J. M. Coetzee’s Literature of Hospice

This essay examines scenes portrayingcare for the aging, ill, and dying across J.M. Coetzee’s fiction. Even as Coetzee’s work models an ideal of hospice that resonates with Derrida’s conception of unconditional hospitality, it also attends to how this ideal is constrained by a global neoliberal regime that conceives of dying as a crisis to be managed. Coetzee’s fiction envisions both care for the dying and dying itself not only as managed, routinized labor but also as potentially unmanageable acts of creation

“To Be from the Country of People Who Gave”: National Allegory and the United States of Adichie’s Americanah

Current debates about Afropolitan literature alternately value it for challenging western stereotypes about Africa and critique it for embracing western capitalism. Chimamanda Ngozi Adichie’s Americanah (2013) complicates these debates by articulating a Nigerian dream that, while imbued with the class mobility of its American counterpart, delinks the dollar from intimately experienced, ongoing histories of white supremacism

Literary Cosmopolitanisms in Teju Cole’s Every Day is for the Thief and Open City

This paper examines cosmopolitanism in Teju Cole’s Every Day is for the Thief (2007) and Open City (2011). The protagonists of both texts maintain cosmopolitan identities largely by embracing an international literary culture in which elite cosmopolitan fiction relays the experiences of marginalized cosmopolitan subjects such as migrant workers and refugees. The texts, however, suggest the parochialism of the protagonists’ cosmopolitan sensibilities by introducing characters who possess creative resilience and language skills that the protagonists lack. Cole’s texts thus foreground the limits of a literary cosmopolitanism that privileges Anglophone fiction published in New York and London and gesture toward alternative literary cosmopolitanisms notable for their linguistic and geographical diversity, if not their glamour. Although Farouq and the “yahoo boys” aspire to membership in an elite cosmopolitan culture, their lives are non-spectacular and relatively immobile. Cole’s texts value a cosmopolitan literariness that neither hails from the intellectual cosmopolitan elite nor takes the dispossessed cosmopolitan migrant for its subject

Sympathy and Cosmopolitanism: Affective Limits in Cosmopolitan Reading

This paper argues that contemporary understandings of cosmopolitan literature are significantly limited by their dependence on sympathetic attachments as constitutive of cosmopolitan practice. I trace a genealogy of the connection between sympathy, cosmopolitanism, and the novel that extends from Adam Smith and Immanuel Kant to Martha Nussbaum and Kwame Anthony Appiah, in order to contend that contemporary models of cosmopolitan reading rely on problematically normative definitions of the ‘human’. J.M. Coetzee's Boyhood, I propose, suggests an alternative model of cosmopolitan reading that neither equates sympathy with humanity, nor precludes those who ‘feel apart’ from participation in cosmopolitan community

Humanitarianism and the Humanity of Readers in FEMRITE's True Life Stories

This paper examines three FEMRITE collections of ‘true life stories’, Today You Will Understand (2008), Farming Ashes (2009), and I Dare to Say (2012), all of which include testimony of women's experiences of war in northern Uganda. While these volumes explicitly aim to abet a project of national awareness and reconciliation, they also self-consciously address themselves to Anglophone audiences in the global North. The nature of this address is distinct. On the one hand, the collections echo an international humanitarian discourse that tends to emphasize that personal testimony is, indeed, ‘true life’. On the other hand, the collections also foreground that the testimonies they present are imaginatively constructed accounts, or ‘stories’, that have been co-authored by FEMRITE writers and women who have lived through war. Non-African Anglophone readers are thus invited to engage with women's testimony in terms that alternately recall and resist western media accounts of the northern Ugandan conflict

Discussing Prognosis: Documented Communication with Elderly Patients with Cancer at the End of Life

The purposes of this study were to evaluate the frequency of documented prognosis discussions among terminally ill cancer patients, to identify correlates of having documented prognosis discussions, and to describe the content of prognosis discussions as documented in patient medical records. Sample data were collected from the randomly selected medical records of inpatients (n=210) aged 65 years or older and admitted with diagnoses of brain, pancreas, liver, gall bladder, or inoperable lung cancer from six large Connecticut hospitals. A standardized instrument was used to extract data concerning patient demographics, hospital course, prognosis discussions, and evidence of advance care planning. Prognosis discussions were recorded in 79 (38%) of medical records and were correlated with emergency admission status (p=0.004) and longer length of hospital stay (p=0.003) on multivariate analysis. Of the documented prognosis discussions, 63% were within one week of admission but after the first day, and 57% included the patient, 76% included the family, 77 % included the doctor, and 69% did not include another health staff member (n=79). Life sustaining treatment discussions and DNR orders were both associated with prognosis discussions (p=0.001 and p=0.001, respectively) and were more often documented after the prognosis discussions. Prognosis discussions included planning for care and treatment in 33 (42%) of discussions documented. In conclusion, we found that prognosis discussions were infrequently documented during the hospitalization of terminally ill patients diagnosed with cancer. We also found that advance care planning, such as discussions of life sustaining treatment and DNR orders, was significantly associated with prognosis discussions and more often occurred after prognosis was discussed

An art of hunger: Gender and the politics of food distribution in Zakes Mda’s South Africa

This article examines the centrality of hunger and food in Zakes Mda’s Ways of Dying, The Heart of Redness, and The Whale Caller. While Mda’s work has been the subject of incisive readings of the politics of development in contemporary South Africa, attention to his treatment of hunger, specifically, helps to clarify the centrality of gender to Mda’s critical re-envisioning of development policies pursued by late and postapartheid governments

Association of radiotherapy duration with clinical outcomes in patients with esophageal cancer treated in NRG Oncology trials: A secondary analysis of NRG Oncology randomized clinical trials

IMPORTANCE: For many types of epithelial malignant neoplasms that are treated with definitive radiotherapy (RT), treatment prolongation and interruptions have an adverse effect on outcomes. OBJECTIVE: To analyze the association between RT duration and outcomes in patients with esophageal cancer who were treated with definitive chemoradiotherapy (CRT). DESIGN, SETTING, AND PARTICIPANTS: This study was an unplanned, post hoc secondary analysis of 3 prospective, multi-institutional phase 3 randomized clinical trials (Radiation Therapy Oncology Group [RTOG] 8501, RTOG 9405, and RTOG 0436) of the National Cancer Institute-sponsored NRG Oncology (formerly the National Surgical Adjuvant Breast and Bowel Project, RTOG, and Gynecologic Oncology Group). Enrolled patients with nonmetastatic esophageal cancer underwent definitive CRT in the trials between 1986 and 2013, with follow-up occurring through 2014. Data analyses were conducted between March 2022 to February 2023. EXPOSURES: Treatment groups in the trials used standard-dose RT (50 Gy) and concurrent chemotherapy. MAIN OUTCOMES AND MEASURES: The outcomes were local-regional failure (LRF), distant failure, disease-free survival (DFS), and overall survival (OS). Multivariable models were used to examine the associations between these outcomes and both RT duration and interruptions. Radiotherapy duration was analyzed as a dichotomized variable using an X-Tile software to choose a cut point and its median value as a cut point, as well as a continuous variable. RESULTS: The analysis included 509 patients (median [IQR] age, 64 [57-70] years; 418 males [82%]; and 376 White individuals [74%]). The median (IQR) follow-up was 4.01 (2.93-4.92) years for surviving patients. The median cut point of RT duration was 39 days or less in 271 patients (53%) vs more than 39 days in 238 patients (47%), and the X-Tile software cut point was 45 days or less in 446 patients (88%) vs more than 45 days in 63 patients (12%). Radiotherapy interruptions occurred in 207 patients (41%). Female (vs male) sex and other (vs White) race and ethnicity were associated with longer RT duration and RT interruptions. In the multivariable models, RT duration longer than 45 days was associated with inferior DFS (hazard ratio [HR], 1.34; 95% CI, 1.01-1.77; P = .04). The HR for OS was 1.33, but the results were not statistically significant (95% CI, 0.99-1.77; P = .05). Radiotherapy duration longer than 39 days (vs ≤39 days) was associated with a higher risk of LRF (HR, 1.32; 95% CI, 1.06-1.65; P = .01). As a continuous variable, RT duration (per 1 week increase) was associated with DFS failure (HR, 1.14; 95% CI, 1.01-1.28; P = .03). The HR for LRF 1.13, but the result was not statistically significant (95% CI, 0.99-1.28; P = .07). CONCLUSIONS AND RELEVANCE: Results of this study indicated that in patients with esophageal cancer receiving definitive CRT, prolonged RT duration was associated with inferior outcomes; female patients and those with other (vs White) race and ethnicity were more likely to have longer RT duration and experience RT interruptions. Radiotherapy interruptions should be minimized to optimize outcomes

Multiple urinary bladder masses from metastatic prostate adenocarcinoma

We present an unusual case of metastatic prostate adenocarcinoma that manifested with multiple exophytic intravesical masses, mimicking a multifocal primary bladder tumor. Biopsy with immunohistochemical analysis confirmed metastatic prostate adenocarcinoma. The patient was treated palliatively with external beam radiotherapy to prevent possible symptoms from local tumor progression. This case illustrates that when a patient with known prostate cancer presents with multifocal bladder tumors, the possibility of metastatic prostate cancer should be considered