St. Martin's Press

The Surprising Source of Improving Female Health and Well-Being in Developing Countries

The following is an excerpt from the new book Power Play: How Video Games Can Save the World by Asi Burak and Laura Parker (St. Martin's Press, 2017): 

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Michael Eric Dyson Calls for Unity in the Face of Trump and Racism

The following is an adapted excerpt published with permission from St. Martin’s Press from the new book Tears We Cannot Stop by Michael Eric Dyson. Copyright January 2017.

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Artificial Hearts Are Lasting Longer - Bridging the Gap for Patients on Year-Long Waiting Lists

The following is an excerpt from the new book Beyond Human by Eve Herold (St. Martin's Press, 2016): 

“Your heart is severely enlarged,” the doctor told her, “and it’s surrounded by fluid. You need to go to the hospital immediately.” So began a journey for Stacie that would call for the courage and endurance that few people ever have to draw upon. Doctors at the hospital told her she would likely not live through the weekend. They advised her to get her affairs in order, to notify loved ones, and prepare for the worst. Rather than accepting the news, she could think only of her children, ages eight, nine, thirteen, and fourteen. Who would take care of them? How would her husband manage without her? “I was so sick that the tears wouldn’t come out, but I told them, ‘There has to be something you can do.’”

Soon it was decided that, as a last resort, Stacie should be transferred to the University of Washington Medical Center (UWMC) in Seattle, where there were more resources than at her local hospital in the town of Puyallup, Washington. Luckily, there she met a cardiologist named Dr. Nahush Mokadam, and he offered her last, and only, option. First, he told her that there was no biological heart available for a transplantation that could save her life. However, there was a very new alternative—the Total Artificial Heart (TAH), made by a Tucson-based company called SynCardia. Only a few hundred people had ever been implanted with the artificial heart, but the FDA had recently approved the technology and UWMC had the capacity to offer it to Stacie.

The TAH was not considered a permanent solution, but a bridge technology that would keep Stacie alive until a suitable biological heart became available. Even then, Stacie had a complication that meant that after her natural heart was removed— an irreversible act—she had only a fifty-fifty chance that the TAH could be attached to her aorta, the main trunk of the heart’s arteries that carry blood away from the heart and out to the rest of the body. Stacie had been born with a congenital narrowing of her aorta. Her first heart surgery, a reconstruction of the aorta, was performed when she was only four years old and, at thirty-one, she had had an aortic valve replacement. Due to the damage from the virus, which doctors estimated had been attacking her heart for two years, the only thing holding her aorta in place was an infected, fragile piece of muscle that was attached to the aortic valve. It was entirely possible that once this small piece of flesh was removed, there would be nothing to attach the artificial heart to. Knowing that once she was put to sleep, she had only a 50 percent chance of ever waking up, Stacie was terrified, but the chance that the surgery would be successful was all she had to cling to. It was an enormous amount of information to process within a few days’ time. The idea of having a totally artificial heart was more than a little unsettling, but thinking of her children, she agreed to go through with the operation.

It turned out that one of the effects of Stacie’s long-term heart failure actually improved her chances of a successful implant. According to Dr. Mokadam, when he removed her heart, rather than consisting of the firm, elastic muscle that characterizes a healthy heart, her heart was so soft and mushy that it just slipped through his hands. It was also dramatically enlarged, and as a result, it had enlarged her chest cavity as well. This was one of the only reasons why Stacie, as an average-sized woman, could accommodate the SynCardia 70-cubic-centimeter (cc) heart, which is sized only for men or large-sized women. Fortunately, the TAH, which includes right and left atria, or upper heart chambers, and right and left ventricles, or lower chambers, which carry most of the work of the heart, could be attached to Stacie’s aorta. But by then, Stacie’s vital organs had begun to fail due to the lack of blood flow, and her lungs collapsed during surgery. She was placed in a two-week, medically induced coma, and connected to an ECMO (extracorporeal membrane oxygenation) machine that took over the circulation of her blood while her vital organs came back online and her lungs started to function again.

After two and a half weeks, Stacie woke up from the coma. Her vital organs were steadily improving due to the increased blood flow, and to her relief, the TAH proved to be “better than the heart I was born with.” Even though she had two tubes coming out of her abdomen attached to the Freedom portable driver, a 13.5-pound apparatus, which she carried around with her in a backpack, she was able to go home and live a relatively normal life while she waited for a matching biological heart. The backpack seemed heavy at first, but she soon grew accustomed to it and the tubes attached to it, which were necessary as long as she had the TAH. The battery in the driver, which kept the heart pumping, had to be recharged every day by being plugged into a wall socket. The battery charge lasted for only eight hours, so she had to be ever mindful that an electrical outlet was always within reach. This in itself caused a certain nagging anxiety, but fortunately, she could keep the driver plugged in at night while she slept.

The upside was that the heart pumped 9.5 liters of blood per minute. Her kidneys started to work again and she suddenly had energy. The color came back into her face. Life flowed through her. She walked the dog, took care of her kids, and went shopping at the mall. It felt like a miracle.

Not everyone responded to Stacie’s condition with sensitivity. People tended to stare at her, with the heavy backpack and the tubes that led from her backpack into her abdomen, and some of them asked “rude, obnoxious questions.” The heart had the audible sound of an amplified heartbeat. Stacie quickly got used to it, but not everyone tolerated it. When she was well enough, she and her family went to the church they had attended before her surgery, a church with a sign outside that said “Come as you are.” After attending one service, the pastor told her that the sound of her heart was bothering some of the other parishioners, and he told her not to come back. Stacie and her husband could hardly believe it, but they agreed not to return.

After 196 days of living with the artificial heart, Stacie got the phone call telling her that a donor heart had become available. She had intensely mixed feelings about the news. On the one hand, she was incredibly excited, but on the other hand, she was worried about removing the artificial heart that worked so well that she had been living a virtually normal life. What if her body rejected the biological heart? With the TAH, rejection was not an issue. She had to take medications to avoid blood clots,  but having a donor heart would mean having to take lifelong drugs to suppress her immune system, a process that carries serious risks. The immunosuppressant drugs meant that a simple infection could potentially take her life. She went through with the biological heart transplant and today Stacie is an active, healthy, full-time mom. She has to have regular biopsies to monitor for rejection of her new heart, and she was recently surprised to learn that she was actually experiencing mild rejection— surprised because she feels so well. Her cardiologist told her that those who experience mild rejection soon after a heart transplant actually tend to do the best in the long run. But she takes nothing for granted. She has no doubt about her priorities. “I got what I wanted, which was to be here with my family,” she says.

Stacie is one of approximately twelve hundred patients to be implanted with SynCardia’s 70 cc artificial heart. Although the large heart is approved by the FDA as a bridge to transplant, SynCardia has now created a 50 cc heart, suitable for women and adolescents, and has obtained FDA approval to explore the use of the smaller heart as a destination therapy, meaning that the implant would be permanent. No one yet knows how long the TAH can last, but the technology is evolving at an incredible rate. The trend toward miniaturization continues, and a 30 cc artificial heart is now in development that performs just as well as the larger versions. In spite of the overwhelming success of the TAH, there are a few drawbacks. Patients must have an open incision with two tubes the size of small garden hoses extending from their abdomen to the driver. Then there is the need to recharge the driver on a daily basis, plus the inconvenience of carrying the backpack at all times. All of these issues pale in comparison when the alternative is death, but the technology is moving quickly toward a more advanced end product: a small, completely self-enclosed artificial heart with a long-life battery implanted under the skin, which eliminates the portable driver and obviates the need for an open incision.

The potential market for artificial hearts is huge. Heart disease is the number one killer of both men and women, and biological hearts are extremely scarce. Many people today die of heart disease when they are otherwise healthy. With a durable, dependable artificial heart, who knows how long their lives could be extended?

To obtain a physician’s perspective on the artificial heart, I spoke with the pioneering heart-lung transplant surgeon Mark Plunkett, MD, who implanted three TAHs as chief of cardiothoracic surgery at the University of Kentucky (UK) College of Medicine. To speak with Dr. Plunkett is to hear the passion he has for artificial hearts and the incredible lifesaving alternative they offer to the “sickest of the sick” patients who would otherwise die waiting for a donor heart. While at UK, Dr. Plunkett pushed to have the medical center invest nearly $1 million to become equipped to offer the TAH to patients. A specialist in pediatric transplants, he has since accepted a position at the University of Florida and the Congenital Heart Center at Shands Children’s Hospital in Gainesville, Florida.

Dr. Plunkett knew from earliest childhood what he wanted to do with his life. Growing up in a small town on Maryland’s eastern shore, he was only seven or eight years old when he started telling people that he wanted to be a surgeon. He remembers vividly how, in 1967, when he was only seven years old, the world’s first human-to-human heart transplant was performed by South African doctor Christiaan Barnard. The recipient, fifty-three-year-old Louis Washkansky, lived for only eighteen days until complications took his life. The transplant, however, was successful, and from that moment forward Plunkett knew that he wanted to be a transplant surgeon. He was already fascinated by medicine, and hearing about the transplant was “just over the top.” He consumed medical information wherever he could find it and dedicated himself to clearing all the academic hurdles to becoming a surgeon. The farther along he got in his studies, the better he felt about his choice, and after an internship at Duke University Medical Center and a fellowship at UCLA Medical Center, he began performing heart and lung transplants on people of all ages, including children.

Plunkett was attracted to artificial organ transplant surgery in part because of the extreme shortage of biological organs, a problem that continues to plague patients with end-stage organ failure. There are over 119,000 people currently on waiting lists for donor organs, and about 7,000 of them die each year still waiting. The problem is that, for various reasons, too few people opt to become organ donors. Meanwhile, with the growth and aging of the U.S. population, the need for organ transplants is growing. Additionally, the average heart transplant only lasts twelve to fifteen years before rejection and heart failure necessitate another transplant. This may not be such a problem in elderly people who may die of other causes before their heart fails, but for pediatric patients, it means that children must go through multiple heart transplants in a lifetime, and each time their transplant gives out, they are faced with the dire shortage of compatible hearts.

Several different artificial organs are now being created and tested, but the technology behind the artificial heart has long been in development. In 1963, Paul Winchell created the first artificial heart, which became the prototype for the Jarvik heart, first implanted in a human in 1983. Over the next few decades, artificial hearts became more sophisticated and patients who received them were living longer and longer. In Dr. Plunkett’s words, the biotech industry is “exploding with gadgets,” and doctors have to look carefully for the ones that prove safe and effective. He is excited about the SynCardia Total Artificial Heart, especially about the future prospects of smaller, totally enclosed hearts that could be a lifetime therapy for children and adolescents, a prospect that he believes is just around the corner. He is especially impressed by the TAH because it doesn’t require drugs that suppress the immune system. The transplantation of a biological organ always requires immune system suppression, which only works for a while; in every case, the body will eventually reject the heart. He sees the next breakthrough in artificial hearts to be a miniaturized version with all the pumping power of the SynCardia heart, but only requiring the patient to wear a belt with a battery pack that continuously recharges the battery rather than the heavy backpack. The next version, a completely self-enclosed heart with a subcutaneous battery, is all but inevitable.

BEYOND HUMAN. Copyright © 2016 by Eve Herold. All rights reserved. Printed in the United States of America. For information, address St. Martin’s Press, 175 Fifth Avenue, New York, N.Y. 10010.

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This U.S. City Is Still Incredibly Segregated, and It's No Coincidence

The following is an excerpt from the new book The South Side by Natalie Y. Moore (St. Martin's Press, 2016): 

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How to Address the Unending, Vile Racism on Predominantly White Campuses

The following is an excerpt from the new book Blackballed: The Black and White Politics of Race on America's Campuses by Lawrence Ross (St. Martin's Press, 2016): 

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Airbnb Is Contributing to the Displacement of Long-Term Tenants in San Francisco

The following is an excerpt from the new book  Raw Deal by Steven Hill (St. Martin's Press, 2015): 

They tapped into a rich vein of people, at first in urban areas in the U.S. but eventually all over the world, who grasped for the financial benefits of hosting travelers. Those hosts in turn filled a niche for travelers looking for low-cost accommodations, particularly during high-season times when hotel vacancies were scarce. Airbnb has become an impressive commercial empire, yet its appeal has been authentically grassroots.

The young entrepreneurs had no idea what they had wrapped their arms around. Now, less than eight years later, Airbnb is a global success story, valued at $25 billion—the same as the 100-year-old Hyatt chain—and self-reporting a mind boggling 25 million nights booked since its inception, with a million current listings across 34,000 cities and 192 countries. It employs a thousand people around the world, and has become not only an economic but also a cultural phenomenon, already an iconic company in its short life. Its young founders have become wide-eyed billionaires who at times seem to barely believe their good fortune in stumbling upon a fabulous new innovation in global hospitality and travel.

But in San Francisco, New York City, Los Angeles and elsewhere, the legacy of their gold rush has been decidedly mixed. Airbnb is not merely a “community-driven hospitality company,” as its founders like to say, but also a catalyst for massive lawbreaking, a tax rogue and, tragically, an impetus for the eviction of longtime tenants, including the elderly, the disabled, children, even people with life-threatening illnesses. Other short-term rental brokerages such as VRBO, FlipKey, Roomorama and Home Away, while much smaller in size, have followed the Airbnb model. For reasons that will be elaborated below, many cities have been left reeling from the bitter disruption of entire neighborhoods, as well as from poisoned landlord-tenant relations that were based on laws that had been stitched together over decades, yet now are being flushed as Airbnb’s investors and local real estate interests rush to cash in. If “belonging” is the idea that defines Airbnb, it depends a lot on whether or not you belong to the right club.

Down and Out in North Beach

Theresa Flandrich is a retired nurse who has lived for 30 years and raised her son in a two-bedroom, rent-controlled apartment on North Beach’s Lombard Street—and now is desperately fighting eviction as a greedy landlord tries to remove her (and other tenants in her building) to make room for Airbnb-ing her apartment (yes, Airbnb has become a verb, with nasty connotations).

Theresa gives me a tour around her North Beach neighborhood. North Beach is one of San Francisco’s most historic and loved districts, also known as “Little Italy” because it was the borough where many Italian immigrants settled in the early 20th century. Seeking opportunity in the wave of European immigration that flooded America, the Italians opened shops, built homes and churches and, with North Beach abutting Fisherman’s Wharf, anchored the then-thriving fishing industry. Joe DiMaggio’s father was a fisherman in the Bay Area, and Joltin’ Joe married Marilyn Monroe at San Francisco City Hall; Joe DiMaggio Playground is located a block from Theresa’s apartment. The North Beach neighborhood was a multigenerational place, where families thrived and kids played stickball in the streets, with grandparents in close proximity to their extended families. Neighbors knew and helped each other and felt a measure of post–World War II security. “It was a real neighborhood,” says Theresa.

But now things look very different. Just on her street alone, on a single block, Theresa can point to five buildings (including her own) where all the tenants have received eviction notices. Around the corner there are several more buildings with threatened tenants. “Most of these buildings,” says Theresa, “were owned by the old Italians who took care of their community. They kept rents reasonable, and didn’t mind rent control because, well, we were all neighbors.” That word says a lot to Theresa. “They wanted to help each other, and as a nurse when they needed medical care I helped them. Everybody took care of each other.”

But then the Italian patriarchs grew old and died, and many of their kids didn’t live in San Francisco anymore and so, for one reason or another, they wanted to sell. A new breed of landlords bought the buildings. Owners like Peter Iskandar of Bubble Realty (yes, that’s really his real estate company’s name), a speculator from Indonesia who saw this neighborhood as his personal gold rush. Like a Monopoly game board, he purchased property after property and began evicting tenants—often using questionable means—so that he could get them out of their rent-controlled apartments. Then he would jack up the rents, sell them as condominiums or, more recently, Airbnb them. The Anti-Eviction Mapping Project shows Mr. Iskandar as having bought at least 10 buildings in the neighborhood.

To make way for his ambitions, he has evicted a 68-year-old woman with breast cancer; Carlo Tarrone, in his seventies and using a walker, who had lived in his apartment for 56 years; and Sandy Bishop, who is 70 and has lung cancer. “I can’t even find a place to live because I don’t make enough money,” Bishop said. “Maybe I should just stay and let the sheriff carry me out.” Iskandar is a one-man wrecking ball, demolishing the lives of elderly and sick people, seemingly targeting the most vulnerable. Some have accused him of bending the rules to commit naked acts of what amounts to “elderly cleansing.”

Just down the street, Theresa shows me a four-unit building that is accessed via a quaint, brick alleyway, reminiscent of the honey-hive maze around Piazza Navona in Rome. All the tenants have been evicted and now, she points out, four lockboxes are visible on the banister outside the front entryway for the apartments—the telltale sign that this building has been Airbnb-ed. The constant carousel of new faces coming and going can check themselves in and out of each apartment, accessing the key via the lockbox for which they are given the combination, without ever meeting the landlord or manager. The transaction can be completed anonymously, facelessly, over the Airbnb website. Where before this building housed families who were part of the neighborhood, now it’s an Airbnb tourist hotel.

Theresa’s building has met with a similar fate, though the circumstances are somewhat different. The owner of her building died at 96 years old. “She and I were close,” says Theresa, “I used to help her take her medications.” Everyone in the four-apartment building was close, including the Palestinian shopkeepers who run a small grocery store on the street level. “They let the neighbors run a tab; if you had a short month, they would let you pay the next month. It was close knit,” says Theresa.

The deceased owner had willed the property to her niece who lives in faraway Laguna Beach, in Southern California. Within a week after getting her hands on the deed, the niece served notice to everyone in the building to clear out, including a man in advanced stages of Parkinson’s disease. The niece claimed she was going to invoke a legal loophole called an “owner-occupied move-in”—moving in members of her family, including herself, none of whom actually lived in San Francisco.

“Seven o’clock in the morning on April 11th, the doorbell rang. And, there was a server,” says Theresa. “My son answered the door and he was just given the papers. I was offended. I was hurt. I was shocked. My son had to go off to work. And he said, the first thing he said was, ‘Oh my God. This is the only home I’ve ever known. I didn’t expect to live here all my life. But I expected you to be here, Mom. This is where we’d continue to celebrate all our holidays and the neighborhood.’”

According to a report by San Francisco’s Rent Board, nearly 2,000 units were evicted in 2013, a 13 percent increase from 2012. Since most rented locations house more than one person (San Francisco is too expensive for most people to have their own private place), housing experts have estimated that figure represents at least 5,000 people evicted in 2013. The landlords have been relentless in using different tactics, some of them illegal, to evict, such as claiming they’re going to rehabilitate their building. The landlords know that, by law, tenants have the right to move back into their unit at the same rent after the rehab is completed. But the tenants don’t know that, and the landlord usually does not tell them because their goal is to remove these tenants from their rent-controlled apartments. They offer them a few thousand dollars to move out, telling the tenants they have no choice, and the tenants— especially when they are elderly, disabled, ill or language-challenged—often don’t have the will or tenacity to fight back. After a few take the buyout and leave, the landlord can really put the squeeze on any that refuse. They harass and threaten them, they cut off garbage service, they refuse to do repairs . . . suddenly water or electricity becomes unreliable.

Property owners also have ramped up their use of “gotcha evictions” to remove tenants from their rent-controlled apartments—trumped-up, petty violations for alleged “nuisances,” such as carrying your bicycle through a common hallway, painting the walls of your apartment or leaving a baby stroller in the common area. In Chinatown, tenants have been threatened with eviction for hanging laundry outside their windows and displaying Chinese New Year decorations in the hallways. Since there is no clear legal standard for what constitutes a “nuisance,” the landlord issues an eviction notice, initiating a legal battle that most tenants are ill-positioned to wage.

In 2014, more than a thousand San Francisco tenants were intimidated out of their homes over these kinds of trumped-up charges. Breach of lease and nuisance violations have become the leading causes of evictions in San Francisco. Most tenants, especially seniors, do not know their rights or are afraid to assert them. Once evicted, most move out of the city because, having been ousted from their rent-controlled apartment, they can’t afford to remain when the median monthly rent for a one-bedroom apartment zoomed in 2015 to nearly $3,500 (up from $2,795 in 2013), and a two-bedroom apartment to $4,500. Under this kind of price pressure, the San Francisco Controller’s Office estimates that the city lost 1,017 rent-controlled housing units in 2013. “When this happens year after year, as it has for many years in a row,” says Sara Shortt from the Housing Rights Committee of San Francisco, “the very fabric of our neighborhoods, our communities and our city is ripped apart.”

But Theresa has successfully fought her eviction by organizing her building and her neighbors. They formed the North Beach Tenants Committee, and at the first meeting the turnout was strong, over 100 people. She has helped Diego resist his eviction, and other people are fighting back. Joe Tobener, a local San Francisco attorney, has represented many tenants against greedy landlords and their illegal evictions. Tobener is a straight-talking people’s lawyer who grew up poor, raised by a single mom with six kids on a cashier’s salary. “I feel like Robin Hood sometimes,” he told me, defending so many vulnerable tenants against the wealthy interests behind these Airbnb-fueled evictions. “We get about 60 calls a week,” many of them from tenants being illegally displaced so landlords can use Airbnb, VRBO, Roomorama, FlipKey or other services to rent to tourists. “There’s so little enforcement, it’s like the Third World,” he says. “Airbnb is contributing to the displacement of long-term tenants in San Francisco.”

San Francisco, like New York City and other major urban areas, has a complicated code of laws and regulations that oversee real estate and landlord-tenant relations. One of the laws prohibits the renting of apartments or homes for fewer than 30 days, to prevent exactly the type of shenanigans that afflict Theresa and her neighbors—property owners who decide it’s more lucrative to turn their property into tourist hotels, thereby reducing the supply of housing available for local people who need permanent residence. That practice is called “illegal hoteling” and was banned decades ago by the Apartment Conversion Ordinance.

Property owners have always tried to skirt this law, but even when Craigslist became the first online service to facilitate short-term rentals, the small number of lawbreakers was ignorable. Now, Airbnb and other short-term rental brokerages, with their sophisticated Web- and app-based portals, have made it super easy for virtually anyone with property to find a short-term tourist to rent to. They have facilitated lawbreaking on a massive scale, and an investigation in May 2014 by the San Francisco Chronicle found 4,798 properties listed on the Airbnb website, and another 1,200 properties on the VRBO site. A colorful map showing the location of each listing was produced, and the thousands of dots covering the map (especially the eastern half of the city) made San Francisco look like it was being swarmed by insects.

In the meantime, much damage has been done to the fabric of San Francisco. Not the least because Theresa and her neighbors have received little help from City Hall. Indeed, San Francisco mayor Ed Lee’s chief financial benefactor, Ron Conway, is a Silicon Valley venture capitalist with a significant financial stake in Airbnb. And Conway is not the only local investor banking on Airbnb. Tech investor billionaire Peter Thiel, a politically connected San Francisco resident who cofounded PayPal and owns a big chunk of Airbnb (as well as Facebook), saw his net worth in 2013 shoot up from $1.4 billion to $2.2 billion, as Airbnb’s value steadily climbed. Tragically, while the new sharing economy service offered by Airbnb is lucrative for a small number of people, it is forcing out longtime San Franciscans and pushing up rents by shrinking the supply of available housing, particularly rent-controlled apartments, from the permanent housing stock. This is what life has become in a gold rush city, where regulations to protect longtime tenants are not enforced because public officials are in thrall to the techno sapien gurus of Silicon Valley.

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America's Cops Are Getting Away With Murder - How Can We Stop Them?

The following is an excerpt from the new book Police State: How America's Cops Get Away With Murder by Gerry Spence (St. Martin's Press, 2015):

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Why the Rich Cash in on Our Suffering from Natural Disasters

The following is an excerpt from the new book Disaster Profiteers: How Natural Disasters Make the Rich Richer and the Poor Even Poorer by John C. Mutter (St. Martin's Press, 2015):

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The Horrors of an Ayn Rand World: Why We Must Fight for America's Soul

Editor's note: The following is an excerpt from Ayn Rand Nation: the Hidden Struggle for America's Soul, by Gary Weiss.

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What Happened on the Night When Phil Hartman Tragically Died

The following is an excerpt from MIke Thomas' new book, You Might Remember Me: The Life and Times of Phil Hartman (St. Martin's Press, 2014).  This excerpt was first published in Salon and is reprinted here with permission.

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