A diary of The Tragic Obsession Tour
Keeping a diary of the Tour... Reads not like a blog but a book with the oldest entry first (a "golb" perhaps?), so to read the latest diary entry, you'll have to click on "learn more" and scroll all-the-way-down....
October 11th -- Two big New York City events kicked off the tour: the New School's Fiction Forum on October 10th and the New York Academy of Medicine on October 11th.
Vigorous discussions of why write a novel instead of a biography or essay -- because we go to nonfiction for facts and fiction for the truth! -- and deconstructing the myth of the physician-scientist as mythic hero. Read about the NYAM event here.
Picked up some great new books at the Great Lakes Independent Booksellers Association tradeshow, including Frank Bill's excellent short story collection "Crimes in Southern Indiana" (check out an interview with Frank Bill) and William Kennedy's latest novel "Chango's Beads and Two-Toned Shoes" (Kennedy has a fictional Hemingway advise an aspiring writer - "Shun adverbs, strenuously"). At the Univeristy of Michigan, Joel Howell from the Center for the History of Medicine delivered a thoughtful introduction. I was flattered when he urged people to read my Lancet essay "A Personal Choice." I wrote the first draft of that in a bar on the back of a magazine subscription flier.
Pathetically lost on the evening drive from Ann Arbor to Detroit -- took over an hour. Hallway carpet at the Detroit Metro Airport hotel looked like a Warhol print. Big monochrome flowers.
October 26th - UM Press tweets "Doctor's ethics hard to stomach." The whole book in five words.
Just added Emory University on March 7th and 8th, 2012 and Ela Area Public Library on January 14th, 2012. Planning trips to Rochester, New York; Boston; Northern Michigan; and Lebanon, Connecticut - Beaumont's homestead! Hoping to make it to Saint Louis, where the ambitious Doctor finally achieved his wealth but then suffered as his obsession become tragic....
November 2nd -- spoke to students and faculty at VCU's Science, Technology and Society Program. The story of a man from a simple background and modest means resonates as all too contemporary.
Tuesday night -- the 1st -- was the Philadelphia premier at the College of Physicians of Philadelphia's Great Hall, a large (great?) neoclassical room filled with portraits of stern men in dark suits. Beaumont would have loved it. Maybe. Jack Truten delivered thoughtful remarks. He picked up themes I'd not intended but yes, when you mix up characters and roll them into a story, they appear. Dinner with friends at Salento with many bottles of red.
Just did a NPR interview with Kathy Bernard and Barbara Kline of 2BoomerBabes. Great questions. Show airs in 2 weeks or so.
A review of Open Wound just up on the web. Reflects on the "sudden collision of Beaumont and Alexis St. Martin is almost like a koan or a parable, with the outcome depending upon the wisdom and integrity of those involved." Nice.
6 November - end of a long week that began in Philadelphia, traveled south to Richmond (spoke on ethical issues in early stage Alzheimers disease) and then west to Santa Fe to participate in the conference "Does the individual matter in science?" I spoke on desktop medicine.
13 November - reading at the MacLean Center for Clinical Medical Ethics at University of Chicago. Dan Sulmasy (ethics) and Alison Winter (historian) gave excellent commentaries. Its fascinating to see the book take on a life of its own. Video of the event should be ready in a week or so. Dinner at Nightwood on South Halsted in the Pilsen area was amazing -- ate at the kitchen counter seats with Erin Weiand and now finally understand the logic of the kitchen. Brilliant and elegant order chaos.
15 November -- Michael Vitez of the Philadelphia Inquirer interviews me on how the Paterno story is emblematic of a Greek tragedy.
22 November - Scheduled a date for a book event at the Trumbull Library and the Beaumont Homestead & lining up readings at Indie stores in Saint Louis, Petoskey, Travers City, and Minneapolis. Bless the indies!
26 November - Tired of just talking about writing, so I resumed sketching notes on the new book and while I was vacuuming, I finally solved a vexing plot problem that has been nagging me for months: how to write about the future before the future becomes the past? Answer: change the present, (or near past). The feeling was like making a diagnosis or finally closing on a research design.
3 December – just wrapped up a three date swing that started up in New Haven at the – yes – Beaumont room of the medical library and then two days in DC starting at the PRIM&R meeting at the Gaylord center where the trees are not painted but illuminated and all is for sale and then the NIH Bioethics Interest Group (yes, they are BIG). Dinner at Morey’s in New Haven was spared a Whiffenpoof song assault. In DC, dinners at Anvil and then Redwood were awesome. Worked on a paper review and email at the cafeteria of the National Gallery. The Warhol “Headlines” exhibit proves DeKooing true – he ruined art.
10 December 2011 -- In answer to how I imagined the relationship between Beaumont and St. Martin, I explain to readers that I thought of the two men as lovers whose relationship slowly fell apart. In the beginning, passion bound them together. Over time, it began to spiral out of control. They grew up and then apart and then back together and a part. And so on. The terms of their bond changed - faith, love, money, power. The relationship was not sexual, though they did have a unilateral physicality (witness the graphic in the NY Times 29 November 2011 review and reproduced at the beginning of this diary), but it was the bond of lovers and that organized the story.
20 December 2011 -- Just mailed out 10 copies of Open Wound to 10 people in the U.S. and Canada. The UM Press supplied me the books as part of the Goodreads "author giveaway program." A most interesting use of social media, a publisher offers free copies of a book and Goodreads members sign up for a copy. The Goodreads "machine" matches the book with the members most likely to prefer the book. And so it goes. In a kind of endless circle of prediction wherein past results may in fact predict future returns.
A book club event last week was a notable experience - an intimate gathering with six people who had just read it. Truly "just," as one member finished the last chapter in the host's living room as we were gathering over drinks. I am fascinated to see how people engage the story. Some side with Beaumont. Others with Alexis. A few with Deborah. Some see it is an critique of American values. Wine helps to loosen the associations.
1 January 2012 -- "I think that, in our time, it is very necessary to purify, to regulate, and to proportion the feeling of ambition, but that it would be extremely dangerous to seek to impoverish and to repress it over much. We should attempt to lay down certain extreme limits, which it should never be allowed to outstep; but its range within those established limits should not be too much checked." A. deTocqueville, Democracy in America. Third Book. Influence of Democracy on Manners Properly so Called. Chapter XIX. Why so many ambitious men and so little lofty ambition are to be found in the United States.
14 January 2012 – evening in flight to Philadelphia. On the 12th I was in Miami for the Human Amyloid Imaging meeting to talk on the ethical and policy issues that amyloid imaging the brain raises. Amyloid is one of the principle proteins implicated in the pathology of Alzheimers disease. Who should receive an amyloid imaging scan, and, if they should, how? Outside a South Beach hotel, a young woman says she was at my talk and found it the most interesting nonscientific talk she has heard at a scientific meeting. Is that praise?
From Miami’s steam heat, to Chicago’s clear chill, I travel to a book event at the Ela Area Public Library in Lake Zurich, just north of Chicago, sponsored by Lake Forest Book Store – an awesome indie store -- to participate in my first multi-author panel. Our gathering becomes a kind of nominal group technique wherein we arrive at a consensus that the low point as a writer is too often the interaction with the industry. When art mates with commerce, sometimes, the marriage produces a powerful spawn, but often the coupling yields a contentious and difficult child, long nights on the couch. And yet we still write. As I write this while gazing on the motherboard of Philadelphia region from my airplane seat, I say thank god for agents.
8 February 2012. Just set up an event at the Big Blue Marble, indie store in Mount Airy, Philadelphia. Have done several book club events. "Pen or computer?" "Music or silence?" "What do you wear?" The writer as object/subject. It's a turn of the tables. In truth, music influenced several passages of Open Wound.
11 March 2012. Back from two days at Emory University. Spoke at the Center for Ethics. Paul Root Wolpe has built a great group and an amazing space. Spoke on the ethics of pre-clinical Alzheimers disease at the Alzheimers Disease Center. Emory is a very cool place. Most popular and well-respected team sport there.... swimming!
Winter camp is now broken and the Spring leg of the Tragic Obsession Tour is underway. Last weekend, I spoke with Marty Moss-Coane on her NPR radio show “Radio Times” about the ethics of the doctor patient relationship. Then read to and talked with a group at the Big Blue Marble, a very cool indie bookstore in the Mount Airy section of Philadelphia. Minter Krotzer was the host and her husband Hal Sirowitz, the poet, was there as well. He asks if writing a novel is easier than writing a short story. I am inclined to agree. A lot of interest in the ethics of what Beaumont did and whether we are smugly judging him with the ethic of our time, when, in his times, what he did, was normative.
Monday the 19th I read at Mount Sinai Research Ethics Author Discussion Series (aka Mount Sinai READS). Great discussion with an audience with a keen interest in issues of research ethics. Someone asks if the historical record for Beaumont, such as in wikipedia, should footnote his discoveries with a criticism of the ethics of his methods, or even purge them as has been done for results from World War II era Nazi research. After the event, I visit the Guggenheim and watch the Europeans tour the galleries. Manhattan is insanely sunlit.
8 April – Taking a rest from a day of skiing in Utah. What started as a nasty terrain of crunchy snow and ice has transformed courtesy of a 12 inch snowfall last night.
The Spring Tour has been enjoyable. Mount Sinai READS was a blast (see gallery of the tour) audience was really engaged in the story. In St. Louis, I passed several hours at Washington University's Bernard Becker Medical Library where I read many of Beaumont’s letters from his Saint Louis years. Many thanks Stephen Logsdon. There, he was a celebrity physician of sorts and making good money but the letters show his desperation to have Alexis back with him. Though his reasons were to perform more experiments, he never explained what he intended to study. He just wanted to be back in the game. Took some photos of the letters and, for the first time, held a copy of Beaumont’s book. Posted some in the gallery including my book and Beaumont’s book together and an excerpt from one of Beaumont’s desperate letters where he writes "I must have him at all hazards...."
Readings and discussions at University of Minnesota and University of Rochester. The exchanges with the audiences over the ethical issues are fascinating. Of course, there is the meaning and purpose of informed consent, but also deeper and broader issues such as how the ethics of medicine and medical research are not purely made by doctors and researchers but, instead, shaped and reshaped by society, how the “other” is easily relegated to the object of discovery and ownership, how American values permeate what is medicine and medical care (hello “health care reform”), how ambition drives the life and work of the scientist.
What is notable is that several readers have seen the ordinariness of Beaumont's ambition. He was not some scheming evil doer, or a tortured soul, but, instead, a hard working American man determined to have for himself and for his family their fair share of the American dream. He was like all of us.
Many thanks to Left Bank Books and the University of Minnesota bookstore for hosting readings and signings!
The Lancet just published a review, "the man with a hole in his side." I’m not confident the image they label as William Beaumont is in fact the man.
25 April 2012 - Back from "The Homecoming" in Lebanon, CT (easier to abbreviate than to try to spell Connect...), where Young Beaumont got his start. Read to and discussed the book with an audience at the Trumbull Library and then toured the Beaumont Homestead. Bit of debate over whether Beaumont advanced the science -- I think he did, but the efforts he took to do it were excessive. He needed some good collaborators, but his ambition kept him from doing that. Much like scientists today who fret and jockey over order of authorship and who should be named on the patent.
Remainder of the weekend in Washington, CT. The earth desperately needs water.
5 Ma7 2012 - Gave the WIliam Carlos Williams Lecture at University of Pennsylvania. In the Q&A, I was asked if, like Williams, I needed medicine to do my writing and writing to do my medicine. Yup.
Here's a bit of my remarks...
"I want to talk about why stories still matter in medicine. I submit that story is key to make sense of things – to make what is called meaning. By story, I mean a string of words that fit together as sentences that together tell a plot that involves one or more characters doing things. A more refined term for this is narrative. In medicine, I think we have some challenges to the role of stories. We are entering a new model of medicine. Exiting a model built on story and entering a new model built on numbers. From a qualitative medicine to a quantitative medicine. From the bedside of the sick patient with a chief complaint driven history of present illness, to the desktop of the client at risk.
My point is that story still matters in medicine but that it matters in a different way than it once did. We are shifting from the history of what happened to the foretelling of what may happen. Story matters to help patients, physicians and the public make sense of the numbers…."
7 May 2012 - Just back fom a cerulean day in Indianapolis for a reading and signing at Bookmamas. And got to catch up with college buddy Lee. Many thanks to Cathleen and Carolyn for opening their store to me.
"Jason Karlawish does a great job of piecing this fascinating story together from various texts and journals of [that] era. The overarching lesson, if there is one to be taught or learned, is that this dynamic is ongoing through centuries. Among doctor and paitne and discovery, where does one draw the line between the betterment of the patient and the betterment of mankind?" Carolyn Everett, Bookmamas, Indianapolis.
20 May 2012 - Working more and more on the new book. I'm using notecards to sketch out the characters and then I pin the cards up on a big cork board to map out their lineages and linkages. Thinking of having one character be a hospital modeled after the now defunct Michael Reese Hospital in Chicago. It's going to be a novel about desktop medicine told from the perspectives of two physicians. One, an aging man, living alone in a continuing care retirement community. The other, his middle aged daughter, at the peak of her career. But then the markets crash and their estranged family is brought back into collision.
25 June 2012 - OPEN WOUND selected as one of five summer reads along with THE IMMORTAL LIFE OF HENRIETTA LACKS and STATE OF WONDER. The Northern Michigan Tour is taking shape. I'll be interview on July 2nd on the WTCM's Ron Jolly Show.
8 July – Home in Philadelphia following the 4 dates in 4 days Northern Michigan Tour. Arrived on Mackinac Island the afternoon of the 3rd via planes to Detroit and then on to Pelston. Sit beside a wide woman who eats a bag of cherries. On the high speed ferry from Mackinac City to the Island, the tourists photograph the boat’s three story high jet of water and then they pose as though DeCaprio and Winslet at the bow of the Titanic. Absence of cars, sun’s glow until 10, and then a blood red full moon. I wander about until dark. Children atop bicycles buzz past like flies.
On the 4th, I tour the Fort and reimagine what I imagined happened some 190 years ago. Best spot is the view down to the harbor where I had Beaumont and Major Thompson contemplate the Cosmopolis of Trade. Island Books sets me up at a table at the entrance and for two hours I chat with a steady flow of customers. Most are, like me, first time visitors. A few elderly people tell me they were last here when they were children. Mary Jane and her family host me for dinner and then fireworks viewed from a bluff overlooking the town.
Morning of the 5th, rain cools the place, settles the dust and spreads the horse smell. I drive from Pelston to Petoskey. Lost for a bit about town.
MacLean and Eakin has set up a display window devoted to the book that features a shotgun. Bess and Jessilyn are my hosts. I show a few slides and discuss the history to an audience of some 25 people and then utter my transition line – “that’s the history, or a history at least, and we read it for the facts, but we read fiction for the truth” – and then I read from Chapter 7 when Beaumont, on an otherwise ordinary day, has his mind sufficiently open, that, as he is ministering to his patient’s open wound, he realizes the wondorous potential his patient’s wound presents him. He just has to figure out how to explore it.
The audience engages on the ethical issues. One man, a rheumatologist, asks if the world of the researcher is really different, and I reply no, no it’s not. And we discuss about the 2008 quote from Jim Wilson which, along with a quote from deTocqueville, frames the book’s opening.
Dinner with Bess and Jessilyn. The kitchen is out of the whitefish spread and the shrimps stuffed with crab and wrapped in bacon. Surf and turf.
Morning of the 6th, I eat salty oatmeal, interview with WMJZ’s Mike Reling and then drive south Interlochen to talk with Aaron Stander at Air Interlochen Public Radio. He has me read from chapter 39:
“In time, their rooms became a factory of discovery, and Alexis was fully transformed. Beaumont came to see only the experiments at hand. Alexis’s thin body became like a patient machine centered at the puckered hole.”
Great to talk books and writers with a fellow writer. Wander the Interlochen campus and pause to hear an orchestra practice in the outdoor stage. Evening signing at Horizon Books and then dinner at a brew pub. The town is packed. Cherry festival is Saturday, and Saturday is my last day, a day in Gaylord at Saturn Books where Jill and her colleagues host a steady flow of customers eager to talk about the book. Lunch at a Diner, Diana’s Delights, reuben on rye and glass of water, and then the drive north to Pelston to return the car, to Detroit, to Philadelphia. When I enter the kitchen, Daisy the puppy executes a twirl of delight.
24 August 2012 - Some tour events are starting to return things like waves. The Mackinac Town Crier publishes a nice story about the book and me, and PRIM&R and NYU's LIterature, Arts, and Medicine Database publish excellent reviews, and Sherwin Nuland sends me wonderful words of praise:
“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 nuland.
3 September 2012 - Back from a family bash at the Eastern Shore of Maryland, my nephew-in-law (?) Stephen points out two typos that totally slipped me by, and when I return to the grid and check my email, Mary Roach, met her through RadioLab, has sent me these thoughtful words of praise:
“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.”
2 October 2012 -- an engaged audience meets me at IUPU medical school's historic Emerson Hall auditorium as part of the Seminars in Medical Humanities and Health Studies. Many thanks to co-sponsors IU School of Medicine, History of Medicine Student Interest Group, John Shaw Billings History of Medicine Society, IU Center for Bioethics, IUPUI Medical Humanities and Health Studies program. It's a thrill to see how a novel engages ethics and how a story about time past makes sense of time present. You can listen to the talk on the Indiana University School of Medicine website.
7 October 2012 -- a great event at Harvard hosted by the Harvard Faculty of Arts and Science Research Administration Services at the Harvard COOP -- several people had read the book and we had a spirited discussion of ethical issues such as informed consent, conflict of interest, the transformation from physician to scientist, and the social and cultural factors shape and distort the researcher. My visit to Boston was cut short when John developed peri-umbilical discomfort that localized to his right lower quadrant. We rushed home to Philadelphia and the CAT scan showed a normal appendix and he improved. In days of old he would have been watchful waiting, or perhaps, in the hands of a more aggressive surgeon, a false positive case....
15 December -- Paperback edition is planned for a Spring 2013 publication.
16 February 2013 -- Paperback due out in April. And just set up a fascinating event at Wisconsin's Fort Winnebago. They are interested in the history of the "other" - a theme OPEN WOUND draws on, especially Part 2 "The only men entitled to happiness."
Check out my interview with the awesome noir writer Thomas Pluck.
31 March 2013 -- Paperback is about to hit the stores and the Spring 2013 campaign of the Tragic Obsession Tour about to begin.
19 April 2013 -- Spoke at Sentara Health Care System's annual ethics conference. I began my remarks reading from Robert Coles' 1979 New England Journal of Medicine essay "Medical Ethics and Living a Life." Coles reflects on how stories, novels in particular, can instruct a physician about ethics. He argues that stories may be even better than reasoning from principles and related analytic approaches. The value of novels is that they show how life's daily choices and decisions, some quite ordinary and happenstance, have such a substantial impact on how one cares for patients. He argues that the divide between the professional work day and the personal private life is largely an artificial divide. Each influences the other and reading novels helps us to understand that.
Quite thrilled to see OPEN WOUND written up in the Italian newspaper Corriere della Sera http://www.corriere.it/salute/13_aprile_14/storia-uomo-buco-stomaco_8297...
May -- Met with medical students at UCSF who are writers and writers to be. They are working with Louise Aronson, doctor and writer on faculty at UCSF. We sit in a circle and talk about the choices of specialty and habit, and whether being a writer is part of being a doctor (yes!). The conversation kindles memories of my solitary years in medical school when I would rise at 5 a.m. to write and sent short stories out to all sorts of journals and magazines.
June 5 -- In Memphis, Tennessee to talk at St. Jude Children's Hospital about Open Wound with the St. Jude clinical research book club. This is now the third time I've met with this kind of book club. I'm beginning to discern how IRB members, staff and clincal researchers see a need to engage not simply the rule-based aspects of research ethics, because it is a deeply rule-based field that includes a "code of federal regulation" and all sorts of detailed guidance and steps, but also to engage the intersections between research ethics and living a life as a researcher and research regulator and reviewer. I did not set out writing Open Wound to make this point or to have the book serve as a kind of "text" for this, but when the book was in press and the publisher asked me to write an "Afterword," I started to reflect on how the life of William Beaumont is the life of the researcher who is making daily choices, choices that will ramify across not only his life but also the lives of his family and Alexis, his patient turned subject turned property. These choices are as ethically charged as the principle and rule-based decisions about what level of risk is a protocol or whether written informed consent can be waived. I am beginning to see how these choices in fact may shape those principle and rule-based decisions.
June 17, 2013 -- a surgeon in Toronto wrote me to say that the Department of Surgery book club is reading "Open Wound." She asked me to send any questions for the club to discuss. Here's what I sent her:
The Afterword does bring up several issues that are topics for discussion. Also, when people discuss the book with me some of the recurrent issues include:
-- The distinction between Beaumont as a doctor-scientist and Beaumont as a husband-father: in the life of the physician and the scientist is there, in fact, a distinction between the professional and the personal?
-- Did the times Beaumont lived in influence how he treated Alexis? If so, then are we simply judging Beaumont by a more informed and thoughtful contemporary ethic?
-- Was Beaumont competent to be a researcher and, if not, was his treatment of Alexis acceptable?
-- Is telling the Beaumont- St. Martin story as a novel "responsible?" Or, should I have written it as an essay / history?
-- What is especially American about the Beaumont- St. Martin story?
-- Could such a story happen today?
14 August -- getting ready to Go Ahead West for the Tragic Obsession paperback tour; stops include Ann Arbor, Traverse City, Fox Run Retirement Community and Fort Winnebago. And I'll be talking with WTCN's Ron Jolly about the book. He's a big fan. Check out the Gallery for the photo of the Mackinac Island Book Club who I spoke with by phone last week.
14 October -- in SF for LitQuake 2013 - talking literature and medicine with Louise Aronson and Chris Adrian. I think my point will be how Open Wound is about transformations - from physician to physician-scientist. I'll read from chapter 7.
Reading Colum McCann's ZOLI -- great line: "Things in life have no real beginning, though our stories about them always do."
3 November 2013 -- I meet with a group of about 15 medical students at Penn, all of them interested in writing. We talk about issue of craft and the writing life. is there some secret? I reflect on hard work and just a bit of bad luck that makes you take stock. I mention the life of Walker Percy, a physician who was sidelined by TB. Sadly, none of them have read Percy; one raised his hand that he'd heard of him. I suppose that's the fate of most writers.