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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 author of this memoir is a poet and writer who developed systemic lupus erythematosis (SLE) during her first year at the University of Pennsylvania. Initially, her condition was difficult to diagnose, which led to her first negative encounters with physicians and the health care system. Later, Ms. Goldstein developed unusual neurological manifestations of SLE. Once again, she had trouble convincing her doctors that her symptoms were not only real, but also disabling. She was fortunate enough to come across a few good physicians who respected her as a person and earned her trust.
Despite her chronic illness, Ms. Goldstein thrived throughout college and graduate school. She approached each new challenge with such a positive attitude that some of her doctors considered her emotionally unstable. (I guess they thought it would be more "normal" for her to lose hope and turn herself into an invalid.) Her graduate work in literature focused on the new field of literature and medicine.
The story is set in the mid-1950s in Italy, where the old order has passed away and the postwar economic miracle is beginning to blossom. Our heroine, Chiara, is the beautiful 17-year-old daughter of Count Giancarlo Ridolfi, the scion of a distinguished (but now impoverished) Florentine family. Indeed, Chiari's family history includes the romantic tale of a 16th century female dwarf.
The (more or less) hero of our story is Salvatore Rossi, an earnest young neurologist who hails from a Communist family in a poor village in the south. One night Chiara and Salvatore meet by chance at a concert and fall hopelessly in love. Neither one knows how to respond to the powerful emotions that possess them.
Chiara consults Barney, her worldly and loudmouthed English friend from boarding school. What should she do? Salvatore consults Gentilini, his older and overwhelmingly married colleague. How should he proceed? Meanwhile, Cesare, Chiara's avuncular and solitary cousin who lives on the family farm, has his own part to play in the story. And, in truth, the story lurches from one misunderstanding to another as the wedding approaches, eventuates, and recedes into the past.
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]
Summary:The poems in this collection are elegant, economical, worldly, and humorous. The tone is generally one of amused ruefulness. In "Alcohol" the poet addresses his subject as "the eighth / and shallowest / of the seven seas." He salutes the "nice" people, "on whom depends / the diminishing goodness of the world."
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.
Fred McCann is an energetic man in his thirties, something of a playboy, when the Second World War breaks out. He becomes a soldier, and in an Italian village one day he goes to a pump for a drink of water. The pump is booby-trapped and explodes. He is blinded and loses all four limbs. The story traces the development of a relationship between Fred and Alice, his nurse in the military hospital.
As he learns to submit to being entirely helpless, reliant on Alice for all his needs, he gradually begins to adapt to his new condition. Then Alice changes everything by having sex with him. At first their new and obsessive relationship makes him happy, restoring some of his old sense of himself as a man. When Alice is moved to another duty and replaced by a sadistic male nurse, Fred is so devastated and makes such a scene that he gets Alice back.
To celebrate her return, Alice sneaks some whiskey into his room and they get drunk. She then says something that appalls him: she calls him her "thing" and confides that she has always hated men, who look at her and touch her and have power. Fred is nauseated, seeing himself reduced to nothing more than a "a phallus on its small pedestal of flesh." He realizes now that he is no longer a man, and later that night he manages to drag himself out into the garden, where there is a small pool in which he drowns himself.
Traumatized from a small plane accident that killed his parents and sister and injured him, Finn has returned to his grandmother's farm in Vermont where he's always spent happy summers, to regroup and continue his life. His trauma has left him unable to speak.
At the farm he is surrounded by the healing presences of his grandmother, an old summer friend, Julia, and the animals. Between painful flashback memories of the accident, Finn begins to allow himself to enjoy moments, especially in the tolerant and undemanding presence of the girl and the woman who are also grieving, but who find ways to help him reclaim life and the present.
Visiting an old childhood hideaway in nearby pine woods, Finn and Julia run into drug dealers who use the isolated spot for their transactions. Finn finally finds his voice when he is forced to rescue Julia in the midst of a spreading fire from an abandoned well into which she was dropped by a panicked drug dealer who feared exposure.
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.
A two-year-old girl is brought to the Emergency Room. Her father believes there's nothing wrong with her, but the mother says that earlier the child had looked "blank," and is sure there's a problem. The physician tries to work out what might be wrong.
The child seems fine, but he automatically looks for signs of abuse, and the triage nurse suggests the parents, who are African-American and on Medicaid, are there because they want "something for free" (127). There are other patients waiting, the child's vital signs are fine, the father wants to leave.
As the doctor is leaving the examining room, he asks whether she might have taken someone's medication, and the mother mentions that the child's grandmother takes "sugar pills," hypoglycemics. They test the child's blood sugar and it is dangerously low. She is admitted to the hospital.
The physician tells the mother she has saved her child's life, and then considers how lucky they had all been--"I felt sick, cold, and damp, terrified by what I had almost missed" (131). He says that since then, he often thinks of the child, "alive in the world, going out into it, . . . decade after decade ahead."