Summary:

The poem begins, "In the beginning it visits / your mother like a polite / but somewhat unobtrusive stranger / whose silence . . . is vaguely disturbing." Later, Alzheimer’s is there all the time. Eventually, it takes over the mind and starts spreading disinformation. In the end communication breaks down. "There is no present . . . " There are only fragments of memories and "her dreamy knuckle clicking / on tables as if in answer to someone’s knocking." [32 lines]

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Ruth Picardie was a journalist working in London. Shortly after her marriage in 1994 to Matt Seaton, also a journalist, she found a breast lump. After testing, she was told it was benign. Two years later, and a year after giving birth to twins, the lump enlarged and this time she was diagnosed with advanced, inoperable breast cancer. She rapidly developed bone, liver, and brain metastases and died in September 1997, aged 33.

This book consists of a selection of Picardie's e-mail correspondence during the last year of her life, the columns she wrote for the Observer newspaper (a series about dying she called "Before I say goodbye"), readers' letters responding to her column, and an introduction and epilogue by her husband. While not, then, strictly a memoir, this collection of texts constitutes an intimate view of a witty, angry young woman undergoing an intolerable illness.

The expected elements are there: diagnosis, chemotherapy, radiation, hope, the loss of hope. What is unexpected is the way these are presented, and the vividness with which we share the prospect of saying good bye to her children, her gradual detachment from her husband, and, as the brain metastases spread, the loss of coherence and the appalling silencing of her powerful voice.

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This book contains 17 short stories, all set in an in-patient hospice, all exploring the reactions of patients and their caregivers--both family members and professionals--to the last stages of terminal illness. A woman struggles to find the strength to write last letters to her loved ones, nurses are surprised when a seemingly unconscious patient suddenly joins in their conversation; the hospice chaplain becomes a patient; and so on. In the title story, a dying woman's daughter finally manages to answer honestly when her mother asks when death will come: "Soon."

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Spencer Nadler, a surgical pathologist for over 25 years in southern California, offers 8 essays, as well as an introduction, epilogue and 9 full color histopathology plates in this collection. As he explains in the introduction, Nadler began his training in surgery, but, during a required year of surgical pathology, he finds his true vocation: "I realized a flair for surgical pathology that I had never demonstrated in surgery." (p. xix) However, over the years, he realizes he misses patient contact--these essays, written over 10 years, are forays into an unusual relationship: the pathologist-patient relationship.

Each essay is about a different patient (or other contact) and tissue. One of the most compelling is the first, "Working Through the Images," in which a woman (Hanna Baylan) with metastatic breast cancer seeks Nadler out so that she may view her cancer cells. She arrives in his office unannounced at 6 p.m. and he proceeds to not only show her the slides, but to listen to her. He becomes a witness to her pain, loneliness, sorrow and hope.

"For years I have processed thousands of such cases, determined the manifold forms of disease, but I've never been an intimate part of anyone's illness, never felt the connections of cells to a larger self." (p. 12) During later visits, Baylan cries in his arms and even brings her youngest son in to meet Nadler and view her cells. By this time, Nadler is completely connected to her: "This is heartrending to me, for I have come to love her . . . I can no longer think of Hanna in terms of the cells I see on her slides." (p. 21)

Other chapters highlight fat and bariatric surgery; neurologic disorders such as brain tumor, Parkinson's, Alzheimer's and paraplegia; heart disease; sickle cell disease; and palliative care. Each chapter conveys Nadler's visual sophistication and ability to graphically describe cells. For instance, within a fat cell "a large fat globule steamrolls other cell contents flat against the outer membrane until it bulges like a mozzarella." (p. 32) More importantly, Nadler ably extends his cellular acuity to the larger human dimension.

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The first poem in this chapbook ("Sonogram") contains two images of a small, mysterious life (the fetus imagined as a "white boat on whiter water" and as a "tiny orca") in the midst of the coldly technical medical world. This juxtaposition is characteristic of B. A. St. Andrews's poems in this small collection. In most of them, she uses disciplined and sparkling language to explore the interface between modern medicine with its impersonal machinery and the irreducible mystery of life.

Some of the images are simply breathtaking. For example, in "A Dying Art: Room 309," a terminally ill artist lies in bed, surrounded by "plastic bags that hang / like udders dripping pigment / into her." In a love poem called "The Body of Science," the poet confesses, "Each time your voluntary / muscles make contact / my involuntary ones / contract." And at the end of "Alzheimer's," she observes, "She stood at the big bay / window screaming but he never / heard what it was she never said."

The four poems entitled "Your Breast a Unicorn" consider the fate of breasts attacked "at consolation's center" by "one aberrant cell metastasized." These learned, wise, and witty poems are, in my opinion, among the very best of the breast cancer genre.

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Crossing Over presents "extended, richly detailed, multiperspectival case narratives" of 20 dying patients served by the Hospice of Lancaster County in Pennsylvania and the Palliative Care Service of Royal Victoria Hospital in Montreal. These complex narratives (each written by a single author) reveal the patient’s story from many points of view, including those of family members and professional caregivers.

The authors explain how this project differs from recent books of clinical narratives by Timothy Quill (A Midwife Through the Dying Process, 1996), Ira Byock (Dying Well: The Prospect of Growth at the End of Life, 1997), and Michael Kearney (Mortally Wounded. Stories of Soul Pain, Death and Healing, 1996 [see entry in this database]). Barnard et al. point out that Quill, Byock, and Kearney are "passionate advocates for their own styles of care . . . Yet these very characteristics--advocacy and close personal involvement--limit their books in important respects." (p. 5) Basically, these authors select cases that illustrate the efficacy of their models and present the patients’ stories from their own point of view.

Crossing Over draws on a standard qualitative methodology that includes tape-recorded interviews of patients, families, and health care professionals; chart reviews; and participant observation. After the introduction, the narratives occupy 374 pages of text (almost 19 pages per patient). Part II of the book, entitled "Working with the Narratives," includes a short chapter on research methods and 29 pages of "Authors’ Comments and Questions for Discussion." The latter is designed to be used as a teaching guide.

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An elderly woman prepares for an announced visit from "officials" to honor the 90th birthday of her demented and bedridden husband, Bernat, once a major force in the scientific community of Communist controlled Hungary. As she flutters about the apartment, preparing to serve cakes and drinks to the anticipated visitors, the reader becomes acquainted with the unnamed protagonist's own concentration difficulty. She repeatedly lapses into remote recall, speaking fondly of an apparent former lover and occasionally sighing for Mommie or Daddy.

During the brief period of waiting, she unfolds bits and pieces of the life of the intellectually privileged and those not so lucky during the Communist regime, and her own regrets for dreams not realized. The reader does not meet the guests, but learns of the visit only through the eyes of Bernat's wife. The visits serves only to enhance her fears that the apartment may be taken, the little pension upon which the couple lives may be rescinded.

As the little vignette draws to a close, the wife enters the room of Bernat, who is obviously profoundly demented, but for whom she cares as one would care for a baby. The sadness of her lonely life dissolves into tears of resigned hopelessness.

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The novel opens with a man known only as Pilgrim hanging himself in London in 1912. Despite being pronounced dead by two physicians, he somehow lives. Pilgrim has attempted suicide many times before but is seemingly unable to die. He claims to have endured life for thousands of years but has tired of living and only longs for death. He has crossed paths with many historical figures including Leonardo da Vinci, Saint Teresa, Oscar Wilde, and Auguste Rodin.

After his most recent suicide attempt, he is admitted to a psychiatric facility in Zurich as a patient of the famous Swiss psychiatrist, Carl Jung. Pilgrim eventually escapes from the institution and masterminds the successful theft of the Mona Lisa from the Louvre. Next, he sets the cathedral at Chartres on fire. The novel ends with Pilgrim driving a car into a river on the eve of World War I. His body is never found.

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This first-person narrative of a runaway girl's short stay in a residential mental health center develops her impressions, resistances, and accommodations from her admission ("I can see right away it's a nuthouse") to her release. These include reluctant interviews with the staff counselor, uncomfortable encounters with nurses, observations of other patients' erratic behavior, and efforts, finally, to communicate with a very detached roommate.

"Stevie" speaks from a place of anger and mistrust. She attempted suicide in the girl's bathroom by slicing her wrists, but regards herself as otherwise quite competent. A turning point comes for her when her silent roommate sings a song she's written which ends with the words, "Don't forget to cry." This moment of vulnerability, which also unveils surprising talent and beauty, moves Stevie from anger toward curiosity and sympathy.

She takes steps toward friendship with her roommate, and finally toward reconciliation with her mother who, she realizes, really wants her home. As she leaves, Zena really addresses her for the first time, reminding her, "Don't forget to cry."

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Summary:

This chapbook consists of two parts. The first part is a sequence of 20 poems that describe the final illness and death of the author's father. He is "a man who won't die," a man who has survived the ravages of several chronic illnesses, but who now faces another surgery, "to have the toe / amputated before gangrene set in." Yet the father is finally "slipping / below the horizon." His son sits in the hospital corridor, imbibing the sights and smells of the present, while moving back and forth in his mind between the past and future.

At last his father dies. Life goes on, connection goes on. The author thinks about his son, "my son is lifting the world / on his back . . . " The second part of the chapbook is a long poem called "Kaddesh for My Father," modeled after Allen Ginsberg's Kaddish and written about a year after his father died.

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