Showing 21 - 30 of 3304 annotations

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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Tree, Broken Tree

Mortimer, Dylan

Last Updated: Feb-03-2020
Annotated by:
Lam, MD, Gretl

Primary Category: Visual Arts / Visual Arts

Genre: Multimedia

Summary:

A tree, colored in pink glitter and outlined in red, stands alone. Two of the main branches are cleaved apart, and green glitter oozes from the wound. This does not look like normal tree sap; the yellow-green color is purulent, and the glitter gives it a toxic glowing effect. Two of the three branches droop weakly towards the ground.  The tree is sickly, possibly dying.  

Because the tree is mounted on a white background, with the tips of branches curling lightly off the panel, the piece also recalls a scientific specimen mounted on display. Those who are familiar with lung anatomy will note how the tree trunk recalls the trachea, and the branches recall bronchi. The pink and red coloring reinforces the idea that this isn’t merely a tree, but also lung tissue.

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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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The Little King

Rushdie, Salman

Last Updated: Dec-19-2019
Annotated by:
Galbo, Sebastian

Primary Category: Literature / Fiction

Genre: Short Story

Summary:

Dr. R. K. Smile, MD, founder of Smile Pharmaceuticals, Inc. (SPI), enjoys a sudden lurch into fortune and celebrity. Dubbed the ‘Little King’ by his Atlanta-based Indian community, Dr. Smile is a towering medical authority, philanderer and philanthropist, known to be both generous and avaricious. His pinnacle pharmaceutical coup, the patent that has earned him billionaire status, is InSmile™, a sublingual fentanyl spray designed for terminally ill cancer patients. Dr. Smile’s entrepreneurial vim, however, hardly stems from benevolent medical research, but rather an ‘excellent business model’ that he observed on a visit to India during which a Bombay ‘urchin’ handed him a business card that read, ‘Are you alcoholic? We can help. Call this number for liquor home delivery.’ The blunt practicality of building a market around sating addiction strikes the doctor as entirely sensible. Often wistful about India’s ‘old days,’ Dr. Smile fondly recounts the insouciance of neighborhood dispensary hawkers, their willingness to ‘hand out drugs without a doctor’s chit.’ Though admitting that ‘it was bad for [their] customers’ health but good for the health of the business,’ Dr. Smile yearns to replicate a similar culture of delinquent pharmacology, an unregulated market capable of profiting from supply-and-demand forces but indifferent to the wellbeing of its patrons. 

In the meantime, Dr. Smile’s wife, Mrs. Happy Smile, a simpering and daft socialite, envisions grand branding prospects that will globalize the Smile name through ostentatious publicity—inscribed name placards at the ‘Opera, art gallery, university, hospital […] your name will be so, so big.’ She refers to the worldwide reputation of the OxyContin family, the proliferation of the family’s name and esteemed place among prestigious cultural institutions: ‘So, so many wings they have,’ she says, ‘Metropolitan Museum wing named after them, Louvre wing also, London Royal Academy wing also. A bird with so, so many wings can fly so, so high.’ 

InSmile™ sales drive Dr. Smile’s burgeoning drug trade, as his prescription becomes preferred to conventional OxyContin highs due to its ‘instant gratification’ in the form of an oral spray. While SPI fulfills special house-calls for American celebrities and customers in ‘gated communities from Minneapolis to Beverly Hills,’ it also ships millions of opioid products to places such as Kermit and Mount Gay, West Virginia—communities, outside fictional contexts, that bear real-world vestiges of the opioid epidemic (West Virginia has the highest rate of drug overdose in the United States). Through a lecture series scheme, Dr. Smile bribes respected doctors to publicize and prescribe the medication, further entrenching the dangerous drug in medical circles.

As the SPI empire collapses following a SWAT-led arrest of his wife, Dr. Smile muses indignantly on his reputation and the ingratitude of his clients. Tugged again by nostalgia for the old country, he justifies his drug trafficking by likening it to quotidian misdemeanors, instances when one could circumvent the inconveniences of India’s law by knowing how to pull the venal strings of corrupt systems—like cutting a long ticket queue at the rail station, he says, by paying a little extra at a backyard office; or bribing government officers to stamp customs papers required to ship restricted antiques abroad—‘We know what is the oil that greases the wheels.’ With this deleterious mindset, combining nostalgia and entrepreneurial greed, Dr. Smile’s future is uncertain, but he is resolved to return—after all, he says, ‘I have lawyers.’

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Spring

Smith, Ali

Last Updated: Dec-02-2019
Annotated by:
Trachtman, Howard

Primary Category: Literature / Fiction

Genre: Novel

Summary:

Ali Smith is a Scottish writer. If she lived in the U.S., hopefully (a word I will come back to at the end) she would be a household name. She is 75% through a quartet of novels that are named for the seasons. Each captures the beauty and lightness of Vivaldi’s famous concerto and the heft of T.S. Eliot’s poetic quartets. Spring seamlessly blends brutal reality and a dream-like state. Anchored in the current world, it unfolds in a Brexit obsessed United Kingdom, and yet it incorporates artists, live and dead, ranging from Katherine Mansfield to Rainer Maria Rilke to Tacita Dean. The scope and inventiveness of the writing are staggering.

The plot will sound very odd in a brief summary. Like many modern novels, it incorporates two separate narrative strands that come together somewhat unexpectedly but satisfactorily in the climactic scenes. In the opening pages, we are introduced to Richard Lease, a modestly famous filmmaker who produced some well-regarded highbrow TV shows in the 1970s and 80s. He is considering an offer for a new film project about an imaginary crossing of paths by Rilke and Mansfield in Switzerland in 1922. But Richard is unable to rouse his enthusiasm partly because of misgivings about who he would have to work with. More importantly, he is still not over the recent death of his screenwriter, Patricia Neal or Paddy, who was more than just his artistic partner for four decades. Richard mulls over memories of their work and life together, reliving conversations and episodes that invoke Charlie Chaplin, Beethoven and Shakespeare. He aimlessly boards a train to Scotland. There, in an act of despair, he lowers himself onto the train track in an attempted suicide .

Richard is saved by a magical 12-year old girl, Florence. Although the description is scant, she is preternaturally bright, articulate, and endowed with an inexplicable power to move people to do what she wants. She supposedly was able to enter a restricted Immigrant Retention Center unaccompanied and persuade the supervisor to order a cleanup of the bathrooms for all the detainees. One morning, Florence encounters Brittany Hall, who is on her way to work as a security guard in one of the notorious British detention centers. Her dehumanizing work with the inmates is grinding her down, the degrading surroundings are destroying her soul.  Florence and Brittany end up at a train station and in an impulsive act, Brittany follows Florence onto a departing that is heading off to Scotland. The warm interaction with Florence on the ride awakens Brittany’s submerged feelings of humanity. They end up at the same destination as Richard, and there Florence persuades him to climb back on to the platform and saves his life.  A reinvigorated Richard, Florence and Brittany meet up with another mysterious character, a woman operating a mobile refreshment stand. The four travel in her crowded truck to Culloden, the site of the disastrous clash during the Jacobite Rebellion in 1746 when the Scots were annihilated by the English army. There the story reaches its climax which I will not divulge in full. But simply said, in full sight of all the tourists attracted to the Culloden battlefield site, it does not end up well for Florence or her mother who suddenly appears on the scene.




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State of Wonder

Patchett, Ann

Last Updated: Nov-21-2019
Annotated by:
Teagarden, J. Russell

Primary Category: Literature / Fiction

Genre: Novel

Summary:

Dr. Marina Singh, a pharmacologist and former obstetrician, is sent to a research site in the Amazonian jungle somewhere in Brazil that is operated by the company she works for, Vogel Pharmaceutical. The company chief executive officer, Mr. Fox, dispatches her there to check on the progress of the research and to get details on the reported death of her colleague, Dr. Anders Eckman, while he was there on a previous research trip. Eckman’s wife, uncertain that he was dead, asks Marina to find out what had happened to her husband. The plot centers on Marina’s dual missions at the Amazon jungle site. 

Marina’s trip reunites her with the legendary and imperious Dr. Annick Swenson, who is an obstetrician and the lead researcher at the site. Thirteen years before, Swenson was Marina’s supervisor during her obstetrics residency. A mistake Marina makes while she’s delivering a baby after disregarding Swenson’s advice drove her out of obstetrics and into pharmacology, and then eventually to Vogel. The company is supporting Swenson’s research hoping it will produce a blockbuster product. Mr. Fox is growing impatient having received only brief and vague communications from Swenson over the past five years. 
 

Decades earlier Swenson had followed her mentor to the jungle location where the Lakashi tribe lives, and after frequent visits over this time, resided there permanently to work on the research Vogel was funding. The research was based on observations Swenson and her mentor made about Lakashi women; they never go through menopause and they are fertile into their old age. Swenson’s project is to find out why, and provide the information to Vogel in order to develop a product that could give women the option to avoid menopause and to have babies much later in life. 

Swenson finds it is the bark of the (fictional) Martin trees when combined with excretions of the (fictional) Purple Martinet moth deposited in the bark Lakashi women ingest that extends their fertility after menopause. Trying it herself, Swenson becomes pregnant at age seventy–three. She also finds that the same bark protects the Lakashi women against malaria. Swenson eventually concludes that her research should not proceed to product development for fertility, but instead for prevention of malaria. Certain that no American pharmaceutical company would “foot the bill for Third World do-gooding,” Swenson decides to reallocate the fertility research funding to her malaria vaccine work without permission from the company (p. 289). A cat and mouse game ensues around the research funding, Swenson’s pregnancy ends, and the mystery of what happened to Anders Eckman is solved. Marina Singh’s life is changed, probably forever.

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Annotated by:
Davis, Cortney

Primary Category: Literature / Poetry

Genre: Poetry

Summary:

There are 46 poems in this volume (the author's second full-length collection), divided into four 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 that claimed her life in August, 2018, when she was forty-nine-years old.  This second collection continues Silver's illness narrative, poems that might serve as a journal of her journey through treatment, anger, despair, determination, and faith.

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