Summary:

This posthumously published collection of essays by Dr. Klawans, an eminent neurologist and writer, explores the interactions between patient, family and neurologist and the implications of specific neurologic diseases. Klawans's special interest in neurology is movement disorders, such as Huntington's chorea and Parkinson's disease, but his outside interests range from evolutionary biology to classical music. His essays, therefore, focus on single patients or families, but the author weaves thoughts about his other interests into each "case."

The book is divided into two sections, "The Ascent of Cognitive Function" and "The Brain's Soft Spots: Programmed Cell Death, Prions, and Pain." In a brief preface, Klawans declares that this book is "more than just a set of clinical tales about interesting and at times downright peculiar patients" from his 35 years of practice, but rather it "humbly grapples with the 'whys' of our brain, not the 'hows.'" (pp. 9-10) In the preface, as well as in one essay, Klawans acknowledges the work and impact of fellow neurologist-writer Oliver Sacks ("Oliver is truly the father of us all." p 12).

The title essay concerns a six-year-old girl who was found, locked and completely speech-deprived, in a closet. Because she is still within the window of opportunity for language acquisition, "Lacey" quickly learns to speak, unlike Victor, the Wild Boy of Aveyron, whose story was immortalized in the François Truffaut film, L'enfant Sauvage. Klawans uses these stories as a launch pad to discuss the evolution of language, including a proposal that the cavewoman, not the man, was responsible for development of the human species as she taught her offspring language.

Other chapters focus on patients with epilepsy, Parkinson's disease, localized and hemispheric stroke, "painful-foot-and-toe syndrome, " and Creutzfeldt-Jakob disease. Two particularly memorable chapters concern Huntington's chorea and Refsum's disease. The chapter, "Anticipation," explores the profound ethical concerns of genetic testing for Huntington's chorea as applied to three generations of one particular family. In the chapter, "The Hermit of Thief River Falls," Klawans recollects his first year as a neurology resident, and his care of a reclusive patient with a rare eponymous illness, Refsum's disease--just in time for a visit by Refsum himself, a famous Norwegian neurologist.

The book concludes with a speculative "afterthought" about genetics, evolution, and the importance of extended "juvenilization" --the protracted post-natal development of Homo sapiens. This essay intertwines some of the threads regarding speech development and evolutionary biology, particularly brain development, that were introduced earlier in the text.

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In this lyrical, funny, sad, heartwarming work, Joyce Dyer takes us inside an Alzheimer's unit where she visits her mother daily and watches as she experiences the many absurdities and contradictions of this disease over several years. Dyer records not only the behavior of her mother and other patients in the unit but also her own feelings of worry, anger, frustration and then acceptance. The prose-poem style of this writing makes the work especially wonderful to read, because it is a work of art as well as a very helpful document.

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A small boy overhears his parents discussing the memory loss of a ninety-six year old neighbor who lives next door in the old people's home. He tries to discover the meaning of "memory" by asking the other residents who tell him, respectively, it's something warm, something sad, something that makes you laugh, something precious as gold.

Young Wilfrid gathers his own "memories" to bring to Miss Nancy, his favorite neighbor because she, too, has four names. Each of his treasures, a freshly laid egg for warmth, a toy puppet for laughter, his grandfather's war medal for sorrow, and his precious football stimulate warm reminiscences for Miss Nancy Alison Delacourt Cooper and smiles and smiles for the two of them.

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In this extensive review of her experiences in public health and rural and urban medicine, Eva Salber, MD, explores the commonalities and the differences in medical practice among three environments: pre-World War II South Africa, urban America, and the hills of North Carolina. Trained in South Africa, where she and her husband practiced for many years, Salber came to the US during a very difficult political period for whites in Cape Town.

In Boston, she pursued her passion for the plight of the poor and their health issues by studying further public health and running a ghetto clinic. Later, as a member of the Duke University faculty, she established rural health clinics in North Carolina. She describes, in this memoir, the contrasts among the cultures as well as her own difficulty in obtaining the funding and support she needed to carry out her work in each setting.

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Atheist theologian and ex-priest, Bernard, takes a leave from his college in the grey, industrial town of Rummidge, UK, to escort his unwilling father, Jack, to Hawaii at the request of his elderly aunt, Ursula, who is dying of cancer. Bernard's domineering sister, Tess, is strongly opposed. To save on costs, they join a charter tour.

On the day of arrival, Jack is hit by a car and confined to hospital. Bernard spends many days traveling between his dad's bedside and Ursula's in an inadequate nursing home. The near-but-far separation between the aged siblings gives Bernard time and opportunity to discover their past.

The exotic, touristic "paradise" on earth and an affair with Yolande, driver of the car that struck his father, awaken Bernard to the sensual pleasures of existence. Ursula, always portrayed as the selfish black sheep, had been sexually abused as a child by her oldest brother Sean--venerated as a hero by the family for his death in the war. A lad at the time, Jack knew of the abuse.

With credible evidence and an impressive lack of self-pity, Ursula explains to Bernard that the experience ruined her marriage and her life. She wants Jack's apology. With the help of his sister and his lover, the newly secular Bernard brings about a reconciliation to the greater peace of all involved, including himself.

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The story is a letter written by a 24-year-old woman to her niece who was given up for adoption. Bitte Liten, from a close Norwegian family, remembers the summer she was 12 when she was sent away during the last months of her sister's pregnancy to stay with her uncle. Her sister, 15, unwed and pregnant, had found adoptive parents for the child, but Bitte, imagining the pleasures of being an aunt and helping care for a baby, wanted her to keep it.

While at her uncle's, she visits her aging favorite aunt in a nursing home. Her aunt, sinking into dementia, doesn't remember her. This leaves her reflecting on how much of life is memory of the past and dreams of the future. Her period comes that summer for the first time, and with it, a new understanding of adult responsibilities and her sister's predicament.

She writes her sister to tell her she understands her decision and will support her. In return, her sister invites her to be at the hospital the day the baby is born. There Bitte meets the adoptive parents as well as the baby, says hello and goodbye to her little niece, and comes to understand something new and harder about what love looks like. Twelve years later, she records all these memories for the niece who has grown up as someone else's child.

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In this short essay on the status of post-menopausal women, Le Guin examines the special status of older, experienced women who have lived through the trials and tribulations of the advent of sexuality, childbearing, and the end of the reproductive period. The author speaks to the special knowledge and wisdom acquired through these experiences and finally suggests that the most telling and viable representative of the human race on earth is the crone, who has known so much of what it means to be human. Le Guin would nominate such a crone for the space venture to the fourth planet of Altair in order to help the Altairians to "learn from an exemplary person the nature of the race."

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This pocket-sized book contains stories from the home front--poems about patients the nurse-author tends in their apartments and in her clinic. Often, the patients speak, teaching us not only what it's like to be elderly and lonely, but also how to view mainstream healthcare from a different perspective.

Most important, we learn about the courage with which these patients cope with illness and poverty, and how nurses honor their patients' choices through non-judgmental caring. Outstanding poems include "The Language of Hearts," "Passages," "Lower Midline Surgical Scar," "The Screamer in Room 4," and "Home Remedies for the Blues."

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Registered Nurse, Muriel Murch decided, at mid-life, to return to college to obtain her BSN (Bachelor of Science in Nursing). She relates this odyssey through a series of generous and quirky letters written to her mother, her children, her husband, and, most strikingly, her deceased Uncle Harold, whose memory serves as Murch's spiritual touchstone.

The book works on two levels. Her struggles as an older woman and already-experienced nurse in a BSN program are delightfully detailed in letters to friends, but to Uncle Harold she reveals the turbulence of her quest: how at mid-life she must rethink her role as wife and mother and view patient care from a new perspective.

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When six fifty-year-old women gather for an annual reunion they've come laughingly to call "Camp Men-o-pause,” at an idyllic midwestern lakeside bed-and-breakfast they face a bewildering and sorrowful difficulty unprecedented in their many years of friendship since college: Micky, in many ways a leader and intellectual bright light among them, has been diagnosed with early Alzheimer's disease. She is present and functioning, but has bouts of confusion and memory loss.

She knows a great deal about her own condition and has shared it with the others. Only with one other, Jan, has she shared her desire to be helped to commit suicide when she becomes seriously incompetent, and, enjoined to secrecy, Jan has to bear the burden alone of deciding whether to make Micky that promise.

The story chronicles the week the women spend together, their various thoughts and conversations about their lives, and the ways in which Micky's disease leads them all to reframe their feelings about friendship, loyalty, aging, and medical options. Much about the week is bittersweet; the story ends inconclusively as Jan is unwilling to promise to help Micky die, but all come to some sobering understandings about what it might mean to "see their friend through” a gradual leavetaking that may erase them all from her memory.

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