Summary:

Frank is an emergency medic and ambulance driver working night shifts for Our Lady of Mercy hospital in Hell's Kitchen, New York City. The novel begins with Frank's resuscitation of an elderly man called Mr. Burke, who has had a heart attack, and ends a couple of days later with Mr. Burke's death in the hospital. Frank is haunted by the patients he has failed to save, some of whom inhabit his experience like kinds of ghosts.

Most insistent is a teenage girl called Rose who died during an asthma attack, in part because Frank was unable to intubate her in time. He is also unable to forget his marriage, which ended because of the deadening effects of his work. And now Frank is also haunted by doubts about the value of restoring life.

He has successfully started Mr. Burke's heart, but the man is brain dead. Frank thus watches as Mr. Burke's family is first given hope and then must learn that there is none. Frank almost falls in love with Mr. Burke's drug-addicted and disillusioned daughter, Mary, perhaps seeing in her an opportunity for a mutual restoration to health.

But when her father finally dies--when the attending realizes that the patient's struggle hasn't been the "survival instinct" but rather a "fight to die"--she blames Frank, who recognizes that his purpose is not simply to keep people alive (or to bring them back from the dead), but rather that "saving lives" means preserving their value, somehow, in his memory. He walks away from the hospital, and when he gets home, Rose--her ghost, and Frank's own symbol for all the patients he hasn't resurrected--is waiting there, to forgive him.

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The narrator delineates the needs of a human heart and soul: "pleasure," relief of pain, and finally, "the liberty to die."

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The philosophy student Kovrin is on the verge of a nervous breakdown. His doctor suggests a rest in the country and so Kovrin decides to visit his childhood friend Tanya Pesotsky on her father's estate. While there he tells Tanya the legend of the black monk: a desert monk whose image has been reflected in mirages for a thousand years and who will soon return in the flesh.

One day in the garden, the black monk appears to the young man. This gives him joy and energy, even though he realizes that it is a hallucination. "What harm is in it?" Kovrin asks himself. As the summer goes on, the black monk continues to visit. Kovrin asks Tanya to marry him, they wed and move to the city. At one point Kovrin's hallucinations and disordered thinking overwhelm him; he agrees to medical treatment which evidently cures his mental disorder. Yet, his feelings of energy and creativity also disappear, along with the black monk.

Kovrin realizes that he hates his wife and she hates him. She returns to her father and his beloved garden, while Kovrin receives a professorship, a position he never actually takes because he is too ill--he has begun to hemorrhage from the lungs. Soon after receiving news of his father-in-law's death, he sees the black monk again and dies of a hemorrhage.

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The film covers two days in the life of Frank Pierce (Nicolas Cage), a burned-out EMT (emergency medical technician) working the socio-economic underside of Manhattan. From the beginning, Frank is upset because recently all his patients have been dying on him, and he is haunted throughout by the hallucinated ghost of Rose, a young woman who collapsed on the street and died, apparently because he could not intubate her correctly.

Frank is highly stressed, he has no life outside his work, and he is self-medicating with alcohol. He tries to quit, but his boss keeps him on by promising time off in the future. In the film's first action, Frank does manage to miraculously resuscitate Mr. Burke, a heart-attack victim, but the patient winds up in the hospital with a very bad prognosis, so even that "saving" works against Frank.

Frank has encounters with numerous patients, many of them street people whose lives are out of control, some of whom are ER (Emergency Room) regulars, such as the demented young Noel (Marc Anthony). He also deals with (and is dealt with by) several highly idiosyncratic EMT partners in his ambulance rounds (John Goodman and others). Frank gets to know Mary Burke (Patricia Arquette), the daughter of the heart-attack victim, and they tentatively move toward being a couple who might help each other survive their lives.

Near the end, Frank, who knows Mr. Burke had tried to tear out his tubes during a brief moment of consciousness, and who feels he has been getting pleading messages from him to end his agonies, surreptitiously takes him off life support long enough for him to die. The physician who responds to the code decides not to attempt resuscitation of this patient who had already been resuscitated 14 times that day. Frank goes to tell Mary that her father has died (but not how), and exhaustedly falls asleep on her breast, apparently having forgiven himself because he has in some sense finally "saved" Mr. Burke.

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Wealthy American widows Alida Slade and Grace Ansley have taken their two marriageable daughters on a Continental tour. As the story opens, the older women linger at a restaurant with a view of the Forum while their daughters leave for an unchaperoned outing. The women talk of how carefully their mothers guarded them, and how their own mothers were in turn warned of Roman fever to keep them in at night.

Alida pushes the talk back to their girlhood, and Grace’s illness after a nighttime sightseeing trip; she reveals her knowledge that Grace had really gone to the Forum to meet Alida’s fiancé, Delphin Slade. Impelled by a mixture of jealousy, guilt, and vengeful satisfaction, Alida declares that she, not Delphin, wrote the letter summoning Grace to the tryst. This initial crisis is followed by a much more powerful one when Grace makes her own revelations about that night at the Forum.

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The first chapter of this memoir consists of two words: "I exaggerate." The narrator then tells us the story of her childhood and early adult experiences as an epileptic. After having her first seizure, at the age of ten, she spends a month at a special Catholic school in Topeka, Kansas, where the nuns teach epileptic children to fall without hurting themselves. This falling may or may not be literal; it is certainly symbolically apt.

During adolescence, Lauren begins lying, stealing, and faking seizures to get attention. She reveals that she has developed Munchausen's Syndrome, whose sufferers are "makers of myths that are still somehow true, the illness a conduit to convey real pain" (88). A neurologist, Dr. Neu, performs surgery severing Lauren's corpus callosum, effectively dividing her brain in half and markedly alleviating the seizure disorder.

Later she attends a writer's workshop where she begins an affair with a married man, a writer much older than she. After it ends badly, she starts going to Alcoholics Anonymous (although she does not drink) and tells her story with such authenticity that when she later confesses that she is NOT an alcoholic, no-one believes her, dismissing her true story as denial. The memoir ends both with her recognition of the value of narrating and with a silent fall to the snowy ground, as the nuns taught her to do, in the knowledge that the sense of falling (rather than the material certainty of landing) is all that is finally, reliably, real.

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This long (11 stanzas of ten lines each) poem takes us through the--at first faulty--cancer diagnosis, treatment, and recovery endured by the speaker's wife, and witnessed by the speaker. The poet personifies the tumor because to do otherwise would mean that he would "have to think of it as what, / in fact, it was: part of my lovely wife." The poison of chemotherapy that renders his wife "averse to it all" is contrasted with "perky visitors" and the flowers that they bring.

The poet imagines that the tumor of which his wife has been cured now resides in "Tumor Hell" where it lies "bleak and nubbled like a poorly / ironed truffle." The doctors who practice in teaching hospitals show the students how to deal with tumors: "batter it . . . strafe it . . . sprinkle it with rock salt and move on."

Now that his wife is better, the poet and his friends consider how he has fared. At first he was unable to concentrate, made lists, "wept, paced, / berated myself, drove to the hospital" and was "rancid with anger." Yes, it was awful, but he rejects pity--even self-pity. Only his wife has the right to give a name to the experience: "let her think of its name and never / say it, as if it were the name of God."

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In 1988, having suffered for years from major depression and borderline personality disorder, and now also showing symptoms of obsessive-compulsive disorder, the twenty-six-year-old Lauren Slater is prescribed a new drug: Prozac. In this "diary," a series of meditations and progress reports on her experience, Slater traces ten years on Prozac, providing a remarkable before-and-after picture of the drug's effects.

She is "hobbled" by her illness: has dropped out of college, has been fired from most jobs, has been hospitalized five times. By the end of the book, she has received a doctorate from Harvard, has a successful career as writer, teacher, and psychologist, and is in a happy marriage.

Despite these unquestionable positives, Slater is ambivalent about the drug, describing the shock of becoming "normal," of being assaulted by health. She describes the sexual dysfunction, her anxiety about losing the need and ability to write the kind of poetry she had written before, and the terrifying moment when the drug suddenly stops working, and she must confront the possibility that it may not be a reliable and permanent solution.

She comes to fear that, healthy, she is no longer herself but something the drug has created. At the same time, though, it is only because of the drug that she is even able to ask these questions. Finally, she thanks her doctor for his ambiguous gift: she has become like a beautiful fish, her "skin all silver," her "mouth pierced" on Prozac, "this precious hook."

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Peppered with a plethora of black and white stills, this book is a compilation of a physician's film reviews and reflections on how movies have mirrored the changes in medical care and in society's attitudes towards doctors and medicine over the last sixty years. Ten chapters blend a chronological approach with a thematic perspective: Hollywood Goes to Medical School; The Kindly Savior:

From Doctor Bull to Doc Hollywood; Benevolent Institutions; The Temple of Science; "Where are All the Women Doctors?"; Blacks, the Invisible Doctors; The Dark Side of Doctors; The Institutions Turn Evil; The Temple of Healing; More Good Movie Doctors and Other Personal Favorites.

The appendices (my favorite) briefly note recurring medical themes and stereotypes ("You have two months to live," "Boil the Water!"). Formatted as a filmography, the appendices reference the chapter number in which the film is discussed, the sources of the photographs, and a limited index.

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Summary:

Alan Shapiro, poet and professor of English at the University of North Carolina, Chapel Hill, chronicles the life and death of his sister, Beth, who died of breast cancer at the age of 49. Beth lived the last four weeks of her life at a hospice in Texas--this memoir traces those weeks in particular and refracts them against decades of family dynamics, turmoil and triumph. The memoir is composed of 14 tersely named chapters ("The Death," "The Joke") followed by "Afterwords": six poems about Beth.

Alan is the youngest of 3 siblings; Beth was the oldest and David, an actor is the middle child. Despite, or perhaps because of their age difference, Beth and Alan were very close. It was he whom she asked to write her eulogy and it was he who stayed the entire 4 weeks of hospice, save for a brief trip home. From Alan's love and devotion grows an admiration for Beth's integrity in life and death.

Beth married an African-American man, fought for liberal causes, and suffered complete estrangement from her parents due to her choices. Her husband, Russ, must deal not only with the loss of his wife and their daughter's loss of her mother, but also with the prejudice of the Shapiro parents and the medical establishment. At one point Shapiro describes how, whenever he accompanied his sister and her husband to the doctor's office, Alan, not Russ, was treated as the spouse and decision-maker.

Shapiro vividly depicts the poignancy of parent-child relationships. Gabbi, the seven-year-old daughter who loves horses, gallops through the house with grace and abandon not possible at the hospice. Alan's anger at his father's actions and his forgiveness of his mother's accomplice role are also strongly demonstrated. A great strength of this book is the choice of detail: the mother completes a book of crossword puzzles during the vigil; the brother becomes infatuated with a particular joke he wants to memorize; nurses leave a solitary rose on the bed of the newly dead at the hospice.

Shapiro is keenly interested in being with his sister right at the moment of her death. He describes the end: "one long, deep, and profoundly eerie moan . . . That moan, I'm certain, marked the end of Beth, the end of life, though the body went on breathing for another minute or so, each breath a little fainter, weaker, the body's electricity guttering down, dissolving, till there was no breath at all." (pp. 111-2)

He also analyzes whether this was "a good death." There had been many gifts: Beth's recognition of her importance, her reconciliation with her father, and her acceptance of her mother's devotion. However, Shapiro also keeps the reader cognizant of Beth's suffering and the now motherless child, the spouseless husband and the myriad other ways that Beth's death marked a void.

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