Half the Kingdom

This novel is a comedy of old age and hospital malfeasance. Half the Kingdom starts with a mystery: an unusual increase in cases of dementia in a major city hospital in New York. It begins with brief portraits of a range of still productive elderly people who are slowly becoming symptomatic. A number of these apparently rational elders propose that they pose as patients and explore the reasons for the diagnostic spike at the city hospital. Fantastically, they are invited to do so by the head emergency room physician, Dr. Miriam Haddad, and her husband, Salman, who is the head of security. The elders are outfitted by hospital staff and given identification tags, clipboards, and intake forms. But Dr. Haddad, a central figure in the book, already knows the solution to the mystery. As hospital spokesperson, she informs a reporter that 100% of elderly patients checking into the ER have “copycat dementia.” She states that “There is no emergency room that is not liable to raise the stress level to one that can cause temporary dementia, particularly in the elderly.” Despite the implication that diagnostic error may be the source of the spike, as the book progresses, many of the people sketched in the vignettes appear flagrantly symptomatic and are admitted as inpatients. Visiting caregivers are treated abruptly. Adults trying to locate their elderly parents contend with hospital protocol and frustrated noncommunicative staff. The message seems clear: hospitals themselves can engender or perpetuate deviant thinking and behaviors.

The author, Lore Segal, is an important writer for the New Yorker and a Pulitzer Prize finalist. In this book she introduces a large number of elderly people and their adult children or friends in brief portraits that are as clever and incisive as New Yorker cartoons. Many are stand-up comedy depictions of recognizable character types. Some vignettes are more serious, focusing on disturbed interactions between paranoid elders, who are increasingly cognitively impaired, and their loved ones, who are increasingly frustrated and annoyed.

Most of the characters are unlovable, and the hospital staff members act in ways that are bizarre. Dr. Haddad constantly wears a hijab but claims to be Jewish. Without consent, she discloses patients’ information to another patient but is assured by the hospital legal department that this is permissible. Her long-planned meeting with the research volunteers never takes place, and we have no knowledge of what they have accomplished. Pieces of this book have been previously published in Harper’s Magazine and the New Yorker. Undoubtedly, the parts are better than the whole.