Summary:

Artist Sue Coe's mother Ellen was 64 years old when she was diagnosed with terminal cancer. The artist and her sister went to Liverpool to be with their mother at home, since Ellen did not wish to spend her last days in hospice. Sue Coe documented her mother's last days by drawing her, producing the series, "The Last 11 Days: July 20th to July 31, 1995." In the first drawing, dated July 20 (first drawing, right side), Ellen was still at the hospice. The drawing concentrates on face and hand, which are also the main features of other drawings in the series. The hand is large and bony as it is brought to Ellen's mouth, which is partially covered by the hand. Ellen's eyes are wide open and express anxiety and fear.

In a drawing dated July 31 (last drawing, left), the last day of Ellen's life, the artist's face and hands loom large in the right foreground while in the left rear the mother lies in bed, a small thin figure, barely awake, mouth open, her large skeletal hands resting on the blanket. The artist's face is thoughtful, sad, resigned--her thoughts seem to be drifting.

Another drawing, dated July 29 shows the artist's sister cradling Ellen in her arms, supporting her head. The mother's eyes are closed and she appears peaceful, comfortable. Of this scene, Coe writes that her sister was "reading a Stephen King novel behind the pillow. That's the only way she could survive, reading a Stephen King novel that just made her mind go blank." (National Museum for Women in the Arts Magazine, Holiday, 2005, p.20)

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Benjamin Rubin is completing his surgical residency in a Tel Aviv hospital when the director of the hospital asks him to accompany him and his wife to India to rescue their daughter who is critically ill.  This invitation distresses him, as he recognizes in it a way of removing him from competition for a position in surgery at the hospital.  He makes the trip, however, and is entranced by Indian culture and mysticism, and, eventually, not by the daughter but by the mother he accompanied.  Back in Tel Aviv, he has a brief affair with the mother, moves into an apartment she owns, leaving his mother's home, and, to allay his obsession with an unavailable woman, marries an independent-minded woman who has also traveled in India and absorbed Buddhist spirituality and Eastern philosophy she discovered there.  Working as an anesthesiologist, Benjy continues in that setting, conflicted about both work and life, unable to connect deeply with any of those whose love he has received or sought.  Eventually his wife leaves with their baby daughter to return to India, where she has found a spiritual home, and Benjy remains in a divided state of mind in a divided country where his own spiritual heritage remains to be plumbed.

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First published in France as a six-volume series from 1996-2003, this narrative is often referred to as an autobiographical graphic novel, but it is more accurately described as a graphic memoir. The author, born Pierre-François Beauchard, tells and draws the story of his family's life with the author's older brother, Jean-Christophe, whom we meet on the first page, in the year 1994: "It takes a moment for me to recognize the guy who just walked in. It's my brother . . . The back of his head is bald, from all the times he's fallen. He's enormously bloated from medication and lack of exercise." Flashback to 1964 when the author is five years old and his seven-year-old brother begins to have frequent grand mal epilepsy seizures. There follows the parents' mostly fruitless search for treatment to control the seizures, including: possible brain surgery which Jean-Christophe refuses in favor of an attempt at zen macrobiotics (this seems to work for six-months), consultation with a psychic, Swedenborgian spiritualism, magnetism, alchemy, exorcism by a priest, psychiatry (a different form of exorcism!).

Jean-Christophe's illness transforms family life as other children mock and fear the boy, the family moves to an isolated area, joins communes, and attempts to cope with Jean-Christophe's increasingly disturbed and disturbing behavior that alternates between passivity and physical aggression. The author has vivid visions and dreams and changes his name to David ("a symbolic act. I've won the war [against the threat of acquiring epilepsy" (164)]; his sister Florence suffers from constant anxiety; his mother grieves for many months after her father dies. As an adolescent and young man Jean-Christophe spends time in several institutions for handicapped individuals as well as at home, where he lives a desultory existence that is interspersed with violence toward the author and his father.

David escapes to Paris, living in a studio apartment paid for by his father, reading, writing stories, drawing, and attending classes at the Duperre School of Applied Arts. "I had to draw and write constantly. I had to fill my time in order to prevent my brother's disease from reaching me" (276). He is lonely but avoids people, feels guilty for neglecting his brother and ‘picking on' him yet is fearful that he too will be taken over by epilepsy, or death. Equally upsetting is when David discovers writings by Jean-Christophe: "He speaks of his despair and loneliness and the words might as well have come from my pen" (316). On and off, in moving displays of empathy, the author attempts to understand what happens to his brother during the seizures -- is he conscious, where does he go, does he die temporarily?

Within the narrative are intercalated multigenerational family histories that include two world wars, and European philosophical and cultural movements that influenced his parents and their search for treatments. The final section of Epileptic relates in words and images the author's adult life as he becomes a commercial artist; struggles through several relationships with women; his own infertility; his ever-present confusion, anger, and misery about his brother's illness; and his founding with five colleagues of the independent publishing house, L'Association: "It's the creation of L'Association that saves me" (327).

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Eloy’s grandmother—his abuela—is dying of cancer.  She has been his faithful companion, teacher and refuge in a home where his parents often fight and his older brother seems to have lost interest in him.  He believes the only thing that will save her now is for him to make the annual pilgrimage on foot to the chapel at Chimayo, 17 miles from their New Mexico home, but his parents, both of who work full time, can’t go with him and won’t hear of his going alone.  Desperate for a miracle, and believing she can be saved by the blessed soil distributed at the chapel where many seem to have experienced miracles of healing, he sets out in secret early in the morning.  On the way a friendly dog begins to follow him and, despite Eloy’s efforts to get rid of him, travels the entire 17 miles with him, sharing the water Eloy reluctantly offers him from the canteen that once belonged to his grandfather.  Much of the story follows Eloy’s thoughts as he travels, and the small difficulties and surprises along the way.  As he finally sees the chapel in the distance, he hears his brother driving by slowly in his low-rider with tinted windows.  Angry at the brother who has given him no support so far and seems to be mocking him, Eloy flips him the finger.  Later, as he stands in line for the sacred soil, his brother enters the chapel with their abuela on his arm.  She explains to Eloy that she is indeed going to die, and that God has other ways of answering prayers.  She sees that Eloy has been sent a companion, and encourages him to bring the dog, whom he has now named, home with him.  His parents, who have steadily refused to let him have a dog, accept him, and Eloy comes to new terms with his grandmother’s approaching death.

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In 1849, Jane Johnson is on a ship headed for Quebec City with her two children. She has had a relatively uneventful crossing – only one old man died and a child was stillborn. She cannot wait to be reunited with her husband Henry. Having left a year earlier, he is waiting for her eagerly. They both now think that they should not have separated. They each clutch the handful of barely literate letters. She has sternly told him that he must be at the ship to greet them. Fully intending to be there, he suddenly falls ill with uncontrollable vomiting and diarrhea and is dragged to a hospital. It is cholera and he realizes that he will die without seeing his little family again. As the boat docks, she thinks she sees him in the crowd.

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Tish brings a knife to the breakfast table and threatens to use it on her stepfather if he tries to come into her room again.  Her mother, working at the sink, does her best to ignore the conversation, in which the stepfather moves from mockery to threats.  Tish carries the knife in her boots to school.  When her gym teacher insists on her removing her boots she begins to scream uncontrollably, is sent to the principal, and, unable to tell her secret, runs away.  She finally makes her way to a friend's father, a lawyer, who listens to her story and assures her of legal protection, though as the story ends, Tish has a lot of decisions left to make, and a long way to go before she feels safe and healed.

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Black Bag Moon is a collection (one is tempted to say a "mixed black bag") of short stories (but not clearly "short fictions" - clarified below) about medical patients. The reputed authors are identified as these patients' physicians, who recount these stories in first person. By my math, there are nine authors who narrate stories about 37 patients in 29 chapters. Most chapters have two patients in unrelated stories that sometimes share a theme. Several of the authors know each other as colleagues and two are a married medical couple. Most of the stories occur in Australia or New Zealand but some are in places are as far flung as England, Scotland and unidentified, possibly fictional, islands in the South Pacific. The practitioners are, for the most part, family physicians and care for people of all ages, providing care for everything from breast masses to congestive heart failure to trauma to occupational health to - almost overwhelmingly - mental illness threatening severe violence. The last - serious mental illness -  is, as are all the patients and their illnesses in this volume, almost exotically different from anything most readers of this database are likely to encounter as health care providers or readers. Think Crocodile Dundee or perhaps television's Dr. Quinn or ‘Doc' Adams of Gunsmoke. Or all the above but in the late 20th Century Outback.

Since most of the stories involve working men and women - mainly men - there is a decided flavor of  A. J. (Archibald Joseph) Cronin's The Citadel to the stories; but the peculiar aspect of Australia's frontier pervades each encounter with the patients in this book, whether they are being treated over the radio for breast lumps, being airlifted to the hospital for a badly broken elbow, or becoming demented from environmental toxins in a land and time wherein OSHA and DEP (and the principles underlying them) might as well be acronyms from Mars.

Curiously, for fiction, there are intermittent footnotes to literary (Honore de Balzac, Soubiran) sources, historical figures (Hippocrates) and relevant texts on subjects covered in the stories, e.g., petrol-sniffing, tropical diseases, and physical diagnosis. 

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At five years old, Willow O’Keefe has lived a life rich in love and exceptional learning; she reads beyond her years and has memorized a startling compendium of unusual facts.  She has also sustained over 50 broken bones, two of them in utero.  She has osteogenesis imperfecta, a congenital defect in the body’s production of type 1 collagen that leaves bones very brittle.  People with the disease generally suffer many fractures and often other conditions—exceptionally small stature, hearing loss, and bowed limbs.  Willow’s parents and older sister have organized their lives for five years around protecting her from damage and helping her heal from her many broken bones.  Though Amelia, her older sister, loves Willow, her parents’, Charlotte and Sean’s, intense focus on Willow’s condition often leaves her jealous and disgruntled.  Things go from bad to worse when their mother learns that a lawsuit for “wrongful birth” is legal in New Hampshire, and could bring them the money they need to cover Willow’s many medical expenses.  Such a step, however, means losing a best friend, since the obstetrician who oversaw Charlotte’s pregnancy and Willow’s birth, and who ostensibly overlooked signs of the disease and failed to warn the parents, has been Charlotte’s best friend for years.  A “wrongful birth” suit is based on the claim that medical information about a congenital defect was withheld that might have been grounds for a decision to abort the pregnancy.  Though Charlotte insists this drastic step is the best thing they can do to insure a secure future for Willow, Sean finds it repugnant enough finally to leave home.  It is clear that even a win will be a pyrrhic victory, and indeed, the outcome is ambiguous, costly, and life-changing for everyone concerned.

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Summary:

This collection of 16 short stories focuses on doctors and patients in San Francisco, where a wide variety of wealth and culture impact the delivery of medical care.  Further, there are many restrictions—financial, bureaucratic, ethical, and legal —that limit what doctors can do, especially in cases of patients near death.

The author, Louise Aronson, is a geriatrician who knows this terrain very well, having trained in San Francisco and worked as a physician there. A skilled writer and close observer, she has created dramatic and often funny stories that reveal social and bioethical complexity. About half the stories describe end-of-life issues for the aged and the dilemmas for their physicians and families.

In ‘The Promise,” Dr. Westphall orders comfort care only for an elderly patient who has suffered a massive stroke, but a hospital gives full treatment because there was no advance directive and the daughter told the attending to do “what he thought best.”

When Dr. Westphall sees this barely functioning patient in a skilled nursing facility seven months later, he tenderly washes her face and hair—although the text teases us that he might have been prepared to kill her.

In “Giving Good Death,” a doctor is in jail charged with murder; he has fulfilled the request of Consuela, a Parkinson’s patient, to help her die. When it appears that she may have died for other reasons, he is released, his life “ruined.” He leaves San Francisco, and, we surmise, medicine. In three other stories, doctors also leave the profession: the cumulative stresses of work and family and/or a sense that it’s not the right path bring them to that choice.

On the other hand, one of the longer pieces “Becoming a Doctor” celebrates the profession, despite all the rigors of training including sexism against women. 

The stories bring multicultural insights; we read of people from China, Cambodia, Latin America, India, Russia, and the Philippines. Some are African-American; some Jewish, some gay. These different backgrounds color notions of health, death, and medical care. There are also pervasive issues of poverty and, at another extreme, professionalism that is hyper-rational and heartless.

Indeed, a recurring theme is care and love for people, no matter their background or current health status. A surgeon realizes (regrettably too late) that the secret of medical care is “caring for the patient—for anyone—just a little. Enough, but not too much” (p. 135). 

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The first person narrator of this debut novel is a young pathologist, a woman who relates the story of her family over the course of the book. The story is bleak: a young German woman marries an Austrian soldier in WWII, moves to Austria with him and has three children - two sons (one of whom dies as a youth following abdominal surgery) and the narrator-daughter. In a running commentary, almost hallucinatory at times,  the narrator offers brief descriptions of  a traditional preliminary internship year during which she acts as a pathologist, cares for in-patients, and even makes a futile ambulance call to a fatally injured man in a freight yard.  Yet, virtually the entire novel revolves around her family:her father (whose tuberculosis is briefly described),  a factory worker with dreams of  inventing an electronic security relay (never realized); intermittent holidays of evanescent family happiness; and a long threnody about her father's eventual death at the end of the book from a hopeless and domestically abusive alcoholism. Her detailed description of his death traumatizes everyone around her and leads to a rupture in the family.

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