Summary:

While riding on a commuter train, Bill Chalmers suddenly forgets who he is and where he is headed. His amnesia is accompanied first by a numbness of his hands and then later his legs. Eventually he is confined to a wheelchair and dependent on his family and a home nurse to care for him. Despite extensive testing and consultations with a variety of doctors, no one can make a definitive diagnosis of his illness.

Chalmers is subjected to many empirical treatments including antidepressants, steroids, plasmaphoresis, and psychotherapy, but his health continues to deteriorate and he loses his job. His wife and son become victims of his predicament. By the end of the story, Chalmers gains insight into his life and discovers that only his dignity still remains in his control.

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John Ames narrates this story in the form of a lengthy letter to his young son. Ames is a 76-year-old minister suffering from angina pectoris and heart failure. He has spent almost all of his life in Gilead, a small town in Iowa. His first wife died during childbirth along with a baby girl. Ames remarried a younger woman who is now 41. They have a son almost 7 years old.

Because Ames believes his death is close at hand, he pens a missive to the boy. Its purpose is to teach his son about all the important things in life Ames may not be around to share with him. During the course of composing the letter, Ames reflects upon his own existence. He recalls the experiences of his father and grandfather who were also ministers.

Reverend Ames likes to think, read, and pray. Born in 1880, he has lived through three wars, the Great Depression, a pandemic of influenza, and droughts. His hope is that his young son will grow into a brave and useful man.

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A teenager with a learner's permit drives his father to the emergency room. The father is hemorrhaging from the nose--the result of blood that is too thin and a punch thrown by his son. The father is abusive, especially when he drinks. Feeling endangered when his father shoves him, the boy retaliates by hitting the man in the face.

The father has valvular heart disease caused by a bout of rheumatic fever. He also has a cardiac arrhythmia requiring treatment with anticoagulation, but the dose of blood thinning medication must frequently be adjusted. After a frenetic ride, they arrive at the hospital and the father immediately enters the emergency room. The boy remains in the car listening to the radio and hoping the noise will somehow expunge the ugly words and perilous sentiment in his head. He discovers too late that a bloody nose can kill a man.

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In short, episodic chapters that move unpredictably and unchronologically through the years between 1956 and 2003, Nick Flynn tells us about his father, Jonathan Flynn--a man of many trades, a writer, an alcoholic with a prison record, a homeless person--and of his own life, which sporadically interweaves with Jonathan's. When Nick was six months old, his 20-year-old mother left Nick's father and made a meager life for herself and her two young sons. A string of her live-in boyfriends and one more failed marriage wound their way through Nick's young life, which was in the seaside town of Scituate, Massachusetts, "the second most alcohol-consuming town . . . in the United States" (77).

At 12, Nick is drinking beer; at 17 he is drinking to get drunk, sometimes with his mother, and smoking marijuana (and later doing other drugs). For years Nick's father "had been manifest as an absence, a nonpresence, a name without a body" yet, "some part of me knew he would show up, that if I stood in one place long enough he would find me, like you're taught to do when you're lost. But they never taught us what to do if both of you are lost, and you both end up in the same place, waiting" (24).

The place where Nick and his father "end up" is the Pine Street homeless shelter in Boston where 27-year-old Nick is a caseworker and Jonathan Flynn appears, a few months after being evicted from his rooming house. Reluctantly, Nick gradually acknowledges his father's presence in the shelter, and gradually, during the next 15 years, reconstructs the lost years through conversations with his father and his father's acquaintances, letters, and manuscript excerpts. The title of the memoir is what Jonathan Flynn mutters at night, when he is looking for a place to sleep (205).

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Endpoint is an extraordinary sequence of seventeen poems John Updike wrote near the end of his life.  Beginning on his birthday in March,  2002, he wrote a poem every birthday for the next 6 years.  Then after his 2008 birthday he wrote several more poems, mostly focusing on his dying from lung cancer.  The last poem, "Fine Point," was dated 12/22/08.  He died in January, 2009.  The poems also include memories of his mother writing and cranking out manuscripts, but never getting published; of childhood friends who became models for characters in his novels; of getting lost in a department store as a three-year-old; of Jack Benny and FDR, Mickey Mouse and Barney Google, as well as five wars. The memories are both personal and international in scope.  His attitude toward them varies from distress to appreciation and gratitude.

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The story begins with Theodore Roosevelt's funeral. The narrator, a reporter with the New York Times, decides to tell a story that happened more than 20 years earlier in 1896 when Roosevelt was Police Commissioner of New York City. A serial killer is murdering young male prostitutes.

Roosevelt invites the infamous Dr. Laszlo Kreizler to form a special unit to track down the killer. The unit also includes the narrator and three members of the police department. Kreizler's qualification is that he is an alienist who champions the radical new concept of forensic psychiatry: the belief that one can predict a criminal's behavior by reconstructing his personality based on evidence in the crimes themselves. This concept smacks of determinism. Thus, Kreizler was violently opposed by many, including the religious establishment, who believed Kreizler was denying that people were morally responsible for their crimes.

Because of the sensitivity of their mission, the small investigative unit operates secretly, but runs into powerful opposition. Over several months Kreizler and his colleagues perform the seemingly impossible job of identifying and tracking down the killer, using Kreizler's psychological methods.

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Dr. Thomas Graboys is an eminent Boston cardiologist who developed Parkinson's disease in his late 50s. Shortly after his wife died in 1998, Graboys noticed unusual fatigue and mental sluggishness. He attributed these symptoms to grief, but they continued and he later experienced episodes of stumbling, falling, and syncope. During 2003 Graboys confided to his diary that it was "increasingly difficult to express concepts." ( p. 30) He also noticed tremor, problems with dictation, and frequent loss of his train of thought, symptoms "typical of Parkinson's." (p. 24)

While Graboys recorded these concerns in his diary, outwardly he denied that anything was wrong, even to family and close friends.  In fact, his denial continued until the day in 2003 when a neurologist friend accosted him in the parking lot and pointedly asked, "Tom, who is taking care of your Parkinson's?" (p. 27) Dr. Graboys faced an even more difficult challenge in 2004 when he developed the vivid, violent dreams and memory lapses that led to a diagnosis of Lewy body dementia, a form of progressive dementia sometimes associated with Parkinson's disease. With the cat out of the bag at last, the author finally began to confront the issue of professional impairment. In mid-2005 Graboys's colleagues seized the initiative and told him that "it was the unanimous opinion of my colleagues that I was no longer fit to practice medicine." (p. 36)

Writing now with the assistance of journalist Peter Zheutlin, Graboys reviews these events with unblinking honesty. He confronts his anger and denial, but also reveals the thoughtful, generous and passionate side of his character. "What will become of me?' This is the question that now lies at the center of Dr. Graboys' personal world. He knows that his loss of mental and physical control will worsen. With almost superhuman effort and his family's strong support, the author has been able to adapt to his limitations and maintain a sense of meaning in his life. Will that continue? In a chapter entitled "End Game," he addresses the question of suicide. Reflecting on his condition, especially the dementia, Graboys asks, "Will I lose myself, my very essence, to this disease?" (p. 161)

In the last chapter, Graboys acknowledges that he has no "simple prescription that will help you or someone you love live a life beyond illness, or tell you how to tap the hope that lives within." (p. 181)  However, he then goes on to make several suggestions of the advice-manual variety: "Use your family and friends as motivation to live life with as much grace as you can muster." "Find a safe place... to unburden yourself of anger." "Acceptance is key to defusing anger, stress, and self-pity."  "Use your faith in God, if you believe in God."  (pp. 181-182)

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The twin of the title is Helmer van Wonderen. He is a 54 year old dairy farmer in Noord-Holland, the northwest peninsula of the Netherlands and the year is 2002, 35 years after his only sibling, his twin brother Henk, died. Henk was the front seat passenger of a car driven by Henk's fiancée, Riet, when the car plunged into lake Ijssel. Riet lived; Henk drowned. Helmer's life immediately changed from that of a 19 year old university student in Dutch linguistics to a farmer and successor to their father, a tyrannical and distinctly unlovable man. Henk had been the father's clear favorite, if we accept Helmer's and the narrator's viewpoints. Helmer stays a bachelor and maintains the farm into the present, the time of the novel. His father is elderly and confined to the upstairs. Helmer treats him with disdain; he feeds and bathes him with barely disguised contempt awaiting his death with a vague sense of hope, symbolized by Helmer's re-organizing and painting the interior of their house at the beginning of the book.

Abruptly Riet, a recently widowed mother of three, re-enters the van Wonderen world with a letter requesting Helmer to allow her youngest child, an 18 year old son, also named Henk, to live with Helmer as a farmhand. Riet wants her son Henk to learn farming and discipline and receive the parental (read "fatherly") direction she feels he needs and she cannot supply. Helmer consents. Henk comes to live with him, working desultorily as a hired hand.

Riet and Helmer become estranged over the latter's lying to her that his father was dead when in fact he was upstairs at the time of her only visit to their home since her fiancé's death. One day Henk saves Helmer's life when the latter becomes pinned by a sheep in a ditch. Henk leaves soon thereafter; the father dies; and a Frisian farmhand from Helmer's youth re-appears at the time of the father's funeral. He and Helmer take off, after Helmer sells the farm, to Denmark, a much vaunted Shangri-La for Dutch farmers in this novel.

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In 1917, the poet Siegfried Sassoon protests the war in a London newspaper. He is saved from court martial by a military friend who argues successfully for his transfer to the Craiglockhart War Hospital where he comes under the care of psychiatrist, William Rivers. Sassoon is not sick, but he and his doctor both know that the line between sanity and insanity is blurred, especially for a homosexual and in a time of war.

The other patients, however, are gravely wounded in spirit if not body; sometimes they are tormented by uncomprehending parents and wives. Rivers’ efforts to unravel their nightmares, revulsions, mutism, stammering, paralysis, and anorexia begin to shake his own psychic strength and lead him to doubt the rationality--if not the possibility--of restoring them to service. He yearns for his pre-war research in nerve regeneration, the quixotic enterprise that serves as a metaphor for his clinical work.

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Summary:

A son’s story of his father’s illness, treatment, and resultant destruction by the "psychic-driving" experiments of Dr. Ewen Cameron at Montreal’s Allan Memorial Institute in the 1950’s. The effect of the father’s illness on the family is recounted, as is the son’s gradual realization, only when he is himself about to become a psychiatrist, that something abnormal must have taken place during those long hospitalizations. Weinstein tells other patient stories in some detail as he recounts the legal fight for compensation awarded finally in October, 1988.

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