Bookends: A Family Doctor Explores Birth, Death, and Tokothanatology

Boron, Susan

Last Updated: Dec-06-2022

Duffin, Jacalyn

Primary Category: Literature / Nonfiction

Genre: Memoir

Summary:

Through ten short chapters, family doctor Susan Boron explains the origin of her neologism, “tokothanatology,” the study of common practices that surround both birth and death, events that “bookend” our existence. Daughter of an obstetrician who pioneered family-centered birth and spouse of a man who worked in palliative care, Boron noticed the tremendous similarities in the gestures, rituals, and obligations of dealing with both the beginning and the end of life. The obligations extend to the loved ones in the sphere of patients in care--a practice, she writes, “from pre-cradle to post-grave.”

One chapter reviews the rituals emerging from many different cultures and religions; another examines portrayals of birthing and dying in image and word; yet another addresses the impact of sudden and unanticipated outcomes. Ethical and legal dilemmas and the contingencies imposed by time and place are discussed frankly.

Recognizing the advantages of medical technologies, she is nevertheless skeptical of their utility in every case and includes practical advice for dealing with pain, showing that midwifery techniques could enhance palliation. Throughout, she acknowledges that things have changed, are changing, and will change again. Sources are referenced in footnotes.

In the end, the repeated message is one we’ve heard many times before, offered in a refreshing way: the importance of empathy and of listening to the patient's wishes in birthing and in dying.

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Severance

Stiller, Ben

Last Updated: Nov-21-2022

Brungardt, Gerard

Primary Category: Performing Arts / Film, TV, Video

Genre: TV Program

The Mouth Agape

Pialat, Maurice

Last Updated: Nov-07-2022

Teagarden, J. Russell

Primary Category: Performing Arts / Film, TV, Video

Genre: Film

Summary:

“Can you take your mother home? There’s no point our keeping her here,” the doctor says to Phillipe about his mother, Monique. Her breast cancer has spread to her spine and probably her brain. Monique had been staying with Phillipe and his wife, Nathalie, in their cramped apartment in Paris during her treatment. They took her to her home in Auvergne, and there she remained, confined to her bed, until she died.

Monique’s husband, Roger, cared for her while also managing the family retail clothing store beneath their apartment. He spoon-fed her, cleaned her, and tried to make her comfortable with the aid of visiting nurses. Phillipe and Nathalie came from Paris to help care for Monique and provide some relief for Roger. As Monique deteriorated, she required more and more of their attention, which was made all the more difficult when she lost her ability to speak. Fatigue set in and nerves frayed. Nevertheless, when Monique died, tears were shed, hugs were shared, and memories were recounted.

Through it all, though, not one of three family members exhibited a bit of grace. As they had before Monique became ill, they lied to each other, cheated on each other, and stole from each other while caring for her. None were above physical abuse—“you slapped me for no reason,” Nathalie reminds Phillipe, Roger paws his female customers just below where Monique lies ill in her bed. Monique, no angel herself, had behaved similarly before cancer crimped her style. After the funeral, Roger returned to his store, and Phillipe and Nathalie to Paris, where they ostensibly would pick up where they left off with their lives of banal wantonness.

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Physician Assisted Suicide and Euthanasia

Sulmasy, Daniel; Rubenfeld, Sheldon

Last Updated: Nov-01-2022

Coulehan, Jack

Primary Category: Literature / Nonfiction

Genre: Collection (Essays)

Summary:

Physician-Assisted Suicide and Euthanasia, edited by Shelton Rubenfeld and Daniel Sulmasy, is an unusual collection of scholarly essays in that it combines essays about Nazi euthanasia with others that deal with contemporary PAD (Physician Aid in Dying) and questions whether there might be a relationship between the two. This perspective is understandable, given the book’s origin. The Center for Medicine after the Holocaust, an organization with the mission “to challenge doctors, nurses, and bioethicists to personally confront the medical ethics of the Holocaust and to apply that knowledge to contemporary practice and research,” invited a group of North American and Israeli palliative care specialists and medical ethicists in 2018 to visit German sites associated with Third Reich euthanasia programs. The intensive discussions that followed resulted in this provocative collection of papers.

Dr. Timothy Quill is among the writers supporting the moral probity and legalization of PAD, while Drs. Diane Meier and Daniel Sulmasy present strong arguments against the practice.

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Station Eleven

Mandel, Emily

Last Updated: Oct-27-2022

Duffin, Jacalyn

Primary Category: Literature / Fiction

Genre: Novel

Summary:

In the not-too-distant future, Arthur Leander, a famous actor, suddenly collapses and dies on a Toronto stage in the final act of King Lear.. That same night the deadly and highly contagious Georgian Flu reaches North America from Russia. Within days, civilization, as we know it, collapses: no electricity, no gasoline, no water, no travel, no Internet, no information, no medicine, and no escape. A handful of survivors hide in their separate lairs, until their resources are depleted and then they flee on foot, at first alone, stealing and foraging for food, trusting no one, and learning to kill. Surviving. The story takes place in Year 20 after the collapse with frequent visits to the past.

Without realizing it, the protagonists are all connected to Arthur– his ex-wives, young son, best friend, a child actor, the paramedic who tried to resuscitate him at the theatre. Older people remember and mourn the “before time” and its marvels that are lost, perhaps forever. In oppressive heat, a troupe of musicians and actors, called the Traveling Symphony, moves from place-to-place around the Great Lakes, performing music and Shakespeare’s plays because “survival is insufficient.” Usually, they bring pleasure and diversion. But they must take care, as some villages are led by cult-like prophets, intent on control by theft, rape, and murder. Only at the end do they reach Severn City, where a fledging community has created a semblance of peace and respect in an abandoned airport with a museum devoted to all that is lost.

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Hurdy Gurdy

Wilson, Christopher

Last Updated: Oct-14-2022

Duffin, Jacalyn

Primary Category: Literature / Fiction

Genre: Novel

Summary:

Brother Diggery, formerly called Jack Fox, tells us that he was given to the monastic order of St Odo at the age of seven in 1341. For another seven years, he is raised in innocence within the strict rules of the community, serving the brother healer, learning herbal remedies, and playing the hurdy gurdy.

As plague arrives in 1349, he is assigned to help care for the anticipated sick – and immediately falls ill. The brothers seal him inside his cell, where he suffers greatly, narrowly escaping death; however, when he recovers and forces himself out of confinement, he discovers that everyone else has died or fled. After filling a mass grave with the remains of his brothers, he sets out on a picaresque series of adventures, blithely unaware that he and his fleas spread illness wherever they go.

Like a fourteenth-century Candide, Brother Diggery’s gullibility and curiosity lead him to discover the wonders of good food, sex, and marriage, the cruelty of lies, theft, and wrongful imprisonment, and the corruption of the church (p. 164). He closes his account in 1352, age 18, already twice widowed, but set for life as a lay physician and father of a young boy whom he plans to give to the monastery of St Odo when he reaches age seven.

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Barefoot Doctor: A Novel

Xue, Can

Last Updated: Sep-06-2022

Miksanek, Tony

Primary Category: Literature / Fiction — Secondary Category: Literature /

Genre: Novel

Summary:

Yun Village, China is a remote town near the mountains. Its 2,438 inhabitants are mostly poor but remarkably optimistic and stoic. Ancestors from the spirit realm visit the hamlet and roam the mountainside. The living and the dead appear to communicate with relative ease. Mrs. Yi (Chunxiu), more than fifty years old, is the village's vibrant "barefoot doctor" - an essentially self-taught healthcare provider with only six months of formal medical training under her belt. Yi's husband is quite supportive of her work. Their only child died at age two.

Yi is revered for her knowledge, patience, and compassion. Most afflictions she treats are chronic diseases, but Yi also delivers babies, cares for children with measles, and counsels a woman who attempted suicide. The therapeutic benefit of attentive, concerned listening along with reassurance are evident in her interactions with patients.

Traditional Chinese herbs, acupuncture, and Western medicine are all in the healer's armamentarium. Yi cultivates herbs and also forages on the mountain for other useful plants. She supposes, "Sickness and herbs are lovers" (p244). As Yi grows older, the need for a successor - a devoted, younger barefoot doctor - is always on her mind. She successfully identifies candidates, then inspires and mentors them.

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Cancer Confidential: Backstage Dramas in the Radiation Clinic

Hayter, Charles

Last Updated: Aug-23-2022

Duffin, Jacalyn

Primary Category: Literature / Nonfiction

Genre: Autobiography

Summary:

All the [medical] world’s a stage! In elegant prose, with Felliniesque flights into whimsical metaphor, physician-historian-playwright Charles Hayter describes his encounters with cancer, as a doctor and as a son, and how the experience changed him as a person.

Just as he finishes his residency training as a cancer specialist, his stoic physician father develops cancer. The story of that family illness is interwoven with vivid case histories of patients, recounted personally rather than clinically. These patients display many of the characteristic reactions and behaviors of his own father.

Several other themes are prominent: the losing battle against death – or rather Death--who is a character lurking in the corners of the consultation rooms; the tensions of a son trying to please his difficult parents with advice and understanding that they seem not to want; the bravery of a gay man coming out to his wife and children to find a new place in the world.

These struggles are placed on a background of the nebulous status of radiation therapy, a maligned and misunderstood specialty.

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Two Nurses, Smoking

Means, David

Last Updated: Jul-20-2022

Miksanek, Tony

Primary Category: Literature / Fiction

Genre: Short Story

Summary:

Two nurses decked in scrubs repeatedly meet outdoors for smoking breaks and banter during the summer and fall months. Gracie, a thin and pale woman, leads an itinerant life as she follows a mobile lithotripsy unit that services "cut-rate hospitals" in New York. She assists with the machine (dubbed "the kidney pounder") that delivers ultrasound energy to smash kidney stones. Marlon, a brawny man and Army vet adorned with a scar on his neck and an arm tattoo, works in the ER at one of the modest hospitals visited by the lithotripsy trailer.

The duo exchange numerous stories about patients they have cared for and eventually details about their own private life including personal hardships. A bond develops and deepens between these two people who "were both damaged, somehow lost" (p50). Their growing relationship is accompanied by physical attraction and culminates later in a night of love-making followed by mutual weeping.

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A Matter of Death and Life

Yalom, Irvin; Yalom, Marilyn

Last Updated: Jun-02-2022

Coulehan, Jack

Primary Category: Literature / Nonfiction

Genre: Memoir

Summary:

After 65 years of marriage, two life-partners face the prospect of final separation, as one of them develops multiple myeloma. This is the crisis that led Irvin Yalom, eminent psychiatrist, novelist, and pioneer of existential psychotherapy, and his wife Marilyn, acclaimed feminist author and historian, to collaborate in writing the story of their journey through Marilyn’s final months of life. In the resulting book, Irvin and Marilyn write alternating chapters until Marilyn becomes unable to write. After her death, Irvin continues with the story of his bereavement.

Marilyn’s chapters include reflections on love and illness, ranging from Emily Dickinson and Henry James to Paul the Apostle. She frequently expresses her gratitude: “I can still talk, read, and answer my emails. I am surrounded by loving people in a comfortable and attractive home.” (p. 20) Most of all, she is thankful for her husband, “the most loving of caretakers.” (p. 15) Yet, as her disease progresses, she comes “to the understanding that I would never be the same again—that I would pass through days of unspeakable misery while my body would decline and weaken.” (p. 76) She decides to pursue the option of physician-assisted suicide, which is legal in California, when her suffering becomes overwhelming.

In his chapters, Irvin resists this decision, maintaining hope for additional “good” life, despite all evidence to the contrary. Near the end, Marilyn’s pain and other symptoms become so severe that she cries out, “It’s time, Irv. It’s time. No more, please. No more.” (p. 139) Her physician arrives, confirms her intention, and surrounded by her whole family, Marilyn sucks the liquid through a straw and quietly passes away.

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