trinity Lutheran Church in Palo Alto. She emailed him. He replied that was about the time he lost his faith and became a Buddhist.

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Book & Cinematic Reviews

Past Issue

Handbook on State Health Care Reform

by John C. Goodman, PhD

Chapter 2: PRINCIPLES OF REFORM

What are the principles of health reform? One might suppose they are fairly easy to enumerate and command widespread support. As it turns out, that is not the case. Here are five recommended principles. If they are followed, the odds of successful health policy reform will be greatly enhanced.

Principle No. 1: No One Should Be Denied Basic Care because of a Lack of Ability to Pay.

A good society does not withhold basic health care from people because they lack the resources to pay for it at the time of delivery. This does not imply that people have a “right” to free care. If that were the case, everyone would have a perverse incentive to become “free riders,” wastefully over consuming care at everyone else’s expense. Instead, most people should be expected to pay their own way most of the time. But no one should have to forgo basic care because they can’t pay for it at the time of delivery.

Principle No. 2: Health Care Should Be Provided in a Competitive Marketplace.

The economic definition of efficiency is: Whatever is produced should be produced at minimum cost. Some studies lend credence to the idea that one out of every three dollars of health care spending is wasted. This implies that, in principle, the same health care could be provided for two-thirds the cost. Alternatively, there could be 50 percent more care for the same amount of money. In other markets, entrepreneurs spur efficient production by repackaging, repricing and taking advantage of new products

and innovations. Principle No. 2 is not being followed whenever entrepreneurs are arbitrarily prevented from serving this function.

Principle No. 3: The Appropriate Level of Insurance Depends on the Assets to Be Protected.

If Principle No. 1 is followed, people will not need insurance to receive care. Instead, they will need insurance in order to protect their earning power and other assets from unexpected health care costs. Other forms of insurance serve as a useful guide. The purpose of life insurance is primarily to protect earning capacity against the consequences of premature death.

Accordingly, the appropriate level of insurance depends on current assets and expected income. The purpose of casualty insurance is to protect the value of, say, a home or automobile. The appropriate level of insurance depends on the anticipated risk and the replacement value of the home or car. Similarly, the purpose of health insurance should be to protect assets against unexpected medical costs.

Principle No. 4: Health Insurance Should Be Personal, Portableand Renewable.

It is a mistake to have a system in which a change of health plans is virtually mandated whenever people change employers. Instead, health insurance should be portable (traveling with the employee from job to

job). Also, it defeats the whole purpose of insurance if premiums can rise in response to an adverse health event. Life insurers do not get to charge more to the insured who get AIDs or cancer. Insurance exists to transfer risk from the individual to an (insurance) pool. Th e price of that transfer is the periodic premium payment. Once the insurance contract is set, the practice of increasing premiums after an adverse event occurs would be like changing the odds on a horse race after the race is underway.2 Accordingly,

people should be able to buy health insurance that is renewable at rates that are independent of adverse health events. In most states, this is required under the laws governing individual insurance. However, such insurance is generally unavailable in the small group market.

Not withstanding all of the above, from time to time people may wish to change their insurance coverage. At that point they should be able to buy real insurance in a real market. It is to everyone’s advantage to be able to face real prices for risk when making changes in insurance coverage. Otherwise, people who are undercharged will over insure, and people who are overcharged will underinsure.

Principle No. 5: Private Insurance Should Be at Least as Attractive as Health Care Provided at Taxpayer Expense.

For many people, the implicit alternative to private insurance is to rely on charity care paid for by others. For those who qualify, Medicaid and S-CHIP programs are alternatives to private insurance. Perversely,

these alternatives encourage people to forgo private coverage paid from their own pockets in order to take advantage of care provided at taxpayer expense. Rational public policy would create the opposite incentives. At a minimum, government should be neutral — giving people just as much incentive to be in the private sector as in the public sector.

 This book excerpt is found at http://www.ncpa.org/

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Book & Cinematic Reviews

Past Issue

Movie Review: By James J. Murtagh, M.D.

"Breaking Bad": Character is Fate

Meth-cooking Walt reaches new height of art: No Excuses

 Warning:  spoiler alert. If you have not seen the final episode of  Breaking Bad, do not read further. The episode contains a major plot twist which is discussed in this Op- Ed.

It is fiendishly appropriate that the modern Greek tragedy, Breaking Bad, ends almost exactly 2400 years since Sophocles wrote Oedipus Rex. Breaking Bad, demonstrates the most intense hell on earth, forcing its worst characters to kill the people and things they love best. But unlike any other modern drama, the main character finds at least partial redemption in admitting, "I did it because I wanted to"- a completely novel idea in modern times!

For five years Breaking Bad, like The Shield, like the Sopranos, and "The Wire", shows evil in all its seductive guises. Of these, Breaking Bad was most shocking, even moving its audience to cheer for the central character, Walter White, the average man in this morality play, the chemistry teacher dying of lung cancer who decided that he had no way out and had no choice but to turn to crime and cook meth. His almost-innocent beginning led to worse crimes and eventually he ends up a drug king pin. Even White's murder of innocents- including an innocent child- evoked a morbid fascination. How much could one man get away with? 

But then the twist. Tonight in the finale, Walt made no excuses. This may be a first since the Greeks and Shakespeare- Walt actually took responsibility and admits he has no one to blame but himself. He had been telling himself that he turned to crime to save his family. Tonight he admits, "I did it for myself. I liked cooking meth. I was good at it."

Whoa! No one in the Inferno, or the Sopranos, or the Wire or the Shield, admitted that they had free will. Most, like Michael Corleone justified themselves, "I had to do it for my family."

The average Shakespearean villains, from Richard III to Macbeth blamed the stars or the weather or the witches. Rarely did a villain admit "I am the author of my own suffering". It was the highest form of Shakespearean art when characters transcended and admitted what they did- Hamlet, King Lear and Othello.

Oedipus was perhaps the first to realize his own free will brought him to his fate: "Apollo - he ordained my agonies - these, my pains on pains! But my hand that stuck my eyes was mine, mine alone - no one else - I did it all myself!"

In modern times, criminals blame a series of dominos in their life. Variations on the twinky defense. Lesser Greek characters also tried to blame crime on micro events- "we started the Trojan war because of an argument, a woman, an apple."

Fate reserves circles in hell for treacherous murderers even below simple murderers. Not being caught appears infinitely crueler than being fried by 2,400 volts in an electric chair. There is a deep freeze as cold as great lake Cocytus Dante described at the bottom of the ninth circle of hell, reserved for the great traitors of all time.

Dostoevsky also believed that punishment was essential to redemption of the human soul. Hell's best-kept secret is that we create it for ourselves. Walt connived, threatened, hoodwinked and betrayed to make a bad end. But Walt, at the last minute, realizes, makes sincere contrition and achieves a redemption.

Robert Frost wrote that torment by ice can be much more painful than by fire, metaphorically contrasting passionate torments with death by hatred. Walt's enemy’s fate is death by ice, frozen into a bland cubicle, with no hope of redemption.

In a larger sense, society also had a hand in Walt's demise. Had Obamacare been in place, and Walt had affordable health care, Walt would have had no reason to turn to crime. Is it worse for a hungry man to steal a loaf of bread, or a dying man to ask for medicine? Perhaps worst of all is the society that creates the criminal by making him steal the bread or the drug.

Congress should take note. Can Congress claim that it has no free will?  I hope our lawmakers watched the program and decided to end the abomination of gridlock and the lack of medical care.

Shakespeare granted the release of death as the greatest boon to both homicidal heroes and villains.  Hamlet, Oedipus and Walt all lived in worlds "rotten." The deserts of New Mexico have much in common with Hamlet's Denmark.

"To never have been born may be the greatest boon of all." Walt had few options at the end. He asks his adversaries to end his life.

Not all villains could be punished by no punishment. The Iagos and Richard IIIs delight in escape. Could fitting punishment depend more on the nature of the criminal, than on the crime? For some criminals, capital punishment is devoutly to be wished. For Dante, divine punishment was necessary for the operation of a divine Universe.

Do we, in the modern world, including our leaders, suffer even more because the possibility of punishment often seems remote?

Sophocles heard it long ago upon the Agean, the turbid eb and flow of human misery.

Walt- your end puts you in the company of the greats. We will miss you.

James J. Murtagh Jr. jmurtag@mindspring.com

This review is found at http://www.medicaltuesday.net/BookReviews.aspx

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Book & Cinematic Reviews

Past Issue

Love in the time of Algorithms

Online dating is awash with deviance. There are perverts, scammers and misanthropic entrepreneurs all hellbent on profiting from loneliness. But then there are women like Laura Brashier, a 37-year-old hairdresser from California and a survivor of cervical cancer. Her treatment left Ms Brashier unable to have sex. Rather than endure the anxiety of conventional dating she decided to set up a dating site for people like her. 2Date4Love describes itself as the site for “people who cannot engage in sexual intercourse to meet and experience love, companionship and intimacy at its deepest level. Since its creation in 2011, it has enrolled thousands of members who might otherwise have struggled to find romance.

WSJ Jan 29, 2013, A13 Bookshelf.

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The American Conservatory Theatre: Dead Metaphor

A.C.T. Presents the World Premiere of George F. Walker's Hilarious Political Comedy
Dead Metaphor

February 28 to March 24, 2013

Directed by Irene Lewis, this dark comedy--from one of Canada's most acclaimed playwrights--satirizes the hypocrisies and politics of postwar living

A soldier returns from the Middle East to find work in this audacious and hilarious dark comedy

SAN FRANCISCO (January 15, 2013)—American Conservatory Theater (A.C.T.) welcomes the . . . world premiere of Dead Metaphor —George F. Walker’s dark comedy that satirizes the hypocrisies and politics of postwar living. When Dean returns home from the war in the Middle East and hits the job market, he discovers that his superior military skills don’t get him very far in the business world. His readjustment to non-bunker life begins by moving in with his aging parents and pregnant ex-(and soon-to-be current) wife. When he is offered a job as poster boy for a crusading politician on her own mission for “truth and justice,” his military ethics collide with the unscrupulous world of national political campaigns—and he discovers that his unique skill set may be his best asset after all. 

Says A.C.T. Artistic Director Carey Perloff: “I read Dead Metaphor all in one sitting—the first scene made me laugh out loud, the second scene was a shocker, and by the third scene I was totally hooked. In the spirit of Bruce Norris’s Clybourne Park, George Walker has an incredible knack for mining dark humor out of impossible circumstances, deploying a kind of vivid satire to make us listen to our own clichés and become aware of our own hypocrisy. And I can think of no one better than Irene Lewis, who staged a brilliant production of David Mamet’s Race for us last season, to bring to life this world premiere by a major Canadian writer. A.C.T. audiences are in for an outrageous ride and a vivid glimpse at the underbelly of modern life and contemporary politics.”

Dan Rubin writes in the program about his conversation with the Playwright, George F. Walker:

In 1971, George F. Walker was a 23-year-old taxi driver from Toronto’s working-class East End. While carting fares around the city, he saw a Factory Theatre Lab poster calling for play submissions by Canadian Playwrights—part of founding artistic director Ken Gass’s visionary “Canadian Only” policy, one of the sparks of Toronto’s theater movement in the 1970s

Walker had been scribbling poems and short stories since high school. Friends from the neighborhood had always said he would become a writer Local writing groups were closed to a working-class kid, however. They were reserved for University of Toronto graduates. And Walker had no idea how approach publishers. Theater in Toronto, on the other hand, “was just getting started,” he remembers, “and they’d take anyone.”

So Walker wrote his first play, The Prince of Naples, and submitted it. A week later, he learned that it would receive a production. On the first day of rehearsal, Walker saw director Paul Bettis’ copy of the script. On it, dramaturg John Palme had written a note: “This guy is a genuine subversive. We’ve got to produce him.”

Where the title of Dead Metaphor came from, Walker explains. There used to be a time when we didn’t send soldiers off to fight wars and then forget entirely about them, like they weren’t even part of our society. Less than one percent of both our populations has anything to do with them. So something that used to mean something—soldiers fighting for their country—is now irrelevant. It is a dead thing. We don’t even know where they are. Off they go and then they come back into our world, many of them in trouble, messed up and with nowhere to go. They come back and they only get noticed when they’re in trouble. And we’re in trouble too.


A.C.T.’s 2012–13 season also features the world premiere music theater event Stuck Elevator (April 4–28), the Bay Area premiere of The National Theatre of Scotland’s internationally acclaimed production of Black Watch (May 9–June 9), and a new production of Tom Stoppard’s ravishing masterwork Arcadia (May 16–June 9).

This play review is found at http://www.act-sf.org/site/PageServer?pagename=events_conservatory

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