Summary:

A woman is pregnant. She is a nurse married to a physician, Jeff, and they have a young son, Willie. The couple is pregnant with their second child. Long before her due date, the woman--author Susan LaScala--begins experiencing signs of premature labor. Because she is a nurse, because she is married to a doctor who takes call, she doesn't want to over-react or bother her obstetrician unnecessarily. But when vague aches turn into cramps, the author enters, as a patient, the world she had known, until then, only as a caregiver.

It is impossible, in a brief annotation, to describe fully the richness of this memoir. Because the author is a nurse, she brings to the story of the premature birth and survival of her daughter, Sarah, a wonderful double vision: LaScala tells this tale not only as a mother and a patient but also as a clinician able to explain, in simple language, the complex technologies used to sustain the life of her one pound nine ounce baby. The author's rendering of the bells and whistles of neonatal medicine, whether describing the process of intubating a preemie (p. 23) or ultrasounding a baby determined to survive (p. 182-3) are precise and haunting.

Equally compelling (and instructive for caregivers) are the author's candid revelations of how it feels to be a patient. She takes to "grading" the doctors and nurses--an "A" for the staff that lets her see her newborn girl (p. 3), and a "C" for a nurse with "No kind words. No warmth" (p.11). She describes her own bodily sensations in language both lovely and informing: the pushing and tugging she feels during her C-Section is a "quiet violence" (p.21); standing beside her daughter during the ventilator weaning process she feels "a witch's brew of fear and panic mixing and growing inside" (p. 225).

In an introduction, physician Barbara Wolk Stechenberg, describes the "gift" that the author has given by writing this memoir. The author has allowed Dr. Stechenberg, who was part of the team that saved Sarah, "a rare glimpse into two worlds" (p. xii). One was the world of intensive care nurses and how "they truly are the primary caregivers" (p. xii). The other world was that of physicians, who "may feel we are empathic and caring, but we really have no idea of the emotional roller coaster many of our parents are riding" (p. xii).

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Summary:

Sandeep Jauhar, M.D., Ph.D. is currently director of the Heart Failure Program at Long Island Jewish Medical Center in New York. Thus, one can assume that he is an accomplished cardiologist and administrator. It was not always so. This memoir flashes back to 10-15 years earlier when the author was casting about for a career, finally settling on medicine almost by default; it follows him to medical school (at Washington University in St. Louis) and then centers on his first year of residency training at Cornell's New York Hospital in Manhattan -- the internship year.

We learn in the introduction to the book that the author will speak freely of self-doubt about career choice, constant anxiety and feelings of inadequacy, exhaustion, and disillusionment. Which indeed he does. But Jauhar first discusses his family background: born in India and emigrating with his family to the USA at age 8; father holding a Ph.D. in plant genetics, now writing academic textbooks and still regretting that he had not been able to afford his dream of becoming a doctor; mother helping to support the family as a lab technician; older brother, Rajiv, a mentor and competitor, charming, self-assured, and unquestioningly headed for a medical career; sister, Suneeta. Sandeep (the author) undertakes graduate work in theoretical physics but as he nears completion of his doctoral degree, realizes that he probably does not have what it takes to be successful in the field. When his girlfriend, Lisa, becomes seriously ill, he begins to (re)consider medicine as a career. Against the advice of his parents who are now convinced he is a dilettante, he applies to medical school and is accepted.

Disillusionment began during the first two years of medical school: "In graduate school I had never learned to memorize . . . But now I couldn't rely on logic and reasoning; I had to commit huge swaths of material to memory" (32). He considered quitting to become a journalist, a profession that had always intrigued him, but which had been discouraged: "my father made it clear that journalism and writing were never to be considered career options because they offered no security" (33). Yet, amazingly, he was awarded a summer fellowship just before starting medical school that placed him in the Washington, DC office of Time magazine; the contacts he made then allowed him to work as a student reporter for the St. Louis Post-Dispatch during medical school and led ultimately to his ongoing and current position as a contributing medical essayist for the New York Times.

Internship for Jauhar unfolds as a series of anxiety-provoking encounters with patients and humiliating encounters with his physician superiors. Feeling inept and inadequate, he stumbles along and worries that he is harming patients. There is too much to keep track of, too many "little things that I find burdensome" (91). "Having so much to do was bad enough, but not knowing why you were doing what you were doing was terrifying . . . Patients were needy, their demands overwhelming . . . Everyone seemed to know how the place worked except me . . . The ecology on the wards was hostile; interactions were hard-bitten, fast paced" (112-113). He is in constant doubt and conflict about his career choice. Even his private life is affected -- his girlfriend Sonia, still a medical student, comes from a medical family, is strongly motivated and secure in her career choice, which aggravates his own sense of insecurity. (Reader, he married her.)

Midway through internship Jauhar suffers a herniated disk. He tries to tough it out without taking time off but his stint as "night float" at Memorial Sloan-Kettering hospital, which specializes in treating cancer patients, proves too difficult-- up all night trying to tend to the severely ill and "taking care of patients about whom you knew next to nothing" (154). He takes a brief leave followed by a reduced schedule. He recognizes that his problems are emotional as well as physical -- he is depressed. But gradually, as his neck problem improves, as he recognizes that medical professionals are actually able to help patients feel better -- his neurologist and physical therapist had "provided hope and comfort to me at a vulnerable time" (181)--, as he makes a house call to a dying patient, as his essays are published in the New York Times, and as the season moves to Spring, his depression lifts and he looks forward to his work.

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The author's mission is to investigate, understand, explain, describe, and puzzle over the nature of phobias -- his own, and that of other sufferers. Allen Shawn is a composer, pianist, and teacher, and is a member of a gifted family: his brother, Wallace Shawn, is a playwright and actor; his father was William Shawn, for many years editor of the New Yorker Magazine. As a musician and academic, Allen Shawn is "successful." And yet, his life is severely limited by agoraphobia, "a restriction of activities brought about by a fear of having panic symptoms in situations in which one is far from help or escape is perceived to be difficult" (13). The author interweaves sections that summarize his extensive readings on the fight-flight reaction, evolution, brain and mind, Freud's theories on phobia--with his personal history, especially as he believes it relates to his phobia.

Shawn's descriptions of how he experiences agoraphobia are vivid and informative, detailing the situations that trigger his physiologic symptoms of panic and disconnectedness: driving on unfamiliar roads, any kind of travel that is unfamiliar, walking across or on the edge of open spaces, traveling across long bridges, being in enclosed spaces (claustrophobia). The agoraphobe, he writes, "feels at risk, as if at risk of sudden death or madness" (14). Shawn tells about what he must do in order to strike out on unfamiliar trips, that is, when he gathers up the courage to take them. He must venture up to the point where panic sets in, turn back, then on another occasion repeat the process but attempt to go further, pushing through the panic, until, one day, he can make the entire journey without turning back. Sometimes he never makes it to the desired goal.

The author points to several different factors that seem to predispose people to phobias: heredity, unconscious imitation of a phobic parent, upbringing. In his own case, in retrospect, his father showed symptoms of agoraphobia. Shawn discusses the underlying repression that was pervasive in his household -- his father carried on a long-term relationship with a woman while remaining married. Shawn's mother knew about the relationship from early on but any discussion of it was forbidden, even after it became common knowledge.

Perhaps more important in Allen Shawn's perception of repression is what happened to his twin sister, Mary, who was born with what is now considered to be autism, and mental retardation. Allen felt close to this girl, even though her behavior was unpredictable and baffling. When he was about eight years old, his parents sent her away to a special boarding school without warning Allen, or offering explanations. From then on he rarely saw her; 10 years later she was institutionalized. The family did not speak much about her and her "'exile' . . . added yet another layer of mystification to an already really mystifying atmosphere. It turned out that even in our temperate environment something extremely violent could occur" (177). Not long after that, Allen began to experience severe anxiety in certain situations.

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Summary:

John Grogan's best selling memoir of his and his family's life with an exuberant, loving Labrador retriever pup that grew into an overly boisterous ninety-seven pound member of the family chronicles the joys and tribulations of dog ownership. Particularly, of Marley ownership. Marley flunked obedience school, required tranquilizers to tolerate thunder storms, destroyed possessions and jumped on people, to name a few traits.

The young married couple adopted Marley before they had children. The reader learns of the pregnancies and births of the Grogan's three children, including a miscarriage, ‘performance failure' during sex timed to ovulation, and an episode of post-partum depression, with an eye to what Marley was up to during that phase of family life, and especially how he responded to his owners' emotional states. Marley's protective stance towards not only the children, but also to a knifing victim in the neighborhood and to Grogan himself when he was struck by lightning, proved the dog's loyalty and devotion.

Marley lived a full life; as he aged, his hearing, sight and mobility worsened. He required emergency abdominal surgery at an old age, recuperated, but then suffered the same stomach bloat and twist problem again.

Grogan, a newspaper columnist, decided, after a period of intense grief, to write an article about Marley. "‘No one ever called him a great dog - or even a good dog. He was as wild as a banshee and as strong as a bull. He crashed joyously through life with a gusto most often associated with natural disasters...' There was more to him than that, however... ‘He taught me to appreciate the simple things...And as he grew old and achy, he taught me about optimism in the face of adversity. Mostly, he taught me about friendship and selflessness and, above all else, unwavering loyalty.'" (p. 279)

The column generated an avalanche of responses; fellow owners of bad yet lovable dogs wrote to the newspaper of their own experiences. These responses were cathartic to Grogan as he and his family learned to live without Marley, the dog who had taught them all so much: "the art of unqualified love." (p. 287)

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In this compelling memoir, Grace, a writer, artist and teacher, unexpectedly finds herself attracted to a carpenter, Howard Staab, whom she meets when looking at a new home. Shortly after their relationship begins, Staab is told in a routine physical examination that he has severe mitral valve regurgitation and will require surgery. Staab, an active, otherwise healthy fifty-three year-old man, has no health insurance. The cardiac surgery will cost over $200,000. Thus Staab and Grace embark on a quest to find an affordable, but excellent surgeon and hospital. Grace details her efforts to find the best care possible, including correspondence with her son, Bryan, a Stanford medical student with interests in international health. These inquiries lead to the possibility of surgery in India.

After a useful, explanatory preface the book begins when Staab and Grace land in New Delhi and enter the Escorts Heart Institute. Staab undergoes a series of tests confirming the need for surgery, which is subsequently performed by Dr. Naresh Trehan. Through Grace's eyes, we also meet nurses, aides, other physicians, administrators and friends. The narrative follows the hospitalization, including dramatic complications and eventual recovery, and also backtracks to better detail the search for care and the predicament of un- and underinsured Americans. Grace also describes the post-hospital phase, including venturing out beyond hospital and hotel walls.

The book, highlighting the fact that Grace and Staab face more than one cultural challenge in this journey, contains both a medical terms glossary and a short list of Hindi terms. Ultimately, Grace concludes she would consider returning to Escorts or a similar hospital should she or a loved-one require surgery, even without the insurance issue. She states: "India, the land of contradictions. Organized chaos. A third-world country with first-world state-of-the-art medical care available for a fraction of the cost of the same procedures here in the U.S." (p. 259)

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Author and teacher Peggy Shumaker was involved in an unexpected and terrible biking accident.  Out of that accident and her following slow recovery she has crafted a remarkable memoir---one that both examines her interactions with the medical community and her family and charts her return from disability---in short essay-like chapters, individual memories that comprise and inform her life before and after illness.  Reading these gem-like pieces, I could imagine her, in the process of recovery, having time and patience to look back at family, friends, custom and community in order to recreate who she was before and who she would be after her accident.  The longest of these "chapters" is several pages; the shortest, only a few sentences.  There is no table of contents guiding readers through the six sections of this book---and how could there be, as the book itself reflects the healing mind as it searches for continuity in the midst of disruption. 

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This memoir chronicles the pre-adolescent and adolescent years of the author, the son of an alcoholic, abusive mathematics professor father and a psychotic Anne Sexton-wannabe confessional poet mother. The only family member who does not abuse the boy in any way is estranged--an older brother with Asperger’s syndrome. Meanwhile, the amount of trauma to which young Burroughs is subjected boggles the mind. Just when one thinks it couldn’t get any worse, it does.

Burroughs, who loves bright, shiny, orderly things, also likes doctors--paragons of cleanliness, virtue and wealth. Unfortunately, his mother’s psychiatrist, Dr. Finch, described as a charismatic Santa Claus-look-alike, is unethical, bizarre and squalid. As Mrs. Burroughs becomes more and more dependent on Finch, she allows her son to be adopted into the crazy Finch household.

This family includes wife Agnes, who copes with her husband’s infidelity by sweeping madly; son Jeff, daughters Kate, Anne, Vickie, Hope and Natalie; grandson Poo; and adopted son, Neil Bookman, who is twenty years older than Burroughs and homosexual. When Burroughs is thirteen, and has told Bookman that he, too, is gay, Bookman forces the boy to have oral sex. They become lovers.

The Finches, meanwhile, exhibit their quirks and weird tendencies in multiple ways. "Bible-dipping" is popular to read the future, as is prophesying by examining Dr. Finch’s turds. A patient with agoraphobia, Joranne, lives in one of the rooms--in fact, she has not left the room in two years. Young Burroughs is allowed to smoke and drink. When Burroughs says he doesn’t want to return to school, Dr. Finch facilitates this desire by giving Burroughs alcohol and pills to fake a suicide gesture, then hospitalizes the boy.

Yet Burroughs manages to befriend a couple of the Finch daughters, and to survive his childhood. The book closes with his departure for New York City and with an epilogue outlining various people’s outcomes. Finch lost his license due to insurance fraud.

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This is a gripping and poignant account of newsman Bob Woodruff’s brain injury and recovery. He was injured in Iraq by a roadside bomb on January 29, 2006, shortly after being named co-anchor for ABC’s World News Tonight. A public figure—even a celebrity—his injury and recovery were well publicized, bringing to light the injuries of many kinds suffered by soldiers (not to mention civilians) in war-torn Iraq. Woodruff received every benefit American military medicine could offer and had impressive support of ABC and various luminaries. He made a spectacular recovery against all odds.

The book is mostly told by Lee Woodruff, Bob’s wife, who flew to Germany on a moment’s notice to see him at the Landstuhl Military Hospital, who waited 36 days for him to wake up, who saw the CT scan with rocks embedded in his head, who managed their four children and household during the long recovery time, and who writes vividly and personably. There are also flashbacks about the lives of Lee and Bob, truly a remarkable couple: their courtship, their time in China and London, their decision to use a surrogate mother to have their second two children.

Bob himself contributes pages, before and long after the accident. Thirty-one photos, both black and white and in color, enliven the text. One photo shows the interior of a critical Care Air Transport Team, a C-17 cargo plane outfitted like an ICU to transport wounded soldiers.  Throughout, the costs of warfare on people, society, materials, and land (not to mention dollars) is dramatically evident.

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This is a short piece, a scant twelve pages, in which Williams remembers Alan, an uncle who had mental deficits. During his breech birth, Alan’s brain was starved of oxygen. In the dominant American culture, Alan is called “retarded, handicapped, mentally disabled or challenged.” Williams concludes, “We see them for who they are not, rather than for who they are.” (p. 29) The title of the work refers to an Alaskan totem pole figure whose expression reminds her of Alan. In Tlingit culture, there’s a story of a kidnapped boy who lived with the Salmon People. When he returned twenty years later, he was seen as a holy man, not an “abnormal.”

To the young Terry Tempest, Alan demonstrated enthusiasm and spontaneity, for example bowling with reckless glee, regardless of where the ball went. When she asked him how he was feeling, he said, “very happy and very sad,” explaining that “both require each other’s company.” (p. 31) She liked his direct answers, those of a person we sometimes call a wise fool. Later, he lived in a “training school,” a joyless, ugly, and smelly place where abnormal children in Utah were sent and warehoused. Suffering from epilepsy, he wore a football helmet to protect him from sudden falls.

At age 22, Alan made the choice to be baptized into the Church of Jesus Christ of Latter-Day Saints. Williams describes the ceremony and how the family supported him through it (including yet another violent epileptic episode). When Alan died at age 28, Williams was 18. Looking at the totem pole, she remembers Alan, seeing him for who he truly was.

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Dr. Pauline Chen is a transplant surgeon and hence highly trained in the surgical care of desperately ill patients. She found, however, that although she had intensive and first rate training, time and again the message she received from her mentors and peers encouraged a distance from frank discussions about dying with patients who were clearly dying. Dr. Chen successfully suppressed her urges to reflect on the meaning of illness and death. Years into her training, she finally witnessed an attending surgeon stay with a patient and the patient's wife until the patient passed away. The widow sent a thank you note to Dr. Chen for allowing a "dignified and peaceful death." (p. 101) Chen notes that observing her attending stand with the patient during death changed her profoundly: "...from that moment on, I would believe that I could do something more than cure. This narrative, then, is my acknowledgment to him." (p. 101)

Final Exam chronicles Chen's journey from medical student to attending surgeon and examines her experiences with death and serious illness - of patients, family members, friends. The memoir contains three parts: Principles, Practice, and Reappraisal - each with three chapters. The book is chronologically arranged, beginning with anatomy dissection at the start of medical school and ending with Chen as an attending arranging for hospice, thus honoring a patient's desire to die at home rather than in hospital. Chen skillfully weaves her stories around commentary on the social, cultural and philosophical issues surrounding death and the medical response to death. An introduction and epilogue bookend the text and 46 pages of extensive notes and bibliography complete the book.

Although Chen claims to have slowly and painfully awakened to the fact that patient needs extend well beyond good technical care, in fact one sees Chen emerge as a caring physician even from her initial patient contacts in medical school. Chen speaks more to her role as an Asian-American than to being a woman in a male-dominated field, but she clearly has what it takes to succeed in this extremely competitive field, including a good dose of compulsiveness and an incredible work ethic.

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