Summary:

In the photograph, the camera frames the window of a rundown motel room on a snowy evening. Inside, a young mother in a pale green nightgown sits on the side of a bed gazing sadly at her sleeping baby curled up on the far side of the mattress.  This is one of the hauntingly beautiful images in “Brief Encounters,” a documentary about the photographer Gregory Crewdson and his project “Beneath the Roses.“

The son of a Brooklyn psychoanalyst, Crewdson and his family spent summers at a lakeside cottage near Pittsfield in western Massachusetts.  It is to this area, with its abandoned shops and dilapidated buildings, that Crewdson returns over and over again to search for settings for his intricately composed photographs.  These towns, he says in the film’s narration, “were really backdrops for a more submerged psychological drama,” one that blurs the line between reality and fiction. Crewdson approaches his photographs as if making a film, with a crew of as many as 60 people and a cast composed of the townspeople he encounters in his travels.  But unlike a film, the photographs capture a single moment in time.  For Crewdson, what happens before and after is of no interest to him. Rather, he is concerned with just that one frame, “a perfect moment.”

Crewdson creates his worlds as a way to explore his own anxieties, fears and desires.  The images he constructs are exquisitely detailed and psychologically complex, inviting multiple interpretations by viewers. An engaging narrator, he directly addresses his own fear of failure, how he struggles to overcome it and to continue working despite periods of self-doubt.

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Five Days at Memorial is the book length expansion  of the New York Times Sunday Magazine article that the author, a Pulitzer Prize-winning physician-journalist, published in 2009. The book, the result of years of research and literally hundreds of interviews, chronicles the five days (August 28 to September 1, 2005) during which the medical staff remaining at Memorial Hospital in New Orleans tried to care for the patients -- over a hundred of them stranded, like the staff, in a hospital without water or electricity --following the flooding wrought by Hurricane Katrina.

After an 8 page prologue, the book is divided into two sections, "Deadly Choices" (228pp, the narrative of those five days) and "Reckoning" (256pp, the legal battles over the injections of midazolam (a sedative) and morphine by some of those staff and prosecuted as homicide -- what others called "euthanasia.") "Deadly Choices" relates almost hourly the five days inside Memorial from the viewpoint of patients, patients' relatives, physicians, nurses, administrators of Memorial, Tenet (the holding company owning and running Memorial) and LifeCare -- the long-term care area within Memorial devoted to the care of terminally ill and debilitated patients -- owned by a separate company. Ethical and legal questions of triage, DNR, record-keeping, accountability, communication (primarily the failure thereof) and leadership are on almost every page. At the heart of this book, however, is the mystery of the unexplained deaths of so many patients during those five days. (On September 11, 2005, a disaster mortuary team recovered 45 bodies from many different places in Memorial, page 234). The crux of the mystery of these deaths is the manner in which nine in particular died in the beleaguered hospital on the fifth and last day when, paradoxically, relief had become real and effective and inclusive, seemingly obviating such injections.

The final pages of "Reckoning" deal with the fallout - historical, ethical, political and medical -- and current events relevant to these five days and the almost two years following. (The final verdict of not guilty -- the actual wording was "Not a true bill" since it was a grand jury declining to indict the one physician, Anna Pou, and the two nurses, Cheri Landry and Lori Budo -- was rendered on July 24, 2007). There are a map of Memorial Hospital and a cast of characters at the front of the book and extensive notes, bibliography and index at the end.

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Kitty Fane is a beautiful young woman whose mother has raised her to make a suitable match. But Kitty refuses a number of suitors; several years pass and eventually she is reduced to marrying Walter, the colonial bacteriologist in Hong Kong. Walter is a shy and awkward man who loves Kitty passionately, but has no idea how to express it; Kitty is charming and socially adept, but vacuous. In Hong Kong Kitty engages in a yearlong affair with Charles Townsend, the assistant colonial secretary, and a married man whose celebrity potential far eclipses Walter's stolid scientific work. The novel opens when Walter discovers his wife's infidelity.

Kitty believes that Townsend is madly in love with her and prepared to divorce his wife and sacrifice his career to marry her. Walter, who suffers from a broken heart, gives Kitty an ultimatum--either Townsend must promise to divorce his wife and marry her, or Kitty must accompany Walter to a city in the interior where he has volunteered to go to fight the cholera epidemic. Townsend demurs; Kitty is crushed; and the desperately unhappy pair travels to the cholera-ridden city, where they move into the house of the newly-dead missionary.

There, Walter (who is also a medical doctor) sets to work, day and night, to institute public health measures and care for dying patients. Meanwhile, Kitty meets Waddington, the British consul, a cynical alcoholic, who is at heart a good and honest person; and the French nuns, who labor tirelessly to care for orphans and the ill. Impressed by the nuns' selflessness, Kitty begins to devote herself to assisting them and trying to understand their spirituality.

When he learns that Kitty is pregnant, Walter asks if it is his child; Kitty responds, "I don't know." This completes the destruction of Walter's heart, and he soon dies of cholera--presumably as a result of experimenting on himself to find a cure. Kitty learns that the nuns, the soldiers, and all the people of the city consider Walter a saint, who has sacrificed himself for their welfare. However, while Kitty has learned to respect her husband, she could never love him.

Kitty stays only briefly in Hong Kong before returning home to London. Shortly before her arrival, she learns that her mother, whom she believes is responsible for her (Kitty's) shallowness, has died. The novel ends with Kitty vowing to bring up her daughter as a strong and independent woman, and preparing to move with her father to the Bahamas, where he has recently been appointed Chief Justice.

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Tish brings a knife to the breakfast table and threatens to use it on her stepfather if he tries to come into her room again.  Her mother, working at the sink, does her best to ignore the conversation, in which the stepfather moves from mockery to threats.  Tish carries the knife in her boots to school.  When her gym teacher insists on her removing her boots she begins to scream uncontrollably, is sent to the principal, and, unable to tell her secret, runs away.  She finally makes her way to a friend's father, a lawyer, who listens to her story and assures her of legal protection, though as the story ends, Tish has a lot of decisions left to make, and a long way to go before she feels safe and healed.

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With the publication of Stag's Leap, it is very publicly (on the flyleaf) revealed that Olds is writing about the sudden, unexpected death of her 32 year marriage when her husband left to be with another woman. She waited 15 years after the event to publish this book, not wishing her children to have to face the immediate publicity.  Stag's Leap refers both to the favorite wine that she and her husband drank together, and to his leap out of the marriage.

The collection is divided into sections: the year of her husband's revelation and departure, beginning with "While He Told Me"; several years following, divided into seasons; and "Years Later." The poems detail her shock, grief, and eventual acceptance, covering a wide range of emotion, hindsight, and insight. Since the poems were written more or less in the moment, and extend over several years, the reader experiences Olds's evolving inner landscape along with her. The perspective is one of shock - with only the slightest hint of possible trouble ahead: while doing the laundry, she found a picture of the "other woman" in her husband's running shorts ("Tiny Siren," p. 56). But "he smiled at me, / and took my hand, and turned to me,/ and said, it seemed not by rote, / but as if it were a physical law / of the earth, I love you. And we made love, / and I felt so close to him - I had not / known he knew how to lie. . ."
 
Throughout much of the book there is this theme of blissful ignorance torn to shreds and a questioning of how the poet could be so deceived in her assumptions about the relationship - "when I thought he loved me, when I thought / we were joined not just for breath's time, / but for the long continuance" ("Unspeakable," p. 4). The realization of self deception and love lost is both annihilating and shameful: "if I pass a mirror, I turn away, / I do not want to look at her, / and she does not want to be seen  . . . I am so ashamed . . . to be known to be left" ("Known to Be Left," p. 18).

These poems are an intense self-examination and an attempt to understand what happened. "I was vain of his / faithfulness, as if it was / a compliment, rather than a state / of partial sleep" ("Stag's Leap," p. 16). "I think he had come, in private, to / feel he was dying, with me" ("Pain I Did Not," p. 26). "maybe what he had for me / was unconditional, temporary / affection and trust, without romance" and "what precision of action / it had taken, for the bodies to hurtle through / the sky for so long without harming each other." ("Crazy," p. 65 ). There is a recognition that their two worlds were vastly different - he a physician, she a poet - and that their personalities were vastly different - he taciturn, she verbal and open. Olds speculates that even her writing about family and marriage could have been a factor in the divorce: "And he did not give / his secrets to his patients, but I gave my secrets / to you, dear strangers, and his, too . . Uneven, uneven, our scales / of contentment went slowly askew" ("Left-Wife Bop," p. 83).

Still, Olds finds something redeeming: "I saw again, how blessed my life has been, / first, to have been able to love, / then, to have the parting now behind me  . . and not to have lost him when he loved me, and not to have / lost someone who could have loved me for life" ("Last Look," p. 14). "What Left?," the last poem in the collection, presents the marriage and its aftermath as a movement: "we did not hold still, we moved, we are moving / still - we made, with each other, a moving / like a kind of music: duet; then solo, / solo." (p. 89)

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This collection of 16 short stories focuses on doctors and patients in San Francisco, where a wide variety of wealth and culture impact the delivery of medical care.  Further, there are many restrictions—financial, bureaucratic, ethical, and legal —that limit what doctors can do, especially in cases of patients near death.

The author, Louise Aronson, is a geriatrician who knows this terrain very well, having trained in San Francisco and worked as a physician there. A skilled writer and close observer, she has created dramatic and often funny stories that reveal social and bioethical complexity. About half the stories describe end-of-life issues for the aged and the dilemmas for their physicians and families.

In ‘The Promise,” Dr. Westphall orders comfort care only for an elderly patient who has suffered a massive stroke, but a hospital gives full treatment because there was no advance directive and the daughter told the attending to do “what he thought best.”

When Dr. Westphall sees this barely functioning patient in a skilled nursing facility seven months later, he tenderly washes her face and hair—although the text teases us that he might have been prepared to kill her.

In “Giving Good Death,” a doctor is in jail charged with murder; he has fulfilled the request of Consuela, a Parkinson’s patient, to help her die. When it appears that she may have died for other reasons, he is released, his life “ruined.” He leaves San Francisco, and, we surmise, medicine. In three other stories, doctors also leave the profession: the cumulative stresses of work and family and/or a sense that it’s not the right path bring them to that choice.

On the other hand, one of the longer pieces “Becoming a Doctor” celebrates the profession, despite all the rigors of training including sexism against women. 

The stories bring multicultural insights; we read of people from China, Cambodia, Latin America, India, Russia, and the Philippines. Some are African-American; some Jewish, some gay. These different backgrounds color notions of health, death, and medical care. There are also pervasive issues of poverty and, at another extreme, professionalism that is hyper-rational and heartless.

Indeed, a recurring theme is care and love for people, no matter their background or current health status. A surgeon realizes (regrettably too late) that the secret of medical care is “caring for the patient—for anyone—just a little. Enough, but not too much” (p. 135). 

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The first person narrator of this debut novel is a young pathologist, a woman who relates the story of her family over the course of the book. The story is bleak: a young German woman marries an Austrian soldier in WWII, moves to Austria with him and has three children - two sons (one of whom dies as a youth following abdominal surgery) and the narrator-daughter. In a running commentary, almost hallucinatory at times,  the narrator offers brief descriptions of  a traditional preliminary internship year during which she acts as a pathologist, cares for in-patients, and even makes a futile ambulance call to a fatally injured man in a freight yard.  Yet, virtually the entire novel revolves around her family:her father (whose tuberculosis is briefly described),  a factory worker with dreams of  inventing an electronic security relay (never realized); intermittent holidays of evanescent family happiness; and a long threnody about her father's eventual death at the end of the book from a hopeless and domestically abusive alcoholism. Her detailed description of his death traumatizes everyone around her and leads to a rupture in the family.

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Elie Wiesel, 82-years-old, has pain that he thinks is in his stomach or esophagus, perhaps caused by his chronic acid reflux.  After tests, however, doctors diagnose cardiac illness and insist on immediate surgery. Reluctant to go to the hospital, Wiesel dawdles in his office. When he does go, doctors believe a stent will do the job. Instead, the intervention becomes a quintuple bypass.

This brief memoir—a scant 8,000 words—presents the “open heart” of a gifted writer as he contemplates his open-heart surgery, his past life, and the future. He asks himself basic, even primal questions about life, death, and the nature of God.            

Although a man with an extraordinary career—prizes, fame, honorary doctorates, friends in high places, professorships—Wiesel experiences and describes ordinary feelings of anxiety, pain, and doubts about his cardiac emergency and possible death. His stylistic gifts describe frankly and vividly a patient’s fears. As many have observed, patients with a serious disease have two difficulties, the disease itself and their emotional responses to that disease.  As Wiesel is wheeled into the OR, he looks back on his wife and son; he wonders whether he will ever see them again.            

He writes that his “thoughts jump wildly; I am disoriented.” He recalls a friend undergoing similar surgery; she died on the table. He says he can’t follow the jargon of physicians. The texture of the prose is rhapsodic, jumping from the present to memories, many of them about war, his past surgeries, or important family events. This short book has 26 “chapters,” some just half a page; they are like journal entries.

As he slowly recovers, he feels pain and has visions of hell, including the concept of ultimate judgment. “Evidently, I have prayed poorly…; otherwise why would the Lord, by definition just and merciful, punish me in this way?” (p. 38).  Because he has a “condemned body,” he feels he must search his soul. In the longest chapter of the book, he reviews several of his writings.

Wiesel asks some of the questions from his famous novel Night (La nuit, 1958).  If there is a God, why is there evil? Auschwitz, he says, is both a human tragedy and “a theological scandal” (p. 67). Nonetheless, he affirms, “Since God is, He is to be found in the questions as well as in the answers” (p. 69).

At the end, he still has some pain but feels much gratitude for his continuing active life and for his grandchildren.

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This book describes San Francisco’s Laguna Honda Hospital, where Victoria Sweet worked as a doctor for 20 years. In the tradition of the Hôtel-Dieu in Paris (literally “God’s Hotel”), Laguna Honda cares for the sickest and poorest patients, many staying there indefinitely because there is no alternative for them. Sweet learns from her long experience at Laguna Honda that “Slow Medicine” has benefits, that a holistic or unified view of patients works best, and that the reductionism and specialization of modern medicine has limitations and costs. During these years Sweet becomes fascinated by the medieval abbess Hildegard of Bingen and earns a Ph.D. focusing on medieval medicine. At the same time (and increasingly) various forces—economic, legal, political, bureaucratic—cause many changes at Laguna Honda, mostly contrary to Sweet’s vision of medicine.

            Part history, part memoir, part social criticism, the book is informative, entertaining, and important for its discussion of the care of our least-well-off citizens and for its perspectives on modern, Western medicine.         

            There are three intertwining strands to this engaging book: Sweet’s medical evolution as a physician, the changes in Laguna Honda, and her investigations of Hildegard of Bingen and other spiritual matters.

            Sweet joins up with Laguna Honda initially for only two months, but she finds the hospital and her work there so fascinating that she stays for 20 years. As an almshouse, Laguna Honda takes care of indigent patients, most with complicated medical conditions, including mental illness and dependencies on alcohol and/or drugs. Many of these cases come from the County Hospital with continuing (but not carefully reviewed) drug treatments. Every 15 or 20 pages, Sweet describes the dilemmas of a particular patient, and her medical (and personal) attention to that patient. The cases are vivid and instructive.

   Clearly Laguna Honda is a major figure on the book; we can even consider it (or “her”) a beloved character and a teacher to the young Dr. Sweet, who learns three principles from her work there: hospitality, community, and charity. 

Because Laguna Honda is old-fashioned in many ways, Sweet reads her own X-rays, goes the to lab to see results, and spends large amounts of time with each patient. Laguna Honda has an aviary, a farm with barnyard, and a solarium; such features help to heal the whole person. While respectful of modern medicine, Sweet slowly learns that a careful review of a patient through Slow Medicine is more accurate and more cost-efficient than standard, reductionist, high-tech medicine. She comes to respect approaches from “premodern” medicine, including that of Hippocrates and Hildegard.

  The second strand is the evolution of Laguna Honda itself. Sweet describes a variety of pressures: the recommendations of consulting firms, rulings from the Department of Justice, a lawsuit, financial difficulties (including fiscal mismanagement), administrators focused on a narrow concept of efficiency, a utilization review board, forms and more forms, and a pervasive sense that modern (including Evidence Based Medicine) is always good. All these and more create a “relentless pressure squeezing the hospital’s Old Medicine into the New Health Care” (p. 322). Sweet demonstrates that her Slow Medicine can actually save money in the long run. Confident that her way is better, she proposes an “ecomedicine unit” that she would match against the modern, “efficient” units in a two-year experiment. (For more information on her concept of ecomedicine proposal, see http://www.victoriasweet.com/.)

            As the hospital is “modernized,” many important features of the old place are gone and many “new and improved” aspects don’t work. Somehow there are no rooms for physicians in the new building while there is plenty of space for administrators and managers. A sophisticated computer system doesn’t work. Sweet doesn’t say “I told you so” directly, but we get the picture.

            The third strand is Sweet’s investigations of spirituality and pilgrimage. She is fascinated by Hildegard’s notions of the healing power of nature, the ability of the body to heal itself, and wholeness as an aim for a person and for a community. Sweet attends a Swiss conference on Hildegard. She hikes the pilgrimage route from France to Santiago de Compostela in four installments and considers notions of pilgrimage. She feels called to pursue her ecomedicine project and to write this book.           

            By the end of the book, both Sweet and Laguna Honda have changed and are now headed in different directions. 

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Eric Calhoune is known to his classmates as "Moby" because of the extra weight he has carried since grade school.  Though his mother is young and athletic, he has inherited the body type of the father he's never known.  Now, in high school, the fat is turning to muscle under the discipline of hard swim team workouts.  But that transformation has been slow in coming, since for some time Eric has taken on a private commitment to "stay fat for Sarah Byrnes."  Sarah, whose name is a painful pun, was severely burned as a small child not, as we are given to believe early on, because of an accident, but because of a cruel and crazy father who stuck her face and hands into a woodstove in a moment of rage.  She has lived with him and his threats for some time; that and her disfiguring scars have made her tough, smart, and self-protective.  Eric and she became friends as social outcasts.  Well-matched intellectually and in their subversive wit, they write an underground newspaper together.  Sarah, however, lands suddenly in the hospital, speaking to no one, making eye contact with no one.  Eric faithfully visits her and, per nurses' instructions, keeps up a running one-sided conversation as if she could hear him.  As it turns out, she can.  She is faking catatonia because the hospital is a safe place, and she has chosen this as an escape route from her father.  Eric and a sympathetic coach/teacher go to great lengths to find Sarah's mother-who, it turns out, can't bring herself to be involved in her daughter's life because of her own overwhelming shame.  Ultimately the father is apprehended, and Sarah, nearly eighteen, is taken into the coach's home and adopted for what remains of the childhood she bypassed long before.  In the course of this main plot, other kids enter the story and in various ways come to terms with serious issues in their own lives, some of which are aired in a "Contemporary American Thought" course where no controversy is taboo.

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