Summary:

Vicki Forman's twins, Evan and Ellie, were born in 2000 at twenty-three weeks' gestation.  Fetuses could legally be aborted up to twenty-four weeks, but rules regulating treatment of extremely premature babies differed from one hospital to another.  Daughter of a doctor, Forman knew how slim were the chances of survival and how great the chances of serious disability if either of the twins did survive.  Grieving, but realistic, she and her husband asked for a DNR order, but learned that such orders did not strictly apply to the situation of children like their twins.  Instead, the line between  the parents' authority and the doctors' remained blurry and decision-making vexed not only by technical and emotional complications, but by conflicting legal guidelines as they made their way through many months of hospitalization and home treatment of their surviving son.

Ellie, the daughter, died at four days.  Evan lived for eight years with disabilities that completely reorganized family life, and required constant monitoring, management of equipment, and careful orchestration of parental relationship to their older child, Josie, and their special-needs child.  Much of the narrative covers the period of hospitalization during Evan's early months and the negotiations between parents, physicians, and other caregivers.  It also touches on Forman's own emotional responses to the strenuous learning curve required of a parent who suddenly finds herself with a special-needs child.

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Baiev’s chronicle of medical life in wartime is full of incident—tragic, touching, and repeatedly traumatic:  his own life was threatened repeatedly by Russians who suspected him and Chechens who resented him for treating Russians.  Members of his extended family were killed and his father’s home was destroyed.  He straddled other boundaries:  trained in Russia, he fully appreciated how modern medicine may bring relief not available even in the hands of the most respected traditional healers, but he mentions traditional ways with the reverence of a good son of devout Muslims.  His perspective is both thoughtfully nationalistic and international.

Finally coming to the States where he couldn’t at first practice the medicine he had honed to exceptional versatility under fire, he lives with a mix of gratitude for the privilege of safety and a longing for the people he served, whose suffering was his daily work for years that might for most of us have seemed nearly unlivable.  Before writing the book, he struggled with his own post-traumatic stress, and continues to testify to the futility of force as a way of settling disputes.  Medicine is his diplomacy as well as his gift to his own people, and the Hippocratic Oath a commitment that sustained him in the midst of ethical complexities unlike any one would be likely to face in peacetime practice.

 

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This collection of stories offers a sidelong view of medicine from the perspective of a thoughtful, experienced doctor of internal medicine at a teaching institution (UCSF) in an urban setting that brings a wide variety of types of patients to his door.  In a context of evident respect and admiration for even the quirkiest of them, Watts admits to the kinds of personal responses most have been trained to hide-laughter, anger, bewilderment, frustration, empathetic sorrow.  The cases he recounts include several whose inexplicabilities ultimately require action based as much on intuition as on science.  He includes several stories of illness among his own family and friends, and makes it clear in others how his professional decisions affect his home life and his own state of mind.  

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This book chronicles a tortured parenthood during the birth and brief life of a severely brain-damaged female infant, Silvie. Doctors predict that the child will live only a few days but instead she survives for seven months. The story is told in first person by the mother, beginning with her arduous labor during a home delivery in the presence of an experienced midwife and the family physician. The baby does not cry when she is born and turns blue even with oxygen that the doctor administers. An ambulance is summoned; "a bigger, better oxygen machine" restores the baby's color and she is brought to a hospital neonatal intensive care unit where she is artificially ventilated and fed.

In the hospital Silvie "fails" all the tests of normalcy. The doctors recommend removing artificial ventilation. "I feared, even more than I feared her death I think (and harder to admit), that they would remove the oxygen pump and the baby would live on and on and never be able to do anything at all" (14). Yet when the child does in fact breathe independently, "I took the fact that she could sustain her own breathing to mean that the baby wanted to live. It was all right to love her" (15). A few days later, however, the medical team concludes that there is nothing further they can do for the baby, that the parents should take the child home, where she will likely die within a couple of days. Upon being prodded, one physician suggests the parents give her an overdose of phenobarbital, which she is receiving for continual epileptic seizures.

At home, the parents feed Silvie by tube, medicate her, change her diapers, hold her, and learn from a friend how to swaddle her. The child never cries, does not focus her eyes on anything, rarely responds to sound or touch, and gains no weight. Whatever random responsiveness there seems to be gives the author a sense of motherhood: "I was able to survive because of my faith in these intermittent chance meetings, believing that Silvie did know when I was here and that I was holding her close in a way that meant love" (37). The parents brace themselves for Silvie's death. The husband's sister visits and councils them to actively put an end to Silvie's life, which they refuse to do. But they do not plan to take extra measures (CPR) if Silvie seems to be dying at home and when they articulate this to a social worker whom they consult to obtain respite care, it becomes clear that she would report them to Child Protective Services.

The husband quits his job as a residential counselor of emotionally disturbed teenagers to do part-time carpentry work -- he is too preoccupied to care about other people's problems. When a friend accidentally breaks the phenobarbital bottle, the parents together with the family physician decide to see how Silvie will get along without the drug. To their amazement, the baby appears slightly more alert and is able to suck from a bottle -- no more feeding tube required. But the husband reminds his wife, "The doctors warned us she might do this. This is the one and only thing she can ever learn. They said when this happened to other parents they started to believe that the baby was getting better" (59).

The parents live in limbo, attempt to live a "normal" life. When Silvie starts to lose weight at age 4 months, the doctor advises to resume tube feeding; they don't see the point, but when hospital physicians use the word, "murder," and threaten to "take over" Silvie's care, the parents relent. The baby lives but "it was the sameness of Silvie that drove you crazy . . . She slept and woke, but was awake that much different? She did not change, she did not change. Her sameness was a stone I wore, an emblem of failure, failed life" (96).

The final act for Silvie begins when the author's mother-in-law is dying of cancer in New York and a decision is made to leave the baby at home in California for several days in the care of a retired nurse. The nurse has been shown how to do the tube feeding, but while the parents are in New York she experiments with spoon feeding, then discontinues tube feeding for three days before the parents return. The parents see that Silvie has deteriorated in their absence and resume tube feeding. For the remaining couple of months the parents wait, investigate institutionalizing Silvie, and finally determine that "the way we loved Silvie meant we loved her enough to let her die" at home, with "a certain amount of fluid and nourishment for comfort, but a gradual withdrawal of excessive food. Replaced with a lot of touching and holding, stroking and whispering" (122). Silvie dies and the author is four months pregnant with the baby she and her husband have decided not to abort.

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Three childhood friends, now adult neighbors who have drifted apart, are brought together through the brutal murder of Jimmy's 19-year-old daughter. Sean Penn plays the grieving father; Kevin Bacon plays Sean, the plainclothes cop on the case; and Tim Robbins is Dave, a man deeply troubled following his childhood abduction and sexual abuse by two strange men. It's an important part of this film that the action takes place in a tough white working-class neighborhood north of Boston in a culture that seems to have no place for emotional problems like Dave's.

This leaves Dave alone with his agonies, feeling alienated from himself and living a kind of Jekyll-and-Hyde existence driven by a love-hate relationship with pederasty. One night he kills a child abuser, and then tells contradictory stories to explain the bloodstains he returns home with. Through a tragic misunderstanding, these things are connected with the death of Jimmy's daughter, and Jimmy turns violent and takes justice into his own hands. Shortly after, Sean finds the true killers, who confess.

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In this film based on a true story, Ramón Sampedro (Javier Barden), a young fisherman from the northwest coast of Spain, is injured in a diving accident that leaves him paralyzed from the neck down and completely dependent for his care on his older brother and his sister-in-law, who make numerous sacrifices in order to care for him. Twenty-seven years later, in his 50's, Ramón is weary of his life, which he feels is without dignity, and he tries to get legal permission to end it.

His brother is adamantly opposed to euthanasia, but Ramón is comforted and aided in his quest by two women who are drawn into his circle. Julia (Bélen Rueda), a lawyer suffering from a degenerative disease, begins to design a legal case for Ramón but soon falls in love with him (although she seems happily married), and he with her. In a particularly moving scene, Ramón-who of course cannot move--tells Julia that her smell is the beginning of his erotic fantasies about her.

Julia helps him edit and publish a book of his poetry, but then, having agreed to a joint suicide, she mysteriously backs out. Rosa (Lola Dueñas), a young single mother who works in a fish-packing factory and who has had a hard life, also falls in love with Ramón. For some time she tries to change his mind, arguing that his example has inspired her and saved her from a life of despair. Ramón challenges her: "The person who truly loves me will be the one who helps me [commit suicide]."

When Ramón's legal appeal (for the same rights the nondisabled have to end their lives) is lost on a technicality, he seems to have nowhere to turn, but Rosa, converted by her love for Ramón, finally agrees to help him die. He achieves his goal in a videotaped end in which he argues that what he is doing is his right and that no others should be blamed or prosecuted for it, sips poison through a straw, and dies.

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This video is the film of the staged one-woman play written and acted by white South African Pamela Gien. The play begins in 1963, in a white suburb of Johannesburg, in the fenced yard of the Grace family and their black servants. Gien starts as six-year-old Lizzie Grace. Gien then fluidly shifts roles to enact twenty-eight different characters from newborn to age eighty-two, black and white, male and female--who talk, gesture, sing and dance in this tour-de-force performance.

The set contains only a large, plain swing; even the berry-bearing syringa tree to which the swing is attached is left to the imagination. Gien’s costume is similarly muted--she is barefoot and wears a beige jumper over a simple tee shirt. A sound system provides music of ethnically diverse origins at appropriate moments.

The play opens with Gien swinging and talking in a girlish voice and using exaggerated childlike gestures. Lizzie exclaims that she is "a very lucky fish": she proceeds to explain to the audience the meaning of her favorable white nailbed spots. Lizzie is, by self-definition, a "hyperactive," outspoken child with great imagination and energy. She is cared for by Salamina, a loving nanny and servant.

Lizzie’s father is Dr. Isaac Grace, who delivers Salamina’s baby in the home. The child, Moliseng, "has no papers" and is harbored illegally by the Grace family--a constant source of worry for all, including Lizzie. Isaac is a Jewish atheist, and Lizzie’s mother, Eugenie, is Catholic and of English descent. Their neighbors, however, are bigoted Afrikaners and create great tension for the Grace household. "Don’t ever make this place your home," advises Dr. Gien to his daughter after dealing with racist clients who do not want to be in the same examining room after a black patient.

Lizzie’s liberal, generous grandfather is brutally murdered by a Rhodesian freedom fighter shortly after the resolution of another crisis: Moliseng, suffering from malnutrition, is missing from the overcrowded hospital. The play then fast forwards through Lizzie’s college years, when Moliseng, at age fourteen, is murdered in youth riots. Lizzie leaves for America, land of the (she pounds her chest) "free and brave." She returns years later, with her infant son named for her grandfather, to visit her father, her demented mother, and, above all, her beloved Salamina.

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This book, designed to accompany an exhibition "on the frequently Excessive & flamboyant Seller of Nostrums as shown in prints, posters, caricatures, books, pamphlets, advertisements & other Graphic arts over the last five centuries," displays and comments on 183 illustrations associated with the art of quackery. As the title suggests, Helfand surveys the graphic material of quackery of England, France, and America during the modern period, although most of the material dates from the eighteenth and nineteenth centuries. In his introduction, Helfand discusses the uncertain boundaries between "regular" (now termed allopathic) physicians and their "irregular" or "empiric" counterparts--quacks.

Through the mid-nineteenth century, many practitioners of both sorts relied on pharmaceutical agents like mercury, antimony, and opium; developed trade symbols and packaging; and flaunted the honorific "Dr." and their affiliation with science. Many patients visited both regulars and irregulars, who might consult with each other. Some physicians even prescribed quacks' proprietary preparations. Helfand also notes differences, such as irregulars' lack of medical training, exaggerated advertising, refusal to disclose the contents of their products, and use of entertainment and sometimes even religion in their "medicine shows."

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Paul Edgecombe (Tom Hanks) is in charge of death row in a 1935 Louisiana penitentiary. The cell block is nicknamed "The Green Mile?due to its green linoleum floor--the path that an inmate must walk from his cell to the room with the electric chair. Paul, a decent, moral man, treats each prisoner with respect. His life changes, however, with the admission of John Coffey (Michael Clarke Duncan), a huge African-American man convicted of the rape and murder of two young sisters. Despite his powerful build, Coffey is gentle--and possesses a miraculous, mysterious power to heal.

Coffey heals Paul's bladder infection, resurrects a dead mouse, Mr. Jingles, that is the treasure of another inmate, "Del,?and cures the warden's wife of her inoperable brain cancer. Each healing requires direct contact between Coffey and the "patient,?and is accompanied by much electric and mystical effects. Coffey takes the infection, brokenness, disease into his body and is able to expel it, though it exhausts him.

Coffey's powers extend to visions and he directly feels the pain of others. He transmits his visions of the death of the two girls to Paul--who realizes that Coffey is innocent (indeed he had been trying to "heal?the children when he was apprehended) and that another inmate on the green mile is guilty of the crime. Paul, counseled by his supportive wife (Bonnie Hunt), asks Coffey what to do. Coffey, exhausted from suffering the knowledge of the evil of the world and cognizant of his lowly position as a poor black man, asks to have the execution proceed. His only request is to watch a "flicker show.?Paul arranges for him to see a Fred Astaire movie.

The executions are graphically depicted. One is particularly gruesome because of the evilness of the whiny, rookie guard, Percy, who deliberately causes a prisoner (Del) to suffer in the extreme. After giving the orders for Coffey's execution and watching him die, Paul quits his job.

The story is framed by Paul as an old man in a nursing home. Paul "tells?his story to another elderly "inmate?as an explanation for why he was overcome when watching the Fred Astaire movie in the common room. Paul reveals that he is far older than thought possible--as is Mr. Jingles who is still alive six decades later. Paul and the mouse were "infected with life?when touched by Coffey.

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In the fall of 1979, Keith Burton, a free-lance journalist, saw the videotape 0105 in a bioethics seminar at Southern Methodist University (see annotation in this database). The structural centerpiece of this 1974 documentary is the interview of a burn patient, Donald "Dax" Cowart, by psychiatrist Dr. Robert B. White at the University of Texas Medical Branch in Galveston. Dr. White had been called in to determine the patient’s competency because of his persistent requests to end the painful treatments, to go home, and to die.

Similar to most viewers of Please Let Me Die, Burton was intrigued by the unanswered questions and the uncertain outcome of the case and ultimately contacted Dax Cowart and his mother, Ada Cowart. Burton invited their collaboration on a follow-up videotape to Please Let Me Die, with the intention of providing "a living record of this man’s struggle for release from pain and despair." [see Keith Burton, "A Chronicle: Dax’s Case As It Happened." In Dax’s Case: Essays In Medical Ethics And Human Meaning, ed. Lonnie D. Kliever. (Dallas: Southern Methodist University Press) 1989: 1].

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