Showing 1 - 10 of 2846 Literature annotations

The Ballad of Typhoid Mary

Federspiel, J. F.

Last Updated: Apr-07-2020
Annotated by:
Belling, Catherine

Primary Category: Literature / Fiction

Genre: Novel

Summary:

The novel's narrator is a widowed 58-year-old Swiss-born physician, Howard J. Rageet, who lives in New York City. His son is a pediatrician, his daughter a medical student. Rageet himself is terminally ill. He is writing a "little biography," of Mary Mallon, the infamous "healthy carrier" also known as Typhoid Mary. Rageet's grandfather, also a doctor, had kept a journal about Mary and his rivalry with his friend, (the real) George A. Soper, whose life's work became tracking Mary and proving that she was responsible for the typhoid outbreaks. Elaborating on the journal, Rageet recounts Mary's life in America.

Born Maria Anna Caduff in the same part of Switzerland as Rageet's ancestors, she arrives in New York Harbor in 1868, aged 13, on a crowded immigrant ship, a fifth of whose passengers had died en route from Europe. The dead include Mary's family. She had been taken care of by the ship's cook, who evidently both taught her to cook and used her for sex. When the ship docks, Mary tries to jump overboard, but is stopped by a physician, Dorfheimer, who smuggles her through Ellis Island and takes her home with him. He is also a pedophile, and he has sex with her. Rageet calls this kidnapping a "humane, benevolent crime." Not long after, Dorfheimer dies of typhoid fever.

Rageet's "ballad" then traces Mary's various positions as a cook (and, often, sexual object), most of which end quickly when the household is infected. She has two relationships that do not lead to the disease. One is with a small girl who has Down Syndrome. Once her connection to typhoid is suspected, the child's family hire Mary to live alone with the child and care for her, hoping the child will be infected and die. The child never becomes ill. The other is with a disillusioned anarchist, Chris Cramer. She lives with him and falls in love with him, but he is not sexually interested in her.

Soper encounters Mary when he is asked by a wealthy Oyster Bay family, her former employers, to investigate a typhoid outbreak in their household. He manages to track her down and eventually, after much resistance, she is arrested, tested, and quarantined. She escapes and continues to work as a cook until her re-arrest. Promising to try and imagine Mary's motives, Rageet breaks off his narrative. He is dying. The novel ends with a postscript written by Rageet's daughter. Implying that her father committed suicide, she tells of Mary's stroke and the last years of her life as a paraplegic, and she provides a final document, the menu for one of the very elaborate meals Mary would have cooked.

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Weather

Offill, Jenny

Last Updated: Apr-03-2020

Primary Category: Literature / Fiction

Genre: Novel

Summary:

Weather is a strange, disturbing, and important book. Offill uses fragments of prose—typically a few lines or half a page—to present a small group of characters in New York City who experience dread, unhealthy behaviors, and many difficult choices. The fragments jump from topic to topic and points of view, suggesting chaos in the characters, in much of modern life, and even in the structure of this novel. “Weather” suggests “whether”: whether humans can survive not only from one day to the next but also in the long term that includes the climate crisis threatening our earth. 

The cast of characters is small and carefully arranged. Lizzie (our main focus) is married to Ben; they have a son Eli. Lizzie’s brother Henry is married to Catherine, and they have a baby girl, Iris; Ben and Lizzie have problematic mothers. A genogram of these and other related characters looks like the cast of a Restoration comedy, full of harmony and good will, but in Weather conflicts swirl and grow chaotically. Catherine divorces Henry. Ben suddenly goes on a three-week trip. Widespread complications include street drugs, alcohol, diet abnormalities, sleep deprivation. There are also mental problems such as confusion, hallucination, loneliness, delusions, and panic, as well as economic difficulties. Only Catherine has a career path, but, at the end of the book, she appears to be “tilting into the abyss too” (p. 179), according to Lizzie. 

While some fragments describe thoughts and actions of the characters, others present a giant whirlpool of cultural, environmental, and historical topics, including doomsday preppers, Rapturists, and the end of civilization, also gun rights, multicultural frictions, popular religion, a need for a strongman to govern, noticeably sick people and loss of medical services. Other topics touched on include hate literature, mob rule, suicide, torture, as well as references to Fukushima, the Holocaust, and 9/11. Many of these worry our characters; others are simply mentioned as “the surround” for all people around the world. Our characters have fantasies of hope but usually feel panic, dread, loneliness, guilt, or despair. Sylvia (Lizzie’s former professor and sometime boss) is an academic who appears to understand climate change and the need to warn people, but she gives up, saying “there’s no hope” (p. 133).  

The first 127 pages swirl around the characters with little progression of story. The next section (4) accelerates the craziness among them all. The last two sections seem more “stable,” but with no actual resolutions. Lizzie says “I will die early and ignobly” (p. 187). In the very last pages, she takes the boy Eli (the only normal major character) to a playground. Later she kneels by her bed and prays for “Mercy” (p. 197). Following the last page, we see only a one-line URL: www.obligatorynoteofhope.com. Is this part of the novel? Do we click on it? 


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Mercy

Montgomery, Judith

Last Updated: Mar-27-2020
Annotated by:
Davis, Cortney

Primary Category: Literature / Poetry

Genre: Poetry

Summary:

"Mercy," winner of the Wolf Ridge Press Narrative / Poetic Medicine Prize, contains nineteen powerful poems--poems that provide an intimate look into the author's role as caregiver to her husband who is living with, and being treated for, liposarcoma.  But the poems in this small volume are not just about husband and wife.  Cancer becomes a third character, one who is often addressed as a presence lingering in the same house, sleeping in the same bed, never absent from every moment of struggle or from any moments of joy.  In the opening poem, "Cozy" (page 1), the couple has "escaped" to a remote rented cabin.  They slip "from love-rumpled featherbed and sheets" feeling "safe" within the sturdy cabin walls that "keep out driving rain or freeze."  For those hours, nothing can spoil their happiness, "even Cancer, who squats on our stoop, / flipping his gold coin in lazy arcs."  At the close of "Cozy," as the couple drives home from their respite, Cancer rides with them, sitting between them "as he hums and nods / pleasantly--first to you, then to me, // one hand lightly resting on each near thigh."  The author weaves this threatening image of Cancer as an ever-present entity throughout the poems that follow.

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Annotated by:
Galbo, Sebastian

Primary Category: Literature / Nonfiction — Secondary Category: Literature / Nonfiction

Genre: Criticism

Summary:

In Death is But a Dream, Christopher Kerr, MD, PhD, the Chief Executive Officer and Chief Medical Officer of Hospice & Palliative Care Buffalo, shares his patients’ end-of-life dreams and visions. The content and intensity of these dreams vary, but often center on patients’ transient meetings with predeceased loved ones, offering a deeply spiritual sense of peace during periods of physical suffering. 

Using patient interviews, Kerr’s book does not fetishize dream events as ghostly commotions or in terms of pseudo-mysticism, or insist on using a religious framework for their interpretation, explaining rather that bearing witness to and legitimizing end-of-life dream experiences constitute a new ethical imperative in the practice of palliative care: “A true holistic approach to patient care must also honor and facilitate patients’ subjective experiences and allow them to transform the dying process from a story of mere physical decline to one of spiritual ascension” (Kerr 28). Case after case, his research documents that because end-of-life dreams provide patients with a singular emotional and psychological comfort that no palliative medication can simulate, hospice professionals need to validate patient dreams by listening carefully and compassionately. 

With this in mind, end-of-life dreams serve as a kind of counter-narrative to dominant cultural understandings and representations of human experiences in hospice, specifically stereotypes of terminally ill individuals as being incapable of meaningful communication, creativity, and understanding. Kerr’s patients’ narratives reveal that end-of-life dreams and visions are not trauma-inducing experiences or instances of religious prophecy, but “help reframe dying in a way that is not about last words and lost love but about strengthened selves and unbreakable bonds across lives” (142). 

Death is But a Dream 
upends medical research, or certain “limitations of science,” that oversimplifies end-of-life dreams by attributing them to neurological deterioration, oxygen deprivation, and the side effects of pain management medication (11). The general lack of rigorous, serious-minded research in end-of-life dream experiences is inseparable, in part, from institutionalized medicine’s “inability to see dying as anything but a failure” which has produced a healthcare system that “reflects a limited view of the totality of the dying experience” (7). The patient accounts that Kerr documents, however, reveal an undeniable dimension of human experience at life’s end whose complexities may be well beyond the reaches of full scientific understanding. End-of-life dreams seem to be part of an elaborate system of compensation (to borrow a term used by Siddhartha Mukherjee), as the mind works overtime to activate and animate certain memories to diminish the physical realities of dying. “There is an adaptation—substantive, spiritual yet cognitively meaningful,” writes Kerr, “a mechanism through which the patient can emerge from the dying process with a positive psychological change” (69). Indeed, the mystery of end-of-life dreams—their visions of loved ones; of seeking forgiveness, healing, and understanding within weeks, sometimes days, of one’s death; of comforting apparitions and visitations—points to a miraculous capacity within the human heart that eases the life-to-death transition.

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Man's 4th Best Hospital

Shem, Samuel

Last Updated: Feb-28-2020
Annotated by:
Miksanek, Tony

Primary Category: Literature / Fiction

Genre: Novel

Summary:

Most of the group are reunited in this sequel to the 1978 blockbuster, The House of God: narrator Dr. Roy Basch and his girlfriend (now wife) Berry, former fellow interns (Eat My Dust Eddie, Hyper Hooper, the Runt, Chuck), surgeon Gath, the two articulate police officers (Gilheeny and Quick), and the Fat Man (a brilliant, larger-than-life former teaching resident). As interns, Basch and his comrades were a crazy, exhausted, cynical crew just trying to survive their brutal internship. Years later, the midlife doctors have changed but remain emotionally scarred.

The Fat Man (“Fats”), now a wealthy California internist who is beginning a biotech company targeting memory restoration, is recruited to reestablish the fortunes – financial and prestige – of Man’s Best Hospital which has slipped to 4th place in the annual hospital rankings. He calls on his former protégés to assist him in an honorable mission, “To put the human back in health care” (p34). Fats enlists other physicians (Drs. Naidoo and Humbo) along with a promising medical student (Mo Ahern) to staff his new Future of Medicine Clinic (FMC), an oasis of empathic medical care that strives to be with the patient.

Every great story needs a villain. Here the main bad guys are hospital president Jared Krashinsky, evil senior resident Jack Rowk Junior, and CEO of the BUDDIES hospital conglomerate Pat Flambeau. The electronic medical records system dubbed HEAL is a major antagonist, and the FMC docs wage war against it and the “screens.”

Poor Roy Basch works long hours, deals with family problems, has trouble paying bills, and experiences health issues (a bout of atrial fibrillation, a grand mal seizure, and alcohol use). Fats has warned of a “tipping point when medical care could go one way or another, either toward humane care or toward money and screens” (p8). Alas, the computers and cash appear victorious. A major character is killed. Many of the doctors working in the FMC including Basch leave the clinic. And fittingly, Man’s Best Hospital plummets in the latest rankings from 4th to 19th place.

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Summary:

A dramatic prologue depicts Joan Kleinman screaming and hitting her husband Arthur in bed. She is ill with Alzheimer’s disease and does not, for that moment, recognize him. The following chapters provide a long flashback, beginning with Arthur’s family background, his youth as a tough street kid in Brooklyn, his medical education, and his marriage to Joan. We learn of their work in China, travels, and professional success. Arthur gradually realizes that the US health care system has become “a rapidly fragmenting and increasingly chaotic and dysfunctional non-system” (p. 126). Further, he sees a reductive focus on patients as mere biological entities, ignoring their personal, familial, and cultural natures. As a result, “Caregiving in medicine has gone from bad to worse.”

Joan suffers from an atypical kind of Alzheimer’s that increased over “that dismal ten years” (p. 156) with Arthur providing care to her, at cost to himself. There is no home health aide, no team approach with doctors, indeed no wider interest in her care other than the state of her diseased brain. Kleinman vividly describes the toll on her and on him.

Kleinman is aware of the privilege he has as a Harvard doctor, well known for his psychiatric work, his teaching and writing, and his wealth—in contrast to other patients and families. Some patients go bankrupt from medical bills.

Visits to nursing homes reveal a wide range of social conditions, contexts, and levels of care; the best have a sense of “moral care” (p. 200). Joan’s final days are hard. Supportive family members agree to her living will and healthcare proxy for morphine pain control only. She dies, apparently “at peace” (p. 232).

In the last pages Kleinman introduces the notion of “soul” as “essential human interactions” (p. 238). He discusses some of the limits of medicine (see paradoxes below) but also praises local efforts to improve humane care, such as team approaches, uses of narrative medicine, and medical/health humanities programs.  

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The Edge of Every Day

Sardy, Marin

Last Updated: Jan-25-2020
Annotated by:
Glass, Guy

Primary Category: Literature / Nonfiction

Genre: Memoir

Summary:

The Edge of Every Day is the memoir of a woman who comes from a “multiplex” family, in which schizophrenia is manifested in successive generations.  

The book consists of a series of essays.  Some, on topics ranging from gymnastics to building altars, were first published independently and do not appear (at least at first glance) to be linked. The choppy effect this produces speaks to the disorganized thinking that psychotic persons experience.  Other essays propel the tragic narrative of family members slipping into psychosis. At the age of ten, the author Marin Sardy, watches as the “shapeless thief” of schizophrenia steals her mother’s personality away.  Later, as she reaches her thirties, she witnesses her younger brother succumb to an even more pernicious illness.   

Despite Sardy’s mother’s conspicuous symptoms, (she advises her daughter to move to Pluto and informs her that her father has been swept away in a tsunami and replaced by another man), she functions just well enough to avoid being compelled to accept treatment. Thus, no one can stop her from going through a large inheritance and becoming destitute.  

Sardy’s brother Tom suffers his first psychotic break in his 20’s and then rapidly deteriorates.  He repeatedly “cheeks” his meds and falls through the cracks of Anchorage’s mental health system. The author and her family scour the streets, hoping to lure him inside for a shower or hot meal. As the weather worsens, they can only hope he will land in prison if it means not being exposed to the Alaskan elements.  Ultimately, the young man, who once sailed through college with A’s, commits suicide in the bathroom of a psychiatric facility. 

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Annotated by:
Davis, Cortney

Primary Category: Literature / Nonfiction

Genre: Journal

Summary:

Nicolas Diat is a French journalist who, over the course of many months, traveled throughout France visiting a number of monasteries.  Because monks live their lives in many ways preparing for death, for eternity, Diat wondered if they had special insights about our final days on earth. "A Time To Die" contains a foreword by Robert Cardinal Sarah; comments by the author ("Extraordinary Stories); eight chapters, each the story of a particular monastery and particular monks; an epilogue; and closing remarks by the author.

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Annotated by:
Field, Steven

Primary Category: Literature / Fiction

Genre: Novel

Summary:

Anthony Marra’s debut novel (published in 2013) is set in Chechnya, the rebellious Caucasus republic that broke away from Russia in 1994, was in short order mired in two wars thereafter, and ultimately lost its independence and was re-incorporated into Russia as a semi-autonomous “federal subject” state.  Marra does not ease us into his story, but propels us headlong into it; it is 2004, and eight-year-old Havaa awakens to find that her father Dokka, suspected of aiding Chechen rebels, has been taken away by Russian troops, who have also burned her house to the ground.  She is alive only because Akhmed, her neighbor and her father’s friend, has spirited her out of her house in the middle of the night and hidden her in his.  Akhmed takes it upon himself to protect Havaa; he knows that the soldiers will be looking for her, because even though the official wars are over, Chechnya remains in the midst of a brutal battle for control, and the policy of the state is to “disappear” not only those it perceives as its enemies, but also their family members.  

Akhmed manages to get Havaa to the abandoned local hospital, where he believes she will be safe.  The hospital is staffed only by a smart, tough, and competent surgeon named Sonja, assisted by a nurse.  Sonja is an ethnic Russian from the area who trained in London and then returned to her homeland.  She agrees to shelter Havaa on the condition that Akhmed, who trained as a doctor but is painfully aware of his inadequacies in that profession (he wanted to be an artist), stay on also as her assistant surgeon.  Soldiers and civilians on both sides arrive in need of care in a hospital barely functioning, with little in the way of staff or supplies. 

Sonja meanwhile is searching for her sister who has disappeared into the chaos of the Chechen wars; she believes that Natasha is alive, but hasn’t heard of her, or from her, in years (we will, in the course of the novel, hear Natasha’s story and learn of another side of the underbelly of this war).  She comes to believe that Akhmed may hold a key to Natasha’s whereabouts, and Sonja of course holds the key to whatever measure of safety exists for Havaa—and thus for Akhmed as well.  Other locals, a local Chechen historian, his turncoat son, and various governmental and non-governmental functionaries round out the cast in the novel.   Akhmed must negotiate in a world where anyone could be an informer, and one person clearly is; where the price for falling into the wrong hands could be death or worse; where federal troops and rebels vie to outdo each other in brutality; and where the rest of the population spends every waking minute simply trying to survive in a lawless society and a landscape gutted by ongoing strife.   When the various narrative arcs ultimately link up the ending is a powerful one.




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From Nothing

Krugovoy Silver, Anya

Last Updated: Jan-06-2020
Annotated by:
Davis, Cortney

Primary Category: Literature / Poetry

Genre: Poetry

Summary:

There are 48 poems in this volume (the author's third full-length collection), divided into three sections.  The author's first book, “The Ninety-Third Name of God” introduced us to her family and especially to her diagnosis--inflammatory breast cancer--the disease discovered in 2004 during her pregnancy, the disease that claimed her life in August, 2018 when she was forty-nine-years old.

In her second collection, “I Watched You Disappear”  Silver's poems invited us to accompany her on her journey through treatment, anger, despair, determination, and faith. This third collection (her penultimate) continues the author's beautifully written illness narrative, again presenting moments of joy and of despair, and always of hope.

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