Summary:

Maren Grainger-Monsen, a filmmaker and emergency medicine physician, chronicles her personal journey towards understanding death and dying as she explores the stories of those near death. The film uses a metaphor of the thread of life, and the three Greek Fates who control life (spinning, measuring and cutting this thread), to interweave Monsen's journey with the lives--and deaths--she encounters.

The film begins with her recollection of two experiences during her emergency medicine training: the first time she is paged to pronounce someone dead and a "crisis point"--resuscitating a patient, brought to the emergency room, who had specifically requested no resuscitation. The remainder of the film focuses on Jim Brigham, a social worker for a hospice program, whom Monsen joins for his home hospice visits and who relates the touching and memorable story of his wife's life and death.

Some of the patients Jim visits are Tex, a man dying of heart failure who had experienced a difficult, scary night; Sean, who has Lou Gehrig's disease and who needs help with paperwork and family concerns; and Anna Marie, who has lymphoma and is taken via ambulance to the hospital for comfort measures. Monsen notes how comfortable Jim is discussing death issues and how compassionate and caring he is with a recent widow in the midst of her "grief work." By contrast, Monsen admits to feelings of helplessness, vulnerability, even terror. She wishes her medical education had not been so devoid of teaching regarding death and dying.

Monsen comments on the wavering line between life and death, and whether the "medical machine" prolongs life or death. She visits a young boy left with severe brain damage following a near-drowning incident and "successful" resuscitation 5 years previously. The boy requires constant care, but his father notes that his son is "doing pretty good."

By the end of the film, Monsen has learned "how to sit with someone . . . while death walks into the room." Death no longer equates with failure. She concludes with her overvoice, "I wonder what it will be like to be a doctor who doesn't see death as the enemy."

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Paul Edgecombe (Tom Hanks) is in charge of death row in a 1935 Louisiana penitentiary. The cell block is nicknamed "The Green Mile?due to its green linoleum floor--the path that an inmate must walk from his cell to the room with the electric chair. Paul, a decent, moral man, treats each prisoner with respect. His life changes, however, with the admission of John Coffey (Michael Clarke Duncan), a huge African-American man convicted of the rape and murder of two young sisters. Despite his powerful build, Coffey is gentle--and possesses a miraculous, mysterious power to heal.

Coffey heals Paul's bladder infection, resurrects a dead mouse, Mr. Jingles, that is the treasure of another inmate, "Del,?and cures the warden's wife of her inoperable brain cancer. Each healing requires direct contact between Coffey and the "patient,?and is accompanied by much electric and mystical effects. Coffey takes the infection, brokenness, disease into his body and is able to expel it, though it exhausts him.

Coffey's powers extend to visions and he directly feels the pain of others. He transmits his visions of the death of the two girls to Paul--who realizes that Coffey is innocent (indeed he had been trying to "heal?the children when he was apprehended) and that another inmate on the green mile is guilty of the crime. Paul, counseled by his supportive wife (Bonnie Hunt), asks Coffey what to do. Coffey, exhausted from suffering the knowledge of the evil of the world and cognizant of his lowly position as a poor black man, asks to have the execution proceed. His only request is to watch a "flicker show.?Paul arranges for him to see a Fred Astaire movie.

The executions are graphically depicted. One is particularly gruesome because of the evilness of the whiny, rookie guard, Percy, who deliberately causes a prisoner (Del) to suffer in the extreme. After giving the orders for Coffey's execution and watching him die, Paul quits his job.

The story is framed by Paul as an old man in a nursing home. Paul "tells?his story to another elderly "inmate?as an explanation for why he was overcome when watching the Fred Astaire movie in the common room. Paul reveals that he is far older than thought possible--as is Mr. Jingles who is still alive six decades later. Paul and the mouse were "infected with life?when touched by Coffey.

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Chicago architect Stourley Kracklite (Brian Dennehy) and his much younger, beautiful wife, Louisa (Chloe Webb), arrive in Italy to work for a year preparing an exhibition on his hero, the post-revolutionary French architect, Etienne-Louis Boullée (d. 1799). They make love as the train enters Italy; however, he scarcely looks at his wife again. On the evening of his welcoming dinner--set in the piazza in front of the Pantheon--Kracklite is wracked by the first of the endless, excruciating pains in his belly.

Louisa is pregnant, but in boredom and frustration, she takes an Italian lover, Caspasian (Lambert Wilson). The dashing, young architect has designs on the American's exhibition as well as on his wife; his photographer sister, Flavia, shares the intrigue. Kracklite entertains the hypothesis that his unfaithful wife is trying to poison him. A doctor tells him that the sinister pains are due to his lifestyle, but he does not believe this diagnosis and drifts into a subdued paranoia with delusions of persecution and of grandeur.

Obsessed with the shapes and contents--the architecture and the anatomy--of bellies in sculpture, painting, and photography, Kracklite photocopies ever larger and larger images which he "maps" on to his own prodigious abdomen. He writes postcards to Boulleé pouring out his fears. He identifies with Roman emperors, Christ, and Isaac Newton, to whom Boullée designed a never-constructed, hemispheric cenotaph, the belly-like model of which appears often, recapitulating Kracklite's obsession and Louisa's pregnancy.

After he learns he has cancer, he ends his life by falling backward in a Christ-like posture through a window during the opening ceremony of his Boullée project. At that same moment, his wife gives birth to their child, having cut the ribbon/cord to open the hemispherical exhibition.

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The Agnew Clinic by Eakins was commissioned by Dr. D. Hayes Agnew's students at the University of Pennsylvania to celebrate the seventy-year-old physician's retirement as Professor of Surgery in 1889. It was unveiled at commencement 1 May 1889. The size of the painting, the largest Eakins ever created, is 84 3/8 x 118 1/8 inches. The artist painted the work in ninety days and received a fee of $750. Its frame carries this inscription in Latin: The most experienced surgeon, the clearest writer and teacher, the most venerated and beloved man.

Dr. Agnew (1818-1892), a Pennsylvania native, was a well-respected surgeon and educator who had served in two army hospitals during the Civil War. He was best known for his competence in removing bullets, but Eakins has chosen to show him performing a lumpectomy or partial mastectomy.

The surgeon is shown standing in an enclosure, having stepped back from the operation. He is lecturing to students, faculty, and spectators seated in the operating theatre. Dr. Agnew holds a scalpel in his left hand. He is wearing a white surgical gown.

Eakins has placed the operating table with the female patient in front of Dr. Agnew. Her hair and face are visible, the ether cone just above her chin. Her right breast and arm are shown; the left breast is being operated on. A sheet covers her lower body. The sheet beneath the patient carries the inscription: University of Pennsylvania. Between Dr. Agnew and the bed we see a closed case holding the sterilized instruments. The anesthesiologist and the surgeons all wear white. Dr. Agnew's nurse, Mary Clymer, stands by the patient's waist. She is dressed in a high white cap, white apron and black dress.

Eakins illuminates Dr. Agnew, the patient and her doctors, and the nurse. The spectators sit in semi-darkness, but they are individualized by face and posture. The painting contains about thirty small portraits of doctors. Most of the doctors and spectators have been identified by name (see site at University of Pennsylvania: http://www.archives.upenn.edu/histy/features/1800s/1889med/agnewclinic.html). Eakins is standing to the extreme right, listening to a doctor who whispers to him. Because of time constraints, Eakins's mini portrait was painted by his wife, the artist Susan Macdowell Eakins.

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As an anthropologist with training in comparative biology, Jablonski is particularly interested in the natural history of humans: how did humans evolve to gain the varied appearances we see today? In particular, she investigates how our skin developed into a covering that is unique among animals in three ways: (1) it is naked--effectively hairless--and sweaty, (2) we come in a wide array of colors (not just the traditional four), and (3) we use our skin as a surface for decoration, a "social placard," which we cover or bare at will, and on which we put make-up, tattooes, scarifications, and piercings, all ways of expressing cultural and personal values.

Our ability to sweat allowed us to cast off the usual mammalian fur coat and to be active even in the heat of the day (when many creatures take shelter). Humans, therefore, could do more and be more as thinkers, builders, and social creatures.

As to our color variations, Jablonski argues that the main root of modern humans came out of East Africa; these people were black, because a lot of melanin in their skin was the best way to avoid too much ultraviolet radiation, although some is needed to create Vitamin D. As humans migrated to the north and the south, Darwinian selection favored lighter skin pigmentation in order to use the lower levels of sunlight.

Jablonski writes, "Dark skin or light skin, therefore, tells us about the nature of the past environments in which people lived, but skin color itself is useless as a marker of racial identity" (p. 95). And, noting an irony: "Naturally dark people in many parts of the world are increasingly seeking ways to lighten their skin, while the naturally light-skinned are trying to find new ways to darken theirs" (p. 159).

We often take our skin and all its functions for granted; our consciousness can change quickly, however, if we experience a skin disease, a sunburn, or a thermal burn (see Carter and Petro, Rising from the Flames: The Experience of the Severely Burned). Jablonski discusses a variety of illnesses, including burns, dermatitis, and skin cancers. Other topics include the importance of touch, how skin relates to emotion and sex, and experiments in artificial skin, useful for covering patients with severe burns.

Jablonski presents a dozen color plates, 44 figures, and maps to enliven her text.

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Dr. Pauline Chen is a transplant surgeon and hence highly trained in the surgical care of desperately ill patients. She found, however, that although she had intensive and first rate training, time and again the message she received from her mentors and peers encouraged a distance from frank discussions about dying with patients who were clearly dying. Dr. Chen successfully suppressed her urges to reflect on the meaning of illness and death. Years into her training, she finally witnessed an attending surgeon stay with a patient and the patient's wife until the patient passed away. The widow sent a thank you note to Dr. Chen for allowing a "dignified and peaceful death." (p. 101) Chen notes that observing her attending stand with the patient during death changed her profoundly: "...from that moment on, I would believe that I could do something more than cure. This narrative, then, is my acknowledgment to him." (p. 101)

Final Exam chronicles Chen's journey from medical student to attending surgeon and examines her experiences with death and serious illness - of patients, family members, friends. The memoir contains three parts: Principles, Practice, and Reappraisal - each with three chapters. The book is chronologically arranged, beginning with anatomy dissection at the start of medical school and ending with Chen as an attending arranging for hospice, thus honoring a patient's desire to die at home rather than in hospital. Chen skillfully weaves her stories around commentary on the social, cultural and philosophical issues surrounding death and the medical response to death. An introduction and epilogue bookend the text and 46 pages of extensive notes and bibliography complete the book.

Although Chen claims to have slowly and painfully awakened to the fact that patient needs extend well beyond good technical care, in fact one sees Chen emerge as a caring physician even from her initial patient contacts in medical school. Chen speaks more to her role as an Asian-American than to being a woman in a male-dominated field, but she clearly has what it takes to succeed in this extremely competitive field, including a good dose of compulsiveness and an incredible work ethic.

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This slim volume is Calvin Trillin’s tribute to his wife Alice, not only his muse and his first and most critical reader but also a figure well known to his readers. First written as a long essay in The New Yorker, the book is a slightly expanded version that chronicles their relationship, their family life, her many and varied interests, her illness—lung cancer—that first appeared in 1976, and her death in 2001 waiting in the heart failure unit of a hospital, her heart having been damaged by the radiation treatment 25 years before.

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Although doctors have told her that things will get better, Jyl’s odds of surviving cancer are only five percent. She lives alone in a mountain cabin and receives cancer treatments at the hospital in town. She sleeps much of the day. “Her intestines had been scalded, cauterized as if by volcanic flow” [p 67], and Jyl continues to experience problem with digestion. She feels fatigued and is easily short of breath.

Her closest neighbors are the Workman’s, a Christian fundamentalist family of seven. They live miles away in a mountain valley near the creek. Without telephone, electricity, or indoor plumbing, they live off the land and toil day and night. Jyl starts carving small boats toting messages to send down the creek for the Workman children to find. Soon 15-year-old Stephan and 7-year-old Shayna visit Jyl. The two children bring her food that the Workman’s have hunted and gathered. They cut and stack firewood for the recluse. Jyl teaches them about geology and gives them small gemstones that her father had collected. The children’s visits revitalize the ill woman.

When Stephan and Shayna do not return to see her, Jyl is overcome by loneliness. She acknowledges that being alone is far worse than any aspect of her disease and treatment. Jyl makes the difficult trek to the Workman’s property to call on the children but finds that the place is deserted. Nothing remains in their boarded-up cabin except a stack of the small boats that she had crafted. Jyl sits outside their cabin and cries. The falling snow and silence envelop everything.          

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Poet Donald Hall writes of his vigil over wife Jane (poet Jane Kenyon), gravely ill with leukemia. To him, the hospital where he spends his days with her is a ship whose huge pounding engines keep the propellers turning so that the voyage to harbor can safely be made. The ship passengers "wore masks or cannulae . . . but I believed that the ship / travelled to a harbor / of breakfast, work, and love."

Hall writes about what he wrote at the time: " ’. . . bone marrow restored . . . I will take my wife . . . home to our dog and day.’ " After weeks of treatment, wife Jane is discharged, months pass, and now, at home, Hall re-reads his own words as he listens anxiously "to hear Jane call for help," and prepares to "make the agitated / drive to Emergency again," knowing that there is no safe harbor and that the ship is going nowhere, a " . . . huge / vessel that heaves water . . . / without leaving / port, . . . / without arrival or destination . . . . "

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Subtitled Women Novelists of Color and the Politics of Medicine, this book draws on novels by eleven women to illustrate how physical and emotional states of health and illness are linked directly to social justice. The book is divided into two parts. The first five chapters deal with individual characters, their illnesses, and sometimes their healing: Toni Cade Bambara's The Salt Eaters, Paule Marshall's Praisesong for the Widow, Gloria Naylor's The Women of Brewster Place: A Novel in Seven Stories, Leslie Marmon Silko's Ceremony, Toni Morrison's Beloved and The Bluest Eye, Louise Erdrich's Tracks, and Sapphire's Push are among the works Stanford uses to examine women who have become ill because of broken ties to their histories and communities, because of racial hatred, or because of domestic and sexual violence (see this database for annotations).

The second part of the book finds novels examining medicine itself. Stanford uses Ana Castillo's So Far from God, Gloria Naylor's Mama Day (annotated in this database), Leslie Marmon Silko's Almanac of the Dead: A Novel (annotated in this database), and Octavia Butler's Parable of the Sower and Parable of the Talents again to raise connections between patients and social conditions but also to ask questions about bioethics and uncertainty, medicine and epistemology, and how medicine might resist dehumanizing trends through the "myriad possibilities of communitas" (218).

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