Summary:

This is a collection of stories from Dr. Remen’s own life and from her practice as a pediatrician and psychiatrist. She works with many cancer patients and others who are terminally ill as well as with the chronically ill. Her stories record patients and their families finding what is authentic and meaningful in their lives when they have been forced deeply into their own vulnerability. She also speaks from her lifelong struggle with Crohn’s disease.

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A thirty-five year old English professor (and brilliant writer) diagnosed with ALS (Amyotrophic lateral sclerosis, Lou Gehrig’s disease) is told he has less than five years to live. Nine years later he publishes a series of 12 personal essays that chronicle his remarkable journey from diagnosis ("Getting Up in the Morning") to being mindful, "cultivating the eternal present" ("Living at the Edge"). He shares with us the interim of conundrums, spirituality, and the quotidian by reflecting on his New Hampshire life: Unfinished Houses, Wild Things, Mud Season, Winter Mind.

In almost every essay Simmons reflects on the rewards of "mystical seeing". We all have "within us this capacity for wonder, this ability to break the bonds of ordinary awareness and sense that though our lives are fleeting and transitory, we are part of something larger, eternal and unchanging." (p. 152) "Most of us have found that a line of poetry or scripture, a passage of music, the turning of a leaf in sunlight, or the sight of a child splashing in a stream can suddenly become a doorway through which, as William James writes, ’the mystery of fact, the wildness and the pang of life, steals into our hearts and thrills them.’" (p. 101)

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Subitled, Invisible Wounds of War. Psychological and Cognitive Injuries, Their Consequences, and Services to Assist Recovery, this monograph features 27 contributing researchers. Published by the RAND Corporation, it is funded by a grant from the Iraq Afghanistan Deployment Impact Fund. The study was conducted under the joint auspices of the Center for Military Health Policy Research, a RAND Health Center, and the Forces and Resources Policy Center of the National Security Research Division of the RAND Corporation.
 
The work deserves our full attention as it delineates and explains the economic, human, medical, political, public health, and social consequences of injuries suffered by returning veterans of US involvement in 8 years of continuous conflict in Afghanistan and Iraq. The introduction defines the three kinds of invisible wounds affecting thousands of the 1.64 million American troops deployed in Operation Enduring Freedom (Afghanistan) and Operation Iraqi Freedom (Iraq) since 2001. These combat related injuries are post traumatic stress disorder (PTSD), major depression, and traumatic brain injury (TBI). Upwards of 26% of returning troops may have mental health concerns, including drug and alcohol dependency, homelessness, and suicide.

The monograph analyses numerous studies of these issues, both governmental and non-governmental, and RAND has conducted its own study. The data collection is recent: from April 2007 to January 2008. RAND estimates that approximately 300.000 persons currently suffer from PTSD or major depression; in addition, 320,000 veterans may have experienced TBI during deployment.

The recommendations include evidence based care at the VA level, the state and community level, and on site in Afghanistan and Iraq. Adequate care would pay for itself and save money in the long run by improving productivity and reducing medical and mortality costs for members of the US armed forces.

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This collection of stories offers a sidelong view of medicine from the perspective of a thoughtful, experienced doctor of internal medicine at a teaching institution (UCSF) in an urban setting that brings a wide variety of types of patients to his door.  In a context of evident respect and admiration for even the quirkiest of them, Watts admits to the kinds of personal responses most have been trained to hide-laughter, anger, bewilderment, frustration, empathetic sorrow.  The cases he recounts include several whose inexplicabilities ultimately require action based as much on intuition as on science.  He includes several stories of illness among his own family and friends, and makes it clear in others how his professional decisions affect his home life and his own state of mind.  

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Part of a series, "Letters to a Young . . . [fill in the career]," this collection of essays by pediatrician-author Perri Klass is addressed to her son Orlando during the recent period when he was applying to medical school. The essays follow a chronological sequence, beginning with the decision to apply to medical school, the first two years of medical school, learning how to examine and talk to patients, residency training, physicians as patients, making mistakes, grappling with the most fundamental human issues in medicine, and the mingling of professional work and life.

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This collection of essays by surgeon-writer Atul Gawande (author of Complications: A Surgeon's Notes on an Imperfect Science --see annotation) is organized into three parts (Diligence, Doing Right, and Ingenuity) and includes an introduction, an afterword entitled "Suggestions for becoming a positive deviant," and reference notes. Each part is comprised of three to five essays, which illustrate, as Gawande explains in the introduction, facets of improving medical care - hence the title of the collection: Better: A Surgeon's Notes on Performance. In typical Gawande style, even the introduction contains tales of patients - a woman with pneumonia who would have fared far worse had the senior resident not paid close and particular attention to her well-being, and a surgical case delayed by an overcrowded operating room schedule. Such tales are interwoven with the exposition of themes and the detailing of the medical and historical contexts of the topic at hand.

The essays, though loosely grouped around the improvement theme, can easily be read as individual, isolated works. The concerns range widely both geographically (we travel to India and Iraq as well as roam across the United States) and topically. For instance, we learn about efforts to eradicate polio in rural south India and the dedicated people who devise and implement the program. Another essay, far flung from the plight of paralyzed children, is "The doctors of the death chamber," which explores the ethical, moral and practical aspects of potential physician involvement in the American system of capital punishment (from formulating an intravenous cocktail ‘guaranteed' to induce death to the actual administration of such drugs and pronouncement of death).

In sum, the topics of the eleven essays are: hand washing, eradicating polio, war casualty treatments, chaperones during physical examinations, medical malpractice, physician income, physicians and capital punishment, aggressive versus overly-aggressive medical treatment, the medicalization of birth, centers of excellence for cystic fibrosis treatment, and medical care in India. The afterword comprises five suggestions Gawande offers to medical students to transform themselves into physicians who make a difference, and by including this lecture in the book, what the reader can do to lead a worthy life.

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The subtitle to this collection of insightful and compassionate essays by gastroenterologist David Watts is: "One Doctor's Reflections on the Oddly Intimate Encounters Between Patient and Healer." Watts provides 48 narratives, most of which concern his patients and are written in the first person. In the preface Watts states "The stories in this book are true" (xv), that he has received permission from his patients, and that he has "disguise[d]" his patients to respect their right to privacy.

The stories cover a range of settings, from Watts's home and locations in the San Francisco Bay area, to the clinic and hospital. They also cover a range of his experience from medical school ("Sylvester" and "Love is Just a Four-letter Word") to his current position as a practitioner and an attending physician at a teaching hospital.

Stories in which Watts clearly situates himself with the patient and details the encounter are most compelling. For example, in the opening essay, "White Rabbits" and later, in "Flu Shot," Watts allows the reader to discover that patience and listening are required to in order for the patient to expose why he or she is truly there. In that space, Watts becomes present for his patient, and one learns that what may initially appear tangential is central to the patient's concern.

Watts writes of some very difficult patients and families, such as a woman who stalks him ("The Stalker's Bridegroom"), a woman who obsesses over caring for her elderly mother ("Home Remedy"), and a woman who demands narcotics ("The Third Satisfaction"). In one of the longer pieces, "Codger," Watts describes an irascible, elderly Jewish patient who skewers just about anyone with his critiques, including Watts's young son, and yet who later exposes his vulnerability by unfolding the tale of his World War II service and discovery of a Nazi death camp. It is because Watts spends time with the Codger and recognizes that the doctor-patient relationship is above all a human relationship that the doctor receives the gift of the story: this terrible experience which informed the rest of the Codger's life.

A few of the vignettes explore the therapeutic potential of poetry. For instance, in "Annie's Antidote" a piano teacher, fearful of endoscopy, asks Watts to recite one of his poems. The poem concerns the tender relationship between Watts and his son and is a metaphor for Watts's patient encounters as well: "for this is one of those moments / that turns suddenly towards you, opening / as it turns, as if we paused / on the edge of a heartbeat. . . " The poem works, the moment opens, and the woman has her endoscopy.

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Sister Outsider is a collection of essays focusing on race/racism, gender/sexism, sexual identity, and social class as these are enacted in a white-supremist, heterosexist, capitalist patriarchy (i.e. the United States). As a Black woman, lesbian, feminist, mother, poet, essayist, and political activist, Lorde's essays in this collection include her often quoted "The Master's Tools Will Never Dismantle the Master's House," an essay that radically challenges how white people "learn about" racism, or how men "learn about" women: "Women of today are still being called upon to stretch across the gap of male ignorance and to educate men as to our existence and our needs. This is an old and primary tool of all oppressors to keep the oppressed occupied with the master's concerns . . . ."

Her essay "Poetry is Not a Luxury" suggests that poetry is "illumination," and is a way to wed ideas and feeling, a way "we help give name to the nameless so it can be thought. The farthest horizons of our hopes and fears are cobbled by our poems, carved from the rock experiences of our daily lives." Other titles include "Sexism: An American Disease in Blackface," "Man Child: A Black Lesbian Feminist's Response" (on being the lesbian mother of a son), and "The Uses of Anger: Women Respond to Racism."

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This collection is introduced with an essay by Suzanne Poirier (editor of the journal, Literature and Medicine). The collection, describes Poirier, looks at how such equations as "sex = disease, homosexuality = disease, promiscuity = disease, and, finally, homosexuality = promiscuity = disease" are, in fact, being challenged, resisted, and "rewritten in a healing way in today's writing about the epidemic [found] in the literary presses, obituary columns, and even freshman compositions." The book contains thirteen essays and an annotated bibliography of AIDS literature from 1982 through 1991.

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In these "narrative recollections" poet Gary Soto reflects on his Mexican American childhood in the ethnically mixed laboring-class neighborhoods of Fresno, California. His was a life lived at the margins--economic margins and cultural margins. In these recollections of family relationships, youthful mischief-making, farm and factory jobs, adolescent rebellion, and the transition to professional writing Soto subtly and humorously draws our attention to the discontinuities between the lived lives of Chicanos and Anglos.

"The Beauty Contest" describes how young Gary entered his younger half-brother in a playground beauty contest. "Strong build, a chipped tooth, half Mexican and half white--he might win, I thought." (43) Gary knows that only a lighter complexioned child could meet the Anglo standards of beauty that prevail. In fact, he has internalized those standards himself: " . . . we were awed by the blond and fair skinned kids in good clothes. They looked beautiful, I thought." We are led to infer that the Anglo contestants come from a world of comfort and parental attentiveness whereas Gary has been left on his own to tend to his brother while his parents are away at their work of manual labor.

In "Looking for Work" Gary wanted to imitate the Anglo families of the television programs that he continually watched. He tried to convince his siblings to wear shoes to dinner and improve their appearance so that "[w]hite people would like us more." (26) In "1,2,3," Soto reconstructs the shocking vindictiveness of an Anglo father after his young daughter falls off of a swing that is being pushed by Gary's Chicana friend, Rosie. Soto ends this piece, "I wanted to . . . explain that it was a mistake; that we also fell from the swings and the bars and got hurt . . . ." (15)

Soto foregrounds violence as an integral part of his childhood. The lead-off sketch, "Being Mean," recounts childhood pranks involving the setting of fires and abuse of pets. But this violence also included and was a response to verbal violence from others, such as being called "dirty Mexicans." (3) "Bloodworth" chronicles the evolution from fisticuffs--"all through elementary and junior high school, it was bob and weave, jab and stick" (95)--to the more controlled violence of the high school wrestling team.

Soto tells of his back-breaking farm laboring and factory jobs in "One Last Time" and "Black Hair." There is no romance in these episodes, "no grace" (124) in the miserable conditions, and no comfort. Rather, there is always the fear that he will forever have to "work Mexican hours, and in the end die a Mexican death, broke and in despair." (123)

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