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Doctors Go on Offensive Against Gun Wounds

Trauma care professionals C. William Schwab and Therese Richmond work at the University of Pennsylvania Medical Center in Philadelphia. After years of treating patients in the emergency room, Schwab and Richmond have co-founded the Firearm Injury Center at Penn in an effort to systematically reduce the epidemic of gunshot wounds in the United States.

21:59

Other segments from the episode on June 21, 2006

Fresh Air with Terry Gross, June 21, 2006: Interview with C. William Schwab and Therese Richmond; Interview with Amy Sedaris; Review of Alan Furst's spy novel, "The Foreign Correspondent."

Transcript

DATE June 21, 2006 ACCOUNT NUMBER N/A
TIME 12:00 Noon-1:00 PM AUDIENCE N/A
NETWORK NPR
PROGRAM Fresh Air

Interview: Drs. C. William Schwab and Therese Richmond of
University of Pennsylvania Health System discuss the Firearm
Injury Center which they co-founded to create safer communities
through systematic reduction of firearm injuries
TERRY GROSS, host:

This is FRESH AIR. I'm Terry Gross.

My guest, Dr. William Schwab, is a trauma surgeon who sees the consequences
of urban violence. He treats several hundred gunshot victims a year.
Surgeons from around the world now come to him to learn how to treat gun
wounds. Dr. Schwab is the chief of traumatology and surgical critical care
at the University of Pennsylvania Health System in Philadelphia. He considers
gun injuries an epidemic that is preventable, so along with Dr. Therese
Richmond, who will join us a little later, Schwab founded the Firearm Injury
Center at Penn, whose mission is to create safer communities through the
systematic reduction of firearm injuries.

What were the kinds of injuries you were seeing that led you to create the
Firearm Injury Center?

Dr. C. WILLIAM SCHWAB: What we were seeing is an ever-increasing number of
complex, multiple gunshot wounds in the youth of Philadelphia, and we decided
together as a team that we needed to look at the root causes of this. Rather
than just patching these young, generally men up and turning them back into

their environment, we really decided that what we needed to do was find why
this was happening, see if we could analyze that and intervene beyond just
physical surgery, physical medicine and put people back into the community.

GROSS: Have the gun injuries that you're treating changed in the years that
you've been treating gun injuries as guns and bullets have changed?

Dr. SCHWAB: Yes. They changed drastically, actually, in the late 1980s.
You may not remember but in the mid-1980s, the 9mm semiautomatic pistol was
made commercially available to citizens of the United States. They could buy
that gun. That gun is a pistol which is different than a revolver. It can
fire multiple bullets in a very, very short time span. It led to multiple
bullets striking the human body. Prior to that, it was--gunshots weren't rare
in the United States but, in fact, most of the time, someone was shot once.
And starting in about 1988 and through now, what we've seen is an
ever-increasing number of bullet holes, organs injured, and when one looks
scientifically, there is very, very good data and experience that say the more
number of times you're shot, the more number of organs injured, the higher
your death rate. So more complex wounding, more complex sequelae and a higher
death rate because of the weaponry.

GROSS: And how does that affect how you treat a patient? You know, if they
have one gun wound, you could focus on that wound, but if they have several
bullet holes, how does that affect the treatment?

Dr. SCHWAB: Oh, it drastically changes how you treat those injuries, and
what's interesting is that the more times the human body is shot, the more
tissue destruction, the more bleeding, the more shock and the more physiologic
consequence of all that. Something that's known now as the legal triad of
death, which is a cold patient, who's in shock, who's acidotic and can't
coagulate or stop their bleeding. So, starting about 12 to 14 years ago, we
had to look at a different way of doing surgery. We had to do it in an
unconventional way, and we developed techniques that look at minimal
acceptable care of each of those injuries, minimal acceptable care to stop
bleeding, to prevent that lethal triad from spiraling down and leading to a
quick death. The term we put on that is `damage control.' When one reads
about what's going in Iraq or Afghanistan now or one reads about things that
are happening in the military or around the world, one reads about damage
control. Damage control is unconventional surgery where someone is dying from
wounds and all the surgery that is done when they are first encountered is
stopping bleeding and saving life...

GROSS: What...

Dr. SCHWAB: ...and then resuscitating a patient and bringing them back a day
or more later and fixing everything anatomically.

GROSS: What would go wrong if you did it the other way around? If you tried
to fix everything the first time around, instead of doing damage control and
then really fixing it the day--a day later.

Dr. SCHWAB: What happens is that the experience shows that people aren't
able to tolerate long surgery. The hypothermia, the acidosis...

GROSS: What's acidosis?

Dr. SCHWAB: Acidosis. You and I live at a certain balance in our body
between alkaline and acid. Ph is what it's called scientifically. Our body
requires a very normal range physiologically for all the cells to function.
If it becomes too acid, there's too much acid around, then things don't work
very well. The cells don't work. Cells don't make energy. Cells don't
utilize oxygen and glucose--sugar--so that you maintain energy support
systems, and like a computer, it very quickly shuts down. Damage control is
aimed at interrupting that spiral, and if--we now have good evidence to say
that if you stay and try to fix everything and prolong the surgery, that in
fact the death rate is higher.

GROSS: I've interviewed people about injuries in Iraq, and what I'm hearing
there about the improvised explosive device wounds sound kind of similar to
what you're talking about because those IEDs, you've got multiple shrapnel
wounds so it's not just like one bullet to treat, so what are some of the
connections between the kind of medicine you're doing in the city of
Philadelphia and the kind of medicine being practiced in Iraq now?

Dr. SCHWAB: Well, there's a lot of similarities. First and foremost, the
type of wounds, whether it's multiple bullets from a pistol or one high-muzzle
velocity bullet wound from a military weapon or an IED, when the tissue
destruction is extensive enough, this same problem with maintaining normal
physiology occurs. So whether the person is--an IED attack or explosion, a
wound, what's going on in Iraq is pretty much exactly the same techniques that
are being used--as we're--being used in Philadelphia and the major cities in
the United States in the last 10 or 12 years. Damage control is very
prominent in the way individual surgeons are handling wounds in Iraq as well
as the mentality on the battlefield, which is that far-forward surgeons will
do a damage control procedure, stop bleeding, stop contamination in and around
the body, and then what they will do is pack those open wounds and ship that
patient back where they'll have definitive surgery hours or days later,
exactly as the damage control that we described from Penn in 1992.

GROSS: So does this mean that war medicine is learning from shootings in
American cities and what the doctors are doing there? Has violence in

American cities gotten to the point where the war doctors are learning from
the urban doctors in America?

Dr. SCHWAB: The answer is yes, and as a matter of fact, that may be a
paradigm shift that's occurred in the last 15 years. War in the history of
man has been the greatest stimulant to the advancements in medicine and
surgery, and what happened in the late 1980s in many of our large urban areas
in America, we saw an ever-increasing of these complex wounds from handguns.
Surgeons had to adapt. Surgeons had to develop. Surgeons had to be
imaginative and come up with new techniques that we found worked and saved
people's lives. If you track back during that time and up to the present
time, we've been training our surgical trainees, our fellows, on all this
techniques, and they are in fact the military surgeons, the combat surgeons
that are in Iraq using these techniques. The improvement in survival was so
profound in the early 1990s, dealing with these gunshot wound victims, this
terrible liability, that in fact the United States armed forces changed the
war manual, that manual that directs most care in the battlefield and added
damage control as a principal technique to take care of these wounds. So I
think the answer to the question is yes. These combat surgeons have learned
from us, and now they're having wonderful successes with our combat soldiers
in Iraq and Afghanistan.

GROSS: Dr. Schwab, we've mentioned that you've trained doctors who have
subsequently gone to Iraq and practiced combat medicine there, but I also know
that doctors from countries around the world have come to your center to learn
about how to treat gun wounds. Why do they need to come to your center and
why do they need to know more about guns? Is it because of increasing
violence in their country?

Dr. SCHWAB: Well, when one looks at the need for surgeons in an emergency
situation and one looks at it globally, there's a number of areas where a
surgeon is needed. Certainly combat surgeons, but also interestingly, in
response to the need for organizations like NATO, the United Nations, the
International Red Cross--all those civilian relief medical organizations want
physicians who know how to take care of wounds. Why? Because those
organizations move in response to conflict.

So about 15 years ago, a number of surgical leaders around the world got
together and said, `This is interesting. We have several countries in which
the doctors and nurses are being mobilized to support those efforts, and they
have no experience with treating wounds.' And it was suggested that in fact
that they come to the United States. So for about 10 years, we've had
surgeons coming, and they spend time with us. For me, personally, it's been a
way to take a terrible liability in American society and at least make it to
some degree an asset. But what we've seen is a constant flow of physicians
from the Asian rim, from Australia, from New Zealand, and especially from the
Scandinavian countries, who come with us for about a month, and in a month's
time, they probably see more gunshot wounds and major injuries than they will
see in three or four lifetimes in their current countries.

GROSS: My guest is Dr. William Schwab, chief of traumatology and surgical
critical care at the University of Pennsylvania Health System and co-founder
of the Firearm Injury Center at Penn.

More after a break. This is FRESH AIR.

(Announcements)

GROSS: My guest is Dr. William Schwab, chief of traumatology and surgical
critical care at the University of Pennsylvania Health System and co-founder
of the Firearm Injury Center at Penn, which is trying to cut down on gun
violence by treating it as a preventable epidemic. In a couple of minutes,
we'll be joined by the center's co-founder, Dr. Therese Richmond, a nurse who
has cared for many gun victims and is an associate professor of trauma and
critical care nursing at Penn.

Now I think you served in the military in Vietnam, do I have that right?

Dr. SCHWAB: I was trained in the United States Navy during Vietnam but I
never went to Vietnam, the country.

GROSS: Did you ever practice combat medicine?

Dr. SCHWAB: I did. We were--I trained in a large naval hospital on the East
Coast. At that time it was 1900 beds, and I was one of the surgical house
officers and eventually the surgical faculty that were receiving wounded
soldiers back from Vietnam. In those days, as opposed to now, it would take
three to four weeks to receive them back. Now it takes, as you well know,
four to five days, sometimes less, to be back from Iraq. But we had a very,
very large part of our practice was related to taking care of the delayed
complications of wounding and to manage some of the more definitive surgeries
and reconstruction of these young soldiers and sailors. And that's where I
became interested in trauma surgery and in ballistics and in wounding.

GROSS: So what are some of the things you learned from combat medicine that
you've applied to working in an American city?

Dr. SCHWAB: There's a simple answer to that and there's a complex answer.
The simple answer is that one of the first things that one had to learn in
order to be a military surgeon is you had to learn ballistics. Ballistics
isn't a part of the typical conventional medical education. But
interestingly, my background in ballistics, because of my military background,
really afforded me, if you would, the science of wounding and how it applies
to medical care, so I felt very, very comfortable with that.

The second thing that you had to learn, to be a military physician, and it was
taught to you as part of the standard curriculum of military surgery, was how
to triage. How to make very, very important decisions about life and death
and be comfortable of those with a minimal amount of data. And the scenarios
that we were put in were: You're the surgeon, you have a certain amount of
resources, you have a certain number of operating rooms, you have a certain
number of units of blood, and you're receiving 30 wounded soldiers. How do
you sort those out between those that are dead, those that will die no matter
what you do and those that you can help and those that you don't need to do
very much about?

I think that set us up very well and set me very up well to lead a civilian
trauma surgeon, where many nights at the University of Pennsylvania, other
places in this city, we're seeing literally 10, 12, 15 patients all coming in
with a matter of minutes that need care, and it allows you to teach that.
Again, not a conventional part of medicine as it is taught in our medical
schools and in our training hospitals, but the military provided that for me.

GROSS: What kind of flipped the switch for you to go just from practicing
medicine to trying to practice prevention of violence, to set up a program
about preventing the kind of violence that you end up treating?

Dr. SCHWAB: The personal side of this is there is nothing more painful in my
life than walking out of an operating room and telling a young mother or a
father that his 16 or 17-year-old child is dead because of a gun wound. That
experience week after week, night after night, in the early 1990s was so
emotional, and it is to this day, so emotional for me, that I had to turn to
people that had skills and experience that I don't have and say, `How can we
stop this?' I can patch them up, surgeons can stop the bleeding, but this is a
disease. This is a problem that goes well away from the operating room. And
it just seemed like we were being overrun constantly with these young kids,
these beautiful kids, and we needed to do something to find a way to break the
cycle. And so we started--with Terry Richmond's help, we started the center,
and the rest is history.

GROSS: What are you trying to do that's different than what was done before
to try to prevent violence?

Dr. SCHWAB: Well, I think the most important thing is what we're trying to
do, and what we tried to do in the early 1990s is to say to American medicine,
to the American public, this is a public health problem. This is something
that needs to be conquered. I mean, it's not exactly the same as cancer.
It's not the same as an infectious disease, but this is violence, and violence
should be able to be studied and we should be able to find a way to lower the
toll from violence or to identify early on those people that may enter into a
violent situation or commit an act of violence.

GROSS: So what's your approach? Are you looking for legislation? Are you
talking to the gun lobby, working for gun control? What's the focus?

Dr. SCHWAB: The most important focus that I think could be identified right
away is research, and only through legitimate research will we be able to
identify the root causes of why people become violent. And, at the same time,
we have to have some short-term solutions to try to lower the toll and to try
to live safer in a society that has chosen to live with guns. And I think you
ought to ask her that.

GROSS: Terry Richmond, what do you think?

Dr. THERESE RICHMOND: That's my mantra, isn't it?

Dr. SCHWAB: It is. That's why I used it.

Dr. RICHMOND: Yes. I agree that, obviously, research is key, but you know,
I think the first thing in how we approach it differently, you actually, in
your questions said, you know, do you talk to the gun lobby, do you talk about
gun control? No. Our goal as injury scientists is to decrease injury and
death from gun violence, and by focusing on decreasing injury and death, we
totally stay away from what's been very polarized in this country: pro-gun or
anti-gun. So from a practical perspective, the first thing we want to do is
to get people to talk to each other. So I could say, you could may be very
pro-gun but I could say, `Well, can't you agree with me that we want to
decrease injury and death? Can we agree on that?' Then let's think about how
we can do that. People think you can't stop this. I shoot you; it happens in
the blink of an eye. It's not like it's had years and years and years of risk
factor to develop cancer or heart disease--in a way. But in another way, you
may have had years and years and years of risk factors that put you at risk
for being shot. And it's simply, if you think about at-risk people in at-risk
environments with hazardous objects, those three things come together in a
point in time, and an injury happens. If we go back and think about all those
things that have to come together, I just have to interrupt one path in order
to prevent that gun injury. That opens up a whole another world of
opportunities. It takes it away from pro-gun/anti-gun.

GROSS: One last question. You've taken out a lot of bullets from a lot of
wounds. What do you do with the bullets afterwards? Do people usually want
them?

Dr. SCHWAB: Actually, there's a chain of evidence that's required when one
removes a bullet, and it's not like television or the old Westerns that we
watched when we were kids when it was dropped into the metal bucket. In fact,
what happens is is that there's a very specific technique to remove a bullet
or a bullet fragment. It is witnessed as it is passed from the surgeon to the
circulating team in the operating room. It is labeled. There is a evidence
chain. It is passed through hospital security and either to the Philadelphia
police or the FBI. It's a very, very strict procedure.

Subsequently, when people come back and ask us to remove bullets, we remove
bullets if they're having problems with the bullets. Bullets rarely migrate.
They don't travel in the human body. They usually get encapsulated in a
think--thick scar that prevents them from moving, and interestingly, there's
probably over 300,000 Vietnam veterans that still have their shrapnel or
bullets that's left from Vietnam. So we know that they don't move around.
But we remove bullets if people ask us to do it. For example, if it's under
your belt line or it's on your shoulder or if it's underneath where you put
your pen every day and it's causing you a problem, most physicians and
surgeons are glad to remove that. But most bullets are really left in the
human body. They cause no problems. Again it goes back to the old saying,
"At first, they do no harm."

GROSS: Thank you so much for talking with us.

Dr. SCHWAB: Thank you.

Dr. RICHMOND: Thank you.

GROSS: Dr. William Schwab and Therese Richmond co-founded the Firearm Injury
Center at Penn.

I'm Terry Gross and this is FRESH AIR.

(Announcements)

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

Interview: Comic actress Amy Sedaris discusses her new movie
"Strangers with Candy" and her acting career
TERRY GROSS, host:

This is FRESH AIR. I'm Terry Gross.

The new movie "Strangers with Candy" is a prequel to the Comedy Central series
of the same name which was created by its three stars: Stephen Colbert, Paul
Dinello and my guest, Amy Sedaris. Sedaris is a performer who has
collaborated with her brother, the writer David Sedaris. "Strangers with
Candy" is inspired by after-school specials, but the characters learn all the
wrong lessons. Amy Sedaris plays Jerri Blank, a 47-year-old ex-con junkie and
prostitute who dropped out at 15 but has decided to return to high school and
pick up where she left off. In this scene, she walks into her first class.
Her teacher is played by Stephen Colbert.

(Soundbite from "Strangers with Candy")

Mr. STEPHEN COLBERT: (As teacher) we have a new student. Jerri Blank. OK,
Mr. Blank, why don't you tell us something about yourself?

Ms. AMY SEDARIS: (As Jerri Blank) Hi. Well, hello. Well, I'm Jerri Blank,
and I'm an alcoholic. I'm also addicted to amphetamines, as well as mainline
narcotics. Some people say I have a sex addiction but I think all those years
of prostitution was just a means to feed my ravenous hunger for heroin. It's
kind of like the chicken or the nugget. The point is I'm addicted to
gambling. Thank you.

(End of soundbite)

GROSS: I asked Amy Sedaris what she did physically to play the character
Jerri Blank.

Ms. SEDARIS: Well, I have a fatty suit on for--I had one made years ago to
fool my father that I'd gained weight. David wrote about it. I'm sure
everybody knows about that. But I wanted--you know, I'm not someone who likes
to play sexy or pretty or anything like that, but with a fatty suit on, I can
do it, and so I wanted to play--it just made me make her like really physical
and sexual, and so I like that. And I--she's a loser and she's--and there's
something about playing losers that I like, too. You know, you have to try
harder, you know, and they're always trying to be liked, and I like playing
people like that. But at the same time, Jerri likes herself. I like myself,
and all my characters like themselves, and I like people who are unattractive
who like to dress up to be attractive but aren't really that attractive. Does
that make any sense? Kind of all over the place here.

GROSS: Tell me why you like that.

Ms. SEDARIS: Because I--they have so much working against them. I like
having stuff to work against, you know. Like, in real life, you know, the
opportunities are different for unattractive people than they are for pretty
people, and I just--everything's just harder, and I like playing people that
have a hard time, you know, I...

GROSS: Well, also in situations like that, things that are supposed to be
pleasing and seductive become really menacing. Like there's a scene in which

you're kind of doing this seductive dance for somebody who you're trying to
seduce, and it's so wrong in every way.

Ms. SEDARIS: It was desperation. Poor Jerri.

GROSS: Desperation. Exactly.

Ms. SEDARIS: She just wants to be liked. And I like the hairstyle. I
wanted to have a professional golfer's hairstyle, and I like short haircuts on
women and I liked--for wardrobe, I just told Vicky Farrell, who did the
wardrobe, that I owned a snake, and that's all I ever told her. So, everyone,
you know, really, brought Jerri Blank alive. And the facial expression, you
know, I've--I mug, you know, and I like making faces, and she's--that
character's in all the plays that Dave and I write together. She's like
always the actress, and then I just give her a different background for each
play. It's like those actresses that think they're versatile but they're not.
You know, it's always the same person, and you're like, but `Wait a minute,'
you know, `you want me to believe that you're,' you know, `a policewoman?' You
know, they're just never convincing.

GROSS: Mm-hmm.

Ms. SEDARIS: And so I always think of the character like Jerri Blank as the
same thing. It's always that actress that I play, and then I just give her
different backgrounds, and this time she got to play, B, Jerri Blank. So
she's the true actress. I'm more like--I'm just a clown. I'm not--I'm not an
actress...(unintelligible).

GROSS: So wait a minute. This is like a double image here. You see yourself
as impersonating this actress, who actually gets roles in movies.

Ms. SEDARIS: Are you high? Yeah, exactly. I know. Even when I get--have
to audition for something, I can't read it unless I do that voice, because
then I know where to make pauses. I'm a horrible reader, you know. I'm just
not good at it. And--but--or if I have to read something and understand it,
if I can read it--if I read it in that Jerri Blank type voice, I'm like, `Oh,
OK, I knew were to put the pause.' `Oh, I know how to read it.' Or `I know how
to understand it now.' It's kind of--yeah, it's kind of weird, but it's just
easier for me to do things through her.

GROSS: Now you're actually very attractive, and I think...

Ms. SEDARIS: Oh, you only say that...

GROSS: I'm only saying that...

Ms. SEDARIS: ...to someone ugly. I really believe that. People will say,
`Gosh, Amy, you're so pretty.' But I'm like, you wouldn't say that if--you
know, I just tend to play people who are a little unattractive, so I mean, I
don't think people would really say that to me if they didn't see that I
played unattractive people. Don't--you know what I mean?

GROSS: Right. You mean, if we measured you--if we weren't measuring you...

Ms. SEDARIS: If I played someone pretty, if I was a pretty copy on TV all
the time or if I was in "Sex and the City" or all that kind of stuff, I doubt
you would say, `Amy, you're so pretty,' because then you would say, `Oh, she
knows she's pretty because she always plays those pretty parts,' you know.

GROSS: So, are you--do you...

Ms. SEDARIS: Do I think I'm pretty?

GROSS: Well, I guess what I'm really wondering is are you self-conscious
about your looks or were you ever. Or like did your looks ever really matter
to you one way or another?

Ms. SEDARIS: I do not think about it. I think about myself as one big prop,
and I'll do anything for a laugh, and I think like--I like the idea when I
have to get dressed up and go someplace it's very special to me, and I like to
do my own hair and makeup, and I like clothes that I own, I don't like to be
dressed for anything and that way I feel like I'm dressing up. So--but I
don't really break it down and think of myself, `Oh, am I pretty or
unattractive?' I don't--I mean, I know I'm not completely ugly where people
shy away, you know, like the Elephant Man. You know, I know I'm not like
that. But I don't--I just don't think about it.

GROSS: Do you usually think of yourself as one big prop? Like when you're
not on stage, what--how do you dress and how do you look?

Ms. SEDARIS: I'm always--it seems like I'm always in something homemade or
an apron, barefoot at home. I dress for comfort, elastic waistbands. It's
true, you know, and I'm just very comfortable. I remember growing up, I had a
neighbor who was very--she was so unattractive. I would go to her house and
her hair would be just a mess, like a monkey, you know, when you could kind of
see her scalp through her head and--through her hair, and she was always in
the basement, and it was dark and she was sewing, and then when she had to
dress up and go out, she was gorgeous, and I remember thinking, `God, your mom
is like so beautiful.' She would put on wigs and lots of makeup and beaded
gowns, and she was nothing like the woman during the day, and I think that
really affected me, you know. I remember thinking, `Wow, what a
transformation,' and I like--I like that. I don't get recognized that much on
the street. You know, I like playing, you know, being in disguise.

GROSS: Now, I want to get back to the voice that you do as Jerri. And you
said that you can only do line readings when you're in a role in her voice.
Would you do her voice a little bit for us so we can hear it back-to-back with
your voice?

Ms. SEDARIS: Sure. She kind of sounds like this, `Hi, Terry. How's it
going? Yeah, it's pretty hot out here today.' That's kind of how she talks.

GROSS: Yeah. It's more nasal, and it also sounds older than your voice does.

Ms. SEDARIS: I always play older for some strange reason, and David said to
me one day, he goes, `What are you going to do when you're like 56,' and I go,
`That's when I'll play teenagers.' You know. I don't know. I've always liked
playing older. When I was younger, I used to pretend that--I would dress up
like my mother and I would try to fool my friends, like David's friends, when
they would come over, and I would pretend I was mom, and they would fall for
it. I was just thinking about it the other day. I must have been pretty good
for them to fall for it. You know, like, I'm a big collector of wigs and I
had props and, oh, gosh, wardrobing. I save everything, and I dressed up just
like my mom, and I truly convinced several people who came to my house that I
was the mother. I just--I don't know, I liked playing older.

GROSS: How old were you when you started getting into props and disguises?

Ms. SEDARIS: Gosh, I have no idea. I missed--I mean, it must have been,
gosh, I--and I know in the third grade I got my first fall, which I still
have, and I'll get a wig every Christmas still. So I mean, my first wig was
in third grade. I'd say I was in, you know, first, second, third grade, you
know, making faces and playing around. I have stuff from when I was a lot
younger.

GROSS: My guest is Amy Sedaris. She co-wrote and stars in the new movie
"Strangers with Candy."

We'll talk more after a break. This is FRESH AIR.

(Soundbite of music)

(Announcements)

GROSS: If you're just joining us, my guest is Amy Sedaris, and she stars in
and co-wrote the new movie "Strangers with Candy," which is a prequel to the
Comedy Central TV series of the same name.

You know, one of the things I find really interesting about you and your
brother David Sedaris is that you're like flip sides of the same coin in a
way. You know, his--in his essays, his personal essays, he often writes about
just the kind of thing that most people would try to keep secret, because
they'd find it embarrassing to reveal. Certain obsessions, habits,
embarrassing situations, you know, physical problems, stuff like that. And
that's exactly what he'll focus on to reveal to everybody in his writing. And
you've always been into disguising, into kind of having some kind of disguise
that separates you from the self that's--you know, that kind of keeps your own
self hidden...

Ms. SEDARIS: Mm-hmm.

GROSS: ...and puts a kind of other self between you and the rest of the
world. I don't know what my question is exactly but you seem kind of opposite
in that sense.

Ms. SEDARIS: Well, it's interesting you should say that because I was
thinking of that last week, too, because I was thinking--somebody was asking
me a question about drama, and I love watching anything serious, you know. I
love drama. I love people who can cry on the spot. I love real actors. And
I don't want to do those roles because I kind of feel like that's who I am in
my real life, like if I'm in a relationship for whatever, I'm at home with you
talking, then I'm going to be who I am. You know, I am who I am. I'm a
pretty real person, and so to me, to do that in front of a camera, I kind of
like, why would I expose myself, like, that's who I am, that's not fun, I
don't feel like I'm playing. I want to feel like I'm pretending, and if
that's me, then I don't really feel like--it's just not as fun, and plus then
what am I in real life? What am I when I'm--let's say I'm with a boyfriend,
I'm crying my eyes out, then that's real. If I can do it on the spot in front
of a camera, that's strange to me, you know. I'm trying to figure out how to
articulate it because someone thinks it's fear, and I'm just, you know, afraid
to do it, and I'm like, `No, I just don't want to.' You know, I just like--I
like feeling like I'm playing, and if I have to memorize lines and have a true
moment and all that, it's like, `I don't know, OK, but aren't there other
people out there who can do it better and who want to do this?' I just don't
see the fun in it. But I'm--that's what--that's why I like to see that stuff
or read those kinds of books, you know. I like the real, the real stuff.

GROSS: You know, I was mentioning how your brother, David Sedaris, will write
things that are, like, so personal, exactly the kind of things that other
people might not want to talk about. I remember once he gave a talk at a--at
an authors breakfast, and he'd been flying around a lot on tour, and one of
the things that he talked about was a boil on his behind.

Ms. SEDARIS: Yeah!

GROSS: And everybody was eating breakfast...

Ms. SEDARIS: Boy, we all heard about that boil!

GROSS: Right. Everybody's eating breakfast, and that's what he's talking
about but that--but it was hysterically funny--it was just hysterically funny,
but that was so typical of him. Would that be very counter to your
personality?

Ms. SEDARIS: No, I would totally do something--I think--I think everyone in
my family is like that. You know, you just kind of put it out there. It's
like there's nothing to be embarrassed about. You know, a lot of people
think, `Oh, you're doing it for shock value, where you just like'--no, you're
just doing it because you can or you want to or it's just the way--your take

on something. That's the first thing you think of. You know, I remember
David helping me in--when I was in high school and I had to memorize, like,
the Julius Caesar speech, you know, `Friends, Romans, countrymen,' and he had
me do it in a completely different, you know, way, than standing up and saying
it. He had me do it in like this talk-show format for the class, you know
what I mean? He would always help me with any kind of project but he would
make me see it in a different way. `Why don't you do it this way?' You know,
`Don't do it the way they expect you to do it. Try it this way, and it will
be a lot more fun.'

GROSS: How did you do `Friends, Romans, and countrymen' as a talk-show guest?

Ms. SEDARIS: I interviewed--I kept breaking up the conversa--like, `Tell me
where you are,' you know. `Who are you speaking to right now?' `Friends,
Romans'--I just kept interacting, like I was being interviewed but it was just
me doing it. You know what I mean? So I would just keep changing seats and
going back and forth, and I would break up the speech by asking the question
that would be in the speech, you know?

GROSS: What did your acting teacher think?

Ms. SEDARIS: Oh. Well, it wasn't for acting. It was for my--it was for
English...

GROSS: It was for English.

Ms. SEDARIS: But I--yes, I took acting in school, and it was--he was always
impr--we would just improvise or we would audition for plays that we would
never put on because like the school didn't have the money. So, at some
point, it was like I had to stop taking drama because he was like, `There's
nothing else to do here. You've done it.' But I won like drama awards and--so
I was kind of like that person in school. And I was still in Girl Scouts, you
know, and I was a Girl Scout until my senior year of high school. I loved
Girl Scouts.

GROSS: What did you like about it? It's so not your character.

Ms. SEDARIS: But that's just it. Well, it is who I am. I love crafts. I
like getting together with a group of people and just doing things. I mean,
all we did was like play games and sell cookies, and there weren't that many
of us. You know, go on field trips, go camping. I did a lot of that when I
was younger. I was in a lot of clubs. I was in Junior Achievement, was
always trying to sell something. And I still do that today with my cupcake
and cheeseball business. I have to make a dollar, you know. I have to see it
and I have to see it in a jar, and just--I have to have several jars in my
apartment, and I love everything about selling a product.

GROSS: When you were in the Girl Scouts, did you like having a uniform?

Ms. SEDARIS: I love uniforms. I collect uniforms.

GROSS: You do?

Ms. SEDARIS: Yes, I do. I have a lot of uniforms. I loved them. David
always said, he goes, `I always remember Amy Bean in uniforms. You know,
coming and going, always in a uniform.' Yeah. I have my Winn-Dixie uniform,
my Red Lobster uniform. I have a nurse--a beautiful nursing uniform. I have
a UPS uniform, police uniform, hospital gear. I have a lot of--there's a
uniform in--it's like a baton-twirling uniform that Tammi Littlenut wears in
the movie "Strangers with Candy." She wears my green little outfit.

I drag all my props to every photo shoot, you know. I'm like, `Here you go,
here's all my props. My glasses, my--you know, my uniforms. What are we
going to do?'

GROSS: Mmm.

Ms. SEDARIS: I'm like a little traveling one-man band.

GROSS: How do you feel when you're the subject of your brother David Sedaris'
fiction or, you know, a personal essay, I should say, and he's writing about
you, maybe, you know, revealing something that you wouldn't necessarily want
revealed or maybe you would, I don't know. Does he ask you first?

Ms. SEDARIS: If you see that son-of-a-bitch--no! He--David doesn't have to
ask me, you know, because I know David's not going to write something--David
knows what he can write about and what he can't write about, so it's usually
OK, you know. He'll send me stories, you know, and the fatty suit story I
didn't see until it came out in print, but he's never embarrassed me. One
time he said something on the radio about--I have a rock--I rock. I rock in
bed on my side at a rapid motion. That's where I get a lot of my thinking
done. And he mentioned that once on the air, and I remember thinking, `Oh,
oh, wow, I--that's odd that he would mention that.' Like I never told anybody
that before. Just because I never thought about mentioning it. So that kind
of just threw me offguard for a little bit, but it was fine, you know. I'm
not embarrassed by it, it's just that he would say it. I was just--I didn't
think it was coming, you know. But I have to rock because that way I can
think about stuff. You know, some people go for runs or get on the, you know,
treadmill and walk...

GROSS: Mm-hmm.

Ms. SEDARIS: You know, I just have to be moving, rocking. And that's why I
could never have hair extensions, and that's why I have a huge nest in the
back of my head. It's from rocking. My hair's all matted up. It's pretty
funny.

GROSS: Now you have a book that's coming out in the fall.

Ms. SEDARIS: Yes, I do.

GROSS: It's called "I Like You: Hospitality Under the Influence."

Ms. SEDARIS: Mm-hmm.

GROSS: Tell us a little bit about what you're doing in the book.

Ms. SEDARIS: Well, it's--I've always been--I like to cook--my mom--everyone
in my family's--we cook for ourselves, and I always wanted to put together a
cookbook, so this book is all my favorite--you know, all my jackpot recipes,
and then I have a crafts section because I like crafting. Or rather, I like
coming up with the idea and having other people craft. I'm really good with
ideas. I just can't always execute it. I don't have the skills. And then I
just have different chapters on different--I put myself in different
situations to entertain. Like if someone's grieving, what to do. Like when
my mom died, that was a challenge. You're having people come to your house,
what do you do? You're certainly not up for it. A challenge about, you know,
feeding a lumberjack, you know, hot lunches, or having a children's party.
And so I took the book seriously. You know, I thought, `I'm going to do a
serious book on, you know, hospitality,' because, you know, I grew up in the
South, and there are these hospitality shows that I was obsessed with, and I
think, you know, I just love everything about it.

So Paul Dinello was reading it and yawning completely throughout the whole
thing, and then he said--the humor in the book came from Paul making fun of
me, you know what I mean. Him commenting on me taking it so seriously. So
now the book is a little bit more entertaining than what I wanted, but it
just--it's just every--it's just me. I shot everything in my apartment. I
hired a small team to make the crafts. I made all the food, and it's been a
total learning experience because I'm not a writer. So--I mean I can write on
my feet, and I just--but I'm not a disciplined writer, and so it's been--it
was really hard. It was really hard.

GROSS: Do you give a lot of parties?

Ms. SEDARIS: I'm a last-minute entertainer. You know, I'll say, `Hey, why
don't you come over tomorrow night and we'll do so-and-so,' and then it kind
of develops. And then I always sell stuff at my parties, like I'll put
like--last night, I had people over, and then I--like stuff I want to get rid
of that I feel too guilty putting in the hallway, I put--set up my sale table
and I have like empty--well, almost empty bottles of lotion, dish detergents,
soap, sponges, if I have pharmaceutical goods, whatever I have and
everything's for 25 cents, and I only take quarters, not two dimes and a
nickel or three nickels and a dime, and I set up my little table and I take it
very seriously. I just like the transaction, and then I sell what I can.

GROSS: That's crazy.

Ms. SEDARIS: But, no, but it's not crazy, Terry, because I'll bet there's a
lot of stuff in your house. Next time you have people come over and you
think, `You know what, I'm done with that book. I don't want to keep it.
Someone will buy it for 25 cents.' And larger sale items I put in my hallway,
like buckets and fans, you know, but people are really happy to get it, and
it's a quarter, you know. The DVD of "Valley of the Dolls" I sold last night
for 25 cents. You know...

GROSS: Now these are your friends. How come you're not giving them away?
How come it's not...

Ms. SEDARIS: Well, because...

GROSS: ...a freebie table?

Ms. SEDARIS: ...no, nothing's free. I like 25--because then I can use that
quarter to do my laundry, and I like--I like--I just like to have the
transaction. They have to pay for it. And I'm not going to break a dollar.
It's like `Go get a quarter.' It's just--I'm just very picky about it. But I
like how people will look at the table, and they look at stuff. They pick it
up, they put it down. It's really fun.

GROSS: Amy Sedaris, thank you so much for talking with us.

Ms. SEDARIS: It was so nice talking to you.

GROSS: Amy Sedaris co-wrote and stars in the new movie "Strangers with
Candy." It opens June 28 in New York and in other cities in July. Her book,
"I Like You: Hospitality Under the Influence," will be published in the fall.

Coming up, John Powers recommends a new spy novel by Alan Furst.

This is FRESH AIR.

(Announcements)

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

Review: Critic at large John Powers reviews Alan Furst's spy
novel, "The Foreign Correspondent"
TERRY GROSS, host:

Alan Furst has a new historical spy novel called "Foreign Correspondent." His
first one, "Night Soldiers," came out in 1988, and he's written eight more
since then. His popularity is on the rise, and his last few books, including
"Blood of Victory" and "Dark Voyage," have been on the best-seller list.
Critic at large John Powers, who says he always snaps up a new one, explains
his appeal.

Mr. JOHN POWERS: A few years ago, I asked the filmmaker David Lynch which
movies he found exciting. Th first title he came up with was Hitchcock's
"Rear Window." `It's got that mood,' he said. `You know, I like a mood I can
sink into.'

I thought about this recently as I `sank into' "The Foreign Correspondent,"
the latest book by Alan Furst, who over the last few years has become our most
acclaimed spy novelist. First, he doesn't give us the cartoon plots of Ian
Fleming or Robert Ludlum. Nor does he try to milk today's headlines with
tales of international terror. Instead, he specializes in a highly literate
escapism that taps into our continuing fascination with World War II.

"The Foreign Correspondent" is quintessential Furst. Beginning in 1938, it
tells the story of Carlo Weisz, an Italian reporter based in Paris who
sometimes writes pieces for a newspaper published by Italy's anti-fascist
opposition known as the Giellisti. After one of the group's leaders is
murdered by Mussolini's secret police, Weisz gets sucked deeper into the
resistance, eventually becoming a pawn in a three-dimensional chess game
played by British intelligence, the French Surete and the totalitarian thugs
in Roman Berlin. In this precarious world of spy and counterspy, merely ghost
writing an anti-fascist memoir can prove as deadly as the overt espionage that
Weisz' lover Clara is doing in Germany.

Furst takes pride in writing spy novels that are different. The heroes aren't
the predictable Yanks or Brits but usually men without a country. Russian
emigre poets, Dutch sea captains, anti-fascist Bulgarians who wind up working
for Stalin's secret police. And their lives don't affect World War II's main
events. They're part of lesser known sideshows. The fight to stop Germany's
supply of Romanian oil, for instance, or the anti-Mussolini underground.

Furst researches his books carefully, and reading them, you always discover
something new and interesting. In fact, "The Foreign Correspondent" inspired
me to order a book about Italian fascism. Oddly, for all his skill, Furst's
not especially good at the things you might expect a spy novelist to excel in.
He betrays no great interest in taut plotting. His stories drift along. And
from book to book, his heroes are so unmemorable, you recall them primarily by
their nationality.

No matter. The reason I read Furst, and I've devoured all nine of his World
War II novels, is that he shares Lynch's grasp of mood. He's superb at
sucking you into the mental atmosphere of '30s Europe, when tens of millions
of people felt the evil gathering and lived with the dread of what torrents it
might bring. Furst has no peer at capturing the crazy, sinister, yet
strangely seductive textures of the run-up to war, especially in Paris, the
center of his fictional universe. He imbues the city of lights with a dusky
menacing glamour, adorning its boulevards with conspirators and
counterconspirators, unsettling headlines and jittery conversations, brasserie
shootouts and teasing erotic encounters. Where bad artists are suckers for
World War II's crudest iconography--think how Viefer Vendetti used gaudy
banners and jackboots to portray a futuristic England--Furst knows that what
makes this period alluring isn't really its murderers row of
dictators--Hitler, Stalin, Mussolini. It's the way that ordinary people lived
in the shadows cast by these oversized tyrants.

Furst's heroes are smart, essentially decent men who'd rather be going on with
their lives, but find themselves inescapably caught up in the wheels of
history. And given the directions those wheels are moving, they just as
inescapably realize that they most do something to resist, like the supposedly
cynical Rick in "Casablanca" or the resistance fighters of Jean-Pierre
Melville's "Army of Shadows," by miles the best movie in our theaters right
now. Characters like Carlo Weisz risk their lives doing dangerous things that
may look minor, might well be forgotten, but maybe, just maybe, will prove
absolutely necessary. Such uninflected courage is especially appealing in an
era like our own, when so many of us feel that today's most unsettling forces,
from international terror to climate change, are too big and too complicated
for even 007 to solve. And this I suspect is one reason why Furst's novels
have recently become so popular. Reassuringly set in an aesthetized past, we
know how World War II came out, after all. Furst captures the feeling of
another time, when things seemed out of control. And by giving us life-sized
heroes, not supermen, he lets us imagine that we too could be capable of doing
our own brave part to slow down the runaway train of history.

GROSS: John Powers is FRESH AIR's critic at large and film critic for Vogue.

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GROSS: I'm Terry Gross.
Transcripts are created on a rush deadline, and accuracy and availability may vary. This text may not be in its final form and may be updated or revised in the future. Please be aware that the authoritative record of Fresh Air interviews and reviews are the audio recordings of each segment.

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