Summary:

Described in minute detail by the narrator, the villagers - who have turned over every stone in the woods, dived many times in the river, and ridden to nearby villages to find Carlos - turn to an old man who requests a perfectly flat piece of wood and a stout candle. He then meticulously fastens the candle to the wood and carefully launches this raft of mystical exploration and recovery on the river. Every villager watches this ceremony with rapt attention. It is truly a riveting passage, for the raft travels under its own power from the river bank against the current, meandering slowly towards the bridge where it finally stops, despite the current, under the bridge, the only place no diver has yet looked:

"The board in the meanwhile has wandered farther under the bridge, but always in a right angle to the fifth post. Now it is under the middle of the bridge. From here it sails towards the fourth post, though only for about a foot. And here it stops as if it were nailed to the water. It does not mind the current nor the light breeze that sweeps softly across the surface of the river. The manner in which the board has halted is entirely different from that in which it stopped before. Now and then it trembles slightly, as if something were breathing against it from below. But it no longer whirls. ... The board begins softly to dance as if impatient. It seems that it wants to be relieved of its torture. It wriggles, swings about itself, though it does not move as much as two inches. One might think it is trying to go down to the bottom."

(page 110-1)

A villager dives and retrieves Carlos and hands his body to his mother:

"With an indescribable nobility and solemnity, and in his eyes that pitiful sad look which only animals and primitive people possess, he steps slowly forward. And Perez, the man whose daily task it is to fell the hard trees of the jungle and convert them into charcoal, lays that little water-soaked body in the outstretched arms of the mother with a tenderness that makes one think of glass so thin and fragile that a single soft breath could break it."
(page 113)

The villagers, in a procession that is tragicomic, take Carlos' body to the graveyard where a well respected teacher, now drunk from all the mescal others have offered him, gives an eulogy that suggests Christ's Sermon on the Mount. However, with inverted symbolism, this sermon is for, not by, Jesus and is delivered by a drunken priest-figure who is so drunk he falls into the open grave. To Traven's credit he introduces this farcical moment to emphasize how none of the villagers, much less the author, and, consequently, the reader, laughs at a decent man trying his best to honor Carlos. It is truly a most moving finale to a most moving book.

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Metzl attacks the “Castle Doctrine” (“a man’s home is…”) as a symbol of narcissism, individualism, and as a risk for all citizens when social structures are abandoned. He closes with some hopeful examples of social change for the better.

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An extended essay on the experience of child immigrants woven around the forty questions that author Valeria Luiselli asks in her work as a translator for children seeking entry into the United States.

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This engaging memoir describes Pearson's medical training at the University of Texas Medical Branch (UTMB) on Galveston Island from 2009 to 2016. During these years her personal values become clear, and she finds fault in her training, in medicine as practiced in Texas, and even in her own errors in treating patients.

Having left a graduate writing program, Pearson took a "postbac," a year of pre-med courses in Portland, Oregon. She interviewed at medical schools "all over the country" and writes satirically about them; she concludes "nothing out of Texas felt quite right," having lived there and done her undergraduate work at University of Texas at Austin. She's a Spanish speaker with a working-class background. When her classmates provide the annual “white-trash”-themed party, she wonders, “do I go as myself?” (p. 21).

Pearson's education continues on three tracks: the formal UTMB courses in medicine, a simultaneous Ph.D. program at the Institute for the Medical Humanities at the University of Texas, and her volunteer work at the St. Vincent's Student Run Free Clinic. The Ph.D. program is off-stage, not mentioned, but the St. Vincent's Clinic becomes pivotal to her development as a doctor and a moral person.

As for medical school, she finds the relentless "truths of biochemistry and anatomy" so reductive that the suffering of people and surrounding politics seem "not to matter at all" (p. 70). Among the politics are: the lack of safety nets for poor people, the use of uninsured (including prisoners) for students to practice on, failures to extend Medicare, pollution (notably from the oil industry), losses of charitable care, and income disparities that include crushing poverty for many. Something of a rebel, she writes that medical school "felt like junior high" (p. 44). She does enjoy the "clinical encounters" with real patients.

St. Vincent's, by contrast, was “a relief.” Her pages sparkle with her conversation with clinic patients, some homeless, all poor, and all suffering. She reports--confesses, she even says--her errors that had consequences for patients. She writes that errors are an unavoidable part of medical education, but that it's wrong that they should routinely happen to the poorest members of society.  

Chapter 8 discusses depression, which she felt after the second year. She writes about high rates of suicide among medical students and doctors; indeed a close friend killed himself during the "post-doc" year. Because some states require doctors to report psychiatric care, some doctors avoid such care. This consequence “drives a suicide-prone population away from the help we may need" (p.92).

The last two years are the rotations through specialties: surgery, dermatology, trauma, rural medicine, neurology, internal medicine, and so on. These are clearly and insightfully described. In one case (internal medicine), she allows the reader to see the irony of a doctor providing hair removal by laser, diet foods, and Botox treatment for wrinkles, “a pure luxury transaction” (p. 183).

Pearson describes the storms, hurricanes, and floods that hit Galveston Island, also the pollution from the oil industry that causes a “cancer belt” along the Louisiana and Mississippi coasts (p. 104). At last she finishes her program, understanding that her identity is simultaneously a person, a physician, and a writer (p. 248). 

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INTRODUCTION            
Writing for all the co-authors, Rita Charon challenges “a reductionist, fragmented medicine that holds little regard for the singular aspects of a person’s life” and protests “social injustice of the global healthcare system” (p.1). She gives a history of narrative medicine, lists its principles, and summarizes the book’s chapters, mentioning that several come as pairs that present theory then practice. The six principles are “intersubjectivity, relationality, personhood and embodiment, action toward justice, close reading (or slow looking), and creativity” (p. 4). The basic thesis is that healthcare can be improved by narrative medicine because “narrative competence can widen the clinical gaze to include personal and social elements of patients’ lives vital to the tasks of healing” (p. 1). 
This is a dense, theory-laden book from the group at Columbia University. The summaries below touch of some of the major points.   

PART I, INTERSUBJECTIVITY             
Ch. 1, Account of Self: Exploring Relationality Through Literature
Maura Spiegel and Danielle Spencer describe the richness of literature that allows readers to respond creatively. In clinical settings, a caregiver may similarly listen attentively and help co-construct a narrative with the patient. Literature can help us explore “the limits of rationality and positivism” (p. 29) and move from “a model of autonomy to one of relationality” (p. 34). 

Ch. 2, This is What We Do, and These Things Happen:  Literature, Experience, Emotion, and Relationality in the Classroom.
Spiegal and Spencer write that current medical education does a poor job of helping future physicians with their emotions.  Clinicians profit from a more integrated self and will listen better to patients and respond to them.      

PART II, DUALISM, PERSONHOOD, AND EMBODIMENT            
Ch. 3, Dualism and Its Discontents I:  Philosophy, Literature, and Medicine
Craig Irvine and Spencer start with three literary examples that illustrate separation of mind and body. This dualism has pervaded modern medicine, causing losses for patients and caregivers, especially when there are power imbalances between them.  The “clinical attitude” (p. 81) dehumanizes both caregivers and patients.           

Ch. 4, Dualism and Its Discontents II:  Philosophical Tinctures
Irvine and Spencer argue that both phenomenology (appreciative of embodied experience) and narrative hermeneutics (privileging reciprocal exchange of persons) help us move beyond dualism.  Theorists Edmund Pellegrino (also a physician), Richard Zaner, and Fredrik Svenaeus help us understand how caregivers and patients should relate. 

Ch. 5, Deliver Us from Certainty: Training for Narrative Ethics
Craig Irvine and Charon write that various humanistic disciplines “recognize the central role narrative plays in our lives” (p.111). There is, however, “indeterminacy” in stories that “cannot be reduced by analyzable data” (p. 113). Narrative ethics urges us to consider issues of power, access, and marginalization for both the teller and the listener. The authors review recent ethical traditions of principalism, common morality, casuistry, and virtue-based ethics. They believe that narrative ethics, emerging from clinical experience and now allied with feminist and structural justice frameworks, will provide a better approach for many reasons. “Narrative ethics is poised to integrate the literary narrative ethics and the clinical narrative ethics” (p. 125).  

PART III, IDENTITIES IN PEDAGOGY            
Ch. 6, The Politics of the Pedagogy: Cripping, Queering and Un-homing Health Humanities
Sayantani DasGupta urges attention to issues of power and privilege in classrooms, lest they “replicate the selfsame hierarchical, oppressive power dynamics of traditional medicine” (p. 137). “Cripping” and “queering” provide new perspectives on knowledge, for example the untested binaries of physician/patient, sick/well, elite/marginalized, teacher/student. Drawing on disability studies, health humanities, and queer politics, DasGupta challenges “medicalization” and the “restitution narrative” (p. 141).  

PART IV, CLOSE READING            
Ch. 7, Close Reading: The Signature Method of Narrative Medicine
Charon stresses “the accounts of self that are told and heard in the contexts of healthcare” (p. 157). Close reading, traced from I. A. Richards through reader response theorists, is “a central method” for narrative medicine (p. 164). Close reading enhances attentive listening, and both of these deepen relationality and intersubjectivity, allowing for affiliation between caregiver and patient (pp. 175-76). Such linkages aid healthy bodies and minds, even the world itself (p. 176).             

Ch. 8, A Framework for Teaching Close Reading
Charon describes how she chooses texts and provides prompts for responsive creative writing. She illustrates “the cardinal narrative features—time, space, metaphor, and voice” (p. 182) in literary works by Lucille Clifton, Henry James, Galway Kinnell, and Manual Puig.  

PART V, CREATIVITY            
Ch. 9,  Creativity: What, Why, and Where?
Nellie Hermann writes that “healthcare in particular has a vexed relationship to the notion of creativity,” in part because of issues of control (pp. 211-12); values of “evidence based” and “numbers-driven” medicine are also factors. Narrative medicine, however, “is about reawakening the creativity that lives in all of us” (p. 214).            

Ch. 10, Can Creativity Be Taught?
Hermann reports on techniques used in the College of Physicians and Surgeons at Columbia, including prompts and a Portfolio program. A “Reading Guide” helps clinical faculty (and others) respond to student writing. Responses to writing can nourish the “creative spark.”  

PART VI, QUALITATIVE WAYS OF KNOWING            
Ch. 11, From Fire Escapes to Qualitative Data: Pedagogical Urging, Embodied Research, and Narrative Medicine’s Ear of the Heart
Edgar Rivera Colón suggests that “we are all lay social scientists of one kind or another,” seeing people in action in various contexts. He affirms an “assets-based approach to public health challenges, as opposed to a deficits-based and pathology-replicating paradigm” (p. 259). We are all embodied actors in relationship to power, privilege, and social penalty. Research through interviews and participant observation show “meaning worlds” in tension with “systemic inequality and structural violence” (p. 263). 

Ch. 12, A Narrative Transformation of Health and Healthcare
Charon presents and analyzes a case study of patient Ms. N. as treated by internist Charon. They’ve been working together for decades. Charon writes up her perceptions and shares them with Ms. N. Speaking together, they “became mirrors for one another” (p. 274). Psychiatrist Marcus discusses transference and transitional space in that experience. A caregiver as witness can shift healthcare from “instrumental custodianship to intersubjective contact” (p. 288).            

Ch. 13, Clinical Contributions of Narrative Medicine
Charon describes applications of narrative medicine, all with the aim of improving healthcare. She describes techniques for interviews of patients, writing methods, and ways to improve the effectiveness of healthcare teams, as well as changes in clinical charts and other narrative descriptions of patients.

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It is a strange and cruel world that Amelia finds herself in. The 17-year-old woman from Mexico who speaks very little English travels to Oakland, California to marry her boyfriend Manolo. Soon after, he is sentenced to 8 years in prison. Amelia is already pregnant. She and her newborn son, Jesus Romero, move in with Manolo's aunt and uncle. Amelia refers to the baby as "mijito" (an affectionate Spanish term for "little son"). He cries constantly and has a hernia that requires repair. But the teenage mother is overwhelmed and frightened. She receives little support.

Amelia and Jesus go to the Oakland Children's Hospital where they meet a cynical but kind nurse who works with a group of 6 pediatric surgeons. Most of the surgical practice consists of Medi-Cal welfare patients and lots of illegal aliens. The nurse encounters crack babies, kids with AIDS, and plenty of disabled children. When the surgeon examines Jesus, he notes bruises on the baby's arms. They are the result of Amelia squeezing him too hard to stifle his incessant crying. Surgery is scheduled but doesn't get done.

Later, the uncle makes sexual advances and, while drunk, rapes Amelia in the bathroom. The aunt insists Amelia and Jesus leave the apartment. She deposits them at a homeless shelter. Amelia spends her days riding buses and her nights at the shelter where she is harassed and robbed. All the while, Jesus cries. Amelia notices his hernia is protruding and she is unable to push it back in place as she was instructed. After office hours, the same nurse evaluates the situation and accompanies them to the emergency room where surgery is performed.

Amelia and Jesus return to the ER. She has been sedated and is staring blankly. Jesus is dead with a broken neck. The nurse from the surgical clinic is at Amelia's side and learns that Jesus was crying in the homeless shelter and keeping others there awake. Amelia shook the infant to try to quell the crying. She didn't know what else to do.

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The subtitle of this collection is "A Voyage to the New World." In the first section, Campo begins his voyage to a new world of self-understanding by experimenting with the language of family, intimacy, healing, and magic. In "I Don’t Know What I Can’t Say, or, Genet on Keats," the poet writes: "There are two sides to life. The side where life / Remains unconsummated, reticent" and the other, which is "the act itself laid bare--a hand / Inside the lion’s mouth . . . . " Campo chooses the latter.In the next section, his voyage takes him through several connected series of 16-line sonnets; each of these series plumbs the depths of a different intimate relationship: Song for My Grandfather, for My Father, for My Lover, and for Our Son. Some of Campo’s finest poems are in this section, including (just a handful from the many) "Grandfather’s Will," "Anatomy Lesson," "Planning a Family," "My Father’s View of Poetry," "Translation," and "Political Poem."In the final section, Campo brings the insight of a seasoned voyager to his day-to-day life experience as a gay Latino physician: "To teach me my own life, to share my grief." ("Planning a Family," p. 49)

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Eloy’s grandmother—his abuela—is dying of cancer.  She has been his faithful companion, teacher and refuge in a home where his parents often fight and his older brother seems to have lost interest in him.  He believes the only thing that will save her now is for him to make the annual pilgrimage on foot to the chapel at Chimayo, 17 miles from their New Mexico home, but his parents, both of who work full time, can’t go with him and won’t hear of his going alone.  Desperate for a miracle, and believing she can be saved by the blessed soil distributed at the chapel where many seem to have experienced miracles of healing, he sets out in secret early in the morning.  On the way a friendly dog begins to follow him and, despite Eloy’s efforts to get rid of him, travels the entire 17 miles with him, sharing the water Eloy reluctantly offers him from the canteen that once belonged to his grandfather.  Much of the story follows Eloy’s thoughts as he travels, and the small difficulties and surprises along the way.  As he finally sees the chapel in the distance, he hears his brother driving by slowly in his low-rider with tinted windows.  Angry at the brother who has given him no support so far and seems to be mocking him, Eloy flips him the finger.  Later, as he stands in line for the sacred soil, his brother enters the chapel with their abuela on his arm.  She explains to Eloy that she is indeed going to die, and that God has other ways of answering prayers.  She sees that Eloy has been sent a companion, and encourages him to bring the dog, whom he has now named, home with him.  His parents, who have steadily refused to let him have a dog, accept him, and Eloy comes to new terms with his grandmother’s approaching death.

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This collection of 16 short stories focuses on doctors and patients in San Francisco, where a wide variety of wealth and culture impact the delivery of medical care.  Further, there are many restrictions—financial, bureaucratic, ethical, and legal —that limit what doctors can do, especially in cases of patients near death.

The author, Louise Aronson, is a geriatrician who knows this terrain very well, having trained in San Francisco and worked as a physician there. A skilled writer and close observer, she has created dramatic and often funny stories that reveal social and bioethical complexity. About half the stories describe end-of-life issues for the aged and the dilemmas for their physicians and families.

In ‘The Promise,” Dr. Westphall orders comfort care only for an elderly patient who has suffered a massive stroke, but a hospital gives full treatment because there was no advance directive and the daughter told the attending to do “what he thought best.”

When Dr. Westphall sees this barely functioning patient in a skilled nursing facility seven months later, he tenderly washes her face and hair—although the text teases us that he might have been prepared to kill her.

In “Giving Good Death,” a doctor is in jail charged with murder; he has fulfilled the request of Consuela, a Parkinson’s patient, to help her die. When it appears that she may have died for other reasons, he is released, his life “ruined.” He leaves San Francisco, and, we surmise, medicine. In three other stories, doctors also leave the profession: the cumulative stresses of work and family and/or a sense that it’s not the right path bring them to that choice.

On the other hand, one of the longer pieces “Becoming a Doctor” celebrates the profession, despite all the rigors of training including sexism against women. 

The stories bring multicultural insights; we read of people from China, Cambodia, Latin America, India, Russia, and the Philippines. Some are African-American; some Jewish, some gay. These different backgrounds color notions of health, death, and medical care. There are also pervasive issues of poverty and, at another extreme, professionalism that is hyper-rational and heartless.

Indeed, a recurring theme is care and love for people, no matter their background or current health status. A surgeon realizes (regrettably too late) that the secret of medical care is “caring for the patient—for anyone—just a little. Enough, but not too much” (p. 135). 

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In this collection of "clinical tales," to use Oliver Sacks' term, Sue Hall, an experienced neonatologist who spent some years as a social worker before medical school, tells a remarkable range of stories about newborns in the NICU and their parents.  As memoir, the stories record moments in a life full of other people's traumas, disappointments, anxieties, and hard-won triumphs where her job has been to hold steady, find a balance point between professionalism and empathy as young parents go through one of the hardest kinds of loss.  Each story is told with clarity and grace, sketching the characters deftly and offering useful medical information along the way on the assumption that many who read the book will do so because they are facing similar challenges and decisions.  Each story is followed by a two- to three-page "Note" giving more precise medical background and offering further resources for those who have particular interest in the kind of case it was. 

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