Summary:

Howard Carter very skillfully weaves together the various meanings that the heart holds for us--biological, medical, psychological, cultural, and spiritual. He does so through four patients that he interviewed when he was appointed to a distinguished professorship in medical humanities in a joint program of St. Patrick Hospital and the University of Montana, in Missoula.

Each of the sections of the book focuses on one of the patients who suffers, respectively, from a prototypical heart problem: a young man with congenital defects who undergoes successful surgery; a middle-aged woman with a viral illness who learns how to live with her chronic heart condition; a middle-aged man whose blocked coronary arteries are cleared, as is the stress in his life; and an old man who turns to spiritual matters as he faces heart failure.

What contribute significantly to the uniqueness of this book are the essays that Carter provides at the end of each Patient Section. They are the vehicles for the synthesis of the patient stories, the scholarly look at how "we have largely lost the anchoring image of the heart" in American society, and his very poignant personal reflections about life in (or at least near) the wilderness of Montana. (See Solid Footing, Higher Ground -Third Essay as an excellent example of his skillful and moving writing.)

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This biography begins on April 20, 1995 when the ashes of Marie and Pierre Curie were transferred from their graves in a Paris suburb and re-interred in the Pantheon, thereby placing the Curies among the "immortals" of France. Thus, Marie became the first (and so far the only) woman to be honored in this way. Goldsmith's biography is a straightforward and well-written narrative that eschews hagiography, wordiness, and psychological interpretations.

The story of Marie Curie (1867-1934) is well known. Born into an intellectual but impoverished Polish family, she struggled to obtain a scientific education, first in Poland and then at the Sorbonne in Paris. While a graduate student, she met and married the young chemist Pierre Curie. Together, with essentially no funding and dismal laboratory space, they discovered and characterized radioactivity. Later, on her own Marie discovered and isolated two new elements, polonium and radium. Subsequently Marie and Pierre created the Curie Institute, where Marie was in the forefront in envisioning medical applications of radioactivity and radium.

The story is especially powerful in its depiction of bias against women in science. Marie had to fight for many years to obtain a faculty position at the Sorbonne (unheard of for a woman), or even space to conduct her experiments. When the Nobel Committee awarded its 1903 Prize in Physics, Pierre had to fight to have his wife included in the citation, even though the bulk of the brains and energy behind the discovery of radioactivity were clearly Marie's. Marie was later vindicated when she won her second (and solo) Nobel Prize in 1911 for the discovery of radium.

Obsessive Genius doesn't shy away from Marie Curie's recurrent clinical depressions, which began during her adolescence, nor from her obsessive, hard-driving personality. The book presents an even-handed picture of repeated conflict between her love of her husband and children (one of whom, Irene Joliet-Curie, in 1935 became the second woman scientist ever to win the Nobel Prize); and her passion for her work.

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This concise and well-written biography is meant to be, as Sherwin Nuland tells us, "a guide for the perplexed," for those who may recognize the name of Maimonides and his historical importance to Jewish religion and culture, or who may even have read some of his works, but have no knowledge of the man behind the name. The story begins, as it should, in Medieval Spain with its vibrant Judaeo-Islamic culture, in which the historical relationship between Judaism and medicine developed and later expanded throughout the European and Islamic worlds. Though they were outsiders in both civilizations, Jewish physicians became the most sought after healers in the Christian and Muslim worlds.

Moses son of Maimon (also known as Maimonides and the Rambam, 1138-1204) was born in Cordoba, the cultural and political center of Muslim Spain. He and his family had to flee Cordoba to avoid persecution in 1148. They wandered through Spain until 1160, when they settled in Fez, Morocco. Again fleeing from persecution, Maimonides moved to Fustat, Egypt, when he was 30 years old and remained there for the rest of his life. During these early years, the young rabbi wrote numerous biblical commentaries, culminating in the Mishneh Torah, his great code of Jewish law. Later, he attempted to reconcile faith with reason in another great work, The Guide for the Perplexed, completed in 1190.

Maimonides's specifically medical work is difficult to characterize and evaluate. The traditional historical assessment is that he was "unique in his time in the theory and practice of medicine." Essentially, he practiced Galenic medicine, as transmitted and developed in the flourishing Islamic tradition. We don't know how he acquired his medical knowledge, but by the time he reached Fustat, Maimonides was acknowledged to be a leading physician and in 1190 he was appointed personal physician to the vizier of Egypt. Late in life, Maimonides wrote a number of medical treatises, most importantly his Medical Aphorisms, which presents a coherent, well-organized, and practical medical system based on Galen and Aristotle.

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Elisabeth Kubler-Ross was born in Switzerland in 1926. She was part of a package deal--a triplet (and a two-pounder at that). That she survived the birth (as did her two sisters, another two pounder and a more robust six pounder) is something of a miracle. As she explains, her early childhood was filled with other more memorable experiences around death as well, including a long battle with pneumonia and deathbed scenes of neighbors in her small town.

In the aftermath of World War II, she was a volunteer in IVSP, International Voluntary Service for Peace. She spent time in Poland and then Germany, aiding survivors of the concentration camps, as well as the defeated Germans, to rebuild their lives. She returned to Switzerland and went to medical school, eventually marrying an American student studying there.

After practicing as a small town family doctor, she came to the U.S. in the 1950s. Her plans to serve a residency in pediatrics were changed to psychiatry (because they didn’t want someone who was pregnant). In Denver, after residency, she was asked to lecture to medical students. She chose a topic that was out of the ordinary, but something she felt at home with--death and dying.

In 1965, in Chicago, she continued her work in this area. At the urging of some theology students she began a weekly seminar with dying patients, health professions students, (and eventually ) their more skeptical teachers. This experience led to the publication, in 1969, of her book, On Death and Dying. It is in this book that the "stages" of dying are discussed. The remainder of The Wheel of Life deals with more controversial aspects of Kubler-Ross’s life.

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At 23 years old, James is brought by his parents to a drug and alcohol rehabilitation center in Minnesota to get treatment for his alcoholism and drug addictions. Physically and emotionally shattered, he slowly recuperates, sometimes insistently conquering his addictions with his own willpower, and at other times with the help of those around him. The consequences of his addictions, his struggle against the platitudes of the Twelve Step programs, and his relationships with his counselors build the tension in the book; his relationship with his family and several of his fellow addicts forms the heart of it.

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Note that this annotation contains spoilers. The sequel to A Million Little Pieces (see this database), Frey's follow-up memoir begins with James serving time in an Ohio prison for crimes he had committed while an addict. On his release, he goes to Chicago where he plans to reunite with his girlfriend, Lilly, and start a new life. As soon as he arrives at the halfway house where she was living, he discovers that she had committed suicide the night before. Shattered again, he tries to establish himself in Chicago without relapsing (with notable bravado: working as a bouncer in various bars).

His friend and "father" Leonard, a mobster who unofficially adopted him during their stint in rehab together, as chronicled in A Million Little Pieces, tries to help him get on his feet financially. After a period as a runner for the mob, James decides to move to Los Angeles to become a writer, with some success. Leonard remains a benevolent father-figure and as their friendships develops, the larger-than-life Leonard and his mob henchman meet James's friends, his family, his girlfriends, even his girlfriends' families--until Leonard disappears. James eventually locates Leonard, and discovers that Leonard is gay, has AIDS, and the two of them spend Leonard's last few days together.

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Joan Didion has written a very personal, powerful, and clear-eyed account of her husband's sudden and unexpected death as it occurred during the time their unconscious, hospitalized daughter was suffering from septic shock and pneumonia.

Quintana, the couple's 24-year-old adopted child, has been the object of their mutual care and worry. That John Gregory Dunne, husband and father, writer and sometime collaborator, should collapse from a massive, fatal coronary on the night before New Year's Eve at the small dinner table in their New York City apartment just after their visit with Quintana can be regarded as an unspeakable event, beyond ordinary understanding and expression. "Life changes fast . . . in the instant. You sit down to dinner and life as you know it ends" (3).

As overwhelming as these two separate catastrophes are, the account provided by Didion evokes extraordinary descriptions of the emotional and physical disorientations experienced by this very lucid, but simultaneously stunned and confused wife, mother, writer dealing with the shock of change. Her writing conveys universal grief and loss; she spins a sticky filament around the reader who cannot separate him or herself from the yearlong story of difficult, ongoing adjustment.

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This densely packed book follows Oschman's Energy Medicine: The Scientific Basis (2000, see annotation) with applications to medical treatment and--very briefly--human performance (athletics, dance, music). Oschman, a cell biologist, shows how electroencephalograms, electrocardiograms, and pulsing electromagnetic fields (which can heal broken bones) are accepted medical technologies, while theoretically related Healing Touch, Therapeutic Touch, Qi Gong, Reiki, Reflexology, massage, etc. are widely used and effective but generally (and inaccurately) considered to be alternative medicine.

According to Oschman, contributions from quantum physics explain that the energies of the body are subtle, instantaneous, and highly efficient in regulation and healing at the cellular level. The body is best understood as a living crystal, which can semiconduct energy, translate physical energy (such as touch) to piezoelectricity, and maintain coherence and continuity. Given our evolutionary heritage, we can sense from healers their intention, empathy, and healing energy. Our bodies heal themselves with energy provided by both standard and nonstandard medicine.

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This collection of stories describes "a medical student's journey" (the subtitle) through the difficult terrain of clinical education. In Audrey Young's case, this is also a geographical odyssey from Seattle to Swaziland to Pocatello, Idaho, as she completes her University of Washington clinical rotations and electives. In one sense the main characters of these narratives are the patients the author encounters in clinics and hospitals. As she writes in the Preface, "Patients teach things that the wisest and most revered physicians cannot, and their lessons are in this book."

In another sense, of course, Dr. Young herself is the central character of these stories; this is an account of her journey into doctoring. The author first takes us to Bethel, a Yupik Eskimo town on the Bering seacoast of Alaska, where she had her initiation into clinical experiences in the form of a summer preceptorship. There she learns that patients are far different from textbook examples, as she confronts the social and cultural factors that influence illness and its amenability to treatment. We follow the author to assignments throughout the WWAMI network. WWAMI is the University of Washington's decentralized clinical training program (Wyoming, Washington, Alaska, Montana, and Idaho).

In Spokane she delivers a baby for the first time, supervised by an opera-loving attending physician. In Pocatello she takes care of her first critically ill neonate. In Missoula her life becomes "one of resigned solitude" in her internal medicine clerkship, where she experiences sleep deprivation and experiences sunlight only "through dusty windows."

During her fourth year, the author finds herself treating desperately ill AIDS patients without a supervising physician (he had gone to Zaire for a funeral and might be back the following week) and also without anti-retroviral drugs. However, it is in Swaziland that she learns the deep power and dignity of medicine, as exemplified by a patient who invites her to a dinner in her honor that requires killing one of his precious chickens.

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This is a comprehensive social history of European (or "Western") attitudes toward death and dying over the last thousand years. Ariès organizes his history into five sequential cultural constructs, each of which conveys the meaning of death to the individual and community, as well as the social institutions around death and dying, during a different period of Western history, beginning in the Middle Ages.

Cultural responses to death must begin by acknowledging that death is mysterious and overwhelming; a wild beast; a meaningless monster. Death lurks at the edge of our consciousness, ready to destroy us and demolish whatever meaning we attribute to our lives. In medieval Europe Christianity had domesticated this monster by establishing a comprehensive set of beliefs and practices that Ariès calls the "tame death." Death was merely a transition to eternal life. The individual was understood as an integral part of the community and not as autonomous and isolated. Therefore, death and dying were communal events, supported by specific prayers and practices (i.e. ars moriendi) that "tamed" the unknown.

In the centuries that followed, Ariès's "tame death" evolved through five stages into the radically different cultural conception of death that characterizes Western society--especially in its American form--today. These changes result largely from the gradual replacement of community-oriented personal identity with today's radical individualism; and the gradual sequestration of death to a position behind the scenes, so that dying and death become remote from ordinary experience.

In today's world we encounter "invisible death," a somewhat paradoxical name because its invisibility allows the savage beast free rein. Death is no longer "tame" because we deny its existence so effectively we no longer develop personal and communal resources to give it meaning. Death's invisibility enhances its terror; our culture's loss of spirituality enhances death's meaninglessness.

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