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Introduction: Infinite Jest, Boston and the ‘city novel’
If the Midwest, and notions of regional identity, had structured the geographies of Broom, Wallace’s move to Boston in 1989 entailed a shift in focus: having been concerned with the construction of a regional ‘heartland’ city in his first novel, he would now set Infinite Jest in and around one of America’s oldest and largest cities. But the depth of Wallace’s engagement with Cleveland and its topographical history in the earlier novel indicates that Boston might well have presented Wallace with more than simply a setting for this next project. How did this city shape Wallace’s approach to his novel? Can Jest be placed in a particular moment in the history of Boston – and of the American metropolis, and the literary and cultural attitudes associated with it? And what might a reading attentive to this geography tell us about Wallace’s relationship to the context of social and economic change in late twentieth-century America?
At first glance, these might seem counterintuitive questions to ask of Jest. Description of the cityscape is sparse: there is no direct glimpse of the exterior geography of the city until page 85, when Tiny Ewell makes a brief journey through Watertown by taxi (Jest pp. 85–7). Narrative action which takes place in the exterior spaces of the city is also limited to a relatively small number of scenes: of the 981 pages of the novel’s main text (excluding endnotes), only around 139 are set in Boston’s streets and public spaces. It is not often in this sprawling text that we find ourselves, like Randy Lenz, ‘abroad in the urban night’ (p. 539). By contrast, the Enfield Tennis Academy (‘E.T.A.’) and Ennet House – the novel’s two dominant institutions – take up a combined total of approximately 507 pages. The novel’s long final chapter, meanwhile, is organised around situations of interiority and stasis, with Hal Incandenza and Don Gately in parallel states of horizontal motionlessness within the confines of E.T.A. and St Elizabeth’s Hospital; the city almost entirely absent, apart from the occasional glimpse. (I refer, here and in the following chapter, to the parts of the text separated by circular figures as ‘chapters’. There are twenty-eight of these, though they are not numbered in the text).
In his 1992 essay on the landscapes of the Midwest, ‘Derivative Sport in Tornado Alley’, David Foster Wallace wrote: ‘the only part of Proust that really moved me in college was the early description of the kid’s geometric relation to the distant church spire at Combray’ (Supposedly p. 11). Space and place, this line suggests, were central to Wallace’s literary imagination. But at the same time, the uneasy juxtaposition of geometry and affect, mathematical abstraction and emotional engagement, is an indication that geography, for this writer, was not a simple matter. Interviewing Wallace for a Rolling Stone feature (that would never in fact appear in the magazine), David Lipsky recalls being given a tour of Wallace’s home: among the assorted furnishings, he notes ‘globes from [an] old cartography thing’. This is a tantalising hint at an explicit engagement with practices of geographical representation; no such ‘cartography thing’ has appeared in print. A clue to its nature, though, might be found in the ‘Eschaton’ scene in Infinite Jest, in which the map of cold war geopolitics and the space of the tennis court are brought into collision, with chaotic results – and to the dismay of the game’s overseer Michael Pemulis, who exclaims: ‘“it’s snowing on the goddamn map, not the territory, you dick!”’ (Jest p. 333). Space and its mediations were not easy to separate in Wallace’s imagination, it seems: ‘I like to mess with maps a little bit’, he admitted in a 1996 interview. He set all three of his novels in recognisable American places – Cleveland, Boston, Peoria – but this geographical familiarity is counterposed with wildly speculative elements. He embellished the landscape of Ohio with an artificial desert of black sand; redrew the diplomatic map of the North American Free Trade Agreement as the ‘Organization of North American Nations’ and placed a vast ecological disaster zone in the middle for good measure; and populated an ordinary Peoria office building with ‘actual, non-hallucinatory’ ghosts (Pale King p. 317). Wallace’s imagination was a deeply spatial one; but one in which space was always a problem, not a solution. This book explores the richly generative problems – aesthetic, social and political – that geography poses in his novels.
Over the first decade of Wallace’s work on The Pale King, the question ‘what is Peoria for?’ had opened the project onto searching questions about the efficacy of literary practice in the face of the geographical upheavals that characterised postindustrial life. Around 2005, though, the shape and status of the project itself began to come more fundamentally into question. In a note to himself dated 7 June 2005, Wallace reflected on the difficulty of incorporating his already drafted material into a coherent structure: he had been working to the assumption that ‘the book were a puzzle and all these pieces fit into it’, but ‘[t]his is not so’ (HRC 39.1). And this pragmatic structural issue was also joined by more fundamental doubts about the purpose of the work Wallace had done and was doing on the project: ‘The despair is that so much time and work has apparently gone into these nuggets, and so many of them just stop, as if the spirit just gave out’ – ‘I do not feel inspired’ (HRC 39.1). Across the ‘electric girl’ drafts, §1 and the Claude Sylvanshine section, the question of place had provided a focal point for Wallace’s renewed worry about the relationship between literary practice and the conditions of work and life in contemporary America. His 2005 note suggests that this conceptual concern had morphed into a compositional crisis.
David Hering places this note at the beginning of Wallace’s third and last phase of work on the novel, running from 2005 to 2007. As Hering points out, the note ‘clearly represents a crisis point in the life of The Pale King’ – necessitating ‘a new narrative strategy that [Wallace] clearly hoped would bring the disparate drafts together’. In Hering’s account, this strategy was the introduction of the character and narrative voice of ‘David Wallace’, who serves as the narrator of §9, §24 and §38 of the published text. At the same time, though – and in §24 in particular – this character’s appearance also coincides with a significantly more developed image of the Peoria Regional Examination Center and its surrounding landscape of ‘Lake James’, which began to form the geographical centre of the developing novel from this point.
The Geographies of David Foster Wallace's Novels takes a fresh look at David Foster Wallace's novels through the lens of historical geography. It explores the connections between Wallace's literary practice and the reshaping of American geographical space that resulted from the transition between Fordist and post-Fordist forms of capitalism, presenting critical readings of the novels together with analysis of manuscripts and notebooks from Wallace's archive. Deploying an innovative methodology that combines aspects of cultural geography and literary criticism, each novel is historically situated through a spatial keyword, expanding our understanding of the connections between social context and formal innovation in Wallace's work.
‘They are also Midwesterners’, Mr. Bloemker notes of the residents at his nursing home in The Broom of the System. To Bloemker, this Midwestern-ness is troubled and ambiguous: ‘this area of the country, what are we to say of this area of the country, Ms. Beadsman?’ (Broom p. 142). The issue is geographical, economic and cultural – the experience of a people who stand in an ambiguous productive relationship with the rest of the nation: ‘we feed and stoke and supply a nation much of which doesn’t know we exist. A nation we tend to be decades behind, culturally and intellectually’ (p. 142). And this geographical experience has a psychological dimension; the locational and existential unease of life in an area of America ‘both in the middle and on the fringe’, both ‘the physical heart and the cultural extremity’ (p. 142). Bloemker’s residents, in his diagnosis, are troubled by a need to ‘come to terms with and recognize the implications of their consciousness of themselves as part of this strange, occluded place’ (p. 142). But there is also an ambivalence in the novel about how seriously we are to take Mr Bloemker’s interpretations: he rehashes the theme in very similar terms later in the novel (p. 369), so that by the time we hear of him ‘acting as if he were whispering to someone under his arm when there was clearly no-one there, and asking Judith and Candy how they perceived their own sense of the history of the Midwest’, we come to recognise a less-than-healthy obsession (p. 446). Midwestern-ness is doubly pathologised here: both the psychology associated with this geographical identity itself, and the interpretation and expression of that psychology, are problematic. In this ambiguous fashion, Bloemker’s orations signpost a dimension of Broom – with its primary setting in and around the Midwestern city of Cleveland, Ohio – that is concerned with the distinctive late twentieth-century experience of the Midwest as a particular American region, and with the ways in which this region can be spoken about.
The notion of the ‘regional’, and of the Midwestern-ness of Wallace’s writing, is the geographical category that has been most extensively brought to bear on Wallace’s work by his critics – though this has led to some disagreement.
Introduction: The Pale King and the Changing Geography of Work
What is Peoria for? The question does not appear in the published text of The Pale King, compiled by Michael Pietsch from the mass of draft material Wallace left on his death in 2008. But it does appear, with almost obsessive frequency, in the margins of notebooks and drafts from the earliest to the last stages of Wallace’s work on the project. The extensive ‘Evidence’ notebook, whose inside cover is dated ‘3/96’ (a month after the publication of Jest), is replete with instances (HRC 43.1). Nearly ten years later, Wallace labelled a zip disk containing draft material ‘WPF/PK 05’ (according to Pietsch’s index of materials, kept in the Harry Ransom Center archive), giving the question of (w)hat (P)eoria is (f)or equal weight alongside the eventual title of the published text (HRC 36.0). In between, numerous drafts and notebooks are headed or annotated with the question. In his extensive treatment of the archival material related to the novel, David Hering identifies a three-stage compositional history: an initial stage running from 1996 to 1999, a second phase from 1999 to 2005, and a third period from 2005 to 2007, with each bookended by a fundamental rethinking of direction. But the persistence of the question of what Peoria is for suggests that this guiding concern with the function of place – in America at the turn of the twenty-first century, and in the novel itself – remained at the centre of Wallace’s project throughout this troubled process.
This concern is also signalled in Wallace’s conversation with David Lipsky in 1996, where it takes on an explicitly economic inflection. Showing Lipsky around Bloomington-Normal, Illinois – where he settled in 1993 – Wallace took pains to outline features of the local economy: ‘there’s a Mitsubishi plant, and then there’s a lot of farm-support stuff. There’s a lot of firms called like Ro-tech and Anderson Seeds. And State Farm Insurance.’ That this material frame was important to Wallace’s work on the novel is indicated by his frequent compilation of detailed lists of imagined industries and services with which to populate his version of Peoria: the ‘Evidence’ notebook contains several notes for invented manufacturing and extractive concerns, like ‘Frigid Coal Inc.’ and ‘Midwest Foam’ – a ‘place that makes foam insulation, rubber foam’ (HRC 43.1).
Wallace’s move to Boston had, as the previous chapter has shown, entailed a reframing of the question of how his literary practice could align with the social conditions that had emerged from the socioeconomic upheavals at the end of the twentieth century: a question that was now intimately bound up with the deep formal and representational problems that the ‘postmetropolitan’ city posed for the novel. The city appears in the early stages of Infinite Jest as a space of fragmentation, loss and nostalgia; but Joelle van Dyne’s broadcast had also signalled the prospect of a connective artistic practice embedded in the metropolis. Is this possibility a dead end for Jest, one that dissipates along with the crowd whose elision from the text reflects the social atomisation of the city? Despite the dominant sense of dissolution, the tentative urban excursions of Joelle and Don Gately in the opening half of the text also contain latent suggestions that a renewed juncture between city and novel might yet revive the metropolis as a shared environment, a lived social space. How the novel builds on this suggestion despite the predominance of fragmentation, and how it locates possibilities of community in the very metropolis that seems so inimical to collective life, is the question I explore in this chapter. And as a starting point, I want to return to Wallace’s own encounter with the social scene of Boston.
In Chapter 2, I emphasised the excitement Wallace expressed on first moving to the city in the summer of 1989; but this excitement proved short-lived, as a serious mental health crisis saw him hospitalised in late 1989 and 1991, before gradually returning to city life through Boston’s addiction recovery network and halfway house facilities. This experience perhaps explains his later reflection that ‘I don’t do well in big cities’, a sentiment that might seem to justify the view that Wallace’s attitude to metropolitan environments was essentially a negative one. But even this crisis, on closer inspection, took on a generative role in Jest’s development.
This chapter considers the status and shape of georgic in early seventeenth-century England in the context of two questions that georgic writers asked themselves repeatedly during this period: first, do farmers work on account of a commitment to virtue and community, or because of competition and self-interest? Second, should farmers aim to uphold customary practices in the fields, or seek ways to innovate and as a result transform the agrarian landscape? The period considered here – roughly, the reign in England of James I (1603-25) – was shaped by fundamental debates about the values of the land and the lives of those who owned and worked it. And poets had to consider quite how the resources of georgic related to these upheavals.
Wallace’s landscapes are haunted by capitalist interventions in the natural world, from the black sand of the Great Ohio Desert to the Great Convexity/Concavity that sits like a pustule between the United States and Canada. This chapter considers Wallace’s writing as an ecocritical gesture that connects human solipsism, hypercapitalism and the despoiling of the natural world. In tracing this connection, the chapter operates on the central theme of disgust, a recurrent and powerful motif throughout Wallace’s body of work. Working alongside the chapter on regional geographies, the chapter shows how Wallace troubled and complicated the regional archetypes that populate his writing by using images of the unheimlich and the grotesque, uniting the threatening, the decomposing and the simply absurd to highlight the depredations of the late capitalist system on the (American) landscape.
To evaluate whether vanA rectal screening for vancomycin-resistant Enterococcus (VRE) predicts vancomycin resistance for patients with enterococcal bloodstream infection (BSI).
A retrospective cohort study.
Large academic medical center.
The predictive performance of a vanA rectal swab was evaluated in 161 critically ill adults with an enterococcal BSI from January 1, 2007, to September 1, 2014, and who had a vanA rectal swab screening obtained within 14 days prior to blood culture.
Of the patients meeting inclusion criteria, 83 (51.6%) were vanA swab positive. Rectal-swab–positive patients were more likely to be younger, to be immunocompromised, to have an indwelling central vascular catheter, and to have a history of MDR bacteria. The vanA rectal swab had sensitivity and negative predictive values of 83.6% and 85.9%, respectively, and specificity and positive predictive values of 71.3% and 67.5%, respectively, for predicting a vancomycin-resistant enterococcal BSI in critically ill adults.
VanA rectal swabs may be useful for antimicrobial stewardship at institutions with VRE screening already in place for infection control purposes. A higher PPV would be warranted to implement a universal vanA screen on all ICU patients.
Both 1- and 2-hour rapid diagnostic algorithms using high-sensitivity troponin (hs-cTn) have been validated to diagnose acute myocardial infarction (MI), leaving physicians uncertain which algorithm is preferable. The objective of this study was to prospectively evaluate the diagnostic performance of 1- and 2-hour algorithms in clinical practice in a Canadian emergency department (ED).
ED patients with chest pain had high-sensitivity cardiac troponin-T (hs-cTnT) collected on presentation and 1- and 2-hours later at a single academic centre over a 2-year period. The primary outcome was index MI, and the secondary outcome was 30-day major adverse cardiac events (MACE). All outcomes were adjudicated.
We enrolled 608 patients undergoing serial hs-cTnT sampling. Of these, 350 had a valid 1-hour and 550 had a 2-hour hs-cTnT sample. Index MI and 30-day MACE prevalence was ~12% and 14%. Sensitivity of the 1- and 2-hour algorithms was similar for index MI 97.3% (95% CI: 85.8–99.9%) and 100% (95% CI: 91.6–100%) and 30-day MACE: 80.9% (95% CI: 66.7–90.9%) and 83.3% (95% CI: 73.2–90.8%), respectively. Both algorithms accurately identified about 10% of patients as high risk.
Both algorithms were able to classify almost two-thirds of patients as low risk, effectively ruling out MI and conferring a low risk of 30-day MACE for this group, while reliably identifying high-risk patients. While both algorithms had equivalent diagnostic performance, the 2-hour algorithm offers several practical advantages, which may make it preferable to implement. Broad implementation of similar algorithms across Canada can expedite patient disposition and lead to resource savings.