Summary:

Maren Grainger-Monsen, a filmmaker and emergency medicine physician, chronicles her personal journey towards understanding death and dying as she explores the stories of those near death. The film uses a metaphor of the thread of life, and the three Greek Fates who control life (spinning, measuring and cutting this thread), to interweave Monsen's journey with the lives--and deaths--she encounters.

The film begins with her recollection of two experiences during her emergency medicine training: the first time she is paged to pronounce someone dead and a "crisis point"--resuscitating a patient, brought to the emergency room, who had specifically requested no resuscitation. The remainder of the film focuses on Jim Brigham, a social worker for a hospice program, whom Monsen joins for his home hospice visits and who relates the touching and memorable story of his wife's life and death.

Some of the patients Jim visits are Tex, a man dying of heart failure who had experienced a difficult, scary night; Sean, who has Lou Gehrig's disease and who needs help with paperwork and family concerns; and Anna Marie, who has lymphoma and is taken via ambulance to the hospital for comfort measures. Monsen notes how comfortable Jim is discussing death issues and how compassionate and caring he is with a recent widow in the midst of her "grief work." By contrast, Monsen admits to feelings of helplessness, vulnerability, even terror. She wishes her medical education had not been so devoid of teaching regarding death and dying.

Monsen comments on the wavering line between life and death, and whether the "medical machine" prolongs life or death. She visits a young boy left with severe brain damage following a near-drowning incident and "successful" resuscitation 5 years previously. The boy requires constant care, but his father notes that his son is "doing pretty good."

By the end of the film, Monsen has learned "how to sit with someone . . . while death walks into the room." Death no longer equates with failure. She concludes with her overvoice, "I wonder what it will be like to be a doctor who doesn't see death as the enemy."

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One of Gilbert and George's very few specific portraits, this is a collage of images culled from their photographs of their friend David Robilliard. Its title, "A.D.", can be taken to mean "Anno Domini" or "After David" or, as the artists suggest, "AIDS David". It is at first an extraordinarily ugly piece, even by Gilbert and George's standards: the uniform flesh tone with pearly globules of moisture (sweat, semen), broken up by the black of shadows, the black bristles of stubble, and the black grid. The image looks like it emerged from one of William S. Burrough's novels, a nightmarish combination of mouth, orifices, bodily cavities.

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This is a collection of 91 poems on medical topics by medical students, physicians in training, and attending physicians; two are Canadian and the rest American. The poems are organized by six traditional groups of medical training and advancement in the profession: Medical Student, First Year; Medical Student, Second Year, Medical Student, Clinical Years; Intern; Resident; and Attending. There are no sections for pre-meds, retired doctors, or other programs (naturopath, chiropractor).

The editors have done a good job of picking well crafted and evocative poems. A dozen have been previously published. For the most part, the poems are short, easily fitting on one page. Almost all are in free verse, although there is one group of haiku, one prose poem, and an impressive sequence of ten Shakespearean sonnets “Breughel at Bellevue” by Anna Reisman.

Many poems treat dramatic moments in training: the anatomy lab, first gynecological exams, physician-patient relationships, especially when a patient is gravely ill or dying. Several poems in the first three sections comment on the differences between the normal social world and the intense medical world of the hospital. Throughout there are references to the pressures of high-tech, unfeeling medicine. Indeed Jack Coulehan sounds this theme in his introduction; he writes that "steadiness and tenderness" are both needed in medical practice.

 

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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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The authors analyze developments in the scientific article in Europe from the seventeenth century to the present. They devote a chapter to "style and presentation" in each century, and a separate chapter to "argument" more specifically in each century, in French, German, and English examples. They find a remarkable similarity of style already evident in seventeenth-century examples, demonstrating that scientific authors were already addressing an international audience. Seventeenth-century articles show an "impression of objectivity" and "a movement toward a more impersonal style" (47), although the English examples were somewhat more personal, less quantitative, and less interested in explanation than were the French examples, and the prose overall is hardly what we would currently expect from a scientific article.

Although the eighteenth-century examples should, perhaps, be considered part of a larger period that included the seventeenth century, Gross et al do track a movement from impersonal to personal style, nominal to verbal style, and minimal presentation to more elaborate presentation during this period. Also, the French examples continue to approximate more closely to twentieth-century norms of scientific style, reflecting their more professionalized community. Overall, the authors characterize much of the eighteenth century as a period of "consolidation and altered emphasis," with "relative stability" of style (116), although the last quarter of the eighteenth century showed a sharp rise in standardization and standards for accuracy and precision.

Gross et al note that nineteenth-century prose still addresses amateurs as well as professionals, and they comment on its persistent difference from "the highly compressed, neutral, monotonal prose" of late-twentieth-century science(137). However, the English and German examples do become more professional in their use of impersonal style, and examples demonstrate a consolidation toward a more "homogeneous communicative style" (138). They also note that the nineteenth century exhibits a "master presentation system approaching maturity," with "title and author credits, headings, equations segregated from text, visuals provided with legends, and citations standardized as to format and position," as well as standardized introductions and conclusions (138).

They find that the combination of an increasing "passion for factual precision" and systematization produces more careful theorizing generally in science during this period, even as individual sciences specialize and diverge (158). Increased attention is given to the process by which facts are linked to theory, and to the role of evidence, governed by an "overriding need for explicitness" (160).

Twentieth-century examples include shorter sentences with more information packed into each by way of "complex noun phrases with multiple modifications in the subject position, noun strings, abbreviations, mathematical expressions, and citations" (186). The scientific article is now generally marked by high incidence of passive voice and low incidence of personal reference, along with a "master finding system" made up of "headings, graphic legends, numbered citations, numbered equations, and so on" (186). They argue that the current state of the scientific article reflects an evolutionary process whereby "current practices are a consequence of the selective survival of practices that were, persistently, better adapted to the changing environments of the various scientific disciplines over time" (212).

 

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In the not too distant future, the morose Egyptian, Antar, works in New York City, as a home-based computer employee, monitoring artifacts which he can study holographically through cyber space. He conjures up the I.D. card of one L. Murugan, who had supposedly disappeared in Calcutta back in 1995. Murugan is/was an expert on Nobel laureate Ronald Ross, discoverer of the role of the anopheles mosquito in the transmission of malaria.

Through flashbacks to the intense week of his disappearance and to episodes in the late nineteenth century, the virtual Murugan roams Calcutta trying desperately to understand and expose a subtext of counter science in Ross's laboratory. He is joined by Urmila, a journalist whose life is endangered by their collaboration.

Murugan theorizes that Ross was sloppy, intent on fame and fortune though a simplistic rendering of the parasite-host relationship; his discoveries were fed to him by others and he was blind to the spiritualistic ambitions of Mangala, his Indian laboratory technologist. Conceiving of the powerful significance of malaria prevention and control, Mangala held different views on the purpose and means of investigating the disease and, Murugan thinks, she anticipated the later discovery of another Nobel laureate, J. Wagner-Jauregg, in the use of malaria for the treatment of syphilis. The travels of Murugan and Urmila imply that these views are still there awaiting their own discovery.

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Please note that in order to properly annotate this novel, the novel's surprise ending will be revealed here. Snowman--who used to be called, Jimmy--is a rare survivor of a dreadful catastrophe that seems to have been both the product and the demise of modern science. He lives in a tree, clad in rags, hiding from relentless heat and hoarding his precarious cache of food and alcohol, while he tries to obliterate consciousness and avoid contact with a peculiar race of beings, the Crakers. Through a series of reminiscences as he makes his way back to where he once worked, Snowman's past slowly advances to meet his future.

The world heated up to be uninhabitable desert and genetic engineering created more problems (and species! [pigoons, rakunks, wolvogs]) than solutions. People became increasingly reliant on artificial environments--both internal and external--while their purveyors--drug and technology firms--held ever greater but unthinking power. The world was divided into two: the rich, safe controlled spaces and the dangerous chaotic realm of the poor. Then an epidemic wiped out most of the human race.

Two friends are central to the story: brilliant but inscrutable Crake whose nerdy gift for science had a role in engineering the 'pure' Crakers and the horrifying world that they occupy; and beautiful, seductive Oryx whose regard of knowing innocence heaps scorn upon messy human desire and emotion. They are the Yin and Yang of the "constructed" world. Only at the end, the reader learns that Oryx was murdered by Crake, who was slain by Snowman. It seems that his arduous journey was simply to destroy the history of the events that he had written and left behind.

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A collection of short stories loosely connected to each other by centering on the experiences of four people from their first encounters during medical school and continuing into young middle age.

The first and third stories “Getting into Medical School, Part I” and “Part II,” are about study partners, Fitzgerald and Ming, who have trouble admitting their love for each other until she is accepted to medical school and he is not. Ming teaches Fitzgerald how to prepare successfully by passing along learning tips her physician-cousin provided her in exchange for sex. In the second story, Ming meets fellow students Sri and Chen and drifts away from Fitzgerald. In the third, he wrestles with feelings of rejection and misery as he realizes she has opted for a relationship with the more culturally “appropriate” Chen; however, her study tips pay off in more than one way when he meets Ming’s unsavory cousin at his medical school interview.

Later stories describe clinical encounters with specific cases, one of the most memorable being “Winston,” about Sri’s relationship with a paranoid person; the tale is told alternatively from the doctor’s perspective and the patient’s. in “Afterwards,” Sri must explain to a man’s wife and son, how he died suddenly at a strange hairstylist salon; the news disturbs the family who discover that the supposedly impotent diabetic had been a regular at a sex shop.

Fitzgerald and Chen become emergency physicians. Less settled, Fitzgerald tries several settings, including working for an air ambulance company. His problem with alcohol emerges from deep disaffection and brooding resentment over Ming’s callous rejection years earlier and her subsequent marriage to Chen. The problem begins to threaten his judgement and seriously compromises his health when he falls ill.

In the ironically titled “Contact Tracing” both Fitzgerald and Chen contract SARS (the latter from the former) during the (real) 2003 Toronto epidemic. They are isolated in adjoining rooms separated by glass and phone each other for support and discussion. They reminisce about Sri who has died of cancer and muse on the relevance of do-not-resuscitate orders. The outcome is both humorous and surprising.

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Canadian surgeon Norman Bethune, 1890-1939, (Donald Sutherland) journeys 1500 miles into China to reach Mao Zedong's eighth route army in the Wu Tai mountains where he will build hospitals, provide care, and train medics. Flashbacks narrate the earlier events of his life: a bout with tuberculosis at the Trudeau sanatorium; the self-administration of an experimental pneumothorax; the invention of operative instruments; his fascination with socialism; a journey into medical Russia; and the founding of a mobile plasma transfusion unit in war-torn Spain.

Bethune twice married and twice divorced his wife, Frances (Helen Mirren) who chooses abortion over child-rearing in her unstable marriage. By 1939, Bethune had been dismissed from his Montreal Hospital for taking unconventional risks and from his volunteer position in Spain for his chronic problems of drinking and womanizing. As his friend states: "China was all that was left." Even there, Bethune confidently ignores the advice of Chinese officials, until heavy casualties make him realize his mistake and lead him to a spectacular apology. The film ends with his much-lamented death from an infected scalpel wound.

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This strong, powerful poem of grief for the death of an infant son in an intensive care unit is written by a poet who lost two of his five children. The rhythm of the poem is jazz, pulsing and pulsating, with well-controlled rests. Some words are run together: " . . . mamaborn, sweetsonchild / gonedowntown into researchtestingwarehousebatteryacid" which evokes (among other things) the frenzied atmosphere of a neonatal intensive care unit and the seemingly inevitable rush towards death.

Much of the poem deals with the distrust of the medical community, which is emphasized by the divide of race: the white doctors and nurses in white uniforms versus the African-American patient and family. The frustration of dependence on others is painful for the father during the nightmare of his baby’s dying. However, the poet reaches a higher level of understanding about his pain and grief; he acknowledges that the baby did receive all that medicine had to offer and he recognizes the complicated responsibilities one acquires by experiencing a loss.

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