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Note: The story and the images in the book we cover in this episode could bring back memories of unhappy and traumatic events for some people who have experienced cancer in some way. 

This episode centers on the fictional story of a forty-three-year-old woman’s course with recurrent, metastatic breast cancer. She has a coming-of-age-daughter and a treasured husband. The story is a common one in literature and in real life, but the way it’s told in Maddie Mortimer’s novel, Maps of Our Spectacular Bodies, is not common in that a lot of the narration—variously in first-, second-, and third-person forms—comes from the cancer itself, as that can be inferred. Nor is it common in Mortimer’s use of a variety of written and graphic forms. While these and many other aspects of the novel are worthy of attention, our interest was limited to what the cancer narration offers to the story and the understanding of cancer from the pathological to the personal. 

Mortimer’s writing style and the literary forms she used made it possible for us to differentiate scenes and scenarios we described as clever, affecting, compelling, gorgeous, or beautiful from events and realizations we described as awful, obscene, terrible, scary, or hard. We worked to reconcile these antipodes as necessary for the complete and poignant portrayal of the course this cancer took and the effects it had on the characters. The distinction also assisted us in considering whether or not all or just parts of the book could be interesting and useful to various constituencies (e.g., patients, family, students, support groups, etc). While doing so, we often expressed astonishment that Mortimer, who was in her mid-twenties when she wrote the novel, and has no formal training in medicine, could possess such sophisticated and technical insights into the molecular biology, pathology, and pharmacology of cancer, and in the emotional torments and practical realities accompanying it.

We were joined by Dr. Laurel Lyckholm from West Virginia University Cancer Institute, who started her medical career as a registered nurse and later became a physician board certified in medicine, medical oncology, hematology, and hospice and palliative medicine. She has formal training and experience in medical ethics and medical humanities, and has a particular interest in support programming for adolescents and young adults with cancer and their families. Her work and dedication have won her many awards for teaching, leadership, and patient care. We were fortunate to have her with us and we thank her profusely for her valuable time and thoughtful perspectives. 

Links

• Publisher (Simon & Shuster) website for Maps of Our Spectacular Bodies
• Video interview with Maddie Mortimer in which she describes how she created the novel.
• Russell Teagarden’s blog piece on doxorubicin infusion effects as the cancer describes them.

Audio source

Audio clips were from Maps of Our Spectacular Bodies audiobook available on Spotify.

Please send us comments, recommendations, and questions to this text link, or email to: [email protected].

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Michael Pollan, a journalist long known for his work in food and nutrition, and as the author of The Omnivore’s Dilemma, shifted his attention to psychedelics when they were beginning to win favor again after having been shunned—legally and culturally—for three decades. Pollan’s interest took the form of “immersive journalism,” meaning he tried some of the psychedelics himself, and directed his investigation into “the potential for these molecules as a tool for both understanding the mind and, potentially, changing it.” The result was his 2018 book, How to Change Your Mind, and a companion documentary film. Taking our lead from his book, we focus on: consciousness, spirituality, and mysticism as what is at work in the effects psychedelics produce, and how they may delineate limits to biomedicine (rational or not), that is, how they brighten or blur the line between classic biomedicine and whatever isn’t. 

Links

• Michael Pollan's website
• Trailer for Netflix documentary film based on How to Change Your Mind
• The UC Berkeley Center for the Science of Psychedelics cofounded by Michael Pollan
• Russell Teagarden’s blog pieces on his book, How to Change Your Mind, and on his book, This is Your Mind on Plants
• Video of Timothy Leary at Golden Gate Park Human Be – In (Jan 14, 1967

Our next episode will feature Maddie Mortimer’s novel, Maps of Our Spectacular Bodies. We are interested in this common, but tragic story of a mother and wife with terminal cancer and a daughter coming of age, told in an uncommon way with cancer cells serving as narrators at times and the use of graphics, poetry, and other forms of storytelling. Joining us will be Dr. Laurel Lykholm, who is a medical oncologist and who also works in medical ethics and medical humanities. 

Please send us comments, recommendations, and questions to this text link, or email to: [email protected].

Thanks for listening, and please follow The Clinic & The Person wherever you get your podcasts, or visit our website.

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Susan Sontag has said, “Illness is the night-side of life, a more onerous citizenship. Everyone who is born holds dual citizenship in the kingdom of the well and in the kingdom of the sick.” Author Lina Meruane challenges the idea that people with illnesses are necessarily separated into a different kingdom than those who are not sick, asserting instead that illness can be part of anyone’s normality. She makes this case through her novel, Nervous System. The novel tells the stories of four family members and a boyfriend who, at one time or another, develop a serious illness or help take care of one of the others with a serious illness: it’s all illness, it’s all the time, it’s normal. We talk with Dr. Meruane about her idea of illness as normality as she presented it in the novel, and about how its atypical structure and its evocative and memorable prose contribute to the stories told and the ideas offered.

Source

Nervous System by Lina Meruane, translated by Meghan McDowell, Graywolf Press, 2021.

Links

• Lina Meruane’s bio
• Russell Teagarden’s blog piece about the novel, Nervous System, and his blog piece about the MRI scene in the novel.
• Russell Teagarden’s blog piece about Lina Meruane’s novel, Seeing Red.
• Video conversation between Lina Meruane and Meghan McDowell about Nervous System.
• Interview with Lina Meruane in LALT magazine about Nervous System.

A big thanks to Lina Meruane for sharing her thoughts on illness as normality and her writing processes.

Our next episode will draw from the journalist Michael Pollan’s books investigating the prospects for psychedelics in the management of various mental health problems, or even to make individuals and communities better than well. 

Please send us comments, recommendations, and questions to this text link, or email to: [email protected].

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Four movies released between 1997 and 2002 picked up on the anger and resentment building among people encountering increasingly aggressive managed health care tactics aimed at reducing costs during that time. The four movies are: As Good As It Gets; The Rainmaker; Critical Care; and John Q. We talk about how they caught and depicted the rage as it was just reaching the surface of broad societal notice and concern. We note how the rage persists despite efforts on many levels to address it over the years, and wonder if it has reached its apogee with the gunning down of a health care insurance executive.

Links

Trailers for featured movies:

• As Good As It Gets
• The Rainmaker
• Critical Care
• John Q

Other movies mentioned:

• Damaged Care (no trailer available)
• Sicko

Russell Teagarden’s blog posting on the featured movies, with more about what is behind the managed care practices generating anger and frustration. 

Russell Teagarden’s published article on proper uses and improper uses of prior authorization. If not available and of interest, contact him at [email protected].

Previous podcast episodes mentioned:

• Consumptive Heroines: Opera and TB with Drs Linda and Michael Hutcheon (Episode 26)
• Life Imitates Art: Covid-19 Edition (Episode 16)

Additional Background

• Daniels N, Sabin JE. Setting Limits Fairly: Learning to Share Resources for Health. New York: Oxford University Press, 2008.
• Wynia MK, Schwab AP. Ensuring Fairness in Health Care Coverage: An Employer’s Guide to Making Good Decisions on Tough Issues. New York: AMACOM, 2007.
• Pearson SD, Sabin JE, Emanuel EJ. No Margin, No Mission. New York: Oxford University Press, 2003. 
• Daniels N, Teagarden JR, Sabin JE. An ethical template for pharmacy benefits. Health Affairs 2003;22:125-137.

Our next episode will focus on illness as normality as we can grasp it from the inventive novel, Nervous System, and with the help of its author, Lina Meruane. Our discussion could lead to the question: Why can’t biomedical writing be more interesting? 

Please send us comments, recommendations, and questions to this text link, or email to: [email protected].

Thanks for listening, and please subscribe to The Clinic & The Person wherever you get your podcasts, or visit our website.

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The trajectories of tuberculosis (TB) and opera met in the mid-nineteenth century most notably with the production of La Traviata in 1853, and then La Bohème near the century’s end. With eminent scholars Linda and Michael Hutcheon, we talk about how these trajectories converged and how these resulting two operas then brought attention to the medical effects of the infection and the sociocultural influences on its spread. We also discuss how the discovery of germ therapy during the time between the staging of these operas affected the way social behaviors changed accordingly, that is, from understanding TB as hereditary to understanding it as infectious. We play audio clips from parts of the operas pertinent to perspectives provided. 

Links

• The combined bio for Linda and Michael Hutcheon.
• The New York Metropolitan Opera on-demand video service where you can get access to high-quality video productions of La Traviata and La Bohème among many other operas and performances. (There could be a 7-day free trial available).
• Homer Simpson performing as Rudolpho in La Bohème singing Oh Dio! Mimi!
• We covered the effects of TB as an aesthetic ideal of beauty during the nineteenth century as represented in paintings earlier in episode 5.

Audio Credits

La Traviata

Preludio (National Philharmonic Orchestra; Richard Bonynge cond London Records 1979)

Prendi, Quest’È L’Immagine (Orchestra of the Opera House, Rome; Tullio Serafin cond; Victoria de los Angeles (Violetta); EMI Records Ltd 1960; digitally remastered 1992)

La Bohème

O Soave Fanciulla (Berlin Philharmonic; Herbert von Karajan cond; Mirella Freni (Mimi); Luciano Pavarotti (Rudolfo); Rolando Panerai (Marcello); London Records 1972)

Si. Mi Chiamono Mimi (ibid)

Mimi È Una Civetta (ibid)

Mimi È Tanto Malata! (ibid)

A big thanks to Drs Linda and Michael Hutcheon who in addition to providing their expertise and perspectives during the podcast, also contributed ideas for the production. 

Our next episode will feature four movies that picked up early—latter half of 1990s—on the building rage to managed care policies and practices in the US that recently took the form of deadly gun violence.   

Please send us comments, recommendations, and questions to this text link, or email to: [email protected].

Thanks for listening, and please subscribe to The Clinic & The Person wherever you get your podcasts, or visit our website.

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The renowned English social realist and portrait painter, Luke Fildes (rhymes with “childs”), created The Doctor in 1891 after Henry Tate commissioned a painting from him for his new museum, the Tate Britain. The subject of the painting was Fildes’ choice. Despite a poor reception among art critics when it was first exhibited, the painting quickly became iconic as the physician ideal. Over its 133-year history, the painting has been used for a variety of purposes, including inspiration, education, propaganda, and politics. During that time, the ways in which the painting represents the physician ideal changed. We talk about these aspects of the painting with Hannah Darvin from Queen’s University in Kingston, Ontario, Canada. She has conducted extensive research into the painting and its creator.

Links

• Image of The Doctor from the Tate Britain Museum.
• About Hannah Darvin at Queen’s University.
• Hannah Darvin’s description of her research for the Harvey Cushing/John Hay Whitney Medical Library at Yale University.
• John Brewer Eberly’s diptych rendering a modern version of The Doctor in which computer technology is interjected between doctor and patient. 

The next episode will feature opera and how as an art form it can render illnesses in ways that elaborate on bioscience texts and teachings. For examples, we will draw from two operas featuring female characters with tuberculosis (“consumptive heroines”), namely, La Traviata and La Bohème. Joining us will be Linda Hutcheon and Michael Hutcheon, who have combined their expertise in comparative literature and medicine, respectively, with their love for opera into an expansive body of scholarly work making both opera and medicine more interesting and better appreciated.


Please send us comments, recommendations, and questions to this text link, or email to: [email protected].

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The scope and intensity of health care products and services available today make it necessary for us to have thoughts about how much of our way of life we would be willing to give up for them. Finding the balance that works for people is a daunting task. They feel the gravitational pull of health care providers and related industries, and they face the pressures family, friends, and cultural attitudes and expectations can put on them to use all the health care services available. We consider this subject as three essayists thought about it. The essayists are Barbara Ehrenreich, Ezekiel Emanuel, and Michel de Montaigne. We identify some of these forces and discuss how the essayists reacted to them in their writings.

Primary Sources:

Ehrenreich, Barbara. Natural Causes: An Epidemic of Wellness, the Certainty of Dying, and Killing Ourselves to Live Longer; Twelve, 2018. 

Emanuel, Ezekiel J. "Why I Hope to Die at 75." The Atlantic, Oct. 2014.

de Montaigne, Michel. The Complete Works. Translated by Donald M. Frame, introduction by Stuart Hampshire. Everyman's Library; Alfred A. Knopf, 2003.

Links:

• Website for the Hartford HealthCare Elevate Health “series of 1-minute informational segments about health topics” heard on Connecticut Public Radio. 
• The recently-published novel from which the last audio clip was taken is Blood Test, written by Charles Baxter and published in 2024 by Pantheon Books. Russell Teagarden's blog piece on novel.
•  Russell Teagarden’s blog piece on Barbara Ehrenreich’s book, Natural Causes: An Epidemic of Wellness, the Certainty of Dying, and Killing Ourselves to Live Longer.
• Russell Teagarden’s blog piece on Montaigne’s essays covering his thoughts on doctors and health care services.  
• Ezekiel Emanuel’s website.
• Ezekiel Emanuel’s 2014 article in The Atlantic (behind paywall).
• Ezekiel Emanuel’s appearance on news show where he updates his position on how he manages his health care. 
• PDF of Montaigne’s collected essays (Project Gutenberg)

The next episode will feature Luke Fildes’ painting, The Doctor (1891) with Hannah Darvin from Queen’s University in Toronto, Canada. Here is the link to the painting from the Tate Britain Museum in London, England. We will focus on how the painting has been viewed as a work of art and how it has served as an ideal of medicine when it was created and since.


Please send us comments, recommendations, and questions to this text link, or email to: [email protected].

 Thanks for listening, and please subscribe to The Clinic & The Person wherever you get your

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When the British band, The Who, released their double album, Tommy, in 1969, many of the songs in it became instant classics and served as anthems for the Baby Boomer generation ever since. The album was characterized as a “rock opera,” because when connected, the songs told the story of the “deaf, dumb, and blind kid,” Tommy. The storyline made possible subsequent musicals, first as a movie in 1975, and then as a Broadway play in 1993 and as a revival in 2024. Underlying the storyline in each of these genres are the psychiatric consequences of childhood trauma Tommy experiences. In this episode, we consider the psychiatric conditions Tommy exhibits through selected songs from the original Broadway production, and how they are used in education and training.

Joining us for this purpose is Dr. Anthony Tobia, who is the regional chair in the Department of Psychiatry at the Rutgers School of Medicine and is also the Service Chief of Psychiatry at Robert Wood Johnson Barnabas Health in New Brunswick, NJ. Dr. Tobia also holds a secondary appointment in the Division of General Internal Medicine there. His interests and scholarly work include the value and application of merging popular culture and psychiatry. The Who’s Tommy is among the many cultural works he has found helpful in depicting psychiatric problems for purposes of teaching health professions students and practitioners, and others in roles helping people with mental illness.

Links:

Original Broadway cast album of The Who’s Tommy, 1993

Background on The Who’s Tommy movie, 1975.

The video of Dr. Tobia’s psychiatry grand rounds on the Phantom of the Opera mentioned in the podcast.

Reddit 31 Knights of Halloween didactic at Rutgers during October.


Thanks to Benedict Teagarden, podcast music and culture director, for pointers  on how the harmonization in See Me, Feel Me contributes to the meaning of the lyrics.

Please send us comments, recommendations, and questions to this text link, or email to: [email protected].

 Thanks for listening, and please subscribe to The Clinic & The Person wherever you get your podcasts, or visit our website.

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Greek tragedies often concern identifiable and universal problems humans have confronted over the millennia. Among these problems are those illness and suffering create. In this episode we draw from Sophocles’ play, Philoctetes, and in particular, how it depicts illness as exile. With our guest, Professor Paul Ranelli, we first cover the characteristics of Greek tragedies that are applicable to illness and suffering (i.e., enduring relevance, catharsis, empathy). We then cover the play, Philoctetes, what it tells about illness as exile, and how it connects to more recent writings on the concept (e.g., Virginia Woolf and Susan Sontag). Lastly, Paul Ranelli talks about an initiative he was involved in with the University of Minnesota Department of Theater Arts and Dance, the Center for the Art of Medicine, the College of Pharmacy Center for Orphan Drug Research, and the playwright Kevin Kling. This collaboration developed and staged an adaptation of Philocteteshighlighting challenges rare diseases pose. Paul describes how it was conceived, developed, produced, and performed. He also talks about how patients, families, students, health care professionals, and others received it. Spoiler alert: they loved it and saw great value in the endeavor.


Primary source

Sophocles. Philoctetes; In The Complete Greek Tragedies, Sophocles II, translated by David Grene; Chicago: The University of Chicago Press, 1957.


Secondary sources

Virginia Woolf. On Being Ill; Ashfield, Ma: Paris Press, 2002. 

Susan Sontag. Illness as Metaphor; New York: Doubleday, 1990. 

Drew Leder. Illness as Exile: Sophocles’ Philoctetes; Literature and Medicine. 1990(1):1-11. 

Vassiliki Kampourelli. Historical empathy and medicine: Pathography and empathy in Sophocles’ Philoctetes. Medicine, Health Care and Philosophy. 2022:25:561–575.

Cynda H Rushton, Bryan Doerries, Jeremy Greene, Gail Geller. Dramatic interventions in the tragedy of the COVID-19 pandemic. The Lancet. 2020 (Vol 396):305-306.


Links

Russell Teagarden’s blog piece on Philoctetes as prologue to current day issues involving illness as exile, pain, ethics, and moral injury.

Video of Theater of War Productions dramatic reading of Philoctetes performed January 9, 2923.

Video of the play RARE, the University of Minnesota adaptation of Philoctetes.

Video of documentary on development of the play.


Thanks to Dr. Paul Ranelli for his contributing is knowledge, expertise, and wit to this episode. 

Please send us comments, recommendations, and questions to this text link, or email to: [email protected].

Thanks for listening, and please subscribe to The Clinic & The Person wherever you get your podcasts, or visit our website.

Executive producer: Anne Bentley

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“Should we worry about the reliability of medical knowledge?” asks philosopher John Huss (University of Akron). We consider this question from the perspective of Thomas Kuhn’s classic, 1962 book, The Structure of Scientific Revolutions. Kuhn explains how science does not evolve incrementally, one step following another, but rather undergoes wholesale revolutions disconnected from all that came before. He called these revolutions, “paradigm shifts” (to his everlasting regret). While Kuhn draws mostly from astronomy to make his case, we draw from recent and past medical examples to show how his concept applies to medicine as well. We talk about how various groups dependent on reliable medical knowledge (e.g., patients, health care professionals, educators) can be affected by the possibility of major shifts in established approaches to health care at any time. There’s no escape from reality, as the song goes.

Primary Source Citation

Kuhn T. The Structure of Scientific Revolutions, 3rd ed, Chicago: The University of Chicago Press; 1996.

Links

Russell Teagarden’s related blog posts on According to the Arts:

• Kuhn’s book, The Structure of Scientific Revolution
• Michel Foucault’s book, The Birth of the Clinic

Dr. Barry Marshall’s story of how he and Dr. Robin Warren engineered the change in peptic ulcer disease from acid based to infection based.

The Clinic & The Person Episode 12 (September, 2023), featuring the paradigm shift from lobotomies and other forms of psychosurgery to psychopharmacology.

Sir Brian May’s bio (guitarist for Queen and PhD-level astrophysicist).


Please send us comments, recommendations, and questions to this text link, or email to: [email protected].

 
Thanks for listening, and please subscribe to The Clinic & The Person wherever you get your podcasts, or visit our website.

Executive producer: Anne Bentley