BOOKS I HAVE BOUGHT AND HOPE TO READ SOON

Curious Incident of the Lesion on the Hip
By DAVID KAMP

Mark Haddon’s book titles seem to belong to “Wallace & Gromit” film shorts. His first novel, published three years ago, was called “The Curious Incident of the Dog in the Night-Time.” The new one is called “A Spot of Bother.” Neither book has anything to do with a plasticine man-dog duo propelled by stop-motion animation. But, like Nick Park, the mastermind behind “Wallace & Gromit,” Haddon trades in a cheerful, quirky, life-goes-on drabness that’s particularly English. And totally brilliant.

“A Spot of Bother” concerns a retiree named George Hall. He’s a decent, sympathetic figure who used to hold a managerial post at a company that manufactured playground equipment. “In a modest way,” Haddon writes, “he had increased the happiness of a small part of the human population.” George now spends his days pottering about his home in provincial Peterborough, an hour north of London, doing acutely provincial English middle-class things — drinking his coffee from a “stripy” mug, waiting as the toast “pinged up,” building a studio in his garden, where he plans to resume his long-dormant hobby of drawing. He’s a bit of a fogy, preferring solitude to company and not wholly comfortable with the fact that his grown son is homosexual. (“It was the thought of men purchasing furniture together which disturbed him.”) But George is a nice fogy. “Things changed,” Haddon reasons on his protagonist’s behalf. “Mobile phones. Thai restaurants. You had to remain elastic or you turned into an angry fossil railing at litter.”

At the outset of the book, George discovers a lesion on his hip. His doctor diagnoses it as eczema. George, disbelieving, is convinced he has fatal cancer. Meanwhile, there are other rumblings of trouble. George learns that his wife, Jean, is carrying on an affair with one of his former work colleagues. George and Jean’s daughter, a high-strung, hot-tempered divorcée and single mom named Katie, has announced that she’s going to marry her boyfriend, Ray, who is kindhearted and prosperous but too discomfitingly working-class for Mum and Dad’s tastes. And the gay son, Jamie, is going through a rough patch with his boyfriend, Tony. These circumstances conspire to make George depressed — first just a little, and then, as time goes on, a lot.

This standard-issue suburban-melodrama stuff is a far cry from “The Curious Incident of the Dog in the Night-Time,” which won raves for its bravura concept — its narrator is an autistic teenager whose unorthodox thought processes subvert the norms of conventional storytelling. “A Spot of Bother” isn’t nearly as audacious, and in other hands and other media, its plot elements wouldn’t amount to much, maybe a weepy nighttime soap or a lesser Steve Martin comedy.

But Haddon is too gifted and too ambitious to write a hacky second novel. In fact, he’s so wondrously articulate, so rigorous in thinking through his characters’ mind-sets, that “A Spot of Bother” serves as a fine example of why novels exist. Really, does any other art form do nuance so well, or the telling detail (“the pig-shaped notepad on the phone table”) or the internal monologue? A dust-up with her fiancé prompts Katie to consider her checkered romantic past: “They took up so much space. That was the problem with men. It wasn’t just the leg sprawl and the clumping down stairs. It was the constant demand for attention.” A church funeral provides George with the occasion to ponder the role of Christianity in his life, or its lack thereof: “He looked round at the stained-glass lambs and the scale model of the crucified Christ and thought how ridiculous it all was, this desert religion transported wholesale to the English shires. Bank managers and P.E. teachers listening to stories about zithers and smiting and barley bread as if it were the most natural thing in the world.”

Beyond the zingers and tragicomic domestic set pieces, Haddon is especially heroic in capturing the tortured dynamics of nuclear-family life: the roles children never grow out of, even after they’ve become adults; the close-quarters intimacy that simultaneously binds and enervates (Jamie sums up his father as “the alphabeticizer of books and winder-up of clocks”); the ever-shifting alliances; the short-lived feuds; the commiserative phone calls about how loco everyone else in the family is. In one swift passage, Katie pinballs from treating Jamie as her dearest confidant to punching him upside the head for being indiscreet to good-naturedly gossiping with him about “Mum’s fancy man.”

“A Spot of Bother” does share one major trait with “The Curious Incident of the Dog in the Night-Time.” In both, about halfway through, Haddon douses his story with accelerant and sets it aflame; abruptly, what has been a rather gently paced book becomes an urgent read, and pages start turning in double-time. It wouldn’t be sporting of me to reveal how, precisely, this happens, but in neither book does the author force matters with sudden ice storms or deluges of frogs or any other kind of dubious ex machina. Haddon is an unmagic realist, a guy who finds enough pathos and humor in the everyday to fashion stories that transport, entertain and keep you reading past your bedtime.

In an uncharacteristic meta-moment in which he seems to be winking at the reader, Haddon writes, “The human mind was not designed for sunbathing and light novels.” He’s talking about George’s aversion to vacations, but he also seems to be poking fun at himself, or wondering if the sort of breezy books he writes have any lasting value.

Well, when they have the kind of heart and intelligence that “A Spot of Bother” does, they certainly do. In a modest way, Mark Haddon will increase the happiness of a small part of the human population.

FREAKONOMICS: Selling Soap
By STEPHEN J. DUBNER and STEVEN D. LEVITT

The Petri-Dish Screen Saver
Leon Bender is a 68-year-old urologist in Los Angeles. Last year, during a South Seas cruise with his wife, Bender noticed something interesting: passengers who went ashore weren’t allowed to reboard the ship until they had some Purell squirted on their hands. The crew even dispensed Purell to passengers lined up at the buffet tables. Was it possible, Bender wondered, that a cruise ship was more diligent about killing germs than his own hospital?

Cedars-Sinai Medical Center, where Bender has been practicing for 37 years, is in fact an excellent hospital. But even excellent hospitals often pass along bacterial infections, thereby sickening or even killing the very people they aim to heal. In its 2000 report “To Err Is Human,” the Institute of Medicine estimated that anywhere from 44,000 to 98,000 Americans die each year because of hospital errors — more deaths than from either motor-vehicle crashes or breast cancer — and that one of the leading errors was the spread of bacterial infections.

While it is now well established that germs cause illness, this wasn’t always known to be true. In 1847, the Hungarian physician Ignaz Semmelweis was working in a Viennese maternity hospital with two separate clinics. In one clinic, babies were delivered by physicians; in the other, by midwives. The mortality rate in the doctors’ clinic was nearly triple the rate in the midwives’ clinic. Why the huge discrepancy? The doctors, it turned out, often came to deliveries straight from the autopsy ward, promptly infecting mother and child with whatever germs their most recent cadaver happened to carry. Once Semmelweis had these doctors wash their hands with an antiseptic solution, the mortality rate plummeted.

But Semmelweis’s mandate, as crucial and obvious as it now seems, has proved devilishly hard to enforce. A multitude of medical studies have shown that hospital personnel wash or disinfect their hands in fewer than half the instances they should. And doctors are the worst offenders, more lax than either nurses or aides.

All of this was on Bender’s mind when he got home from his cruise. As a former chief of staff at Cedars-Sinai, he felt inspired to help improve his colleagues’ behavior. Just as important, the Joint Commission on Accreditation of Healthcare Organizations would soon be inspecting Cedars-Sinai, and it simply wouldn’t do for a world-class hospital to get failing marks because its doctors didn’t always wash their hands.

It may seem a mystery why doctors, of all people, practice poor hand hygiene. But as Bender huddled with the hospital’s leadership, they identified a number of reasons. For starters, doctors are very busy. And a sink isn’t always handy — often it is situated far out of a doctor’s work flow or is barricaded by equipment. Many hospitals, including Cedars-Sinai, had already introduced alcohol-based disinfectants like Purell as an alternative to regular hand-washing. But even with Purell dispensers mounted on a wall, the Cedars-Sinai doctors didn’t always use them.

There also seem to be psychological reasons for noncompliance. The first is what might be called a perception deficit. In one Australian medical study, doctors self-reported their hand-washing rate at 73 percent, whereas when these same doctors were observed, their actual rate was a paltry 9 percent. The second psychological reason, according to one Cedars-Sinai doctor, is arrogance. “The ego can kick in after you have been in practice a while,” explains Paul Silka, an emergency-department physician who is also the hospital’s chief of staff. “You say: ‘Hey, I couldn’t be carrying the bad bugs. It’s the other hospital personnel.”’ Furthermore, most of the doctors at Cedars-Sinai are free agents who work for themselves, not for the hospital, and many of them saw the looming Joint Commission review as a nuisance. Their incentives, in other words, were not quite aligned with the hospital’s.

So the hospital needed to devise some kind of incentive scheme that would increase compliance without alienating its doctors. In the beginning, the administrators gently cajoled the doctors with e-mail, faxes and posters. But none of that seemed to work. (The hospital had enlisted a crew of nurses to surreptitiously report on the staff’s hand-washing.) “Then we started a campaign that really took the word to the physicians where they live, which is on the wards,” Silka recalls. “And, most importantly, in the physicians’ parking lot, which in L.A. is a big deal.”

For the next six weeks, Silka and roughly a dozen other senior personnel manned the parking-lot entrance, handing out bottles of Purell to the arriving doctors. They started a Hand Hygiene Safety Posse that roamed the wards and let it be known that this posse preferred using carrots to sticks: rather than searching for doctors who weren’t compliant, they’d try to “catch” a doctor who was washing up, giving him a $10 Starbucks card as reward. You might think that the highest earners in a hospital wouldn’t much care about a $10 incentive — “but none of them turned down the card,” Silka says.

When the nurse spies reported back the latest data, it was clear that the hospital’s efforts were working — but not nearly enough. Compliance had risen to about 80 percent from 65 percent, but the Joint Commission required 90 percent compliance.

These results were delivered to the hospital’s leadership by Rekha Murthy, the hospital’s epidemiologist, during a meeting of the Chief of Staff Advisory Committee. The committee’s roughly 20 members, mostly top doctors, were openly discouraged by Murthy’s report. Then, after they finished their lunch, Murthy handed each of them an agar plate — a sterile petri dish loaded with a spongy layer of agar. “I would love to culture your hand,” she told them.

They pressed their palms into the plates, and Murthy sent them to the lab to be cultured and photographed. The resulting images, Silka says, “were disgusting and striking, with gobs of colonies of bacteria.”

The administration then decided to harness the power of such a disgusting image. One photograph was made into a screen saver that haunted every computer in Cedars-Sinai. Whatever reasons the doctors may have had for not complying in the past, they vanished in the face of such vivid evidence. “With people who have been in practice 25 or 30 or 40 years, it’s hard to change their behavior,” Leon Bender says. “But when you present them with good data, they change their behavior very rapidly.” Some forms of data, of course, are more compelling than others, and in this case an image was worth 1,000 statistical tables. Hand-hygiene compliance shot up to nearly 100 percent and, according to the hospital, it has pretty much remained there ever since.

Cedars-Sinai’s clever application of incentives is certainly encouraging to anyone who opposes the wanton proliferation of bacterial infections. But it also highlights how much effort can be required to solve a simple problem — and, in this case, the problem is but one of many. Craig Feied, a physician and technologist in Washington who is designing a federally financed “hospital of the future,” says that hand hygiene, while important, will never be sufficient to stop the spread of bacteria. That’s why he is working with a technology company that infuses hospital equipment with silver ion particles, which serve as an antimicrobial shield. Microbes can thrive on just about any surface in a hospital room, Feied notes, citing an old National Institutes of Health campaign to promote hand-washing in pediatric wards. The campaign used a stuffed teddy bear, called T. Bear, as a promotional giveaway. Kids and doctors alike apparently loved T. Bear — but they weren’t the only ones. When, after a week, a few dozen T. Bears were pulled from the wards to be cultured, every one of them was found to have acquired a host of new friends: Staphylococcus aureus, E. coli, Pseudomonas, Klebsiella.. . .

THE DEPARTED

The small-time hoods in “Mean Streets,” Martin Scorsese’s breakthrough movie, from 1973, were not habitual users of the Queen’s English. Some of the conversations between Robert De Niro and Harvey Keitel, improvised on the spot, would begin with one man saying a word or two, then the other grabbing at the words, turning them inside out, flinging them back, and so on, until a full-scale brawl was under way in which the emotions were flawlessly clear but the sentences little more than fragments. The habit of building a tempest out of nothing became a Scorsese trademark, widely imitated by other directors, including Dito Montiel, who made the new independent movie “A Guide to Recognizing Your Saints,” in which almost every scene turns into a clamorously inarticulate fight. Scorsese, meanwhile, has moved on to a different mode of discourse. “The Departed” is not one of his greatest films; it doesn’t use the camera to reveal the psychological and aesthetic dimensions of an entire world, as “Mean Streets,” “Taxi Driver,” “Raging Bull,” and “Goodfellas” did. But it’s a viciously merry, violent, high-wattage entertainment, and speech is the most brazenly flamboyant element in it. “The Departed” is a remake of the Hong Kong thriller “Infernal Affairs,” directed by Andrew Lau and Alan Mak, and it has the speed and volatility of Hong Kong movies. But Scorsese and the screenwriter, William Monahan, have added weight to the cops-and-robbers plot by setting it in the Irish neighborhood of South Boston and by digging deep into urban tribal lore—the memories of loyalty and betrayal going back for decades, the nasty old jokes, the bullying insults and invective. The men commit obscene acts, and speak in cynical taunts, and the extreme violence and virtuoso cursing seem to feed off each other. It’s still not the Queen’s English, but every speech is complete in its profane eloquence.

Jack Nicholson’s Southie crime lord, Frank Costello, sets the tone. Frank, who bears more than a passing resemblance to the notorious Boston thug James (Whitey) Bulger, is not isolated in high-walled solemnity, like the Italian grandees in “The Godfather.” Instead, he’s walking the street where people can see him; or he’s mapping out strategy from a grotty little bar. Nicholson wears a satanic goatee and mustache, and his eyebrows flip up and down like semaphore flags; he gives the ultimate mad-Jack performance, a free-ranging and spontaneous impression, complete with Irish ditties, of a man who relishes each filthy deal and bone-crushing blow. “Non serviam,” he growls at a neighborhood kid, an altar boy, quoting James Joyce—by which he means that every man must refuse obedience to institutions like the Church (obedience to institutions like the Mob is another matter). The boy in question grows into Colin Sullivan (Matt Damon), an ace detective in the Massachusetts State Police, and he belongs to Frank, tipping him off by cell phone when the police want to make a move on him. Colin’s opposite number—almost his twin—is Billy Costigan (Leonardo DiCaprio), who’s also a Statie, but a straight one. After a number of excruciating initiations, Billy, working undercover, penetrates Frank’s inner circle. This is a double-mole story, in which the moles wind up hunting each other—the kind of interlocking narrative machinery that John le Carré used to construct in his spy novels. The deceptions of le Carré’s spooks, however, depended on the spacious geography of international espionage. In the cloistered neighborhood and Police Headquarters of this film, each mole is constantly in danger of giving himself away to the people he sees every day.

The story is highly improbable, although Scorsese and Monahan keep the complicated goings on clear and taut, and the entire movie is acted with spirit and conviction. DiCaprio, his mouth pinched in tension, his voice gravelly and low, holds his own against Damon, who has a charming and plausible line of patter as the calculating Colin. Scorsese also gets terrific work from Mark Wahlberg, as a combustible but honest Special Investigations Unit cop, and Vera Farmiga, as a police psychiatrist who is drawn to neurotic and violent men. All the characters are unusually intelligent, and the fast, scurrilous talk binds the tightly edited short sequences together. Scorsese, however, is trying to do with words what he used to accomplish with the camera, and he doesn’t produce the kind of emotional involvement that once made his movies so exhausting and also so satisfying. At the end, he seems eager to dispose of his characters in order to fill out a pattern: one after another gets shot at point-blank range (there’s hardly an actor who retains the back of his head), and shock gives way to disbelief and even laughter. “The Departed” is murderous fun, but it’s too shallow to be the kind of movie that haunts your sleep.

TV: SIX DEGREES

ABC’s “Six Degrees” is executive-produced by one of “Lost” ’s creators, J. J. Abrams, and it shines with his trademark gloss. Handsomely shot on Manhattan locations, the show is laced with wit and blessed with fine actors, particularly Hope Davis as Laura, a playful woman who’s trying to get past her war-correspondent husband’s death in Iraq (she begins by tossing out his old clothes); and the majestically surly Campbell Scott as Steven, a once noted photographer who, after years of boozing, rediscovers his gift when he photographs a stranger—Laura—sobbing on a stoop.

Yet the coincidences that bring the show’s six wayfarers together to form their own little island on the big island are vexingly hokey. “No one is a stranger—for long,” Carlos, the public defender (Jay Hernandez), intones in a voice-over at the close of the pilot. He has just run into Mae (a dewy Erika Christensen) on the subway as she is about to leave town—after seeking her everywhere since winning her release on a charge of indecent exposure. She had clambered onto a moving street sweeper near Washington Square and thrown off her top in sheer jubilation at being young and bodacious in the greatest city on earth. First of all, that’s exactly what the good folks in Jericho, Kansas, suspect is going on here. Second, it would never happen—no sanitation driver would waste time re-wetting Fifth Avenue when the show’s production team had already slicked it down.

When Laura makes the acquaintance of Whitney (Bridget Moynahan) at the pedicurist, it’s because Whitney, a fellow-Wasp, notices her Sonic Youth T-shirt and wonders if it’s from a vintage store:

LAURA: I was at the show.
WHITNEY: At Roseland?
LAURA: Yeah. Fall of ’95. It was the night before—
WHITNEY: Thanksgiving. I was there.
LAURA: Really?


Are you sure that was us and not one of the show’s writers? Whitney, a high-powered P.R. woman, also prepares one of those “as if!” meals for her boyfriend on the roof of their building, complete with a wet bar, candles, tulips, champagne, and linen napery. There seems to be only one thing missing—hold on, I’ll think of it . . . Oh, yes: food.

In the second episode, after delivering a schmaltzy voice-over about how “anything is possible” here, Damien (Dorian Missick), a limo driver with a gambling problem (sigh), picks up a lucky penny that Laura lost on the street, and his fortunes turn. Apparently, there are eight million stories out there in this crazy, big-hearted town—but it’s all one story, really, the one about trusting in your dream. Please. Just play “New York, New York” and have done with it.

The deeper problem is that we always know more than the characters: we know that Laura’s new au pair, Claire, is really Mae, and that she’s on the run; that Whitney’s boyfriend is a roué; that Carlos’s client, accused of shooting a man, is innocent and that the actual shooter is his new friend, Damien. We’re meant to be ensorcelled by the show’s glittering web of serendipity, but we’re just impatient: C’mon, people, get up to speed! One reason “Lost” sustains interest is that the characters know more than we do, so it’s as if we’re working alongside them to solve the island’s mysteries. This makes us feel a part of their small tribe—as well as of the much larger one out there in the dark. It’s a simple formula: “Lost” is more.