Summary:

The physician-narrator is looking in on a 30 year old patient named Ricky. Readers immediately learn that the patient has cerebral palsy: his ear mashed flat, his neck contorted into a tight C, almost quadriplegic. These first stanza clinical observations are indisputable. The narrator then shifts from the medical facts to more subjective thoughts ranging from Ricky’s previous treatment responses and medications to Ricky’s adult heterosexual response to the proximity of a female, and finally to the narrator’s own wishes for this patient. Ricky’s parents, the narrator notes, have similarly but uncomfortably witnessed their son’s ogling response to a pretty nurse or doctor or a provocative adult television image. The parents’ response, he notes, to these observations has been to redirect Ricky’s focus by switching the channel to Nickelodeon, a program geared towards children.  Not unlike situations in several writings by William Carlos Williams, this physician has moved from objective medical information to his own interior thoughts about Ricky’s circumstances and confinement.  Rather than sticking with the facts associated with the patient’s medical condition, he wonders, imagines, and expresses in this poem seemingly un-doctorly thoughts. 

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This story centers on Lena, an immigrant teen from Ukraine, whose entire family has been traumatized and uprooted by family deaths during a violent pogrom.  Relocated to Chicago, in a tiny apartment on Bittersweet Place, the family struggles to survive in the years prior to World War I. Wineberg’s tale of disrupted life and resettlement is weighted by formidable issues that stretch beyond the ordinary range of family experiences. 

Lena, the intelligent, highly observant and resilient adolescent, narrates an unvarnished tale of survival for the extended family clustered together in this strange new world, but especially for herself.  While the family’s economic and financial circumstances are difficult, her own life is made worse by an unkind teacher, mean-spirited classmates, and hormonal impulses.  Her uncle touches her inappropriately, a favorite uncle goes mad, a cousin dies, and her mother, who is unfamiliar with the new world setting and mores, drives her crazy. 

Nevertheless, Lena is a clear-eyed survivor exhibiting a surprising toughness of character and determination. For example, her introduction to sex is far more direct than might occur with most girls of that time.  In addition, when her teacher fails cruelly to support her artistic talents, she shows amazing defiance.   When she discovers that her father has a beautiful female friend, undoubtedly a lover, her consideration of this circumstance does not render the crushing blow that might be expected.  In retrospect she is more adult, more mature than most young women might be in each of these situations.  She is a remarkable young woman with a spirited edge.

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Although Dr. Helman’s untimely death did not permit a final editing by this prodigious writer, the published edition is not a book-in-progress. An Amazing Murmur of the Heart: Feeling the Patient’s Beat represents a powerful and persistent continuation of observations and themes that grew out of medical education, close observations of physicians and patients, and his studies in anthropology. All of these forge an approach to patient care that is out of the ordinary.  

As his previous writings suggest, Helman is passionate about medicine but concerned, equally about the emergence of those who fail to listen and to those who might be called techno-doctors.  While professing his appreciation of and attraction to the magic machine or computer, he is mindful of its absence of emotion and ambiguity.  “For this post-human body is one that exists mainly in abstract, immaterial form.  It is a body that has become pure information.” (p. 11)

Chapters are comprised of stories about patients and their care providers, each representing complex facets that defy precise measurement, answers and conclusions.  As Helman steadily notes, the physician must be an archeologist:

Most patients present their doctors with only the broken shards of human life—the one labeled infection, disease, suffering and pain each of these shards is only a small part of a much larger picture….the doctor will have to try and reconstruct the rest. (p.66)

In general, the chapters illustrate first an initial review of medical history, and then specific patient stories.  Of the two, the story is most important.  “Mask of Skin,” for example, begins with an overview of skin from Vesalius to the present: largest organ, stripped bare by anatomists, penetrated by disease, later scanned and X-Rayed, tattooed, re-fitted by surgeons, etc.   That said, Helman the physician-anthropologist, moves from science to specific stories about patients whose skin may cover profound experiences, psychic and otherwise, that might be overlooked by a dermatologist.   Although skin is involved in each of that chapter’s stories, the willing physician must dig deeper in his observations and caring manner to make more profound discoveries.      

In a chapter entitle “Healing and Curing” the author describes an old friend, a practitioner who provides advice about patient care that ”was not included in his medical texts”.  Patients are more than a diagnosis dressed in clothes.  Doctors must make patients “feel seen, listened to, alive”.  Always patients should be regarded as people who happen to be sick.  From his admired colleague Helman learned to be an attentive listener  to the "tiny, trivial, almost invisible things" in patient encounters and stories. To truly heal as well as cure requires the doctor to empathise with what the patient is feeling thereby requiring both an act of imagination and of the heart.  The chapter, of course, continues with with stories that illustrate the points enunciated by his colleague and accepted by his disciple. 

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The poem was inspired by a painting of the same title by Edward Hopper (Early Sunday Morning). Stone describes what is visible in the painting and then muses about what "may be" happening. For example, in "the next block someone may be practicing the flute."

Hopper's painting, like all art and literature, is an invitation for engagement, reflection, and expansion. While Stone inventories the painting's urban terrain, he is compelled to enter into the picture with his imagination. By doing so he demonstrates our dual capacity for both the facts of science and the less precise, but equally valuable impulses of fiction.

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At first the title seems to relate to the main character's lay-off or departure from his job as a professional cellist in a bankrupt and dissolving orchestra.  As the story continues, the title's unpredictable meaning becomes clear. 

Not surprisingly, jobs for cellists are difficult to find. Shattered by his desperate situation, Daigo, the central character (Masahiro Motoki), and his wife Mika (Ryoko Hirosue), return from the city to his hometown where they begin to experience stresses and discomforts associated with joblessness.  After a long period of searching, Daigo responds to an ad for someone to work in departures. Believing that he is applying for a travel advisor job, he discovers that the position involves the ceremonial art of caring for the bodies of those who have recently died--or departed.  He learns about encoffination, the elaborate ritual of washing and dressing the body before placement in the casket prior to burial, from Sasaski (Tsutomu Yamazaki), his new employer. 

Mika is so appalled and ashamed when she learns about his new career, she decides to leave him.  In spite of his own unhappiness, Daigo continues on.  With the remarkably skilled Sasaski at his side, Daigo develops great sensitivity in the ritualized care that is provided before family mourners.  Each of the caring situations becomes for Daigo, a rich story about the textures of human life.  He seeks solace for himself and another measure of dignity for the departed by playing beautiful music on his cello.  Most viewers, including the eventually reconciled Mika, are impressed by the beauty of this probably unfamiliar Japanese ceremony.

Another moving dimension of Daigo's personal story occurs when information is revealed about the father who had abandoned him when he was a child.  Circumstances intervene so that Daigo's new skills and sensitivities contribute to an understanding of that distant past and an opportunity to provide his father with a dignified departure ceremony.    

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The story centers on Tsotsi (meaning thug), an adolescent in Soweto, the shantytown slum of modern Johannesburg, South Africa.  There Tsotsi (Presley Chweneyagai) leads a loose-knit gang of menacing thugs.  When gang members are first encountered, Butcher reveals his disturbing and sinister nature; Boston (Mothusi Magano), except for his alcoholism, represents a potentially thoughtful but ineffective source of goodness and decency; Aap (Kenneth Nkosi), a simpleton, is devoted to Tsotsi; and Tsotsi seethes with, as yet, inexplicable rage. 

As the story unfolds, a petty crime leads to senseless murder and an old wheelchair-bound man is threatened and cruelly abused.  Finally, Tsotsi, without gang participation, shoots a woman during an auto theft.  When he drives recklessly away, he discovers an infant in the stolen car's backseat.  Rather than killing the baby, his first inclination, he puts it into a paper bag and takes the baby home.  This new relationship--and responsibility becomes the harrowing twist in the story.   

Throughout, short and disturbing flash backs of Tsotsi's childhood reveal unimagined beginnings that have led to the boy's simmering rage and the string of unforgiving actions.  While concerns about vulnerable children within a context of social injustices are foremost in the minds of film viewers, the overwhelming circumstances and complexities frustrate thoughts about realistic interventions. 

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The title recalls Clotho, the Fate charged with spinning the thread of life which would someday be clipped by her sister, Atropos. The two-stanza poem describes the circumstances of illness within a hospital setting. In stanza one, with a patient unable to urinate on his own, the poet employs desert images to suggest the dryness felt by the incapacitated sufferer ("throat-filling Gobi," "dry as Arabia," sunburnt cage of bone," "shekel," "rugs," "camel," etc.).

Stanza two begins with the riddle of the sphinx, another reiteration of desert imagery, but moves quickly to modern medical intervention by substituting the cane, the third leg of the elderly, with an IV pole for liquid sustenance and the "snake-handlers fist of catheters," ridding the body of its wastes. Clotho's role has been usurped by technology's miracles, and an appeal is made for the "kind, withdrawn face trained in the arts of love."

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Sissman, whose chronic illness inspired him to incorporate illness experiences into his writings, muses about where he is likely to die. Like an archaeologist he begins with a vivid description of factors and events contributing to various wings and pavilions. He knows this hospital well: its external facades with "Aeolian embrasures" and "marble piping" associated with certain patrons or patronesses such as "the Maud Wiggin Building . . . commemorat[ing] a dog-jawed Boston bitch".

Slowly the narrator moves from the hospital's exterior layerings to imagine himself, a patient on a gurney, wearing the "skimpy chiton" while being subjected to syringes, "buttered catheter[s]," and IV "lisps and drips." Just before death his blood will "go thin, go white" and finally, there will be a journey through the hallways to the morgue and then to the undertaker. "That's all." The account is prosaic, an inventory or catalogue of steps familiar to anyone who has worked in a hospital setting. As a poet, however, Sissman transforms the ordinary into vividly fresh portrayals.

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The speaker in this short poem is a physician whose father's "castrated body" is "crooked in prostatic pain." From the family home in Tennessee, the dying man's wife provides daily phone reports to the son about her husband's deteriorating condition. The speaker's mind swirls with conflicting feelings: he thinks about "Dr. Death," whose efforts he has just come to understand; he thinks about the suffering experienced by his father and his mother's "terminal voice"; and he considers "how many of those little pain killers it might take."

Similarly, recollection of the Hippocratic vows intrudes to counsel against the kind of assistance his filial nature wants to provide. The internal debate about choices directs readers back to the title's imperative, "let's talk about it," suggesting, I believe, the need for social and professional discourse about quality of life, futility, and physician-assisted-suicide.

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Sometimes overlooked by those attracted to Wharton's longer, more ironic novels, this novella is one of stark simplicity set against a bleak New England countryside at the beginning of the 20th century. With characteristic economy, Wharton tells a compelling story about the human need for passion and affection in a situation where only abject coldness exists.

Ethan Frome is introduced by the narrator in this way: "It was there that, several years ago, I saw him for the first time; and the sight pulled me up sharp. Even then he was the most striking figure in Starksfield, though he was but the ruin of a man" (3). Determined to learn more about Ethan, while temporarily located in an appropriately-named village, the narrator manages to gather pieces of information about the figure who seemed an "incarnation of frozen woe in the melancholy landscape" (11).

The spark of hope that might have led young Ethan toward education and escape expired when care for his chronically-ill mother fell first to him and then to a cousin named Zenobia. Unable to abandon his mother and their needy homestead, he was easily attracted to Zenobia, the kindly young woman who assisted in his mother's care. They married, the mother died, and Zenobia inexplicably assumed a sick-role that would make Ethan's life loveless and tragic. Permanently stuck in Starksfield, his years become emotionally and economically depressed. Barely able to eke out a living hauling lumber and subjected to his bed-ridden wife's petty and constant demands, Ethan's impoverishment seems unending.

Miraculously, a third person, Mattie, enters the narrative. A distant cousin with no resources, she has been summoned by Ethan's increasingly mean-spirited wife to do chores within the house. The scene is set for two lonely and isolated people, despite age differences, to discover small bits of warmth in stolen moments together. Walks through the snow or gentle kindnesses in the dull household routine sustain the otherwise desolate pair of innocent lovers. An unexpected turn of events transforms a hopeless set of circumstances into permanent desolation and trauma. The conclusion is one of unimaginable horror.

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