"Human Debris": Border Politics, Body Parts, and the Reclamation of the Americas in Leslie Marmon Silko's Almanac of the Dead

Ann Folwell Stanford*

Unruly Texts: Text as Body

Progress is what
they call it. I call it cemetery,
charnel house, soul sickness.

--Paula Gunn Allen ¹

What does it mean to say I have survived
until you take the mirrors and turn them outward
and read your own face in their outraged light?

--Adrienne Rich ²

Given the outpouring of scholarly work on Leslie Marmon Silko's first novel, Ceremony (1977), the silence of literary scholars around her second, Almanac of the Dead (1991), is intriguing. ³ Almanac was met with nearly fifty reviews, ranging from ecstatic to grudgingly appreciative to hostile. While some reviewers criticized the novel for its violence and harshness, others hailed it as a masterpiece. ⁴ As of this writing, however, only a handful of critical articles on Almanac have appeared in print. ⁵ Almanac's difficult and harsh subject matter may, in part, explain why: there is little about which to feel good in Silko's sprawling tale. The novel critiques and challenges the colonialism of the last five [End Page 23] hundred years in this country, and it marks a significant departure from Silko's previous work in style and content. Told without the lyricism that characterizes much of Ceremony, Almanac presents brutal realities in unflinchingly stark language.

The novel is also structurally challenging. Sven Birkerts aptly comments that writing about Almanac is akin to "describing Rodin's 'The Gates of Hell' figure by figure." ⁶ Almanac is divided into six parts ("The United States of America," "Mexico," "Africa," "Arizona," "The Americas," "The Fifth World," and "One World, Many Tribes"), with each part containing one to eight "books" (most with geographic names--"The Border," "The North," etc.--but some with titles such as "Reign of Death-Eye Dog," "The Foes," "The Warriors"). Each book then contains short chapters (some as many as twenty-one) with such titles as "Abortion," "Suicide," "Shallow Graves," "Terrorist Bombs," "Vampire Capitalists," "Blood Madness," and "Spirit Macaws." With some seventy characters and a wide array of events spanning five hundred years and several continents, Almanac's plot is difficult to pin down. It is backgrounded in a textual field that represents, through its elaborate web, the cost of European conquest, colonization, and oppression. Fashioned like the spider web structure Silko says is integral to Pueblo storytelling, Almanac's myriad characters and stories are intricately connected, although Silko states that she called the novel an almanac precisely because she had not planned for such connections. ⁷ What emerges in the writing represents more an ancient circular Mayan almanac than a European almanac with its linear chronology. ⁸ Although Mayan almanacs are constructed within the novel, their content is less important than the larger almanac of the late twentieth century that Silko designs--an almanac of the morally bankrupt living dead. ⁹

Spatially, Tucson, Arizona, functions as a focal point in the novel, with much of the action radiating away from or towards the city. Arizona is about to go belly up from the effects of a declining economy and devastating drought. As riots, uprisings, and civil wars plague Mexico, Central America, and South America, both U.S. and Mexican borders become clogged with those fleeing oppression and danger. Drawing on Native American and African beliefs, particularly Voodoo, Silko explains that she thinks of Tucson as a crossroads, since it was an important site on the pre-Columbian routes for trade from New Mexico into Mexico, "a place of intense conflict between all the spirits, and all the forces." ¹⁰ As the prophecies have foretold, the inexorable movement of the people is northward and, while it may take five hundred or five thousand years, the indigenous will reclaim the diseased and corrupted land (and [End Page 24] presumably become instruments of its healing). ¹¹ The prophecy itself is inscribed on a map (drawn by Silko and reproduced on both end papers) and includes the reminder that "[s]ixty million Native Americans died between 1500 and 1600" and that "[t]he defiance and resistance... continue unabated.... When Europeans arrived, the Maya, Azteca, Inca cultures had already built great cities and vast networks of roads. Ancient prophecies foretold the arrival of Europeans in the Americas. The ancient prophecies also foretell the disappearance of all things European."

Against this backdrop and into a complex milieu Silko inserts a host of unlikely characters who work--in one way or another--as part of the resistance. Among them are twin sisters, Lecha (a demerol-addicted psychic who helps police locate the bodies of murder victims and has a lucrative profession as a talk-show guest) and Zeta (who has made a fortune running drugs and guns across the North and South American borders with the help of Lecha's son and his sometime lover Paulie), and twin brothers, Tacho (who functions both as chauffeur for the wealthy Menardo and as a spy for the indigenous resistance movement) and El Feo (who heads that movement in the far south of Mexico). Both brothers commune with spirit macaws for advice. Angelita aka La Escapía--"the Meat Hook"--organizes for the violent overthrow of those in power while protecting the non-violent projects of Tacho, El Feo, and their followers. ¹² Rambo Roy and Clinton, homeless Green Beret Vietnam veterans in Tucson, organize an Army of the Homeless in the effort to retake "stolen" goods and land from the wealthy. In the north, Wilson Weasel Tail, a law-school dropout and poet ("Only a bastard government / Occupies stolen land!" [p. 714]), bills himself as "'a Lakota healer and visionary'" (p. 716) and points out hopeful signs such as Euro-Americans having nervous breakdowns and psychotic episodes "in record numbers" (p. 738). Another character, the Barefoot Hopi, "travel[s] the world to raise political and financial support for the return of the land to indigenous Americans" (p. 616) and, himself an ex-convict, organizes incarcerated prisoners for a future uprising against the U.S. government. There is also Awa Gee, a computer genius who creates viruses and plans to disable computer systems nationally, along with the nation's electrical system ("Earth that was bare and empty...that had been seized and torn open, would be allowed to heal and to rest in the darkness after the lights were turned out" [p. 683]). Many of these and other characters converge at novel's end at the International Holistic Healer's Convention in Tucson, where "German root doctors" and "Celtic leech handlers" join with "new-age spiritualists...[whites who] claimed to have been trained by 110-year-old Huichol Indians" [End Page 25] (p. 716), the Green Vengeance eco-warriors, and a host of others including the sisters, Lecha and Zeta.

Hauntingly realistic, the malaise the novel describes is overwhelming. Alcohol and cocaine are the mainstay of the wealthy, sex is brutal and used as a tool for manipulation or pure self-gratification (as in the example of Judge Arne and his "beloved basset hounds" [p. 655]), in Mexico City "trash cans are stuffed with newborns" (p. 47), and the heads of the U.S. ambassador to Mexico and his chief aide float in plastic shopping bags in the gardens of Xochimilco. But most horrible in this narrative are the forces for evil and the nightmare of the contemporary social contract in the Americas. Those who can afford to--many of the characters in Almanac--have gone mad with technological idolatry and materialistic gain. Indeed, the lure of the infinite possibilities promised by technology is coupled with a widespread disregard for all human life that does not directly serve the interests of the wealthy. Together these forces create an atmosphere of social approbation for the manipulation of science and medicine by (and for) the most wealthy and powerful members of society. Human organ sales, a laboratory where genetic manipulation and in vitro fertilization are placed in the service of creating a pure-blooded master race, and a "deep ecology" movement that recruits "eco-warriors" from the ranks of terminally ill AIDS patients to become human bombs provide only a few examples of the ways Almanac addresses itself to complex medical and ethical issues. For example, the ecology warriors urge their recruits, "Go out while you're still feeling good and looking good! / Avenge gay genocide by the U.S. government! / Die to save the earth. / Mold long underwear out of plastic explosives and stroll past the U.S. Supreme Court building while the justices are hearing arguments" (p. 730). ¹³

Medicine provides a useful, although limited, approach to this complex and, yes, unruly novel. Like Ceremony, Silko's Almanac represents illness, but in strikingly different ways. Ceremony contextualizes individual illness and healing in a way that insists on the integral connection between an individual sick body and a socially diseased world. ¹⁴ In Ceremony, healing comes about as the main character, Tayo, recognizes and acknowledges the connection between individuals and society and as he understands the link between his own illness and internalized racism. If Ceremony is the story of illness, a re-discovery of the healing self, and a return to community by way of fighting evil or "the witchery," Almanac appears to be the story of evil's return and apparent dominion. The last pages of Ceremony, for example, celebrate the witchery's temporary loss of power that has turned back on itself, [End Page 26] that "has stiffened / with the effects of its own witchery" but, the text warns, is only "dead for now" (p. 261). Where, in Ceremony, Tayo struggles toward healing and away from the internalized racism that so cripples his sense of himself and his world, in Almanac the focus shifts from the social context of individual illness to the context of institutionalized medicine itself. Medicine becomes, in a sense, the patient, finding itself functioning within a diseased (and infectious) world. It is a context in which murder, poverty, war, and the commodification of bodies and body parts all undermine any semblance of moral order, a context in which what a recent issue of Daedalus calls social suffering is the reality for all but the exploitive and privileged few (and even those few are trapped in self-made hells). ¹⁵ Almanac compels readers to look at that context and to ask how it both profits and destroys medicine at the same time.

* * *

Arnold Krupat writes that "contemporary Native American literatures tend to derive from an ecosystemic, nonanthropocentric perspective on the world" that is essential to human survival. ¹⁶ Silko's Almanac creates a society that has, to put it mildly, failed to develop such a perspective. As Katherine Callen King says, "At the core of Almanac of the Dead is the conflict between the predominantly European American communities that dominate, divide and despoil the land and the predominantly Native and African American communities who have been dispossessed." ¹⁷ One character explains that Europeans left their gods in Europe when they came to conquer the Americas. A death-dealing imitation of spirituality resulted, one that not only allowed for violent conquest (as well as destruction of the land and each other) but demanded it. This same character claims that Europeans do not know how to listen to the "souls of their dead": "Thus Europeans were haunted by the dead in their dream life and were driven mad by the incessant cries of unquiet ancestors' souls. No wonder they were such restless travellers; no wonder they wanted to go to Mars and Saturn" (p. 604).

But it is not only Euro-Americans who have lost belief in their past or their ancestors. Silko constructs indigenous characters who deny their heritage and emulate Euro-Americans with their idolatry of wealth and technology. Part of the complexity of Almanac arises from Silko's refusal to identify one group as completely evil, another as completely [End Page 27] good. What Silko makes clear, however, is that those who distance themselves from indigenous origins become, like the Euro-Americans, heartless, passionless machines of greed and destruction. ¹⁸

Silko's disturbing and apocalyptic tale places medicine and science under the microscope of an unrelentingly critical gaze, one that foregrounds the distortions to which medicine is subject in a society obsessed with the gods of material gain and technological progress. The novel challenges readers to consider not only the individual's role but also the role of institutional blindness, complicity, and neglect as factors contributing to oppression and disease. In Almanac, medicine is an enterprise as menacing to the poor as it is advantageous to the wealthy. Almanac does not, however, simply level a critique at medicine. Instead, it anatomizes the context in which medicine must do its work. The institution is both culpable and vulnerable. Unlike popular and science-fiction novels that paint medicine's potential horrors in lurid colors, Almanac instead looks at the society medicine has helped create and within which it is trapped.

Almanac is difficult reading, however, because it not only warns about and critiques technological progress but also insists on locating the roots of technological madness in the initial conquest of the Americas. Indeed, the history of technology has been, in its unchallenged state, itself a narrative of noble conquest--the conquest of "the enemy, whether it be human or the natural world--a narrative of progress, and of the betterment of humanity in general." ¹⁹ Almanac, however, undercuts the concept of technology as the noble conqueror. The malaise in Almanac represents (in the terms of psychoanalysis) a return of the North American repressed: the reality of violent conquest. Carefully constructed historical narratives have attempted to erase the brutality of this conquest. The violent roots of our national origins are, however, the palimpsest that will not be erased and that continually disrupts our notions of bedrock decency and democracy. The text suggests that the insanity and corruption represented in Almanac are simply the natural outcomes of two centuries of living with the psychic chasm that lies between the myth and rhetoric of religious/democratic roots and the reality of conquest. Silko embeds medicine in the conflict arising from the fruits of a progress that yields its spoils to a mere handful of the world's inhabitants and depends for its success on exploitation or oppression of the rest. ²⁰

Indeed, Silko weaves several issues relevant to medicine throughout her elaborate textual web: Almanac's interrogation of medicine's profit motive; the commodification of the body (especially in the [End Page 28] biomaterials business and human organ transplantation); and the consequences of misplaced faith in technology and the ways such faith turns on itself. Each of these issues stands in direct contrast to Almanac's vision of an indigenous force (and its allies) that continually gathers strength for the earth's reclamation and healing.

* * *

One of the characteristics of the declining, but dominant, society created in Almanac is its ability to tolerate (and maintain) a patent disregard for human life and, while doing so, to make a sizeable profit. Almanac's narrator tells a story of sorcerers, or witches, who had once populated entire villages and who had pledged "to prey only on outsiders" and not on one another. They broke those pledges, however, and often "in the most bloodthirsty manner": "This destruction, this sorcery, this witchcraft, occurred among all human beings. The killing and devouring occurred behind bedroom doors, inflicted by parents and relatives, and the village of sorcerers continues generation after generation without interruption" (p. 478). Chilling though this description may be, it hardly sounds like myth or ancient history. One only has to tune in to the nightly news to hear similar--and worse--stories. Genocide, ethnic cleansing, spousal and child abuse, gang warfare--all continue in escalating fury, while technological progress is virtually ineffectual in the face of these issues.

Silko's fable thus becomes a mirror for our own diseased world. And oddly enough, the sorcerers take on the characteristics of healers. The narrator notes that the sorcerers had gotten rich "making up and selling various odd sorts of alleged 'tribal healing magics' and assorted elixirs, teas, balms, waters, crystals, and capsules to the city people, mostly whites" who "anxiously purchased indigenous cures for their dark nights of the soul on the continents where Christianity had repeatedly violated its own canons" (p. 478). They sell these products, of course, at high prices, and, aping what we would today consider good biopsychosocial (and traditional) techniques, "The sorcerers listened to the ailments and complaints of the city patients to gain knowledge of the patients' lives; the cures the sorcerers had then sold their 'patients' had cost hundreds, but consisted mostly of floor sweepings containing rodent dung and cotton lint" (p. 479). Sorcery thus takes a leaf out of medicine's book, learning about the profit potential in disease and suffering. By linking sorcery's greed and charlatanism to [End Page 29] medicine's profit-making aspects, the novel implicates and warns contemporary medicine of the complicated and destructive marriage of greed and technology that supposedly serves human life.

The concept that illness is big money especially fascinates Trigg, a minor character in Almanac. Trigg's wild enthusiasm for the profits he has made in the blood plasma and illegal organ harvest business and for those profits that await him as the need (and possibility) for human organ transplants rises is not surprising. The need for human organs in this country has grown exponentially with the dramatic advent of transplantation technology coupled with the discovery of immunosuppressive drugs like cyclosporine in the l970s and, later in the late l980s (as cyclosporine's benefits were eclipsed by its side effects and failures), the development of FK 506. ²¹ Renée Fox and Judith Swazey look at a set of statistics on kidney transplantation, "the oldest and most often performed transplants," and point out that in 1991 the list of patients waiting for cadaveric kidney transplantation grew monthly by two hundred. The authors of the study note that three hundred additional donors were needed per month to reverse the shortage crisis significantly, and one hundred simply to break even. ²² At the same time that six persons awaiting transplants has risen, however, the number of cadaveric donors remains at between sixteen to eighteen per million people (population). ²³ It is hardly news that a lucrative market in illegal organ harvesting--a potential gold mine--lies at the ready, or that, recognizing this fact, Silko makes use of it in her critique of modern medicine and contemporary society.

Silko's concerns about the traffic in human organs are particularly significant in light of such contemporary cases as that of physician H. Barry Jacobs, founder and medical director of International Kidney Exchange, Inc., who in 1983 solicited 7,500 hospitals to enter into a national and international marketing scheme through his company. ²⁴ He proposed "commissioning kidneys from persons living in the Third World or in disadvantaged circumstances in the United States for whatever price would induce them to sell their organs, and then negotiating their acquisition, for a fee, by Americans who could afford to purchase them." ²⁵ In Almanac, human bodies--and body parts--become simply another high-yield market commodity. Hot sellers include not only human organs (hearts, livers, lungs, kidneys, corneas), but also fetal brain material, human skin for grafts, and, of course, blood plasma. A brisk trade exists between the U.S. and South America, where videos of live torture, abortions, fetal dissections, experiments, and surgical operations are made and sold. Sex-change surgeries and "ritual circumcisions of six-year-old [End Page 30] virgins" (p. 103) are especially popular: one viewer is so thrilled he is "afraid to feel how much he enjoyed the scalpel sinking through skin and flesh" (p. 538). In such a context, human beings are reduced to their marketable parts, the consequence of which is an easily rationalized commodification of the body. Patricia A. Marshall claims that

the biomedical 'gaze'...of organ transplantation technology fosters a view of the person as a disembodied entity. It is precisely this shift in orientation to the human body, and to the person in the body, that heightens concerns for opponents of a commoditization of human body parts. If the body is viewed as marketable, the person is at risk of being viewed as a commodity. This perspective exacerbates the objectification of the human body that already exists in biomedicine and sharpens the separation of the spiritual, social, and mindful body from the physiological being. ²⁶

The commodified body, then, moves from an external (such as prostitution) to an internal (full of "saleable" parts) commodification and, as such, becomes potential prey to medical technology and its practitioners.

Zygmunt Bauman's notions of how modernist society deals with the Other sheds light on the potential function of such commodification. Bauman characterizes modern society as one that is "anthropoemic," that is, one that "vomits" its enemies, or the Other, the not-us. He contrasts this idea with Claude Levi-Strauss's notion that older societies were "anthropophagic," that is, they ate or ingested the Other. Bauman argues that "[o]ur way of dealing with the Other (and thus, obliquely, of producing and re-producing our own identity) is to segregate, separate, dump onto the rubbish tip, flush down into the sewer of oblivion." ²⁷ For Bauman, racist discourse and politics are the "manifestations of mainly anthropoemic...strategy of modern order-maintenance." ²⁸ Almanac's transformation of the organ-as-gift to the organ-as-commodity illustrates Bauman's concepts well. In their discussion of the transaction between donor and recipient, Fox and Swazey note that "[a]t the center of organ transplantation is a gift of surpassing significance....Paradoxically, it is an offering that so perfectly epitomizes one of the ultimate Judeo-Christian values of our society--the injunction to give ourselves to each other in ways that include our strangers as well as our brothers and sisters--it transcends what is ordinarily asked or expected of us." ²⁹ The authors argue that as our society moves further away from the gift mentality, we find it easier to think of transplantation in more value-neutral, biologized terms. [End Page 31]

Almanac's focus on human organ transplantation constructs a closed loop containing both of what Bauman terms the anthropoemic and anthropophagic elements of "order-maintenance," for it is not all bodies that are rendered fodder for scientific and medical gain, but, predictably, those that are deemed worthless (and Other) by the dominant society. In 1985, the Transplantation Society issued guidelines for the distribution and use of organs, pointing out what current news media report with some regularity:

In a South American country...advertisements from desperate individuals have appeared in newspapers offering a kidney or even an eye (for corneal transplantation) for money. In this regard, many of us receive occasional pathetic appeals from people in disadvantaged countries offering to sell a kidney to get money, often for care of an ill relative. Besides being an eloquent comment on the social inequalities of our society in general, such appeals raise unsettling ethical questions of a more specific nature....Furthermore, an active market of living unrelated kidney transplantation with payment to donors is occurring in at least one city in India; some of these donors make their way, with the potential recipient and "proof" of consanguinity, to the West. Thus recently, a major newspaper has described the buying of kidneys from impoverished donors for transplantation in private hospitals in Western countries. Some donations were coerced, some for meager fees; and allegedly there was no follow-up of the donors after surgery. ³⁰

With the specter of ethnic cleansing hovering over the world and with the paranoid policing of borders in the U.S. and elsewhere, the commerce in human bodies has a menacing pragmatism--getting rid of certain (radically unstable) categories of people, so-called undesirables (the anthropoemic function), and, in so doing, creating the means to save those worth saving (with organ transplantation fulfilling the anthropophagic function).

Silko deepens her critique of contemporary society by suggesting that the connection between the commodification of body parts and medicine's profit motive is closely tied both to the idea of technological progress and to many forms of oppression. For example, Trigg, the owner of several blood plasma centers, buys much of his biomaterial in Mexico where "recent unrest and civil strife had killed hundreds" (p. 404). ³¹ The unrest in Mexico--caused by the oppression of countless poor--is very much to Trigg's advantage because it will supply plenty of cadavers for organ harvesting ("Mexican hearts were lean and strong, [End Page 32] but Trigg had found no market for dark cadaver skin" [p. 404]). Trigg figures that even if the war abated and cadavers became less available from Mexico, "[h]oboes or wetbacks could be 'harvested' at the plasma centers where a doctor had already examined the 'candidate' to be sure he was healthy" (p. 663). Other characters in Almanac have similar ideas. Serlo, a wealthy Argentinean in search of sangre pura, believes that the "common rabble" are fit only to be organ donors. In addition, he claims that HIV was created by a research team as "the first 'designer virus' specifically for targeted groups. The filthy would die. The clean would live" (p. 548). A third character, Clinton, an African American Vietnam vet (and co-leader of the Army of the Homeless), would have no trouble believing this. In fact, he is convinced that "[i]llness, dope and hunger...[are] the white man's allies" because "only dope stopped young black men from burning white America to the ground" (p. 426).

Trigg, wheelchair bound since college days, provides perhaps the most egregious example of a predator who is legitimized by, supported by, and necessary to medicine. To buyers he supplies not only blood plasma but also other biomaterials, including human organs. With "the price quotes for fresh whole blood, human corneas, and cadaver skin" buzzing in his head, Trigg has adroitly worked his connections with "human organ transplant research teams at the university hospital" (p. 389). As the owner of a chain of plasma donor centers, Trigg has bought up the downtown area of Tucson "block by shabby block" in order to get it rezoned for his centers. It is not just that Trigg will make an extraordinary profit from Blood Plasma International (and all that it involves), but, as he brags to real-estate mogul Leah Blue (who also happens to be the wife of a professional broker of international assassinations), the "donor centers busted neighborhoods and drove property prices down without moving in blacks or Mexicans." This scheme allows Trigg to buy up the surrounding property at "forty cents on the dollar" (p. 379).

Almanac suggests additional ways in which medicine's profits are used for the wealthy's gain at the expense of the poor. Trigg recruits street people, hitchhikers, drug addicts--all examples of what he would consider disposable human beings--to give blood at his center. Hiring Rambo Roy (Clinton's co-leader of the Army of the Homeless) to comb the parks and alleyways for donors, Trigg pays him fifty cents for each person he brings in. Trigg writes of these "donors" in his journal:

These alleged human beings, the filth and scum who pass through the plasma donor center, get paid good money for lying with a needle [End Page 33] in their arms--an activity they pursue the rest of the day anyway. I could do the world a favor each week and connect a few of the stinking ones up in the back room and drain them dry. They will not be missed. (P. 386)

Trigg does, in fact, bleed several dry, using his centers to obtain organs and "other valuable human tissue" (p. 387) that he sells illegally to West German consortia and to his "silent partners" in U.S. medical schools. For Trigg the "donors" are merely "human debris. Human refuse. Only a few had organs of sufficient quality for transplant use" (p. 444). ³²

Trigg understands that it is not therapeutic drugs any more, but biomaterials ("the industry's 'preferred' term for fetal-brain material, human kidneys, hearts and lungs, corneas for eye transplants, and human skin for burn victims") that will "be the bonanza of the twenty-first century" (p. 398). Progressive technologies such as a recently available saline gel developed by the Japanese to keep human organs "fresh-frozen and viable for transplants for months, not hours" (p. 404) add to the bliss of possibility for Trigg. In his character, Silko brings together her critique of medicine's profit motive, its reliance on the power of technology, and its reproduction of oppressive systems, behaviors, and attitudes. Through commodification of the body (and its internal parts), medicine becomes a principal agent in the segregating and ingesting of "human debris," or in the maintenance of social order, as Bauman would put it.

And from those who still have wealth, there is even more money to be made from illness and suffering. Trigg's vision of creating his own medical conglomerate in southern Arizona--a hospital, ambulance service, mortuary, housing developments for the handicapped (soft money might be available from the government) as well as "fat farms" and the always profitable alcohol and drug treatment centers--comes close to suggesting corporate medicine. For Trigg, "[t]he health-care industry is a sleeping giant" that he proposes to awaken to fabulous financial gain: "There were millions and millions to be made" (p. 382). After afternoons of sex together, Trigg and Leah dream of ways to make more and more profits. Trigg argues constantly that the big money will be found not in real estate but in the medical and biomaterials industries. In fact, Trigg finally convinces Leah to join with him in his medical schemes:

Leah was on track about a medical hospital. They could build the facility near the detox-rehab hospital. They would need a regular hospital from time to time for their detox patients. Leah had got the [End Page 34] idea for a kidney dialysis machine that would serve the sector of town houses and condominiums that would presumably be bought by kidney patients and their families or by health insurers to house their Arizona dialysis patients. (P. 387)

Like a blight, Trigg's schemes grow as he develops plans for his medical complex (and a sex or "pleasure" mall for those well enough to enjoy it). Even though the state of Arizona is collapsing (and therefore cheaply bought), terminally ill patients, in their misery, would not notice or mind the thousands of homeless people sleeping in Tucson's arroyos and streets. Nor would they care about being in such close proximity to Mexico's civil wars and the flood of immigrants pouring into Arizona. Setting his sights not only on terminally ill patients, though, Trigg plans for Tucson to become an international center for research, organ transplants, and cosmetic surgery ("when the fat came off or was sucked out, yards and yards of sagging wattles and crepey skin remained to be snipped off or tucked" [p. 663]).

Not only obsessed with the financial returns from his bio-enterprises but also driven by the certainty that medical technology will progress far enough in his lifetime to heal his spinal cord injury and allow him to walk again, Trigg has, like many characters in the novel, an unwavering faith in technology as the redemptive force in contemporary society. Yet neither his wealth nor his belief in technology's power can ultimately save Trigg. When he is finally murdered, Leah wonders if the transplant doctors had finally gotten him: "Trigg used to say not even the lowest street addicts were as greedy as surgeons. His 'silent partners' at the medical school had made millions with their heart and lung transplant racket, but routinely they had accused Trigg of skimming profits" (p. 751). Trigg is, in fact, murdered by his procurer, Rambo Roy, who swears that one of the first things the Army of Homeless will do after the revolution is to accuse the biomaterials business of mass murder. The point here is not simply that Trigg and the doctors are corrupt (although they are), but that medicine's faith in technology is dangerously misplaced. If medicine does not have the moral vision to employ the technology in solidarity with and on behalf of the oppressed, Silko insists, those people most vulnerable will continue to be exploited, and the exploiters will continue to self-destruct.

This unfailing trust in technology becomes a key element in the ongoing self-destruction of Euro-Americans and others who have left their heritage behind. For example, Menardo is a Mexican Indian who has worked hard to distance himself from his people and his past. He [End Page 35] is the multimillionaire owner of Universal Insurance. Universal (with its name that begs the question, "for whom?") protects the interests of Mexico's elite against theft, vandalism, and natural disasters as well as against an ever-present and more dangerous threat of revolution and insurrection.

But Menardo the insurer begins to realize there is no insurance that can protect his life, and he becomes completely fixed on the (perceived) powers of a bullet-proof vest given to him by his client, Max Blue (husband of Leah). Menardo is haunted by violent nightmares and the dread of death. Wearing the vest, however (even while sleeping), he sees himself as "a man to be reckoned with--a man invincible with the magic of high technology" (p. 503). Enthralled--obsessed--with the vest's presumed powers, he finally orders his Indian chauffeur, Tacho (El Feo's brother), to fire a gun at him while he wears the vest, planning to impress his fellow gun-club members who are standing near by. What follows is later billed a freak accident. As Tacho reluctantly shoots the pathetic Menardo, the vest fails to protect him: "Microscopic imperfections in the fabric's quilting; a bare millimeter's difference and the bullet would safely have been stopped" (p. 509). Menardo's complete trust in technology's powers of protection becomes an example of Silko's witchery turning on itself.

The circumstances of Menardo's death anticipate the story of the "Ghost Shirts," told much later in the novel by activist-poet Wilson Weasel Tail at the International Holistic Healers Convention. Weasel Tail tells how the Europeans became disillusioned when they discovered these shirts hadn't really protected their people from death, as promised by the Native Americans. Weasel Tail explains that

the anthropologists, who feverishly sought magic objects to postpone their own deaths, had misunderstood the power of the ghost shirts. Bullets of lead belong to the everyday world; ghost shirts belong to the realm of spirits and dreams. The ghost shirts gave the dancers spiritual protection while the white men dreamed of shirts that repelled bullets because they feared death. (P. 722)

Like the white anthropologists', Menardo's terror of death (as well as his horror of being identified as indigenous) leads him to trust only in the (white man's) bulletproof vest while he fails to understand (and actively derides) the kind of protection that could help him, that which would come from a spiritual source. The trust in technology and the denial of his ancestors and spiritual roots are symptomatic of what [End Page 36] Menardo's grandfather had termed (when Menardo was young and still in touch with his family) the temporary reign of "Death-Eye Dog" currently in force in the Americas. Death and destruction characterize the epoch in which the "orphan" Europeans (as well as those orphaned from their Indian heritage) are compelled to kill each other and destroy the earth as well (p. 258). Menardo's trust in the vest undoes him, as does absolute trust in any technology.

Misplaced trust in technology again is foregrounded in a scene in which an Alaskan Yupik woman uses the "old ways" to outwit modern aerodynamic technology:

White people could fly circling objects in the sky that sent messages and images of nightmares and dreams, but the old woman knew how to turn the destruction back on its senders....The old woman had gathered great surges of energy out of the atmosphere, by summoning spirit beings through recitations of the stories that were also indictments of the greedy destroyers of the land. With the stories the old woman was able to assemble powerful forces flowing from the spirits of ancestors. (P. 156)

The "powerful forces" allow the Yupik woman to work a plane-crashing spell by rubbing a special weasel pelt on a TV screen that displays the weather channel as she intones a tragic story from the community's collective past. The screen fills with interference, and then a picture:

The pilot descends, then climbs and descends again, searching for a hole, searching for a break in the fog he entered only a minute earlier. The needle of the compass whirls and shivers in magnetic fields of false and true north. The altimeter is frozen at 2,000 and nothing can dislodge it. The copilot works frantically....Then the screen goes white. (P. 157)

Here technology (aerodynamics) is appropriated by those it oppresses and becomes a micrograph of what is to come on a global level. Significantly, the crashed plane is owned by the "largest single insurer of petroleum exploration companies in Alaska" (p. 159). For a society committed to oppressive practice, there can be no insurance, the novel warns. The people themselves will rise up against the most sophisticated weapons and tools. In its completely improbable manner, the source of change will arrive through the dispossessed, primarily the indigenous of the Americas and those who ally themselves with them. [End Page 37]

* * *

Nothing in Almanac spells good news to medicine. The novel forces readers to grapple with (among other things) the purposes and uses of scientific and medical technological progress as it exists in a cruel and unjust world. ³³ Silko refuses to absolve institutions from complicity in this oppression and insists that they are accountable to the community and society in which they exist. As such, institutions are also at risk or vulnerable to manipulation purely for profit, as Trigg's use of medicine well illustrates. Although Silko provides readers with few answers, the characters who are not hopelessly corrupt are those who are willing to listen to improbable voices--such as those of the prophetic macaws that lead Tacho, El Feo, and a growing Native American group and their allies traveling northward; the exhortations of Wilson Weasel Tail or the Barefoot Hopi ("he talked about the dead as if their spirits still hovered among the living" [p. 625]); or the inner voice that prompts an exiled Laguna to return home to his native land and rejoin his community. In Almanac, the struggle seems to be to wrest one's inner light from the deep shadows of modern technological hell and find the courage to act in accordance with that light. In addition, as one reviewer notes, the larger context of Almanac is "that the apocalypse of the rapacious is at hand and that coalitions are formed by those who act." ³⁴

Almanac specifically challenges medicine to consider its choices and its actions in a social milieu that is profoundly destructive, not only to the poor and vulnerable, but to medicine itself. The question is whether or not medicine will risk listening to the improbable voices it can hear if it stops to listen, and how it will institutionally gather forces for its own healing, as well as for the difficult work of moving forward into the healing of the human community. The how of that move forward is profoundly complicated and is not the responsibility of institutionalized medicine and health-care providers alone. As medicine sees itself as an accountable member of the human community--the global community--perhaps new ways of doing and seeing will render it less vulnerable to the greed and corruption of characters like Trigg.

Almanac of the Dead, complicating the notion of progress, bids readers to look carefully at connections, convoluted and messy, among technological progress (such as the increased capacity for organ transplant); our assumptions about borders (who is, after all, an "American"?); our assumptions about worthiness and unworthiness; and how those assumptions are linked to pernicious and tenacious foundations of racism, classism, and sexism. Medicine is inextricably bound to the [End Page 38] ongoing enterprise of oppression and domination. It is that link, the novel insists, that allows medicine to be corrupted--infected--by people like Trigg, who will, for a profit, serve the double purposes of ridding the country of undesirables and providing their organs for those deemed worthy; or like Menardo, who believes technology will provide the antidote to death. As long as medicine functions blindly within the corrupting and corrupted social systems of the Americas, it, too, remains both diseased and infectious.

Ann Folwell Stanfordis an associate professor at the School for New Learning, DePaul University. Currently she is at work on a book that looks at contemporary women novelists of color and the politics of medicine. She and Suzanne Poirier are co-editing a collection of essays written by the Chicago Narrative and Medicine Group on medical discourse.

Notes

* This paper was presented in a modified form at the Annual Meeting of the Society for Health and Human Values in San Diego, California, October 1995.

1. Paula Gunn Allen, "Molly Brant, Iroquois Matron, Speaks," in Skins and Bones: Poems, 1979-87 (Albuquerque, N.M.: West End, 1988), 13.

2. Adrienne Rich, "Through Corralitos under Rolls of Cloud," An Atlas of the Difficult World: Poems 1988-1991 (New York: Norton, 1991), 48.

3. Leslie Marmon Silko, Ceremony (New York: Viking, Penguin, 1977); and Almanac of the Dead: A Novel (New York: Penguin, 1991). All quotations are from these editions and are cited parenthetically in the text.

4. Melissa Hearn, for example, hailed Almanac as a profound book of prophecy, one that draws upon Silko's Native American heritage, feminism (this, I think, is highly debatable), and Marxism (Prairie Schooner 67, no. 2 [summer 1993]: 149-51). Another critic calls it "one of the most ambitious literary undertakings of the past quarter century," albeit a failed one (Sven Birkerts, "Apocalypse Now," The New Republic 205 [4 November 1991]: 39-41, quotation p. 39). Linda Niemann, writing for The Women's Review of Books, claims that Almanac is the "best book" she has "read in years," one that is "an ark filled with the stories and the voices and the people who will create a new world out of the destruction of the old" ("New World Disorder," Women's Review of Books 9, no. 6 [March 1992]: 1-4, quotation p. 1).

5. See Katherine Callen King, "New Epic for an Old World: Leslie Marmon Silko's Almanac of the Dead," in Laura Coltelli, ed., Native American Literatures, Forum 4-5, (1992-1993): 31-42; Laura Coltelli, "Almanac of the Dead: An Interview with Leslie Marmon Silko," ibid., 65-79. Sharon P. Holland treats a section of Almanac as part of her article "'If You Know I Have a History, You Will Respect Me': A Perspective on Afro-Native American Literature," Callaloo: A Journal of African-American and African Arts and Letters 17, no. 1 (winter 1994): 334-50; and her "Qualifying Margins: The Discourse of Death in Native and African American Women's Fiction" (Ph.D. diss., Univ. of Michigan, 1993), abstract in Dissertation Abstracts International 53 (1993). I want to thank A. LaVonne Ruoff for first alerting me to the King and Coltelli pieces.

6. Birkerts, 39.

7. Leslie Marmon Silko, "Language and Literature from a Pueblo Indian Perspective," in Philomena Mariani, ed., Critical Fictions: The Politics of Imaginative Writing (Seattle, Wash.: Bay Press 1991), 83. In her interview with Coltelli, Silko also describes the novel's structure as a "spiral in which every story or single character is somehow connected with the other" (p. 67).

8. Ibid. See also Silko's chapter, "Notes on Almanac of the Dead," in her Yellow Woman and a Beauty of the Spirit: Essays on Native American Life Today (New York: Simon and Schuster, 1996), in which she discusses writing the novel and especially her notions of time as round, "like a tortilla" (p. 136) in which all times exist "side by side for all eternity" (p. 137).

9. I have been asked on several occasions whether I believe this is a dystopian novel. I am uneasy about relegating Almanac to the realm of dystopia with its intrinsic element of fantasy or the future (the "not yet"). Is the world as horrible as Silko's novel suggests? The one I know isn't, but it bears a frightening resemblance at times. An important truth resides in Silko's vision of technology run amok and the move forward of the dispossessed to retake and heal the land (which, in fact, may make this novel lean more towards the utopian genre, depending on one's point of view. That is, for the dispossessed this novel might well be utopian).

10. Coltelli, 65.

11. Bernard Neitschmann surveyed armed conflicts occurring in 1988 alone and, as Ward Churchill reports, found that "of the 125 or so 'hot wars' he cataloged [sic], fully 85 percent were being waged by specific indigenous peoples, or amalgamations of indigenous peoples, against one or more nation-states...which claimed traditional native territories as their own." Although the reclamation of land will take years, Almanac implicitly challenges readers to think now about the notion of solidarity and where one stands in relation to the world's oppressed people (Ward Churchill, "A North American Indigenist View," in Elaine Katzenberger, ed., First World, Ha Ha Ha! The Zapatista Challenge [San Francisco, Calif.: City Lights Press, 1995], 151).

12. The Spanish word for hook or spike is escarpia.

13. One character believes that the deep ecology movement, with its focus on overpopulation, is a front for ethnic cleansing. "It was no coincidence the Green Party originated in Germany. 'Too many people' meant 'too many brown-skinned people.' ...'Deep ecologists' invariably ended their magazine ads with 'Stop immigration!' and 'Close the borders!'" (p. 415). Careful readers will note that the eco-warriors also appear in the previous paragraph on "forces for good." This is one of the problems and, probably, truths of Silko's novel: there are no clear heroes, although there are many who are clearly villains.

14. Like Ceremony, many novels by women of color in the United States take the human body as one of their concerns, complicating notions of health and illness in various ways. These novels explore the complexities of individual illness, but refuse to separate that illness from its social context, frequently marginalizing or ignoring the medical profession altogether. These are texts concerned with the problematics and possibilities of individual healing in a world that itself bears symptoms of terminal illness. There are many such novels. See, for example, Toni Cade Bambara's The Salt Eaters (New York: Vintage, 1981); Paule Marshall's Praisesong for the Widow (New York: Obelisk/Dutton, 1983); Gloria Naylor's The Women of Brewster Place (New York: Penguin, 1983) and Mama Day (New York: Vintage, 1989); Toni Morrison's The Bluest Eye (New York: Washington Square, 1972), Beloved (New York: Albert A. Knopf, 1987), and Song of Solomon (New York, Signet, 1978); Louise Erdrich's Tracks (New York: Harper/Perennial, 1989); Sandra Cisnero's Woman Hollering Creek (New York: Vintage, 1992); Ana Castillo's So Far from God (New York: Plume, 1994); Alma Luz Villanueva's Naked Ladies (Tempe, Ariz.: Bilingual Press, 1994), and Amy Tan's The Joy Luck Club (New York: G. P. Putnam's Sons, 1989) and The Kitchen God's Wife (New York: G. P. Putnam's Sons, 1991); among others.

15. For a discussion of the idea of social suffering, see in particular Stephen R. Graubard, "Preface," and Arthur Kleinman, Veena Das, and Margaret Lock, "Introduction," Daedalus 125, no. 1 (winter 1996): v-x and xi-xx, as well as the host of excellent articles contained in the issue.

16. Arnold Krupat, The Voice in the Margin: Native American Literature and the Canon (Berkeley, Calif.: Univ. of California Press, 1989), 55.

17. King, 39.

18. In fact, this society seems to have fallen prey to the witchery's primary goal in Ceremony: to take the heart out of living human beings and leave them entirely without feeling.

19. Margaret Lock, "Displacing Suffering: The Reconstruction of Death in North America and Japan," Daedalus 125, no. 1 (winter 1996): 207-44, quotation p. 208.

20. One critic, commenting on Ceremony, points out that "technology becomes merely the stopgap that whites use to fill up the emptiness left after 'the lies devoured white hearts'" (Lisa Orr, "Theorizing the Earth: Feminist Approaches to Nature and Leslie Marmon Silko's Ceremony," American Indian Culture and Research Journal 18, no. 2 [1994]: 145-57, quotation p. 149, Silko quotation from Ceremony, 191.) Orr also notes a connection between Ceremony and Almanac in Silko's concepts of technological progress and nature.

21. See Renée C. Fox and Judith P. Swazey, Spare Parts: Organ Replacement in American Society (New York: Oxford, 1992), especially 3-30, on transplant technology, for a rich detailing of the effects of immunosuppressive drugs. Although neither cyclosporine nor FK 506 has become the miracle drug it was first assumed to be, they and other immunosuppressives have made possible more organ transplants than ever before.

22. Ibid., 45.

23. Roger W. Evans, "Organ Procurement Expenditures and the Role of Financial Incentives," JAMA 269, no. 24 (1993): 3113-18. Evans notes that in 1986, for example, 8,972 persons awaited kidney transplant, and that the number increased to 23,586 just seven years later in 1993. Numbers for liver transplants rose from 289 to 2,644; for hearts, the figure grew from 282 to 2,840. The total rise of those awaiting kidney, liver, pancreas, heart, heart-lung, and lung transplants went from 9,632 in 1986 to 31,333 in 1993.

What to do about these shortages in organs for transplantation is less simple than documenting them. In the U.S., articles in scholarly journals run the gamut from attempts to improve the current system for organ procurement to considerations of entirely new systems such as conscription (a type of organ draft, not unlike our military draft), compensation (where families of deceased persons are paid for the donation), and a market system (A. H. Barnett and D. L. Kaserman, "The Shortage of Organs for Transplantation: Exploring the Alternatives," Issues in Law and Medicine 9, no. 2 [1993]: 117-37). With organ markets, which most writers argue would be limited to cadaveric organs, potential donors or surviving family members would offer their organs for a market-determined price to procurement firms. Remuneration could take the form of lowered health-insurance payments, burial insurance, or outright cash payments. Scholars have argued variously about the ethical problems inherent in all of these proposals. Such arguments, which are numerous, are represented in the following small sample: Raymond L. Horton and Patricia J. Horton, "Improving the Current System for Supplying Organs for Transplantation," Journal of Health Politics, Policy and Law 18, no. 1 (1993): 175-88; George I. Mavrodes, "The Morality of Selling Human Organs," Progress in Clinical and Biological Research 38 (1980): 133-39; Stephen J. Spurr, "The Proposed Market for Human Organs," ibid., 189-202; R. Schwindt and A. R. Vining, "Proposal for a Future Delivery Market for Transplant Organs," Journal of Health Politics, Policy and Law 11, no. 3 (1986): 483-500.

24. Fox and Swazey, 65. Jacob's gambit led to the 1984 National Organ Transplantation Act that established networks for organ procurement and outlawed commercial markets in transplantable organs.

25. Susan Hankin Denise also discusses the Jacobs case in "Regulating the Sale of Human Organs," Virginia Law Review 71 (1985): 1015-38.

26. Patricia A. Marshall, "Organ Transplantation in Egypt: The Concept of Ownership and the Problem of Consent," unpublished manuscript.

27. Zygmunt Bauman, Mortality, Immortality and Other Life Strategies (Stanford, Calif.: Stanford Univ. Press, 1992), 131. My thanks to Nancy M. P. King for calling my attention to Bauman and the relevance of his thinking to this project.

28. Ibid., 155.

29. Fox and Swazey, 39-40.

30. Quoted in Fox and Swazey, 66-67.

31. Marshall points out that "the expansion of western scientific technology has been characterized as a new kind of imperialism," 21.

32. The heinousness of Trigg's methods are further evident in his confession to Roy that he gets "excited" picking up hitchhikers as part of his harvesting methodology:

He had thought of it as a roll of the dice or a hand of five-card draw. The winners and the discards. Discards were "locals" or those with too many kin....Trigg had not minded the killing....Trigg talked obsessively about the absence of struggle as the "plasma donors" were slowly bled to death pint by pint. A few who had attempted to get away had lost too much blood to put up much fight even against a man in a wheelchair. (Pp. 443-44)

Trigg pays "extra" if the victim puts up no struggle and agrees to the procedure, giving the victim "a blow job while his blood filled pint bags; the victim relaxed in the chair...unaware he was being murdered" (p. 444).

33. Another novel that works similarly is Richard Powers, Operation Wandering Soul (New York: W. Morrow, 1993), in which a pediatric surgeon in a large public hospital in Los Angeles is confronted with the agonies of his patients' lives and diseases and begins to understand them in the broader context of war and global poverty's horrors.

34. Niemann, 4.

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