Surgical Resident Atul Gawande

DATE April 17, 2002 ACCOUNT NUMBER N/A
TIME 12:00 Noon-1:00 PM AUDIENCE N/A
NETWORK NPR
PROGRAM Fresh Air

Interview: Dr. Atul Gawande discusses his book, "Complications: A
Surgeon's Notes on An Imperfect Science"
TERRY GROSS, host:

This is FRESH AIR. I'm Terry Gross.

`Medicine is a strange and, in many ways, disturbing business,' writes my
guest Dr. Atul Gawande. He says, `There is science in what we do, yes, but
also habit, intuition and sometimes plain old guessing. The gap between what
we know and what we aim for persists, and this gap complicates everything we
do.' Dr. Gawande is a resident who is close to completing his training in
general surgery at a Boston hospital. He's also the son of two doctors. He
writes about medicine and science for The New Yorker magazine. Now he has a
new collection of essays called "Complications: A Surgeon's Notes on An
Imperfect Science." Several of his essays are about fallibility, how even the
best doctors make mistakes. I asked him to describe a mistake he made in the
operating room.

Dr. ATUL GAWANDE ("Complications: A Surgeon's Notes on An Imperfect
Science"): This was a patient who had come in after a car crash, and she was
not breathing when she arrived. You immediately try to put a breathing tube
down into her throat so that you can pump air into her lungs, and it would not
go. There was bleeding coming up from her mouth to the point that her airway
then became completely blocked off, and we had to do an emergency
tracheostomy.

It was a crazy night with already a person who'd come in to the emergency room
stabbed in the neck, and our attending trauma surgeon was down in the
operating room with that gentleman. And so it was left to me, and at that
point, I was at third year of training. I had done a couple of tracheostomies
before, but certainly not in an emergency setting. But I knew that it came
down to my finding my way in.

GROSS: You should just very briefly describe what the procedure is.

Dr. GAWANDE: So what you have to do is cut down into the trachea, right into
the neck, and find a way to get a breathing tube that could go into the lungs
and pump air back through. I didn't know quite where to cut. But I made my
best calculation and did it. But it was almost too late. By the time I found
what I thought was the airway, she had arrested. Her heart had stopped
beating. The attending surgeon had then made it upstairs from the operating
room by that time and found us doing chest compressions. He took over, but
there was maybe a minute left before we thought her brain could be damaged,
and he could not get it. And the only thing that averted total disaster was
that the anesthesiologist gave one more try from above, as we would say,
trying to put a tube back down through the mouth and used a child-size tube,
and that actually reached down into her lungs. We were able to bring air,
provide oxygen to her, and she came back.

GROSS: On those occasions when you have made a mistake...

Dr. GAWANDE: Yeah.

GROSS: ...have you discussed it with patients? Can you do that?

Dr. GAWANDE: You have to, but it's terribly hard. The hard part is--I'll
give you the example of the woman whose tracheostomy we did not succeed with.
We did tell her that we had tried and we had failed and that, as a result of
that, there was a long period in time, a full 24 hours, where we were not sure
she would wake up at all because she'd been without oxygen for so long. And
we did have to tell the family, `Look, her airway had shut down. We had tried
to get an emergency tracheostomy to open up her airway. But we had failed.'
It's one of those situations that makes it very hard to--you're very aware of
the legal ramifications of what you're saying. But I think we owe it to
ourselves to put those legal ramifications aside and speak with candor to
patients about what has happened to them or to families about what's happened
to their loved ones.

GROSS: How does the threat of malpractice suits affect what you're trained to
do or to say to patients and their families when something does go wrong?

Dr. GAWANDE: You know, it's funny. We don't have any formalized training
about how to speak to patients and tell them what's going on. In medical
school, you do have sessions--they'll even be videotaped--going through an
interview in an office with a patient who comes in with a belly pain or
something like that. But this process of coping with complications or how
things go wrong is something that you absorb simply as an apprentice, watching
other people, seeing how they do it. I think it's really hard trying to grasp
that if your physician is fallible and things go wrong, how can they also be
doing things successfully? And you have, on the one hand, the notion that 97,
98 percent of the time, things do go uncommonly well, and somehow these
ordinary people are able to do extraordinary things. But it's the moments of
failure, which everybody struggles with and remembers, and I think we either
have the choice of trying to paper over those moments or face up to them and
try to explain them and then begin to grapple with how we can reduce the
likelihood that the errors will happen, and then also acknowledge the patients
when the errors do happen.

GROSS: My guest is Dr. Atul Gawande. He's a resident in surgery at a Boston
hospital. He also writes about medicine and science for The New Yorker
magazine. He has a new book called "Complications: A Surgeon's Notes on An
Imperfect Science."

How did you start writing? Did you know that you wanted to practice medicine
and write about medicine, too?

Dr. GAWANDE: Well, I came to it long after I had decided I was going to
become a doctor, but it was still early in my training. A friend of mine
who'd started Slate Magazine, which is an Internet magazine, in its early days
came to me and asked if I would do a favor of him of writing a piece about
medicine, because in those days it was early in the beginning of the Internet
and no one was reading the magazine and, as a result, no one was writing for
it. And it become a monthly column for me and a way I could really begin to
use writing as a way of thinking about the dilemmas that came up in my
day-to-day practice as a doctor.

I got lucky. It turned out one of the few readers was an editor at The New
Yorker. And I learned through the grapevine that he was actually liking what
I was writing about. And I had a longer piece I wanted to write, but it was
too long for the Internet. And so I wrote him a letter and he let me write
for--and he said, `Go ahead,' and it became an opportunity then to write
regularly for The New Yorker.

And I've had the chance to think through problems like mistakes and the areas
in medicine which are still a mystery to us, we don't know everything about
what's going on, about unusual operations and also about this sort of
fundamental difficulty for both doctors and patients, which is grappling with
uncertainty in medicine.

GROSS: In your new book "Complications," you have a chapter about pain, and
you write, `Every pain has a story.' How true.

Dr. GAWANDE: Yes. Yes.

GROSS: And you write particularly about a certain type of mysterious pain
that doesn't seem to be tied to anything that a doctor that see, either that
the doctor can see on the body or that the doctor can see through imaging of
the body, through MRIs or X-rays. Give us an example of that type of
mysterious pain that a doctor can't explain.

Dr. GAWANDE: Well, the most common kind is simple back pain. Chronic back
pain afflicts millions of people in the United States alone. And yet when you
do X-rays and MRIs to find what might be wrong with their spine or their
spinal--the discs around their spine, you often don't find anything
structurally wrong. We in medicine have a hard time dealing with these
patients because what we'll often do is dismiss this as a pain that's all just
in the head. And for patients, it's extremely hard to deal with because what
they feel is exactly there in their back, and yet they have a doctor telling
them, `Oh, I don't see anything.'

There's more and more evidence in science and studies that you can have pains,
however, that emanate from the brain, are completely real--it's as if there's
a program for chronic pain that's unreeling in the brain--and that it can
start with an injury to the back. And the hard part, I think, for both
doctors and patients is grappling with what is not a clearly physical but not
clearly not physical kind of pain. We end up doing operations on people's
backs that are sometimes unwarranted. We end up having patients who feel
dismissed because they might be asked to go see a psychiatrist to help sort
through the sources of the pain. And in that chapter, what I'm trying to do
is explain to people how it is that in this area where we know actually
remarkably little, we can both make--both patients and doctors make judgments
that lead us in wrong directions.

GROSS: My guest is Dr. Atul Gawande. His new book is called "Complications."
We'll talk more after a break. This is FRESH AIR.

(Soundbite of music)

GROSS: My guest is Dr. Atul Gawande. His new book is called "Complications:
A Surgeon's Notes on An Imperfect Science."

Well, it sounds from your article that one of the theories now is that the
pain system itself can go haywire and it's not necessarily attached to an
injury or to a structural problem. It could just be the pain system itself
getting out of whack.

Dr. GAWANDE: That's right. The pain is a kind of program in the brain, and
it's almost--you can imagine it as kind of a symphony. There is the feeling
of the pain and there's the memory of the pain itself, and there's all the
emotions that go along with it. And what can set the symphony playing is
certainly, you know, a hammer to the back. But if you've had a significant
injury to your back or anywhere else in your body, it can become possible that
the pain program starts to get unleashed with even a normal sensation, just a
touch to the back or sometimes even a depression or social circumstances.

I tell the story of this architect who has had a terrible back pain for eight,
nine, 10 years that has made it impossible for him to do his work. He is a
guy who built medical schools and now is barely able to make it out of his
house. And he's gone for X-rays and MRIs of every kind, and the doctors keep
telling him, well, they don't find anything. What seems to be going on for
somebody like him, where just sitting in a chair and trying to get up can
bring on a pain as if someone has put a knife into his back, is that he is a
victim of a problem where his pain system has started to go haywire, go out of
control. And we're only beginning to provide answers for medications that
actually could focus not on the back but instead on this haywire pain system
and also find other kinds of treatments that might work as well that may not
even be medical or using drugs.

GROSS: Can you give us an example of one of the new medical ways of treating
this kind of pain when what you're dealing with is the pain system itself as
opposed to a more physical problem that's manifesting itself in pain?

Dr. GAWANDE: Well, one of the medications that has turned out, to people's
surprise, to have made a difference is anti-seizure medications. Anti-seizure
medications are medications that kind of reduce the threshold at which the
brain cells would fire in certain parts of the brain. And an anti-seizure
medication can turn out to help for people with these kind of chronic pains
that just won't go away and can become so devastating. And it's because we
started to shift the focus from trying to figure out what we might do to the
muscles in the back there or to the bone or the discs in the back and to focus
then on the pain system itself that's working in the brain.

GROSS: How does the anti-seizure medication affect the pain system?

Dr. GAWANDE: Well, what it seems to do--and this is now into a kind of
speculation that researchers have a hypothesis for how it's working. But that
it is controlling the--it is stabilizing what may be cells that fire almost
too readily. It raises the threshold for when fibers in the pain system would
be unleashed and fire. And by raising that threshold, make it easier for the
pain--making it less likely that the pain system would go off with just a
light touch to the back or the day when you find that things just aren't going
right and that only compounds the pain that's going on in your back.

GROSS: You mentioned that toxins are sometimes used to help stop the pain.
What kind of toxins, and what's the principle behind using them?

Dr. GAWANDE: Well, there are these unusual studies using frogs from South
America that have poisonous toxins that can kill people. And what
researchers have tried to do is tame those toxins by altering them ever so
slightly until they reach the point that they're not toxic any longer but
still working on the same brain cells that they targeted in the first place.
So instead of killing those cells, they modulate them so that the pain then
doesn't occur. One of those drugs has been found, in early animal trials, to
be 30, 40, 50 times more powerful than morphine, with the hope that it would
be a kind of morphine without those same side effects that morphine can have.

These are the early directions that research is going in that's opened up by
beginning to think about chronic pain as a problem that is not necessarily
just simply the tissues of your shoulder or your back, but instead a process
that is centrally in the brain.

GROSS: So there's a lot of pretty interesting work going on in this area.
When you have pain, the doctor always asks you to rate it on a scale of one to
10. Now it seems to me, well, that's such a subjective scale. And is it
according to how much you think you could possibly endure? Or are you
supposed to be comparing your pain to the average pain, like if the average
person has pain, how severe is your pain, and how can you know what someone
else's pain is like, and how your pain might compare...

Dr. GAWANDE: Right.

GROSS: ...to their pain? Is there any way that's a little less subjective of
reporting how much pain you're in to a doctor?

Dr. GAWANDE: There is not, in the sense that, you know, pain is only what you
experience. And that's what makes it so hard for you as a patient to convey
to doctors. And that's what makes it hard for doctors sometimes to be as
aware and sympathetic as we sometimes ought to be. I think what's really
important about that question that we ask, you know, `Rate your pain on a
scale of one to 10,' is, number one, that we ask it. It's become the kind of
the fifth vital sign besides your temperature and your pulse and your blood
pressure and your breathing. It's become an important habit for us to ask how
much pain you have.

And then by asking people to rate it, it tells us how important it is for
them, because the sensitivities and thresholds that different people have for
pain vary enormously and change over time. There's an interesting and
fascinating study of athletes. And I talk, for example, in the book about the
study of ballerinas in which it was found that these ballerinas had
extraordinarily high thresholds for pain. They tolerated as a daily matter
pain that is beyond levels of even football players. And it's partly because
of their training; it's partly because of the culture of ballerinas to accept
the pain. But it also explains why they end up with frequent chronic
injuries, because they've inured themselves to pain to the point that their
own joints can break down before they recognize what's going on.

GROSS: Does it frighten you ever to watch your patients go through severe
pain and to know the kinds of things that humans sometimes have to endure?

Dr. GAWANDE: It does. There's a doubleness to doctoring, which is that you
are someone who is spending years and years training yourself to be
dispassionate and analytical about what you do. You have to be systematic.
You have to know the literature; you have to know the science. You have to
have experience in dealing in situations so that you make good decisions. At
the same time, we are all humans ourselves, subject to the same frailties that
our patients have. And being able to grasp that distinction, not let go too
much of one side or the other, is the hard thing to do.

I think at times I'm probably too cold. And then at other times, you can find
yourself absorbed so directly in the experience of what is happening that you
have to step back for a minute and remember that this patient needs you to do
something and not just feel something.

GROSS: Well, Dr. Atul Gawande, I want to thank you very much for joining us.

Dr. GAWANDE: Oh, and I want to thank you.

GROSS: Dr. Atul Gawande is the author of "Complications: A Surgeon's Notes
on An Imperfect Science." He also writes about medicine and science for The
New Yorker. I'm Terry Gross, and this is FRESH AIR.

(Soundbite of music; funding credits)

GROSS: Coming up, a history of the underground women's resistance in
Afghanistan. We talk with Cheryl Benard, author of "Veiled Courage." And Ken
Tucker reviews the new album by Chicago singer/songwriter Jim Roll. It
features collaborations with novelists Rick Moody and Denis Johnson.

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

Interview: Cheryl Benard discusses Afghan women's resistance
TERRY GROSS, host:

This is FRESH AIR. I'm Terry Gross.

Even before the Taliban took away all of women's rights, an Afghan women's
resistance group fought against the subordination of women. My guest, Cheryl
Benard, has written a history of the group RAWA, the Revolutionary Association
of the Women of Afghanistan. The book is called "Veiled Courage." Benard
first learned about the group during a 1982 trip to the country when she was
helping assess the efficiency with which aid was being delivered to Afghan
refugees by the international community.

Benard is now a consultant to the RAND Corporation in Washington, DC. She's
married to Zalmay Khalilzad, the Bush administration's special envoy for
Afghanistan. He was born and raised in Afghanistan. I asked Benard to
describe RAWA.

Ms. CHERYL BENARD (Consultant, RAND Corporation; Author "Veiled Courage"): It
started out as an intellectual student movement similar to what happened in
the 1970s on Western campuses, kind of an elite phenomenon of women who got
together to discuss the topics of the day and felt rebellious about some of
the things in the society around them.

And then Afghanistan started falling apart with the overthrow of the monarchy,
the coup, the countercoup, the Soviet occupation. And RAWA had the choice to
either dissolve itself and wait for better days or to change itself into
something else politically. And what happened was they underwent several
transformations. First they went into the opposition, to the pro-Soviet
government in Afghanistan, which necessitated their beginning clandestine work
because the degree of repression and the number of arrests were very high and
work began to become dangerous. So they started to operate underground a
little bit.

And then the diaspora began, and large numbers of Afghans had to flee the
country because the situation became so difficult. And most RAWA members also
ended up in Pakistan or in Iran in refugee camps. And again the organization
could have dissolved, especially after its founding leader, Meena, was
murdered. But instead they decided to use the resources that they had, which
was mainly education, to work in the refugee camps, and they started to set
up schools and literacy programs and health programs.

And at that point the organization underwent its most interesting phase
because it moved from being an upper middle-class movement of intellectuals to
becoming a movement that really represented the entire population and had
started to have a large number of just ordinary rural non-literate members who
joined through attending literacy classes in the camps until it became an
extremely broad-based movement.

And then they started embarking on the work that they became known for in the
United States, too, through a CNN-BBC documentary that many, many people
saw...

GROSS: "Behind the Veil."

Ms. BENARD: ..."Behind the Veil."

GROSS: Mm-hmm.

Ms. BENARD: Yes. They started doing secret documentation of Taliban
excesses, such as the public executions in the soccer stadium, by filming them
from behind their veils. And this was work that was extremely dangerous
because if they had been caught, they definitely would have been killed.

GROSS: RAWA was founded by a woman named Meena. What led her to create it?
What was happening in her life that led her to create a women's group?

Ms. BENARD: She was a very earnest girl, even in high school already. It was
a time of great political turmoil in Afghanistan, and she found that very
fascinating. She was very upset by the huge social problems and the social
disparities that she saw around her. Apparently she was one of those
teen-agers with a strong social conscience.

And when she became active at the university, there were a lot of political
groups around, but she saw that they were missing two components. Women were
not involved in them and they weren't what she thought they should be in terms
of being more normally middle-of-the-road kind of democratic. They were more
extremely left or extremely right. And she wanted a broad-based, very
democratic group that allowed women to become very active in it, so she formed
the first women's organization in Afghanistan.

GROSS: Now I think she went to the same university as Gulbuddin Hekmatyar,
and they were there at about the same time. What is his importance in this
story?

Ms. BENARD: Gulbuddin Hekmatyar is one of the fundamentalist leaders, one of
the mujaheddin who fought against the Soviets in the 1980s. He, at the time
that Meena was a student, was a student as well. He was already a pronounced
fundamentalist. He had a group around him who engaged in such pursuits as
throwing acid at women students who were not dressed what in his view was the
correct Islamic style of dress. He would have preferred women not to be
allowed at the universities at all.

I actually met him in Peshawar in the 1980s and interviewed him. It was a
very bizarre experience. He lived in a kind of fortress setting where it was
rumored that he had his own personal prison where he kept his opponents. And
he was an extremely feared figure. He was associated with many assassinations
and killings. And he is rumored to have killed Meena's husband, who was
murdered in Pakistan, along with many, many other more liberal activists
during that time.

GROSS: What was Meena's marriage like? Did she have an arranged marriage?
Did she marry for love?

Ms. BENARD: Meena is very romantic. Yes, she married for love. She met her
husband at the university, and it was, from the beginning, both a personal and
an intellectual partnership. We have a number of her writings on this
subject. And she describes him in a way that I think we can imagine him very
well. There are a number of men like that. He supported the women's
movement. He supported her work. But he also could never resist a humorous
approach to this, so he liked making his jokes about it as well.

She had a sort of a fundamental discussion, that she relates in her memoirs,
with him when she decided to form her own women's organization. And he asked
what the relationship of that organization to his own group would be. He had
a more pronounced leftist organization that he was the head of. And she told
him that they would need to learn how to separate their personal relationship
from their political relationship because she wanted her group to be different
from his in terms of its political values and also to operate completely
independently. It was one of the enduring problems of her political life, and
also of RAWA, that Afghans found that very, very difficult to believe, and
they persisted in thinking that her organization just had to be kind of a
shadow of his and that he was probably secretly in charge of the whole thing.
And she was often trying to refute that, but it was hard to convince people of
it.

GROSS: Now you mentioned that she had written about her views on marriage.
Do you think that Meena was influenced by the Western feminist movement?

Ms. BENARD: She was definitely influenced by all of the thoughts that carried
through during the 1970s and '80s in the West, too, the thoughts of what
women's role in society should be. She also realized something that I think
contributed to her importance. She realized that since her life was very
unconventional by Afghan standards, and her marriage was unconventional,
people were going to be watching her very closely. And rather than fight
against that, she accepted it. And she accepted the fact that she was going
to become a role model for many Afghan women.

And so at various points in her life, for example when she was pregnant, she
made a point of confronting the questions that were in people's minds very
openly in saying, you know, `Just because a woman is pregnant doesn't mean
that she can't continue with her work.' This was something very radical, a
very radical thought for Afghan society. Just because a woman is married
doesn't mean she can't have her own opinions and her own organization and her
husband can't support that.

Her husband, you know, was very helpful in that regard and very often also
made public statements on that, saying that he realized the enormous
importance of her work and the enormous importance of getting women more
engaged politically. So they made their marriage also a political act in the
sense of demonstrating what an alternative kind of a relationship between a
man and a woman could be.

GROSS: My guest is Cheryl Benard, author of the new book "Veiled Courage:
Inside the Afghan Women's Resistance." We'll talk more after our break. This
is FRESH AIR.

(Soundbite of music)

GROSS: My guest, Cheryl Benard, is the author of "Veiled Courage," a history
of RAWA, the Revolutionary Association of the Women of Afghanistan. It's also
a profile of RAWA's founder, Meena.

Meena, the founder of RAWA, the Revolutionary Association of Women of
Afghanistan, was murdered. What do you know about the circumstances of her
murder?

Ms. BENARD: Meena was murdered during the mid-1980s. The Soviets were
occupying Afghanistan. The United States was backing an alliance of
mujaheddin, of mostly fundamentalist resistance groups that were trying to
eject the Soviets and were fighting against them. There were also a number of
other political groups based in Pakistan who were also fighting against the
Soviets, more liberal democratic groups. The US did not support those groups
because they thought that it would be better to support the more fanatical
groups who were likely to throw themselves into the struggle against the
Soviets with more fervor and abandon. And therefore there was a power
struggle among the various resistance groups, and the liberal democratic ones
were systematically destroyed and their leaders killed by the fundamentalist
ones, and one of those leaders was Meena.

GROSS: The American government has become very sympathetic to the women's
resistance in Afghanistan and to women's rights in Afghanistan. At the time
that Meena was murdered, do you think that the American government then had
much knowledge of her work and the women's resistance...

Ms. BENARD: Meena was...

GROSS: ...or much interest?

Ms. BENARD: The decision had been made on a policy level that the war in
Afghanistan could not be won, but one was merely going to try to increase the
costs. And that fateful and erroneous decision led to liberal democratic
groups getting no support from the United States. And in retrospect we can
see how extremely shortsighted and dangerous that decision was because what
happened was that education became run by fundamentalists. The next
generation of Afghans was raised in Madrasas. And essentially the United
States helped produce the Taliban and helped produce the events that led to
September 11th by encouraging one sector in that society at the expense of
another.

And Meena often said that if she had only a fraction of the money that each of
the radical fundamentalist resistance groups was getting from the United
States, she could educate all the children in the refugee camps in liberal
democratic values, but she didn't get that support. She had to run her
schools by running little handicraft centers and little factories and
workshops by refugee women.

Hopefully now that the US has discovered women as a force for democracy and
for civil values in the Islamic world this will change and they will have that
more on their radar screen and will continue to support such groups.

GROSS: What is RAWA doing now in Afghanistan?

Ms. BENARD: RAWA has come to the judgement that they're worried about the
interim government and they are concerned about the high degree of
participation of the Northern Alliance. And so they have decided to wait and
see and to continue their activities in the border area and in the refugee
camps until they feel that the security situation is better and the political
situation is more reliable.

GROSS: And they're worried about the former members of the Northern Alliance
because the Northern Alliance was responsible for a lot of rapes when they
were ruling Afghanistan.

Ms. BENARD: Yes. That's correct. They have had extremely bad experiences
with the Northern Alliance, and they don't trust them. And they don't think
that people who have been involved in that sort of thing belong in a
government. They believe that they belong on trial for war crimes. And, in
fact, along with the past government, they have initiated a proceeding that
they want to try for that. They want to try to put some of these people on
trial for war crimes.

GROSS: Cheryl Benard is my guest. Her new book is called "Veiled Courage:
Inside the Afghan Women's Resistance."

We've seen several women suicide bombers in the Middle East in the past few
weeks. What does it say to you that women are taking on this role that only
men have done before, at least among the Palestinians? I don't know that
suicide bombers are the area where we want equality. But still, this must say
something.

Ms. BENARD: Well, for me personally, as a Western feminist, even Meena's
position was very thought-provoking. She consciously--when the situation in
Afghanistan started falling apart and she had to decide what to with her
organization, she made a conscious decision that women should make up their
minds to take exactly the same political risks that men do because it was her
belief that the reason women haven't gotten any further in politics and aren't
really taken seriously, that they continue to be cautious, that when you're
out in front risking your life, it's the men. And as long as only men do
that, only men will get the power afterwards. And she decided for her
organization that they were not going to do that, that they were going to take
exactly the same risks that men do. And they were also going to put their
lives on the line for what they believed in.

However, she also determined that they wanted to be non-violent. One of the
founding principles of RAWA is non-violence and not using arms or any kind of
violent interventions. They have been widely criticized for that, and many
people have felt that to take that level of risk against the Taliban and not
arm yourself and not use weapons is very unwise. So I suppose the female
suicide bombers are taking the logic a step further and are saying that if
you want full, equal political rights, then you have to accept the full level
of engagement and the full tactics and political tactics that men do. I have
a problem with it, but I can see the logic.

GROSS: Cheryl Benard, I'm wondering if studying the women's resistance in
Afghanistan has led you to any new thoughts about feminism in the United
States.

Ms. BENARD: Yes. I think that we can certainly learn a lot from RAWA. And
one of the things we can learn from is their willingness to use the support of
men. This is something that the women's movement in the West usually
disdains, and I think that's a mistake because if we really believe that the
new society we're aiming for is better for everyone, then I don't see why men
shouldn't participate in bringing it about. And for RAWA, this has been a
completely natural thing to do. And for us here it seems difficult, and I
think we should study their approach.

Another thing that we can learn from them is their admiration of other women.
This is often very difficult for Western feminists. There's a lot of--as
anyone who's been in a women's group will know, there's unfortunately a high
degree of mutual criticism and of not wanting anyone to emerge as a leader,
sort of a false egalitarianism. And the way RAWA admires Meena, for instance,
and really devotes themselves to her principles and admires the risks she
took--that, I think, is very productive and useful, too.

GROSS: Cheryl Benard is the author of "Veiled Courage: Inside the Afghan
Women's Resistance."

(Soundbite of music)

GROSS: Coming up, Ken Tucker reviews a new CD by singer-songwriter Jim Roll
that features his collaborations with novelists Rick Moody and Denis Johnson.
This is FRESH AIR.

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

Review: Jim Roll's new album "Inhabiting the Ball"
TERRY GROSS, host:

Jim Roll is a singer/songwriter from Chicago whose new third album called
"Inhabiting the Ball" features collaborations with a couple of well-known
novelists: Rick Moody, author of "The Ice Storm," and Denis Johnson, best
known for his short story sequence "Jesus' Son." Rock critic Ken Tucker has a
review.

(Soundbite of "Bonnie and Clyde")

Mr. JIM ROLL (Singer/Songwriter): (Singing) Rocking away with Faye Dunaway
and Bonnie and Clyde. Just leave it to be with your hair flying over your
eyes, gun at your side. Blue is blue when you're being untrue. So was it
three or was it two, was it two? Rocking away with Faye Dunaway...

KEN TUCKER:

That's Jim Roll on his own. He wrote the lyrics and the music to "Bonnie and
Clyde," a nice chunk of wordy rock 'n' roll that seems to exist primarily to
compare the musician's object of desire to Faye Dunaway circa 1967.

Now let's hear what happens when Roll supplies the melody for a lyric by
novelist Rick Moody.

(Soundbite of music)

Mr. ROLL: (Singing) A farm stand ...(unintelligible) farm stand. The rain
never ends, the roof's got the bends. The crows rise up above the road. The
trucks pass bearing the widest loads. Satin blonde by a black car by a
(unintelligible) who waits for her friends. The hair and nails coil like a
(unintelligible) that breathe. They give the land away for free. Killjoy,
killjoy. Don't be a killjoy. She used to climb...

TUCKER: Rick Moody, a self-conscious artist--and I don't necessarily mean
that as a criticism--is shrewd enough to know that the last thing a novelist
should do in a piece of music is fill it with a lot of novelistic--that is to
say, narrative--detail. So instead he offers a series of simple images: a
farm stand whose roof is warped from the rain, crows swooping past. The
images are stark, unadorned, like those from a William Carlos Williams poem.
It's nice, nothing more, nothing less.

Now let's hear what happens when Denis Johnson, a generally more fervid writer
than Moody and a poet as well, hands Jim Roll a lyric.

(Soundbite of music)

Mr. ROLL: (Singing) When they hung my handsome Daniel, he looked so high
surprised. The gold fell from his pockets and a crow fell from the skies.
When they hung my handsome Daniel, he looked so high surprised.
(Unintelligible) on the 12th day of July. Although the judge had sentenced my
handsome Daniel to die, when the trap door opened, he looked so flat
surprised; you should have seen his eyes. My Daniel was so handsome, should
have seen his eyes.

TUCKER: Well, that's different from everything Jim Roll's done before.
Johnson's fondness for invoking death with abrupt images, in this case a
hanging, and his use of mysterious possessives--why does the narrator call him
`my handsome Daniel'? Is he talking about a son, a lover? It adds to the
atmosphere of the song.

(Soundbite of music)

Mr. ROLL: (Singing) ...(Unintelligible) was a sapphire green, her
(unintelligible) a slim 19. Her age, in fact, was in between. She read
in-flight magazine. His tribulations were obscene, the way around him events
careened. The times were really pretty lean when he read in-flight magazine.
(Unintelligible) that grammar clean, their fonts and photos must be keen. All
the prizes are routine for your in-flight magazine.

TUCKER: Here's where Rick Moody picks an easy target, condescending to the
sort of woman who would read something as flimsy as an in-flight magazine.
Jim Roll's Chuck Berry guitar riff and nicely sour harmony vocal disguises the
smugness which pops up again later when Moody lets you know he knows who
George Plimpton is.

I prefer the directness of Denis Johnson's words in "Heartache Song."

(Soundbite of music)

Mr. ROLL: (Singing) All your promises, the things you said, using grand words
like `eternity' and `love.' You told me together we would see the end of
time. You told me together, we would watch that last star fall. The horrible
truth is that you meant it. The awful truth is you meant every word. My
heart breaks for anybody out there saying these words tonight. My heart
breaks for anybody listening.

TUCKER: I have no idea how Jim Roll came to collaborate with Moody or
Johnson, but it was a good commercial idea, since it guarantees that someone
like me will give the songs a closer scrutiny. For the record, as it were, I
recommend Denis Johnson's stuff with enthusiasm. Check out his poetry
collection called "The Throne of the Third Heaven of the Nations Millennium
General Assembly," and give this guy Jim Roll a spin.

GROSS: Ken Tucker is critic at large for Entertainment Weekly. He reviewed
"Inhabiting the Ball" from Jim Roll.

(Credits)

GROSS: I'm Terry Gross.

(Soundbite of music)

Mr. ROLL: (Singing) The strings were frayed on your guitar. The nylon
strings, the busted case. The frets had pried themselves away. The capo,
too, was stuck in place. B's and A's and G's and E's, worn the way you held
them down. The picks had all been rounded off. The pitch pipe made a buzzing
sound when you gave away your blue guitar. You gave away your blue guitar.
You gave away your blue guitar. I wonder where you are.
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