Summary:

Kirklin, a physician and Lecturer in Medical Humanities at the Royal Free and University College Medical School, and Richardson, a historian and associate at the Wellcome Trust Centre for the History of Medicine, are both educators in medical humanities in London. This well-written and concise volume focuses on "the role of the humanities in medical education" and is aimed at "those wishing to integrate medical humanities into their own teaching, and learning." (p. xv) The chapters are written by a variety of educators with a wide range of backgrounds, including artist, medical student, writer, nurse, surgeon and philosopher.

At least two stimuli are cited as reasons for the development of this book: (1) the 1993 publication by the General Medical Council of Tomorrow's Doctors which recommends the inclusion of medical humanities in the required curriculum for undergraduate medical education in the UK and (2) a national conference, "The healing arts: The role of the humanities in medical education" in London, March, 2000. The rationale for such a book is delineated in several prefatory statements including remarks by Professors Sir David Weatherall and Sir K. George M. M. Alberti (Alberti is the president of the Royal College of Physicians). The book concludes with recommendations for further reading, schemata for undergraduate and graduate degrees in medical humanities at University of Wales, Swansea, and an index.

The nine chapters in this volume combine pedagogic philosophy, citations for literature and art and how to encourage reflection about these selections, tools for encouraging student creativity, reproductions of art and literature generated by students or patients or used by teachers for discussion, and some practical advice about teaching medical humanities and its, at times, uneasy connection to the rest of the curriculum. Each chapter reflects the individual contributor's area of expertise and experience. For example, in "Fostering the creativity of medical students", the authors Heather Allan, Michele Petrone (who painted the striking cover art), and Deborah Kirklin provide useful guides for teaching creative writing and art production by students studying cancer and genetic disease.

In a particularly insightful chapter, "Medical humanities for postgraduates: an integrated approach and its implications for teaching," Martyn Evans describes the challenges of developing a full-fledged interdisciplinary program for graduate as well as undergraduate studies in Wales. He addresses concerns about "bolt-on" versus integration of medical humanities in the curriculum, risks of superficiality, and how such studies may transform the culture of modern medicine. Several chapters address a theme (such as "clinical detachment" or understanding the patient's perspective) and include topic-specific sources and guidelines.

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The author, an internist and medical educator with a long-term interest in literature (she recently was awarded a Ph.D. in English literature), describes the literary exercise she uses to develop empathy in students taking her required course in medical interviewing. Charon has her students choose a difficult medical encounter from their own recent training and then write, using the first person, the story of that patient’s life in the day before the difficulty--including being treated by the medical student who is doing the writing. Because much of the story must be imagined, the writer’s intuition is automatically brought into play.

Because it is told from the patient’s point of view, the medical student is forced to see the patient whole and without reference to medical terms. Charon argues that this exercise of the imagination yields a combination of objectivity and empathy that forms the basis for good medical care. She also finds that the exercise helps medical students see themselves as their patients see them--and thus to understand, for instance, the effect on their patients of their youth and nervousness.

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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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This is the first "selected poems" by Claes Andersson to appear in English. Drawn from his 18 collections published in Finland, they are generally short (less than one page) poems without titles. As the Introduction notes, Andersson's early poetry features blunt language, while his later work strives for more musicality. Drawing on his psychiatric experience, Anderson uses "private life as a foundation for an investigation of all that shapes our identity."

Friendship is a frequent theme in these poems, as in "Philemon and Baukis": "If you become a fir / I'll be a birch/ Thus you protect and warm me / through the cold seasons / In return I'll dance for you / in the summer nights . . . " (p. 75) One of the most striking poems in the collection is "the new theology," which begins: "Disease is the conscience of the body / What would we be without our ailments . . . " (p. 112)

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This book is composed of a series of essays written by Dr. Percy over a period of twenty years from 1954 to 1975. All have been published in journals except the last one, "A Theory of Language." The first one was written before his first novel, The Moviegoer, was published. These all reflect his recurring interest in the nature of human communication.

The first essay, "The Delta Factor," is perhaps the easiest to understand. It has a long subtitle: "How I Discovered the Delta Factor Sitting at my Desk One Summer Day in Louisiana in the 1950's Thinking About an Event in the Life of Helen Keller on Another Summer Day in Alabama in 1887." Percy asks why man feels so sad in the twentieth century; he goes on to state that this book is about two things: man's strange behavior, and man's strange gift of language and how understanding the latter might help understanding of the former.

Percy's view is that man's singular asset, which differentiates him from animals, is language. His interest in language and how children acquire language is almost certainly related to the fact that one of his daughters is deaf, hence also his interest in Helen Keller. Subsequent essays are further approaches to these questions, including the importance of symbolization as an essential act of the mind and a basic human need.

The essay, "The Message in the Bottle" is built around the supposition that a man who is a castaway on an island and has no memory of his past life finds on the shore a series of bottles which contain messages. The man, who has become a useful member of the island community, must decide which messages appear to state empirical facts and which seem to refer to the nature of reality. Dr. Percy sees that the messages can be in some ways like the news of the Christian faith. This fits with his own personal way of dealing with a feeling of alienation by turning to religion. He sees belief in one of the theistic historical religions as a way to redeem man from the catastrophe which has overtaken him. He describes not only himself but also man as a castaway who can recognize his need and have hope that some message might relieve his predicament.

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Narrated in the first person, the transforming events of Peter's life as a 15 year old are told years later. The opening paragraphs set the scene: "the older brother who went off to school" leaving "the brilliant . . . mother . . . bereft"; the father, "son of a bankrupt Hudson Valley apple grower"; "the darkening drift and dismay of my parents." Into this family unease steps the local veterinarian, Dr. Mason, whom Peter assists during after-school hours, and who is a sometime dinner guest in his parents' home.

Dr. Mason not only tries to persuade Peter to go into a medical profession, ignoring Peter's interests (writing poetry, reading about mountain climbing) but self-importantly insists on "offering [him] lessons in nothing less than all of life" (63). Dr. Mason, we learn, is singularly unqualified to dispense such lessons. He is, at least in Peter's eyes, overbearing and insensitive in his interactions with the owners of the pets he treats, and perhaps even unethical in his professional decisions. Then, Peter discovers, his mother is having an affair with Dr. Mason (who is also married). It is the burden of this knowledge that drives the narrative.

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This autobiography by Janet Frame, a preeminent New Zealand writer, was originally published in three volumes in 1982, 1984, and 1985. The first volume is titled To the Is-land. In it the author tells the story of her early life "with its mixture of fact and truths and memories of truths." She describes her mother as a rememberer and a talker, partly exiled from her family through a marriage outside the family's faith and her father as having a strong sense of formal behavior that did not allow him the luxury of reminiscence. Her siblings (4 sisters and 1 brother) are described in equally perceptive language. The brother suffered from epilepsy which was poorly controlled and this had a strong influence on family dynamics.

Frame's writing is so descriptive and personal that it is easy to envision oneself as a family member. She was very early attracted to words and became a voracious reader. The family was poor and moved often but there was a firm family kinship. One older and one younger sister drowned when swimming which had a large impact and drew Janet much closer to the remaining younger sister. Janet was a good student and won many prizes; she writes that she "identified most easily with the stoical, solitary heroine suffering in silence."

The second volume, An Angel at My Table, concerns itself with Janet's experience as a student at Dunedin (Teacher)Training College and her subsequent breakdown and commitment to mental institutions. She was very lonely in college and retreated more and more into her own world of literature. At the end of her year of probationary teaching she walked out of the room during the visit of the school's inspector and disappeared.

After a suicide attempt she was eventually committed to Seacliff, a mental hospital. Her stay there, she writes, and later in another facility which eventually lasted most of seven years, was in a world she'd never known among people whose existences she never thought possible. She describes it as an intensive course in the horrors of insanity. She received multiple electric shock treatments and was scheduled for a lobotomy when it was learned that she had won a prestigious award for a book she had written.

Frame was discharged on probation and lived for a while in a small cottage owned by a well known writer who befriended her. After her book of prose and poems was accepted for publication she was awarded a grant that allowed her to travel abroad.

The third volume, The Envoy from Mirror City, is quite mystical and concerns itself with her life as a writer in England, Spain, and New Zealand after her return. She describes Mirror City as the saving world which sustains writers. She has continued writing and eventually learned that the diagnosis of schizophrenia, with which she had been burdened, was incorrect. With some life experience and wise psychotherapy she was able to write about her life in the mental institutions, among other things.

In all she has published eleven novels, four collections of short stories, a volume of poetry and a children's book.

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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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The Exact Location of the Soul is a collection of 26 essays along with an introduction titled "The Making of a Doctor/Writer." Most of these essays are reprinted from Selzer's earlier books (especially Mortal Lessons and Letters to a Young Doctor). Six pieces are new and include a commentary on the problem of AIDS in Haiti ("A Mask on the Face of Death"), musings on organ donation ("Brain Death: A Hesitation"), a conversation between a mother and son ("Of Nazareth and New Haven"), and the suicide of a college student ("Phantom Vision").

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At the age of 42, Barbara Rosenblum learns, after several misdiagnoses, that she has advanced breast cancer. This book, co-written by Rosenblum, a sociologist, and her lesbian partner, Sandra Butler, a feminist writer and activist, is a record of their lives together from the diagnosis until Rosenblum's death three years later. Early on, Rosenblum decides that her dying will be exemplary and self-conscious, and she and Butler use their writing as a way to create an illuminating examination of their lives over those three years.

The book's title is accurate; the writing takes the form of alternating meditations by two women, on the effects of cancer on their relationship, their work, their families, and their social, political, and spiritual beliefs. Especially significant are the differences between their voices, and the differences between the experience of the person who is dying and that of the person who is going to have to survive and grieve. The writers bravely explore the conflicts between them as well as their profound bonds.

After a mastectomy and eighteen months of chemotherapy, Rosenblum has a very brief respite, followed by liver and lung metastases, and prolonged further chemotherapy. A few months after ending treatment, she dies at home.

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