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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.
The poem takes place in a respiratory ward of a children's hospital, where the narrator hears "a children's wind ensemble / hooting through the weary nocturne." One mother is massaging her child's back, "working calm's liniment between shoulder blades / scarcely bigger than chicken wings."
The narrator appears to be a friend or relative, who silently tries to breathe for the breathless child, whose panic is held in check by "his mother's dulcet voice." It seems like everything will be all right "as long as the hand strokes, and while the voice croons . . . " [30 lines]
The narrator was ridiculed during adolescence because he was fat and socially inept at school. He had one friend, Marion, "a slender girl who came up on holidays from the city / to my cousin's farm." He liked to show-off to others, but couldn't express his feelings, especially to Marion, who he only now realizes was "my first love." At the age of 19, during her nursing training, "she had a fatal accident / alone, at night, they said, with a lethal injection / and was spared from seeing what my school did to the world." [28 lines]
Bruno Kamenar is a pale and thin ten year old boy who lives with his stepmother and younger brother in Croatia in 1948. His father, Pero, has just returned home after serving in the Yugoslav Federal Army. With the constant threat of a Soviet invasion serving as a backdrop, Bruno is plagued by frequent nightmares as well as a cough. He finds solace both in drawing and in the company of the family cow.
Sadly, Bruno contracts tuberculosis from the cow's fresh milk. At first he is unable to be treated because the government rejects an offer of free streptomycin from the Swiss. It is only after Pero publicly criticizes his country's refusal of medical aid and becomes a political prisoner that UNICEF physicians arrive at Bruno's home and treat him with streptomycin and PAS.
He recovers and his father is released from prison. As he watches the family cow and its pen incinerated, Bruno is filled with horror and relief by the death of an animal that once provided food and comfort but almost killed him.
Consider the possibility of a man whose sense of hearing is so enhanced that he can discern the noise of the entire world and also mimic all the sounds made by men and beasts. Imagine a human being who can SEE sounds as well as hear them. It is little wonder that he would have an affinity and talent for music.
Johannes Elias Alder is such a musical genius born in 1803 with a preternatural gift of hearing. The illegitimate son of the village curate, Elias experiences a physical metamorphosis as a child and by the age of ten is already a man. He effortlessly composes magnificent music that he plays on the organ.
Although Elias falls in love with his cousin, Elsbeth, she marries another man. After this loss, he becomes tired of life. Elias commits suicide at the age of 22 by refusing to sleep and succumbing to starvation and an overdose of belladonna.
This stark and sensual poetry collection is divided into three sections. The first, "Graveyard Shift," introduces the narrator's themes: the keen observation of suffering; the questioning of God's role in such suffering; the way caregivers and patients meld in shared moments of trauma; the struggle to integrate the reality of death and grief into a life outside the healthcare arena.
A longer second section, "Lessons," contains a chronology of poems that broaden the poet's themes. Suffering becomes personal through sexual abuse ("The Burning"), death of a baby ("To the Woman in the Next Bed," "Waiting Room," "Last Lullaby for the Dead Child"), and breast cancer ("Keeping Watch"); the mystery of God's role becomes the narrator's religious quest.
The final section, "The Ones Who Come," opens these themes to the universal: children and adults lost to "the holocausts" of war, poverty, and illness ("Lizard Whiskey: A Parting Gift from Viet Nam," "After the Siege," "The Ones Who Come," "The Man Who Stays Sane"), and how history repeats these cycles of birth, suffering, and death.
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.
Millie is a "baby nurse," hired as a domestic helper and live-in night nurse who cares for other women's infants up to the age of two years. She is "condemned by life to love many babies and lose them all" (1). Millie is described as old, but we are not told how old, or of what else her life has consisted; probably little, since she appears to have cared for one child after another, and has no home apart from where she is employed.
The story begins as she starts a new job, caring for Mrs. Jones's baby daughter. She adores the baby, but is tense and possessive, strongly dislikes the Jones's noisy six-year-old boy, and complains to Mrs. Jones about the other servants. Reluctant to let the baby grow up, she does not encourage her development, and she is overly defensive and protective of the child.
As the baby gets older, Millie becomes more and more anxious until, after a fight with one of the other servants, Mrs. Jones fires her. The story ends where it began, in the waiting room of the employment agency as Millie seeks a new position, a new baby to love and lose.
Alice Goodwin is the wife of Howard, a midwestern dairy farmer, the mother of two daughters aged five and three, and the nurse at a local elementary school. She and her friend, Theresa Collins, a family therapist who lives in the nearby suburbs, take turns watching each other's children. One morning, while Alice is momentarily distracted, Theresa's two-year-old daughter, Lizzy, falls into the pond on the Goodwin farm. Despite Alice's attempts to resuscitate her, she dies after three days in the hospital.
Not long after, while she is severely depressed, Alice is arrested on (false) charges of sexually abusing some of the schoolchildren in her care. Confused, and thinking only of Lizzy's drowning, Alice says to the police, "I hurt everybody." They take this to be a confession.
She spends three months in prison awaiting trial, until Howard sells the farm to pay her bond. The novel gives us both Alice's experiences in prison--in a world she had hardly imagined--and Howard's struggle to take care of their children. Theresa, who seems never to have blamed Alice for her child's death, helps him and they develop a powerful bond. The novel ends with the trial, in which Alice is exonerated, and their family's tentative beginning of a new, urban life.
In short chapters that alternate between remembered scenes of abuse, reflections upon those scenes, and tributes to the natural beauties and human kindnesses that tempered years of domestic violence, the author provides a galling, but not sensationalistic, record of what child abuse looks and feels like. Only when she was older and mostly beyond the reach of a father who routinely beat and sexually abused her and her siblings did the author find out that her father had been dismissed from a police force for gratuitous violence and had subsequently submitted to electroshock treatments for mental illness.
The title describes the nature of the narrative; in its deliberate discontinuities it testifies to the stated fact that there are places where memory has left a blank. Much of the telling is an attempt to piece together a story of recurrent violence, felt danger, and arbitrary rage that seemed at the time both regular and unpredictable.
The sanity of the narrative testifies to the possibility of healing. The writer makes no large claims for final or complete release from the effects of trauma, but does strongly testify to the possibility of a loving, happy, functional adult life as healing continues.