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Editor Helman is a physician and anthropologist as well as a published author of short stories, essays, and a medical anthropology textbook. For this anthology he has selected short stories, case studies, memoir and novel excerpts whose purpose is "to illustrate different aspects of [the] singular but universal relationship" between doctors and patients (1). In the introduction he discusses how these selections illustrate storytelling in medicine; the unique experience of individual illness; differences between fast-paced contemporary technological specialized medicine, and an older more leisurely medicine where the physician employed all his/her senses to diagnose illness, doctors made house calls, and patients recovered over time, or died.
The anthology is subdivided into three parts: "Doctors," represented by the work of Mikhail Bulgakov, Franz Kafka, Sir Arthur Conan Doyle, and Rachel Naomi Remen; "Patients," represented by authors Renate Rubenstein, Ruth Picardie, Rachel Clark, Clive Sinclair, W. (William) Somerset Maugham, and O. Henry; and "Clinical Encounters," with work by Oliver Sacks, Cecil Helman, William Carlos Williams, A. J. (Archibald Joseph) Cronin, Anton P.Chekhov, and Moacyr Scliar. (In total there are 16 selections.) Each piece is preceded by a paragraph of biographical information about its author and an introduction to the text.
In short, episodic chapters that move unpredictably and unchronologically through the years between 1956 and 2003, Nick Flynn tells us about his father, Jonathan Flynn--a man of many trades, a writer, an alcoholic with a prison record, a homeless person--and of his own life, which sporadically interweaves with Jonathan's. When Nick was six months old, his 20-year-old mother left Nick's father and made a meager life for herself and her two young sons. A string of her live-in boyfriends and one more failed marriage wound their way through Nick's young life, which was in the seaside town of Scituate, Massachusetts, "the second most alcohol-consuming town . . . in the United States" (77).
At 12, Nick is drinking beer; at 17 he is drinking to get drunk, sometimes with his mother, and smoking marijuana (and later doing other drugs). For years Nick's father "had been manifest as an absence, a nonpresence, a name without a body" yet, "some part of me knew he would show up, that if I stood in one place long enough he would find me, like you're taught to do when you're lost. But they never taught us what to do if both of you are lost, and you both end up in the same place, waiting" (24).
The place where Nick and his father "end up" is the Pine Street homeless shelter in Boston where 27-year-old Nick is a caseworker and Jonathan Flynn appears, a few months after being evicted from his rooming house. Reluctantly, Nick gradually acknowledges his father's presence in the shelter, and gradually, during the next 15 years, reconstructs the lost years through conversations with his father and his father's acquaintances, letters, and manuscript excerpts. The title of the memoir is what Jonathan Flynn mutters at night, when he is looking for a place to sleep (205).
The narrator is an alcoholic who has signed himself into a "drying-out facility." He has been there before and tries to reassure his companion, J.P., that their unpleasant withdrawal symptoms will improve. J.P. likes to talk and the narrator encourages him to do so because he would rather listen to J.P.'s stories than think about his own predicament. After hearing about J.P.'s marriage--infatuation, love, children, drinking, fighting ("who knows why we do what we do?")--the narrator is able to tell his own story.
His story includes a wife with whom he was once happy but from whom he is now estranged, and a girlfriend who has received a cancer diagnosis. Each woman had brought him to the drying-out facility, at each separate occasion. "Part of me wanted help. But there was another part." The narrator's ambivalence extends to his relationship with these two women. He can't face his girlfriend's illness or her son, and he knows that if he calls his wife she will ask him "where I'm calling from" and he will have to explain.
The narrator is confined to her bedroom in a summer house as part of the rest cure for her "nervousness." A nursemaid takes care of the baby. Her husband John is a physician who insists that she remain completely inactive, not even picking up a pen to write.
The bedroom was formerly a nursery. It has ugly yellow wallpaper with a recurring pattern that begins to obsess the narrator. Given her loneliness and lack of emotional support, she begins to see a woman confined in the pattern of the "repellent, almost revolting" wallpaper. Eventually she decompensates and has a complete emotional breakdown.
Marriage à la Mode is a set of six paintings which were subsequently made into engravings. The series depicts the dissolution of a marriage conceived of greed and vanity. This fictional, arranged marriage between a Viscount and a rich merchant’s daughter is doomed to end in tragedy. "The Visit to the Quack Doctor" (also called "The Inspection") is the third in the series.
By this point, the husband has contracted a venereal disease and he and his diminutive mistress are visiting a quack doctor and female accomplice. This bold, angry assistant commands the center of the picture--she bears the tattoo of a criminal on her breast, holds a jackknife and is clothed in a wide black dress with a red and gold fringed apron. The toothless, bowlegged, leering doctor is colored in browns like the background of the picture.
The Viscount is seated, has a plaster on his neck, and extends a box with three black pills towards the doctor. His grinning expression is one of foolish pleasure. The mistress, who barely reaches the height of the seated Viscount, is the only sad figure and object of pity. Surrounding these figures are numerous icons of death, such as skulls, skeletons, anatomical dissections, and a torture machine complete with French instruction book.
Barney Panofsky--like so many of Richler’s protagonists (and like Richler himself, one suspects)--is a hard-drinking, hard-smoking, foul-mouthed, hedonistic writer and producer. He has many sexual exploits in his past and loads of self doubt in his present, together with digitalis and dentures.
But there was only one true love in his life, although he has had three wives: Clara a mysterious artist-poetess whose suicide in Paris helped to establish his fame; "the second Mrs. Panofsky" whom he loathed for all of their short time together; and Miriam, mother of his three children and his partner for decades, until Barney blows it with presumptuous inattention culminating in a vain indiscretion, and she leaves.
Since the end of his second marriage, Barney has lived under the shadow of the unproven accusation of having murdered his best friend, Bernard "Boogie" Moscovitch. Supposedly, he committed the crime in a drunken rage provoked by his discovery of Boogie in flagrante with "the second Mrs Panofsky." Barney may have been drunk, but he didn’t do it. At least, he doesn’t remember doing it.
Barney’s "version" is an autobiographical account written in old age, and annotated with footnotes by his priggish and obsessive son. It is Barney’s side of the murder and his life, and it leads up to and devolves from that fateful evening when, far from being angry, he felt joy in a bedroom scene that would be his ticket to live with Miriam.
He recalls drinking with Boogie and their going for a swim. But he alone still expects to see Boogie stride through the door. Everyone else, including his children, believe that he was the killer, spared imprisonment because Boogie’s body was never found. The weight of Barney’s guilt waxes and wanes.
But remembering anything is increasingly difficult for Barney. He fears dementia. As its specter looms over his memories, it raises doubt about the veracity of his "version."
In 1917, the poet Siegfried Sassoon protests the war in a London newspaper. He is saved from court martial by a military friend who argues successfully for his transfer to the Craiglockhart War Hospital where he comes under the care of psychiatrist, William Rivers. Sassoon is not sick, but he and his doctor both know that the line between sanity and insanity is blurred, especially for a homosexual and in a time of war.
The other patients, however, are gravely wounded in spirit if not body; sometimes they are tormented by uncomprehending parents and wives. Rivers’ efforts to unravel their nightmares, revulsions, mutism, stammering, paralysis, and anorexia begin to shake his own psychic strength and lead him to doubt the rationality--if not the possibility--of restoring them to service. He yearns for his pre-war research in nerve regeneration, the quixotic enterprise that serves as a metaphor for his clinical work.
The story of a woman artist's slow decline into dementia and death as told through the eyes, words, and reflections of her philosophy professor son. Through his memories of their 1950s life together, he reconstructs a speculative analysis of her early married life with his soil-scientist, Russian-immigrant father.
The one older brother becomes a neuropathologist who investigates the very disease that slowly strips their mother of herself. Their father tends to her growing needs at the family farm, but he dies suddenly and she must be placed in an institution where one nurse alone seems to respect her dignity.
The brothers' rivalries and misunderstandings are recapitulated in their different responses to their father's death and their mother's illness: the physician retreats to scientific explanations of the "scar tissue" in her brain; the philosopher looks for evidence of personhood and for reassurance that death should not be feared. His obsession with his mother's condition stems from a deeply felt sense of guilt; it destroys his marriage and condemns him to depression, hypochondria, and shame as he creates and diagnoses the same illness in himself, long before it can be detected by doctors.
Augusto and Michaela Odone (Nick Nolte and Susan Sarandon) are the adoring parents of a bright little boy who inexplicably develops alarming behavioral problems, after they return from working in the Comoro Islands. A series of investigations results in a diagnosis of adrenoleukodystrophy (ALD), but the boy rapidly deteriorates into a bed-ridden, inarticulate state. Frustrated by the medical profession's inability to help, Augusto and Michaela embark on an odyssey of salvation, studying lipid metabolism, promoting international conferences, and trying to disseminate their findings to other parents.
Their insights lead them to experiment with at least two effective therapies, one of which is erucic acid (Lorenzo's oil). Michaela feels guilt as well as grief, when she understands that the X-linked disease is passed from mother to son. In an effort to keep Lorenzo at home, she refuses to admit the extent of his disability, alienates her family, dismisses nurses, and assumes most of the care herself, nearly ruining her own health and her marriage. The film ends hopefully with tiny signs of recovery in Lorenzo. The credits roll over the faces and voices of happy, healthy-looking boys who have been taking Lorenzo's Oil.
Fiona has Alzheimer's disease and Grant must finally place her in an institution. He is dutiful in his caregiver role and respectful of her past beauty and affection. To his horror however, he watches Fiona establish a romantic bond with another demented patient, Aubrey, whose appearance, behavior, and education are nothing like Grant's. At first, Grant resents the threat, then he gradually accepts Fiona's need.
The situation is aggravated when Aubrey's wife, Marian, brings him home. She really does not want him there, but cannot otherwise keep her house. Fiona is miserable and begins to lose weight. Grant awkwardly tries to encourage Marian to send Aubrey back, or at least to allow regular visits. She is unwilling, but eventually she relents. However, Fiona improves anyway, her disease having rapidly eradicated the memory of Aubrey, while Grant and Marian are exchanging telephone messages about the possibility of a date.