Civil Surgery: 'Bleeding Blue and Gray'

DATE May 25, 2005 ACCOUNT NUMBER N/A
TIME 12:00 Noon-1:00 PM AUDIENCE N/A
NETWORK NPR
PROGRAM Fresh Air

Interview: Ira Rutkow discusses Civil War medicine as described in
his new book, "Bleeding Blue and Gray"
TERRY GROSS, host:

This is FRESH AIR. I'm Terry Gross.

`The carnage of the Civil War was an enormous emotional and physical burden
for the poorly educated, inadequately trained and ineffectually organized
physicians of the era,' writes my guest, Ira Rutkow. The doctors of that time
knew nothing about microorganisms and how they spread disease. Antibiotics
were not yet invented. Hospitals were unsanitary and doctors often did as
much to spread disease and infection as to stop them. Rutkow's new book,
"Bleeding Blue and Gray," is about how medicine was practiced during the Civil
War and how medical institutions changed as a result of the war.

Rutkow is a clinical professor of surgery at the University of Medicine and
Dentistry of New Jersey. He's also general editor of the 11-volume series on
Civil War medicine. Early in his book, "Bleeding Blue and Gray," Rutkow
writes about the Battle of Bull Run, known in the South as Manassas, which
killed 750 people, wounded 2,494, with more than 1,500 missing.

What were some of the ways that doctors were unprepared to deal with this kind
of massive number of people killed and wounded?

Dr. IRA RUTKOW (Author, "Bleeding Blue and Gray"): Well, you used the most
important word, and that really sort of is the theme of the book, and that is
unprepared. It's just that doctors, as they existed back then, were
unprepared. There was a medical department of the United States Army which
was incredibly small. I think the number was 80 physicians at the start of
the Civil War to take care of all the casualties, and they added numbers of
physicians slowly. But at the time of Bull Run, there was just a total lack
of preparedness. No one had any expectation that so many people were going to
be shot and wounded and dying, and they lay there for days on the battlefield.
There were no ambulances; there were no physicians who were told what to do.
One of the quotes in the book says it's like a time when there was no king.
No one knew anything. That's what the problem was with the beginnings of
Civil War medicine.

GROSS: There's a quote I'd like you to read, by William Williams Keen, who
was an assistant surgeon for the 5th Massachusetts Infantry, and he worked out
of a makeshift hospital in a church. And I think this describes really
beautifully what medicine was like during the Civil War. Would you read this
quote for us, but first introduce the context?

Dr. RUTKOW: Oh, I would love to read this quote. This is a wonderful passage
from a book that William Williams Keen wrote. He was a Philadelphia surgeon,
and I stress the word `surgeon' 'cause it's vastly different when you and I
think of a surgeon today than what it was back in 1860s. William Keen was
asked to become a surgeon to a Massachusetts regiment, and I can only tell you
that Williams Keen had been in medical school for four months when he was
asked to become the surgeon of this entire regiment. So in other words, when
you were shot or if you needed your arm amputated, you were going to somebody
who had been in medical school. I'm not talking about residency or an
internship. He'd been in medical school for exactly four months. So this is
William Keen's story of Civil War medicine, which he wrote approximately 20
years after the end of the Civil War.

And this is the quote: "We operated in old bloodstained and often pus-stained
coats. We operated with clean hands in the social sense, but they were
undisinfected hands. We used undisinfected instruments from undisinfected
plush-lined cases, and still worse, used marine sponges which had been used in
prior pus cases and had only been washed in tap water. If a sponge or an
instrument fell on the floor, it was washed and squeezed in a basin of tap
water and used as if it were clean. If there was any difficulty in threading
the needle, we moistened it with saliva and rolled it between
bacteria-infected fingers. We dressed the wounds with clean but undisinfected
sheets, shirts, tablecloths or other old soft linens rescued from the family
rag bag."

That is the essence--that's the end of the quote--that's the essence of Civil
War surgery, certainly at the beginning of the war.

GROSS: What were some of the misunderstandings about how diarrhea and typhus
were spread? And those were really epidemic on the field in the Civil War.

Dr. RUTKOW: Well, the misunderstandings were very similar to the surgical
problems and that was a total lack of knowledge, of understanding about
bacteria and germs, so that they would use dirty water. They would use water
that people had bathed in, that people had defecated in, they had urinated in.
They had gone to a stream and upstream people had used it for their daily
whatever. They were bathing there, washing clothes, and that stream came down
a few yards and they would use that water to go ahead and cook food with. So
they were just passing things on to one another. I mean, we're talking
literally about millions of cases of diarrhea, millions of cases of dysentery.

GROSS: What did the doctors think was causing the diarrhea and the dysentery?

Dr. RUTKOW: They had no idea. They came up with all thoughts--all sorts of
opinions. I remember one of the things I read was it was the cold air was
causing it. Another one was that the men were sleeping too close to another.
Third was the fact that they slept in tents where they didn't raise the sides
of the tents each day. So they had all these myths about what was causing
diseases, but they didn't have fundamental understanding of what disease even
was.

GROSS: What was the state of surgery--so many of the wounded soldiers
required amputations. What were amputations like then?

Dr. RUTKOW: It was something that you and I would not want to participate in.
It was not a fun event for the soldiers or for the doctors. Back then, speed
was the essence of amputations, and the reason was that anesthesia had just
been developed, you know, about a decade and a half before. Not everybody had
anesthesia available, so it was very often that you would undergo an
operation, there might not be anesthesia, and even then the types and amount
of anesthesia they had often was not quite adequate. And the--it was a speed
event, because the doctor or the surgeon had to cut off the extremity, be it
the arm or the leg or the finger or the toe, as soon as possible because the
patient was screaming, was in agony. And you read excerpts from their diaries
and from journals of amputation of an extremity in 90 seconds. I mean, it's
unbelievable in today's world. They could do an entire amputation in 90
seconds. But it was different than what you and I perceive today of an
amputation.

GROSS: What were the odds of surviving a surgical amputation?

Dr. RUTKOW: That's a great question, and everybody always asks that, and I
don't have an answer. I can tell you that there were tens of thousands of
amputations that were done. We're looking at certain battles where literally
hundreds were done in a given day. But I've never seen a statistic of the
actual number of people who survived, in other words, how many people became
infected. Usually once they became infected, then survival was lessened. And
I've never seen a real number on the actual percentages of the people who
survived. I would imagine that it was somewhere--50 percent at best.

GROSS: You say gangrene was one of the most feared complications for soldiers
who were wounded. Why?

Dr. RUTKOW: Well, there was this entity called hospital gangrene, and
hospital gangrene is a disease entity that we do not have today. It doesn't
exist, so we don't really know exactly what it was, but it was a massive
infection. They talk about it spreading at the rate of an inch an hour on a
soldier's body, and you could literally watch the gangrene spread up the
soldier's leg or his arm at an inch an hour, and the tissue was just dying.
It was probably some type of mixed bacterial infection that would have been
easily treated today with antibiotics, but back then they never heard of the
word `antibiotics.' They had no idea about bacteria, and all they knew what
to do was to try and stay ahead of the disease that was advancing. So if the
disease was up to the middle of your calf, they would cut up to below your
knee so they would try and stop the disease. Sometimes it worked; sometimes
it didn't work. In addition, one of the other treatments was after they did
the operation, they would pour nitric acid or other things onto the tissue to
try and stop the spread of the disease. Sometimes it was a question of who
was going to win the battle. The surgeons were melting away tissue; they were
cutting away tissue. The bacteria were doing their thing. It was--in
essence, you never really knew who was going to win. But it was a horrible
disease process and it was easily spread, not only from soldier to soldier but
also from soldier to physician, soldier to nurse, soldier to caregivers. It
was just a mess.

GROSS: What were some of the disagreements within the medical profession
about how to treat injuries and illness?

Dr. RUTKOW: I think that was one of the most fascinating things I learned
about American medicine at the time. American medicine in the 19th century,
certainly up through the 1870s and maybe even into the 1880s, was a very
contentious profession. And I use the word `profession' very lightly because,
I mean, I'm not even sure it was a profession yet in the classic sense.
People fought with one another. The surgeons just tended to be very feisty.
They were very divisive. They fought with one another constantly about all
sorts of things. It was a time of, you know, democracy in America and
individualism, and it was a time of independence. So throughout the 19th
century, you had this core of doctors who grew up with one another who were
constantly arguing with one another. One of the reasons was because it was so
unscientific and there was no science involving medicine. They couldn't prove
or disprove anything. No one had any idea what was going on. So whatever you
said was as legitimate as what the next person said.

So the problem was, they argued about everything. There was nothing that they
didn't argue about. They argued about the way that you did amputations. They
argued about when the amputations were done. They argued about how you should
treat the diarrhea or the dysentery. And the bottom line was, no one was
right. Everybody was wrong because they didn't understand the very basis of
science, of medicine.

GROSS: My guest is Ira Rutkow, author of the new book "Bleeding Blue and
Gray." We'll talk more about Civil War medicine after a break. This is
FRESH AIR.

(Soundbite of music)

GROSS: If you're just joining us, my guest is physician and medical historian
Ira Rutkow, and his new book is called "Bleeding Blue and Gray: Civil War
Surgery and the Evolution of American Medicine."

Let's talk a little bit about the nurses who worked in the Civil War
hospitals. They were led by Dorothea Dix. And what were their jobs like?

Dr. RUTKOW: The nurses' jobs were nothing that you and I, again, could
imagine in today's world. One of the reasons was that nursing schools didn't
exist. At least at the time there were medical schools, but nursing schools
didn't exist. And the concept of a nurse is vastly different in 1860s and
Civil War medicine than anything that we can think of today. If you were a
wife and your husband had been shot and you went down to the hospital to find
him and to hopefully take care of him, you then became a nurse, you were given
the title of nurse, so that women who were washing-women, who followed the
troops around and washed the clothing--they were entitled nurse.

In addition, there was a formal group led by Dorothea Dix, as you said--United
States Nursing Corps, established by the government. And she recruited
nurses. But there were really not many of them--maybe a hundred or 200 who
served during the course of the war. The vast majority of nurses were people
who volunteered on their own, went down to the various hospitals, went to work
in the hospitals. It was this amorphous group, it wasn't a real fixed group.
And they think that approximately 3 to 5,000 women served as nurses throughout
the Civil War. But again, their duties were vastly different than what you
and I know today.

GROSS: Two of the people who served as nurses in a volunteer basis, as you're
describing, were Louisa May Alcott, who wrote "Little Women," and the great
poet Walt Whitman. How much did they write about their Civil War experiences?

Dr. RUTKOW: Well, Louisa May Alcott wrote an awful lot that came out of the
Civil War. Many of her books portrayed her time as a nurse at the Union
Square Hospital. It was not really a long time that she was in service; she
was only there for approximately two or three weeks and then left. Her
father brought her back.

Walt Whitman went to search for his brother who he thought had been shot. It
ended up that the brother was fine and had not really been wounded much. And
Walt Whitman ended up staying in Washington area for maybe one to two years,
taking care of the wounded, writing back to his newspaper, the Brooklyn Eagle,
daily reports of what was happening with the war. So Whitman was there much
longer than Louisa May Alcott.

GROSS: Well, she got sick, and that's one of the reasons why she left. She
got very sick.

Dr. RUTKOW: She got horribly sick. She was at this hospital; she got very,
very sick. The woman who was what they called her matron, Hannah Ropes, who I
also write about, she had instructed Louisa May Alcott on what to do, what not
to do. And Louisa May Alcott lasted approximately two weeks before she came
down with what was either dysentery or typhoid; no one really knows what
everybody was having back them. But she became deathly ill and almost died.
And Hannah Ropes, the woman who was recruiting her and who was her matron,
died the day that Louisa May Alcott's father took Louisa May Alcott back to
Massachusetts.

GROSS: Although there weren't really any breakthroughs during the Civil War
in the way of antibiotics or anesthesia or an understanding of germs, there
were breakthroughs in terms of sanitary conditions. And you credit a lot of
that to the Sanitary Commission, which was run by Frederick Law Olmsted.

Dr. RUTKOW: Yes.

GROSS: And before we go any further with him, maybe you could read a quote in
which he described the conditions that he faced in the war.

Dr. RUTKOW: Well, this is a quote. And Frederick Law Olmsted was writing to
Henry Bellows, who had sort of founded the United States Sanitary Commission.
The Sanitary Commission was a philanthropic group. It was not involved with
the military; it was not involved with the federal government. It was a
volunteer group that was going to help the soldiers, the wounded soldiers, to
provide sort of homelike conditions at the time of the battle. They were
going to provide food and basics that they needed. And if they were shot,
they were going to provide medical things. And Olmsted was on what they
called the Peninsula at the time, which was in Virginia, and was in the middle
of a very bad campaign. Many of the Union soldiers had been shot. And this
was in the days following the Battle of Fair Oaks.

And I quote: "At the time of which I am now writing, Monday afternoon,
wounded were arriving by every train, entirely unattended or with most a
detail of two soldiers to a train of 2 or 300 of them. They were packed as
closely as they could be stowed in the common freight cars without beds,
without straw, and most with a wisp of hay under their heads. They arrived,
dead and live together, in the same closed box, many with awful wounds
festering and alive with maggots. The stench was such as to produce vomiting
with some of our strong men, habituated to the duty of attending the sick and
wounded of the Army," end of quote.

And that was what Army life was for the wounded following a major battle.
They were all packed in cars. They were shipped together. They gave one
another an infection. If one had been shot and his wound got infected, then
the next one got it. They all touched one another, same dressing, same
sponges, as we had discussed previously.

GROSS: And that was a description written by Frederick Law Olmsted, who
headed the Sanitary Commission. What did Olmsted go on to become famous for?

Dr. RUTKOW: Well, Olmsted actually was famous almost already at the time of
the Civil War. He was a young man; he was in his 30s when they asked him--and
I have to preface everything by saying that all the men in this book, other
than for the nurses who were the women, all the men were very young. Even
Louisa May Alcott--they were in their 20s when they went to war. The surgeon
general of the United States Army was 32. Olmsted was in his 30s.

He was famous already at that time because they had planned and were in the
process of developing Central Park in New York City, and he was the major
designer and organizer and ran the construction crews that were designing
that. And he went on after the war to become very famous as a landscape
architect.

GROSS: So what did the Sanitary Commission under Olmsted's direction do to
improve the conditions at the Civil War hospitals?

Dr. RUTKOW: Well, I think very specific things were done by the Sanitary
Commission. They were able to, for whatever reason, bring in supplies, both
medical and non-medical supplies to the battles before the federal government
was able to get things in. And in fact, Olmsted often writes to his wife Mary
that he says he's most proud of the fact that he was able to get shiploads and
freight loads of railroad cars into battlefield sites before the federal
government was able to get their own supplies in.

And the reason was because the members of the Sanitary Commission, men like
Olmsted and Bellows and other people who were running it, stayed on top of the
situation. They sent their literally spies and other people out to find out
where they thought the next battle was going to be, and they made sure that if
a battle was going to, let's say, be near Richmond in the next month or so,
they began stockpiling things sort of near that area so they could rush them
into the battlefield right after the battle. So the Sanitary Commission
proved very, very important in terms of organizing and helping the troops,
both before, during and after the battle.

GROSS: Now you describe that there were breakthroughs in hospital design
during the Civil War as people started to pick up on the suggestions that
Florence Nightingale had made earlier. What were some of those suggestions
that were adopted in the states?

Dr. RUTKOW: Well, I found out in my readings and my research that prior to
the Civil War, hospitals as you and I know it really didn't exist. They were
very small places, log cabins often. They were almshouses. The poor went to
the hospitals to die. There was no great hospitals where there were all these
scientific discoveries where you went to get the latest and greatest in
medical knowledge. That just didn't exist.

But eventually throughout the course of the Civil War, they began to realize
they needed to have hospitals, and this concept came about that directly
related to Florence Nightingale and her experience in the Crimean War of what
they called pavilion hospitals. And pavilion hospitals are the forerunner to
what you and I know as the large modern hospital today. Pavilion hospitals
were these immense structures that could hold 2 and 3,000 men at a time, where
they would have a central corridor, and off this corridor would be radiating
these huge pavilions that could hold 80 or a hundred men, and they might have
20 or 30 of these pavilions sort of based around this core.

And this concept of cleanliness and that things had to have air flow through
and that you needed to have less dirt, so they reduced the number of right
angles in these buildings--these were all concepts that came out of the Civil
War. And eventually they led to the building of the great hospitals in
America that started in the 1880s and the 1890s that now we perceive as the
modern American hospital.

GROSS: Now you've said that there weren't really medical breakthroughs during
the Civil War. There were breakthroughs in sanitary conditions, but no real
new medical discoveries. But not long after the Civil War there were
breakthroughs in antibiotics and understanding of microorganisms. Was the
Civil War connected in any way to those breakthroughs, even though it didn't
happen at that time?

Dr. RUTKOW: No, and I write that it was very sad for what happened during the
Civil War because the Civil War, 1861 to 1865, came about at the time we were
on this cusp of the scientific revolution in medicine. But that scientific
revolution did not really come about until the 1870s, into the 1880s, so that
Civil War medicine, again in the 1860s, was almost the same as what had been
practiced in the 1500s, in the 900s, in the 200s and in the BCs. And that's
the sad part about the Civil War. If it had happened 10 to 15 years later,
you would have seen dramatic changes in the way that people were being taken
care of.

GROSS: Ira Rutkow, thank you so much for talking with us.

Dr. RUTKOW: You're very, very welcome.

GROSS: Ira Rutkow is the author of the new book "Bleeding Blue and Gray:
Civil War Surgery and the Evolution of American Medicine."

I'm Terry Gross, and this is FRESH AIR.

(Soundbite of music)

(Soundbite of applause)

GROSS: The new film "Mysterious Skin" is about two boys who are sexually
molested and affected in completely different ways. Coming up, we talk with
the film's director and producer, Gregg Araki, and Scott Heim, the author of
the novel the film is based on. Also, Maureen Corrigan reviews a new novel by
Martha Cooley.

(Soundbite of music)

* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *

Interview: Gregg Araki and Scott Heim discuss the film "Mysterious
Skin," which is based on Scott Heim's novel of the same title
TERRY GROSS, host:

This is FRESH AIR. I'm Terry Gross.

The new movie "Mysterious Skin" tells the parallel stories of two
eight-year-old boys who are sexually molested by their Little League coach and
affected in completely different ways. One later becomes a gay prostitute.
The other is so traumatized, he blanks out the memories and is haunted by his
inability to account for the missing time. All he knows is that something
terrible happened. He later comes to believe that the only explanation is
that he was abducted by aliens. The movie traces the lives of these two boys
into their late teens.

My guests are Gregg Araki, the director, screenwriter and producer of the
film, and Scott Heim, author of the novel "Mysterious Skin," which the movie's
based on. The New York Times film critic A.O. Scott wrote, `The film's
subject matter may be grim. Mr. Araki addresses the characters' sexual
experiences with unflinching candor, but "Mysterious Skin" is infused with
remarkable tenderness and beauty. It's one of the best movies I've seen so
far this year.' The Pulitzer Prize-winning writer Michael Cunningham said
about novelist Scott Heim, `He's a serious writer who's unafraid to swim in
the darkest water.'

Scott Heim, Gregg Araki, welcome to FRESH AIR. Scott Heim, let me start with
you. You wrote the novel that the new film "Mysterious Skin" is based on.
Why did you want to compare how two boys were affected by being sexually
abused by their Little League coach?

Mr. SCOTT HEIM (Author, "Mysterious Skin"): Well, I think the initial sort of
genesis of the book came about because I had written a short story that was
about a kid who had been sexually abused in his past, and then I started
writing a short story, you know, just completely separately about a boy who
thinks he has, you know, memories of a UFO abduction. And, you know, they
were quite different time period away from each other, but I realized at some
point just how similar people's memories are or, you know, when people go
under hypnosis or supposed alien abduction, the things they say are just
really similar to the things people say when they, you know, have sort of
recovered memory of child abuse, of molestation.

GROSS: What are some of those similarities between abduction stories and
recovered memories?

Mr. HEIM: Well, I think, you know, initially what I was struck by was just
sort of some of the--you know, sort of the tactile things that people were
reporting and, you know, things like the way it felt to be examined on a table
or touched by these sort of extraterrestrial hands and, you know, how people
feel violated when, you know, they think they've, you know, been examined by
aliens. And, you know, sometimes when people read the book or sometimes when
I explain the book to people, people kind of nervously laugh or, you know,
it's usually the skeptical people that think, you know, that's just silly.
Why would people actually believe that happened to them?

But, you know, I hope that in writing the book--and I think Gregg would maybe
say the same thing in making the movie--I didn't want to discount those
people's stories, because, you know, I don't know if those stories are real or
imagined or fake. I just know that a lot of people have those, you know,
memories or have those experiences that, you know, they think they honestly
had. And it's just fascinating to me how similar they are to the people who,
you know, bury their memories of being molested and, you know, when they come
out in hypnosis, the things they say are very, very similar.

GROSS: Gregg Araki, why did you want to make a film based on Scott Heim's
novel, "Mysterious Skin"? What did you relate to about the story?

Mr. GREGG ARAKI (Director, "Mysterious Skin"): I first read the book back in
1995 when it was first published, and it really just floored me. I mean, I've
never read such a powerful story. It had a huge kind of emotional impact on
me. And I was really struck by how Scott managed to tell this very dark, very
unsettling story, but in this incredibly beautiful and poetic language, and we
really tried to translate that to the screen in our adaptation. I mean,
Scott, I think, is, you know, an extraordinarily talented writer and the way
his language was just--it was so lyrical and so beautiful and we really wanted
to sort of replicate that with the cinematography and the design of the movie.

GROSS: Well, I'd like to compare how you each handled a pivotal scene from
early in the story, and this is a scene in which the coach, the Little League
coach seduces Neil, and it shows the shift in tone that the coach uses. You
know, first--you know, the coach alternates between being very seductive and
clowning around like if he were another child. Neil has gone back to the
coach's house. The coach's house is filled with video games and toys and the
kinds of foods that kids love. In fact, the food that figures into this
particular scene is a variety pack of cereals, you know, that kind of pack
that has lots of small boxes of different cereals in it. And I want to play a
clip from the film, and it starts with the coach in his apartment sitting next
to Neil, and the coach is putting his hand on Neil's leg.

(Soundbite of "Mysterious Skin")

Mr. BILL SAGE: Neil, I've been thinking a lot about you this week.

CHASE ELLISON: (As Neil) I'm hungry.

Mr. SAGE: Sure. You want pizza? I might have something here you'd like.

ELLISON: (As Neil) Whoa.

Mr. SAGE: What'll it be, little buddy?

ELLISON: (As Neil) My mom never buys these things. She says they're a big
waste of money.

Mr. SAGE: Let's eat then.

GROSS: A scene from "Mysterious Skin," and at this point in the scene, the
coach chooses his favorite sugared cereal and Neil, the boy, chooses his
favorite sugared cereal, and as they start to eat, Neil accidentally spills
some cereal, and he feels bad, and the coach says, `Don't worry about it,' and
the coach starts just taking his cereal and throwing it up in the air, and
then they both start opening up cereal boxes and tossing the cereal up in the
air, and after this moment of childish abandon, the coach starts molesting the
boy.

Scott Heim, the movie "Mysterious Skin" is based on your novel of the same
name. Can you talk a little bit about writing this scene and why you've set
this first molestation in this environment of childhood exuberance and
child--of kid cereal, you know, of the kind of sugared cereals that children
eat, and the cereal is now all over the floor?

Mr. HEIM: Well, obviously, the whole book for me--writing the whole book in a
lot of ways is about juxtaposing extremes. For instance, I wanted to have
this really dark material set in Kansas, where I'm from, because people
usually think of Kansas as this sort of serene, safe place, and so for me,
that scene--literally the first molestation or first, you know, sexual
encounter between the boy and the man in the movie, you know, takes place on
top of the spilled cereal on the kitchen floor, so I wanted to have kind of
this really bright, colorful image of childhood which, you know, sort of the
brightest kind of child cereal that you can think of and sort of use that as
the bed for where this initial, you know, sort of horrifying life-changing
sexual experience takes place.

And, you know, for me that was kind of the scene that--it was one of the first
scenes in the book that I wrote, and I was actually writing--first writing the
book when I was getting my MFA degree at Columbia, and that was kind of the
scene that a lot of my classmates bristled at and a lot of people said that,
you know, `I think you're going too far with this, and people are really going
to be angry.' And my teacher pulled me aside and said, `Listen, this is kind
of going to be the thing that drives your book and, you know, sure, it will
make people angry, but it's kind of one of the major, you know, turning points
of your book,' so she, you know, suggested that I go further with it, and I
did.

GROSS: Gregg Araki, can you talk about directing the scene in the film, what
you wanted to show or imply? And I want to say that the coach in this scene
is really behaving like a kid, and he's even--like when he's throwing the
cereal up in the air, he's sticking his tongue out in the kind of way that
some children do when they're concentrating on trying to read or draw, and
he's so behaving like a child, but then he turns around and becomes this,
you know, sexual molester.

Mr. ARAKI: Bill Sage, the actor who plays the coach, I think did an amazing
job with this character. I mean, obviously, it's an extremely challenging
role for an actor, and he really sort of keyed into that idea that the coach
was sort of, in a way, this sort of overgrown boy and had turned his house
sort of into this boys' club. I mean, the scene, you know, as we're talking
about it--I mean, it is probably one of the most disturbing scenes in the
whole book, but it was really so important to me as a filmmaker to not take
this scene out of the film adaptation, because it was one of the scenes that
really sort of blew me away when I read it.

I mean, it is disturbing, but there's such a sort of rawness and such a sort
of truth to it, and it's really, I think, one of the most powerful scenes in
the book and in the film. The tricky part was that I didn't want to
traumatize the young boy who is playing young Neil, eight-year-old Chase
Allison, and it was very important to the producer, Mary Jane, and I to not
traumatize any children in the making of this film about childhood trauma. So
what we ended up doing was the film is extrem--that scene is extremely
cleverly shot in a way, in the sense that it's really all in the sort of
editing and the use of subjective camera and eye line, like where the actors
are actually looking, and we had to film the scene--I wanted to like keep the
scene for all its sort of--you know, the importance it had to the story, but I
wanted to also film it in a way where the young boy could be protected from
what the scene is actually about, and this was basically true of the whole
film.

Both Chase and George were--George Webster plays young Brian. They were kept
from what the actual--they had never read the entire script and sort of only
did their scenes beat by beat and kind of moment by moment, and we had to sort
of construct this almost alternate reality and alternate movie that the kids
were actually performing in.

GROSS: But, you know, in this scene, what happens between the coach and the
boy is implied. We don't see it.

Mr. ARAKI: Yeah. And it's actually filmed--and for people who are very
astute sort of film students or filmmakers, they can see how this scene is
sort of shot in two halves, so the halves are brought together through
editing, so it feels like this extremely horrifying thing is actually
happening when it really--this kind of--it never happened in reality, but it's
happening on the screen.

GROSS: Now, Neil, the boy in the scene, he basically knows as a child that
he's attracted to other men, and before the coach molests him, the first time
he sees the coach, he's thinking, wow, this coach--this guy reminds me of the
kind of guys that--you know, that he loves to look at in magazines, that kind
of Marlboro Man type with the moustache, the macho kind of looking guy. In
the actual novel, the character thinks, remembering back to this moment,
`desire sledge-hammered my body.' Does that make the coach's actions any less
reprehensible to either of you, the fact that the boy is actually attracted to
the coach?

Mr. ARAKI: Yeah. That was one of the things about the book that, you know,
as I said before, was really--what makes the book for me such a powerful kind
of experience and what makes the story such a powerful experience is the way
that Scott has sort of constructed it, in the way that there are these two
boys; there is, you know, Brian, who is, you know, fair-haired and blond and,
you know, is very introverted and believes that he was abducted by an alien.
He sort of blocks this trauma out of his memory. And then there's Neil, who's
dark-haired and who is, from a very young age, gay and has this, you know, gay
desire for the coach. The fact that there are both of these stories and these
boys, in a way, sort of function as yin and yang and dark and light to each
other--both their stories combined in the way in which they each experiences
trauma and then deal with it in polar opposite ways, the sort of aftermath of
what happens to them--I think that's, for me, what really makes this story
work.

GROSS: My guests are Gregg Araki, the producer, director and writer of the
new film "Mysterious Skin," and Scott Heim, author of the novel "Mysterious
Skin," which the movie is based on. More after a break. This is FRESH AIR.

(Soundbite of music)

GROSS: My guests are Gregg Araki, the producer, director and writer of the
new film "Mysterious Skin," and Scott Heim, author of the novel "Mysterious
Skin," which the movie's based on. The movie tells the parallel stories of
two boys who are sexually molested by their Little League coach. Brian is so
traumatized, he blanks out all memory of what's happened. Neil, who had a
crush on the coach, becomes a male prostitute.

You know, the character of Neil as a teen-ager, looking back on this
experience of being sexually molested by the coach, thinks, `Half of me
realized it wasn't right. The other half wanted it to happen.' And he also
think, `Oftentimes, I wonder where Coach lives now, what he's doing, whether
something like prison or lynch mobs or disease hasn't killed him. But looking
back, it doesn't matter. What matters is how, for the first time in my life,
I felt as if I existed for something.'

So, you know, although this child turns into a male prostitute, although his
sexual life has been kind of deformed by this experience of abuse, he has some
fond memories of Coach. Coach cared about him, he thinks. And, you know, I
think a lot of people will be very uncomfortable hearing this degree of
ambiguity in Neil's experience of being abused.

Mr. ARAKI: I mean, for people who have been abused, I mean, I've heard
statistics as high as one in four children in America are--experience some
sort of sexual abuse, and that, I think, is--what is so powerful about this
story is that it is ambivalent for a lot of people, and it does--and then
there's the guilt associated with that. I mean, Joe Gordon-Levitt, who
does such an amazing job playing 18-year-old Neil, is kind of a method actor,
and he and I had a lot of talks about Neil's character, and--because Neil does
talk about the coach in this very sort of idealized way, almost kind of
romantically talking about how he is the one true love of his life and how,
you know, the summer that they were together was sort of, you know, this
affair that he kind of can't forget.

And, you know, my feelings had always been--I mean, Scott might feel
differently having, you know, been much closer to the characters than me.
But as somebody as--when I read and, you know, my sort of take on the film as
I was directing it was really feeling like, in a way, Neil is even more
damaged than Brian. I mean, Brian, the boy who believes he was abducted, you
know, is, you know, introverted, nervous, asexual, wets the bad, has these
blackouts and knows with--he's just sort of a nervous wreck essentially after
this trauma, whereas Neil, on the surface, is, you know, this sort of
beautiful James Dean "Rebel Without a Cause" kind of sexual--you know, the
sexy sort of bad boy. But he's acting out in this incredibly sort of
self-destructive way. He's kind of hypersexual, the self-destructive way.

And I think that his damage is so much--it's so much deeper and so much more
sort of internalized. I mean, we--Joe and I talked a lot about how Neil was
sort of incapable of attachment and connection and that--you know, one of the
characters says about Neil that, you know, he has a black hole where his heart
should be. And, you know, it's always my feeling that, you know, the Neil
character--I feel like at the end of the movie he sort of realizes that he and
Brian have been living in this sort of fantasy world of believing he was
abducted. And I think Neil, in his own way, has a kind of awakening in terms
of he's sort of seeing his abuse in--for the first time without the sort of
rose-colored glasses of his, you know, crush.

GROSS: As I mentioned, in the novel, the first time that the boy Neil sees
Coach, you know, he's already attracted to men. And looking back, he
remembers that the first time he saw Coach, he thought, `Desire sledgehammered
my body.' And in the movie, what you do, Gregg, the first time Neil sees
Coach--and Coach is running towards his 'cause this is at the Little League
field...

Mr. ARAKI: Running towards him in slow motion.

GROSS: In slow motion, as if it's one of those corny romance movies, where...

Mr. ARAKI: It's like Bo Derek in "10."

GROSS: Exactly. Exactly.

(Soundbite of laughter)

GROSS: And I thought that's such a kind of clever way of getting at that,
like, inappropriately romantic feeling that the boy has. Can you talk about
deciding to do it that way?

Mr. ARAKI: Oh, well, we--one of the moments that--I mean, obviously the coach
is going to change Neil's life in a profound way and--you know, so there was
that sort of corny, cliched, slow-motion moment. But it's interesting. When
people have a moment like that, where they meet somebody that's going to
change their life, frequently they describe it in, you know, cheesy movie
terms as, like, a slow-motion moment. And so that was very kind of natural.

The reverse shot of Chase was--actually that shot was the idea of the
cinematographer, Steve Gainer, who do--amazing Steve Gainer. It's one of
those tracker zooms, where the close-up of the young Neil staring at the
coach, and his background is sort of shifting, but his--he decides that his
face in the frame is staying the same because of the shifting perspective of
the lens. So it's sort of this kind of compressing moment for young Neil.

And then it's also sort of intercut with these flash frames of these kind of
cheesy Playgirl-type centerfolds from the '70s, so--which is kind of a
reference to a scene that's more developed in the book, where young Neil
discovers these Playgirl magazines as a young boy under his mother's bed. And
that was actually one of the scenes in the book that really, like, kind of
nailed me in a sense; that I specific--it's such a vivid memory for me that I
can--I think I was slightly older, maybe like 10 or 11, but I remember the
first time I saw my first, like, Playgirl centerfold. And it was that kind of
a moment, like it really sort of was like a revelation for me.

GROSS: I want to thank you both for talking with us.

Mr. ARAKI: Thank you so much.

Mr. HEIM: Thank you.

Mr. ARAKI: It was great.

GROSS: Gregg Araki wrote, directed and produced the new movie "Mysterious
Skin." It's based on the novel of the same name by Scott Heim.

Coming up, Maureen Corrigan reviews the new novel "Thirty-Three Swoons" by
Martha Cooley. This is FRESH AIR.

* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *

Review: Martha Cooley's "Thirty-Three Swoons"
TERRY GROSS, host:

Martha Cooley's 1998 debut novel "The Archivist" was an improbable
best-seller. It imaginatively delved into the emotional life of the poet T.S.
Eliot. Cooley has just published her second novel, "Thirty-Three Swoons,"
which our book critic Maureen Corrigan says is also an unexpected mixture of
fact and fiction, memories and desire.

MAUREEN CORRIGAN reporting:

Many years ago I had the perfect blow-the-high-culture night out in New York
City, one that began with dinner in a greasy spoon coffee shop and ended with
listening to Bobby Short at the Carlyle Hotel. The highlight of that evening,
though, was seeing the British actress Fiona Shaw in a one-woman performance
of T.S. Eliot's poem "The Waste Land." It was staged in a derelict theater in
Times Square. Bare lightbulbs hung from the ceiling, and beautifully dressed
theater-goers who felt the call of nature had to resort to Port-A-Pottys out
on the sidewalks.

In this ideal, post-apocalyptic setting, Shaw made me experience "The Waste
Land" for the first time as a deeply emotional work of art. After years of
studying the poem and teaching it as an intellectual jigsaw puzzle, I felt it
for the first time, felt the desperation in all those voices trying to hold
their splintering world together.

In her best-selling debut novel "The Archivist," Martha Cooley worked much the
same revelatory magic on T.S. Eliot himself. Without diminishing his identity
as an intellectual, Cooley brought to the fore an Eliot who was a man of
feeling. Cooley's intricately plotted novel itself appealed both to readers'
brains and hearts.

Now Cooley has just published her second novel called "Thirty-Three Swoons."
And though it doesn't quite evade the dreaded curse of the second book, it's
still a really intriguing novel. I probably sound like I'm damning
"Thirty-Three Swoons" with faint praise, but I don't mean to. Even a mildly
flawed novel, like this one by Cooley, is worth reading because, unlike so
many of her literary contemporaries, Cooley has mastered the art of folding
historic figures into her fiction without making the final product feel
gimmicky or cannibalistic. Cooley's sweep in "Thirty-Three Swoons" is every
bit as ambitious as it was in her debut. The plot roams from the Russian
Revolution to contemporary life in New York, with layovers in the Paris of the
'20s thrown in.

A rough summary of the story goes like this. A 50-ish, divorced woman named
Camilla Archer, who owns a theater memorabilia shop in New York, is reeling
from the sudden death of her old cousin, Eve. After Eve's death, Camilla
begins having strange dreams about her father, Jordan, another family member
who, like Eve, was intensely erotic, yet emotionally distant. Also starring
in these dreams is the real-life figure of Vsevolod Meyerhold(ph), a famous
Russian theater director who was murdered during Stalin's reign of terror.

The disturbing dreams are, in fact, conjured up by Meyerhold's doppelganger, a
kind of provocative shadow spirit who's decided to burrow into Camilla's dream
world because of her theatrical background and because Jordan, who traveled
the globe inventing rare performs, once met Meyerhold. `Besides,' this
devilish sprite explains, `Camilla needs some serious scaring out of her soft
cocoon of a life.' That's just the bare bones of Cooley's plot, and her
language throughout is every bit as haunting as her premise.

Here, for instance, is how Camilla describes her father's profound
understanding of the power of scent: `My father's perfumes melded coolness
and warmth, elegance and carnality. For Jordan, perfume was, more than
anything else, an acknowledge of impermanence. Fragrance is time-bound. It
ends in decay. Rather than attempting to deny or overcome this reality,
Jordan found ways of exploiting it. He orchestrated his fragrances' life
spans like beautifully shaped musical compositions. Magically mobile, they
registered in the mind like a dream.'

Perfume, whether it be the expensive stuff or the drugstore variety, gives me
a headache. I haven't worn it in years. But Cooley's sensual meditations
made me want to pop a pre-emptive migraine pill and douse myself in Chanel.
Indeed, her descriptive powers are spellbinding, but occasionally that spell
is broken by irritants having to do with plot or character development. For
instance, it feels like foul play when Cooley withholds information from
readers, information that's common knowledge to her characters and crucial to
the epiphany of the novel. Also, Camilla, the prufrocian(ph) main character
who needs a supernatural shove into the active life, doesn't seem sufficiently
different from a lot of the other characters here, who also sit around and
brood a lot.

"Thirty-Three Swoons" is perhaps itself not swoon-inducing. Rather, like a
very fine but not superb perform concocted by Jordan, it fascinates, troubles
and faintly lingers.

GROSS: Maureen Corrigan teaches literature at Georgetown University. She
reviewed "Thirty-Three Swoons" by Martha Cooley.

(Soundbite of music)

(Credits)

GROSS: I'm Terry Gross.
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