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Queen of the Sugarhouse

Studer, Constance

Last Updated: Sep-14-2021
Annotated by:
Davis, Cortney

Primary Category: Literature / Fiction

Genre: Collection (Short Stories)

Summary:

Constance Studer's engaging "Queen of the Sugarhouse" contains nine short stories ranging in length from 9 to 21 pages, each story complete in itself.  Her nursing expertise is evident in several stories, including "Mercy" (page 3), "Shift" (page 77), "The Isolation Room" (page 95), "Testament" (page 112), "Special Needs" (page 122), and the title story, "Queen of the Sugarhouse" (page 138). 

While many of the stories specifically revolve around medicine or nursing, others examine a variety of issues, often with healthcare peripherally involved. 

In "Shelter" (page 21), a homeless vet who served in the Gulf War struggles with PTSD, the difficulty of obtaining permanent disability, the inability to find work or a suitable living space, and his quest to find treatment for his many physical problems after chemical exposure during Desert Storm.  He sees a different doctor at each appointment and no one truly helps him. "Finding today's meal or bed or beer takes all my energy, leaving me nothing left over for thinking about next week.  I am a veteran and can no longer vote because I have no home" (page 27).  Studer takes us into this man's life and struggles with clarity and empathy.


"Think Beauty" (page 37) questions what makes a woman beautiful (or believe she is beautiful) against a back story examining friendship and all that entails.  "This Middle Kingdom" (page 58) tells a story that encompasses both the heroics of a ski team that saves skiers in distress and how difficult it can be to feel compassion for those who end up in trouble because they flaunt the rules or advice of the experts--a theme quite relevant for our times. 

The book's opening story, "Mercy" (page 3) explores a nurse's various reactions after she makes an error while dispensing medication. As in every story in the collection, multiple themes weave in and out, driven by a character's decision or dilemma.  In "Mercy," we see how medical personnel can truly care for and worry about their patients; how even a small error may cause a nurse deep distress, both for her patient and for her future; how the nursing shortage leads to burnout; and how "real life" continues on in the background, in this case, a passionate love affair that leads both to marriage and to grief.  "Grief is a train that doesn't run on anyone else's schedule" (page 15).

"Shift" (page 76) tells of a physician who is devoted to his work and his patients in the ER ("His white coat flaps, stethoscope bounces as the doctor runs, its weight a comfort, like a rosary for a priest" page 76) while his wife feels neglected.  The story moves between the chaos of the ER and the story of his marriage, a love that began when the doctor was in medical school.  After his wife leaves him, the doctor sleeps with the lights on, hoping she will return.  But whenever he closes his eyes, he only sees scenes from the ER.  The story ends with words the doctor has said so often to a patient: "Please sir, lie still.  I'm going to numb you now.  Hang on, man.  Soon the pain will be gone" (page 93). 

"The Isolation Room" (page 94) follows a woman, a writer, who has been, she believes, placed unnecessarily and mistakenly in a psychiatric ward.  As we read, we wonder if this woman is truly afflicted with a mental disorder or if she is simply extremely imaginative, perhaps betrayed by her husband who arranged for her admission. The main character is likeable, often seemingly sensible, perhaps incredibly but differently talented: "Maybe to be out of her mind meant she'd finally make the leap from logical to intuitive, into her true skin, a room all her own ... a writer, that teller of lies, pursuer of truth by means other than logical, that follower of breadcrumbs through the scary forest wherever they lead?" (page 97).


"Testament" (page 112) follows a student nurse in her first month of training and touches on the care of difficult patients, their various religious beliefs, and how healthcare providers' families are not immune to illness. "Special Needs" (page 121) follows Maria, a waitress with an unexpected pregnancy and wheelchair confined brother. The title story, "Queen of the Sugarhouse" (page 137) is a poignant examination of breast cancer; the terrible trial of chemo and radiation; the complex relationship between the suffering mother and her daughter, a nurse; and how life changes when the drama of uneasy but genuine love and relationship ends.  "I think I hear Mama's voice, then
realize it's only the sound of water over rocks.  Tears are this river carrying me forward" (page 153).


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The Expendable Man

Hughes, Dorothy

Last Updated: Sep-14-2021
Annotated by:
Field, Steven

Primary Category: Literature / Fiction

Genre: Novel

Summary:

A young man, an intern at UCLA Medical Center, is heading out of Los Angeles on his way to his niece’s wedding in Phoenix.  He has signed out for the long weekend and he is eagerly anticipating some time with his family, which will include (though he doesn’t know this yet) his niece’s college roommate, an eligible young woman from a prominent Washington, DC, family, who will be at the wedding also.  Driving his mother’s late-model Cadillac, with his suitcase, medical bag, and his father’s golf clubs in the trunk, he is fifteen miles out of Indio and in the middle of nowhere when he spots a teenage girl by the side of the road.  She’s a bit disheveled and is carrying a small canvas travel bag and a white plastic handbag and nothing else; she looks to him like the girls his younger sisters refer to as “cheap.”  He pulls over and rolls down his window.  She is sullen and somewhat evasive in answering questions, and she happens to be going to Phoenix also.  Hugh feels that he can’t just leave her here, in the desert, where who knows who she might encounter, so he
offers a ride; he decides, however, that he will drop her off at the next town, where she can catch the bus. 

What could possibly go wrong, right?

This is the set-up of Dorothy Bridges’ The Expendable Man, and the answer is, of course, plenty.  It is not a big reveal to say that the girl’s motives seem dubious and she proves hard to be rid of, being dropped off and then showing up again, including showing up at Hugh’s Phoenix motel room, where he refuses to speak to her.  It is not even a big reveal to say that the morning after she shows up at his motel room her body is found in a canal on the outskirts of Phoenix, and the autopsy reveals her to have been pregnant—and aborted.  Nor is it a big reveal—indeed, it is only logical to assume—that the suspicion of the local police falls on Hugh, the last person—and conveniently, a physician—known to have seen her alive.   It will be up to Hugh to prove his innocence despite the damning circumstances.

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Annotated by:
Ratzan, Richard M.

Primary Category: Literature / Poetry

Genre: Poetry

Summary:

This is a poem by one physician-poet, Richard M Berlin, a well published psychiatrist in Massachusetts, that celebrates the life and work of another physician-poet, John Stone, and recounts the effects of the latter’s poetry on Dr. Berlin over thirty years. The poem was published twice, once in JAMA in 2006 and again in Psychiatric Times in August 2008, shortly before John Stone died in his sleep of cancer in November.

The poem is 24 lines in free verse with no stanza breaks. As the title indicates, it is an occasional poem. The occasion? Poet A reading the admired work of Poet B, like Keats’s “On First Looking into Chapman’s Homer”. In his poem Berlin commemorates the occasion of his having just read Stone’s 2004 volume of poetry, Music from Apartment 8. The title of Stone’s volume derives from Stone’s mother’s address in Decatur, Georgia. Consisting of five sentences, the poem begins with an account of his reading Stone’s poetry as “a hiker” who stops to “admire the view of snow-capped peaks.” The second sentence records the Berlin’s reflections “three decades later” of Stone and the premature death of Berlins’ father. Following this thought, the poet compares Stone’s poetry to the compass his father would have been had he lived longer, Stone’s compass directing him to the possibility of his writing poetry as well, a poetry originating with our patients’ heartbeats. The penultimate sentence is a prayer that Stone is “drinking deep from whatever stream brings you to your knees.” Berlin ends with the further hope that Stone will be able to hear Berlin’s “boots striding behind” Stone’s, “both soles still strong.” There is no published record that I could find that Stone read Berlin’s poem.

In a subsequent essay, Berlin discusses this poem and the history of his relationship to Stone and the latter’s poetry. (1)

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Annotated by:
Teagarden, J. Russell

Primary Category: Literature / Fiction

Genre: Novel

Summary:

Cyril Wilkinson and his wife Kay make a pact. On Kay’s eightieth birthday, when Cyril is already eighty-one, they will commit suicide together. Cyril, a physician in the British National Health Service (NHS) secured a supply of secobarbital as the means to their end. It was 1991. They have planned well ahead; another twenty-nine years will pass before Kay’s eightieth in 2020. 

Motivating the pact was the death of Kay’s father after “a good four years of steady deterioration, followed by a solid ten of nothing but degradation” from dementia (p. 7). They had just arrived home from his funeral service, and were reflecting on what they had been through. At one point, Cyril says, “Your father frankly made me suicidal—or homicidal—or both. Half an hour in his presence passed like a mini ice age,” and then promises Kay, “I will do almost anything to keep the two of us from acceding to such a fate” (p. 12). But Kay is dubious. 

That’s what everyone says...Everyone looks at what happens to old people and vows that it will never happen to them...Somehow they’ll do something so their aging will proceed with dignity...Everyone thinks they have too much self-respect to allow a stranger to wash their private parts...Then it turns out that, lo and behold, they’re exactly like everyone else! And they fall apart like everyone else, and finish out their miserable end of their lives like everyone else. (pp. 12-13)
And so Kay dithers over the next few months whether to agree to the pact, but once her mother begins showing signs of dementia; “I’m all in,” she tells Cyril (p. 17).

Cyril and Kay proceed through the subsequent twenty-nine years, with Kay raising their three children, retiring, finding new work and passions; Cyril going on and on about politics, the NHS, old people; and both watching their remaining parents pass on, traveling to far-flung locations, becoming grandparents, aging. Then the day arrives; happy birthday, Kay? 

The novel structure is simple or complex depending on how a reader approaches it. The first chapter sets up the pact. The second chapter leads up to the day of reckoning and becomes the first story telling what became of the Wilkinsons’ plan. The next eleven chapters envision alternative scenarios unfolding from choices Cyril and Kay make before and on their pre-determined end date. Some scenarios stem from one or both of them not going through with their pact. Some scenarios involve recognizable and available options today, and some are wholly futuristic and unattainable. Some scenarios are happy, some are sad, all are unsettling. These chapters can read as independent stories offering different choices and endings. But they can also be read as interdependent and collectively building toward a point of view on the question: Should we stay or should we go?   
 

The interdependence and complexity of the chapters arise from the through lines among them. From the third chapter on, for example, the first few sentences of each chapter are taken verbatim or slightly modified from some part of a preceding chapter. Other blocks of text appear in one or more chapters. One through line even extends beyond the book to another of Shriver’s novels (So Much For That). Kay and Cyril exhibit the same personalities and preferences, and express the same general hopes and desires through all the chapters. Other through lines are shared events or recurring arguments and debates; however, not always with the same outcomes.

The four years preceding Kay’s eightieth birthday overlap both the decision of the United Kingdom (UK) to leave the European Union (“Brexit”) and the Coivd-19 pandemic. Thus, during the time Cyril and Kay are deciding whether they will actually leave or remain on Earth, the UK is deciding whether to leave or remain in the European Union, and while Cyril and Kay are seemingly willing to die rather than fight the ravages of old age, millions of people are willing to fight the ravages of Covid-19 rather than die. These juxtapositions pop up often giving the Wilkinsons’ decision added poignancy.


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Freud on My Couch

Berlin, Richard

Last Updated: Aug-11-2021
Annotated by:
Davis, Cortney

Primary Category: Literature / Poetry

Genre: Collection (Poems)

Summary:

Richard Berlin is the author of two poetry chapbooks and three full-length poetry collections.  "Freud on My Couch," Berlin's fourth full-length collection, consists of 46 poems divided into six sections, and a "Notes" section at the end.  As in his previous collections, Berlin writes as a physician, husband, father, friend, lover of music--and as a man who understands that he and his patients share a common and fragile humanity.

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Secret Wounds

Berlin, Richard

Last Updated: Aug-06-2021
Annotated by:
Coulehan, Jack

Primary Category: Literature / Poetry

Genre: Collection (Poems)

Summary:

In Secret Wounds, his second full length collection of poetry, psychiatrist Richard Berlin continues his exploration of the inner world of medicine with a sequence of 73 poems that flow seamlessly, uninterrupted by grouping into topics or sections. In the first poem, “Lay Down Sally,” the author attends a man dying on dialysis, and concludes with “A nurse hangs the morphine. / I write my blue notes.” In the last, “The Last Concert of Summer,” he reflects on his long experience with the sick and suffering, ending the poem with, “I place a stethoscope in my ears and listen / to the heart when I’ve run out of things to say.” In between, the poems reflect varied incidents, topics, conflicts, and wounds, as they occur from medical education (“Teaching Rounds,” “Touch,” “On Call, 3 AM”) through a life in medical practice (“Rage,” “The Scientists,” “How a Psychiatrist Parties”) to something like enlightenment (“Note to Pablo Neruda,” “A Psychiatrist’s Guitar,” “End of Summer”).

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The Empathy Exams

Jamison, Leslie

Last Updated: Aug-02-2021
Annotated by:
Zander, Devon

Primary Category: Literature / Nonfiction

Genre: Collection (Essays)

Summary:

Leslie Jamison starts The Empathy Exams with a quote from The Self-Tormentor by Terence, first in Latin, then in English: “I am human: nothing human is alien to me.”  In beginning this way, she sets up the book to explore the human condition and what it means to relate to one another with caring despite the interpersonal complications that can often arise. Through a series of nonfiction essays (some initially published elsewhere) she explores how we express our feelings and process those of others. To do this, Jamison uses a number of different lenses, large and small, including ultramarathons, immigration, incarceration, a Morgellons disease conference, and more.  

The book takes its name from the first essay in which Jamison juxtaposes her experience as a standardized patient for students in medical school with being an actual patient. She specifically explores the ways in which empathy is created/manufactured and extended in medicine, both from medical professionals and loved ones.

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The Ministry of Bodies

O'Mahony, Seamus

Last Updated: Jul-26-2021
Annotated by:
Miksanek, Tony

Primary Category: Literature / Nonfiction

Genre: Memoir

Summary:

Starting eight months before his retirement, a gastroenterologist chronicles a myriad of encounters between himself and others - patients and their family members, colleagues, administrators, hospital staff, and even drug reps. He has worked for many years at a large Irish hospital dubbed the "ministry." His professional work there is divided between the endoscopy unit (where he performs colonoscopies and EGDs), medical wards, an outpatient clinic, and the ER.

Given his specialty, the roster of patients tilts heavily towards gastrointestinal problems: alcoholic cirrhosis, GI bleeding, chronic diarrhea, and abdominal pain. But additionally, his days are filled with patients presenting with a variety of medical problems including pneumonia, mental health issues, heart failure, serious fractures, dementia, seizures, anemia, and cancer. He attends to many frail elderly folks in the emergency department. His interactions with patients range from intense to jovial, from unexpected to heart-wrenching. For example, a woman with chronic abdominal pain asks the doctor if she might be suffering from PTSD. When asked why she thinks that might be possible, her reply is "My son hung himself. I found him" (p191).

The doctor is beleaguered by frequent, and at times wacky, emails generated by the hospital bureaucracy as well as unproductive meetings. He must cope with his own health problems too (a vitreous detachment, arthritic hands, and unexplained nosebleeds). He decries the "foolishness" of excessive medical testing and overtreatment and cites the case of a young woman with irritable bowel syndrome who already had over 1,200 test results logged in the hospital lab. He describes the ministry as "an oasis of kindness and comfort" but "also a place of chaos and conflict, of institutional cruelty" (p8).

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Summary:

Richard M. Ratzan brings together scholars and creative writers to celebrate the legacy of the sixteenth-century Flemish physician and anatomist, Andreas Vesalius (1514–1564), and his 1543 landmark text, De Humani Corporis Fabrica (On the Fabric of the Human Body). Ratzan defines the volume as an “ekphrastic collection of poetry, art and short prose” inspired by “the inimitably conceived and executed anatomical woodcuts” of Vesalius’s most enduring creation (xi). Organized by different genres, Ratzan presents introductory essays, ekphrastic works, translations of Vesalius-inspired poems, and detailed note and bibliography sections. The collection does not merely panegyrize but articulates the deeper intellectual import of De Humani’s meticulous anatomical renderings. Sachiko Kusukawa’s introductory essay frames De Humani as a “rhetorically charged polemic and defense” that challenged the European medical institution in two key ways (3). First, it promoted the revival of the “ancient [Greek and Roman] practice of healing based on diet, medicines and surgery,” a bold effort that aimed to resuscitate anatomy and other forms of “hands-on engagement” that had fallen out of favor with Vesalius’s contemporaries (2). Second, De Humani emendated the anatomical descriptions advanced by Galen, a second-century physician who promoted dissection in his Anatomical Procedures and whom European physicians considered an authority (3). This volume captures the fascinating fusion of artistry and intellectual individuality that characterizes Vesalius’s work.

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Summary:

Native Ohioan Brian Alexander cares a lot about his state and its many economic problems, especially as they impact healthcare. For this book, he’s an on-the-ground reporter covering the events in and around a hospital in the small town of Bryan from 2018 to 2020. He is also an in-depth interpreter, analyzing the many dilemmas of this small hospital and emphasizing that these represent parallel problems of social justice for all of contemporary American healthcare.  An opening chapter reviews some of the difficult history of this area, including economic collapse, lack of public health, lack of health insurance, and collapse of jobs in supply chains for Detroit.           

While the timeline of the story is short, it has wide breadth in local and national issues. These are illustrated by the stories  of specific people. Marc Tingle, a local contractor has a heart attack; his wife falls ill and is diagnosed with cancer. Medical bills mount up. Marc has a second heart attack and a stent inserted. He, like many others receives “rescue” medicine, not preventive healthcare, due to social or economic issues beyond their control. Similarly, we read about Keith Swihart, overweight and diabetic. He has a foot ulcer that requires surgery and later partial amputation. He has eye problems that progress to near blindness. Valerie Moreno injures her back at work but does not report it to the company, considering herself tough, but she must have spine surgery. After being laid off, she has part-time jobs, money problems, and turns to OxyContin pills. These are dramatic and painful stories.  

Many families make “just enough money to disqualify themselves…from Medicaid, but not enough to afford coverage offered by an employer or via the Affordable Care Act” (p. 242).            

Such patients illustrate a deadly whirlpool of issues: lack of routine medical care, inadequate health insurance, no national health program, a collapsed economy with no good jobs or prospects of advancement, poor nutrition, pervasive poverty, racism, sexism, and more.           

Amidst all this, we follow Phil Ennen, the CEO of this hospital (CHWC--for Community Hospitals and Wellness Centers) in Bryan. He wants to rely on his local, traditional values of “we can fix this,” but now he must confront the threats of national hospital chains, the need to cut staff and services, and the seductive lures of adding for-profit and high-tech services. Eventually, he sees no path forward and accepts the board’s invitation to retire. His replacement will have all the same problems.           

A closing section sees the arrival of Covid-19, a threat to this hospital and, of course, the nation at large. Alexander writes, “the virus seeped into the fault lines created by American pathologies. The country had changed from being an ongoing project to improve democratic society and live humanistic ideals to being a framework for fostering corporate profit” (p. 268).  

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