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This book concerns the care of dying persons. Hospice care provides a multidisciplinary approach to caring for the whole person, including his or her physical, emotional, social, and spiritual needs. Often, however, discussion about hospice or palliative care tends to focus almost exclusively on relieving physical symptoms. Kearney tells us a number of dying patients' stories. Some die at peace, in seeming fulfillment. Others die in great distress, with what Kearney calls "soul pain," a deep existential anguish that is not relieved by symptom control or social support.
Kearney proposes two complimentary models to describe what occurs in dying persons whose "soul pain" is relieved. For the first, he recounts the Greek myth of Chiron. The wise centaur Chiron suffered from an incurable arrow wound inflicted by Hercules. Chiron learned that if he would be willing to sacrifice his immortality on behalf of Prometheus, he would be freed from his suffering. After he did this and descended into the underworld, Zeus raised him to the heavens, where he became a constellation.
Thus, the mythological model has a hero who is wounded, struggles, makes a choice, then descends into the depths, and finally returns transformed. The second, psychological model portrays the mind as having a surface rational part (where the ego resides) and a deep symbolic and intuitive part (where the "deep center" resides). The relief of "soul pain" lies in choosing to reject the ego's resistance and "letting go" to get in touch with the deep center.
This is a personal narrative by one of America's most accomplished authors. For the past thirty years Reynolds Price has written novels, stories, poems, essays. In this memoir Price describes his battle with a spinal tumor detected in 1984 which left him with some neurological impairment. He struggled with his own rehabilitation and eventually recovered with the aid of biofeedback and hypnosis.
The most compelling part of the book is near the end. The author muses about the meaning of his illness, "advice I'd risk conveying to a friend confronted with grave illness or other physical or psychic trauma" (p.182). He puts the travails of life into a philosophical perspective that is almost Zen-like.
As Joanne Trautmann Banks indicates in the Foreword of this fine anthology, "when we are sick, very sick, it is often the nurse who is closest to our bodies, minds, and souls." This experience of closeness to suffering is well-reflected in the poetry and prose of the 49 nurses whose work is collected here. While these writings vary widely in form and style, they focus almost exclusively on the nursing interaction; they are nurses' stories of patients and nurses' reflections on nursing. Two major themes pervade the book. One is the powerlessness of nurses in the face of illness and suffering. The other is their tough, unsentimental devotion to their patients and the profession.
Of the poetry, particularly fine pieces include: "Raiment" (Carol Brendsel); "Daffodil Days" (Celia Brown); Butterfly (Jeanne Bryner; see this database); "What the Nurse Likes" and The Body Flute (Cortney Davis); "Hospital Parking Garage" (Jeanne LeVasseur); and "Euthanasia" (Belle Waring). Among the excellent prose pieces are "Nighthawks" (Carolyn Barbier), a tale in the voice of a ventilator-dependent woman who has elected to discontinue treatment and die; "While His Life Went on Around Him" (Angela Kennedy); "Wisteria" (Leslie Nyman); "Where Are You Now, Ella Wade?" (Joyce Renwick); and "Bev Brown" (Sybil Smith).
Adolescent orphan Nell Trent escapes with her gambling-addicted, mentally infirm grandfather from the villainous "dwarf" Daniel Quilp, to whom the old man, obsessed with making Nell wealthy, has lost his money and his shop. Quilp and a host of other malevolent and benevolent characters track the pair's journey through urban, rural, and industrial England. When the good characters reach the peaceful hamlet where Nell and her grandfather have settled, Nell has just died, soon to be joined by her grief-stricken grandfather.
Ingenious Pain tells the life story of James Dyer, a surgeon in eighteenth-century England who is gifted--and cursed--with the inability to feel physical or emotional pain. Beginning with his postmortem, the novel traces the thirty-three years of his life, from his illegitimate conception on a frozen river, through the rise of his career from itinerant quack's assistant to ship's surgeon, and then to the court of Empress Catherine of Russia where he meets Mary, a mysterious woman who performs magical surgery on him with her hands, enabling him for the first time to feel and, as a result, to love.
At first this new ability drives him mad, and he is submitted to the infamous torments of Bethlehem Hospital. He gradually recovers, but his new sensitivity has disrupted his identity as a surgeon. He performs one last operation, saving the life of a Negro wrestler by opening his chest and massaging his heart. His own death, not long after, seems to signify that he has at last become a normal man, and this is a form of redemption.
This poem is one in a series written by Ted Hughes, addressing his wife, the American poet Sylvia Plath, who committed suicide in 1963. Here, the speaker recalls a time when he and his wife were living in Spain, and she became ill: "You lay helpless and a little bit crazy / With the fever." For Plath, the illness seems intolerable. She whispers, "Help me" to her husband, "crie[s] out for America," and sobs "I am going to die." He takes care of her, feeling as if he is "a nursemaid" or "suddenly mother." He cooks soup and spoon feeds her.
What worries him, though, is her reaction to being ill. He wonders whether she's exaggerating, and fears that if she treats a fever as if it were "the most impossible / Of all horrible things," then how will she be "when things get really bad"? He feels himself withdraw his sympathy for her, but then he recognizes what he calls "the overload"--a bluntedness which he likens to "the callous / That eases overwhelmed doctors."
The end of the poem is ambiguous: both he and his wife are overloaded; where her response is (hyper?) sensitivity, his is anesthesia. He continues to feed her the soup. (67 lines)
This poem is one in a series written by Ted Hughes, addressing his wife, Sylvia Plath, who committed suicide in 1963. After her first suicide attempt, and before she met Hughes, Plath was given electroconvulsive therapy (ECT) for depression (see Plath's novel The Bell Jar for her own description of this). In this poem, Hughes contemplates the mechanics and symbolism of what seems so brutal and elemental a treatment.
He focuses on the fragility and beauty of her body--"Your temples, where the hair crowded in, / Were the tender place"--and then makes us imagine the effect of electrodes there, in ever more shocking images: "They crashed / The thunderbolt into your skull," "They dropped you / A rigid bit of bent wire / Across the Boston City grid." He then suggests that there is a link between this treatment and the kind of poet she became: her "voice" was scarred and "over-exposed / Like an x-ray," and when her words returned they were distorted and vulnerable, "Faces reversed from the light / Holding in their entrails." (38 lines)
The film opens with a short series of images of hospitals, dead bodies, landscapes, a hand impaled by a nail, and a bespectacled young boy lying uncomfortably under a thin sheet. (The shot of an erect penis was removed for distribution outside Scandinavia.) A young nurse (Bibi Andersson) is assigned to look after a great actress, Elizabeth (Liv Ullman), who had been playing Electra to critical success. Elizabeth is completely mute, but the psychiatrists cannot detect any discrete pathology and have no diagnosis.
At first the nurse worries that the case may be too complicated for her, because of the difference in age and experience. The pair are sent to the doctor's summer cottage by the sea. The actress remains silent, but her nurse chatters endlessly, trying to draw out the patient. Eventually, in a complete reversal of psychotherapeutic roles, she is compulsively confiding her fears and intimate secrets of sexual adventures.
To her horror, she reads a letter written by Elizabeth to the psychiatrist that describes the confessions as nothing more than amusing diversions. She is angered and deliberately tries to harm Elizabeth. Then she delivers a stern accounting for her patient's silence, as a rejection of her femininity, her marriage, and especially of her son. This scene is portrayed twice--once with the camera on the nurse; once with the camera on the patient. The irritated husband comes for his wife, they return to the city, where Elizabeth's future is ambiguous. But at the completion of their relationship the nurse has grown in wisdom and confidence.
Dr. Ernest Lash, single and around 40, discovers his enthusiasm and love for psychoanalysis, the talking therapy, after several years of practice as a psychopharmacologist. As the novel opens, we meet a smart, somewhat smug and self-absorbed Dr. Lash who practices from his office located in the privileged community surrounding Sacramento Street in San Francisco. He has an active psychoanalytic practice, ambition for respect and notice by the seniors of his professional community, and some aspiration to greater success as a theoretician and writer on the subject of psychoanalysis. Central to his character is a love for his work, where it appears that pride in technique and outcome shadows genuine concern for his patients and their unhappiness.
Early in the novel, a male patient, Justin, who has been working with Ernest for several years, announces that he is leaving his wife, Carol, for another woman. Ernest is pleased since he views the marriage between Justin and Carol as unhealthy, while a bit dismayed that Justin fails to acknowledge Ernest's contribution in helping Justin develop the confidence to take this step. Justin ends his relationship with Ernest Lash--feeling that he no longer needs his help--as the beginning of the novel takes an intriguing direction.
Justin's now abandoned wife, Carol, in a state of betrayal and desire for vengeance--she has a hateful attitude toward all psychiatrists after her psychotherapist of many years ago had an affair with her--decides to enter therapy with Dr. Ernest Lash in the hope of seducing him. She disguises herself with a name change and enough distortion of her past and present so that Dr. Lash will not be able to connect her to Justin. She wishes to expose him as a charlatan, and destroy his career.
Carol is an attorney, and smart. Dr. Ernest Lash is lonely and drawn to Carol. The therapy sessions and the progression of their relationship are central to Yalom's exploration of the intersubjective experience, where strangers struggle with the ambiguity of their own motives and intentions in the intimate world of psychoanalysis. Who is giving, who is receiving? Who is being helped, and who is helping?
Yalom weaves this central element of the plot with many other relationships. Dr. Marshal Streider is a senior psychoanalyst with ambitions for national recognition and a preoccupation with money. He is Dr. Ernest Lash's supervisor. He takes great pride in the fact that he treats many wealthy patients, and is engaged in his own boundary dilemmas when he invests, using insider information from one of his patients.
Dr. Seymour Trotter is a senior psychoanalyst who is condemned and removed from psychoanalytic practice after entering a sexual relationship with one of his patients. We learn that Seymour Trotter was once president of the American Psychiatric Association, and a mentor to Marshal Streider. His maxim, "My technique is to abandon all technique" (p. 7), both haunts and guides Ernest Lash throughout the novel as Ernest grapples with his own passions and temptations, while striving in his goal to achieve humane and healing therapy for his patients.
At Christmas, 1913, the two Rappard boys and their grandmother (May Robson) bring a cake to the Brussels nursing home where the English matron, Edith Cavell (Anna Neagle), is caring for their dying mother and many small children. The prayer is for peace, but in a few short months war has spread over Europe and the oldest boy is sent to fight.
He is taken prisoner, but escapes to the nursing home because he hears that Germans are shooting prisoners. Cavell, with a network of friends including the boys' grandmother, the barge-owner Mme Moulin (ZaSu Pitts), and a dignified Countess (Edna May Oliver) help him and two hundred other wounded young men to escape into Holland and France.
By August 1915, Cavell and her friends are betrayed by a German spy and put on trial. Despite international pleas for her release or detention, she is shot at dawn on 12 October 1915. Linking nursing to religion, the priest who attends her final hours tells her, "it is God's will," while the hymn, "Abide With Me," sung in the final scene of her 1919 memorial service at Westminster Abbey, reminds viewers that she had been "help of the helpless."