Open Wound: The Tragic Obsession of Dr. William Beaumont

“The relationship between doctor and patient is hard enough to parse when both are in the same room. ... And of the gallons of ink spilled over the centuries in attempts at clarification, few efforts in recent memory lay out the frustrations and confusions and crystalline moments of grace better than Dr. Jason Karlawish’s marvelous new book Open Wound.”
-- The New York Times

“A remarkable debut novel….”
-- Jackson Taylor, author of The Blue Orchard

"Open Wound" should be required reading in medical schools...."

-- Jake Halpern, author of Fame Junkies and Commentator for NPR's All Things Considered

 

A shotgun misfires inside the American Fur Company store in Northern Michigan, and Alexis St. Martin’s death appears imminent. It’s 1822, and, as the leaders of Mackinac Island examine St. Martin’s shot-riddled torso, they decide not to incur a single expense on behalf of the indentured fur trapper. They even go so far as to dismiss the attention of U.S. Army Assistant Surgeon William Beaumont, the frontier fort’s only doctor.

But in the name of charity and goodness, Beaumont ignores the orders and saves the young man’s life. What neither the doctor nor his patient understands—yet—is that even as Beaumont’s care of St. Martin continues for decades, the motives and merits of his attention are far from clear. In fact, for what he does to his patient, Beaumont will eventually stand trial and be judged.

Rooted deeply in historic fact, Open Wound artfully fictionalizes the complex, lifelong relationship between Beaumont and his illiterate French Canadian patient. The young trapper’s injury never completely heals, leaving a hole into his stomach that the curious doctor uses as a window to understand the mysteries of digestion. Eager to rise up from his humble origins and self-conscious that his medical training occurred as an apprentice to a rural physician rather than at an elite university, Beaumont seizes the opportunity to experiment upon his patient’s stomach in order to write a book that he hopes will establish his legitimacy and secure his prosperity.

Beaumont, always growing hungrier for more wealth and more prestige, personifies the best and worst aspects of American ambition and power.

 

Reviews

“In the grand tradition of the finest historical novels, Jason Karlawish accurately brings to life one of the most fascinating episodes in American medical lore, one that marked our nation’s very first entry into the rapidly developing field of research on human subjects. We read here of inspired thinking, courage, ambition, betrayal and of one of the greatest conundrums --- still with us today --- in the ethics of medicine.”

- Sherwin B. Nuland
Author of Doctors: The Biography of Medicine and How We Die

“Starting with the bare scaffolding of what is known, setting aside the flimsy particle board of legend and presumption, Jason Karlawish has crafted a carefully reasoned and beautifully written portrait of Beaumont and St. Martin. There is more truth -- deeper truth -- in this fine work of fiction than in many biographical writings on the pair.”

- Mary Roach
Author of Stiff: The Curious Lives of Human Cadavers and Gulp: Adventures on the Alimentary Canal

"This is an excellent historical novel, so real that the biting winds of the western frontier seem to flutter across its pages and cool our sweaty brows. Within this, however, is something much more profound -- a dark and gripping morality play about friendship, ambition, and the very essence of what it means to be a doctor. This should be required reading in medical schools. I will not soon forget this book."

- Jake Halpern
Author of Fame Junkies and Commentator for NPR's All Things Considered

"Open Wound is an enjoyable book that is not only a fascinating fictionalized biography of one of America’s great medical pioneers, but is also an exploration of the complicated relationship between doctor and patient when it becomes transgressive. Saving St Martin may have been Beaumont’s greatest success as a physician, but St Martin became first his indentured servant and later his nemesis. Karlawish, a physician and ethicist at the University of Pennsylvania, has crafted an excellent work of fiction with the power to illuminate difficult ethical issues, perhaps giving Beaumont a new fame and notoriety—this time as a cautionary figure in medical history."

- Noah Raizman, The Lancet

“After a fur trapper is shot in an accident in northern Michigan in 1822, Dr. William Beaumont, an army surgeon, fought to treat the young man despite pressure not to run up a tab doing so. But what appears to be altruism develops into something far more complicated as the open stomach wound of Beaumont’s patient, Alexis St. Martin, proves scientifically useful to the doctor and potentially to millions of other patients. In this historical novel, the two become entwined in each other’s lives medically, financially and even legally. Karlawish sketches their fraught relationship in the ensuing decades artfully, with clear relevance to the ethical questions of modern medicine.”
- Kristin Gerencher, The Wall Street Journal

“Novels based on true stories can be challenging to write because authors must work that much harder, but Dr. Karlawish, a professor of medicine and medical ethics, has succeeded admirably. I recommend this well-written and fascinating book to anyone interested in early medicine.”
- Susan Zabolotny, The Historical Novel Review

Open Wound is a story about ambition and ego in a time before institutional review boards or the oversight of human research. ... It is a fascinating story from medical as well as ethical standpoints.”

- Natasha Bagdasarian, JAMA

"This is a remarkable story, compellingly written, of how one man's ambition brings him both the fame he coveted and crushing failure. The propriety of a physician treating his patient as a living laboratory and as an avenue to personal glory is set down for the reader to judge. Beaumont was a man both desperate and delusional, yet one who advanced medical science albeit with questionable methods. A provocative read from cover to cover."
- Don Faber
Author of The Toldedo War

“A highly readable and plausible reconstruction of the medical and personal interaction between St. Martin and Beaumont.”
- Richard Selzer
Author of the novel Knife Song Korea and Mortal Lessons: Notes on the Art of Surgery

“OPEN WOUND is a fascinating novel about scientific ambition on the American frontier. Read this fine book for its meticulous reconstruction of 19th century life, and for its evocative portrait of a medical researcher whose hunger for success leads him down an ethically dubious path.”
- Karl Iagnemma
Author of The Expeditions

"In a remarkable debut novel Jason Karlawish excavates the medical past of Dr. William Beaumont with astonishingly accurate detail. This book recreates an ante-bellum medical world where the quackery of yesteryear is thrown challenge by newer, more modern sciences. The ethical questions that envelop Doctor Beaumont and his patient are here laid bare for all to see--sliced through by Karlawish’s sharp scalpel of finely-honed research. The human paradox of Doctor Beaumont will bring question to the mind of anyone who’s ever sought medical advice or worried that they ought invite second opinion; it is a novel that illustrates just how fast miracles of medicine can change and how fast medical ambition can be bound to the mysteries of the body. One can't judge this tale without pondering the possible experimental horrors our own bones and flesh might be enduring in our own time."
- Jackson Taylor
Author of The Blue Orchard

“Those who appreciate well researched and written historical novels and those who want to learn informally and imaginatively about the history of medicine can appreciate Karlawish's attention to recreating the past. More significantly, the fictional account engages the ethical imagination, leaving readers to reflect on what to make of Beaumont, St. Martin, and the culture of medicine they operated in.  Yes, the doctor gave his patient life-saving care and provided charity, even paying the balance owed on his indenture.  But Beaumont benefited professionally and personally from opportunistically turning St. Martin into a research subject, one who was not invested in furthering knowledge about the science of digestion.  Yes, the doctor made an important contribution to medical knowledge, but by subjugating an uneducated and poor patient.  Do we read Beaumont's robust ambition and assiduous dedication to a goal as admirable personal and American cultural values? Or do we see them as aberrations of the human spirit when success depends on taking advantage of the vulnerable?  Does Beaumont's rise from humble origins make him sympathetic?  And what do we make of St. Martin?  Do patients, especially unique ones, have a duty to participate in a project that will serve humankind?  Does St. Martin make an admirable sacrifice or was he exploited?  What do we make of a medical system that enlists the  poor and vulnerable to benefit others, including physicians and medical researchers? These questions continue to resonate.”

- Carol Schilling
NYU's Literature, Arts, and Medicine Database

"Karlawish offers us a nuanced cautionary tale. He demonstrates how an ethical person can slip—how easily those with power and high standing can take advantage of the sick and the poor. More intriguingly, Open Wound raises questions about fundamental American values like freedom, equality, progress, and ambition—and whether they can truly coexist."

- The Pennsylvania Gazette

“The story is fascinating on many levels, but it is Karlawish’s portrayal of Beaumont’s unstoppable, desperate, and almost dangerous ambition that takes center stage in this engaging historical account…. The story of the man with the hole in his side remains important, not only as a narrative of the early days of medical research and the emerging ethical issues, but as a cautionary tale and case study of that most American of personality traits – ambition.”

- Ariella Green, PRIM&R’s Ampersand

"For me, the book was personal. As a medical researcher, the amount that I identified with Beaumont was frightening. I identified with the endless hours of work, the travel, the unresponsive government funder, the criticism from fellow researchers, the constant self-criticism, the exasperated spouse, the children wanting to see more of me, the difficulty in finding happiness, the ambition... Indeed, the ambition is what caused the most introspection for me. While it is quite clear that Beaumont's intentions at the beginning of the book were to help a patient and to advance science, those intentions became quite muddy over the years. It made me think about my research and my patients."

- Dan Matlock, MD, GeriPal

Open Wound: The Tragic Obsession of Dr. William Beaumont

Available in hardback, paperback and ebook formats, University of Michigan Press.

Reader reviews at Goodreads and Amazon.

Candid reflections from a medical researcher about how OPEN WOUND speaks to contemporary ethical challenges.

Read an interivew with Jason Karlawish and the noir fiction writer Thomas Pluck.

OPEN WOUND comes to Italy! Read the story in Corriere della Sera.

NPR's Science Friday does a show on Mary Roach's Gulp that features the strange tale of Dr. Beaumont and Alexis St. Martin.

Watch an interview with Jason Karlawish about how he wrote Open Wound and how his training and work as a physician and researcher shaped the story.

Listen to a podcast of the November 12, 2011 interview with Jason Karlawish on the NPR show "2BoomerBabes."

Read Abigail Zuger's review of Open Wound in The New York Times and listen to a Science Times podcast interview with Jason Karlawish.

Listen to NPR's Aaron Stander interview Jason Karlawish on Interlochen Public Radio's Michigan Writers On The Air.

Science Progress website -- "where science, technology and progress meet" -- posts an excerpt from Open Wound.

Listen to a podcast of March 14, 2012 interview with Jason Karlawish on NPR's Radio Times.

Read "A physician's obsession" in Yale Medicine.

OPEN WOUND selected as one of five summer reads.

Holey Cow - NPR's Radio Lab does a show on William Beaumont.

Listen to Jason Karlawish talk about and read from Open Wound at Indiana University School of Medicine.