Summary:

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 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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Eva McEwen is born in Scotland in 1920. Her mother dies shortly after giving birth to her. At the age of six, Eva is "visited" by two strangers (an older woman and a teenage girl) that only she can see and hear. These mysterious companions steer the course of her life. During World War II, Eva serves as a nurse in a burn unit.

She falls in love with a plastic surgeon but her supernatural attendants have other plans for Eva. She secures a job as a school nurse, marries a teacher, and has a daughter. Sadly, Eva dies at a young age from cancer of the liver and pancreas. Thus the novel ends much like it began, with the tragic death of a young mother who leaves behind a devoted husband and daughter while ghostly visitors are poised to both share and meddle in the youngster's life.

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This monumental portrait of the 17th century knight, Sir Richard Saltonstall, and his family was commissioned for the Saltonstall family home. The wealth of the family is indicated by intricate tapestries, a woven rug, jewels, and the rich fabrics of clothing and curtains. Absent from the picture is any religious iconography.

Saltonstall stands left of center and draws back the rich red curtain on the deathbed of his first wife. With his ungloved right hand he holds the hand of his eldest child, a son. This son is still young enough to wear a dress, but his coloring and the dress style indicate a boy. He in turn holds the arm of his younger sister, so that a diagonal line is formed from the father's hat, down his arm and through the two children.

The pale dead mother lies all in white, her eyes open, and her upturned hand reaching towards her children. On the right side of the picture sits Saltonstall's second wife, and she holds her baby on her lap. She also is dressed in white and is separated from her husband by the first wife. In addition, the diagonal line between Saltonstall's left hand and his baby is interrupted by his dead wife. However, he does gaze in the direction of his second wife, although no one in the portrait looks directly at another person.

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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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A young doctor, recently assigned to a country hospital, is fraught with anxiety, especially over his lack of experience with obstetrical problems. One night the midwives call him; a woman is having a difficult labor. The fetus is presenting in a transverse position. The doctor must reach internally and “turn it around by the foot,” as Anna Nikolaevna, the seasoned midwife, reminds him.

The doctor has never performed this procedure. He buys time by going back to his room to consult the textbook (under the pretext of going for cigarettes). Finally, he can't avoid it any longer. He performs the rotation. It works! Both mother and baby are saved.

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The speaker recalls his need to call forth a "slender memory" of his father. This memory from childhood is both "painful" and "sweet." In contrast to his father, who, as a political prisoner had devised complex mnemonics, the speaker has a haphazard memory. But is it his memory, or what he recalls that is "illogical"? "My father loved me. So he spanked me. / It hurt him to do so. He did it daily." The speaker remembers, also, how his father protectively wrapped him in his own sweater to shield him from cold. Years later, the speaker wears the sweater.

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A succinct poem [29 lines] that captures the essence of the position in which one finds oneself after a parent, or both parents, have died. Full of evocative phrases, this poem is less about grief than it is about awareness of adult responsibility and one's own future demise: "there is nobody / left standing between you / and the world . . . ."

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Sleep is a much sought-after prize in this novel. Bonnie Saks is a 39 year old woman whose life has spiraled out of control. Already divorced and the mother of two young boys, she is tormented by insomnia. Her life is further complicated when she discovers she is pregnant and struggles to complete her unfinished dissertation on American literature.

Ian Ogelvie is a 29 year old psychiatrist and sleep researcher experimenting with a breakthrough drug known as Dodabulax that greatly enhances REM sleep. While Ian helps Bonnie sleep, she in turn provides him with a wake up call of sorts. Ultimately, Bonnie becomes uneasy with the changes triggered by her blue pills. Despite suffering a miscarriage, her life becomes more tolerable and her insight much clearer.

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The poet conjures up the image of the doctor who delivered him and his siblings ("All of us came in Doctor Kerlin's bag"), the doctor who arrived at the house in his fur-lined coat and ascended to his mother's bedroom, and later came down and arranged the instruments in his bag (a "plump ark"), which by that point was otherwise empty. In the boy's fantasy, Doctor Kerlin's small eyes were "peepholes into a locked room," in which were strung "the little pendant infant parts / . . . neatly from a line up near the ceiling-- / a toe, a foot and shin, an arm, a cock."

On a visit to the ruined temple of Asclepius, the god of healing, the poet finds himself remembering Doctor Kerlin, and also the incident when, as an altar boy, he fainted during a procession at the healing shrine of Lourdes in 1956. Now many years later, he pulls up some tufts of grass from around the temple and sends them to friends suffering from cancer. He remembers entering the bedroom after Doctor Kerlin left, his mother on the bed asking, "And what do you think / Of the new wee baby the doctor brought for us all / When I was asleep?" [94 lines]

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