Showing 91 - 100 of 654 Nonfiction annotations

Out the Window

Hall, Donald

Last Updated: Mar-02-2012
Annotated by:
Kohn, Martin

Primary Category: Literature / Nonfiction

Genre: Essay

Summary:

The writer Donald Hall gives us a lyrical armchair view through the windows of his house not only of the New Hampshire landscape, but also of his and his anscestors lives lived in that landscape. His honest and moving account from his 83rd year  is captured in the following: "I feel the circles grow smaller, and old age is a ceremony of losses, which is on the whole preferable to dying at forty-seven or fifty-two [the ages his wife Jane Kenyon died and his father died]. When I lament and darken over my diminishments, I accomplish nothing. It's better to sit at the window all day, pleased to watch the birds, barns, and flowers. It is a pleasure to write about what I do" (p.41).

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Annotated by:
Schilling, Carol

Primary Category: Literature / Nonfiction

Genre: Biography

Summary:

Rosalind Franklin: The Dark Lady of DNA is the biography of the scientist whose research James Watson and Francis Crick needed to elucidate the structure of the DNA molecule.  Even though the discovery has had profound implications for modern medicine, Franklin's contribution to it almost remained obscure.

In 1968 Rosalind Franklin (1920-1958) became visible to the world beyond a small circle of scientists when Watson published The Double Helix (1968), his "personal account" of puzzling out DNA.  If not for Watson's self-incriminating candor about stealing glances at Franklin's research, we might not know how crucial her lucid x-ray diffractions of hydrated DNA were to him and Francis Crick.  However, the account that indirectly acknowledged Franklin's contribution to their work represented her in a patronizing caricature.  Since ovarian cancer took her life a decade before Watson's memoir appeared, others have been left to respond to his version of the DNA story and representation of his female colleague.  Among Franklin's defenders, Brenda Maddox offers the most complete and insightful restoration of the scientist, her research, and her life. 

Maddox's biography draws from not only the many scientific archives and personal papers of scientists Franklin worked with in England, Europe, and America, but also from previously undisclosed letters written by Franklin, her friends, and her family.  Maddox also interviewed Franklin's relatives.  Doing so allowed her to position Franklin's life within the history of her close, extended Anglo-Jewish family, generations of wealthy London publishers and bankers who experienced discrimination.  This history does more than belie some of Watson's hasty assumptions about Franklin's background.  It creates a biography of a complex woman who negotiated biases as a citizen and a scientist.     

The biography is divided into three parts.  The first narrates the story of Franklin's childhood, rigorous education, and successful career before accepting the fateful research post at King's College, London.  She's known for thinking skeptically and working mathematically.  Yet early on she showed an aptitude for three-dimensional thinking and for understanding crystalline structures.   As an undergraduate at Cambridge she speculated about a "'Geometrical basis for inheritance'" (56).

The second section concentrates on the 27 months at King's when she worked uneasily with Maurice Wilkins, who showed her revelatory x-rays of DNA to Watson.   This balanced account of a controversial episode in the history of science offers evidence that Franklin was close to drawing the same conclusion about the structure of DNA that Watson and Crick rushed into print.  This section also accessibly explains the molecular biology of her day and the painstaking physical and intellectual intricacies of making and interpreting x-rays of crystalline molecules. 

The third section reminds us that Franklin had a very productive, though short career after leaving DNA to others.  She directed research programs for the study of plant viruses, and she investigated the polio virus shortly before she died.  Respected scientists, including Crick, praised her research.   Many, unlike Wilkins, liked working with her.  More than 40 years after viewing what's known as Franklin's Photograph 51, Watson publicly acknowledged that seeing it "'was the key event'" in understanding the geometry of DNA (316).  (See the note on Photo 51 below.)        

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Blue Nights

Didion, Joan

Last Updated: Dec-22-2011
Annotated by:
Shafer, Audrey

Primary Category: Literature / Nonfiction

Genre: Memoir

Summary:

Joan Didion's memoir, The Year of Magical Thinking, chronicled the overlap of two catastrophes: the critical illness of her adopted daughter Quintana Roo and the sudden death of her husband of forty years, John Dunne. Between the writing of that memoir and its publication in 2005, Quintana died at age 39. She had suffered a 20 month illness which started as a flu, advanced to pneumonia and sepsis, with intracranial hemorrhage and other complications necessitating 5 surgeries and extended intensive care unit stays. Blue Nights is a meditation on Quintana, and her mother's consuming sense of loss over the tragedy of her only child.

Blue nights refer to the quality of the light during evenings around summer solstice, a time of year which the author feels starts the whole cycle of diminishment and death. The memoir begins with a reminiscence of Quintana's wedding in July 2003 (the same year she falls ill and Dunne dies), as seen 7 years on by Didion. Throughout the description of the wedding are particulars of dress, flowers, design choices and locale which are not only precise, but also hold tremendous meaning to Didion. The branding of clothing, furniture, dishware, hotels etc, is dominant in many parts of the book - the Didion-Dunnes' family life was filled with movie stars, glamorous restaurants, and the hard work of writing. We see Didion on book tours and backstage during the Vanessa Redgrave one woman show of A Year of Magical Thinking.

Although Quintana's death and dying are prominent in the book, her whole life is explored. Issues of her adoption, her mental illness(es), her precociousness and talents, and above all, her relationship with her mother are intimately explored. The reader is given her childhood poems and descriptions of her nightmares and toys.

Another prominent theme is aging. The author was born in 1934, the same year, she notes, as Sophia Loren. Didion experiences neuromuscular problems and describes a particularly frightening episode of loss of consciousness and bleeding. She fears the deterioration of her cognitive abilities and laments she is unable to gain weight. She has a supportive and loving family and network of friends, but ultimately she ponders her aloneness, the lack of someone's name to write down on hospital forms as her emergency contact.  

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Primary Category: Literature / Nonfiction

Genre: Treatise

Summary:

This is a huge and wonderful book about cancer, the collection of diseases that sickens people all over the globe and kills many of them. An epigraph to the book states, “A quarter of all American deaths, and about 15 percent of all deaths worldwide, will be attributed to cancer,” but the book also describes medical advances that now heal, prevent, or palliate most forms of cancer.

Mukherjee, a cancer physician and researcher, has several strong themes. He sees cancer as an affliction with a long history, a story worthy of a biography; indeed recent discoveries show it to be rooted in our genes (although external factors such as viruses, asbestos, and tobacco smoke can cause genetic disruption). The story of cancer implies a surrounding triangle, the stories of sick people, treating physicians, and biological researchers, all of which Mukherjee artfully weaves across 472 pages. Cancer has Rohrschach blot qualities: depending on time, place, and role in life, humans have perceived different attributes of cancer. As the book ends, however, there is a coalescence of scientific understanding that is satisfying—although there is certainly more to be learned and we are all still vulnerable to genetic errors and, of course, we are intractably mortal.

Another strand is the nature of stories themselves, their twists and turns, presumed early solutions, and personal and social values embedded in them. Mukherjee threads throughout the book the case of a contemporary kindergarten teacher, Carla Reed, who has a leukemia. He bookends his text with ancient Persian Queen Atossa with (presumably) breast cancer. Reed, healed by the end of the book, was Mukherjee’s patient; Atossa was described by Herodotus: both suffered emotional turmoil because of their disease.  Mukherjee understands the affective dimensions of disease for patients and caregivers alike; literature represents these in various ways, and he quotes in his chapter epigraphs and in his prose many writers who describe human experience deeply: Aleksandr Solzhenitsyn, Susan Sontag, Charles Dickens, Thomas Mann, William Carlos Williams, Carlo Levi, and Italo Calvino, to name a few.

The primary story, however, is the interplay of cancer and a large cast of observers, investigators, doctors, scientists, activists, and government officials. Sidney Farber and Mary Lasker dominate the first 100 pages with their two-decade war against cancer. While surgery—historically dramatic and disfiguring—had been a mainstay for treatment of cancer, Farber pursued a biochemical route, which elaborated into chemotherapy, the second major approach of the late 20th century.

Mukherjee also explains ancient views, Hippocrates’, Galen’s humors, Vasealius’ anatomy, Hunter’s stages, Lister’s antisepsis, and Röntgen’s X-rays, which became the third major approach. By 1980, however, the American “War on Cancer” had not been won.

Further advances in cellular biology and genetics would be needed to make targeted molecular therapy possible.  Mukherjee tells this complicated story clearly and engagingly, showing the human investigators to be personable and dogged in their pursuits.  

Another important approach is prevention. The biostatistical work of Doll and Hill, for example, showed the links between tobacco and lung cancer. Screening, such as Pap smears and mammograms, also saved lives, but the basic cellular understanding still eluded investigators.

The final 150 pages explain the search for and discovery of genetic factors, specifically oncogenes. Harold Varmus and J. Michael Bishop were the leaders, winning a Nobel Prize in 1989. Bert Vogelstein, Judah Folkman, Robert Weinberg and Douglas Hanahan took the work further, opening the doors for such drugs as Herceptin, Gleevec, and Avastin. 

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Summary:

Candice Millard portrays several figures in the 19th century whose lives came together to change history: newly-elected President of the U.S. James Garfield; the insane would-be assassin Charles Guiteau; Doctor Bliss, the arrogant physician who claimed control of Garfield's care; Alexander Graham Bell, who invented a device to find the bullet; and major political figures of the time. Ironically, Garfield attended the Centennial Exhibition in Philadelphia in 1876 where Joseph Lister was displaying his germ theory of infection and Alexander Graham Bell demonstrated his telephone. But when Guiteau shot Garfield in 1881, the bullets did not kill him.  What killed him after months of suffering was the massive infections caused by the doctors' probing without clean hands or clean instruments. At the autopsy, the doctors saw evidence of massive infections, but the bullet was encysted and harmless. All the probing by the doctors created a tunnel, but it was not the path of the bullet.  "Gentlemen, we have made a mistake," said the doctor.

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The Story of San Michele

Munthe, Axel

Last Updated: Nov-14-2011
Annotated by:
Ratzan, Richard M.

Primary Category: Literature / Nonfiction

Genre: Autobiography

Summary:

The author takes us on a highly colorful autobiographical tour of his medical career - his personal life never enters this account - from a classical medical education in Paris as a young expatriate Swede (he remains expatriate the entire book) to his internal medicine practice in France, including a tour of Naples as a volunteer during the cholera epidemic of 1881 and his finally settling in Italy. There are also anecdotes - many of them side-splitting and told with uncommon skill - about conducting a corpse back to Sweden, a truly thrilling journey to Lapland,  encounters with the legendary Charcot, his return to San Michele whence the book begins with a mythopoetic retelling of his first visit there, and his last years at San Michele as patron of a community (both local and international) and as collector and explorer of the nearby Mediterranean.        

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Primary Category: Literature / Nonfiction

Genre: Treatise

Summary:

This short, gripping book describes Taylor's massive stroke, a burst blood vessel in the left side of her brain. Ironically, she was at 37, a neuroanatomist at Harvard, well versed in the anatomy and function of the brain. Her knowledge allowed her to understand from the inside her rapid loss of mental function and, with treatment, her very long (some eight years) recovery to health and, once again, professional activity.

Taylor presents an overview of brain structure and function, emphasizing the different roles of the left and right hemispheres. Since her left hemisphere was damaged and needed to be "rebuilt," in her term (learning to read, to dress herself, to drive a car, to think), she had plenty of time to explore her right brain and understand its wisdom and peace. This is her insight: our culture prizes the admirable but often frantic work of the left brain, putting us in stressed, competitive modes of thinking and acting, often aggressive and argumentative. "My stroke of insight," she writes, "is that at the core of my right hemisphere consciousness is a character that is directly connected to my feeling of deep inner peace" (page 133). Both sides of the brain have their strengths and uses, but she especially enjoys the spiritual and humane aspects of the right brain and, by extension, invites her readers to consider these resources for themselves and for the larger society.

Taylor credits her mother's care for much of the recovery, although it is clear between the lines that Taylor herself worked hard with various therapists (speech, massage, acupuncture). Despite the severity of her injury and the surgery, she appears to have returned to professional work at a high level, fully recovered and very grateful.

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Annotated by:
Aull, Felice

Primary Category: Literature / Nonfiction

Genre: Memoir

Summary:

Sherwin Nuland has had a distinguished career as a surgeon on the faculty at Yale University and as an author with interests in history of medicine, medical ethics, and medical humanism. In this memoir we become acquainted with a different side of Nuland, that of son to a widowed, immigrant father with whom the author had a complex and difficult relationship.

We learn also that Nuland has suffered from depression on and off since he was preadolescent, experiencing a major breakdown in midlife. This book attempts to make sense out of the family dynamics and the depression. At the same time, it describes the insular world of Russian Jewish immigrants living in New York City's Lower East Side and Bronx in the first half of the 20th century.

Nuland explores, frankly and openly, his ambivalent relationship with his father, Meyer Nudelman, and contrasting adoration of his mother, who died when Nuland was 11. The young Sherwin (Sheppy) Nudelman lived in fear of his father's strict rules and unpredictable anger. Further, Sheppy was required to assist his father whenever he went out of the house because Meyer Nudelman had an unsteady gait that made walking difficult and that became increasingly severe. Although the boy initially enjoyed these neighborhood jaunts with his father, he was increasingly resentful of them as his father's condition deteriorated and as his own interests focused more on people and activities outside the home. His father's strong Yiddish accent, strange gait, and sloppy appearance were a major embarrassment.

The last third of Lost in America--chronologically the era of World War II, the Nazi atrocities, and after--concern Nuland's maturation and his path toward the profession of medicine. As he and his brother, Harvey, were contemplating a future in the world of Gentiles, they decided to change their last name from Nudelman to Nuland. Sherwin Nuland was accepted to medical school at "Waspy" Yale and chose to enroll there, deliberately distancing himself (on the surface) from his father and his culture.

In medical school Nuland realized that Meyer Nudelman's physical symptoms were caused by late stage syphilis. The initial shock and disbelief of that discovery dissipated; Meyer's growing helplessness and tremendous pride in the accomplishment of his son allowed for a measure of understanding and affection between the two.

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Townie

Dubus III, Andre

Last Updated: Oct-13-2011
Annotated by:
Aull, Felice

Primary Category: Literature / Nonfiction

Genre: Memoir

Summary:

This memoir spins out in detail the despair and violence that emerges from a childhood of poverty and parental absence. When Dubus was preadolescent, his writer father of the same name (see Andre Dubus), took up with a student of his, and the parents divorced. Andre's mother became a social worker, working full-time with no support system, exhausted. Although Andre's father lived nearby and paid child support, it was never enough to keep the four children and their mother out of poverty. They moved frequently, always to the rough sections of depressed Massachusetts towns on or near the Merrimack River. The memoir describes vividly the smells of the polluted river; garbage strewn lawns; smoky, raucous bars; afternoons and evenings spent aimlessly watching television and, in adolescence, neighborhood kids and punks doing drugs and sex in Andre's home - before his mother arrived back from work each evening  .

At school, in bars, and around the neighborhood, kids and adults beat each other up - violence was a constant. Andre was slight and fearful but also drawn to watch the frequent fights. He avoided direct involvement when he could, was beaten up when he couldn't, and loathed himself in either case. He felt like a non-person: "There was the non-feeling that I had no body, that I had no name, no past and no future, that I simply was not. I was not here" (78). Finally, after being unable to help his brother during a fight, Andre resolved to build himself up physically--lifting barbells, bench pressing, and eventually taking boxing lessons.

Now when there was the threat of a fight, he plunged in quickly, inflicting damage. He could defend himself and those he cared about. But always there was the need for vigilance and the need - frequently actualized - to explode in rage. Later, he came to realize that being quick to jump into fights was a way "to get out what was inside him. Like pus from a wound, it was how [I] expressed what had to be expressed" (191). Gradually Andre came to think there might be other ways "to express a wound."

In the second part of the memoir, Dubus writes of how that other way evolved into creative writing. Training for physical prowess had imposed some discipline in his life, which meant being able to concentrate in school, do homework, and read. There were stints in and out of college (eventually he graduated from the University of Texas in Austin), making ends meet as a gas station attendant, construction worker, fast food manager, bartender, and later-- halfway house counselor. At the local Massachusetts college he attended for a while, he overheard himself being called a "townie." He navigated at the interface of the old neighborhood where he still lived and the life of the more privileged. He became more self-aware, more interior, and at the same time, more interested in the larger world. Threaded throughout this period is a developing relationship with his father, whose writing he admired and whose approval he craved.

In spite of the author's ambivalence toward his father - "where were you when I needed you?" (333)--one probably cannot overestimate the role that the senior Dubus played as a writer model for his son. Dubus read and admired his father's stories. He saw the discipline required to write, even though Dubus senior's weekends were often spent unwinding in bars (sometimes with the younger Dubus). Andre met his father's academic colleagues, met other writers, met writers who had stable relationships with a spouse.

He even learned that a writer can be a sports fan (Boston Red Sox), and avid sports participant (jogger). One of the most moving chapters in the book describes the first baseball game Dubus ever attended or watched - at age 13 - (with two tickets from his father), to see the Red Sox play the Yankees in Boston. Dubus went with a friend who explained the game to him as it unfolded. Dubus was stunned: "Every time one of them walked up to home plate with his bat, hundreds of men and boys would yell insults at him I couldn't quite make out, just the tone, which I knew well, but it wasn't directed at me or anyone I would have to try to protect, and I felt relieved of everything, part of something far larger than I was, just one of thousands and thousands of people united in wanting the same thing, for those men from our team to beat the men from the other team, and how strange that they did this by playing, that one beat the other by playing a game" (161-162).

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Summary:

Johanna Shapiro, Director of the Medical Humanities Program at University of California Irvine School of Medicine, brings her considerable skills and experience as medical educator, writer and literary critic to this unique volume of medical student poetry. Shapiro collected over 500 poems by medical students not only from her home institution but also from other US medical schools and performed a content and hermeneutic analysis. As Shapiro carefully details in her methodology section, she treats "poetry as a form of qualitative data, and [therefore] techniques of analysis developed for other sources of qualitative data (such as interviews, focus groups, and textual narratives) can be applied to an understanding of poetry." (p. 42)

Relying on the work of Arthur W. Frank (see The Wounded Storyteller), Shapiro devises a typology of student poems: chaos, restitution (and anti-restitution), journey, witnessing, and transcendence (this last category was not Frankian in origin). These categories are developed and explicated in Chapter 2: Functions of Writing for Medical Students. As the author notes, poems traverse the boundaries between types; nonetheless, the framework of the analysis rests with this typology. Further, Shapiro explores the metaphors of topography (illness as a foreign land) and quest (student on a heroic, however tentative or confused, journey) throughout her study.

The book contains many fully reproduced medical student poems, contextualized with academic theory on medical education. Hundreds of references, particularly in the fields of narratology and medical education, are cited. After three chapters of theory and methods, eight topics are explored using the outlined analytic tools: anatomy class, becoming a physician, patient experience, doctor-patient relationship, student-patient relationship, social and cultural issues, death and dying, love and life. Prefacing each of these topics is a scholarly essay providing historical and research foundations; every chapter concludes with a summation.

Within the chapters are examples of poems, not only organized by typology, but also by content. For instance in the patient experience chapter, the topics are: "patient pleas for empathy and compassion," "patient fears and suffering," "stigmatized voices," "vulnerability/courage of child patients," and "personal experiences of illness." Within each topic/subtopic, different poems are highlighted and fully analyzed. Additionally, other poems, not reproduced, are quoted as illustrative examples. Summary arguments are provided at the conclusion of each chapter as well as in the final chapter: "Strangers in a Strange Land: What Matters to Medical Students on Their Journey and How They Tell About It."

Although Shapiro states that her purpose "is not to address the literary and aesthetic attributes and value of the poems", she also notes "when students write authentically about their own experience, the results are uniformly moving, compelling and impossible to ignore." (pp 44-5) Indeed many of the poems are rewarding to read not only for content but also for word choice, word play, imagery and narrative line. For instance, in "Ode to the Peach" Brian McMichael explores the senses Neruda or Pollitt-like: "you invite me with / your voluptuous curves / your feminine little cleft". (p 236) Another example is the humorous, self-deprecating "Piriformis" by Curtis Nordstrom relating an early clinical experience by a medical student who hopes against hope that the patient's presenting complaint will require the student to demonstrate his acumen. Unfortunately the sum total of the student's knowledge base is limited to the location of the piriformis muscle; both the student and patient are "so screwed" when, "Alas, the patient presents with / an upper respiratory infection." (p. 16)

Shapiro's sensitivity and generosity of spirit vis-à-vis the medical student experience are evident throughout the volume. She concludes that "what may be most noteworthy about the analysis of these poems is that, amidst their own difficulties and fears, time and again these students reported engaging deeply with their patients." (p 259) She hopes that medical educators will be encouraged to support "in solidarity" the "idealism and high aspirations" expressed in these student poems. (p. 260)

In a postscript, Shapiro reveals her own experiences as a poet-patient. After noting that "[m]edical students are mostly annoyingly healthy, energetic, smart, and capable young adults who like order, structure, and control", (p 261) she also acknowledges how frequently students grapple with the topic of death and dying in their poems. That her poems emerged from advising a student creative writing group demonstrates how poetry can be renewing and vital not just to the student, but to the educator as well.

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