A Matter of Death and Life

Yalom, Irvin; Yalom, Marilyn

Last Updated: Jun-02-2022

Coulehan, Jack

Primary Category: Literature / Nonfiction

Genre: Memoir

Summary:

After 65 years of marriage, two life-partners face the prospect of final separation, as one of them develops multiple myeloma. This is the crisis that led Irvin Yalom, eminent psychiatrist, novelist, and pioneer of existential psychotherapy, and his wife Marilyn, acclaimed feminist author and historian, to collaborate in writing the story of their journey through Marilyn’s final months of life. In the resulting book, Irvin and Marilyn write alternating chapters until Marilyn becomes unable to write. After her death, Irvin continues with the story of his bereavement.

Marilyn’s chapters include reflections on love and illness, ranging from Emily Dickinson and Henry James to Paul the Apostle. She frequently expresses her gratitude: “I can still talk, read, and answer my emails. I am surrounded by loving people in a comfortable and attractive home.” (p. 20) Most of all, she is thankful for her husband, “the most loving of caretakers.” (p. 15) Yet, as her disease progresses, she comes “to the understanding that I would never be the same again—that I would pass through days of unspeakable misery while my body would decline and weaken.” (p. 76) She decides to pursue the option of physician-assisted suicide, which is legal in California, when her suffering becomes overwhelming.

In his chapters, Irvin resists this decision, maintaining hope for additional “good” life, despite all evidence to the contrary. Near the end, Marilyn’s pain and other symptoms become so severe that she cries out, “It’s time, Irv. It’s time. No more, please. No more.” (p. 139) Her physician arrives, confirms her intention, and surrounded by her whole family, Marilyn sucks the liquid through a straw and quietly passes away.

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Ward Rounds

Beernink, K. D. (Kenneth Dale)

Last Updated: Apr-25-2022

Coulehan, Jack

Primary Category: Literature / Poetry

Genre: Collection (Poems)

Summary:

This is a collection of poems about patients, written by a young physician in the late 1960s. The book is organized around the theme of a hospital ward. Each poem is named for a patient and has the patient’s disease as its subtitle. The poet composed these poems during his own illness when, as he says in the original Introduction, “my patients reappeared to me, and I lived again in my mind all the many emotions we experienced together.” K. Dale Beernick died of chronic myelocytic leukemia at the age of 31 in 1969. In Ward Rounds he recounts his experiences as a medical student and house officer. He uses a variety of forms and techniques, including rhyme, blank verse, haiku, and even one villanelle. The poems vary in quality and impact. Among the best are "Penny Brown" (rheumatic heart disease), "Theodosus Bull" (delirium tremens), "Anonymous" (spontaneous abortion), and "Minnie Freeme" (post-necrotic cirrhosis).

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The First Wave

Heineman, Matthew

Last Updated: Apr-18-2022

Bruell , Lucy

Primary Category: Performing Arts / Film, TV, Video

Genre: Film

Summary:

First Wave documents the early days of the COVID-19 pandemic at Long Island Jewish Medical Center (LIJ) in New York from March through June of 2020. It opens with a graphic scene of a rapid response team trying to save a patient with COVID whose heart has stopped. Despite their efforts, the patient dies. After the team pauses for a minute of silence at the bedside, the grueling work of saving lives continues.

The film follows Dr. Nathalie Dougé, an internist who was born in the Bronx to Haitian parents. Most of her patients are Black, Hispanic or immigrant. Two patients with COVID are essential workers: Brussels Jabon, a Filipino nurse who undergoes an emergency C-section after she is brought to the emergency room, and Ahmed Ellis, a school safety officer with the NYPD. Both have young children and supportive families.

Nurses hold up IPads so families can Facetime with the patients. It’s terrifying and sad for the families to see the patients on screen and not to be present when they are needed the most. It’s emotionally difficult for the healthcare team as well who are the only ones to hold a patient’s hand during these encounters. One nurse describes the effect of holding the phone while family members have five minutes to Facetime with patients, “You become the family member, and it seems like you’re losing your family.”

The emotional toll of losing so many patients, while fearing that they too may contract the virus and bring it home to their own families, weighs heavily on the healthcare teams. They are trained to compartmentalize, to separate work from personal life but their empathetic response to their patients follows them home. “I think about him every night when I go home,” nurse Kelli Wunsch says of Ahmed. “I just want him to do well.”

Scene after scene of teams rushing to resuscitate a patient who has coded are interspersed with more hopeful moments of a reunion between husband and wife, the sound of the song “Here Comes the Sun” when a patient is taken off the ventilator, and the cheerful encouragement of a physical therapist working to help a patient regain enough strength and mobility to be discharged. At times the camera moves outside the confines of the hospital to the outside world: Dr. Dougé alone at home with her dog celebrating her birthday with friends over zoom, eerily empty streets during the lockdown, and families anxiously awaiting news from the hospital. We see bodies taken to refrigerated trucks and people cheering the health workers at 7pm from windows across the city.

In May, when protests erupt following George Floyd’s murder, Dr. Dougé, joins the protest with other frontline workers carrying a sign, “Racism is a Public Health Issue” and ”I Can’t Breathe” scrawled on her surgical mask. Amid the “I Can’t Breathe” cries of the protestors, she relives the myriad times she has heard her patients gasping those words to her just before they are placed on ventilators.

Both Brussel and Ahmed become stable enough to be taken off the ventilator and released from the hospital to return home to their families. Despite their recovery from the acute phase of the illness, it is clear their health remains severely compromised. As the cheers of the staff in the hospital lobby fade, tough work lies ahead for these patients and their families.

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The Shapeless Unease: A Year of Not Sleeping

Harvey, Samantha

Last Updated: Apr-04-2022

Teagarden, J. Russell

Primary Category: Literature / Nonfiction

Genre: Memoir

Summary:

In the opening dialog, the author, Samantha Harvey, tells a friend what this book is about.

Friend:    What are you writing?
Me:    Not sure, some essays. Not really essays. Not essays at all. Some things.
Friend:    About what?
Me:         Not sure. This and that. About not sleeping, mainly. But death keeps creeping in. (p. 1)

That’s as good a description of the book as could otherwise be offered.

As unstructured as the book’s content is, so is the book’s format. The only breaks in the text are distinguished by infinity signs. Time stamps are placed within the text between some of these breaks. The times are sequenced during a night (or a composite of nights) when Harvey is awake between midnight and 7:30 am. Texts following the time stamps describe the acute effects of insomnia on her at those particular moments and could be read as diary or journal entries.

Harvey’s insomnia came suddenly at the age of forty-three and morphed into an unrelenting assault that at times made her wonder if the only sleep available to her is the sleep of the dead.

When I don’t sleep and don’t sleep and don’t sleep, I don’t want my life; neither do I have in me the propulsion (courage? know-how?) to take it. So I have to endure my life when it’s unendurable, and this is an impasse. (p. 33)

Can I escape this? The sword hangs. There is nothing to put my mind at rest – every day presents a new threat: the night. Every night is a battle, most often lost, and any victory is one day long, until its challenger comes along: the next night. I understand why people kill themselves, or break down. (p. 82)

Throughout the book, across all the text sections, and following all the time stamps, Harvey details what insomnia does to her physically, psychologically, and existentially. She desperately explores the possible causes such as menopause, fear, traffic noise, and Brexit among others, and heartbreakingly tells of all she has done to get sleep such as seeing doctors, smiling more, counting blessings, and changing behaviors. None come to any effect, as she reports to her unhelpful doctor.

I do these things, they don’t help.
Over time they will.
Over time they haven’t.
I feel unhelpable.
Nobody is unhelpable.
I am.
Nobody is. (p. 139)

Just as Harvey had informed her friend, she takes up other topics in other forms that directly or indirectly relate to her insomnia, and sometimes do not relate at all. Among the various forms are vignettes; thoughts and obsessions; meditations; and a short story. Topics include deaths in the family (including a dog’s); peculiarities of different languages; why so many TV shows have the word “secret” in their titles (she spends “nights spent thinking about this”) (p. 67); what fuels insomnia; how worry, anxiety, and fear differ from one another; writing; time; and the relationships between science and religion, and between reason and faith. Harvey’s background in philosophy shows.

A year on, Harvey discerns a cure for insomnia. Using a metaphor involving swimming against waves and currents or with waves and currents, the cure is to be derived from the “wisdom in knowing that we are sometimes the cause and influencer of our own currents and tides, which we make in otherwise still waters.” She further elaborates on this idea and how it leads to a moment when “you’ll drop each night into sleep without knowing how you once found it impossible” (p. 175).

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Seeing Red

Meruane, Lina

Last Updated: Jan-31-2022

Teagarden, J. Russell

Primary Category: Literature / Fiction

Genre: Novel

Summary:

Before it happened there was the dread of it. “They were brittle, those veins that sprouted from my retina and coiled and snaked through the transparent humor of my eye,” says Lina Meruane, the first-person narrator and main character. If those veins burst, Lina could go blind. All that can be done to prevent such a disaster she’s told, “is to keep watch day by day over its millimetric expansions...keep watch over the sinuous movement of the venous web advancing toward the center of my eye.” Adding to her dread are “impossible admonitions to follow.”

Stop smoking...don’t hold your breath, don’t cough, do not for any reason pick up heavy packages, boxes, suitcases. Never ever lean over, or dive headfirst into water. The carnal throes of passion were forbidden, because even an ardent kiss could cause my veins to burst. (p. 5)

And then, “it was happening. Right then, happening” (p. 3). She had only bent over to retrieve a syringe for her scheduled insulin injection. She’s paralyzed. “I didn’t straighten up or move an inch, didn’t even try to breath while I watched the show. Because that was the last thing I would see, that night, through that eye: a deep, black blood (p. 4).

Lina is in the dissertation stage of a PhD degree at a New York City university. The story veers from this pursuit to one of restoring her eyesight. The other primary characters are Lina’s Galacian love interest and fellow academic, Ignacio, who shepherds her through this journey, her New York retinal specialist, Dr. Lekz, and her parents who are both physicians—her father a cardiologist, her mother a pediatrician—practicing in Lina’s native country, Chile.

Soon after the bleeding incident, Lekz tells Lina that at least a month would be needed for her eyes “to clear up so I can take a look at this mess” (p. 32). “Weren’t you going to go to Chile to see your family? Go to Chile. Take a vacation” (p. 33). The story relocates from New York to Santiago, and from Lina’s medical problems to her familial dynamics—“I never wanted you to be my doctor, it’s enough for you to be my father” (p. 50). The visit also becomes a time for Lina—and Ignacio—to see what life might be like if she never regained full sight, and to contemplate options for such an eventuality. She had become “an apprentice blind woman” (p. 20).

Lina and Ignacio return to New York city for the hoped-for reparative surgery. The procedure produces promising signs, but Lina must wait at least the four weeks it takes for Helium gas bubbles to dissipate so Lekz can see the results. During this period, Lina tries to keep her head position down and her spirits up. Often the opposite resulted. Before four weeks passes, however,

Blood, again, in my eye. A fine thread of blood that comes from I don’t know where...I’m watching as the eye watches its thread of blood, looking at everything without ceasing my cries: I’m bleeding I’m bleeding again. (p. 142)

Futility looms, “knowing they were going to operate on me but that no cure existed” (p. 113). Lina and Lekz consider their options. After Lina’s initial bleeding incident, Lekz had “dropped the phrase transplants in experimental stages” (p. 5). The idea stuck with her. She had spoken about it separately with her mother and Ignacio. Both were fraught conversations. Nevertheless, Lina and Lekz return to the topic.

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Mysterious Medicine: The Doctor-Scientist Tales of Hawthorne and Poe

Poe, Edgar Allan; Hawthorne, Nathaniel

Last Updated: Jan-25-2022

Field, Steven

Primary Category: Literature / Fiction

Genre: Anthology (Short Stories)

Summary:

Mysterious Medicine: The Doctor-Scientist Tales of Hawthorne and Poe is one in a series of books called Literature and Medicine dedicated to the exploration and explication of the intersection of the two titled disciplines. This volume, edited by L. Kerr Dunn, looks at the short stories (mostly—it includes one sonnet) of Nathaniel Hawthorne and Edgar Allan Poe from the viewpoint of each author’s use of, and in some cases experiences with, doctors, diseases, and the medical profession. The volume begins with an Introduction that situates the writings within the medical and social milieu of the period (the authors were contemporaneous) and illustrates the way in which the tales reflect the times.

The stories are grouped by author and arranged chronologically. Among the nineteen entries included are “The Minister’s Black Veil,” “Lady Eleanore’s Mantle,” “The Birthmark,” and “Rappaccini’s Daughter” for Hawthorne, and “The Black Cat,” “The Fall of the House of Usher,” “Berenice,” and “Some Facts in the Case of M. Valdemar” for Poe; each entry is preceded by a brief introduction and followed by discussion questions. An extensive list of scholarly references closes out the volume.

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Nervous System

Meruane, Lina

Last Updated: Dec-13-2021

Teagarden, J. Russell

Primary Category: Literature / Fiction

Genre: Novel

Summary:

Ella needs time for finishing her doctoral dissertation on black holes she has been writing for years and thinks an illness could provide the time: “Just enough to take one semester off, to not have to teach all those planetary sciences classes to so many distracted students whom she had to instruct evaluate forget immediately (p. 6). Before she can decide which illness would best suit her purposes, a mysterious illness finds her.

A sudden cramp shoots down the spine and then, stillness... (p. 9)

An unbearable stinging had settled into her shoulder neck ember... (p. 10)

She felt an invisible wound wrapping her up and suffocating her... (p.10)

A slight numbness that starts in the shoulder and extends along the arm to the elbow until it reaches the back of her right hand, the fingers where it all started. (p. 12)

Inflammatio. In flames. En llamas. Ardor without romance. (p. 10)

Quickly, then, the story shifts from Ella’s dissertation odyssey to her diagnostic odyssey. As she makes her way along this journey during the first chapter, other characters come into the picture: El, Ella’s long-term boyfriend and forensic scientist, is one. The others in her family history are “the Father,” “the Mother,” “the Brother,” and “the Twins”—none are ever named (neither, really, is Ella or El because they are “she” and “he,” respectively in Spanish). Except for the Twins, each of the subsequent four chapters center on one of these characters and how they figure into the family history. Just as in the first chapter, the stories are told through and around the health challenges each character faced; all harrowing, many life-threatening, and some metaphorical.

Ever present in these histories is the story of Ella’s birth mother,“genetic Mother”. She died giving birth to Ella. Ella’s stepmother, “the Mother,” is called at different times, “the volunteer Mother,” “the replacement Mother,” and “the living Mother.” The Brother, alternatively known as “the Firstborn,” shares with Ella her birth mother and was born nine years before her. The Twins, known separately as “the Boy Twin” and “the Girl Twin,” came after the Father remarried. Another dimension shaping the stories is both the Father and the replacement Mother work as practicing physicians.

Ella’s prominence in each chapter makes her our witness to El’s recovery after an explosion rips through his mass grave excavation site, and his many surgeries for separate gastrointestinal troubles; the Mother’s aggressive and brutal breast cancer treatment; the Firstborn’s recurring bone fractures (an “osseous enigma”); and the Father’s bleeding ulcers and life-threatening hemorrhagic complications from prostate surgery.

The author, Lina Meruane, structured the book in a somewhat unconventional form. She delineates sections within each chapter with asterisks centered on the page (“***”), and these sections rarely comprise more than two paragraphs. Dialog is neither separated from other text nor signaled with quotation marks. The text moves back in forth in time, from here to there in place (presumably somewhere in South America), and sometimes takes the form of pensées rather than plot narrative. But, overall, the book moves towards resolving some mysteries surrounding family history.

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The Problem of Alzheimer’s

Karlawish, Jason

Last Updated: Nov-29-2021

Teagarden, J. Russell

Primary Category: Literature / Nonfiction

Genre: History

Summary:

In a 1976 Archives of Neurology essay, the neurologist Robert Katzman successfully argued for relabeling “senility” as “Alzheimer’s disease.” He urged rejecting various forms of dementia and senility as common consequences of aging, and accepting them as a disease requiring all the attention any other important disease deserves. Now medicine and society had a problem—"The Problem of Dementia,” the famed physician Lewis Thomas called it in a 1981 essay published by the popular magazine Discover, and he noted that, suddenly, “a disease of the century” had arisen (p. 3).

Forty years on, Jason Karlawish thinks there is still a problem, but in keeping with Katzman’s call, he refers to “The Problem with Alzheimer’s.” Based on the history he covers and the experiences he shares in this book, nothing of much significance has occurred since “The Problem of Dementia” became the “The Problem of Alzheimer’s.”

Karlawish is a physician who cares for people with Alzheimer’s and a researcher delving into “issues at the intersections of care, ethics, and policy” (p. 5). He draws on his experiences in this book, which he describes as “the story of how once upon a time, Alzheimer’s disease was a rare disease, and then it became common, and then it turned into a crisis.” Karlawish wants to answer why during the time between Thomas’ essay and the year 2010, “nothing really changed,” and how that could be the case in “the richest and most powerful nation.” (p. 6) He tells this story in four parts.

The first part concentrates on efforts clinicians and researchers were making following Thomas’ call to distinguish Alzheimer’s disease from normal aging, other dementia types (e.g., frontotemporal, Lewy body), and precursor syndromes (e.g., minimal cognitive impairment). They were looking for definitive clinical patterns, imaging studies, diagnostic tests, and pathologic markers for the disease.

In the second part, Karlawish goes back in time to when Alois Alzheimer first found what are known today as “plaques” in the brain of a patient who had an early onset of severe, progressive dementia. He traces the attention this finding drew to eventual advances in imaging and biochemistry aimed at diagnosis. Karlawish also covers how a cascade of events over the decades following Alois Alzheimer’s finding disrupted the pursuit of a pathophysiological basis for dementia. These events included the rise and dominance of Freudian psychology; followed by two world wars; the cold war; the overshadowing of AIDS; Medicare political and funding constraints; tussles among patient advocacy groups; loss of asylums where care and research had coexisted; clinical failure of the first drug; and the continued debate over whether dementia is a consequence of aging or is a disease.

Karlawish moves on in the third and fourth parts to cover what “we will have to learn to live with the disease so as to improve the lives of persons...to provide the care they need to live well at home...and repair the broken system” (p. 171). Success in his view requires integrated biological, psychological, and social components. He reports the progress on each of these three fronts: some failed approaches continue to fail (such as drugs targeting amyloid); some psychological interventions show promise (though at times causing moral tension); some of the social configurations engineered for Alzheimer’s patients, families, caregivers, and society have produced triumphs and some disasters. He has much to say about why and how this search must go on, but with some much-needed course corrections.

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How To Be Depressed

Scialabba, George

Last Updated: Nov-28-2021

Glass, Guy

Primary Category: Literature / Nonfiction

Genre: Collection (Essays)

Summary:

How To Be Depressed is a book with a most unusual structure. It is introduced by an essay entitled “Intake” that was previously published in a literary magazine. The bulk of the book, “Documentia,” is taken up by an edited selection of the author’s psychiatric records from 1969 to 2016. It is rounded out by an interview with the author and by his “Tips for the Depressed.”

Author George Scialabba ascribes his “exceptionally flimsy…shock absorbers” to his “constantly worried” parents (p.3). While studying at Harvard he becomes involved with a strict religious organization. After leaving that group he undergoes a crisis of faith and his first episode of depression. Paralyzed by self-doubt, he drops out of graduate school and begins a cycle of clerical jobs that are beneath his intellectual capability. After many years he gradually wins distinction as a freelance essayist. However, due to his incapacitating symptoms he never has a steady writing job and has difficulty attaining financial security.

In his introduction, Scialabba tells us that “the pain of a severe clinical depression is the worst thing in the world. To escape it, I would do anything” (p.1). As attested to by the notes of his well-meaning psychiatrists and psychotherapists, he has diligently applied himself to a wide variety of treatments. Sadly, if anything he gets worse over time, and eventually requires electroconvulsive therapy.

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Oli Otya? Life and Loss in Rural Uganda

Bruell, Lucy

Last Updated: Oct-27-2021

Field, Steven

Primary Category: Performing Arts / Film, TV, Video

Genre: Film

Summary:

Most of us are aware that the discipline of Palliative Care, with its focus on excellent pain management, other comfort measures, and psychosocial and spiritual counseling, has made a dramatic difference in the way patients are treated near or at the end of life. However, for most of us, knowledge of Palliative Care is usually limited to how it functions in so-called “first world” countries. What is Palliative Care like in areas around the world that have less-effective systems of health care delivery?

Lucy Bruell’s documentary, Oli Otya: Life and Loss in Rural Uganda, aims to tell this story. Bruell, an award-winning documentarian (and coincidentally—and full disclosure—the Editor-in-Chief of the NYU Literature, Arts, and Medicine Database), follows a husband-and-wife team, an internist and a palliative care specialist, who travel each year to Uganda to volunteer with a small palliative care service based in a rural hospital. Along with the team nurse, nursing assistant, and spiritual counselor, and a medical student who has accompanied them for this trip, they see patients in the hospital, the clinic, and most of the time, in the patients’ homes, often covering many miles in a day in this rural area of the country.

It is the stories of these patients that constitute the heart of the film. A woman who has been catastrophically burned in a revenge crime, a man with metastatic cancer who can no longer walk, a woman with end-stage rheumatic heart disease who insists on gifting the team with a live chicken for their work, a young man with a progressive neurodegenerative disease whose mother ascribes his behavior to demons—we meet these and other patients as the team makes its rounds, interacts with villagers and herbalists, and fights to overcome shortages of critical medicines.

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