Summary:

Volck’s memoir describes his medical practice and learning in a variety of settings (Cleveland, Baltimore, Cincinnati), but, more importantly, in non-metropolitan places, such as Tuba City on the Navajo Reservation in Arizona and rural clinics in Honduras. He suggests that his knowledge of medicine has largely come as he has practiced it and not from his formal education. Further, he believes that best medical practice is not primarily high-tech, urban, or industrial. Each of the 15 chapters has a title—a topic, a person, or a theme—but also one or more locations specified. For example, we have “Chapter One, A Wedding, Navajo Nation, Northern Arizona,” suggesting the importance of culture and locale. Further, the chapters include personal associations from several realms beyond the topic and place as Volck seeks to understand medicine, healthcare, and how we live in the world.           

Of the first seven chapters, five are set in Navajo land, where Volck is an outsider by his cultural heritage and his profession, a doctor with a pediatrics specialty. From time to time he reflects on his training, the English verb “to attend,” and specific patients, such as two-year-old Alice in Tuba City and eight-year-old Brian in Cleveland. Both children died while in his care. Working on the front-line of medicine, he considers the weaknesses of our modern attitudes toward death and our wishes for control. He also wrestles with personal lifestyle issues of balancing medicine, family, and an urge to write.
             
Other chapters describe restlessness in his profession, the growth of his family (including the adoption of a Guatemalan baby girl), hiking in the Grand Canyon, camping in the rain, and a retreat with Benedictine monks. Chapter 11 “Embodying the Word” discusses literature and medicine, lectio divina (a Benedictine reading practice), and the need to listen carefully to patients’ stories.            
The final chapter returns to Cincinnati, Honduras, and Tuba City. Volck has found more projects in the Navajo Nation, including a youth service project from his church. With permission, he conducts interviews and plans a book on the Navajo, “drawing on cultural history, anthropology, history, medicine, and politics” (p. 201).

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This film focuses on the interaction between 5-year-old Alexandria and Roy, a Hollywood stuntman in the early days of film.  The two are residents of a rehabilitation hospital, and both are recovering from falls they’ve taken: he’s paralyzed from the waist down as a result of a failed stunt; she’s broken her humerus as the result of a fall she’s taken in an orange orchard.  (A child in a migrant family, she’s been tasked, at 5 years of age—presumably out of economic necessity—with climbing ladders to pick oranges.)  Having accidentally intercepted an affectionate note—Alexandria’s child-missive—meant for the kindly but preoccupied nurse Evelyn, paralyzed Roy befriends the girl and quickly wins her over by telling her the wondrous tale of a masked bandit and his companions, all of whom have been betrayed by the evil emperor Odious, and all of whom are united in their quest for vengeance against the ruler.  While Roy narrates the story, we see it take place through Alexandria’s eyes, and the characters she envisions are drawn from people in her life.  The role of the heroic masked bandit she assigns to Roy himself, blended to a poignant degree with her deceased father.  Alexandria sometimes interrupts and asks questions about or challenges the story’s development, whereupon Roy makes adjustments: it’s clear that the story is a co-constructed project.  Roy has, however, become increasingly despondent over his paralyzed condition and over the fact that his fiancée has broken off the engagement as a result of Roy’s condition.  As time goes on, Roy uses his unfolding story as a means of manipulating Alexandria to retrieve morphine from the hospital dispensary.  He tries and fails to commit suicide with the pills that Alexandria supplies.  In the process, he winds up bringing about a severe injury to the child.  Filled with remorse and guilt, Roy alters his story such that it can be a source of separation between him and the girl: it becomes cruel and violent, and suggests that the hero is a weak, inglorious imposter who deserves to die.  The anguished Alexandria protests, demanding that Roy change the story.  Roy refuses, insisting that “It’s my story.”  But Alexandria retorts, “It’s mine, too.”  And Roy relents.  The masked bandit of the story is redeemed, and Roy himself is as well.  The film closes first with Roy, Alexandria, the hospital patients and staff watching the film in which Roy’s acting had led to his accident.  As the scene approaches the point where the accident had occurred, Roy feels understandable anxiety; but the film has of course been edited.  Roy is relieved, but turns to Alexandria, in the hopes that she is not terrified.  He finds her beaming.  Then the film we are watching, The Fall, shifts to a rapid series of black-and-white footage of stunts—the effect is reminiscent of the love scenes gathered at the end of Cinema Paradiso—narrated by the marveling Alexandria.  Each clip features a person in imminent, catastrophic danger—who is then impossibly rescued at the last second by fortunate chance.  As Alexandria blows us kisses through a character who is falling backward, we are left in a state of bewildered gratitude over this strange gift of stories we human beings offer each other—stories that assure us over and over again how, confronted with the calamities we see no way of escaping, we are nonetheless saved. 

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Evan Hansen, an awkward, lonely high school senior, struggles with Social Anxiety Disorder. On the advice of his therapist, he pens supportive letters to himself: “Dear Evan Hansen, Today is going to be an amazing day, and here’s why.  Because today all you have to do is be yourself. But also confident.”   

Connor, another loner student, picks up one of Evan’s letters and, several days later, commits suicide.  When Connor’s parents find the letter, they take it to be their son’s suicide note.  Instead of dissuading them, Evan concocts an account of a close friendship with the classmate he barely knew, creating an email trail. Connor’s family swallows the story.  

As Evan gains the attention he has always craved and comes out of his shell, he finds that he cannot stop himself.   He founds the “Connor Project,” an organization dedicated to preserving his “friend’s” memory where he shares his musings on social media:  “Have you ever felt like nobody was there?  Have you ever felt forgotten in the middle of nowhere?  Have you ever felt like you could disappear?  Like you could fall, and no one would hear? ...Well, let that lonely feeling wash away…Lift your head and look around.  You will be found.  You will be found.”  Once Evan’s postings go viral, the Connor Project becomes a veritable industry, with a budget, and fans who look to it for inspiration.  As the stakes rise, the Project can flourish only by being fed more lies. 

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The speaker of this poem is a nurse who is recalling and attempting to come to terms with a disturbing clinical encounter she’d had the week before.  (I should note at the outset that there’s no indication in the poem as to whether the nurse is male or female.  I choose to think of her as female).  What had happened is that a mother had brought her five-year-old son in for treatment, and the nurse’s exam revealed that the child had second- and third-degree burns on his torso—in the shape of a cross.  The mother, weeping, confessed that her boyfriend had, as a punishment, applied a cigarette to the child’s body—while the mother had held her son.  Seeing the mother’s tears, the nurse considered offering the woman some Kleenex, but could not bring herself to do so.  The child retrieved the box of Kleenex, then clung to his mother’s skirt, and glowered at the nurse.  Then the nurse had participated with three others in prying the boy away from his mother.  In the present of the poem, a week after the encounter, the nurse attempts to deal with the guilt and shame she feels in her failure of professional decorum and compassion—at having failed to rise above her moral judgment against the mother and offer the woman basic human kindness and respect.  In confronting the chaos of her emotions, the nurse turns to a story she’d learned in high school: the story of St. Lawrence.  The significance of her attempt to think with this story can be overshadowed, for readers, by the intensity of the clinical encounter she recalls; but her endeavor is of at least equal significance as the encounter.

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The Renewal of Generosity: Illness, Medicine, and How to Live contemplates the phenomenon of generosity as it is realized in the stories of physicians and patients.  For Arthur Frank, generosity is grounded in the willingness of people to give themselves over to dialogical processes of communication wherein participants best realize themselves through relational engagement: generous, dialogical communication leads to a renewal and realization of human being. Health care systems today tend to impede communicative generosity, however, and the result is a de-humanization and de-moralization of both physicians and patients.  As a remedy, Frank proposes, first, that we re-figure our conceptualization of the physician-patient relationship—from the economic or business metaphor of “provider” and “client,” we should turn to the metaphorical conceptualization of “host” and “guest,” which clearly has implications for manner of treatment and communication that occurs in the relationship.  In addition, Frank turns to and thinks with stories of physicians and stories of the ill to reflect on the ways that generosity is realized.  Drawing on the wisdom of the striking philosophical triumvirate of Marcus Aurelius (Stoicism), Mikhail Bakhtin (Dialogism), and Emmanuel Levinas  to amplify the reflections emerging from the physician and patient stories, Frank ultimately proposes “exercises” for training to generate a vivifying generosity within the medical profession, which can in turn lead to a re-humanization and re-moralization for physicians, improved care for patients, and enhanced flourishing for all.

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INTRODUCTION            
Writing for all the co-authors, Rita Charon challenges “a reductionist, fragmented medicine that holds little regard for the singular aspects of a person’s life” and protests “social injustice of the global healthcare system” (p.1). She gives a history of narrative medicine, lists its principles, and summarizes the book’s chapters, mentioning that several come as pairs that present theory then practice. The six principles are “intersubjectivity, relationality, personhood and embodiment, action toward justice, close reading (or slow looking), and creativity” (p. 4). The basic thesis is that healthcare can be improved by narrative medicine because “narrative competence can widen the clinical gaze to include personal and social elements of patients’ lives vital to the tasks of healing” (p. 1). 
This is a dense, theory-laden book from the group at Columbia University. The summaries below touch of some of the major points.   

PART I, INTERSUBJECTIVITY             
Ch. 1, Account of Self: Exploring Relationality Through Literature
Maura Spiegel and Danielle Spencer describe the richness of literature that allows readers to respond creatively. In clinical settings, a caregiver may similarly listen attentively and help co-construct a narrative with the patient. Literature can help us explore “the limits of rationality and positivism” (p. 29) and move from “a model of autonomy to one of relationality” (p. 34). 

Ch. 2, This is What We Do, and These Things Happen:  Literature, Experience, Emotion, and Relationality in the Classroom.
Spiegal and Spencer write that current medical education does a poor job of helping future physicians with their emotions.  Clinicians profit from a more integrated self and will listen better to patients and respond to them.      

PART II, DUALISM, PERSONHOOD, AND EMBODIMENT            
Ch. 3, Dualism and Its Discontents I:  Philosophy, Literature, and Medicine
Craig Irvine and Spencer start with three literary examples that illustrate separation of mind and body. This dualism has pervaded modern medicine, causing losses for patients and caregivers, especially when there are power imbalances between them.  The “clinical attitude” (p. 81) dehumanizes both caregivers and patients.           

Ch. 4, Dualism and Its Discontents II:  Philosophical Tinctures
Irvine and Spencer argue that both phenomenology (appreciative of embodied experience) and narrative hermeneutics (privileging reciprocal exchange of persons) help us move beyond dualism.  Theorists Edmund Pellegrino (also a physician), Richard Zaner, and Fredrik Svenaeus help us understand how caregivers and patients should relate. 

Ch. 5, Deliver Us from Certainty: Training for Narrative Ethics
Craig Irvine and Charon write that various humanistic disciplines “recognize the central role narrative plays in our lives” (p.111). There is, however, “indeterminacy” in stories that “cannot be reduced by analyzable data” (p. 113). Narrative ethics urges us to consider issues of power, access, and marginalization for both the teller and the listener. The authors review recent ethical traditions of principalism, common morality, casuistry, and virtue-based ethics. They believe that narrative ethics, emerging from clinical experience and now allied with feminist and structural justice frameworks, will provide a better approach for many reasons. “Narrative ethics is poised to integrate the literary narrative ethics and the clinical narrative ethics” (p. 125).  

PART III, IDENTITIES IN PEDAGOGY            
Ch. 6, The Politics of the Pedagogy: Cripping, Queering and Un-homing Health Humanities
Sayantani DasGupta urges attention to issues of power and privilege in classrooms, lest they “replicate the selfsame hierarchical, oppressive power dynamics of traditional medicine” (p. 137). “Cripping” and “queering” provide new perspectives on knowledge, for example the untested binaries of physician/patient, sick/well, elite/marginalized, teacher/student. Drawing on disability studies, health humanities, and queer politics, DasGupta challenges “medicalization” and the “restitution narrative” (p. 141).  

PART IV, CLOSE READING            
Ch. 7, Close Reading: The Signature Method of Narrative Medicine
Charon stresses “the accounts of self that are told and heard in the contexts of healthcare” (p. 157). Close reading, traced from I. A. Richards through reader response theorists, is “a central method” for narrative medicine (p. 164). Close reading enhances attentive listening, and both of these deepen relationality and intersubjectivity, allowing for affiliation between caregiver and patient (pp. 175-76). Such linkages aid healthy bodies and minds, even the world itself (p. 176).             

Ch. 8, A Framework for Teaching Close Reading
Charon describes how she chooses texts and provides prompts for responsive creative writing. She illustrates “the cardinal narrative features—time, space, metaphor, and voice” (p. 182) in literary works by Lucille Clifton, Henry James, Galway Kinnell, and Manual Puig.  

PART V, CREATIVITY            
Ch. 9,  Creativity: What, Why, and Where?
Nellie Hermann writes that “healthcare in particular has a vexed relationship to the notion of creativity,” in part because of issues of control (pp. 211-12); values of “evidence based” and “numbers-driven” medicine are also factors. Narrative medicine, however, “is about reawakening the creativity that lives in all of us” (p. 214).            

Ch. 10, Can Creativity Be Taught?
Hermann reports on techniques used in the College of Physicians and Surgeons at Columbia, including prompts and a Portfolio program. A “Reading Guide” helps clinical faculty (and others) respond to student writing. Responses to writing can nourish the “creative spark.”  

PART VI, QUALITATIVE WAYS OF KNOWING            
Ch. 11, From Fire Escapes to Qualitative Data: Pedagogical Urging, Embodied Research, and Narrative Medicine’s Ear of the Heart
Edgar Rivera Colón suggests that “we are all lay social scientists of one kind or another,” seeing people in action in various contexts. He affirms an “assets-based approach to public health challenges, as opposed to a deficits-based and pathology-replicating paradigm” (p. 259). We are all embodied actors in relationship to power, privilege, and social penalty. Research through interviews and participant observation show “meaning worlds” in tension with “systemic inequality and structural violence” (p. 263). 

Ch. 12, A Narrative Transformation of Health and Healthcare
Charon presents and analyzes a case study of patient Ms. N. as treated by internist Charon. They’ve been working together for decades. Charon writes up her perceptions and shares them with Ms. N. Speaking together, they “became mirrors for one another” (p. 274). Psychiatrist Marcus discusses transference and transitional space in that experience. A caregiver as witness can shift healthcare from “instrumental custodianship to intersubjective contact” (p. 288).            

Ch. 13, Clinical Contributions of Narrative Medicine
Charon describes applications of narrative medicine, all with the aim of improving healthcare. She describes techniques for interviews of patients, writing methods, and ways to improve the effectiveness of healthcare teams, as well as changes in clinical charts and other narrative descriptions of patients.

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Extremis, a Netflix documentary directed by Dan Krauss, follows Dr. Jessica Zitter a palliative care ICU physician at Highland Hospital in Oakland, California. The documentary begins with an exasperated Dr. Zitter trying to communicate with a patient on a ventilator: “Is this about the breathing tube? You want it out?” she asks. When the patient nods in affirmation, Dr. Zitter replies, “What if you die if I take it out?” The questions confronting the physicians, patients and their loved ones get no easier over the course of the film. The documentary is propelled by a dramatic tension between its protagonists: on one side Dr. Zitter, who is compassionate but dogmatically pragmatic, on the other side the family members of patients who are driven above all by hope and faith. This tension manifests itself in palpable ways. In one particularly powerful scene, a patient’s daughter says to Dr. Zitter: “it would feel like murder to pull that life support. That’s what it would feel like to me…I feel like maybe as a doctor, you know, being as smart, and being as knowledgeable, and being inside medical journals, it can dwindle your optimism a little bit.” Dr. Zitter replies simply, “I’m just trying to help you make a decision that’s right for your Mom.”  Of course, for Dr. Zitter there does appear to be a categorically appropriate decision in all of these cases. In most of her conversations, she is transparently trying to get family members to see that there is no realistic chance of meaningful recovery for their loved ones. That is not to say that she is insensitive to the family’s wishes or the complex bioethical conundrums which arise around her. In fact, her bravery and deftness in broaching these serious and difficult topics is on full display throughout the film. 

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The subject of Psychobook is psychological tests, both classic tests and newly created ones. Oversized, with more pictures than text, it is truly an art book.    

Psychobook begins with an introduction by Lionel Shriver, a journalist and novelist, which proves to be a very personal indictment of psychological testing.  There follows a more even-handed historical essay by Oisin Wall, a curator at the Science Museum in London.    

The bulk of Psychobook is comprised of photographs of tests and archival material related to tests.  For example, along with intelligence tests designed to screen potential immigrants, we find images of new arrivals being tested at Ellis Island.  Likewise, we see beautifully reproduced Rorshach inkblots along with pictures of Rorshach and older inkblots that may have inspired him. The Thematic Apperception Test (TAT) is a projective test in which subjects respond to images with their fantasies.  Here we see the 1930s originals cut out of magazines alongside updated images especially commissioned for this volume. Each is provocative in its own way.  As an added bonus, a series of photographs of psychotherapists in their offices from the 1930s to the present is interspersed with the content on psychological testing.     

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The narrator Lucia works in a California city emergency room. Her job title is not specified - possibly a registration clerk or triage nurse. She enjoys working in the ER and marvels at the human body: "I am fascinated by two fingers in a baggie, a glittering switchblade all the way out of a lean pimp's back" (p90). Death, however, is a regular visitor.

All day, ambulances back up to the emergency room, gurneys rumble by, and charts accumulate. The staff is too busy. Patients are restless, frightened, and angry. She notes how everything associated with the ER appears gray - patient's skin, blankets, emergency vehicles. And perhaps the prognosis of patients as well: "Everything is reparable, or not" (p90).

Lucia describes Code Blues, the deaths of gypsies, an encounter with a blind man whose wife was DOA, drunks, and suicide attempts. She wonders why the elderly fall down so frequently. She's frustrated by the large number of people who come to the ER without an actual emergency and longs for "a good cut-and-dried stabbing or a gunshot wound" (p93). But Lucia worries that she has become too desensitized working in the emergency room, maybe even inhuman. Yet the flow of patients doesn't slow down - those with true life-threatening conditions and those who probably don't need to be there.

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This ambitious novel presents unusual events ten years after an international adoption.  Because of the Chinese one-child policy, Chinese peasant woman Xiao Lu abandons her second daughter Chun in a rural market, knowing that the child will be sent to an orphanage. An American couple adopt the child, calling her Katie. As a celebration for Katie’s tenth birthday, they return to southwest China, hoping to meet the birth mother.  

In a series of unusual events, they find Xiao Lu, and it is, at first, a joyous event. Troubles mount, however, as the birth mother wants Katie to stay with her, and Katie feels a mystical bond between them. Xiao Lu, having left her husband, now lives as a hermit in a hut on the slopes of The One Hundred Mile Mountain. She sweeps the 100 steps of The Elephant Temple daily and practices calligraphy in her hut.  

Pep and Clio Macy, having married late, could not get pregnant. The novel satirizes them as aging Yuppies, spoiled and materialistic. Clio wears a Movado watch worth hundreds if not thousands of dollars. The family’s cockerpoo has been boarded at home. Katie dislikes being the only Chinese American in her private school.  

After the birth mother has been found, the mood of the book changes. Xiao Lu wants her child returned, and the Macys fear that they are in danger. In the last 100 pages, nature itself attacks the Americans with snakes, monkeys, bats, a huge millipede, and even the weather. Pep is injured and receives rough, traditional medical treatment from a monk; it appears to be effective, however, in healing his heart physically and spiritually—a resonance with the book’s title. Katie becomes more and more like Xiao, learning calligraphy and some Chinese language. When Xiao is grievously injured by the monkeys, the Macys effectively care for her, and previous conflicts are resolved.

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