Book Blast! South Eight by Larry Atlas
The emotionally-charged story of South Eight follows a young doctor’s collision with the demands and contradictions of modern acute care medicine, both its power and failings and the moral questions it ultimately provokes.
For Dr. Abel Arkin, those questions reach back to his time as the spotter on an Army sniper team in Afghanistan, when the clarity of his training and skills converged with the uncertainty of mission outcomes and personal trauma. The old dilemmas and doubts join those of the present when a newly arrived patient tries to blackmail him with the threatened exposure of a wartime catastrophe and simultaneously underlines Arkin’s increasing ambivalence about what he is actually accomplishing for his patients, what may be missing from the life-and-death calculations he makes every day. In pitch-perfect language, Atlas builds suspense not simply around a disturbing medical and professional dilemma, but in troubling questions of individual trust and conviction. Both a literary mystery and love story, South Eight is also a piercing exploration of the reality of modern medicine, one with important insights for doctors and nurses, as well as for the patients they treat. Which is to say, for all of us.
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South Eight – Q&A with Larry Atlas
Question: Why did you get into healthcare? What did you do before healthcare?
Larry Atlas: After a couple years in the Army, and after subsequently earning
bachelor’s and master’s degrees at Bennington College, I went to New York to begin a
career in theatre. My goal, my first love, was playwriting, but for a long time I had to
make a living as an actor until the writing took over. Eventually my plays began to be
produced, and that led to writing work in Hollywood. I also got involved in a couple small
scale tech startups, one for the first online actors’ casting system, another for the first
fully ‘browsable’ video technology, for which my partner and I hold the patent. In mid-
life, essentially on impulse, I went to nursing school, fell in love with that work, the
people I met, and switched careers. I earned an MSN from Stony Brook and became a
nurse practitioner, practicing hospital medicine for ten years after four years as an acute
care nurse. Early in my career change, I found enormous satisfaction in caring for
others rather than seeking fame, money or personal gratification for myself. This
satisfaction was tempered by a deeper understanding of the limits of our care for the
sick/elderly, and that moral distress over our shortcomings led me to take a break from
work, during which South Eight was completed.
Question: What do you wish more people knew about working in healthcare?
Atlas: Suicidal thoughts are more common among physicians than among other
professions, despite good pay, high status in society, education, typically higher levels
of support at home. Each year hundreds of physicians commit suicide. Even before
COVID, nurses suffered from depression at twice the rate of the general population.
There is a moral distress associated with curing an acute illness, “saving a life,” while at
the same time knowing that by doing so we may “condemn” patients to more suffering,
day after day, month after month, year after year. There are obviously more factors than
that. Simply witnessing suffering is hard. Being present for death reaches into every part
of us. But the dichotomy of potentially hurting while thinking we’re helping, and the
necessity of denying it, can be crushing.
Question: Why did you choose to write this book? How did writing it compare to writing
a play or screenplay?
Atlas: Like many of my physician/NP colleagues I experienced burnout, in my case
after 14 years of hospital practice, first as a nurse, then as a hospitalist NP, providing
medical care to acutely ill patients. When I took some time off to restore, I wrote this
book, both to process feelings, and to consider solutions. It was also an exciting and
challenging introduction to prose-writing, which I had literally never done before. In fact,
I started out not once, but twice to write something along these lines for the stage. But
the experience of working in the hospital, with patients at crucial moments in their lives,
was simply too internal, for me at any rate, to examine in dialogue only. I can see South
Eight on the screen because the camera lets us in to a character’s inner landscape in a
way that plays do not. Of course, plays let actors use and interact with language in a
way that nothing else does, and I will always love that about playwriting. For me there is
nothing to compare with writing for actors, imagining what they might do with what
you’re writing, as you’re writing it. Novel-writing is a much lonelier process!
Question: What sort of impact do you hope your story makes with readers? What will
they walk away with?
Atlas: We, collectively, have managed to isolate ourselves from the realities of aging
and physical decline. The experience of those realities—a part of nature, and once a
part of humanity’s daily existence—has been outsourced to doctors, hospitals and
nursing homes, relieving us of fundamental questions about how we age and die, but
placing an extraordinary burden on them. We need a new approach to aging and the
illnesses that come with it. With a huge cohort of people just now entering their
seventies, they are unlikely to be satisfied with the habits and practices of previous
generations. Two questions arise from the reality of aging and death: when, and how.
Almost always, we, both as patients and providers, ask only “when?” and answer “not
now.” The vastly more important question for aging patients is “how.”
Question: How closely does the setting in South Eight mirror your real-life
Atlas: I would say very closely. Hospitals are extraordinary places, utterly unlike
anything else I’d experienced before I began working in them. The people who work
there are connected in unique ways, bonded by a shared experience of life and death
and suffering that outsiders can simply never know. And they experience a unique set of
obligations and stresses, of power and powerlessness, that would have been
unimaginable to me earlier in life. That sense of a world apart was so singular that even
when I took a break, I felt compelled to write about it.