No Words

The Virtues of Appropriate Fear

Anesthesiologists shouldn't "scare" easily but they should "scare" appropriately. That is, an anesthesiologist needs to be able to keep functioning under stress, with as much calm, composure, and efficiency as a situation will allow, and call for any necessary help without reservation in the face of danger; but he or she also needs not to be so cavalier or arrogant as to be dismissive of extremely tough clinical situations, or be in denial that such situations are, in fact, frightening and dangerous.

Three examples of the latter come to mind - situations which have always commanded, and forever should command, a clinician's humble and healthy respect: 1) the potential need for intubation of a pregnant woman 2) the neonate, infant, or child in distress and 3) possible airway loss in a patient whose jaw has been wired shut.

In the last several weeks we had in our recovery room a patient whose clinical situation and appearance after surgery were something like this (this is the closest comparable illustration I could find on Google Images, from this paper in the Journal of Oral and Maxillofacial Surgery):

His lower jaw (mandible) had been secured to his upper jaw (maxilla) with a combination of wiring and elastics, and by secured I mean fixed SHUT. After surgery he was kept sedated for comfort and the breathing tube he had in his windpipe through his nose was kept in place.  The swelling of his cheeks and lips was severe, and any doctor, nurse anesthetist, or nurse who saw it would have had, as I've outlined above, what I like to call a "healthy respect" for the state of his airway. This is a potential life-threatening nightmare waiting to happen. When you are on call for the night and a patient like this is in the PACU waiting to be transferred to ICU you hope to God, even if you're not sure God exists, that all goes well and the breathing tube stays where it's supposed to. Fortunately he was transferred to the ICU in stable condition, and the night passed without incident.

As did the next night.

On the third night of his ICU stay my beeper went off at about one in the morning with a stat call to the ICU. I talked to one of the nurses on the phone and she said, "It's the oral surgery patient. He bolted forward and self-extubated."

I ran to the ICU and found this young patient grey as a storm cloud, with a low heart rate and, according to the monitor, the lowest oxygen saturation I'd ever seen in someone who wasn't dead. The covering night physician for the ICU, two respiratory therapists, and four or five ICU nurses were around the bedside getting equipment ready and assisting each other with resuscitation maneuvers.

"What do you need?" one of them said.

"Cutters," I said immediately, followed by, "Suction. Scope. Meds."

I immediately starting cutting the jaw securements, thinking all the while, "The oral surgeon's gonna kill me, but oh well." Fortunately a video laryngoscope was at the bedside and I was able to insert it into the patient's mouth and within a few seconds visualize the epiglottis and glottic opening clearly. The breathing tube had indeed slipped out and was dangling behind the arytenoid cartileges.

"Do we have any nasal RAEs in here?"

"What's that?"

"Never mind. Magills."

Someone handed me the bent forceps we use to advance nasally placed tubes through the vocal cords. Fortunately for us the patient's youth and vigor meant that even with sedation he was attempting to draw breaths, and with the laryngoscope blade lifting his epiglottis, these breaths were actually helping to improve his oxygenation even with the breathing tube dislodged.

I maneuvered the tube just to the entry point into the trachea, then manually advanced it in. With the breathing tube back in place his oxygen saturation came back up to 100%.

Once we felt the situation was stable we all took a deep breath, then called the oral surgeon, who came to the hospital immediately and re-secured the maxilla and mandible.

Honestly? I was SCARED. But you know what? I was supposed to be scared. There's a bad kind of scared that paralyzes you and makes you incapable of thinking clearly and doing what you need to do, and a good kind, the kind that removes any possibility of complacency or denial that something bad is happening right in front of you (pompous Downton Abbey doctor, anyone?).

We need to de-stigmatize the word and idea of fear a little bit and realize that not all kinds of fear are harmful or bad. Some fear is healthy and can actually protect people.

The Other Side of the Drape

My son had been having episodes of belly pain right around his belly button for several weeks. I watched and waited. Between these bouts of mild abdominal pain he was completely fine - healthy appetite, active, happy. But I had a feeling something was brewing. I was waiting for the other shoe to drop. The disease finally declared itself: several nights ago his belly pain was severe and unremitting. He was in tears. He couldn't sleep. The pain had shifted a little bit to the right. Sometimes walking made it worse, and when I examined his abdomen, pressing on the area and abruptly letting go increased the pain. Yet he was also able to tolerate the pressing, and to hop up and down on either foot. Still, I was pretty sure of what he had. It was time to take him to the hospital. Appendicitis.

"Where would you rate your pain on a scale of 1 to 10?" asked the E.R. nurse at our local hospital.

"Um...6.5," my son answered. His dad and I had to chuckle. This ultra-mathematically-precise answer was so in-keeping with his personality.

Some community hospitals evaluate and treat appendicitis in children but many refer patients directly to Children's Hospital, as ours did. I was glad of this; it's a terrific hospital, with complex, well-oiled systems which include not only health care delivery but also family and child supports. But I was also a little nervous. I had learned to anesthetize children here, and the training process had been demanding. I didn't know what it would be like to be on the other side of things.

My son and I walked into Children's just after midnight. It should have felt like home turf in a way, but it felt utterly foreign. We were led straight into an exam room. A strikingly beautiful pediatric resident came to interview and examine my son and did the same exact physical exam I had done at home. His peritoneal signs (i.e. symptoms that suggested an irritated abdominal lining) were even less prominent in the emergency room, and he had no real fever and an only slightly-elevated white blood cell count. I was concerned that the doctors there would lean toward discharging him, but I had a strong feeling we needed to be there for the long haul. The pediatric emergency medicine fellow came to see him as well. She repeated the questions and the exam. I can see now why this process can be irritating to family members who may not be familiar with training institutions. Can't the senior people just get the info from the junior people? Why do they have to ask the same questions and repeat the exams over and over? The answer is that doctors have to practice seeing with their own eyes, touching with their own hands, and knowing with their own inquiries. They can't just take someone else's word for what's going on with any given patient.

At 3:15 we went up to get an ultrasound of his abdomen. The radiology fellow seemed to be the serious, soft-spoken type (or maybe he was just quiet due to the time of day?), focused, with a cerebral air and a gentle manner. I watched as he scanned my son's belly, right kidney, left kidney, bladder, mid-abdomen. He pressed hard several times on a spot just to the right of my son's navel, and each time my son would wince or say "ow." After 45 minutes the fellow said he was 90% sure it was appendicitis, but it was hard enough to see the tip of the appendix that he was going to recommend a CT to confirm. "Usually it's a point of pride for me not to have to jump to CT confirmation, but in the interest of certainty I think I need to swallow my pride and send you guys to CT just to be sure." I was already sure, based on everything that had happened, but I respected the self-effacing and careful way he was willing to place my son's well-being ahead of his own professional "image" which, in my opinion, wouldn't have been

diminished anyway.

The E.R. nurse wheeled my son back to the exam room in the emergency department to await the next step. When we arrived he thanked her for transporting him. With a look of amazement she turned to me and said, "Who has such nice manners at four in the morning with belly pain?" I was so proud of him for staying sweet and patient despite his fear and discomfort.

The pediatric resident came in again to let us know they were in talks with the surgical team to see if the surgeon wanted to wait for CT confirmation or go straight to the O.R. based on the exam, labs, and ultrasound. We waited another hour after she left. My son confided, "Mommy? I'm worried about the surgery." I reassured him there was nothing to worry about: we were in one of the best hospitals for children in the country, perhaps in the world, and I trusted the surgeons and anesthesiologists there to take good care of him.

What reassured him most, however, was actually meeting his surgeon, a man who will be on my love-forever list for making my son feel instantly comfortable and for saving his life. We forget, when we are involved with several appendectomies a week most weeks out of the year, and it's one of the most bread-and-butter operations performed, we forget that these operations literally save patients' lives. Without them, patients risk dying. As my consent form read, "Alternatives: none." Our surgeon didn't want to wait around for a CT. He agreed with me. Everything pointed to appendicitis. He was going to bring my son to the O.R. to take his appendix out.

The surgical resident came to have me sign the consent form. By this time word had gotten around that I was an anesthesiologist, and that I had done some of my training there. Every new person who introduced himself or herself to us mentioned this to me. I had to smile when the surgery resident ACTUALLY USED HIS STETHOSCOPE and listened to my son's heart and lungs. He truly would not have been breaching any care standard if he had deferred the heart and lung examination at this point in the process - we were going to the O.R. regardless of what how heart and lungs sounded - but I appreciated this gesture.

We were transferred up to the O.R. holding area where my son changed at last into a hospital gown. His belly pain had been waxing and waning throughout the night, but now the pain was increased and holding. "Now that we're taking it out, it's making its last stand," he said good-humoredly through his pain. To my delight the pediatric anesthesia fellow on-call that night was a friend and former colleague of mine, and the anesthesia resident on-call was someone from the program that had trained me, which made me feel very comfortable because I know those residents are HAMMERED into doing the right thing for their patients from the first day of training. I knew these two, and their attending anesthesiologist, would all take very good care of my son.

And now came the hardest part: waiting. Waiting sucks. It was six in the morning. Even though all I wanted to do was sleep, I could only doze off for about twenty minutes. I wandered aimlessly through the parents' lounge. I watched the slice of sky between buildings outside the window change from black to grey to light blue as dawn broke over the city of Boston. Over an hour later the liaison called into the operating room for an update, and the specimen still hadn't been taken out of my son's body. I found that a little worrisome. Another colleague who was working in a nearby ICU stopped by to visit me after his morning rounds. Facebook friends were sending volumes of good wishes. I felt incredibly uplifted and supported but every clock tick was like something poking me to remind me that all was not yet well. It was like waiting for a plane to land and fearing that something might still happen.

Finally after about two and a half hours the surgeon came out to tell me they were done and my son was in recovery. The appendix had not perforated but it was one of the nastiest he had seen in years. It had been walled off under scar tissue from my son's body's attempts to defend against its brewing trouble, hence the equivocal nature of his peritoneal signs. The appendix was snaked back up behind the liver and toward the side, and it was large and gangrenous. They had had to widen the umbilical incision in order to be able to get it out. The surgeon showed me a photo (shared here with my son's permission):

That's when it hit me. My son could have died. Without this guy, and the other members of the surgery and anesthesia and nursing teams, or if we had been dealing with this 150 years ago, my son likely WOULD have died or at best gotten very, very, critically ill. ICU ill. It's a chilling and humbling thought.

My son did very well. He was lucky to have a room to himself when he went up to the floor. My husband and I got a tour of the place, which was clearly designed to be as family-friendly as possible, and every time we walked by his doorway my son would give us a sweet, wan smile from his sick bed. We watched "A Bug's Life" and "The Princess Bride" while my son had some Jello and mac-n-cheese and I had salads from Au Bon Pain, which at children's is a 24/7 operation. I had to go home for the night to rest for 24-hour call the next day, but my husband stayed with our son overnight and was able to take him home the next morning. My son never once forgot to say "Thank you" to his caregivers whenever they did something for him. Before I left for the night he even thanked me for bringing him to the hospital. I am grateful for his sweetness, and for the wonderful individuals who saw us through his first major ordeal. We owe them all a debt that I can only repay by trying to be for my patients what they were for us.

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Addendum 3/14/12: My son's thank-you note to his surgeon.

Haunting Music

Today in the hospital we were all surprised to hear strains from a harmonica playing "Somewhere Over the Rainbow," "Silver Bells," and other gentle favorites in the preoperative holding area. It was a patient playing in his stretcher - hospital gown, I.V., and all. Hearing soothing music played live in a setting in which such a gift is completely unexpected is indescribable. When he came out of surgery he played again. We could hear soft harmonica music from the area in the recovery room reserved for people who are going to be fast-tracked home. What a beautiful visitation for our not-so-hallowed halls. I have permission from "Harmony Hank," as I'll call this patient, to share this memento of those moments here. On rare occasions, magic does happen in the hospital!

***

There are some works of art that have captured my heart forever and will always be on my list of favorite or "most influential" works or "works I love most."

Then, among these, there are those I cannot, cannot, cannot imagine my life without. They have taken root inside me and are woven into my permanent intellectual and psychic fabric. I cannot shake them. They are part of me. They haunt me. They possess me like spirits inside.

Liszt's Piano Sonata in B minor, which I've recently been re-obsessed with in light of an announcement that Philippine concert pianist Cecile Licad will be performing it in Boston next month, and which I happened to look up TODAY only to learn that it premiered ON THIS DAY in 1857, is one of those latter works.

For me it will always be inextricably intertwined with Frederick Ashton's ballet Marguerite and Armand, and frankly if I didn't know better I would have thought, listening to the music, that Liszt had written it specifically for Alexandre Dumas fils' story The Lady of the Camellias, the subject of Ashton's ballet. I like to think Liszt did have this story in mind; the play premiered in Paris in 1852, Verdi's opera La Traviata opened in 1853, and Liszt composed the sonata in 1852 and 1853 and published it in 1854. Coincidence? Moreover he had been romantically involved with Marie Duplessis, the inspiration for the character of Marguerite Gautier, between 1845 and 1847. Surely the Lady of the Camellias was at least an indirect inspiration to the Sonata in B minor?

Ashton describes seeing the ballet unfold in his mind upon hearing the sonata on the radio. One might say that because he was a talented choreographer he was able to fit the ballet to the music, but once you see the ballet, you realize that it's also the other way around: the sonata follows the story EXACTLY. The best Youtube version I could find is between time index 42:55 and 1:12:30 of this Youtube upload of the documentary Nureyev: I Am a Dancer. Fonteyn and Nureyev, for whom the ballet was created by Ashton, will always be THE Marguerite and Armand, to my mind. Sylvie Guillem may have had more acrobatic technique, but she didn't have the soul for it. Tamara Rojo, though, who recently danced the role in London, may have been able to bring both qualities together - flawless technique and mature artistry. I'd love to see her Marguerite.

As for the sonata, my favorite recording of it is still Alfred Brendel's from 1981, but Andre Watts played a stunning version in Tokyo in 1988, and Evgeny Kissin's is amazing too. The piece epitomizes the Romantic period. It's almost PAINFULLY emotional and unapologetically melodramatic. But it also expresses what we mere mortals have no words to express, and sometimes we need that kind of intensity, especially in a world that holds the UN-emotional - rational and the scientific - so dear.

What is Death

I've only had to declare death a couple of times. Once in a three-year-old and once in an adult. In each case the heart had stopped beating. Death was clear.

Brain death is tougher to cope with, both clinically and psychologically. I imagine it would make anyone want to say, at some point, "Are you sure? Are you really sure? How do you know? How can you be sure?" Some times when brainstem function is gone and seems clearly irretrievable, there remains a good, strong heartbeat. Strong. Vital signs vigorous.

At one point this month, as I often do around Halloween, I was watching an old episode of the T.V. Show Ghost Whisperer. I enjoy ghost stories. I think whether or not one believes in a soul that can live on after bodily death, ghost stories can be interesting and appealing because everyone can relate to the feeling of being haunted or wanting to haunt. Even the impulse to visit places we haven't seen in years is this kind of gravitation toward haunting. The place still haunts us, and we want to return to haunt it for bit.

In this episode the main character, who is able to see and speak to spirits, receives signs and visions from a man whose body is in a coma but whose soul longs to break free and move on. His family is reluctant to remove life support, so he remains tethered, unable either to wander as an earthbound spirit or cross into a realm of peace that lies beyond this world. Every time I walk into an ICU I think of this episode. Even if ghosts and spirits don't exist, how can we know whether some remote corner of a patient's consciousness feels this sense of being trapped, tethered to ventilators and tubes?

If a family makes a decision to release their loved one and permit the life-giving gift of organ donation, I think of how painful it must be to leave the bedside for the last time. I've heard the sobbing of parents and siblings as I've waited to bring a brain-dead person to the O.R. for organ removal. I've watched a woman tearfully thank the doctors and nurses on her way out of the ICU for the last time as she leaves her sister in our care. I've looked down at someone younger than myself, thinking, "Your life was just starting," and felt sick and sad. Yet the automatic drill sergeant in my mind kicks right in: Not now. No time for feelings now. You have a job to do. Make sure all the families waiting for new beginnings today have the best, most well-cared-for organs you can help this patient provide. But I feel sick, I want to say. I want to cry. No. No sick. No cry. You do what you have to do and cry later. So that's what I do.

Anyone who wonders why an anesthesiologist would be needed for organ donation by a brain-dead person clearly has no grasp of what an anesthesiologist's job is. An anesthesiologist's job is to keep a patient's organs well-perfused and well-oxygenated. Usually this is synonymous with keeping a patient alive under anesthesia. In this special case, it means keeping the patient's heart and lung functions stable so that the donated organs can continue to give life in another or several others. I won't lie and say this type of case feels just like any other, even like just another cardiac case. It doesn't. It's strange. The patient is dead in the ways that matter most to his or her loved ones but alive in ways that will matter to others. Dead but not completely dead. I am taking care of a living shell of someone. A body that is dying and that eventually will come to a full stop.

For the anesthesiologist that moment comes when surgeons cross-clamp the aorta (and, if the heart is being removed, cut the heart out). After that, we can just walk out of the room. For the transplant surgeons it's just the beginning; after about four hours of harvesting they must rendez-vous with the organs and recipients at their respective medical centers and keep operating for eight or ten more hours, this time to put the harvested organs into hopeful people who have been waiting for this new start. For us, though, it's time to turn off the machine and leave the patient behind: the only time we ever leave a patient unattended in the room. This always feels eerie and wrong, but after all, what is there to do, when there is no beating heart left, no circulation, no breathing? And at some point, there is an almost-palpable change in the energy in the room. The person does indeed become a shell, with none of the vibe given off by a living individual.

Afterward all sorts of thoughts swirl around. What if that had been my loved one? Or me? What would I have wanted done, or done differently? I had ice cream last week. I hugged the person I love most in the world last night. This person will never do either again. I want to see Florence again before I depart the universe. I want to make croissants from scratch. I want to hear my son play the Bach Double Violin concerto, which he's starting to work on. I want to laugh really hard at a play with my daughter. What else should be on my bucket list? The thoughts just keep coming, when there's time and space for them, and Mr. Mental Drill Sergeant no longer needs to keep me task-oriented.

Organ removal is even more humbling, I think, than cardiac surgery. It's a concrete reminder of our own fragility and our tenuous hold on life. Lately I've been researching my children's ancestry on their father's side as well as mine, and as I go back and back and back many generations, and see birth dates and death dates and marriages - all huge events when we go through them, but mere drops in the ocean of time when you see them listed over the years - I can't help but think of how paradoxical it is that we are so small and insignificant, yet so dear and so meaningful. I also realize that what we pass on in terms of ideas and good actions is so much more important that what we pass on chromosomally. Our lives are so brief, then death comes for us all. There's no avoiding it. This moment is all we have.

Time to go and make the most of it.

9/11

images by Reuters, Doug Kanter, Shannon Stapleton, and Joe Raedle

Moving Beyond Mammy: Why I Strongly Disagree With Some Criticisms of The Help

I read Kathryn Stockett's novel The Help two years ago, when it first became a literary sensation. I loved and was astounded by it; it quickly became one of my favorite books of all time, among novels like Harper Lee's To Kill a Mockingbird, Barbara Kingsolver's Prodigal Summer, Natalie Babbitt's Tuck Everlasting, Marilynne Robinson's Gilead, Mark Salzman's Lying Awake, and now also Sara Gruen's Water for Elephants. It was unexpectedly very personal for me. I grew up in a society where the privileged have help, the help wear uniforms and eat in the kitchen and call their employers their "masters," and in some families the kids are taught "not to get too friendly with the help." I was lucky, though, and had someone like Constantine (portrayed by Cicely Tyson in the photo above): a woman I bonded with who's like a second mom to me, who's now been in our family for forty years and whom I love with all my heart, and who I know loves me with all of hers. Because of her I learned that love transcends a lot of barriers people can try to erect in various situations.

My brief mention of The Help in a blog post from when I first read it in 2009 summarizes the major themes that made me like it so much: "story and story-telling, truth and lies, having a voice and keeping silence and secrets, writing and how it transforms both writer and reader, and the true meaning of dignity and of significance." It's also, one of my friends adds, about "the power you get over your own story when you break the secrets and silence." She and I read it as READERS, I might even venture to say students of literature - but not as scholars of history. For this reason, critics who have blasted both the book and the movie for (supposedly) failing to be true to the historical times in which the novel is set, and for not focusing on Black History and the sufferings endured by Blacks in the South in the 1960's, have irritated me profoundly. The book was not written to be a documentary about the Civil Rights Movement. It was written to be the story of the intertwining lives of three very different, complex, and compelling women. Novels are about CHARACTERS and novel writing is and should be entirely focused on who those characters are and how those identities drive what happens to them.

No one should presume to tell an author, "Your character should have done this" or "done that." Only the author knows her characters well enough to know why those characters do what they do; she then opens up their lives to us in moments, and we can get to know those characters, but not with the intimacy and authority to be able to dictate what their actions should have been. Any such criticisms are projections by readers, which may be out of keeping with the characters' identities and completely untrue to the world of the book. And that, right there, is the problem: people with an axe to grind couldn't accept a CREATED world, the world of the novel, but rather wanted it to be the world as THEY would have it or depict it.

I read the Open Statement to Fans of The Help by Ida E. Jones, National Director of the Association of Black Women Historians (ABWH) and a review by journalist and University of Georgia professor Valerie Boyd, who wrote Wrapped in Rainbows: the Life of Zora Neale Hurston. I sincerely respect the fact that they know much more than most of us about African American history, and I appreciated being educated on perspectives that might not have occurred or been familiar to me, but I couldn't agree with many of the statements they made. Some of them annoyed me because they missed the point, and because by being so ready to criticize the work - perhaps even before reading the book or seeing the film, like some of their commenters, and perhaps because it was not written by a Black woman? - these critics willfully obviated the possibility of appreciating its many gifts.

The ABWH statement asserts, "Portraying the most dangerous racists in the 1960's Mississippi as a group of attractive, well-dressed society women, while ignoring the reign of terror perpetuated by the Ku Klux Klan and the White Citizens Council, limits racial injustice to individual acts of meanness." What a short-sighted attitude. Stockett clearly did not set out to portray "the most dangerous" racists or write another Mississippi Burning. It's unfair to paint her as intentionally "ignoring" the more violent aspects of the 1960's simply because her novel is about the moments behind closed doors, about diaries and journaling, about words on pieces of paper. I thought that was the very beauty of her novel - that it's about these non-spotlighted things. Does EVERY author who chooses to write about Black women have to have a scene in her novel with a burning cross? Is that a requirement? I thought the special thing about this book WAS its focus on the tiniest moments - it's about the little things that aren't so little. The WHOLE POINT of it is that racism isn't just in KKK violence but ALSO, and perhaps even more insidiously, in the fake smiles of the well-dressed hypocrites and the not-so-hidden sneers of day-to-day interactions.

I also COMPLETELY disagree with the description of any of the characters as "asexual, loyal, contented caretakers of whites." There are no Mammies in Stockett's book - just real-seeming, complex women with courage and heart. Each African-American woman in the book had an identity and a personality. There aren't well-developed male characters, but I think it's because another big POINT of this book is the power and impact of WOMEN's relationships with each other - the focus was, rightly, on Skeeter, Abilene, and Minny.

Many object to the fact that a Black male in the book is an abusive alcoholic. This, too, I find immature: the need for only positive portrayals when a given negative element is important to the story. Do people really think just because African Americans suffered for years, and continue to suffer in many ways still, that there were no wife-beaters among them, as there were among Caucasians, back in the 60's? Do all writers have to walk on egg shells and give terrible traits only to white people in their novels? This kind of reverse racism demonstrates some pretty stunted growth. The literature of my own culture suffers from similar post-colonial tensions. Poor us, it cries; look how the Spaniards raped and enslaved and colonized our people, and after them, the British and the Americans. We have to highlight how evil the white people were, and how long-suffering and noble we are. Give me a break. We have to tell the stories as the stories are - that's what writers DO.

At some point, the literature of a people has to move beyond the need to be perpetually and repeatedly social justice literature. Literature should ultimately be about story first and foremost - story and character. I don't think a story about any group is necessarily obligated to speak for "The Experience" of that group; a writer has to be true to the characters she creates, and those characters may NOT be at all representative in the way historical scholars would understand "representative," whatever that means. I thought the women in The Help were all worth "getting to know" for all their different strengths and faults - a sign of good writing and a story worth reading. In the end I always approach novels as being about the novel's characters, NOT about Black people in Mississippi or Native Americans in New Mexico or Haitians in Haiti. In this particular book, the message of having the courage to tell one's story, to use writing as a way of asserting voice, to paint oppressors of any kind as ultimately ridiculous, and to work together in friendship for justice despite danger, comprised such a valuable STORY that I find politicizing it really unnecessary and unhelpful. The characters are strong, courageous, humorous, imperfect, loyal to EACH OTHER, and different from one another. What's so Mammy about that?

There were many other points made in the aforementioned pieces and the comments they generated that inspired only incredulity and disagreement in me. Boyd's soap-boxy review The Help: a feel-good movie for white people can't even leave the anti-white venom out of its title. If a white person wrote something entitled "A Feel-Good Movie for Black People" there would be a public outcry. I am neither a white person nor a Black person and I certainly did NOT feel good about the pain I read about and saw on the screen, but like one African-American woman journalist who left a comment, I felt very good about the love I saw between women friends and the way the women "ultimately save themselves by telling their stories." Boyd's sweeping generalizations and judgments - that Black people would never confide in white people, that no white person would be remarkable enough to earn Black women's trust, that Skeeter was ONLY motivated by ambition as a writer and not by genuine compassion for the Black women working as domestics in her town, that this novel should have encapsulated the experiences of all maids working in Jackson in the 1960's AND been a portrayal of the larger Civil Rights Movement AND (unrealistically) shown a white woman breaking some kind of mold to confront her only circle of friends with their behavioral ugliness - reveal the bigoted stereotypes and narrow view of white people in her own mind. She's supposed to be this accomplished journalist and scholar - yet she can't rise above what one commenter aptly described as "petty grandstanding."

I honestly think a lot of people out there are just plain SORE that a white woman would DARE tell stories from Black women's point of view AND do such an amazing, vivid, compassionate job. Sour grapes, I say. They need to move beyond judging something for what they WANT it to depict and judge it instead by what the author actually set out to do - get into the small moments, the pouring of tea in kitchens and changing of diapers in the nursery, explore the daily moments and relationships in the lives of three characters: Skeeter, Abilene, and Minny. This is what novels do. They are not Civil Rights documentaries. Stockett didn't want to write a novel about the lynching of innocent, persecuted Black men; she wanted to write about courageous, funny, gifted, strong, inspiring women and their friendships, obstacles, trials and choices. I think her incredible writing and her portrayal of these characters has honored women of all races, and she should be praised and thanked for it.

But please don't be like the intellectually lazy commenters under Boyd's review who don't feel like thinking for themselves and have decided instead, based simply on her tirade or other negative hype, to hate The Help already and not bother to read the book or see the movie. Have a little cultural integrity and responsibility and experience the work for yourself, then decide. It deserves that much, if only because it has us all thinking and talking.

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Addendum 8/18/11: for an articulate, balanced, scholarly critical essay on what The Help could have done better, with a concrete and appropriate LITERARY example, check out this wonderful NPR piece by W. Ralph Eubanks: "Eudora Welty's Jackson: The Help in Context." He gracefully avoids undermining his own credibility by not lapsing into shrill, knee-jerk invective and thus successfully invites readers to open their minds and think critically - presumably the desired effect of any good critic.

8/29/11: Another thoughtful critical piece that makes an excellent point.