Summary:

The title and first line, "My Beautiful Grandmother / died ugly," set the tone for contrasts that continue throughout the poem: health and illness, beauty and ugliness, youth and age, life and death, staying and leaving. The poem initially describes the grandmother as aged, ready to die, anorexic and in such pain that she required six years of morphine. The needles used to inject medication, which left her arms bruised "black and blue" are contrasted with her previous embroidery needles, which she had used to stitch "pink cornucopias / on square after square of white cotton."

The grandmother was ready to die for a long time, to a place and time apart--to the mountains and to her spirited youth, when she was "dashing" and her "mind was as quick / as the stitch of a sparrow's wing." The poem continues with the compression of time yet marking the effects of time: old love letters to the grandmother crumble "like stale bread" in the hands of the granddaughter. The poem concludes with a short stanza alluding to difficulties that the granddaughter experienced leaving the Georgia town where her "beautiful grandmother stayed."

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This outstanding anthology of poems, stories, excerpts and essays by African-American writers is prefaced by a poem ("Aunt Sue’s Stories" by Langston Hughes), a foreword, two essays and an introduction. The book is then divided into three sections: Section I, Illness and Health-Seeking Behavior; Section II, Aging; and Section III, Loss and Grief.

Each section begins with an introduction which clarifies the choice of the section’s theme and briefly describes each piece. At the conclusion of each section is a list of ten to fifteen questions which "are intended for personal reflection and group discussion." Brief autobiographical information for each of the thirty-one authors is presented in Appendix 1.

As Secundy notes in the introduction, a divide exists between the health care worker and patient, which is particularly prominent when color and economic status are different between them. Secundy, as an educator in the medical humanities, selected pieces that reveal "the significance of color and social distinctions" when African-Americans face illness or enter the health care system.

The selections chronicle struggle and survival, illness and loss, humiliation and pride, triumph and sorrow. These pieces speak to all of us, as Edmund Pellegrino states in his essay, "Ethnicity and Healing": "[p]aradoxically, as we learn more about the uniqueness of African-American culture, we are drawn closer to the common humanity we share with the subjects of these stories and poems."

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During the opening credits, the camera slowly pans over the myriad medications for Marvin (Hume Cronyn), the elderly, bedridden invalid cared for round-the-clock by his daughter, Bessie (Diane Keaton). The film opens with Bessie visiting Dr. Wally (Robert DeNiro), a pathologist cum primary care physician, for diagnostic tests which show that she has leukemia.

Bessie also takes care of her Aunt Ruth, whose electric unit for pain relief and penchant for soap operas provide comic relief in this bittersweet drama about families and responsibilities. Because Bessie's best chance for survival is a bone marrow transplant, she contacts her sister, Lee (Meryl Streep), estranged since their father's first stroke and Lee's decision not to help care for him.

Lee's oldest son, Hank (Leonardo DiCaprio), is a troubled seventeen-year-old who sets fire to their home and is hospitalized in a mental institution. Released for this special trip to visit his Aunt Bessie, Hank continues his rebellion by refusing to be tested as a possible donor. Lee is a dysfunctional mother: she does not respond to her son's apology regarding the arson, she has her younger son light cigarettes, and she confuses discipline with control.

The family unites in and around Marvin's room. Reunions are never as smooth as planned, and tensions, stored bitterness, and anger erupt. The sisters confront each other in their failures as sisters--Bessie had never contacted her nephews in any way and Lee had never looked back. But through it all, love and caring emerge: the sisters come to a new understanding, Bessie's reaching out to rebellious Hank is reciprocated, and Lee even learns to communicate caring to her son.

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Worlds Apart is a set of four documentary videos designed to stimulate thought and discussion about the effects of culture on communication and medical decision-making. Each video encapsulates the story of a real patient and his or her interactions with physicians and family.

The four videos are: (1) Kochi Story--an Afghan man, diagnosed with stomach cancer, decides about chemotherapy amidst miscommunication due to translation issues and religious convictions; (2) Chitsena Story--the mother of a four-year-old girl from Laos is caught between physicians who tell her that her daughter needs surgery to correct an atrial septal defect, and her mother who upholds the traditional Khmu beliefs that scars, including surgical scars, are injurious to a person in future lives; (3) Phillips Story--an African-American man on dialysis discusses the prejudices against black people in the health care system, particularly the decreased chances for receiving a renal transplant; (4) Mercado Story--a 60-year-old Puerto Rican woman who lives in Hell's Kitchen, New York City, explains the complex social situation which affects her ability to take care of her chronic health problems, such as diabetes and hypertension.

The films depict the patients and families in various settings--in doctors' offices, at other health care facilities, at home or work, during religious ceremonies. Phillips Story is different in that only the patient speaks during the film--in the other three stories we hear family members, translators, and physicians. The pitfalls of translation by a family member or friend are discussed, as well as the need for the physician to elicit information from patients about the social contexts that may affect their health and decisions.

For example, Mr. Kochi's religious beliefs contravene the use of continuous infusion chemotherapy, but not other regimens--this distinction is not elucidated for many months. Hence cultural competency in health care requires that the provider not assume reasons for patients' behaviors and decisions but rather emphasizes communication to understand the particulars of the situation.

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A man begins to lose his word-finding abilities, his ability to perform everyday activities and his ability to communicate with his wife. He realizes his growing losses and incapacities. Even as he worries how to make amends to his wife, he grows distant and isolated. The poem ends with a vivid scene: the man stands in front of the woodpile with the axe raised--he looks at but does not recognize his wife screaming behind the closed bay window. "[H]e never / hears what it was she never said."

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The lives of writer Cathy Crimmins, her lawyer husband Alan Forman, and their seven-year-old daughter were changed forever on July 1, 1996, at a lake near Kingston, Ontario. "Alan’s brain got run over by a speedboat. That last sentence reads like a bad country-western song lyric, but it’s true. It was a silly, horrible, stupid accident." (p. 5). While Alan steered a small boat back to dock at the end of their vacation, a teenager drove a speedboat literally over him, causing major traumatic brain injury (TBI) including seizures, coma, hemorrhage and paralysis.

Crimmins chronicles her husband’s remarkable recovery with a mix of humor, medical information, anger at HMO denial of benefits, and gratitude for the care of physicians, nurses, therapists, EMT, friends and family during this grueling, and in many ways, never-ending ordeal. Although Alan survived -- and is now capable of walking, speaking, reading, loving, working and driving -- he is a different person. The injury to his frontal lobes causes him to be disinhibited, erratic, angry, irrational, petulant, obsessive, devoted yet cruel to his daughter, and prone to severe "cognitive fatigue."

TBI is a bizarre, unpredictable illness. Crimmins notes that the degree of Alan’s recovery is atypical for the force of his trauma. In addition, TBI survivors say and do wacky things: "Where is the mango princess?" was one of Alan’s first utterances after emerging from his coma. Alan’s pre-accident sharp-edged humor was replaced by bland affability and a disturbingly vacant gaze. Yet some of what he says and does is heart wrenching and poignant.

The book clearly documents that the trauma is not limited to the patient. As Crimmins so eloquently and honestly recounts, she, her daughter, and all who knew Alan were traumatized by the accident and its aftermath.

Crimmins is an aggressive caregiver, thrust kicking and fighting into the caregiver role. Her advocacy for her husband, including research into the best rehabilitation facility, day hospital, vocational rehabilitation program, doctors, therapists, etc., was unwavering and crucial to his optimal care and outcome.

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Constructed as a triptych, the novel chronicles several generations of a Scottish family, the McLeod’s, across three Junes: Part I Collies, 1989; Part II Upright, 1995; and Part III, Boys 1999. In the first part, patriarch Paul McLeod assuages his grief and loneliness following his wife’s death by traveling to Greece on a tour. He tells the tour guide about his wife’s lung cancer: "A terrible ordinary death, you might say. Or an ordinary terrible death." (p. 23) Paul’s unrequited yearning for Fern, a young artist, heralds a succession of missed opportunities for expressions of love involving the McLeod’s.

The second part is a first person narrative by Fenno, Paul’s eldest son. Fenno, the gay owner of a Manhattan bookstore, cares for Malachy, a New York Times music critic, who has AIDS. Paul’s death brings the three sons together (Fenno and his younger twin brothers David, a veterinarian who lives in Scotland with his wife Lillian, and Dennis, a chef, who arrives from France with his wife and children).

The family relationships are complicated, and David’s infertility leads to revelations about strengths and weakness of various family members. Meanwhile, Mal’s illness and his decisions about controlling the end of his life, also give Fenno insight into loyalties and family secrets.

The last section, a coda, reverts to third person narration and reintroduces Fern, now widowed due to a freak accident and also pregnant. Themes of parenthood, responsibility and relationships continue to be developed.

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One Breath Apart: Facing Dissection is a pictorial and narrative account of gross anatomy class in medical school. The book highlights the educational, moral and metaphysical opportunities anatomy courses afford those who dissect and learn from the cadaver. Educator and thanatologist Sandra Bertman has expanded on her work with medical students previously summarized in her book Facing Death: Images, Insights, and Interventions (see annotation).

Written with the first year medical student in mind, One Breath Apart is a compilation of drawings and writings by students from the University of Massachusetts Medical School between 1989 and 2002 in response to course assignments. The book is dedicated to the professor of the anatomy course, Sandy Marks - of note, the medical humanities module, including assignments and events were integrated into the course. Bertman describes the course and provides a plethora of student work.

Additionally, the book is enhanced by photographs by Meryl Levin, with writings by Cornell-Weill medical students, excerpted from Levin's marvelous study,  Anatomy of Anatomy in Images and Words. Also included is a foreword by Jack Coulehan, who writes of his experience with his cadaver ("We named him ‘Ernest,' so we could impress our parents by telling them how we were working in dead earnest." p. 7) and the lifelong impact of dissection on the student.

Of particular note is the variety of content included in this intriguing volume. Artistry is not a medical school admissions criterion, yet a number of the drawings have design components which are thought-provoking and profound. For example, on page 80 a female doctor adorned with white coat, stethoscope and bag stands beside an upright skeleton. They are holding hands.

Bertman concludes the book with photographs, drawings and text related to the annual spring memorial service for the body donors. The section includes eulogies by students and responses by donor family members. Writes medical student Nancy Keene: "Studying his body provided an opportunity which enhanced my education. But it was the giving of his body, which has remained with me as a lasting memory." (p. 87)

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In his debut novel, Dr. Khaled Hosseini tells a tale that begins in his homeland, Afghanistan, and ends in his adopted country, the United States. Amir, son of a wealthy Pashtun merchant, narrates the story. Amir and his father, Baba, are attended by two Hazara servants, Ali and his hare-lipped son, Hassan. Amir and Hassan are friends, but Amir is troubled by a guilty conscience over multiple slights and sly insults aimed at Hassan. The burden of guilt intensifies over an incident at a kite-flying contest when Amir is twelve years old.

Kite flying in Afghanistan is an intricate affair involving glass-embedded string that contestants use to slice the strings of other kites. The winner is not only the one with the last kite flying, but also the one who catches the last cut kite--the kite runner. At the close of the contest, Amir witnesses the traumatization of his friend Hassan, the finest kite runner, at the hands of an evil youth, Assef. Too shamed to help Hassan, Amir is nearly swallowed by his cowardice: the rest of the story follows the consequences of his guilt.

Amir and Baba emigrate to the United States during the Soviet invasion of Afghanistan, but Amir, as a young adult, returns during the Taliban regime in order to redeem himself and help Hassan's son. The story is filled with plot twists and revelations of secrets and hidden relationships, which enable Amir to confront some of his shortcomings. The oppression, torture, and murder of Afghanis by the Taliban are graphically depicted.

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This documentary film explores the interdisciplinary quest to understand the mind--its relationship to the brain, to the soul, to consciousness and sentience, and to the societal implications of free will. The film begins with the crisscrossing flow of people in a train station and an overvoice expressing the existential questions of "who are we?" and, ultimately, "who am I?"

This compelling image, filmed in black and white, serves as a representation of people as humanity and as individuals, as well as a metaphor for flow, such as of time or of impulses along a neural network. Hence, already in the introduction, the viewer is aware that this film will address some of the deep philosophical questions of all time complemented by visual imagery which enhances and enlarges on the dialogue.

The film is then divided into twelve sections: The Soul, The Body, Mental Disorder, Mind to Molecule, Bit to Brain, Consciousness, Free Will, Citizenship, The Moral Brain, The Brain on Trial, The Medical Mind, and Who Am I? Experts from multiple fields such as theology, neuroscience, psychiatry, law and justice, philosophy, sociology, history of medicine, physics, computer science, and filmmaking offer insights and questions either directly to the camera, or as voice-over for other imagery.

For example, to name just a few of the numerous eminent persons in the film, there are statements by mathematical physicist Roger Penrose (Shadows of the Mind: A Search for the Missing Science of Consciousness, and The Emperor’s New Mind: Concerning Computers, Minds and the Laws of Physics), philosopher Daniel Dennett (Darwin’s Dangerous Idea: Evolution and the Meanings of Life, and Brainchildren: Essays on Designing Minds), philosopher John R. Searle (Mind, Language and Society: Philosophy in the Real World) and neurologist Antonio Damasio (Descartes’ Error: Emotion, Reason and the Human Brain). The multiple experts all address the basic question posed by the film: "What will a science of the brain add to the human story?" but the approaches to the question, and what aspects of the question are most important, vary considerably in this far ranging journey through religion, history, ethics, medicine and science.

A few of the many interesting segments of the film include sections on cognitive neuroscientist Nancy Kanwisher who studies specialization by parts of the brain, such as a face-recognition center; developmental neuroanatomist Miguel Marin-Padilla, who has studied the motor cortex for over 25 years, which he demonstrates by dissection to be smaller than the tip of his finger; and Dennett’s one-armed robot, Cog, which is "learning" in developmental stages as an infant would. Eloquent commentary is also provided by computer scientist Jaron Lanier, sociologist Howard Kaye, psychologist Nicholas Humphrey, and filmmaker Ken Burns, among others.

Much of the film deals with psychopathology and implications for morality, behavior, and responsibility for behavior (free will and crime). Segments include an interview with a patient with manic-depressive disorder, a historical note on Phineas Gage (whose dramatic wound of his frontal lobe so altered his behavior), and a lawyer, psychiatrist and judge discussing free will, diminished capacity, and the legal system.

The film concludes with some concerns about reductionism to the biologic model of the mind, the growing haziness of borders between human and artificial intelligence, and the role of psychoactive medications. Although full mapping of the brain may not lead to complete understanding of the mind, still, the film concludes, the quest is fun.

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