52 pages • 1-hour read
Home Again
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Background
Content Warning: This section of the guide contains discussion of illness or death.
Medical Context: 1990s Heart Transplantation
Published in 1996, Home Again reflects wide social interest in the medical advancements and ethical complexities of heart transplantation in the 1990s. This era marked a turning point for the procedure, which had passed through a high-risk clinical trials into a viable and more common-place treatment for end-stage heart disease. Due to improved surgical techniques and the introduction of immunosuppressant drugs like cyclosporine in the 1980s, one-year survival rates for heart transplant patients reach 78% by the mid-1990s. (Christie, Jason D., et al. “The Registry of the International Society for Heart and Lung Transplantation: Twenty-sixth Official Adult Lung and Heart-Lung Transplantation Report—2009.” ISHLT, 2009). The increased success rate made a “second chance at life” a more tangible reality but the process remained fraught with practical and medical challenges. Much of these concerns were centered around the fair allocation of scarce donor organs, a national system run by the United Network for Organ Sharing. Dr. Allenford’s warning that Angel’s “chances of getting a new heart … in time, are running at about fifty-fifty” (59) highlights the life-or-death waiting game many patients faced. Although donor rates have improved in recent decades, the demand for organs still far outstrips patient need, making this a relevant concern today. (Jain, Rashmi, et al. “Donor Selection for Heart Transplantation in 2025.” JACC, 2025).
The narrative also explores wider ethical concerns around heart transplantation in the US, especially in the 1990s when wider society was adapting to the procedure’s wider roll-out and its potential personal, emotional, and moral implications. Angel’s terror at receiving a “dead person’s heart” (14) and the requirement for a psychological profile reflect real-world concerns at the time about patient adaptation, identity, and the ethical dilemma of benefiting from another’s death. The context of 1990s transplantation medicine thus frames Angel’s personal journey within a complex psychological and existential struggle which played out in society as a whole.
Social Context: Celebrity Culture and the Rise of Tabloid Media
Home Again captures the escalating media culture of the 1990s, a decade defined by the rise of invasive tabloid journalism and the cult of the celebrity. The 1990s saw the roll-out of the Internet and the expansion of cable network TV across America, driving a new sense of mass cultural trends. (Harrison, Colin. American Culture in the 1990s. 2010). The novel’s protagonist, movie star Angel DeMarco, is a product of this environment, where fame is both a privilege and a threat. The narrative opens with paparazzi swarming a film party, setting this context from the outset. The novel makes numerous references to real media outlets of the era, including People magazine, the Enquirer, and the tabloid television show Hard Copy, locating Angel’s experiences within a real and recognizable framework.
The increasingly blurred lines between public interest and private life is a phenomenon exemplified by the 24-hour news cycle surrounding the O.J. Simpson trial (1994-1995), which turned a criminal case into a national spectacle. The intense public scrutiny and the media’s willingness to pay for inside stories created an environment where a celebrity’s personal crisis could become profitable entertainment (Neubauer, Tatjana. “The Mediatization of the OJ Simpson Case.” 2023). Home Again, written during this time, reflects this phenomenon directly through Angel’s frantic need for secrecy. His threat to his doctor, “If anyone finds out about this—anyone—I’ll sue this god-damn hospital” (15), is framed as a rational response to a media machine that thrives on personal tragedy. The novel thus uses the context of 1990s tabloid culture to explore the profound conflict between a public persona built on adoration and the isolating, vulnerable reality of private suffering, where fame offers no protection.
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