Showing 11 - 20 of 1276 annotations tagged with the keyword "Death and Dying"

Spy of the First Person

Shepard, Sam

Last Updated: Jan-30-2018
Annotated by:
Glass, Guy

Primary Category: Literature / Fiction

Genre: Memoir

Summary:

Spy of the First Person is a short semi-autobiographical narrative about a man with a debilitating condition.  He spends most of his time sitting in a wheelchair on his porch, goes for tests to the Arizona campus of the Mayo Clinic, and has a “handicapped sign hanging from the rearview mirror of his car” (p. 15). The man’s illness is unnamed, but we learn that his motor skills are grossly impaired: “His hands and arms don’t work much.  He uses his legs, his knees, his thighs, to bring his arms and hands to his face in order to be able to eat his cheese and crackers” (ibid).   

The story is told from various, shifting points of view.  At times we are in the head of the protagonist.  At other times, the perspective is that of a nosy neighbor who peers at the sick man through binoculars, hence the book’s title. There is a parallel narrative about an elderly couple and the wife’s gradual decline in health.  The Southwest plays such an important role here one might even say that it too is a character. 
 

There are also frequent shifts of tense.  It is not always clear whether we are in the past or present.  We alternate between the central character’s fantasies, memories, and observations. The effect of intertwining voices and tenses is reinforced by the brevity of the chapters, many no longer than a paragraph.  The overall impression is that while he may no longer have full control over his body, the man has retained an active (one might say overactive) mind.
 

Spy of the First Person
concludes as the man’s children take him to a Mexican restaurant.  The vivid description of a meal shared with his loved ones provides a sharp contrast to the inner thoughts that provide the bulk of this book.

View full annotation

So Much For That

Shriver, Lionel

Last Updated: Jan-18-2018
Annotated by:
Teagarden, J. Russell

Primary Category: Literature / Fiction

Genre: Novel

Summary:

The book opens with Shep Knacker packing his bags for his long-dreamed of “Afterlife”—his word for retirement—in Pemba, an island off the coast of Tanzania. He plans to take his wife, Glynis, and his high school aged son, Zach. This plan is not unexpected because Shep and Glynis have made many “research” trips during their 26-year marriage to find the right place (though never to Pemba). But, there were always reasons not to act on their research. An intervention was needed. Glynis is not home while he is packing because she is at some “appointment.” When she gets home, Shep informs her of his plans for the three of them to leave for Pemba, and he further informs Glynis that he’s going whether she comes or not. In response, she informs him that she has cancer—a bad one (mesothelioma); he unpacks, so much for that.

What unfurls from there is more complicated than just the challenges Glynis’s disease produces, though these are monumental challenges. Other people, too, are in need of Shep’s attention. His father’s decrepitude is advancing, his sister is on the brink of homelessness, and his teenage son is detaching from him and life in general. Shep eventually loses his job as an employee at the handyman company he once owned (“Knack of All Trades”) then sold to fund his Afterlife. There’s more. 

Shep's best friend, Jackson, who also worked with him at Knack of All Trades has two girls, and one of them has familial dysautonomia. This progressive genetic disease of the nervous system produces a constellation of medical problems that are bizarre, intense, and serious, before it ultimately produces a tragic end. The trauma and tragedy this disease inflicts in this story (and in life) encompass the entire family, in spite of the heroic efforts of Jackson’s wife, Carol. 
 
The many plot lines in this novel at times proceed independently of one another, and at other times intersect. They concern serious illness experiences and the effects they have on families and also how the American health care system can place burdens on those who need it. Nevertheless, the two families, beaten down by illness, fatigued from encounters with doctors and hospitals, and exasperated from fights with insurance companies, rally enough to make it to Pemba. The trip becomes financially affordable as the result of some narrative gimmickry involving a financial settlement of $800,000 from the company that put asbestos in equipment Glynis had used years before. They would spend the rest of their lives there, longer for some than for others.   

View full annotation

Calcedonies

Nisker, Jeffrey

Last Updated: Jan-17-2018
Annotated by:
Duffin, Jacalyn

Primary Category: Literature / Plays

Genre: Play

Summary:

The play has two characters: Ruth and Friend (who is a male doctor).Ruth is an engaging, straight-talking quadriplegic who can zip and dance with her chin-operated wheelchair and takes delight in terrorizing medical staff both physically and verbally. She wants to write poetry and is waiting for a device to make it possible for her to use a computer. She keeps developing bedsores that threaten her life and require long admissions to the hospital before they will heal. She desperately wants to live no matter what happens, as she feels that having no mind would be worse than having no body.Friend is a male doctor with children who is ashamed of having examined her while she was unaware. Burdened with his guilt, he asks to be her “friend.” Ruth is skeptical and runs circles around him, but eventually comes to trust him and believe in his sincerity.She makes him a witness to her advance directive to instigate all heroic measures, as she is afraid of the kindly "ethical" and cost-effective arguments not to treat the disabled. But Ruth dies horribly from sepsis, and Friend is helpless to prevent it. She never obtains the device that would have allowed her to put her poems into printed words.

View full annotation

Patiently Waiting For…

Nisker, Jeffrey

Last Updated: Jan-17-2018
Annotated by:
Duffin, Jacalyn

Primary Category: Literature / Fiction

Genre: Novel

Summary:

An artist, Ruth, lives with quadriplegia and manages to drive (and dance) with a special wheelchair that she controls with her chin. She also enjoys terrorizing doctors in the hospital corridors, where she is seen on a regular basis because of frequent bouts of infected bedsores. She has a new computer and is “patiently waiting for” a biomedical engineer to set it up to manage, like her chair, with her chin. She wants to write, to draw, to create. But the wait list is long, technicians scarce, and every candidate deserving.

On one of her admissions, Ruth meets the physician-narrator who is appalled by a medical resident’s lack of empathy in relating her case as if she were not present. Distressed by the encounter, the doctor is all the more disturbed when he notices that Ruth’s birth date is the same as his own.

He tries to make it up to her by withdrawing from her care in order to be her “friend,” one who tries to understand and will defend her strong desire to live despite her disability. Driven by curiosity about her past, her sharp wit, and how she faces each day, the doctor never quite achieves his goal and constantly feels guilty for letting her down as an advocate and a friend, and possibly also for being able-bodied himself.  He never visited her in her group home, and when she comes to hospital in florid sepsis, he is unable to prevent his colleagues from letting nature take its course. His own bout with severe illness, possibly MS—more likely a stroke--resonates with Ruth’s plight. Long after her death, he can imagine the acid remarks that she would make about his foibles.

View full annotation

Life & Times of Michael K

Coetzee, J. M.

Last Updated: Jan-09-2018
Annotated by:
Galbo, Sebastian

Primary Category: Literature / Fiction

Genre: Novel

Summary:

A civil war rages inexorably in J. M. Coetzee’s novel, Life & Times of Michael K. Details of the war are vague, but the fighting will determine whether “minorities will have a say in their destinies” (Coetzee 157). Riots splinter communities, peoples are displaced, the military patrols and slaughters, and prison camps are erected. The novel’s first half introduces an unlikely protagonist at the center of the bloody tumult: Michael K, a municipal gardener—a gentle “simpleton” with a harelip “curled like a snail’s foot”—who cares for his ailing mother in Cape Town (3). Sick and unable to work, K’s mother resolves to return to her birthplace and girlhood home, Prince Albert, a far-flung cluster of homesteads in the Karoo, where she hopes to convalesce peacefully. Their migration permits, however, never arrive, likely lost in the abyss of State bureaucracy. Gathering his mother and their few possessions in a makeshift wheelbarrow, K attempts the arduous journey anyway but the passage is thwarted by a government checkpoint. As his mother’s condition deteriorates, she is hospitalized and dies, her body cremated before K gives hospital officials consent.  

The novel’s lulling elliptical cycle pushes K along the currents of departure and circumvention, to capture and escape. Pressing on to Prince Albert where he will deliver his mother’s remains, K is arrested and incarcerated in a railcar where he and other prisoners remove landslide rubble from a remote part of the rail line. Released after finishing the labor, K arrives to Prince Albert where he settles on the property of the ramshackle homestead and begins contentedly scavenging. Far from the tremors of war, he hunts birds, nibbles roots and bulbs, turns over rocks for grubs, drinks from streams, and, in a fit of wild hunger, drowns and slaughters a wild goat. All the while he finds a package of pumpkin and melon seeds that for the rest of his time on the property he will sedulously plant and water— “[t]his was the beginning of his life as a cultivator” (59). Immersed in this blanched world, at the center of its arid winds and mineral expanses, K devotedly coaxes his mean crop to life. But the war encroaches on K’s hiding place and he absconds to a mountain cave where he hides, and nearly starves.  

The stillness, silence, and sunlight of the Karoo seep into K’s bones: “If I were cut, he thought, holding his wrists out, looking at his wrists, the blood would no longer gush from me but seep, and after a little seeping dry and heal. I am becoming smaller and harder and drier every day” (67). Imperceptibly, K becomes the ephemeral ‘stuff’ of this harsh land: “He thought of himself not as something heavy that left tracks behind it, but if anything as a speck upon the surface on an earth too deeply asleep to notice the scratch of ant-feet, the rasp of butterfly teeth, the tumbling of dust” (97). K is shortly captured by the military and forced into a resettlement camp. Through the elliptical current of the novel, he escapes and returns to the Prince Albert homestead, where he finds his crop trampled. He nourishes the vines back to life and, in a moment of lonely exaltation, grills pumpkin flesh: “All that remains is to be a tender of the soil. […] He chewed with tears of joy in his eyes” (113). What K seeks, or what is seeking him, is a life of solitude, remote from peril and unrest, living in quiet reciprocity with the earth, exercising simple cultivation—a skill conspicuously anachronistic (but universally essential) in an age marked by the depravities of war.  

Wringing nourishment from veld-grown pumpkins, however, leaves K famished, and winds and squalls gut his makeshift shanty. Soon K is picked up, again, by a military patrol (he is suspected of abetting rebels camping in the mountains) that consigns him to a government hospital. The novel’s latter half is narrated by the hospital’s medical officer, a caring man who, doubtful of the war’s objectives, takes special interest in K’s recovery. By now, severely malnourished, K resembles “someone out of Dachau” (146). The medical officer is baffled by K, not for his uncooperative responses nor refusal to eat hospital food, but because of his status as a kind of ahistorical oddity in a time of modern warfare: “a human soul above and beneath classification, a soul blessedly untouched by doctrine, untouched by history, a soul stirring its wings within that stiff sarcophagus […] a creature left over from an earlier age, like a coelacanth or the last man to speak Yaqui” (151). The medical officer realizes K’s condition lies beyond simple diagnosis; rather, K’s body craves “a different kind of food, food that no camp could supply” (163). Sometime in the night, K vanishes from the hospital with his packet of pumpkin seeds, moving toward another remote patch of earth to cultivate.

View full annotation

The Children Act

McEwan, Ian

Last Updated: Jan-05-2018
Annotated by:
Duffin, Jacalyn

Primary Category: Literature / Fiction

Genre: Novel

Summary:

Approaching age 60 and childless, Fiona Maye is a family court judge who must decide if 17 year-old Adam has the right to refuse blood transfusions for his leukemia. He and his parents are Jehovah’s Witnesses.  The Children Act does not allow a child to make this decision until age 18. Fiona is an atheist and her 35-year marriage to an academic is falling apart.  She takes the extraordinary step of visiting Adam to know him and understand his conviction. He is beautiful and gifted, he writes poetry and plays violin. Why would he not want to try to live? She makes her decision having no idea if it will be morally, legally or medically right. To say more would spoil it.

View full annotation

Summary:

Dr. Monika Renz’s work with dying patients is unusual if not unique in the way she appropriates and applies insights from Jungian depth psychology, practices available in patients’ faith traditions, and musically guided meditation to invite and support the spiritual experiences that so often come, bidden or unbidden, near the end of life.  An experienced oncologist, Dr. Renz offers carefully amassed data to support her advocacy of focused practices of spiritual care as a dimension of palliative care, but is also quite comfortable with the fact that “neither the frequency nor the visible effects of experiences of the transcendent prove that such experience is an expression of grace” because “unverifiability is intrinsic to grace.”  Still, her long experience leads her to assert not only that “grace” can be a useful, practical, operative word for what professional caregivers may witness and mediate but also that affirmation and support of patients’ spiritual, religious, or transcendent experiences in the course of dying can amplify and multiply moments of grace, which manifest as sudden, deep peace in the very midst of pain, profound acceptance, openness to reconciliations, or significant awakenings from torpor that allow needed moments of closure with loved ones.  Describing herself as “an open-minded religious person and a practicing Christian,” she reminds readers that God is a loanword, whose basic form in Germanic was gaudam, a neutral participle.  Depending on the Indo-Germanic root, the word means “the called upon” or “the one sacrificed to . . . .”  Openness to the divine in both patients and caregivers, Dr. Renz argues, can and does make end-of-life care a shared journey of discovery and offer everyone involved a valuable reminder that medicine is practiced, always, at the threshold of mystery.

View full annotation

Primary Category: Literature / Nonfiction

Genre: Memoir

Summary:

Victoria Sweet describes her training in medical school, residency, and work in various clinics and hospitals. From all of these she forms her own sense of what medical care should include: “Slow Medicine” that uses, ironically, the best aspects of today’s “Fast” medicine.   

Her dramatic “Introduction: Medicine Without a Soul” describes poor—even dangerous—care given to her elderly father at a hospital. An experienced physician, she calls Hospice and saves him from a “Death Express” the hospital has “quality-assured” (pp. 6, 8). 
 
The book continues with 16 chapters in chronological order. The first ten describe Sweet from a late ‘60s Stanford undergrad and “a sort of hippie” (p.14), next a learner of “facts” in preclinical studies at Harvard, plus the clinical rotations (including Psychiatry, Internal Medicine, Pediatrics, and electives), then an internship as a doctor and her work in various clinics and hospitals. Throughout she’s collecting skills, concepts, even philosophies (Jung, feminism, Chinese chi, value of stories). She also describes particular patients important to her learning. She dislikes “just good enough” medicine at the VA (p. 95), “unapologetic budgetarianism” (p 141), medicine that is reductive and uncaring, and futile care for dying patients.  

Halfway through, we find an “Intermission: In which Fast Medicine and Slow Medicine Come Together.” With a year off, Sweet signs on as physician for a trekking group headed for Nepal. Unexpectedly, she treats an Englishman in the Himalayas. Returning home, she treats a man whose pulse is declining and rides a helicopter with him to a hospital. She realizes that she can take on the full responsibility of being a doctor, including when to use Fast medicine and when to use Slow.  

The following chapters deal with the 1980s emergence of AIDS, a hand injury to Sweet (she sees herself as “a wounded healer,” p. 182), her new understanding of medicine as “A Craft, A Science, and an Art” (Chapter 12) and conflicts between medical care and economics-driven medicine (“checked boxes,” administrators, quality assurance, even outright corruption).  She scorns use of the labels “health-care providers” and “health-care consumers” (p. 211) and discovers Hildegard of Bingen’s medieval vision of medicine. She works for 20 years at Laguna Honda, the topic of her earlier book God’s Hotel (2012). Chapter 16 closes the book with “A Slow Medicine Manifesto.”  

Sweet pays tribute to her teachers, both in a dedication to the book, and throughout the pages: professors, preceptors, nurses—especially a series of Irish Kathleens—and patients. There are some 20 case studies of patients throughout the book, their medical dilemmas, their personalities, and Sweet’s Slow Medicine that involves creating a healing relationship with them, finding the right path for treatment, even watching and waiting.

View full annotation

Annotated by:
Miksanek, Tony

Primary Category: Literature / Nonfiction

Genre: Memoir

Summary:

In this follow-up to his masterful memoir Do No Harm, British neurosurgeon Henry Marsh must deal with old age and retirement after nearly four decades as a doctor. Stepping down engenders mixed feelings, and he confesses to "longing to retire, to escape all the human misery that I have had to witness for so many years, and yet dreading my departure as well" (p17).

Marsh keeps busy by spending time in Nepal training young doctors and operating. He also makes visits to the Ukraine to perform surgery and teach. He has a fondness for creating things and purchases a fixer upper cottage that he struggles to repair. Marsh recounts previous neurosurgical cases, mostly patients with brain tumors. He remembers the distress at being sued by patients. He reveals his own admission to a psychiatric hospital as a young man. Regrets, both personal and professional, are confessed.

View full annotation

Annotated by:
Natter, Michael

Primary Category: Literature / Nonfiction

Genre: Graphic Novel

Summary:

Taking Turns, Stories from HIV/AIDS Care Unit 371, is a graphic novel written and illustrated by nurse and artist, MK Czerwiec. In it, she details what it was like to be a nurse during the AIDs epidemic in Chicago in the 1990s. The book, however, is much more than a story about AIDS care during that time. Czerweic tackles patient/provider relationships, boundaries, hospital struggles, the role of art in medicine and healing, but most profoundly: death and dying. 

View full annotation