Month: January 2015

Review: Being Mortal

Being Mortal: Medicine and What Matters in the End

Atul Gawande

I believe strongly that doctors are women and men who work in a health-care facility of some kind, including Being Mortalhospitals, clinics, shelters, combat support hospitals, etc. Doctors, ahem, do not host talk shows. Medicine is a challenging, ever-evolving field of study and practice. One cannot be both a practicing doctor and a television personality.

That is, unless you are Atul Gawande.

On Feb. 10, PBS will break this rule when the Frontline documentary crew shadows the surgeon, author and New Yorker writer. The show is a tie-in with Gawande’s new book, Being Mortal, which chronicles the history and current state of end-of-life care, an issue that’s come to the fore through the proposing and passing of “death with dignity” initiatives in many states. Gawande takes us inside the nursing home, assisted living communities, to learn what these institutions are getting right and getting wrong, and to offer a view of the alternatives, such as hospice.

I have enjoyed most of Gawande’s writing, but I believe he’s surpassed his previous successes with Being Mortal. While his other books have been intimate and instructive, there is greater depth here that opens the author to his audience as never before. As the book progresses, it becomes a memoir, of sorts, of his father’s final years, a touching, factual documentation that delivers a bold-stroke illustration of his argument without overshadowing the narrative.

The focus of the book, however, is not on Gawande or his family. It is on the thousands of families struggling with end-of-life issues everyday. An indirect consequence of medical progress, Gawande argues, is that extending life has overshadowed sustaining quality of life, and in modern times, we have the luxury of distancing ourselves from our mortality.

“Technological society has forgotten what scholars call the ‘dying role’ and its importance to people as life approaches its end,” Gawande writes.

Being Mortal begins with a scholarly frame: the author calls up one of my favorite books, Tolstoy’s The Death of Ivan Ilyich, drawing attention to the relationship between the titular character and his butler, Gerasim. Without falling down the rabbit hole of Tolstoy’s existential treatise, the takeaway for Gawande is at what point do we stop pursuing cures (which agonized Ilyich) and provide comfort instead (as offered by Gerasim).

As Gawande puts it: “…it is clear that there are times when the cost of pushing exceeds its value.”

Defining when it’s that time is an uncomfortable topic, and as the author explains, it leads to many difficult conversations, but is important for the benefit of the dying as well as their caretakers.

The Frontline episode should be fantastic, as the show usually is, and will hopefully wean Americans off the junk food of television doctors Oz, Phil, et al. and snake-oil salesmen like Eben Alexander.

Instead of junk food, Gawande gives us science, history and heart in a page-turning treatise on the way we die now, and how we could do it better.

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Dispatches from the War on Drugs

Two new books explore the macro and micro effects of failed drug policy

In 1996, Dan Baum published the definitive account of America’s complicated relationship with psychoactive Drugs Unlimitedsubstances. Smoke and Mirrors: The War on Drugs and the Politics of Failure is an exhaustive, apolitical narrative history of the war’s origin, evolution and cost, and though public opinion has changed (a recent Pew Research study found that Americans now favor treatment over prosecution and are against mandatory minimum sentencing by a two-to-one ratio), the book remains an important document of the human toll of the drug war.

I bring up Baum’s work because Drugs Unlimited: The Web Revolution That’s Changing How the World Gets High, by UK journalist Mike Power, is its 21st century bookend. At the time Smoke and Mirrors was penned, the Internet was in its infancy, data transfer rate was measured in kilobytes and computer literacy was limited.

In the decades since, the Web has expanded the chemical landscape, altering which drugs we do, how we acquire them, and in an effort to stay a step ahead of the law, Power writes, producers, suppliers and consumers have shifted into the wildly erratic world of “research chemicals”—legal alternatives to and analogues of illegal compounds sold widely over the Internet.

The consumption of psychoactive plants is nothing new (the earliest known head trip dates back about 13,000 years), but until the 1970s and ’80s, recreational drug users had only a handful of chemicals to choose from. In 1971, the United Nations identified just 234 legal substances; 243 new compounds have been identified in just the past four years.

Accelerated culture, indeed.

These new chemicals are often untested, of shady origin and composition and can be far more lethal than their outlaw counterparts. They’ve also inspired media-invented “epidemics” of bath salts and synthetic marijuana—fueling a digital age reefer madness that keeps drug policy mired in the past.

But Drugs Unlimited is as much about hypertext transfer protocol as politics. The psychonauts who once explored inner-space have journeyed into cyberspace, and the market has moved from the corner to the CPU.

Power’s narrative is thorough and engaging, but at times can be too thorough, particularly when it comes to the chemical names. For example, Power is compelled to include a complete stock list from a chinese distributor, which includes more than 90 compounds with names like 5-MeO-DALT, Methiopropamine (MPA), Fluoromethamphetamine (and its analogues), Desoxypipradrol (2-DPMP) and so on.

Granted, he does this for effect: “Among that unreadable alphabet soup of drug names there are hallucinogens, stimulants, empathogens and cannabinoids. Working out which of them are legal or which have been outlawed in various countries would require thousands of hours of legal time or case law study.”

This certainly helps shed light on the challenges facing consumers and law enforcement, but at times, the emphasis on product names can be overwhelming.

Aside from that, Power crafts an accessible narrative that is one of the most important books of the millennium. What Baum did for the American drug war, Power does for the U.K., from the digital age to the Deep Web.

The Triangle: A Year on the Ground with New York’s Bloods and Crips

Kevin Deutsch

While Drugs Unlimited operates at a broad level, The Triangle goes micro. For a harrowing year, journalist Kevin The TriangleDeutsch shadowed the gang-bangers of Hempstead, Long Island, in a place known as the Linden Triangle—ground zero of a 2012 turf war that turned an already rough neighborhood into a slaughterhouse. Forget the stereotypes of suburban Long Island. Think The Warriors rather than The Great Gatsby.

Dramatically reconstructed from interviews, legal records and first-hand experience, The Triangle is as fast-paced and action-packed as a first-rate thriller—a literary narrative as entertaining as it is troubling. The cast includes leaders, hitters and corner crews from both the Bloods and Crips; the terrorized residents of Hempstead; cops, criminologists and others in the justice system; and a minister who leads midnight prayer groups on the corners.

Deutsch stitches together their stories with a novelist’s skill. He’ll (rightfully) earn high marks in the press for his research and daring, but his ability to manage this Dostoyevskian cast without disrupting the narrative flow is worth noting.

Racial and social problems emerge that are intrinsic to the drug war. Incarceration and surrounding gentrification has turned Hempstead into an island of poverty. The gangs are the biggest employers in the Triangle, and those who would oppose the gangs are financially trapped in their territory.

Deutsch doesn’t give us an easy out. The reader is forced to confront the capriciousness of life in Hempstead, the social and legal conditions that created it and the self-defeating strategies of the gangsters that maintain a vicious status quo.

There is something heroic about the ability to survive in this environment, particularly in defiance of hateful neighbors (one Nassau County government official recommends that they “carpet-bomb Hempstead”: “Let the blacks and Hispanics go back to New York City. They’re better off there. Long Island isn’t that kind of place.”) Yet, Deutsch is wise to avoid romanticizing thug life, and not afraid to reveal the cowardice of its so-called soldiers:

Tyrek, leader of the Crips set, earned his membership by stabbing a pregnant teenager in the stomach. His ace card in the turf war is a suckerpunch, not a fair fight. J-Roc, a rising soldier in the Bloods, talks a big game, but struggles to intimidate a senior citizen. Ice, leader of the Bloods, helps promising kids get an education, yet orders the kidnapping and gang-raping of his rivals’ sisters, girlfriends and mothers.

Sadly, for all the lip service about honor, the Crips and Bloods mostly prey on the vulnerable. The true casualties of this war are the women in the crossfire. “The gangsters see sexual violence as a strategic and tactical weapon, as important to their arsenal as guns and blades,” Deutsch writes in the chapter “Extreme Tactics,” which includes the retaliatory abduction and gang rape of a female Crips employee.

At least the victim, in this case, actually works for the gang. That is not a prerequisite. Flex Butler, a Crips lieutenant, brags about assaulting the 15-year-old sister of a guy who’d stolen $2,000 worth of cocaine.

“‘[He] was hiding from us,’ Flex says. ‘So we got his sister when she was walking home from school. She fought hard, but there was a lot of us.’”

So yeah, these are not sympathetic characters. Deutsch doesn’t condemn, patronize, glorify or victimize, but presents the residents of Hempstead in all their unresolved moral complexity. For the most part, he avoids the cinematic histrionics common to gang narratives. The lone exception is D-Bo, a promising kid whose attempt to escape the corner gets a bit of the Hollywood treatment. Much is made of the timing of a confrontation with his gang (even though he’d been at home for a month), which leads to a chase scene, a misunderstood shooting and a dramatic exchange between the corner boy and the officer who tried to help him escape while awaiting the paramedics.

But I’ll forgive Deutsch this one instance of going for the heart strings. Otherwise, this is an unflinching look at the fear, fame and futility of gang warfare.

Strong writing, compelling characters and front-line reporting make this an entertaining read, but Deutsch’s detached, yet compassionate handling of the material makes The Triangle an important one as well.

Both Drugs Unlimited and The Triangle are worthy books on their own, but for anyone with a love of history, sociology or just damn good journalism, this is a one-two combination that, together, offers a wide perspective of the War on Drugs.

Review: Is There Life After Football?

Is There Life After Football?: Surviving the NFL

James A. Holstein, Richard S. Jones and George E. Koonce, Jr.Is There Life After Football

I couldn’t have known it at the time, but in one night I met two athletes who would become prominent figures in the modern NFL concussion narrative: Mike Webster and Jack Tatum. At the time, Tatum was recently retired, but Webbie was still playing for my hometown Steelers, and of the seven or so players I met at this banquet, these are the only two I remember.

Because I bleed black and gold, I was happy to meet Webster. I remember him being incredibly friendly, shaking hands with both my father and me and penning a thoughtful autograph. But as cool as that was, I was really excited to meet the notorious Tatum, the icon of NFL villainy for permanently paralyzing wide receiver Darryl Stingley.

This had earned Tatum one of the coolest sports nicknames of all time, and he was at this banquet promoting the first of his three autobiographies, They Call Me Assassin.

Tatum didn’t just look mean–the air around him chilled, the energy darkened. Something repulsive oozed off of him and kept the crowd at a distance. He didn’t crack a smile, had none of Webster’s warmth. When I handed him my autograph sheet he literally just signed his name. No message, no greeting. Just “Jack Tatum.” He was terrifying, and I came away from that encounter star-struck.

Of course, my opinions of both men are much different now.

Nevertheless, both men symbolize the celebrity and consequence of football’s golden age: Tatum the intimidating aggressor whose ferocity and win-at-all-costs mentality are prized attributes and Webster the tough-as-nails scrapper who attained on-field glory at the cost of his mind, body and dignity off of it.

In the past decade, we’ve learned about the long-term health risks of playing professional football. With every early death, suicide and descent into darkness and bankruptcy, it becomes more difficult to enjoy a Sunday slugfest with a clear conscience. In another two decades, we may not recognize professional football, because we’re just now recognizing the toll it takes on its players.

An important new book on the subject, Is There Life After Football?, considers not only the physical and neurological toll of the sport, but also the psychological impact of job-mandated violence, short careers, and the wild financial swings common among players.

Penned by two sociologists and an unexpected scholar (former Green Bay Packers star George Koonce–that is, Dr. George Koonce), Is There Life After Football? provides a sobering and insightful view of this transition through the personal anecdotes of Koonce and the research of Holstein and Jones. Most jarring is Koonce’s admission of a reckless act at the end of his career. It wasn’t exactly a suicide attempt, but he did drive his car off the road just to see what would happen.

This anecdote is all the more poignant when considering the recent driving death of Rob Bironas.

Though not as accessible as the prose styles of Malcolm Gladwell and Michael Lewis, the authors do a great job of distilling difficult material into a digestible form. It’s also a treat to read for anyone who enjoyed watching those plucky Packers of the 1990s. Juxtaposing those dynamic teams with Koonce’s experiences gives the book a Behind the Music vibe.

The takeaway is the same. Just as those we see on stage and screen are real people, so too are the men behind the facemasks.

Perhaps in a box, somewhere, at my parents’ house is a slip of paper with Webster and Tatum’s autographs. If I ever find it, I’ll frame it, perhaps donate it to a museum, where it can memorialize a different time, alongside bare-knuckle boxing and Crack the Whip as American pastimes whose time has passed.