Category: Books

Dying in the City of the Blues:

Sickle Cell Anemia and the Politics of Race and Health

By Keith Wailoo

University of North Carolina Press,

325 pp., $34.95 ($16.95, paper)

For every era, there are characteristic diseases that attract
public attention, and in every disease there are particular features that gain
cultural currency and achieve high levels of popular visibility because they
embody social concerns, cultural anxieties, and political realities.”

Obvious case in point: AIDS in the ’80s. Earlier case in point
and of vital concern to African Americans: sickle cell anemia in the ’70s. But
as Keith Wailoo (author of the above quote) explains in his important new
study, Dying in the City of the Blues, sickle cell’s nationwide
visibility beginning some 30 years ago had a visibility some 70 years ago on
the streets of Memphis and on one street in particular: Beale.

When Lizzie Douglas (aka Memphis Minnie) sang “Memphis
Minnie-jitis Blues,” was she singing not of meningitis but of sickle
cell’s symptoms? And “the blues” itself — the “low down
shakin’ chill” of Robert Johnson’s “Crossroads Blues,” a chill
born of a malaria-prone river valley, transferred to a city itself a
geographic, commercial, and cultural crossroads — was it not an emblem of one
of sickle cell’s target populations and that “invisible”
population’s predicament: Delta blacks and their quite real but
“invisible” pain?

Wailoo, an award-winning professor of social medicine and history
at the University of North Carolina, doesn’t overdo the possible link with the
blues, but he does establish the undeniable links between sickle cell anemia
and three issues of key meaning to modern Memphis history: “scientific
medicine in friction with race relations and health care politics.” All
three in local terms were to become by the ’70s, in national terms, what
Wailoo calls “a complex cultural negotiation” between what science
shows, society dictates, and leaders legislate. Read what you will into that
academic buzzword “negotiation”; Wailoo’s demonstration of disease
as “commodity,” as “politics,” and as
“narrative” are his book’s triple features. General readers need not
beware; Memphis readers, read the record:

By the 1920s, in a town H.L. Mencken once described as a
“rural-minded city” (and Wailoo adds, “arguably still
is”), Memphis was receiving a steady influx of rural blacks at a time
when the paternalistic “plantation complex” of the South was in its
last stages. And by 1926, the local VA hospital was reporting its first case
of sickle cell anemia, a disease in some African languages referred to as a
“state of suffering” and, in the VA report, a disease diagnosed
independent of the more common conclusion, malaria. Three years later, Dr.
Lemuel W. Diggs, with a “distinctly new, laboratory perception of
disease” taught to him at Johns Hopkins, was brought to UT-Memphis. The
medical school as a teaching institution was suffering; Memphis blacks, many
of them indigent and many of them complaining of repeated infections, joint
and abdominal pains, and general lethargy, were suffering too — from Jim Crow
and the substandard health care that went with it. The opening of the city’s
General Hospital and UT’s affiliation with that hospital helped answer the
needs of both: The school got a concentrated pool of patients; African
Americans got at least a semblance of professional care to compare
(unfavorably) with that of whites.

In the ’30s, however, what the author terms “new habits of
clinical surveillance” and New Deal activism (in the form of New Deal
dollars) raised not only the status of UT nationally but the visibility of
“sicklers” locally, and with it a highly “circumscribed”
visibility for blacks — as patients obviously and as nurses conceivably, as
UT-trained doctors never. Under the political machine of Edward
“Boss” Crump, the health care for blacks improved too but as an
aspect of Democratic Party patronage, until a report by the U.S. Public Health
Service listed Memphis as having the highest infant death rate in America.
Civic action immediately kicked in: in the form of John Gaston’s bequest to
build a new city hospital; in the form of postwar fund-raising efforts among
whites and blacks to build Le Bonheur Children’s Hospital; in the form
of private donations by philanthropists such as Herbert Herff and Abe Plough
to advance the ground-breaking research conducted by Diggs and Dr. Alfred
Kraus at UT; and, beginning in the late ’50s, in the form of St. Jude
Children’s Research Hospital, whose mission statement explicitly forbade any
and all racial considerations.

Where did this leave sickle cell the disease? On a molecular
level, thanks to Linus Pauling’s discoveries, and on a “commodity”
level, thanks to federal dollars. Patients were growing in
“immanent” value, the “legitimizers” of research agendas.
But by the ’60s advances in scientific understanding and advances in Memphis’
international reputation as a center for sickle cell research meant also new
views of the disease, with different lessons for different observers. Wailoo
calls it the “politicization of disease” to describe Congressman Dan
Kuykendall’s successful fight to win research dollars (and black votes) in
response to his district’s redrawn boundaries and “changing
complexion,” and he quotes from others the “ethnic disease
politics” to describe the ’70s upswing in new theories of black identity
generally, new theories of sickle cell biology specifically. But with the
recent rise of managed health care and the recent advent of expensive gene
therapies, a free market caused a shift away from academic health centers and
away from sickle cell as well, a disease that afflicts and kills far fewer
than, say, hypertension.

For Memphis, the city at the crossroads of Southern culture that
had managed to make medicine central to its economy, Medicaid-turned-TennCare
meant consignment to the state’s medical-economics margin. The big bucks were
now in Nashville, courtesy of one of that city’s leading cash generators,
Columbia/Hospital Corporation of America. A loss to Memphis, then, and a loss
to the attention paid the city in the closing pages of Dying in the City of
the Blues.

But for a serious loss for readers, consider this: the absence
altogether of case histories to go with Wailoo’s account of sickle cell
science and policy, of names, faces, individuals to go with what is in every
other respect an admirable sociology of medicine. We read of doctors,
lawmakers, concerned citizens, film stars, sports stars. We read of agendas,
protocols. We read of “racial identities” and “strategies of
accommodation,” “explanatory models” and “disease
landscapes,” “forces.” We read of blood smear techniques and
recombinant DNA techniques, of hydroxyurea therapy. What we hear nothing from
are the sufferers themselves, excepting perhaps the lone lyrics of Memphis
Minnie.

Wailoo ends his book on a literary high note, borrowing from
Ralph Ellison and that writer’s Invisible Man. Unfortunate to think in
this one book especially, given Keith Wailoo’s otherwise thorough work, of
sicklers invisible here.

Demonology

By Rick Moody, Little, Brown, 306 pp., $24.95

Rick Moody

Ambitious and occasionally glorious, Rick Moody’s new collection of short stories, Demonology, is amazingly, infuriatingly inconsistent. Moody succeeds when he works to communicate the deep grief and sorrow, the worry and weariness of his characters, but when he strays from the emotional to the overly conceptual, his writing becomes pointlessly clever and woefully condescending, too concerned with surface to consider craft.

“The Chicken Mask was sorrowful, Sis.” So begins the first story, “The Mansion on the Hill.” It’s an intriguing sentence in its duality, for by “sorrowful” Moody means both pathetic and regretful: The mask is a talisman of good times long past and the bad times in which his characters are inescapably mired. Such an item appears in almost every story here, as the inhabitants find themselves trapped in bad situations that can only get worse.

After dressing as a chicken to advertise a fast-food restaurant called Hot Bird, Andrew Wakefield — the man behind the mask — finds work at the Mansion on the Hill, a wedding hall featuring a number of different chapels with names like the Ticonderoga and the Rip Van Winkle. Here, Andrew helps organize and host all types of weddings, from modest to extravagant, while steering clear of his dour, demanding boss. But in this “place of fluffy endings,” Andrew carries a “barely concealed sadness,” and Moody captures it with deep empathy, despite the story’s comic tone and satiric edge. While excelling in this regard, “The Mansion on the Hill” recalls recent works by George Saunders, who carves surprisingly moving tales from bizarre workplaces. Moody does not fare well in this comparison.

More successful is “Forecast from the Retail Desk,” in which Everett Bennett, a self-styled psychic who works at an online investment firm, claims he can see the future, specifically the bad things that will happen to the people around him. His skill, he discovers, is not a gift but a curse: Everett blames himself for all the tragedies that befall people, as if by predicting an event he directly causes it. Tortured by the horrible visions of an unchangeable future, he is likewise haunted by the grave mistakes of the past. Writing in first person, Moody creates in Everett a genuinely compelling, truly soulful character, one whose forlorn voice marks this harrowing story with a profound, lurking sadness.

The collection’s best moments come during its longest piece, a two-part novella titled “The Carnival Tradition.” In it, Gerry Abramowitz recounts a car accident that leaves him with a crippled arm, which he calls the Claw, and an addiction to painkillers. He also reminisces about his teenage years in New England, specifically a rich kid’s Halloween party that ends in a fiery disaster. This section reveals Moody at his finest, seamlessly evoking the awkwardness of adolescence during the late 1970s and creating an air of autumnal melancholy. And through prose that is both lucid and wrenching, Gerry becomes his most realistic creation, a character tragically defined by his own bitterness and defeat.

In too many stories, however, Moody’s high-concept experimentalism and dense writing style prevent the development of character, tone, and setting. “On the Carousel” uses the business language of Hollywood — net, back end, options, test screenings — to examine “whether language itself clutters up what otherwise might be simple.” Illustrating this idea is Lily, a script doctor who, while driving through Los Angeles, frets over her possibly mentally handicapped son, her job, and her husband. She pulls into a McDonald’s to buy juice for her daughter and ends up in the crossfire of a gangland shoot-out.

It’s an interesting concept certainly, but that’s all it is. To an extent, Moody develops the idea through his acrobatic, ever-intelligent prose and excruciatingly slow pacing, but since Lily is neither a realistic nor a very well-developed character, he ends up talking the idea to death.

Ultimately, Moody’s most damning sin in Demonology is that he cannot distinguish his strengths from his weaknesses. At his worst, his writing is strained and inflated, too dependent on gimmicks to adequately engage the reader. But at his best, he can be thought-provoking and highly original, his dense, often graceful prose capturing all the angst and loss of characters anchored to history.

Demonology contains some truly memorable stories, and their images and emotions stick around long after the book has been placed back on the shelf. But as a whole, it suffers a lack of cohesion and purpose that prevents it from achieving its lofty ambitions.

The Body Artist, By Don DeLillo, Scribner, 128 pp., $22

Don DeLillo is a writer’s writer. Ask many contemporary fiction writers whom they read and an inordinate number of them might answer, “DeLillo.” That’s because he has all the gifts, because he has come to represent an artistic integrity and a willingness to take risks missing from much fiction today, and because, for all his erudition, he is as entertaining as the human race. He may be the most beloved of the postmodernists. He’s not impenetrable, but neither is he Robert Ludlum.

DeLillo’s last novel was the gargantuan Underworld, a bursting-at-the-seams, complex zodiac of a novel, a book seemingly as large as its subject: the 20th century. It should have won all the major fiction awards, and, as time passes, its importance will only be magnified. Now DeLillo has followed the massive with a missive, a 128-page novella about intimacy and loss.

The Body Artist is the story of Lauren, the titular “body artist” who uses her torso in experimental performance art, and Lauren’s husband, film director Rey Robles, who dies after the first chapter. Lauren’s return to the home they shared coincides with the appearance of a strange young man, an ageless creature really, almost a blank, a human template, who is “impaired in matters of articulation and comprehension.” Suddenly he is just there in the house, seated on a bed in his underwear, as if he had been transported from another dimension.

Lauren names her guest Mr. Tuttle and begins to carry on an almost one-sided conversation with him. His replies, when he replies at all, are enigmatic non sequiturs. As the author describes it, “There’s a code in the simplest conversation that tells the speakers what’s going on outside the bare acoustics. This was missing when they talked.”

Mr. Tuttle also comes and goes like a revenant, like the birds to the feeders at Lauren’s window, visitations she is enchanted by. Soon Lauren begins to suspect that Mr. Tuttle is aping conversations she and Rey had. How long has this stranger been in the house? she asks herself. Is he really there now? Or is he just a catalyst to propel Lauren into the next phase of her life? If this is a haunting, it’s a haunting by what? She tries to capture Tuttle’s oblique statements on tape, as if preserving them is saving something: a part of Rey, a part of herself.

“His subject is people in landscapes of estrangement” reads one of Rey’s obituaries. “He found a spiritual knife-edge in the poetry of alien places, where extreme situations become inevitable and characters are forced toward life-defining moments.” Clearly, this is a precise summing-up of DeLillo’s entire, brilliant oeuvre and this new addition to his body of work. The Body Artist, ultimately, is a discomforting examination of Lauren’s search for that “life-defining” moment.

Fans of DeLillo will be delighted with this short, numinous story, a neoteric Grimm tale, an ultramodern spectralogy. The story is made up of particulars, precisely observed and described; each line meticulously crafted and essential to the whole. “[Lauren] was alert to the clarity of the moment but knew it was ending already,” DeLillo writes early on, and the action of The Body Artist seems to take place between such twinklings of observation. It is a work of such refined and well-tuned writing it seems to be a high-wire act, a poem written with a switchblade.

“Time seems to pass,” DeLillo writes at the opening of the novel. “The world happens, unrolling into moments, and you stop to glance at a spider pressed to its web. There is a quickness of light and a sense of things outlined precisely …. You know more surely who you are on a strong bright day after a storm when the smallest falling leaf is stabbed with self-awareness.”

The Body Artist is DeLillo’s most delicate work, a finely etched cryptogram, where mystery is made concrete and the concrete is made mysterious. Its magic is like Beckett’s: serious comedy built slowly and carefully, like that spider’s web. Put another way, this is a novel made of spun glass, brittle, elegant, and sharp at the edges — further proof that Don DeLillo is one of our finest and most important writers.